The Study Didn't Even Ask About Meth

Last week I wrote about a San Francisco study that looked at how MSM and trans women perceive risk from substance use. It covered needle sharing, opioids, sex while under the influence. Solid research. But the researchers themselves flagged something I haven't been able to stop thinking about.

Meth wasn't part of the survey.

A separate 2025 study of nearly 30,000 sexual and gender minority people in the U.S. found that 35% reported meth use. Of those, 45% had injected it in the past year. That's roughly 1 in 6 of the entire sample putting a needle in their arm for meth specifically. Meanwhile, general population meth use sits around 1%.

So we have a risk-perception study designed for our community that skipped the substance our community uses most. Not because the researchers didn't care — they flagged it. But because the survey tools weren't built to ask about it in the first place. Most substance-use instruments were developed around opioids and alcohol, where the federal funding lives. When those tools get applied to populations where the substance landscape looks completely different, whatever they didn't ask about stays invisible.

And invisible means unmeasured. Unmeasured means unfunded. Unfunded means 4.5 million people with stimulant use disorder and less than 900,000 getting treatment. That's an 80% gap.

Here's the part that connects it all: meth-related deaths rose fiftyfold between 1999 and 2021. And by 2021, 61% of those deaths also involved an opioid. The fentanyl supply is killing meth users too. These aren't separate crises. They're the same crisis with a blind spot.

You can't reduce harm from something you refuse to measure.

Medical Disclaimer

This article shares sexual-health education, research summaries, and personal commentary. It does not provide individual medical diagnosis or treatment. Research findings and public-health recommendations may change as new evidence becomes available. Talk with a qualified healthcare professional about symptoms, testing, medications, prevention options, and decisions affecting your health.

Research Note

The racial disparities in this data deserve their own post. Between 2015 and 2019, meth use disorder among Black adults increased more than tenfold. American Indian and Alaska Native communities saw the steepest overdose death increases. The crisis doesn't hit everyone the same way, and that matters.

Sources:

• Springer Nature (2025). Intravenous Methamphetamine Use, HIV Status and PrEP Uptake Among a U.S. Sample of 29,880 Gender and Sexual Minorities, 2022–2023. AIDS and Behavior. https://link.springer.com/article/10.1007/s10461-025-04846-0

• CDC National Center for Health Statistics (2025). Drug Overdose Deaths in the United States, 2023–2024. https://www.cdc.gov/nchs/products/databriefs/db549.htm

• The Pew Charitable Trusts (2024). Stimulant Use Is Contributing to Rising Fatal Drug Overdoses. https://www.pew.org/en/research-and-analysis/fact-sheets/2024/08/stimulant-use-is-contributing-to-rising-fatal-drug-overdoses