Amidst rising rates of methamphetamine (meth) use, how can we support the mental health of those impacted? In this three-part blog series, we explore meth use as it relates to mental health among GBT2Q people.We consider opportunities to better address meth use in GBT2Q communities in a manner that speaks to our resiliency and ability to thrive. In part one, we focus on contextualizing sexualized substance use in GBT2Q communities.
Meth Use on the Rise
Meth use is rising across Canada. National findings from a survey of people who inject drugs found 43% of individuals reported injecting meth between 2017 and 2019, a significant increase from 6.8% between 2003 and 2005.1 Furthermore, provinces such as Alberta, Saskatchewan, and Ontario have reported at least a three-fold increase in the use of meth among individuals accessing treatment or harm reduction services.2 This sharp increase in use is also reflected in data on drug-related harms. The rates for both meth-related emergency department and in-patient admissions have risen significantly. In Toronto alone, amphetamine-related emergency department visits rose from 1.5% in 2014 to 8.3% in 2021.3
Crystal Meth is Nothing New for GBT2Q Communities
Yet, these numbers aren’t surprising for many of us. Compared to the general population, GBT2Q people are 10 to 20 times more likely to use crystal meth.4 A common factor for many GBT2Q people who use meth is the intersection of sex and substance use known as “party and play (PnP)” or “chemsex”. People’s reasons for using substances vary, but—when it comes to sex—some use crystal meth to enhance sexual experience and reduce inhibitions.5
Contextualizing Sexualized Substance Use in GBT2Q
Sexualized substance use, or PnP, is a social practice for GBT2Q people emerging from unique cultural, political, and social contexts.6 Yet, not everyone who engages in PnP does so in the same way. Similarly, the impact of meth use on mental health can manifest differently for different people, or at different points in their lives.
One positive outcome of sexualized substance use is that GBT2Q people of differing social locations are able to build community. Research exploring the benefits and pleasures of sexualized substance use has also highlighted how it can support GBT2Q people to:
- escape from oppression and stigma and manage negative feelings such as a lack of confidence and self-esteem and internalized homophobia;
- increase their capability to have the sex they wanted (increasing arousal and libido, increasing sexual confidence, reducing inhibitions, and increasing sexual stamina);
- enhance the qualities valued in sex (increasing sexual attraction, intensifying sensations, increasing intimacy and facilitating sexual adventure);7,8
Yet, meth use is also known to be addictive, and some GBT2Q people who engage in PnP face short-term and long-term harms that affect their mental health. Some report challenges such as difficulty with abstinence, and increased difficulty in forming and maintaining sober relationships.9 Other possible outcomes, both short and long term, include10:
| short term | long term |
| increased aggression or hostility | anxiety, depression, and paranoia |
| feeling agitated, anxious or panicky | insomnia |
| feeling very powerful or better than others | reduced concentration and poor memory |
| psychosis or psychotic behaviour | |
| homicidal or suicidal ideation | |
| violence |
Research has also highlighted a two-way relationship between sexualized substance use and mental health challenges.11 Evidence suggests engaging in sexualized substance use can lead to negative mental health outcomes, or history of mental health challenges can also lead to sexualized substance use.12 Other factors that are associated with PnP among GBT2Q people include:
- societal oppression (e.g., heteronormativity, homophobia, genderism, transphobia, discrimination);
- history of trauma (e.g., violence, bullying, sexual abuse);
- lived experience with mental health challenges (e.g. depression and anxiety);
- experiences of rejection, isolation, shame, and a lack of belonging;
- and stigma associated with HIV, mental illness, addiction, and substance use.13,14
Going forward
One thing that’s clear is more needs to be done to support people who use meth. At present, there are limited crystal meth harm reduction services across the nation tailored to the needs of GBT2Q communities, and culturally competent substance use services are few and far between. In part two of this series, we’ll focus on service provision, access, and continuum of care considerations that can begin to better address and support crystal meth use in GBT2Q communities.
Written by David Absalom
David Absalom is a public health professional committed to bridging the worlds of research, policy, social justice, and advocacy. He works across the health system to advance the health and well-being of GBT2Q and Black communities.
1. Tarasuk, J., Zhang, J., Lemyre, A., Cholette, F., Bryson, M., & Paquette, D. (2020). Nosocomial Infection Surveillance: National findings from the Tracks survey of people who inject drugs in Canada, Phase 4, 2017–2019. Canada Communicable Disease Report, 46(5), 138.
2. Methamphetamine (Canadian Drug Summary) (ccsa.ca)
3. Tardelli, V. S., Johnstone, S., Xu, B., Kim, S., K Kim, H., Gratzer, D., George, T. P., Le Foll, B., & Castle, D. J. (2023). Marked Increase in Amphetamine-Related Emergency Department Visits and Inpatient Admissions in Toronto, Canada, 2014-2021. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 68(4), 249–256.
4. Arthur S, Berlin G, Card K, Carson A, Goodyear T, Jollimore J, Klassen B, Krell S, Mniszak C, Montiel A, Purdie A, Knight R, Lachowsky N. “Supporting Gay, Bisexual, Trans, Queer, and Two-Spirit (GBT2Q) People who Use Crystal methamphetamine.” Community-Based Research Centre, 2021.
5. Souleymanov, R., Brennan, D. J., Logie, C. H., Allman, D., Craig, S. L., & Halkitis, P. N. (2021). Social exclusion, resilience and social worker preparedness: Providing services to gay and bisexual men who party-n-play. The British Journal of Social Work, 51(8), 3228-3247.
6. Ibid
7. Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., & Weatherburn, P. (2015). Illicit drug use in sexual settings (‘chemsex’) and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sexually transmitted infections.
8. McGuire, M., Card, K. G., & Lachowsky, N. J. (2020). The Crystal Methamphetamine Project: Understanding the Need for Culturally-Safe Supports and Services Addressing Crystal Methamphetamine Use among Gay. Bi, and Queer Men (Both Cis and Trans).
9. Ibid
10. National Alcohol & Drug Knowledgebase
11. Ibid
12. Ibid
13. Ibid
14. J. Harink, A. Purdie, M. Kwag, J. Jollimore, S. Rayek, K. Lari, P. Hoong, K.G. Wilson, A. Luna, D.C. Valenzuela, and N.J. Lachowsky (2019). Addressing Mental Health Issues and Problematic Substance Use Among Gay and Bisexual Men (GBMSM) in British Columbia. Vancouver, British Columbia: Community-Based Research Centre.
15. Ibid
