Persisting inequalities in past-year drug use by sexual identity: trends across England's 2007, 2014 and 2024 Adult Psychiatric Morbidity Surveys

Introduction Sexual minority people experience disproportionate discrimination and minority stress, contributing to poorer health and health-related behaviours, including drug use. Increasing drug potency and adulteration may heighten associated harms. UK evidence on sexual identity inequalities in drug use is dated, and whether inequalities have changed over time is unclear. Methods Adult Psychiatric Morbidity Surveys 2007 (N=7403), 2014 (N=7546) and 2024 (N=6912) provide repeated cross-sectional probability samples of the household population of England. Weighted prevalence of past-year drug use was analysed by sexual identity, sex and age. Logistic regression adjusted for age, sex and area deprivation. Trends focused on 16-64-year-olds. Results In 2024, past-year drug use among adults 16+ was reported by: 9.1% heterosexual, 18.3% gay/lesbian, 26.8% bisexual, 28.3% other identity adults. Among 16-64-year-olds, drug use in sexual minority adults (2007=22.9%, 2014=27.5%, 2024=24.9%) remained at least double that of heterosexual adults (2007=10.3%, 2014=9.9%, 2024=11.6%), with adjusted odds ratios of 2.4 (95% CI:1.7-3.2, 2007), 3.2 (2.2-4.8, 2014) and 2.2 (1.4-3.4, 2024). The gap between sexual minority and heterosexual women appeared to widen, although confidence intervals were wide. Conclusions Sexual identity inequalities in drug use persisted over 17 years in England. Prevention, treatment and policies should address these inequalities and their social determinants including discrimination and exclusion. Routine drug statistics should be reported by sexual identity. Health surveys should collect gender identity and be large enough to enable disaggregation of sexual and gender identities.