We interviewed 12 BMSM in Chicago and 13 BMSM in Houston (n = 25). A majority identified as gay (56%), with 12 participants (48%) reporting having a high school diploma or equivalent; their average age of first substance use was 15.2 years (SD = 2.9) (see Table 1). Participants perceived cannabis to be categorically distinct from other intoxicating substances. Through inductive thematic analysis, we elucidated that participant attitudes towards cannabis compared to “hard” or “heavy” substances, such as methamphetamine, cocaine, ecstasy, and opiates (i.e., heroine and prescription pills), were shaped by a wide range of factors, including their social network, need fulfillment (i.e., emotional and physical homeostasis), and perception of risk.
Table 1
Demographics and Substance Use among BMSM in Chicago IL, and Houston TX, n = 25; year 2019–2021.
|
N (%)
|
Age (M, SD)
|
26.6 (3.7)
|
Site Location
|
|
Chicago
|
12 (48%)
|
Houston
|
13 (52%)
|
Sexual Orientation
|
|
Gay or Homosexual
|
14 (56%)
|
Bisexual
|
7 (28%)
|
Straight or Heterosexual
|
4 (16%)
|
Education
|
|
K-12
|
6 (24%)
|
GED
|
2 (8%)
|
High School Diploma
|
10 (40%)
|
Some College
|
7 (28%)
|
Employment Status a
|
|
Unemployed
|
11 (44%)
|
Part-Time
|
8 (32%)
|
Full-Time
|
5 (20%)
|
Opioid Used Ever
|
12 (48%)
|
Age of First Substances Use (n, SD)
|
15.2 (2.9)
|
Number of Times in Jail/Prison (n, SD)
|
3.9 (3.6)
|
Living with HIV
|
11 (44%)
|
Housing instability in the last 60 days a
|
6 (24%)
|
Substances Used Ever
|
|
Cocaine
|
17 (68%)
|
Methamphetamine
|
8 (32%)
|
Club Drugs b
|
18 (72%)
|
Hallucinogens c
|
4 (16%)
|
Cannabis
|
25 (100%)
|
Alcohol
|
18 (72%)
|
Pain Pills d
|
9 (36%)
|
Heroin
|
1 (4%)
|
Cough Syrup and Codeine
|
4 (16%)
|
a Missing data
b E.g., Ecstasy (MDMA), gamma hydroxybutyrate (GHB), ketamine (‘Special K’)
c E.g., Psilocybin (‘magic mushrooms’), lysergic acid diethylamide (LSD/ ‘acid’)
d E.g., OxyContin, Vicodin, Valium, Xanax
|
Social Network
Older family members and their experiences with substance abuse were frequently cited as a negative influence on how participants perceived “harder” substances and their desire to avoid them. One participant reflected: “I learned through my own experiences, but it was mostly by was watching others.. . Like my grandmother, some of her best friends was crackheads. My uncle––I watched him and how drugs messed him up” (Houston (HOU), 28). In contrast, peers and peer-aged family members (e.g., brothers, cousins) were often identified as positively influencing participants into initiating both “hard” drug and cannabis consumption; one participant stated, “Yeah, my sister actually got me doing drugs basically – weed” (Chicago (CHI), 22). Additionally, peers and peer-aged family members provided participants easy access to cannabis, whether that be through their connections, selling, or using cannabis. “I have brothers that sell weed and stuff like that, and so, it was easy to maneuver to get that” (CHI, 29).
Participants described how the social aspects of using cannabis within their networks differ from use of other substances. One participant shared this dynamic, “I mean, my friends do drugs, but it's not -- we're all like the same. It's not like we sit in a big circle and pop ecstasy pills or do lines or do barbs or nothing like that. We may smoke the blunt together, yeah we do that” (HOU, 27). Others expressed disdain and distrust for network members who used hard drugs, “Meth is more with other drug addicts and junkies. .. These people don't care about you. They're drug addicts. We’re all drug addicts. And some of these people don't -- most of them don't have a life. Nothing going on for themselves and people have told me they’d rather see me high than sober”(HOU, 24)
While references to the sexual orientations of friend groups were rarely made, when they were, hard drugs were linked to being LGBT. “And the methamphetamine is awesome too. And the methamphetamine is used for gay community. It’s like a gay drug. It's like a party drug and it’s for sex” (HOU, 24). Whereas, with one exception, cannabis was not linked to sexual orientation at all, “but straight people they just smoke, you know, hang with them and smoke and I snapped out of it like that” (CHI, 23).
Need Fulfillment
Participant consumption of cannabis was often motivated by a desire to fulfil basic needs (e.g., inducing hunger or sleep) and maintain emotional and physical homeostasis. For example, participants consumed cannabis in order to complete productive tasks (e.g., schoolwork and house cleaning). Another participant recalled how it helped them cope with depressive symptoms: “I wasn't eating properly, I wasn't being nourished properly. So, I started using marijuana” (HOU, 26). Participants also used cannabis to deal with stress and to achieve a sense of general euphoria or wellbeing. One participant expressed, “Once I got out of jail I just really had nobody and so it was like I was really, really dependent on weed. Like, that was my life -- stress reliever, my coping mechanism, like everything actually” (CHI, 25).
Finally, participants frequently described using cannabis to cope with a variety of traumas that can be particularly common among populations of young Black MSM with histories of criminal legal involvement. These included recent incarceration, deaths of family members due to violence and other causes, an HIV diagnosis, and assault. “Later my grandmother got sick and that took another turn -- I guess her getting sick and the news about my HIV made me start really using. So, I guess all those like the mix of things was like going on” (HOU, 27). Cannabis helped them to regulate their emotions and provided relief from negative feelings (e.g., anxiety and depression) in the face of these events. “You know, if I start getting into my thoughts and my feelings, I, you know, I want to smoke weed just to kind of relax me and calm me down, calm my anxiety down” (HOU, 29).
Because many participants used cannabis to fulfil needs, including dealing with psychological and physiological conditions (e.g., depression, ADHD, anorexia), they generally framed cannabis not as a “hard” drug but rather as a therapeutic agent or an “herbal” remedy, even replacing prescribed medications. One participant reported that it might be safer that prescribed medications, “Marijuana is, is edible and it's therapeutic; it’s normal stuff. .. more like a social therapeutic. Instead of taking half of these psychotropic medications, I’ve found that marijuana does the same thing and it's herbal” (HOU, 24).
Perception of Risk
Participants’ perceived risk of cannabis use versus other, “harder” substance use was driven by their attitudes towards addiction and their understanding of the potential harmful physiological effects, such as overdose, associated with using non-cannabis substances.
I just kind of feel like marijuana is the only drug that probably wouldn't kill me. That is why it is the one I use most often. I can use it more and feel safer using it. Cocaine is something I do, but not as often as I do marijuana. I have more fear that I might overdo it with something like cocaine. .. If I think it is milder, I will use it. I have heard some concerning things about what cocaine can do, like effect blood pressure and the heart. (HOU, 29)
Despite participants having a general attitude towards cannabis as being “safer” than other intoxicating substances, their attitudes towards their own individual cannabis usage were mixed; some participants expressed that their cannabis usage was wholly under their control, some described feeling dependent on cannabis consumption, and some matter-of-factly described it as being a non-problematic yet essential part of their everyday lives. One participant described intentionally pursuing a non-problematic usage regimen: “Keeping it [cannabis use] under control is my main concern. There's a thin line between checking in with everything and then abusing everything. So just making sure that I keep myself on the positive side of that” (CHI, 25). Concerns about substance use disorder were pervasive in the sample, with some participants moving from using hard drugs to cannabis because they experienced or observed negative effects of those other drugs that the assumed they could avoid with cannabis. “I don’t like the pills, slouchy and stuff like that. Yeah, it made me real sleepy like, pills like, I was like, I looked like a heroin addict. You know what I mean? Like nodding and stuff, I mean I was like, I don’t like that. .. After I overdosed no, I only use marijuana” (CHI, 24). Participants assessed the point at which cannabis usage is therapeutic versus when it becomes problematic according to dynamic personal criteria and experiences with other substances.
Cannabis usage is informed by participants’ social and physical environments, and these networks and needs also influence participants’ experiences with cessation and relapse and/or persistent recovery from substance use including cannabis usage. Another individual demonstrates that their established networks persist despite their decision to cease usage, “Everything good. We can still hang out. They don’t put any pressure on me to use [cannabis]. They are respecting my decision to not use” (HOU, 27).