1. Substance Misuse in LGBT populations
Jamie Willis
Training & Outreach Manager
London Friend

2. 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

3. 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

4. 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

5. 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%

6. 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

7. 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

8. G deaths Data published by Imperial in December 2016
61 G-related deaths
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

9. Let’s talk technology

10. 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%)

11. 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

12. 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)

13. 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

14. 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

15. Contact details www.londonfriend.org.uk
@lgbtfriend