Among nearly 10,000 sexual minority patients in a large health system, bisexual individuals had significantly higher rates of cannabis use, cannabis use disorder risk, and mental health diagnoses than gay or lesbian patients, with bisexual males at particular risk.
Primary care providers serving LGBTQ+ patients, mental health clinicians, and health equity researchers.
What the researchers found
Bisexual patients had higher odds of cannabis use than gay/lesbian patients (females: aOR 1.67; males: aOR 1.47). Bisexual males had greater odds of CUD risk (aOR 1.48), depression (aOR 1.86), and using cannabis to manage depression (aOR 2.44) compared to gay males. Bisexual females had higher odds of severe stress diagnosis (aOR 2.44) vs. gay/lesbian females.
Why it matters
Sexual minority health research often treats LGB populations as a single group. This study reveals important differences within that community: bisexual individuals, especially males, carry significantly higher burdens of cannabis use and mental health problems, suggesting they need targeted healthcare approaches.
The numbers in context
9,869 patients. 30.7% reported past 3-month cannabis use. Bisexual females vs. gay/lesbian: cannabis use aOR 1.67. Bisexual males vs. gay: cannabis use aOR 1.47, CUD risk aOR 1.48, depression aOR 1.86, cannabis for depression aOR 2.44. Bisexual females vs. gay/lesbian: severe stress aOR 2.44.
How the study worked
Cross-sectional analysis of electronic health records from 9,869 sexual minority patients (lesbian, gay, or bisexual) aged 18+ with primary care visits at a Los Angeles university health system from June 2020 to May 2023. Cannabis screening via ASSIST during annual wellness visits. Multivariable regression adjusted for age and race/ethnicity.
What this study cannot tell us
Single health system in Los Angeles may not represent broader populations. Cross-sectional design cannot establish causation. EHR-based screening may miss some cannabis use. Cannot distinguish between medicinal and recreational cannabis use. No heterosexual comparison group. Self-identified sexual identity may not capture all sexual minorities.
How to read the evidence
Large clinical sample with validated screening tools and EHR-confirmed diagnoses, but single-site cross-sectional design limits generalizability and causal inference.
When this study was published
Published 2025, using 2020-2023 health records.
The bigger picture
Bisexual individuals face unique stressors including identity erasure, double discrimination, and lower social support from both heterosexual and gay/lesbian communities. The finding that bisexual males with depression are 2.4 times more likely to use cannabis for symptom management suggests self-medication in response to inadequate mental health support.
Questions still open
- Whether targeted mental health interventions for bisexual patients reduce cannabis use disorder risk
- How these patterns differ in healthcare systems outside of Los Angeles
Common questions
Why do bisexual individuals have higher cannabis use than gay or lesbian people?
Is using cannabis for depression effective?
Read the original research
Cannabis use, risk of cannabis use disorder, and anxiety and depression among bisexual patients: A comparative study of sex and sexual identity differences in a large health system.
Drug and alcohol dependence, 274, 112762
Citation
Setrakian, Naira; Gelberg, Lillian; Koerber, Julia; Chung, Un Young; Akabike, Whitney N; Gorbach, Pamina M; Seamans, Marissa J; Shoptaw, Steven; Cerezo, Alison; Javanbakht, Marjan. (2025). Cannabis use, risk of cannabis use disorder, and anxiety and depression among bisexual patients: A comparative study of sex and sexual identity differences in a large health system.. Drug and alcohol dependence, 274, 112762. https://doi.org/10.1016/j.drugalcdep.2025.112762
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