Among 96,482 youth, LGBTQ+ teens who were bullied and used cannabis were less likely to report suicidal ideation compared to bullied non-users, while opioid and hallucinogen use were associated with significantly higher suicide attempt rates.
school counselors, LGBTQ+ youth advocates, suicide prevention specialists, pediatricians
What the researchers found
Bullied LGBTQ+ youth had 2.71 times higher odds of planning suicide attempts. Opioid/prescription drug use increased attempt odds 4.6-fold, hallucinogen use 8.89-fold. No significant association between alcohol and STB. Unexpectedly, cannabis moderated the bullying-suicidality association: bullied youth who used cannabis were less likely to report suicidal ideation and planning than bullied non-users.
Why it matters
This is one of the largest studies examining the intersection of bullying, substance use, and suicidality in LGBTQ+ youth. The cannabis finding is counterintuitive and important: while not endorsing cannabis use, it suggests some youth may use it as a coping mechanism that temporarily reduces suicidal thinking.
The numbers in context
96,482 youth from 2003-2019 YRBS. Bullied LGBTQ+ suicide planning: OR 2.71. Opioid use + attempt: OR 4.60. Hallucinogen use + attempt: OR 8.89. Cannabis moderated bullying-ideation link: lower suicidal ideation in bullied cannabis users vs. bullied non-users.
How the study worked
Cross-sectional analysis of combined 2003-2019 Youth Risk Behavior Survey (N=96,482). Hierarchical logistic regression examining interactions between bullying victimization, substance use (alcohol, cannabis, hallucinogens, opioids), and suicidal thoughts and behaviors in LGBTQ+ youth.
What this study cannot tell us
Cross-sectional YRBS data cannot establish causation. Self-reported bullying and substance use. Cannabis finding does not mean cannabis is therapeutic for suicidality — it may simply be a less harmful coping mechanism than other substances. Historical data (2003-2019) spans different cannabis eras.
How to read the evidence
Very large nationally representative dataset with adjusted analyses, but cross-sectional design and self-reported data limit causal conclusions. Cannabis finding is unexpected and requires replication.
When this study was published
2025 publication analyzing 2003-2019 YRBS data.
The bigger picture
The differential substance-suicide associations highlight that not all substance use carries the same risk. While opioids and hallucinogens amplify suicidality risk in bullied LGBTQ+ youth, cannabis may serve as a coping mechanism — though healthier alternatives should be developed.
Questions still open
- Does cannabis serve as a harm-reduction coping mechanism for bullied LGBTQ+ youth?
- Could targeted interventions replace substance-based coping in this population?
Common questions
Does substance use affect suicide risk in LGBTQ+ youth?
Why might cannabis reduce suicidal thinking in bullied teens?
Read the original research
Understanding Suicidal Thoughts and Behaviors Among LGBTQ + Youth: Differential Associations Between Bullying and Substance Use.
Prevention science : the official journal of the Society for Prevention Research, 26(3), 449-461
Citation
Tiedge, Cayson W; Valido, Alberto; Rivas-Koehl, Matthew; Garcia, Brian A; Robinson, Luz E; Clements, Graceson; Espelage, Dorothy L. (2025). Understanding Suicidal Thoughts and Behaviors Among LGBTQ + Youth: Differential Associations Between Bullying and Substance Use.. Prevention science : the official journal of the Society for Prevention Research, 26(3), 449-461. https://doi.org/10.1007/s11121-025-01783-1
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