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

Referrals from GUM, A&E, statutory drug services 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 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) £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

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

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

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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 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 www.londonfriend.org.uk www.londonfriend.org.uk/antidote antidote@londonfriend.org.uk www.facebook.com/londonfriend Twitter: @JamieWillis71 @lgbtfriend 020 7833 1674