Characteristics of drug‐related deaths among individuals identified as LGBTQ+ in the United Kingdom, 1997–2024

Background and Aims Individuals from sexual and gender minorities (LGBTQ+) are understudied and at increased and differential risk of experiencing drug‐related harms when compared with the general population. We aimed to determine the case characteristics, circumstances of death and type of implicated drugs among LGBTQ+ individuals dying due to drug‐related causes. We also aimed to assess any differences between deaths occurring in the context of sexualised vs. non‐sexualised drug use. Design Retrospective cohort study. Setting Coronial records submitted to the National Programme on Substance Use Mortality (NPSUM) in the United Kingdom (UK), 1997–2024. Cases Decedents identified as LGBTQ+. Measurements Information was available on decedent sociodemographics, characteristics of death and drugs implicated in death. Findings A total of 83 decedents were identified as LGBTQ+. Forty‐six were identified as cis men (55.4%), four as trans men (4.8%), two as cis women (2.4%) and 31 as trans women (37.3%). Forty‐five were identified as gay, including 44 gay men (53.0%) and one gay woman (1.2%), with three identified as bisexual (3.6%). Decedents were predominantly of White ethnicity ( n = 68, 81.9%) with a mean age of 38.2 years (standard deviation 12.1; range 16–84). Overall, 16 (19.8%) cases were deemed intentional. Poisoning was the main disease or condition that was certified as the underlying cause of death ( n = 46, 55.4%). The median number of drugs implicated in death was 2 [Interquartile range (IQR) 1, 2] with multiple drug toxicity implicated in the majority of cases ( n = 42, 50.6%). The two most common drug groups implicated in death were opioids ( n = 31, 37.3%) and gamma‐hydroxybutyrate (GHB) and related compounds ( n = 14, 16.9%). Death occurred in the context of sexualised drug use in 21 cases (25.3%). There were statistically significantly fewer cases in which any opioid (33.9% vs. 4.8%, P = 0.009) or any benzodiazepine (21.0% vs. 0.0%, P = 0.02) were implicated when compared with cases of non‐sexualised drug use. Conclusions Over the last three decades in the United Kingdom there have been consistent numbers of drug‐related deaths each year in which individuals were identified as LGBTQ+, results likely representing conservative estimates. A minority of drug‐related deaths occurred in the context of sexualised drug use.