Question  What are the prevalence of and risk factors associated with lifetime nonmedical prescription opioid use among transgender adolescent girls and young women who are sexually active?

Findings  In this cross-sectional study of 297 transgender girls and young women, 35 participants (11.8%) reported lifetime nonmedical prescription opioid use. Risk factors for opioid use included smoking cigarettes and identifying as a sexual orientation other than gay, lesbian, or bisexual.

Meaning  These findings suggest that evidence-based services for substance use, particularly those specifically aimed at treating opioid use disorder, can and should be tailored comprehensively to transgender populations, particularly transgender girls and young women.