Goodyear Trevor, Mniszak Caroline, Jenkins Emily, Fast Danya, Knight Rod
British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
School of Nursing, University of British Columbia, Vancouver, Canada.
Harm Reduct J. 2020 Mar 30;17(1):23. doi: 10.1186/s12954-020-00365-4.
North America and other parts of the globe are in the midst of a public health emergency related to opioid overdoses and a highly contaminated illicit drug supply. Unfortunately, there is a substantial gap in our understandings about how this crisis affects key populations not conventionally identified within overdose-related surveillance data. This gap is particularly pronounced for gay, bisexual, and other men who have sex with men (sexual minority men)-a population that experiences substance use-related inequities across adolescence and young adulthood.
We draw on in-depth semi-structured interviews conducted in 2018 with a diverse sample (N = 50) of sexual minority men ages 15-30 who use substances and live in Vancouver, Canada, to identify how patterns and contexts of substance use are occurring in the context of the opioid overdose crisis.
Our analysis revealed three themes: awareness, perceptions, and experiences of risk; strategies to mitigate risk; and barriers to safer substance use. First, participants described how they are deeply impacted by the contaminated illicit drug supply, and how there is growing apprehension that fatal and non-fatal overdose risk is high and rising. Second, participants described how procuring substances from "trustworthy" drug suppliers and other harm reduction strategies (e.g., drug checking technologies, Naloxone kits, not using alone) could reduce overdose risk. Third, participants described how interpersonal, service-related, and socio-structural barriers (e.g., drug criminalization and the lack of a regulated drug supply) limit opportunities for safer substance use.
Equity-oriented policies and programming that can facilitate opportunities for safer substance use among young sexual minority men are critically needed, including community- and peer-led initiatives, access to low-barrier harm reduction services within commonly frequented social spaces (e.g., Pride, night clubs, bathhouses), nonjudgmental and inclusive substance use-related health services, the decriminalization of drug use, and the provision of a safe drug supply.
北美和全球其他地区正处于与阿片类药物过量使用及高度污染的非法药物供应相关的公共卫生紧急状态。不幸的是，我们对于这场危机如何影响在与过量用药相关的监测数据中未被传统认定的关键人群的理解存在重大差距。这种差距在男同性恋、双性恋和其他与男性发生性关系的男性（性少数群体男性）中尤为明显——这一群体在青春期和青年期都面临与物质使用相关的不平等。
我们利用2018年对50名年龄在15至30岁、使用物质且居住在加拿大温哥华的性少数群体男性进行的深入半结构化访谈，以确定在阿片类药物过量危机背景下物质使用的模式和背景情况。
我们的分析揭示了三个主题：对风险的认知、看法和经历；降低风险的策略；以及安全使用物质的障碍。首先，参与者描述了他们如何受到受污染的非法药物供应的深刻影响，以及对致命和非致命过量用药风险高且不断上升的担忧如何与日俱增。其次，参与者描述了从“可靠”的毒品供应商处获取毒品以及其他减少伤害的策略（如毒品检测技术、纳洛酮试剂盒、不单独使用）如何能够降低过量用药风险。第三，参与者描述了人际、服务相关和社会结构方面的障碍（如毒品定罪和缺乏规范的毒品供应）如何限制了安全使用物质的机会。
迫切需要以公平为导向的政策和项目规划，以促进年轻性少数群体男性有机会更安全地使用物质，包括社区和同伴主导的倡议、在常见的社交场所（如骄傲游行、夜总会、澡堂）提供低门槛的减少伤害服务、无歧视且包容的与物质使用相关的健康服务、毒品使用合法化以及提供安全的毒品供应。
