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Comparing Outpatient Opioids, High-Risk Prescribing, and Opioid Poisoning Between Transgender and Cisgender Veterans: A Cross-sectional Analysis.

Boyer TL, Blosnich JR, Hubbard CC, Sharp LK, Cashy JP, Suda KJ. Comparing Outpatient Opioids, High-Risk Prescribing, and Opioid Poisoning Between Transgender and Cisgender Veterans: A Cross-sectional Analysis. American journal of preventive medicine. 2022 Aug 1; 63(2):168-177.

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Abstract:

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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