Transcript Club Drug Use in London

Substance Misuse in LGBT
populations
Jamie Willis
Training & Outreach Manager
Antidote @ London Friend
London Friend
• Small charity working to promote health &
well-being of lesbian, gay, bisexual and trans
(LGBT) people
• Identity, self esteem, mental health, sexual
health, well-being
• Drug and alcohol service – Antidote
• Almost exclusively club drug use
Antidote experience
• Established 2002 at Turning Point
• Moved to London Friend 2011
• Community support service – psychosocial
interventions, complementary therapies
• Mid – late 2000s increased crystal and G
• Medical pathways
• Club Drug Clinic and GUM satellites
• Chemcheck group
• SWAP - Structured Weekend Antidote
Programme
What is chemsex?
• Most significant recent issue in LGBT drug use
• Intentional use of drugs to help enhance
and/or facilitate sex
• Gay, bisexual, MSM
• Three main drugs: mephedrone, GHB/GBL,
crystal methamphetamine
Changing trends
Issue
2005 – 179 clients
2013/2014 – 758 clients
Alcohol
130 – 73%
79 – 11%
Cocaine
46 – 26%
86 – 11%
Ecstasy/MDMA
37 – 21%
9 – 1%
Ketamine
23 – 13%
44 – 6%
GHB/GBL
3 – 2%
334 – 46%
Crystal meth
0 – 0%
373 – 51%
Mephedrone
0 – 0%
461 – 64%
Heroin
5 – 3%
2 – >1%
Crack
14 – 8%
6 – 1%
Referrals from GUM, A&E,
statutory drug services
8%
63%
Chems
Mephedrone (Mcat, meow meow etc.)
• £15 to £20 per gram - Stimulant; a cathinone, similar to
amphetamine.
• Used for dancing, sex
• Increasingly responsible for psychotic presentations
Crystal Methamphetamine (Crystal, Tina, Ice)
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£60 -£80 per half gram - Powerful amphetamine, crystalline form (occasionally
powdered)
• Used widely by MSM in sexual contexts. (Low incidence of non MSM use in UK)
• Powerful high, compulsive behaviour, increased libido, users awake for days
• Increasingly responsible for psychotic presentations/sexual
health consequences
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GBL (GHB) Class C
Gammabutyrolactone/Gammahydroxybutyrate
• “G”, “Gina”
• A solvent, used industrially
• Liquid (ingested orally)
• 2 principal dangers; toxicity (overdose) and
physical dependence
• 30ml bottle = (approx) £15
• Sedative (though with stimulant-like effects)
• Euphoria; used to dance, sleep; for sex,
confidence, as an anti-depressant
• Used mostly by LGB communities
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G deaths
Data published by Imperial in December 2016
• 61 G-related deaths 2011-15
• Notable increase in 2015 (29 deaths, 119%
rise on 2014)
• All but one male, age range 22 – 67
• Other chemsex drugs detected in 65% of cases
• 33% of sample known to be HIV+
• Rise “at least in part” associated to chemsex
Let’s talk technology
Chemsex data
The Gay Men’s Sex Survey 2014 has some of the
most up to date published data:
• Lifetime use of: crystal (8.3%); GHB/GBL
(12.5%); mephedrone (16.5%)
• Injecting: ever (2.9%); ever in London (3.33%);
HIV+ (11.3%); HIV+ in London (14.4%)
• In past year those who injected: crystal
(59.9%); mephedrone (60.65); GHB/GBL
(1.8%)
Recent trends in MSM
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55% injecting history
Prefer to use ‘bareback’ sites to find sex
39 % HIV positive
46% with HIV attribute diagnosis to drugs
40% non-adherence to ARVs whilst ‘high’
91% of HIV negative men accessing PEP said
that that this was following a chemsex session
Recent trends in HIV + MSM
• 1 in 3 HIV + MSM reported chemsex in the last year which
was associated with risky sexual behaviour & STI diagnosis
• Chemsex, associated with increased odds of sexual
behaviour with a risk of onwards HIV transmission (i.e.
sdUAI with a detectable VL)
• Chemsex associated with greatly increased odds of
hepatitis C infection
(“Chemsex” and High-Risk Sexual Behaviours in HIV + MSM” Pufall et al, Imperial
College London, PHE, UCL)
Who seeks Support ?
• Typically different profile to traditional drug
services
• Higher functioning
• Less likely to have criminal record
• Respond well to interventions & treatment
• Triggers include arrest & negative experience
whilst using
Psychosocial Intervention
• Intervention vs Treatment/Support – needs greater
differentiation
• Assertive Community & Healthcare Based Interventions Only 12% of Antidote clients would feel comfortable
accessing ‘mainstream’ treatment
• Motivational Interviewing, CBT, relapse prevention - But
with cultural adaptations: e.g. relapse prevention through
management of online sexual-social profiles
• Tackle sexual health and drug use together
Contact details
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www.londonfriend.org.uk
www.londonfriend.org.uk/antidote
[email protected]
www.facebook.com/londonfriend
Twitter: @JamieWillis71 @lgbtfriend
020 7833 1674