Transcript Club drugs - The Student Health Association

CLUB DRUGS
Dr Alexander Margetts, Clinical Psychologist
David Stuart, Antidote Manager
[email protected]
BAHSHE, York. 06/07/12
Talk Overview
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Why Club Drugs?
New Users, New Drugs
The Club Drug Clinic
LGBT perspectives
What to do?
Q&A
Heroin and Crack Cocaine use decreasing
Alternatively, in 2010,
300,000 16-24yrs had tried Mephedrone.......
Drugs used by ‘clubbers’
Drug
Ecstasy
Cocaine
Ketamine
Benzodiazepines
Mephedrone
GHB
Crack
Heroin
Winstock et al. Addiction 2010, 106, 154-161
Percentage (lifetime)
89.5
84.6
66.1
42.0
41.3
15.2
13.6
6.7
LGBT Drug use
UKDPC: Drugs and diversity 2010
New Users, New Drugs
• GBL/GHB
• Crystal Methamphetamine
• Ketamine
• Mephedrone
• Legal Highs
GBL/GHB
• Colourless, liquid solvent. Pipette
into a drink or use nail varnish pads
• Similar effects to alcohol: relaxed,
euphoria, ↑ sex drive and sensuality
• Used mainly for sex and clubbing
• Difficult to get the dose right
• V. easy to overdose – “going under”
• Physically addictive very quickly with
dangerous withdrawals if dependent
•Will require medical detox if become
dependent – outpatient or inpatient
depending on severity and risk factors
Crystal
Methamphetamine
• Methamphetamine, crystal, Ice, Glass,
Tina, Yaba, Krank, Tweak
• Tablet, powder or crystals – smoked,
injected, inserted
• Can be taken in ‘runs’ lasting days,
sexualised use in MSM community
• Intense rush, euphoria, exhilaration, ↑
energy, sex drive, confidence, sociable ↓
appetite
• Risk contracting BBV’s through injecting,
sharing pipes, risky sex.
• Paranoia, psychosis, impulsivity
Ketamine
•K, Ket, Green, Special K, Super K,
Vitamin K, Lady K, Cat Valium, KitKat, Horse Tranquiliser
•Anaesthetic white powder or liquid –
usually snorted (ketamine inhalers),
occasionally injected
• Euphoria, transcendental-like
experiences, mild hallucinogenic
• High doses can lead to a ‘K- hole’
• Ketamine Bladder & Cramps
Mephedrone
• Meph, MC, m-cat, 4-MMC, Miaow,
Meow Meow, Bubbles, Bounce,
Charge, Drone, White Magic
• Powder or tablets, snorted, mixed
with a drink, injected
• Stimulant: euphoria, speediness,
increased sex drive
• Anxiety, heart palpitations,
hallucinations, agitation, psychosis
• The original ‘Legal High’, criminalised
in 2010 following media activity. Many
more sprung up since.
Club Drug Clinic:
‘One Stop Shop’
• Psychiatry
• Psychology
• Peer Support
• Sex Health/HIV
• Hepatology
• Urology
• A&E/ICU
Clinical, Research, Consultation
The
Team.....
Consultant
Psychiatrist
&2
Training Drs
Research
Assistant
Clinical
Psychologist
+2
Assistants
Club
Drug
Clinic
ANTIDOTE
Drug
Workers &
Volunteers
Employmen
t Specialist
Clinical
Nurse
Specialist
Sexual
Health
Worker
How we help
• Information and advice
• Assessment of what the client is using &
the problems it might be causing
• Assessment of other problems –physical,
psychological
• Keyworking – individual and group
• Specific medical treatments
• Specific psychological treatments
• Sexual Health Testing
• Training, teaching, consultation
• Research
Referral Process
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Remove barriers to treatment
‘Sexual Health’ model
Any borough, any/no GP
Confidential & Non-Judgmental
Self – phone, e-mail (<30 secs!)
Staff and Clinicians – Referral form
QR Codes: 423 hits (& counting!)
www.clubdrugclinic.com
Heterosexual Drug Use
Cocaine
Ketamine
Alcohol
MDMA
GBL
Mephedrone
LGBT Drug Use
GBL
Crystal Meth
Mephedrone
Alcohol
Cocaine
Ketamine
CDC in partnership with ANTIDOTE
The UK’s only LGBT Substance Misuse Service
10 year history serving the Substance Use needs of
London’s LGBTQ community
8,000 contacts, 700+ people in treatment each year
“Club Drugs” are Problematic Drugs
Our scene
highly
sexualised
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Normalised Drug/Alcohol use
on our Bar and Club Scene
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From “Huggy” to Hardcore”
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72 hour
clubbing,
sex-on-premises
venues,
On-line hookups,
Crystal sex
parties…
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24 HOUR SAUNAS…
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The popularity of BareBacking
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Shame re: sex, intimacy anxiety,
internalised homophobia
Crystal Methamphetamine, Crystal, Tina.
• 3, 4 + day “benders” of speedy, unboundaried chaotic sexual
marathons.
• Effects managed with GBL use.
• Repetitive GUM presentations.
• Increased HIV/Hep C infections.
• Drug-induced psychosis very common.
• High likelihood of psychological dependence.
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MANY more people now injecting..
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2 Distinct Issues
• Toxicity/Overdose
• Dependency/
Overdosing in
clubs/saunas/ sex-parties.
Large numbers of people
forming dangerous
addictions, using hourly
every day, just to avoid
unmanageable and
dangerous withdrawal
symptoms.
HOW dependence begins,
progresses
Used to sleep after a big weekend of continual use,
leading to..
using to manage the comedown during the week,
leading to..
using to aid sleep at bedtime,
leading to..
using for any stress or discomfort,
leading to..
regular use/dependence
What to do? Assessment
1. Presume clients are using, and use permissive language
when asking. "And what drugs are you using at the
moment?" is much more likely to get an honest answer
than "Do you take drugs?"
2. If using, find out the contexts (as clients will often take
different drugs for different reasons, sometimes to
counteract each other!). "And how often do you use X at
the moment?" "Where do you tend to get your X from?"
"How much is X costing at the moment?" "What ways do
you like to take X?" "Do you tend to use X with others or
by yourself or both? How often do you use X during sex?
"How long have you been using X for now?" "Have you
found yourself using more or less X lately?"
What to do? Assessment
3. Don't presume problems (many people use safely), but always
check: "Are you happy with your use?" "What are the good
things you get from X?" "Are there any downsides or negative
side effects from X?" "If you wanted to change your use do you
know where you'd go if you wanted a bit of support?"
4. Check to see if you've missed anything: "Is there anything I've
not asked about X you wanted to say?" "Were there any
questions you had for me about X?"
5. It's fine not to know the answers, be honest and let them
know how you're going to find out, and ask them how they'd
like you to update you e.g. clinic meeting, phone call, email,
etc.
What to do: Keywork
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Identifying “Contemplation” or “Action”
Setting Goals
Recognising Triggers
(Places, situations, people, emotional states, stress,
sexual arousal..)
List of Pro’s and Con’s
Managing Cravings
Recognise and anticipate triggers/associated situations
Acupuncture, breathing, meditation
Remove yourself from situation “Time Out”
Delay, Distract, Decide
What to do: Keywork
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Make a list
Saying “no” confidently/setting boundaries
Anticipating certain invitations/situations
Encouraging other interests
Communication skills.
Honesty/support from appropriate
friends/family
• Harm Reduction
• Referrals
• Listening is Support
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What to do: Signposting
To local borough drug services.
To minority group services eg; LGBT
To local sexual health, HIV, Hep services
Counselling, support groups, NA, AA etc
Domestic violence support/helplines
Legal advice
Mental health support
Youth support
Benefits/housing advice
Back to work support
Needle exchange/safer injecting advice
Questions & Reflections
[email protected]
www.clubdrugclinic.com