This cohort-control study, titled “PRIDE Endures”, looked at the impact the COVID-19 pandemic has had on drug use and sexual behavior, specifically exploring the relationship between drug use and sexual behavior among sexual minority men before and during the COVID-19 pandemic. Cohorts were recruited via geosocial networking apps for gender minorities, between May 6 and May 17, 2020 (COVID) and November 2017 and November 2019 (pre-COVID). This study looked at the comparison of 455 survey respondents during COVID and 65,707 respondents pre-COVID. The results showed that use of marijuana declined significantly from 45.7% pre-COVID to 34.5% during COVID. Similarly, the use of other illegal drugs (cocaine/crack, methamphetamine, and MDMA) declined from 22.9% pre-COVID to 11.0% during COVID. Furthermore, condomless anal sex (CAS) reportedly declined significantly from 71.6% pre-COVID to 26.4% during COVID, but the number of casual sex partners did not differ significantly. Further analysis indicated a strong association between marijuana and other illegal drug use with both more casual sex partners and higher engagement in CAS during COVID despite the reporting of each outcome decreasing. These findings suggest that although overall drug use may have fallen, the sexual minority men who use drugs are at a particularly high risk of engaging in sexual behaviors that place them at risk for COVID-19 infection as well. Ultimately highlighting the urgent need of both HIV and COVID-19 prevention among sexual minority men who use drugs during COVID.