"Am I gonna get in trouble for acknowledging my will to be safe?": Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis
"Am I gonna get in trouble for acknowledging my will to be safe?": Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis
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DOI：
10.1186/s12954-020-00365-4
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发表时间：
2020-03-30
影响因子：
4.4
通讯作者：
Knight, Rod
中科院分区：
文献类型：
--
作者：
Goodyear, Trevor;Mniszak, Caroline;Knight, Rod
北美和地球仪其他地区正处于与阿片类药物过量和高度污染的非法药物供应有关的公共卫生紧急情况之中。不幸的是，我们对这场危机如何影响传统上未在过量相关监测数据中确定的关键人群的理解存在很大差距。这一差距对于同性恋、双性恋和其他与男性发生性关系的男性（性少数男性）尤其明显--这一人群在青春期和青年期经历了与物质使用有关的不平等。方法我们利用2018年进行的深入的半结构化访谈，对15-30岁的性少数男性使用物质并居住在加拿大温哥华的不同样本（N = 50）进行了分析，以确定在阿片类药物过量危机的背景下物质使用的模式和背景。结果我们的分析揭示了三个主题：风险的意识，观念和经验;战略，以减轻风险;和障碍，以更安全的物质使用。首先，与会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，以及人们如何越来越担心致命和非致命的过量用药风险很高且不断上升。其次，与会者介绍了如何从“值得信赖的”药品供应商处采购药物以及其他减少危害的战略（例如，药物检查技术，纳洛酮试剂盒，不单独使用）可以减少过量的风险。第三，参与者描述了人际、服务相关和社会结构障碍（例如，毒品刑事定罪和缺乏规范的毒品供应）限制了更安全地使用药物的机会。迫切需要以公平为导向的政策和规划，以促进年轻的性少数男性更安全地使用药物的机会，包括社区和同伴领导的倡议，在经常光顾的社会空间内获得低障碍的减少伤害服务（例如，骄傲，夜总会，浴室），非评判性和包容性的物质使用相关的卫生服务，毒品使用的非刑罪化，以及提供安全的药物供应。
Background 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. Methods 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. Results 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. Conclusions 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.