Introduction
Transgender veterans have a high prevalence of substance use disorder and physical
and mental-health comorbidities, which are associated with prescription opioid use
and overdose risk. This study compares receipt of outpatient opioids, high-risk opioid
prescribing, and opioid poisoning between transgender and cisgender (i.e., nontransgender)
veterans.
Methods
A secondary analysis of Veterans Health Administration health record data from January
1, 2018 to December 31, 2018 was conducted in 2021. Transgender veterans (n=9,686) were randomly matched to 3 cisgender veterans (n=29,058) on the basis of age and county. Using the same matching criteria, a second
cohort was created of all transgender veterans and a matched sample of cisgender veterans
who were prescribed an outpatient opioid (n=7,576). Stratified Cox proportional hazard regression measured the RR of each prescription
outcome and opioid poisoning.
Results
Transgender veterans had a 20% higher risk of being prescribed any outpatient opioid
than cisgender veterans (adjusted RR=1.20, 95% CI=1.13, 1.27). Transgender and cisgender
veterans who were prescribed an opioid did not have different risks of high-risk prescribing:
overlapping opioid prescriptions (adjusted RR=0.93, 95% CI=0.85, 1.02), daily dose
>120 morphine milligram equivalents (adjusted RR=0.86, 95% CI=0.66, 1.10), or overlapping
opioid and benzodiazepine prescriptions (adjusted RR=1.05, 95% CI=0.96, 1.14). Overall,
transgender veterans had more than twice the risk of opioid poisoning than cisgender
veterans (RR=2.76, 95% CI=1.57, 4.86). The risk of opioid poisoning did not differ
between transgender and cisgender veterans who were prescribed an opioid (RR=1.09,
95% CI=0.56, 2.11).
Conclusions
Transgender veterans had a greater risk of being prescribed an outpatient opioid than
cisgender veterans but did not have different risks of high-risk opioid prescribing.
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Article Info
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Published online: April 05, 2022
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
