Among 15 sexual and gender minority people assigned male at birth who inject drugs or use opioids in Los Angeles, polysubstance use was universal and was driven by material insecurity, sexual enhancement and balancing of stimulant effects, and emotional and trauma management, so interventions must integrate basic needs, mental health, substance use, and sexual health services.
All participants reported lifetime polysubstance use.
Participants used methamphetamine to meet the increased energy demands of living in materially insecure risk environments, then used opioids for energy management and to prevent "overamping."
Participants used methamphetamine to enhance sexual drive and experiences, followed by opioids, cannabis, or gamma-hydroxybutyrate (GHB) to balance the stimulant effects.
Participants used multiple substances (opioids, methamphetamine, cocaine, alcohol) for mood management, emotional regulation, and managing past traumatic experiences.
The authors conclude that polysubstance use patterns among SGMP are shaped by intersectional stressors exacerbated by material needs insecurity, and that interventions should integrate multiple service types.
This study interviewed 15 sexual and gender minority people in Los Angeles who were assigned male at birth, had sex with men, and injected drugs or used opioids. Everyone interviewed had used more than one substance at a time or in sequence. The researchers wanted to understand how and why this happens, since earlier research shows these communities have higher rates of polysubstance use and related harms. Participants described three main reasons. First, some used methamphetamine to keep up with the energy demands of unstable living conditions, then used opioids to manage that energy and avoid "overamping." Second, some used methamphetamine to enhance sex and then used opioids, cannabis, or GHB to balance out the stimulant. Third, many used various substances to manage moods and emotions and to cope with past trauma. This research suggests that polysubstance use among these individuals is closely tied to unmet basic needs, stress from multiple forms of marginalization, and sexual and emotional wellbeing. The authors argue that services work best when they combine help with basic needs, mental health care, substance use treatment, and sexual health care. The study is small and qualitative, so it describes experiences rather than measuring how common they are.
Rebecca P. Smeltzer, Gilbert A. Orta Portillo, Siddhi S. Ganesh, Julia Koerber, Erin E. Gould, R. Bolanos, et al.. (2026). "We'll Just Warm Ourselves up with Drugs": Polysubstance Use among Sexual and Gender Minority Persons (SGMP) Who Inject Drugs in Los Angeles, California.. Substance Use & Misuse. https://doi.org/10.1080/10826084.2026.2750876