Higher Prescription Tranquilizer Misuse Among Bisexual Individuals in the United States, 2021–2023

Prescription tranquilizer misuse poses negative health outcomes including respiratory distress and overdose. Given the higher prevalence of substance use by sexual minority individuals, assessing the prevalence and motives of prescription tranquilizer misuse in this group is a priority. This study examined prescription tranquilizer misuse by sexual identity using a US nationally representative dataset. We used the adult sample from the 2021–2023 National Survey on Drug Use and Health (NSDUH) (<i>N</i> = 139,524). The outcome was past-month prescription tranquilizer misuse, including benzodiazepines, muscle relaxants, or any other prescription tranquilizer, and the exposure was sexual identity (i.e., heterosexual/straight, gay/lesbian, bisexual). We conducted a binomial logistic regression model, adjusted for age, sex, race/ethnicity, past-month distress level, and other substance use. We calculated reasons for prescription tranquilizer misuse by sexual identity among adults with past-month prescription tranquilizer misuse. Among total adult respondents (13.3% aged 18–25 years, 51.3% female, 12.1% non-Hispanic Black, 17.3% Hispanic), 2.6% identified themselves as gay/lesbian, 5.4% as bisexual, and 0.5% misused prescription tranquilizers in 2022 (representing 1,170,818 US adults). The adjusted model showed that bisexual individuals (<i>vs.</i> heterosexual) were more likely to misuse prescription tranquilizers (aPR = 2.20, 95% CI = 1.41, 3.42). Bisexual individuals who misused prescription tranquilizers did so “for emotions” (48.2%) at a significantly higher prevalence than heterosexual (23.9%) and gay/lesbian individuals (23.8%). We estimated ∼1.1 million US adults misused prescription tranquilizers in 2021–2023 and found that bisexual individuals were more likely to misuse prescription tranquilizers. Bisexual adults frequently reported “for emotions” as a reason for prescription tranquilizer misuse.