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Differences in substance use among trans, non-binary and cis people in Spain: a cross-sectional study
Florentino Quinteiro1, Sara Moreno-García2,3, María José Belza4,5,6
1Preventive Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain.
Substance Abuse Treatment, Prevention, and Policy
|July 9, 2026
Summary
Transgender and non-binary people (TNBP) in Spain show higher substance use prevalence than cisgender peers. Public health strategies must address TNBP-specific vulnerabilities and cultural factors in substance use.
Area of Science:
- Public Health
- Epidemiology
- Sociology
Background:
- Substance use disparities are noted between transgender and non-binary people (TNBP) and cisgender individuals.
- Limited comparative studies exist, particularly within European contexts.
- This research addresses the prevalence of substance use among TNBP in Spain.
Purpose of the Study:
- To estimate and compare past-year and past-month prevalence of multiple substance use.
- To compare substance use between transgender women, trans men, non-binary individuals, and their cisgender counterparts in Spain.
Main Methods:
- A cross-sectional study utilized data from 19,948 individuals (aged 15-45), including 1582 TNBP.
- TNBP were primarily recruited via the Transaludes online survey; cis participants and some TNBP were from the EDADES national drug use survey.
- Prevalence of 11 substances was assessed for past-year and past-month use, with adjusted prevalence ratios (aPR) calculated via Poisson regression.
Main Results:
- Cannabis was the most frequently used substance across all groups.
- Poppers were the second most used substance among trans women; non-medical tranquilizers were second for trans men and non-binary people.
- TNBP, especially trans women and non-binary individuals, exhibited higher aPRs for most substances compared to cisgender peers.
Conclusions:
- TNBP demonstrate elevated substance use rates relative to cisgender individuals, with notable differences among women.
- Public health policies require tailored approaches considering cultural and social factors unique to TNB communities.
- Addressing structural vulnerabilities is crucial for effective public health interventions targeting substance use in TNB populations.
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