Cannabis use and mental health among young sexual and gender minority men: A qualitative study

Acceptability of integrating mental health and substance use care within sexual health services among young sexual and gender minority men in Vancouver, Canada

BACKGROUND

Despite well-established evidence showing that young sexual and gender minority (SGM) men experience disproportionate mental health and substance use inequities, few sexual health services provide mental health and substance use care. This qualitative study examined the experiences and perspectives about integrated care models within sexual health services among young SGM men experiencing mental health and substance use challenges.

METHODS

Semi-structured interviews were conducted with 50 SGM men aged 18-30 years who reported using substances with sex in Vancouver, Canada. Interviews were analyzed using thematic analysis.

RESULTS

Three themes were identified: 1) participants asserted that their sexual health, mental health and substance use-related health needs were interrelated and that not addressing all three concurrently could result in even more negative health outcomes. These concurrent health needs were described as stemming from the oppressive social conditions in which SGM men live. 2) Although sexual health clinics were considered a safe place to discuss sexual health needs, participants reported not being invited by health providers to engage in discussions about their mental health and substance use health-related needs. Participants also perceived how stigmas associated with mental health and substance use limited their ability to express and receive support. 3) Participants identified key characteristics they preferred and wanted within integrated care, including training for health providers on mental health and SGM men's health and connections (e.g., referral processes) between services. Participants also recommended integrating social support programs to help them address SGM-related social challenges.

CONCLUSION

Our findings highlight that SGM men's sexual health, mental health and substance use-related health needs and preferences are interrelated and should be addressed together. Tailored training and resources as well as structural adaptations to improve communication channels and collaborative connections between health providers are required to facilitate the development of integrated care for young SGM men.

Sexual orientation-based microaggressions and cannabis use outcomes among sexual minority individuals: The impact of negative affect and coping-motivated cannabis use

INTRODUCTION

Sexual minority individuals report significantly more cannabis use and problems than their heterosexual peers, possibly due to their frequent experiences with sexual orientation-based microaggressions. As a result, sexual minority individuals may turn to cannabis use to cope with the negative affect associated with these experiences. No known studies have tested this hypothesis; therefore, the current study tested if sexual orientation microaggressions are positively associated with negative affect (anxiety and depression), cannabis coping motives, and cannabis-related outcomes (frequency, problems); if coping motives are positively associated with cannabis-related outcomes; and if negative affect and cannabis use to cope with negative affect serially mediate the relation between sexual orientation microaggressions and cannabis-related outcomes.

METHODS

Sexual minority undergraduate students who reported cannabis use in the past three months (N = 328; 71.3 % cis-female) completed an online survey.

RESULTS

Microaggressions were significantly positively correlated with anxiety, depression, coping-motivated cannabis use, cannabis-related problems, non-sexual orientation-related stress, and overt sexual orientation-based discrimination. Additionally, after controlling for non-sexual orientation-related stress and overt sexual orientation-based discrimination, microaggressions were indirectly positively related to cannabis use frequency and problems via the sequential effects of negative affect and coping motives. This relation remained significant when examining negative affect specific to sexual orientation microaggressions and cannabis use to cope with this microaggressions-specific negative affect.

CONCLUSIONS

Results highlight the adverse impact of sexual orientation microaggressions in terms of negative affect and negative cannabis-related outcomes.

'I created my own access:' understanding mental healthcare access experiences among LGTBQ + youth who use cannabis in Canada

In North America, LGBTQ+ youth have high rates of cannabis use and face mental health issues. We conducted a photovoice study to describe the perspectives, needs, and motivations of forty-six LGBTQ+ youth who use cannabis as they access mental healthcare services. Participants' photographs were discussed in individual semi-structured interviews conducted by peer researchers. Following a thematic analysis of the interview transcripts, we first found that, beyond medication, LGBTQ+ youth sought mental health services facilitating introspection to better understand their sexual and gender identities and mental health. Second, participants sought affirming health professionals but often felt judged by providers. Third, access to desired services was often described as uncertain and taxing, which impacted their mental health. Fourth, participants' agency was determined by their experience with mental health services, which translated into resilience to tackle access challenges and cannabis use to mitigate their mental health struggles. Our findings point to the need for mental healthcare delivery that goes beyond medication provision but which in addition foster therapeutic processes based on a holistic understanding of mental health. A trusting dynamic between health professionals and LGBTQ+ youth is imperative to counteract the feelings of stigma experienced by LGBTQ+ youth using cannabis in Canada.

Cannabis Use Differences Among Sexual Minority Versus Heterosexual Females and Males in Oklahoma: The Roles of Mental Health, Cannabis Perceptions, and Cannabis Marketing Exposure

INTRODUCTION

Despite the high cannabis use rates among sexual minority (SM) individuals, less research has examined factors related to cannabis use among SM (vs. heterosexual) individuals, especially in places with legal medical cannabis retail markets and high structural stigma, like Oklahoma.

METHODS

Data were from a survey of Oklahoma adults, including 3020 females (18.6% SM) and 2279 males (10.1% SM). Bivariate analyses examined associations of sexual identity with cannabis-related factors (i.e., perceived harm, positive attitudes, marketing exposure, depressive symptoms, anxiety symptoms) and cannabis use and use severity (i.e., past 30-day use, daily/near-daily use, cannabis use disorder [CUD] symptoms). Logistic regression examined associations of sexual identity and cannabis-related factors with cannabis use and use severity among females and males, separately.

RESULTS

SM (vs. heterosexual) females reported greater odds of past 30-day cannabis use and daily/near-daily use, lower harm perceptions, greater marketing exposure, and higher rates of depressive/anxiety symptoms. Lower harm perceptions and greater marketing exposure were associated with greater odds of past 30-day use, whereas marketing exposure was associated with greater odds of daily/near-daily use. SM (vs. heterosexual) males reported greater odds of daily/near-daily use and higher rates of depressive/anxiety symptoms.

CONCLUSIONS

SM (vs. heterosexual) females reported higher rates of cannabis use, whereas SM (vs. heterosexual) females and males reported higher rates of daily/near-daily cannabis use. Potential targets for cannabis-related health campaigns aimed at reducing use differences include correcting misinterpretations of harm that may emanate from cannabis marketing efforts among females and addressing depressive symptoms among males.

Cannabis Use and Sharing Practices Among Sexual Minority and Heterosexual Individuals During the COVID-19 Pandemic

Purpose: Cannabis behaviors during the COVID-19 pandemic among sexual minority (SM) individuals in the United States remain understudied. This study assessed the prevalence and correlates of cannabis use and cannabis sharing, a potential risk for COVID-19 transmission, among SM and heterosexual-identified individuals in the United States during the COVID-19 pandemic. Methods: This cross-sectional study used data from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020. Included participants reported past-year nonmedical cannabis use. Associations between frequency of cannabis use and sharing behaviors by sexual orientation were evaluated using logistic regression analysis. Results: Overall, 1112 respondents reported past-year cannabis use; mean age 33 years (standard deviation = 9.4), 66% male identified (n = 723), and 31% SM identified adults (n = 340). Increased cannabis use during the pandemic was similar among SM (24.7%; n = 84) and heterosexual (24.9%; n = 187) respondents. Any sharing during the pandemic was 81% for SM adults (n = 237) and 73% for heterosexual adults (n = 486). In the fully adjusted models, the odds of daily/weekly cannabis use and the odds of any cannabis sharing among SM respondents were 0.56 (95% confidence interval [CI] = 0.42-0.74) and 1.60 (95% CI = 1.13-2.26), respectively, compared with heterosexual respondents. Conclusions: SM respondents were less likely to use cannabis with high frequency during the pandemic but more likely to share cannabis compared with heterosexual respondents. Sharing cannabis was high overall, which may increase COVID-19 risk. Public health messaging around sharing may be important during COVID-19 surges and respiratory pandemics especially as cannabis becomes more widely available in the United States.

Pot at the End of the Rainbow: Cannabis Use Among Sexual Minorities

Introduction: Gay, lesbian, and bisexual individuals (i.e., sexual minorities) use cannabis more frequently than heterosexuals; however, little research has directly compared sexual minorities' patterns of cannabis use (e.g., quantity, age of onset, forms of cannabis used) with heterosexuals. Some research has identified motivations for cannabis use in sexual minorities, but much of this research has been qualitative and/or narrow in scope (e.g., focused on sexual motivations). To the best of our knowledge, no previous research has used a validated measure to examine motives for cannabis use among sexual minorities. Additionally, cannabis use is known to be associated with mental health symptoms, but little research has examined relationships between cannabis use and mental health in this population. Materials and Methods: Data analyses were performed on archival survey data collected from 10 undergraduate psychology subject pools across the United States (N=4,669) as a part of Project ART (Addictions Research Team). Participants indicated their sexual orientation using a 5-point scale, and responses were used to classify participants into three groups: the majority of the sample (n=3,483) were classified into the heterosexual group, about one quarter were classified into the bisexual group (n=1,081), and a small number were classified into the gay group (n=105). Results: The bisexual group was more likely to report using cannabis. They also reported using cannabis more frequently, were more likely to report use of all product types (i.e., flower, concentrates, and edibles), and reported more severe symptoms of cannabis use disorder (CUD) than the heterosexual group. The bisexual group also reported higher levels of coping and enhancement motives for using cannabis and reported higher levels of all measured mental health symptoms (e.g., depression, suicidality, generalized anxiety, and social anxiety) compared with the heterosexual group. Conclusions: Increased frequency of cannabis use, use of a broad range of different products, and use of cannabis to cope with mental health concerns may be placing bisexual individuals at greater risk of CUD. Findings from this study can be used to guide future research and help target mental health interventions among bisexual individuals.

The endogenous cannabinoid system modulates male sexual behavior expression

The endocannabinoid system (ECS) plays a key neuromodulatory role in the brain. Main features of endocannabinoids (eCBs) are that they are produced on demand, in response to enhanced neuronal activity, act as retrograde messengers, and participate in the induction of brain plasticity processes. Sexual activity is a motivated behavior and therefore, the mesolimbic dopaminergic system (MSL) plays a central role in the control of its appetitive component (drive to engage in copulation). In turn, copulation activates mesolimbic dopamine neurons and repeated copulation produces the continuous activation of the MSL system. Sustained sexual activity leads to the achievement of sexual satiety, which main outcome is the transient transformation of sexually active male rats into sexually inhibited animals. Thus, 24 h after copulation to satiety, the sexually satiated males exhibit a decreased sexual motivation and do not respond to the presence of a sexually receptive female with sexual activity. Interestingly, blockade of cannabinoid receptor 1 (CB1R) during the copulation to satiety process, interferes with both the appearance of the long-lasting sexual inhibition and the decrease in sexual motivation in the sexually satiated males. This effect is reproduced when blocking CB1R at the ventral tegmental area evidencing the involvement of MSL eCBs in the induction of this sexual inhibitory state. Here we review the available evidence regarding the effects of cannabinoids, including exogenously administered eCBs, on male rodent sexual behavior of both sexually competent animals and rat sub populations spontaneously showing copulatory deficits, considered useful to model some human male sexual dysfunctions. We also include the effects of cannabis preparations on human male sexual activity. Finally, we review the role played by the ECS in the control of male sexual behavior expression with the aid of the sexual satiety phenomenon. Sexual satiety appears as a suitable model for the study of the relationship between eCB signaling, MSL synaptic plasticity and the modulation of male sexual motivation under physiological conditions that might be useful for the understanding of MSL functioning, eCB-mediated plasticity and their relationship with motivational processes.

Typical Sources and Locations of Marijuana among US Young Adults: Differences by Sexual Minority Status

Background: With the widespread legalization of cannabis and use among all age groups, location and source of cannabis remains to be researched, especially among minority populations. Methods: We pooled data from the 2018-2019 National Survey on Drug Use and Health and investigated differences by sexual minority status of where individuals obtained cannabis. Results: Results found that gay/lesbian and bisexual individuals who reported use were more likely to get marijuana from buying it, trading it for something else and getting it for free or sharing someone else's, compared to heterosexual individuals. Furthermore, more than one in five lesbian/gay individuals reported obtaining marijuana from someone they just met while nearly 25% of bisexual women reported obtaining marijuana from a friend. Conclusions: Findings from the present study may inform harm reduction and policy initiatives.

A Review of Disparities in Cannabis Use and Cannabis Use Disorder Affecting Sexual and Gender Minority Populations and Evidence for Contributing Factors

Purpose of Review

Sexual and gender minorities (SGM) appear to be at elevated risk for cannabis use (CU) and cannabis use disorder (CUD) compared to cisgender heterosexuals. However, risk factors remain understudied among SGM. This review aims to summarize evidence for disparities in CU and CUD affecting SGM and factors contributing to these disparities.

Recent Findings

We found strong evidence that sexual minorities are at elevated risk for CU and CUD is elevated for sexual minority women. Evidence supports a concurrent association between minority stress and CUD symptoms. There is robust support for coping motives as a mechanism linking minority stress to subsequent CU and CUD. Studies also point to CU norms and contexts as potential risk factors.

Summary

SGM are at high risk for CU and CUD, and minority stress, CU norms, and contextual factors are implicated. Additional research is needed on CU among gender minorities, prospective effects of risk factors, and interventions for SGM.

Risky Sexual Practices, Sexually Transmitted Infections, Motivations, and Mental Health among Heterosexual Women and Men Who Practice Sexualized Drug Use in Spain

Sexualized drug use (SDU) has been poorly studied among heterosexuals. The purpose of the present study was to analyze the prevalence of and gender differences in types of substances, risky sexual practices, sexually transmitted infections (STIs), motivations, and psychological adjustment among heterosexual women and men who engage in SDU. The study sample consisted of 1181 heterosexuals (795 women) between 18 and 78 years old (mean age = 24.4, SD = 7.4). Approximately 12% of the participants had engaged in SDU. No differences were found in the prevalence of SDU between men and women. Alcohol, cannabis, and 3,4-methylenedioxy-methamphetamine (MDMA) were the substances most frequently used for sexual purposes. Men were significantly more likely to use MDMA, ecstasy, cocaine, and erectile dysfunction (ED) drugs, and they tended to have more sexual partners than women. Likewise, SDU was related to have more sexual partners, penetrative sex without a condom, practice a fetish, be diagnosed with syphilis, chlamydia, and others STIs, and present more depression symptoms (but not with more anxiety). In conclusion, SDU was associated with poorer physical and mental health. It is, therefore, necessary to design programs aimed at reducing the incidence of the consequences of SDU on the physical and mental health of both men and women. Moreover, programs that seek to understand why these individuals engage in SDU should be undertaken.

The Influence of Cannabis and Alcohol Use on Sexuality: An Observational Study in Young People (18–30 Years)

The consumption of cannabis and alcohol results in a variety of effects on the psychic functions of young users. Notwithstanding their widespread and prevalent use, the impact of these drugs on sexual health remains unknown. Thus, the aim of this study is to analyse the influence of alcohol and cannabis consumption on sexual function in young people. An observational study was conducted in 274 participants aged 18–30 years. The following selection tools were used: Alcohol Use Disorders Identification Test, Cannabis Abuse Screening Test (CAST), and Changes in Sexual Functioning Questionnaire Short-Form. Participants who were at high risk of having cannabis-related problems performed better on the CAST concerning sexual function, arousal, and orgasm. Participants at high risk had higher arousal and orgasm scores than those who were not at risk for cannabis problems. Improvements in sexual function were found between people who were at high risk of having alcohol problems and those who were not at risk. Sexual function in young people who use cannabis and alcohol more frequently was shown to be better than in those who do not use either, highlighting the need for more information aimed at the young population.