Sexual Identity and Motivations for Prescription Drug Misuse Among U.S. Adults.

Although we know that sexual minority populations, particularly bisexual individuals, tend to be at increased risk for substance use, less research has focused on prescription drug misuse (PDM). The current study is the first to assess differences in motivations for PDM by sexual identity and sex. This is important as research has established a link between certain motivations and adverse outcomes. This study used data from multiple years of the National Survey on Drug Use and Health (2015-2018). Respondents who reported past-year PDM were asked follow-up questions to identify motivations for PDM. We ran several weighted cross-tabulations to estimate the prevalence and 95% confidence intervals for motivations for PDM by sexual identity (i.e., heterosexual, lesbian or gay, and bisexual) for males and females separately. When chi-square tests were significant, comparisons using design-based multivariable regressions were conducted. Prevalence rates for both PDM and substance use disorder associated with prescription drugs were higher among sexual minority adults than heterosexual adults. With regard to motives, bisexual females were more likely to endorse recreational motives (i.e., to get high) for prescription opioids, tranquilizers, and stimulants than heterosexual females. Gay males were more likely to endorse self-treatment motives (e.g., to relax, to lose weight) than both bisexual and heterosexual males. High prevalence rates and endorsement of recreational motives identify bisexual females as an important at-risk population. It is important for clinicians to consider how prevention, treatment, and intervention strategies focused on PDM may be improved to best target this unique population.