“We’ll Just Warm Ourselves up with Drugs”: Polysubstance Use among Sexual and Gender Minority Persons (SGMP) Who Inject Drugs in Los Angeles, California

BACKGROUND: In the United States, sexual and gender minority people (SGMP), including lesbian-, gay-, bisexual-, and transgender-identifying individuals, report disproportionately higher rates of illicit single substance use and polysubstance use compared to their heterosexual and cisgender counterparts. We conducted a qualitative analysis to better understand the disparate polysubstance use-related outcomes among SGMP reported in the extant literature. Our research question was: METHODS: = 15). Eligibility criteria included sex with men and injection drug use and/or opioid use in the last two years. Data were collected at a community site associated with a syringe services program in Los Angeles, CA between May 2022 and November 2022. RESULTS: All participants reported lifetime polysubstance use and discussed use of: (1) methamphetamines to meet increased energy demands of living in materially insecure risk environments followed by opioids for energy management and to prevent "overamping;" (2) methamphetamine to enhance sexual drive and experiences followed by opioids, cannabis, or gamma-hydroxybutyrate use to balance stimulant effects; and (3) multiple substances (such as opioids, methamphetamine, cocaine, alcohol) for mood management, emotional regulation, and managing past traumatic experiences. CONCLUSIONS: Our findings describe and contextualize drivers of polysubstance use patterns among SGMP experiencing significant intersectional stressors exacerbated by material needs insecurity. Interventions must comprehensively integrate basic needs, mental health, substance use, and sexual health services to address inequitable polysubstance use-related health outcomes among SGMP.