From Prevention
To Treatment
Supporting the Continuum of Care
for 2SGBTQ+ Methamphetamine Use
A brief report back on the March 2025 think tank.
Purpose
This report summarizes key recommendations from the 2025 Methamphetamine Think Tank. It aims to inform efforts by the Ontario HIV Treatment Network (OHTN) and community organizations to enhance the continuum of care related to methamphetamine use among 2SGBTQ+ communities.
The continuum of care can include prevention (encompassing both preventing initiation of methamphetamine use and/or progression to problematic use), harm reduction initiatives, and enhancing treatment options for 2SGBTQ+ individuals who use methamphetamine.
Continuum of care
Background
Methamphetamine is a stimulant that is used commonly in the context of Party and Play (PnP or chemsex) by 2SGBTQ+ communities. Most often, methamphetamine is used in this context to heighten sexual experiences, foster social connections, and lower inhibitions. However, the use of methamphetamine continues to be associated with increased vulnerabilities to sexually transmitted and blood borne infections (STBBIs), adverse HIV-related health outcomes, as well as mental health challenges.
On March 21, 2025, the Methamphetamine Working Group, supported by the OHTN, hosted a provincial Think Tank to improve the continuum of care for 2SGBTQ+ individuals living with HIV and at risk of HIV who use methamphetamine. The event brought together over 50 participants (Appendix A), including clinicians, researchers, public health staff, community organizations, and individuals with lived/living experience from across Ontario.
The day was organized into three themed sessions:
Sessions
The Prevention Session included a presentation by a community member on their personal experiences with methamphetamine – how he was first introduced to it, and what ultimately made him want to stop. This was followed by research presentations on factors which may motivate or deter methamphetamine use, as well as an overview of past prevention campaigns. Attendees collaboratively brainstormed inclusive and non-stigmatizing prevention interventions tailored to the diverse experiences of 2SGBTQ+ communities.
The Harm Reduction Session included a community conversation circle highlighting the needs of underserved populations such as 2SGBTQ+ newcomers, street-involved individuals, trans and non-binary communities, and racialized communities.
The Treatment Session included an overview of current treatment options for methamphetamine use, followed by a conversation with community members about experiences of seeking support for their meth use, highlighting success and addressing gaps. The session concluded with a hybrid presentation from UCLA researchers on a novel treatment intervention, the “Getting Off” App, which includes gamified features to support those who wish to stop their use.
The day concluded with a priority-setting session to identify key actions for the next two years.
The Think Tank aimed to achieve the following objectives:
- Foster connections and collaborations across multiple sectors concerned with this issue.
- Identify and document opportunities for research, programs, and advocacy and develop actionable steps to implement these initiatives.
The documented opportunities for research, programs, and advocacy were intended to guide future work by the Meth Working Group, and associated agencies and partners. They were also intended to inform organizations, policy makers, and opportunities to fund and otherwise support upcoming initiatives aligned with the OACHA Action Plan to 2030. Both of these objectives were met. The first objective was achieved by holding a networking social the night prior to the Think Tank and organizing collaborative activities throughout the Think Tank. The second objective was met via a priority-setting session at the end of the Think Tank, which asked attendees to decide on the top three items they would like to see prioritized in the next two years.
The Think Tank identified the following key overarching recommendations for the OHTN:The following sections provide an overview of session discussions and recommendations across the continuum of care.
Prevention Session
Identified priorities and recommendations
The group identified the priorities below. Click to expand and see the resulting recommendations.
We recommend that an organization or facility currently working with individuals who use methamphetamine (e.g. HQ Toronto) look into the feasibility of a longitudinal cohort study. This includes establishing partners, funding, and a mechanism for community input.Discussion Highlights
The session began with a community member sharing personal insights into both his motivations for using methamphetamine and what ultimately made him want to stop. This was followed by a presentation from Dr. Paul Shuper, Senior Scientist at CAMH, who shared findings from the Ontario Project on Trends in the Initiation of Crystal Meth (OPTIC). This community-driven study focuses on the factors that influence decisions to start—or avoid—using methamphetamine among gay, bisexual, and queer men who have sex with men (gbMSM).
In phase 1 of this study, interviews were conducted with gbMSM (aged 18+), including those who initiated meth use or considered it in the past two years. 23 interviews were conducted, with diverse representation across Ontario (primarily the Greater Toronto Area, Ottawa, Southwestern Ontario, and Thunder Bay). Most participants were gay cis men, aged 37 on average, with 61% non-white and 17% HIV-positive.
Prevention Campaigns
Danielle Giliauskas from OHTN’s Evidence and Knowledge Synthesis team presented findings from two major methamphetamine prevention campaigns in the last 20 years. Research overall showed that anti-drug campaigns often generated stigma, with messaging that promoted abstinence and perpetuated a negative perception of drug use.
2004 campaign
Funded by Peter Staley and driven by grassroots efforts, it used fear tactics to discourage meth use. The campaign evoked emotions like shame, fear, and stigma.
- Most people who said the campaign made them think about not starting crystal meth were white, HIV-negative, and did not engage in bareback sex.
- Most people who said they were glad someone was addressing crystal meth use in the gay community were also white, HIV-negative, did not bareback, had not recently used meth, and/or did not participate in PnP.
- In contrast, individuals who used meth in a PnP context were more likely to say the campaign made them want to start using crystal meth or use it more.
2020 Free LA County Campaign:
Aimed to reduce stigma around meth use by testing messages that promoted less fear-based language. Social post exposure in the campaign showed a 36% higher likelihood of MSM reporting exposure to the messages. The campaign was effective, with an average score of 4 out of 5 for making individuals less likely to use meth in the future.
Harm Reduction Session
Identified priorities and recommendations
The group identified the priorities below. Click to expand and see the resulting recommendations.
We recommend targeted funding to expand and sustain programs that center peer-led approaches, including programs that support people who are trans and non-binary, newcomers, and/or racialized.
We recommend expanding the inclusion criteria for programs serving people who use drugs to ensure equitable access to comprehensive, wraparound health and social services. These programs should be available to all 2SGBTQ+ community members, regardless of immigration status or income level.
We recommend the launch of a methamphetamine-focused ECHO (Extension for Community Healthcare Outcomes) to support knowledge sharing and case consultation among clinicians.
We recommend the development and offering of specialized training for service providers that emphasizes cultural competency and trauma-informed care. Include topics such as supporting individuals experiencing psychosis.Discussion Highlights
A Community Conversation Circle, facilitated by Mark Gaspar, Senior Policy and Strategic Issues Advisor at Toronto Public Health, brought together representatives from ASOs and community organizations to explore the needs of often underserved populations, including 2SGBTQ+ newcomers, trans and non-binary individuals, racialized communities, and street-involved people.
Orville Burke, from BlackCAP, shared insights into how shame around meth use often extends beyond the individual, affecting families and friends, especially within the African, Caribbean and Black (ACB) community where use remains hidden due to stigma and shame. He noted that integrating harm reduction education into broader social programming, rather than having programs focusing solely on drug use, has proven effective in engaging communities. He emphasized the importance of visible role models who openly share their experiences with others in reducing stigma.
Jessica Fox, one of the few community advocates in Canada who discusses methamphetamine use in the context of trans communities, described the healthcare barriers trans individuals face, especially those engaged in sex or survival work. She stressed the need for supportive, welcoming healthcare environments and advocated for trauma-informed, compassionate care. Many trans people feel pressured to pass as cisgender due to safety concerns, especially as discrimination increases towards trans and gender diverse communities. She highlighted that motivational interviewing is an important tool to meet people where they are.
Ower Oberto, from Latinos Positivos and PWA, advocated for immigration-focused harm reduction. He emphasized that many newcomers avoid seeking help due to fear of deportation, criminalization, and stigma. He called for inclusive, low-barrier services that support people regardless of immigration status or income level.
Steph Massey from the 519 emphasized that psychosis is a health issue, not a criminal issue. In her view, the war on drugs is really a war on communities. She closed by reminding attendees that not all drug use is problematic or rooted in pain—sometimes people use for pleasure, and it’s important to recognize this distinction to reduce stigma.
This conversation underscored the need for a compassionate, trauma-informed approach to support individuals across different communities, promoting inclusivity, understanding, and harm reduction in the face of increasing challenges.
Treatment Session
Identified priorities and recommendations
The group identified the priorities below. Click to expand and see the resulting recommendations.
We recommend that the established alliance advocate for increased availability of treatment options in Ontario, emphasizing novel, evidence-based approaches (e.g. injection naltrexone) tailored to the evolving needs of communities.
We recommend that the established alliance advocate for the reinstatement and sustained funding of culturally competent, identity-affirming public treatment programs designed for 2SGBTQ+ communities who use methamphetamine.
We recommend the exploration of partnerships, community consultations, and funding opportunities to localize the Getting Off app, ensuring it meets the specific needs of Ontario’s 2SGBTQ+ communities.Discussion Highlights
Tim Guimond, Mental Health Director at HQ Toronto, presented an overview of current methamphetamine treatment approaches, including both psychosocial and pharmacological options. He emphasized that no single treatment works for everyone, and evidence remains limited. Combined treatments, including medications and psychotherapy, have shown benefits. He also noted that stimulant-induced psychosis is treated with antipsychotics, though these may increase impulsivity and complicate recovery. Psychotherapy remains a key supportive treatment, while emerging therapies like repetitive transcranial magnetic stimulation (rTMS) are being studied.
Following this presentation, two community members shared their personal experiences with accessing treatment, being in treatment, and life after treatment, including the various challenges they experienced. The challenges included a lack of culturally competent care for 2SGBTQ+ communities, the need to hide their identities for safety, and insufficient oversight and regulation in private treatment facilities. One community member highlighted HQ as a positive example of an inclusive treatment program, though noted that it remains inaccessible to those living outside of Toronto.
Finally, Dr. Michael Li and Dr. Ray Mata (UCLA, Friends Research Institute) presented on treatments they are administering in Los Angeles as well as a novel treatment intervention: The Getting Off App, a self-guided digital intervention for 2SGBTQ+ individuals who use meth, based on the Getting Off Program originally developed by Drs. Cathy Reback and Steven Shoptaw in the late 1990s. A similar intervention to the “Getting Off App” does not exist in Ontario, and thus, there is an opportunity for implementation.
The app was designed to translate a manual 24-session cognitive behavioural therapy program into a user-friendly, self-guided format for smartphones. The app features gamified elements to increase engagement. Some users completed all 24 sessions in as little as two days, while others took longer.
An RCT evaluated the app's effectiveness in reducing meth use and activities known to be higher risk for HIV transmission. Participants were divided into two groups: one received immediate access to the app, and the other had a delayed start. The immediate access group showed higher app usage and more significant reductions in meth use and other activities associated with HIV transmission.
Federal funding cuts in the US have halted research efforts at Friends Research Institute, leaving the project in limbo despite promising results.
Across the Continuum
Identified priorities and recommendations
The group identified the priorities below. Click to expand and see the resulting recommendations.
We recommend that the established alliance advocate for the reinstatement and sustained funding of culturally competent, identity-affirming public treatment programs designed for 2SGBTQ+ communities who use methamphetamine.
We recommend that organizations prioritize funding for community-led projects that align with the priorities identified at the Think Tank. Funding should be flexible, low-barrier, and responsive to the evolving needs of communities.Overarching Values to Guide Implementation
To ensure that all recommendations and actions meaningfully support 2SGBTQ+ communities who use methamphetamine, the following core values should be considered across programs, research, and policy development across the continuum of care:
Address social and structural determinants of health.
Integrate housing, mental health, employment, food security, and other social determinants into program and policy responses.
Meaningful inclusion of communities.
The leadership, expertise, and lived experiences of underrepresented groups—particularly trans and gender-diverse people, newcomers, people who use drugs, and racialized communities—should be considered in all initiatives. Involvement should be ongoing, compensated, and non-tokenistic. Representation must span governance, program design, research, and frontline service delivery.
Avoid stigmatizing language.
The Think Tank took place during a time of intensification of punitive and coercive approaches to drug use in Ontario. Program and policy responses that aim to prevent methamphetamine use among 2SGBTQ+ communities or support harm reduction and treatment for 2SGBTQ+ individuals who use methamphetamine must use factual, accurate, and caring language. Language should reflect the range of experiences 2SGBTQ+ people have of methamphetamine and not contribute to stigmatizing drugs or drug users.
Engage with current research.
Program and policy responses to methamphetamine use among 2SGBTQ+ communities should be informed by ongoing engagement with current research and aligned advocacy efforts. The Agenda for Action, developed by the HIV Legal Network as part of the Connection, Care, Community: Strengthening Harm Reduction for GBTQ People who Use Drugs in Canada initiative, offers valuable guidance and can serve as a foundational resource to support these initiatives.
If you are interested in joining the alliance or if you have any questions or comments please contact Maria Sunil, [email protected].
Want to learn more about what happened at the think tank? Download the appendices.
Acknowledgements
We gratefully acknowledge the generous support of our sponsors, Gilead and ViiV, whose contributions made this event possible.
Special thanks to the Methamphetamine Working Group—co-chaired by Eric Mykhalovskiy and Jordan Bond-Gorr, with members Paul Shuper, Trevor Hart, Tim Guimond, Tim McCaskell, and David Soomarie for their invaluable insights throughout the planning process. The Methamphetamine Working Group was supported by OHTN staff members Maria Sunil, Roger Prasad, and Danielle Gilliauskas.
We also sincerely thank Mark Gaspar, our event facilitator, for his thoughtful input, and the OHTN staff for their dedicated logistical support.
Most importantly, we offer our heartfelt gratitude to the community providers and individuals with lived or living experience, whose perspectives profoundly shaped both the planning and the event itself. We are also thankful to the many attendees who shared their insight, energy, and expertise, enriching the discussions and driving this important work forward.