Substance use is a common part of life in Canada, and for many people it is social, pleasurable and woven into everyday life. But it also carries risks, which are shaped far more by structural forces like discrimination and criminalization than by individual choices. Canada is in the midst of an unprecedented toxic drug crisis, and the populations most exposed to harm are those already marginalized by the conditions in which they live.

2SLGBTQ+ people are among those most affected. They use substances at higher rates than their cisgender, heterosexual counterparts, face greater barriers to care and carry the compounding burden of minority stress, structural marginalization and the “double stigma” of both substance use and 2SLGBTQ+ identity. Substance use in 2SLGBTQ+ communities can be both a response to discrimination and unmet needs, and a driver of additional risk, making it a complex, intersecting issue that requires a nuanced response. Yet 2SLGBTQ+ people are largely invisible in substance use data, programming and policy.

This Health in Focus educational resource provides an overview of the substance use health needs of 2SLGBTQ+ people, with particular attention to harm reduction, and offers practical guidance for providers across the care continuum. It is designed to help understand why 2SLGBTQ+ people use substances, what gets in the way of care and what providers can do to offer more affirming, effective and equitable support.