Methamphetamine (meth) use is on the rise, yet limited progress has been made by our healthcare system to respond. Amidst a dramatic increase in meth use among GBT2Q people, our communities are often missing out on immediate and long-term support to reduce substance-related harms. In part two of this blog series, we focus on service provision, the continuum of care for meth use, and considerations to better address sexualized substance use in mental health policy.
Developing and Scaling Up GBT2Q-Specific Harm Reduction Services
The context surrounding crystal meth and other substance use in GBT2Q communities is complex and unique. This means mainstream substance use services often lack the skills and knowledge required to offer culturally affirming, accessible care for GBT2Q people. GBT2Q-specific services are necessary to provide a safe, non-judgemental space for GBT2Q to openly discuss the relationships between their queer identities, crystal meth use, sexual health, and mental health. GBT2Q-specific harm reduction services, for example, are limited, but service users and providers have highlighted the importance and demand for them as they provide a sense of belonging and opportunities for social connection among GBT2Q people.1
In developing GBT2Q-specific harm reduction services, intersectionality is crucial for meeting the needs of diverse GBT2Q. Guaranteeing services are built with the socio-cultural and political drivers of meth use in mind can reduce barriers to access and honour resilience. Resilience-based approaches to GBT2Q-specific harm reduction services focus on GBT2Q people’s strengths and view us as individuals who are working hard to cope with multiple forms of oppression and traumas throughout the life course. With strength-based approaches come alternative meanings and explanations of sexualized substance use and desire that have often been stigmatized within care settings. Fostering resilience in GBT2Q-specific harm reduction services takes an important step in challenging stigmatizing and pathologizing models of care.2
A culturally competent continuum of care
In their report “Supporting Gay, Bisexual, Trans, Two-Spirit, and Queer (GBT2Q) People who Use Crystal methamphetamine in Metro Vancouver and Surrounding Areas,” CBRC and their co-authors identified how GBT2Q-specific services should include: group counselling, peer support groups, inpatient, and outpatient programs, and virtual programs for individuals who live in more rural settings and/or who face other barriers to accessing in-person services. Offering these types of services more widely would increase accessibility, meeting GBT2Q people where they are based on their desire and readiness to change their crystal meth use. This recommendation also speaks to the need for a continuum of care model, offering harm reduction services alongside addictions treatment and other supports. Creating a more effective continuum of care and integrating wrap-around supports responsive to GBT2Q communities’ multiple health priorities is key to better support GBT2Q people who engage in crystal meth use. Along with expanding services, this will also mean improving communication and referral between services so that GBT2Q people are able to start with the programs that meet their most immediate needs and current circumstances. As their needs change, they can transition to the most appropriate services within the continuum. Developing a continuum of care maximizes benefits and addresses gaps in pathways of care.3
However, academic literature also offers insights on how to improve existing substance use services for GBT2Q people. This includes addressing financial constraints, mismatches between clients’ degree of treatment readiness and program requirements, staff shortages, and lack of case management or tracking procedures to ensure better followup.4
Accounting for Sexualized Substance Use in Mental Health Policy
A GBT2Q-specific harm reduction continuum of care is necessary to mitigate crystal meth related harms and foster mental health and well-being for GBT2Q people. Yet, improved outcomes also necessitate change at a policy level.
Explicitly naming and including GBT2Q’s sexualized substance use in mental health and substance use strategies will ensure there is a comprehensive framework to improve policy development and the coordination of programs and services to maximize impact. With collaboration and coordination from all orders of government, and endorsement from community stakeholders, service providers and service users, we can advance a compassionate, equitable and evidence-based plan to improve mental health and wellbeing, and reduce crystal meth related harms for GBT2Q communities.5
1. 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.
2. 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.
3. Ibid
4. 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.
5. Ibid
