Lifetime Nonprescribed Opioid Use by Sex, Race/Ethnicity, and Sexual Identification Among U.S. High-School Students.

Abstract

The opioid crisis continues to be a public health concern. Little attention has been given to the relationship between the intersectional heterogeneity of racial/ethnic identification and sexual/gender minority status on opioid use among U.S. high-school students and how this risk varies by sex. Data were derived from the national 2023 Youth Risk Behavior Survey (N=20,103) for U.S. high-school students. This study estimated the odds of lifetime nonprescribed opioid use (n=2,465) among exposures race/ethnicity and sexual/gender minority status and stratified by sex. Compared with heterosexual White adolescents, all categories of sexual/gender minority and race/ethnicity (White [AOR=2.23, 95% CI=1.57, 3.14], Hispanic/Latino [AOR=3.29, 95% CI=2.09, 5.19], Black [AOR=2.68, 95% CI=1.87, 3.85], and other [AOR=2.84, 95% CI=1.88, 4.31]) had elevated odds of lifetime nonprescribed opioid use, which varied by sex. Compared with heterosexual White girls, the strongest association was among sexual/gender minority Hispanic/Latino girls (AOR=3.26, 95% CI=1.98, 3.36), followed by sexual/gender minority and Black (AOR=2.53, 95% CI=1.70, 3.76). Compared with heterosexual White boys, the strongest association was among sexual/gender minority racially other (AOR=4.58, 95% CI=2.38, 8.82), followed by sexual/gender minority Hispanic/Latino (AOR=3.23, 95% CI= 1.68, 6.19). Compared with heterosexual and White, heterosexual Black boys had elevated odds of opioid use, whereas no difference was found among heterosexual Black girls. This study highlights the heterogeneity of opioid use within intersectional adolescent groups and that sex, race/ethnicity, and sexual identity need to be examined as subsets of the population through an intersectional lens. Interventions tailored with an intersectional approach are needed to reduce structural stigma and promote targeted opioid-use initiation reductions.