From the Department of Medicine, Boston Medical Center, Boston, MA (HMB, EKJ); Addiction Medicine Fellowship, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI (HMB); Division of General Internal Medicine, Rhode Island Hospital, Providence, RI (HMB); Section of General Internal Medicine, Boston University School of Medicine, Boston, MA (AYW, JS, CGS); Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA (JS, CGS).
J Addict Med. 2022;16(4):407-412. doi: 10.1097/ADM.0000000000000919. Epub 2021 Sep 22.
In the midst of the opioid crisis, increasing attention has been given to assessing and addressing substance use disorders (SUDs) among transgender and gender diverse (TGD) populations. As electronic health records begin to more uniformly collect gender identity data, clinicians and public health professionals are better able to examine the prevalence of SUDs and the receipt of SUD treatment services in these populations.
We utilized cross-sectional electronic health records data from January 2005 to December 2019 from a large safety-net hospital in Massachusetts. A cohort of TGD patients was identified using self-reported gender identity data as well as diagnostic and procedures codes associated with receipt of gender-affirming care (n = 2000). We calculated odds of SUD diagnosis and receipt of medications for SUD among TGD patients.
Among a cohort of 2000 TGD patients, 8.8% had a SUD diagnosis. SUD diagnoses were more common among older, Black, and transmasculine patients, as well as those holding public health insurance. SUD diagnoses were less likely among those reporting college-level education. Of those with an opioid use disorder (OUD), 46% were prescribed an FDA-approved medication for OUD.
SUD diagnoses among TGD patients were associated with demographic, socioeconomic, and gender-related factors. We found a modestly lower prevalence of non-tobacco SUD among our cohort of TGD patients than the national average of 7.4%. Despite a relatively better receipt of prescription treatment services than the national average, the low rate of treatment overall represents a missed opportunity to address SUDs in these vulnerable populations.
在阿片类药物危机中，人们越来越关注评估和解决跨性别和性别多样化（TGD）人群中的物质使用障碍（SUD）。随着电子健康记录开始更统一地收集性别认同数据，临床医生和公共卫生专业人员能够更好地检查这些人群中 SUD 的流行程度和 SUD 治疗服务的接受情况。
我们利用了马萨诸塞州一家大型医疗保障医院 2005 年 1 月至 2019 年 12 月的横断面电子健康记录数据。使用自我报告的性别认同数据以及与获得性别肯定护理相关的诊断和程序代码，确定了 TGD 患者队列（n=2000）。我们计算了 TGD 患者 SUD 诊断和 SUD 药物治疗的几率。
在 2000 名 TGD 患者的队列中，8.8%有 SUD 诊断。SUD 诊断在年龄较大、黑人、跨男性和持有公共卫生保险的患者中更为常见，而在报告接受过大学教育的患者中则不太常见。在患有阿片类药物使用障碍（OUD）的患者中，46%的患者开了 FDA 批准的 OUD 治疗药物。
TGD 患者的 SUD 诊断与人口统计学、社会经济和性别相关因素有关。我们发现，我们的 TGD 患者队列中，非烟草 SUD 的患病率略低于全国平均水平 7.4%。尽管接受处方治疗服务的比例相对较高，但总体治疗率较低，表明在这些弱势群体中，解决 SUD 的机会被错失。
