Increased Risk of Opioid Prescribing Reported in Transgender Veterans

white pills and pill bottle
Prescription bottle with blank label for copy space and white pills or tablets on metal table for opioid epidemic illustration
Investigators assessed outpatient opioid prescription practices among transgender and cisgender veterans.

Transgender veterans have a greater risk of being prescribed any outpatient opioid compared with cisgender veterans, according to the results of a study published in the American Journal of Preventive Medicine.

Researchers evaluated Veterans Health Administration (VHA) records to compare the prevalence of outpatient opioid prescriptions received by transgender and cisgender veterans. Eligible participants were enrolled or engaged in VHA health care at any time from January 1, 2018, to December 31, 2018.

Cisgender veterans were randomly matched 3:1 with each transgender veteran based on age and county of residence. The primary outcome was any outpatient opioid prescription.

The overall cohort had 9686 transgender veterans (65.4% men; 79.3% White) and 29,058 cisgender veterans (87.6% men; 70.3% White) aged 18 years and older. The opioid-recipient group included 1894 transgender veterans (63.5% men; 78.7% White) and 5682 cisgender veterans (86.9% men; 71.1% White).

A higher proportion of transgender veterans were prescribed any outpatient opioid (19.9%) compared with cisgender veterans (14.8%; P <.01). Transgender veterans had a 20% greater risk of receiving an opioid prescription than cisgender veterans (adjusted relative risk [ARR] 1.20; 95% CI, 1.13-1.27), after adjustment for covariates.

No significant differences were found between transgender and cisgender veterans regarding any measures of high-risk opioid prescribing, including any day of opioid overlap (ARR 0.93; 95% CI, 0.85-1.02), daily dosage greater than 120 morphine mg equivalents (ARR 0.86; 95% CI, 0.66-1.10), or opioid-benzodiazepine overlap (ARR 1.05; 95% CI, 0.96-1.14), after adjustment for covariates.

Transgender veterans were found to be at increased risk for opioid poisoning compared with cisgender veterans (RR 2.76; 95% CI, 1.57-4.86) in the overall cohort. In the opioid-recipient group, risk for opioid poisoning was not significantly different between the groups (RR 1.09; 95% CI, 0.56-2.11).

The investigators noted that transgender veterans could be underestimated because self-identified transgender veterans may not have transgender-related diagnoses, and veterans without a transgender-related diagnosis may self-identify as transgender. Also, residual confounding of ages within groupings is possible, and health care encounters may not have been accounted for. Furthermore, opioid poisoning may be underestimated owing to veterans seeking care outside the VHA system.

“Future research is needed to investigate opioid prescription and overdose among transgender veterans to clarify the risk of opioid-related overdose and other adverse events,” stated the study authors. “This will be especially important as VHA plans to expand medical coverage for transgender patients, which will increase the need for safe and appropriate pain management strategies.”


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. Am J Prev Med. Published online April 5, 2022. doi:10.1016/j.amepre.2022.02.011