- Researchers surveyed 376 men who use crystal methamphetamine across Canada
- They found that some men who wanted help reducing meth use perceived difficulty getting help
- Researchers stress the need for integrated and multidisciplinary services for men who use meth
The use of meth (crystal meth, crystal methamphetamine) appears to have increased over the past two decades in different communities. In particular, some subgroups of gay, bisexual and other men who have sex with men (MSM) use meth. One Vancouver-based study of 774 MSM reported that 19% of participants used meth in the past six months, with “21% of those using it at least weekly.”
Some people who use meth can become dependent on it. A team of researchers in British Columbia, Ontario and Quebec conducted an online survey to better understand meth use in MSM and possible barriers faced by a subgroup of men who wanted to reduce their use of meth or quit using it altogether.
The researchers found that the men in the study felt that there were more barriers to getting help for meth use if they had any of the following:
- low income
- sometimes used meth before or during sex
- perceived themselves to have a greater need for help (in reducing or quitting) than other men
In the journal Substance Abuse, Treatment and Policy, the researchers reported these findings and urged “greater investments in one-stop, low-barrier, culturally appropriate care for [MSM] who use meth.” The researchers also stated that “better integrating health, social and substance use support services may reduce some of the perceived difficulties of getting help for substance use among sexual and gender minority MSM.”
Study details
Researchers recruited participants between February and June 2020 through several means, including the following:
- advertisements on hookup platforms such as Scruff and Squirt
- social media such as Facebook, Reddit and Twitter
- community-based organizations – the Community Based Research Centre (CBRC) in B.C. and the Gay Men’s Sexual Health Alliance (GMSH) in Ontario
The researchers restricted their recruitment to adults living in Canada who were cisgender men, transgender men and non-binary people. All participants stated that they had had sex with a man in the six months prior to completing the survey. They also disclosed having used meth in that period.
The survey enquired about many issues that were related to general health and meth use.
Researchers were able to analyse data from 376 completed surveys.
The average profile of participants was as follows:
- age – 42 years
- gender: cisgender – 94%; trans or non-binary – 6%
- main ethno-racial categories: White – 72%; people of colour – 28%
- sexual orientation: gay – 77%; non-gay – 23%
- 70% of participants had an annual income less than $60,000
Results
Participants’ frequency of meth use was as follows:
- daily or almost daily – 33%
- once or twice in the past six months – 32%
- weekly – 17%
- monthly – 18%
According to the researchers, “77% of participants reported for at least half of the time that they were using meth, it was prior to or during sex.” The researchers also stated that “greater frequency of methamphetamine use was also associated with a greater proportion of use within a sexual context.”
Social nature of meth use
Researchers found that nearly 40% of people reported that “they hardly ever used meth alone.” A total of 14% of people reported using meth alone nearly all of the time and 15% reported using meth alone about half of the time. The researchers also found that “greater frequency of use was also associated with using alone more frequently.”
Mode of using meth
The main modes of using meth were as follows:
- 40% snorting
- 23% injecting
The researchers stated that among people who injected meth the following also occurred:
- 22% shared syringes
- 28% shared water
- 21% shared filters
- 19% shared containers or spoons
Healthcare provider knowledge about their patients’ meth use
A total of 34% of participants disclosed that their primary care provider knew about their use of meth, while 43% disclosed that their primary care provider did not know. The remaining 23% did not have a primary care provider.
Questions about the need for help
Researchers asked participants about their need for reducing or quitting substances across a scale ranging from “completely” needing help at one end to “not at all” needing help at the other end. Participants described their need for help as follows:
- 6% completely needed help
- 18% needed help a lot
- 42% needed a little help
- 35% did not need help at all
Using statistical analysis, the researchers found that each of the following factors was linked to what they described as participants having “increased perceived difficulty of getting help”:
- having a low income
- engaging in more sexualized meth use
- having a greater perceived need for help
Issues to consider
Based on these and other findings, along with statistical analyses and their knowledge about care and services for people who use meth, the researchers made many interesting points and some recommendations:
Treatment guidelines and other services are needed
“There is much room for improvement within the status quo public health and medical systems to better serve those seeking care. This is consistent with the significant amount of literature that highlights barriers to care for people who use drugs. This challenge is all the more difficult given lack of consistent treatment guidelines and efficacious treatments for people who use methamphetamine, much less for populations with unique needs such as sexual and gender minority MSM. We recommend the development of consistent treatment guidelines, efficacious treatments, and public health messaging that supports engagement with marginalized populations, such as sexual and gender minority MSM.”
Under one roof
The researchers stated that people with lower income perceived greater difficulty in getting help for substance use. Other studies have also found that people with low incomes report barriers to accessing care for their drug use. These other studies underscored at least two barriers:
- poor quality of interaction with care providers
- complexity of the healthcare system
The researchers recommend that funding be allocated for what they called “interdisciplinary, integrated services” for people who use meth. These services would ideally be “one-stop, low-barrier, integrated care that is culturally sensitive and trauma-informed. The need for these services is particularly important given the bifurcation of services tailored for sexual and gender minority MSM and other people who use drugs”. The researchers noted that tailored services for MSM “may not be culturally safe for people who use methamphetamine” and vice versa.
Sexualized drug use
The researchers made the following comment about sexualized drug use: “Given that sexualized drug use is an important setting for social connectedness and sexual expression, participants may fear loss of social connection with their friends or loss of their sexual subculture and identity if they reduce or quit using methamphetamine. It is important to note that sex is an important way for sexual and gender minority men who have sex with men to form social connections and friendships, and that ‘party and play’ is a setting where this can occur, given the effects that drugs such as methamphetamine have on feelings of pleasure and connectedness. Of course, these benefits do not necessarily negate harms that may arise from ‘party and play’ use. Indeed, we observed that greater frequency of use was associated with more frequent sexualized methamphetamine use.”
The researchers stated that historically, stigma towards drug use has existed among some MSM-oriented service providers. They also note that some harm reduction services have not always been adequately equipped to serve MSM. Together, these can create a barrier to healthcare access.
The researchers also stated: “It is essential that services [geared towards] certain groups (e.g., for people who inject drugs or sexual or gender minority MSM) support and engage with each other to increase ease of access. This has implications for how support services are designed and located. Inclusive services that acknowledge the important role that sex plays in social connectedness for the sexual and gender minority MSM community may provide opportunities to address socially produced barriers to care.”
The need for tailored harm reduction services
The researchers made the following comment about the need for harm reduction services tailored to meth users: “Given the prevalence of injection drug use and sharing equipment in this sample, harm reduction strategies should focus on providing harm reduction supplies and services for drug use and sexual activity in tandem, such as new needles, snorting kits, gloves, condoms, lubricant, HIV pre-exposure prophylaxis and hepatitis C screening. Organizations that provide these supplies and services may also be well placed to provide referrals to support services for reducing drug use.”
Being connected to a healthcare provider
Another point made by the researchers is as follows: “Ensuring all people are attached to primary care providers may help ensure they receive referrals to substance use and mental health treatments. Among patients that do have primary care providers, screening, brief interventions and referrals to treatment can help open dialogues about substance use or patient education on treatment options and how to access the services and supports they want.”
The researchers closed their report by stating: “Better integrating health, social and substance use support services may reduce some of the perceived difficulties of getting help for substance use among sexual and gender minority MSM.”
—Sean R. Hosein
Resources
Party and play in Canada: What is its impact on gay men’s health? – Prevention in Focus
Party Time – Positive Side
The Crystal Methamphetamine Project – Community Based Research Centre
REFERENCES:
- Card K, McGuire M, Bond-Gorr J, et al. Perceived difficulty of getting help to reduce or abstain from substances among sexual and gender minority men who have sex with men (SGMSM) and use methamphetamine during the early period of the COVID-19 pandemic. Substance Abuse Treatment, Prevention, and Policy. 2021 Dec 13;16(1):88.
- Fischer B, O’Keefe-Markman C, Lee AM, et al. ‘Resurgent,’ ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America. Substance Abuse Treatment, Prevention, and Policy. 2021 Feb 15;16(1):17.
- Miller CL, Kerr T, Fischer B, et al. Methamphetamine injection independently predicts hepatitis C infection among street-involved youth in a Canadian setting. Journal of Adolescent Health. 2009 Mar;44(3):302-4.
- Cheng B, Sang JM, Cui Z, et al. Factors associated with cessation or reduction of methamphetamine use among gay, bisexual, and other men who have sex with men (gbMSM) in Vancouver Canada. Substance Use and Misuse. 2020;55(10):1692-1701.
- Lachowsky NJ, Dulai JJ, Cui Z, et al. Lifetime doctor-diagnosed mental health conditions and current substance use among gay and bisexual men living in Vancouver, Canada. Substance Use and Misuse. 2017 May 12;52(6):785-797.
- Colyer SP, Moore DM, Cui Z, et al. Crystal methamphetamine use and initiation among gay, bisexual, and other men who have sex with men living with HIV in a treatment as prevention environment. Substance Use and Misuse. 2020;55(14):2428-2437.