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Men and women who identify as lesbian, gay, or bisexual are more likely to misuse opioids than those who identify as heterosexual, a new study shows.

Led by researchers at NYU School of Medicine and , the study estimates that 5 percent of adults who identify as heterosexual in the United States have misused opioids in the past year—the number climbs to 9 percent for individuals who identify as gay or lesbian, and 12 percent for those who identify as bisexual. And just within the past month, 1 percent of those who identify as heterosexual have used opioids, while 4 percent of those who identify as bisexual have.

The study relies on data taken from among 42,802 people involved in the 2015 National Survey on Drug Use and Health (NSDUH). Study participants were surveyed about their sexual orientation and any misuse of opioids in the past year, as well as past-month and past-year prescription opioid use. Misuse was categorized as using the drug without a prescription, using in larger amounts or for longer than directed, or using against a doctor’s recommendation.

According to researchers, previous studies have found that those who identify as gay or bisexual are more likely to use drugs and experience addiction-related illnesses, such as alcoholism and use of other drugs. Researchers say the new study is the first of its kind to examine differences in sexual orientation using a nationally representative sample of adults in the United States.

Among the study’s key findings was that women who identified as bisexual were twice as likely to misuse opioids than individuals with other sexual orientations.

“Our study highlights that adults of sexual minority status—particularly women identifying as bisexual—are at increased risk for opioid misuse,” says senior study author , an associate professor in the at NYU School of Medicine and a researcher in the Center for Drug Use and HIV/HCV Research at NYU College of Global Public Health. “With the opioid crisis escalating nationwide, it is important to focus on preventing misuse among groups at highest risk.”

The researchers believe the underlying cause of opioid misuse among bisexual women could be their need for a coping mechanism from the stress and stigma that arises from being not only a minority within a largely heterosexual culture, but also within the lesbian and gay community.

To address the growing problem of opioid misuse in these groups, the researchers advocate for the development of more educational programming to help prevent drug use and misuse.

“Primary care providers, educators, and even parents should consider sexual orientation when assessing those at risk of opioid misuse,” says , an associate professor in the Department of Population Health at NYU School of Medicine, a researcher in the Center for Drug Use and HIV/HCV Research, and lead author on the study. “Not only do we need to consider sexual orientation as a risk factor, but we also need to monitor these groups more closely once they’ve been identified.”

In addition to authors Duncan and Palamar, Sophia Zweig, BS, and H. Rhodes Hambrick, BS, from �ٺ���Ƶ Health, served as research assistants on this study.

Funding support for the study was provided by National Institutes of Health grant K01 DA038800.