Methamphetamine (meth) use is on the rise and our mental healthcare system has not caught up to respond to the needs of GBT2Q people. With few culturally relevant supports in place, GBT2Q communities are often left dealing with untreated symptoms or visiting emergency departments for immediate crisis supports (e.g. anxiety, panic attacks, psychosis).1 The recent influx in amphetamine-related emergency department visits and drug-related harms begs the question, how can providers best deliver care and support GBT2Q people who use meth2 3? In the final entry of this blog series, we focus on capacity building and suggested practices in delivering care to GBT2Q people who use meth.
Read parts one and two of this blog series.
Education and Capacity Building
Understanding the nature, context, and extent of crystal meth use in lives of GBT2Q communities is key to determining the various needs of our communities without positioning them in a stigmatizing manner. Academic literature suggests, positioning crystal meth use from a drug enforcement lens socially excludes, stigmatizes, and criminalizes GBT2Q people for their substance use.4 Thus, it is critical that providers are aware of these stigmatizing discourses and work to challenge them in their practice. Without this, many GBT2Q will continue to face barriers trying to overcome the fear of experiencing stigma when accessing care. Having an awareness of the socio-cultural and political issues that frame how we think about and respond to crystal meth use in GBT2Q communities is vital to providing safe and affirming spaces to engage GBT2Q people about their crystal meth use. In turn, it allows providers to appropriately support the needs of our communities without further stigmatizing or criminalizing behaviours. If providers wish to build their capacity in working with their local GBT2Q communities who use meth, they should work in partnership with GBT2Q communities, service providers and organizations. Additionally, the Gay Men’s Sexual Health Alliance developed the Introduction to Party & Play (PnP)/ Chemsex training module. Here you can learn in greater detail the social and cultural context of crystal meth use in GBT2Q communities and how to provide care through a trauma-informed lens.5
Providing Care to GBT2Q people using Crystal Meth
There is no clear-cut approach to working with GBT2Q people who use crystal meth. As discussed in previous blog series, GBT2Q people use crystal meth for a variety of reasons and differ in their interest and readiness to change their use. There are, however, considerations providers can be aware of when working with GBT2Q people who use crystal meth that may be experiencing a crisis. Gavin Bejaimal, a former Gay Men's Sexual Health & Harm Reduction Coordinator at AIDS Committee of Toronto, shared several tips to best support GBT2Q people who use crystal meth:
- Recognize there are few spaces GBT2Q people can openly discuss and explore their substance use. Be aware of the layers of internalized shame that may accompany crystal meth use and consider how experiences may differ according to people’s social positioning and intersectional forms of oppression they may (or may not) face.
- Embed honest, holistic, non-judgemental, and de-stigmatizing approaches when working with GBT2Q people.
- Listen—and truly listen—to GBT2Q people and their needs. If you need more exposure to GBT2Q meth use challenges, visit forums like Reddit and Erowid. Use these narratives as case studies to think critically of how you would support them in your practice. Prepare yourself when the time comes.
- Remember, not everyone’s goal is abstinence. Sometimes the goal of the work is to simply offer empathic aid and or emotional support and/or validation. If GBT2Q people express interest in changing their substance use or are experiencing harms, then explore how harm reduction could play a role in the support you offer.
- Harm reduction is a holistic approach; it is not always about substance use. It can be simple reminders of drinking more water, eating better, sleeping earlier, or connecting with GBT2Q people with social supports.
In addition to Gavin’s tips, literature has also shared the following tips:6 7
- Take Mental Health First Aid and crisis intervention trainings to improve your de-escalation skills.
- Build your knowledge of the side effects of crystal meth use to better identify challenges such as paranoia or stimulant-induced psychosis.
- Be patient and remember the symptoms and effects of crystal meth can be experienced for hours at a time.
- Be empathetic and meet individuals where they are. Listen to them, maintain a calm, non-judgemental and respectful approach. Take their lead and provide support accordingly.
- Be mindful to not ask too many questions as they may have a low tolerance for multiple questions.
- Try to build a relationship with individuals. Be honest and genuine in your interactions and explain your actions. Building trust and rapport with individuals can also help to de-escalate situations.
- Reduce stimulation. If possible, give individuals space and reduce noise or any other forms of stimulation from their immediate environment.
- Put away your phone. Technology can be triggering and can be experienced differently to someone experiencing paranoia.
- Be aware of your body language and remind them that they are safe.
- Recognize your own boundaries and capacity and ask for help from others when necessary.
- De-brief after an initial crisis, if possible. See what additional resources or supports the individual may need in an effort to prevent future crises.
Going Forward
GBT2Q communities deserve a mental healthcare system that suits our needs. From the lack of a culturally relevant continuum of care, to the gaps in service provision, education, and capacity building, it’s clear there are opportunities to strengthen the ways we support GBT2Q people who use meth. It is my hope that this blog series can provide us with a brief roadmap to guide our thinking on how we can better support the mental health and well-being of GBT2Q communities.
1. 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. 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. Ibid
5. An Introduction to Party & Play (PnP)/Chemsex - GMSH
6. Good Practices for Working with Participants Who Use Crystal Meth (hidtaprogram.org)
