Problematic substance use among trans and non-binary people in Spain: An overlooked reality.

Abstract

Trans and non-binary people (TNBP) are particularly vulnerable to problematic substance use (PSU) due to multiple structural factors such as discrimination. This study analyzes the prevalence and associated factors of PSU among TNBP in Spain. Cross-sectional study based on data collected through an online survey conducted between October 2023 and March 2024 using diversified sampling through social media, community organizations, and gender identity support centers. 1562 trans and non-binary individuals aged ≥ 15 years residing in Spain. PSU in the past year was assessed for 13 substances and a composite indicator for any of them, based on DSM-5-TR criteria for substance use disorder across various life domains. Prevalence estimates and 95% confidence intervals (95%CI) were calculated. To identify factors associated with PSU, a Poisson regression model with robust variance was fitted to obtain adjusted prevalence ratios. In the past year, 18.6% (95% CI: 16.7-20.6) of TNBP reported PSU, most commonly cannabis (11.8%), non-prescribed tranquilizers (5.2%), and cocaine (2.4%). Independent factors significantly associated with PSU include ages 25-34, no university education, and in the past year, experiencing physical violence, anxiety or depression, engaging in sex work, regular use of any substance, cannabis use, and cocaine use. There is a high prevalence of PSU among TNBP in Spain, which is closely linked to social vulnerability and mental health factors. Public health interventions are urgently needed to address the specific needs of TNBP and eliminate health inequities in PSU rooted in systemic discrimination.