As Canada grapples with an opioid overdose crisis, harm reduction workers have stepped in to reduce the risks and harms of drug use. Supervised consumption sites (SCS) and overdose prevention sites (OPS) across the country now offer new injecting equipment, naloxone to reverse an opioid overdose, and referrals to treatment. Sites like Prairie Harm Reduction in Saskatoon also have inhalation rooms for people who smoke drugs such as crystal methamphetamine (crystal meth), and calming spaces where clients can relax. But these services only work for people who choose to use them. In Canada, more and more gay, bisexual and men who have sex with men (gbMSM) are using drugs like crystal meth before or during sex. With this phenomenon, known as party n’ play (PnP), harm reduction needs a different approach.
What is PnP?
PnP can have different meanings, but it usually refers to two or more people—mainly gbMSM—who meet to take drugs (“party”) and have sex (“play”). Drugs are used in these settings to enhance the sexual experience. These are mostly crystal meth, gamma-hydroxybutyrate (GHB), cocaine and ketamine. Parties are often held at people’s homes and organized through hook-up apps or personal networks. Unsanctioned parties can also be held at sex clubs and bathhouses, although venues discourage this. The privacy of these events can help men who are not “out” or comfortable at gay bars to connect with others. Using drugs during sex can also override someone’s feelings of shame and anxiety, helping them to explore their sexuality and feel accepted. Crystal meth can heighten feelings of confidence and euphoria, but this is followed by an abrupt comedown when effects wear off. As a result, some people may keep using over multiple days.
Since the 1980s, harm reduction for people who use drugs has focused on tools like clean needles and drug equipment. This has been successful at reducing HIV and hepatitis C transmission. Early HIV activists also applied the harm reduction approach to sex by sharing the message that condoms can prevent transmission of the virus. As the HIV epidemic has continued, these messages have evolved: for example, we now know that effective treatment means you can’t pass HIV on during sex (“U=U”). However, harm reduction approaches often treat people who use drugs and gbMSM as separate groups. When it comes to PnP, some community members have developed their own tools to bridge this gap.
Managing risks
Colin Johnson is a Black, gay, long-term HIV survivor from Toronto. As a community activist and passionate advocate for harm reduction, he hosts his own PnP events planned around harm reduction principles. To reduce the risk of HIV and hepatitis C, he gives his guests clean pipes and syringes, containers for used needles, and plenty of condoms and lube. He also stocks his home with water, fruits and snacks. And to reduce the risk of overdose, he keeps naloxone on hand and tests his drugs before each event. “There is shame associated with queer sex, which is driven by homophobia,” Johnson says. This shame can be magnified by racism and stigma around HIV. To combat this, Johnson tries to create a relaxed, welcoming space at his parties. He makes sure that people can decide what they are comfortable with, and that nobody feels judged if they are living with HIV.
Akia Munga, another community activist from Toronto, also notes that shame is a driving factor for guys who party. “Queer sex is not often talked about,” he says. “While you’re living in a heterosexual community, PnP allows you to have the sex you want without shame.” Parties can provide a way to escape these feelings. They create an overwhelming sense of connection to others, partly from the drugs themselves but also from the context they are used in. In this sense, Munga explains, drug use serves a purpose. But the intensity of this experience can create problems when people return to their normal lives. Feelings of rejection and isolation can be heightened after a party is over, prompting some guys to use drugs again.
While the drugs used for PnP can be enjoyable, they also carry some risks. Dr. Michael Fanous, a pharmacist in Toronto, explains that these can vary depending on which drugs a person uses, their physical and mental health, and any medicines or supplements they are taking. “Many drugs are taken by people who PnP,” Dr. Fanous says, “but the biggest risks come with crystal meth. These range from heart complications and sleep problems to mental health issues like depression, anxiety and psychosis.” They also say that GHB “can cause something we call cardiorespiratory depression, where your heart rate and breathing become dangerously slow.” Both GHB and crystal meth carry a risk of overdose, which can be fatal. This is common with GHB, because doses are small and hard to measure precisely—especially if you’re already high.
Dr. Fanous explains that “prescription medicines like HIV treatment or anti-depressants can also change the effect of drugs on your body, making overdose more likely. Injecting or ‘slamming’ drugs also increases this risk.” When these drugs are mixed with sex, someone may be less able to consent or might make choices they normally wouldn’t. Dr. Fanous says, “It’s important for anyone who is thinking of PnP to stay in touch with your healthcare team. Harm reduction counselling and accountability partners—people who can help you keep on top of your drug use—are also great tools.”
While there are risks with using any drug, not all drug use is problematic. The Canadian Mental Health Association (CMHA) outlines a spectrum of drug use. This ranges from casual or non-problematic use to problematic use and, finally, chronic dependence. For some guys, PnP can be a manageable part of their sex life. But for others, PnP can have serious effects. The CMHA says drug use is problematic when it has severe negative consequences on someone’s personal life, family, friends and community. Chronic dependence is when someone can’t stop using despite these effects. This can lead to the loss of jobs and housing, which may then lead to survival sex (where someone has sex to meet their basic needs for food and shelter). When someone regularly uses drugs during sex, this can affect their relationship with sex and intimacy in the long term.
For people living with HIV, there are some extra risks to be aware of with PnP. Using drugs for long periods can make someone forget to take their medication, which could cause drug resistance over time. Mixing some HIV medications with party drugs could cause side effects like depression, paranoia and thoughts of suicide. In certain situations, the law also requires people to disclose their HIV status before having sex. If someone uses drugs they may forget when and where they need to do this, which could have serious consequences.
Harm reduction: a new approach
Harm reduction for PnP is a challenge because of the nature and range of drugs that are used. Dr. Fanous explains that “the same harm reduction strategies can’t always be applied to all substances. For example, harm reduction strategies developed for opioid and other drug use generally aren’t useful for crystal meth.” This requires a tailored approach for each drug: for example, someone who wants to reduce or stop using GHB will have different needs from a person who wants to reduce or stop using crystal meth. Dr. Fanous says that stopping crystal meth use can be hard because “long-term use is associated with decline in cognitive function and increased episodes of psychosis. This can often be a challenge when trying to quit.”
The privacy of PnP events can make it hard for HIV organizations to provide supports. A lack of tailored programs means that many men who PnP don’t know where to turn for help. Beyond this, guys who party are often skeptical about using harm reduction services. One reason is that services like supervised consumption sites are often built to serve people who use opioids. These don’t work for people who use party drugs, or who only use drugs during sex. In addition, typical clients for these services have a low income or are marginally housed. By contrast, all kinds of gbMSM use crystal meth, no matter their income.
Benjamin Warren, Gay Men’s Sexual Health Coordinator at AIDS Committee of Cambridge, Kitchener, Waterloo and Area (ACCKWA), explains that for guys who party, “Sexual pleasure, connection and a sense of community may be the focus—it’s not always about the drugs.” He also says that “those who engage in PnP don’t identify as a drug user in the typical sense and do not connect to the idea of harm reduction.” Stigma around queer sex can also turn some away from services that do not speak directly to them. This stigma is heightened for racial minorities. In 2020 the Community-Based Research Centre (CBRC) surveyed Canadians who PnP, and their findings support this: among gbMSM who used meth frequently, 60% were not confident they could find support programs where they felt comfortable.
On the other hand, some LGBTQ+ services may deter clients by pushing abstinence or referrals to detox treatment. Many participants in the CBRC project said that the services they had used were abstinence based, and some said they had been banned from these for using drugs. Stigma toward drug use among LGBTQ+ people can also turn men away from community supports. Ryan Tran, Manager of Education and Outreach at Asian Community AIDS Services (ACAS) in Toronto, explains that guys who use drugs are hesitant to access his support groups, because “they do not want to seen or outed by other members of the community.”
To fill this gap, some LGBTQ+ organizations now offer tailored harm reduction services. Organizations like the AIDS Committee of Toronto (ACT) and ACAS offer drop-in peer support groups, while others bring harm reduction directly to their clients. For instance, MAX in Ottawa offers a discreet online service for people to customize and order their harm reduction supplies, which can be picked up or delivered. They also conduct outreach at gay bars to share harm reduction tips with local guys. For all these examples, being culturally relevant and responsive are more successful than a “one size fits all” approach. Ultimately, they rely on confidentiality, trust and a non-judgmental approach to clients.
Among the experts who spoke to CATIE, all said that people who use drugs should play a critical role in delivering these services. Ryan Tran at ACAS explains that “people who use drugs know more, are less likely to be judgmental and usually have good intentions of wanting to help others.” Maticus Adams from MAX also says that people who use drugs can “develop programs for people who PnP, identify gaps and clarify messaging ensuring cultural competence.” At ACCKWA, for example, people who PnP play a key role in training other members of staff. Across the board, service providers agreed that people who use drugs and work in the sector should be fully supported. They said that these peer workers should also be involved in debriefing sessions after training workshops and given access to counselling support if needed. They also said that adequate pay for peer workers is a form of harm reduction.
While there has been progress in building these tailored supports, some gaps remain. A major problem is access, since many services are only available in cities like Vancouver, Toronto or Montreal. These services often only address certain needs, like harm reduction supplies. To improve this, service providers who spoke to CATIE suggested a more integrated approach. Ideally, services should explore the connection between the mental health challenges that queer men face—such as the trauma of homophobia, transphobia and racism—and their relationship to drug use. Tim Guimond, a queer psychiatrist, explains that PnP can appeal to people struggling with their mental health. “There are people who feel they are on the margins,” he says, “and PnP is a way for them to feel better and be accepted.” To address this, he says, it’s important to build community connections. He argues that ideal services would be client centred and holistic. These would include drug counselling and psychotherapy to help people manage their health.
Community activists Johnson and Munga also emphasize the need for open conversations about PnP among LGBTQ+ organizations. They suggest that service providers need staff training, more psychologists, harm reduction specialists and greater funding for culturally relevant programming. And although some organizations are starting to respond, more work is needed to combat stigma by agencies, activists and people who use drugs. Only then will guys who PnP have the information, skills and tools to do so safely.
David DK Soomarie is an openly queer HIV-positive advocate who works with LGBTQ+ and HIV-positive communities in Toronto.
Illustrations by Fiona Smyth.
Harm reduction tips
- Plan for your safety. Think ahead of time about your limits. Are you taking risks with people you trust? How much will you use, how long will you use and what method (e.g., smoking or injecting) are you comfortable with?
- Find a therapist or friend outside of the PnP scene you can have honest conversations with.
- Start low, go slow. Give your drugs time to work before taking another dose.
- Know where your supplies are coming from.
- If you are using fentanyl strips, be cautious as these test only a small amount. If the test is negative, it doesn’t always mean that there is no fentanyl in your drugs.
- Consider getting naloxone training.
- Make sure to take care of your body. Give yourself food, water and time to sleep.
- Get regular sexual health checkups.
- Ask yourself if PnP is meeting your needs. The reasons people use drugs can change; if it stops being enjoyable, take time to reflect on this.
- Know the Good Samaritan law. If you call the police to report an overdose, you shouldn’t be charged for drug possession.
- Tell a friend where you are going.
- Set a timer so you don’t forget to take your HIV medications. Speak to your doctor or pharmacist about any recreational drugs you are taking, so they can advise you about interactions.
- If you want to reduce or stop your use, take an inventory of how much you are using. This can help you decide how to reduce it and understand your triggers.
- For information on support groups or counselling, contact your local LGBTQ+ organization.