Unfortunately, the LGBTQ+ community experiences higher rates of opioid use disorder (OUD) than people in the sexual and gender majority. Some in the community turn to opioids (prescription pain pills like Vicodin or Percocet, heroin or fentanyl) for a sense of relief from harassment and bullying, and related feelings of worthlessness and rejection. Others are prescribed opioids post-surgery or to address the chronic pain associated with HIV, which overly affects[1] gay and bisexual men.
Opioid use, no matter the initial reason, can lead to dependence. This means needing more opioids to get the same relief and/or experiencing withdrawal symptoms if they are suddenly stopped and addiction. Unfortunately, the LGBTQ+ community experiences higher rates of opioid use disorder than people in the sexual and gender majority.
Medications for opioid use disorder
OUD is a treatable disease. The best outcomes result from the use of medications such as buprenorphine (i.e., Suboxone, Zubsolv), methadone and naltrexone (i.e., Vivitrol). When used as prescribed and coupled with trauma-informed care, they can address withdrawal symptoms and cravings as well as reduce the risk of relapse.
Your child or loved one may have questions. How will these medications interact with others they are taking? What happens when taken with hormone replacement therapy (HRT) or puberty blockers for transgender people? What happens when taken with antiretroviral therapy (ART) for people with HIV and pre-exposure prophylaxis (PrEP) for those most at risk of getting HIV? Your child or loved one’s health care provider is in the best position to offer guidance. Generally speaking, using medication to treat opioid use disorder along with the above treatments is safe with monitoring and routine follow-up.
More on hormone replacement therapy
Some transgender people use hormone replacement therapy, such as estrogen or testosterone, to reduce feelings of gender dysphoria. Gender dysphoria is the distress a person feels when the sex they are assigned at birth doesn’t match their gender identity.
Hormonal treatments are essential for transgender people, akin to using insulin or an asthma inhaler. It can be administered by patch, cream, as oral medication or an under-the-skin injection. People who use HRT as medication are prescribed on a daily, weekly or monthly basis. Suddenly stopping the medication can cause negative side effects, like depression, mood swings or suicidal thoughts.
There may be interactions between buprenorphine (a medication to treat opioid addiction) and spironolactone (a medication used by trans women to suppress testosterone). Your loved one’s treatment provider can help you weigh the benefits and risks of prescribing these medications together.
Accessing appropriate treatment programs
In treatment programs for OUD and other substance use disorders, transgender people must have access to their usual medications — just like any other medication for mental or physical health. Be sure to ask treatment programs how they address HRT. Some treatment centers have “no-needle” policies or rules about self-administration of medications. Privacy during medication administration can support transgender clients as well.
Many states have anti-trans legislation that makes it difficult or even illegal to obtain HRT or other gender-affirming medications[2]. To better serve high-risk transgender people, caregivers and facilities may need to provide support, keep medication on hand or advocate for your loved one. Services like Plume can help transgender people access the care they need, regardless of location.
If you’re looking for gender-affirming treatment for your child, make sure to discuss considerations for current medications, such as HRT. Creating supportive spaces for LGBTQ+ people helps improve their outcomes — and create safe access to the recovery support they need to stay healthy.