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.