Charli XCX's "365" pulses on the dance floor as strobe lights illuminate a mass of sweaty bodies. In the hallway by the bathroom, I wait patiently for clubgoers to pass by.

"Fentanyl test strips?” I ask them. "For you or your friends?"

This is harm reduction in action: a strategy that prioritizes community well-being and human life over convincing people not to do drugs. It pairs drug education with lifesaving resources such as fentanyl test strips and naloxone (typically known by the brand name Narcan). In doing so, harm reduction empowers people to recognize an overdose and know how to intervene, potentially saving a life in the process.

Research is unclear about LGBTQ+ overdose rates, particularly when it comes to fentanyl. We do know that LGBTQ adults are twice as likely to use illicit drugs due to social stigma and lack of specialized support. It is not uncommon to find drugs in nightlife spaces like gay bars and clubs, as these spaces remain a common social outlet for LGBTQ adults. Yet, when we talk about tackling substance use and overdose death in the LGBTQ community, party environments are often deemed a risk.

What if we treated them as an opportunity instead?

Volunteering for End Overdose Boston, my local chapter of the national nonprofit, has brought me to nursing classrooms, resource fairs, and nightclubs. Each setting is unique, but I have found the club particularly impactful.

For one, harm reduction in a club is accessible.

It means that people do not need to seek out a doctor or reputable clinic to learn about drugs and how to safely avoid an overdose. Narcan training typically takes five minutes, which is the same amount of time people might spend waiting for the bathroom or bartender. Convenience lowers access barriers.

Additionally, club overdose education creates a timely opportunity for people to ask drug questions in a space where they are often relevant, whether they are drug users or not. Clubgoers may engage with or ignore harm reduction volunteers entirely without coercion.

Accessibility extends beyond patrons as well. One of the most impactful trainings I taught was with a club security guard who often encountered drugs but never learned how to use Narcan. He left our table with resources and more knowledge. Harm reduction in LGBTQ nightlife spaces emphasizes the role of community in a community-related issue.

Medical distrust remains a prominent issue in the LGBTQ+ community, with many people afraid to speak to a doctor about drugs due to fear of judgment or advice prioritizing abstinence over proactive measures. Stigma and distrust further this issue, with studies like the United States Trans Survey flagging 33% of participants as having experienced a negative experience in a healthcare environment due to their gender identity.

Overdose education can be tailored according to the specific social dynamics relevant to LGBTQ people. For example, educators might spend time speaking about drugs most common in LGBTQ nightlife spaces. They might also use popular nicknames instead of medical terms.

Trust is also paramount. Suppose a gay man has a question about his partner's drug use and wants to know about fentanyl testing. In that case, he can ask openly, knowing harm reduction educators are aware of the space they are in. This can make a stigmatized topic more approachable and easier to tackle. It is helpful if trainers are familiar with the LGBTQ community and relevant party spaces, as personal experiences can add depth to the discussion.

Frankly, a one-size-fits-all approach doesn't tend to work when it comes to drugs. Not all drugs are the same, and not all people who consume drugs are the same.

Some may question why LGBTQ framing is needed. Can harm reduction work in all club settings? In short, yes. However, the approach can be more effective when grounded in community. Why not meet people where they are? Encouraging dialogue about drugs and overdose prevention in LGBTQ spaces may empower peer education and community discussion, an approach similar to HIV prevention and safe sex.

Harm reduction education in a nightclub setting is actionable. Fentanyl, which is highly addictive and can be deadly, is showing up in party drugs. If people consume party drugs in party environments, we should teach lifesaving strategies in those party environments. Those partygoers could theoretically apply this information about how to intervene the same night. They may be more likely to test a substance for fentanyl rather than risk overdose if resources to do so are free and on hand. Club education can function as a direct-to-consumer or direct-to-bystander model. Even if someone doesn't do drugs, they might know a friend who does.

In a party environment, knowing the difference between someone falling asleep due to alcohol intoxication and falling asleep due to overdose is paramount. Paired with on-hand resources like test strips and Narcan, LGBTQ people can be equipped to support peers without involving a middleman. This approach works. I personally completed a harm reduction training at a community event and left with two doses of Narcan to carry. A few months later, I used one of those doses when witnessing a drug overdose on a train platform.

Harm reduction in LGBTQ nightlife spaces is accessible, community-oriented, and actionable. While not an end-all solution, it's a positive step in the way we realistically frame and approach LGBTQ drug culture.

Jack MacDonald is a Boston-based harm reduction advocate, writer, and Program Coordinator at Harvard. He is a Public Health Voices fellow for the Harvard LGBTQ Health Center of Excellence. Jack graduated from Boston College and has been featured in the Wall Street Journal’s Future View column. Views are his own and do not represent his employer's or affiliated organizations' views. You can find Jack on LinkedIn and Bluesky.

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