LGBTQ Drug Addiction Treatment: Opioids, Meth, Cocaine and More

Drug addiction treatment works best when it matches the substance you use and the life you live. The approach that helps most with opioids is different from the one that helps most with methamphetamine or cocaine. For LGBTQ people, good treatment also has to make room for identity, stigma and the stress that can sit underneath substance use. This guide explains the main treatments by drug type, how to stay safer while you get there, and how to find a program.

Why LGBTQ people may need a tailored approach

The National Institute on Drug Abuse (NIDA) reports that sexual and gender minority people face stigma, discrimination and a higher risk of harassment and violence, and that these stressors raise the risk of behavioral health problems. Research finds higher rates of substance misuse and substance use disorders among sexual minority adults than among heterosexual adults. NIDA also notes that LGBTQ people often enter treatment with more severe substance use, and that treatment should address the specific factors in their lives, such as homophobia, transphobia, family conflict and isolation.

NIDA points to research showing that specialized programs for gay and bisexual men appear to produce better outcomes than general programs, even though few programs offer them. That is one reason this directory focuses on programs that report a program or group for LGBTQ clients to SAMHSA. You can start browsing on our LGBTQ drug rehab page.

Opioids: heroin, fentanyl and prescription painkillers

Opioid use disorder has the strongest set of medical treatments of any drug addiction. Medications for opioid use disorder (MOUD) are combined with counseling and support. The U.S. Department of Health and Human Services describes three options:

HHS advises talking with your doctor about which medication fits you, and SAMHSA offers shared decision-making tools to help with that conversation. Taking MOUD is treatment, not "trading one drug for another." When you call a program, ask directly whether it offers or supports methadone, buprenorphine or naltrexone, and whether you can stay on a medication you already take.

Opioid withdrawal is very unpleasant but, according to SAMHSA's clinical guidance, uncomplicated opioid withdrawal is generally not life-threatening. Medications such as buprenorphine, methadone or clonidine can make it much easier. Our guide on what to expect in detox covers the process.

Stimulants: methamphetamine and cocaine

SAMHSA's resource guide on stimulant use disorders states that, unlike opioids, there is no FDA-approved medication for stimulant use disorders. Treatment relies on behavioral approaches, and several have strong research support:

• Contingency management (CM) gives clients rewards, such as vouchers or prizes, for goals like attending sessions and providing stimulant-negative drug tests. SAMHSA rates the evidence as strong, and studies link CM to fewer days of stimulant use, fewer cravings and fewer HIV risk behaviors. Many CM programs that have been studied run about 12 weeks with frequent drug testing.
• Cognitive-behavioral therapy (CBT) is a short-term, goal-focused therapy that helps change the thoughts and habits around use. Studies link it to less frequent stimulant use and fewer risky sexual behaviors.
• Community reinforcement approach (CRA) works to make a substance-free life more rewarding, with help on relationships, work and daily structure. It is often paired with CM.

NIDA notes that motivational interviewing, social support therapy, contingency management and CBT have all shown benefits for gay and bisexual men in particular. If you use meth or cocaine, ask any program whether it offers contingency management. Not every program does, and it is one of the best-supported options available.

Other drugs and mixed use

Many people use more than one substance. Alcohol, benzodiazepines (such as Xanax or Klonopin), other sedatives and stimulants are often combined. Mixing changes both the risks and the treatment plan:

• Benzodiazepines and other sedatives can cause dangerous withdrawal, especially when combined with alcohol. SAMHSA's guidance calls for a slow, medically managed taper rather than stopping suddenly.
• Alcohol withdrawal can also be life-threatening. See our guide to alcohol and LGBTQ recovery.
• Opioids combined with benzodiazepines raise overdose risk, and the CDC specifically recommends carrying naloxone if you use both.

Mental health matters here too. NIDA reports that LGBTQ people with substance use disorders are more likely to have other conditions such as depression, and that screening for them is especially important. If that applies to you, look at programs that offer LGBTQ dual diagnosis care.

Fentanyl in the drug supply

According to the CDC, fentanyl is far stronger than heroin, and most recent fentanyl-related overdoses are linked to illegally made fentanyl. It is commonly mixed into heroin, cocaine and methamphetamine, and pressed into fake pills made to look like prescription medications. Many people have no idea their drugs contain it. Fentanyl cannot be seen, smelled or tasted, and even a small amount can be deadly.

That means anyone using drugs bought outside a pharmacy, including stimulants, is at risk of an opioid overdose. The CDC notes that fentanyl test strips are inexpensive and usually give results within minutes, but a negative result is not a guarantee, because strips may miss some fentanyl-like drugs. The CDC also warns that xylazine, a non-opioid sedative, is increasingly found in the illegal supply and is especially dangerous combined with opioids.

Naloxone: keep it close

Naloxone reverses an opioid overdose when given in time. The CDC says it is available over the counter without a prescription, and anyone can carry it and use it on someone who is overdosing. You cannot give it to yourself, so tell friends, partners and roommates where it is.

Signs of an opioid overdose include:

• Very small, pinpoint pupils
• Falling asleep or losing consciousness
• A limp body
• Slow, shallow or stopped breathing
• Choking or gurgling sounds

If you see these signs, the CDC says to call 911, give naloxone right away without waiting for emergency workers, try to keep the person awake and breathing, lay them on their side, and stay until help arrives. More than one dose may be needed. Naloxone will not hurt someone who has not taken an opioid. Many states have Good Samaritan laws that can protect people who call for help from some drug possession charges.

Finding a program

Start with the level of care that fits your situation. Medical detox may come first, especially with sedatives, alcohol or heavy opioid use; you can browse options on our LGBTQ detox page. After that, treatment may be residential or outpatient. Our guide to inpatient vs outpatient LGBTQ rehab explains the trade-offs.

When you call, ask:

• Do you offer methadone, buprenorphine or naltrexone, or can I continue one I already take?
• Do you offer contingency management for meth or cocaine?
• Do you treat mental health conditions at the same time?
• Do you have a program or group for LGBTQ clients, and how do staff handle names and pronouns?
• What happens after I finish, and how do you connect me to ongoing care?

More ideas are in our list of questions to ask an LGBTQ rehab. Transgender and nonbinary readers may also want to read our transgender rehab guide, and gay and bisexual men can see rehab for gay men.

Your next steps

• Get naloxone today if you or anyone around you uses opioids or any drugs that could contain fentanyl.
• If you use opioids, ask a doctor about buprenorphine or another MOUD.
• If you use stimulants, look for a program that offers contingency management.
• Do not stop benzodiazepines or heavy alcohol use suddenly; get medical help first.
• Check your coverage with our insurance guides, then search by location in our state directory.

If you are reading this for someone else, our guide to helping an LGBTQ loved one with addiction can help you start the conversation.

Sources

• NIDA: Substance Use and SUDs in LGBTQ* Populations
• HHS: How Do Medications Treat Opioid Addiction?
• SAMHSA: Treatment of Stimulant Use Disorders
• SAMHSA: Detoxification and Substance Abuse Treatment, Quick Guide for Clinicians (TIP 45)
• CDC: Fentanyl Facts
• CDC: Reverse Opioid Overdose to Prevent Death
• CDC: Recognizing and Responding to an Opioid Overdose

Related guides

• Why LGBTQ-Specific Addiction Treatment Matters | LGBTQ Rehab
• Questions to Ask an LGBTQ Rehab Before You Enroll
• Transgender Rehab: Finding Addiction Treatment That Respects Your Gender
• Minority Stress and Addiction: How Stigma Affects Substance Use
• Family Rejection, Chosen Family and Recovery
• LGBTQ-Friendly vs LGBTQ-Specific Rehab: What's the Difference?

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