Monty Moncrieff - European ChemSex Forum 2016, London Training session

1. The Chemsex
‘Phenomenon’
European Chemsex Forum, April 2016
Monty Moncrieff
Chief Executive, London Friend
@lgbtfriend @montymoncrieff

2. Who are we?
• London Friend – since 1972
• LGBT health & well-being
• Coming out, social groups, activity groups
• Mental health – counselling
• Sexual health & HIV Prevention
• Antidote – drugs & alcohol service
• One of first services in UK to identify trend we
now know as ‘chemsex’

3. Overview
• What is chemsex?
• LGBT drug use
• The London experience
• The UK response

4. The Chemsex Phenomenon

5. What is chemsex?
• Most significant recent issue in LGBT drug use
• Having sex whilst using drugs
• Gay, bisexual, MSM
• Specific intention to meet to use and have sex
• Three main drugs: mephedrone, GHB/GBL,
crystal methamphetamine

6. Why is it a concern?
• Marked change in drugs used
• Changing context and methods of use
• Increasing presentations to services (GUM,
drug treatment)
• Backdrop of rising HIV diagnoses & infections

7. Drug use by LGBT people
Illicit drug use in past year amongst adults by sexual orientation,
Crime Survey for England & Wales 2014

8. Drug use by LGB people
Illicit drug use in past year amongst adults, Crime Survey for England & Wales 2014

9. Drug use by LGB people
Illicit drug use in past year amongst adults by drug type & gender,
Crime Survey for England & Wales 2014

10. Drug use by LGBT people
• Part Of The Picture research by LGBT Foundation - up to seven
times more likely to be using drugs (LGB)
• UK Drug Policy Commission review 2010
• All reports consistently higher levels
• Evidence of “early adoption” e.g. ‘legal highs’
• Increased sexual risk behavior particularly associated with
some drugs
• Uptake of services low and perceived not to meet needs

11. The drugs
• New UK guidance for
drug management
• Comprehensive
information on NPS
• www.neptune-clinical-
guidance.co.uk
• New LGBT/MSM
supplement

12. The drugs: mephedrone

13. The drugs: mephedrone
• White powder
• Former ‘legal high’
• Stimulant
• Energised
• Snorted, ingested or
injected
• Clubbing, sex
• Moreish
• Difficult comedown
(edgy, paranoid)
• Mental health impact
• Impact of wakefulness

14. The drugs: GHB/GBL

15. The drugs: GHB/GBL
• Powder, but comes
dissolved as a liquid
• Ingested
• Depressant but at the
right dose gives
euphoric effect
• 1ml dose
• Clubbing, sex
• VERY dose specific
• Can ‘go under’ –
comatose
• Fatal at higher dose
• Dependence forming
(physical)
• Don’t take larger dose
to aid sleep or ‘take the
edge off’ a comedown

16. The drugs: crystal meth

17. The drugs: crystal meth
• Extremely strong
stimulant
• Crystalline powder or
crystals
• Snorted, smoked,
injected
• Compulsive, repetitive
actions
• Mainly sex
• Prolonged high
• Mental health impacts
• Difficult comedown
(edgy, paranoid)
• Impact of wakefulness

18. Leading up to chemsex today
• Early 2000s – concern about crystal meth
• Lots of media stories, little evidence
• Headline: “1 in 5 gay men using deadly drug”
• Research: 19.5% men in gay gyms had tried it;
most used infrequently; high drug-using
sample; no evidence of increase 2003-05

19. Leading up to chemsex today
• GHB made illegal in UK 2003
• Evidence of switch to GBL
• Stronger, longer lasting – role in dependence?
• Club scene: passing out, emergency
responses, death

20. Club response to G
• Orange Nation group of
clubs launched
campaign 2004
• Many other venues
joined
• Focused only on G, not
other drugs

21. Presentations to services
Antidote:
• Occasional G in mid 2000s
• Crystal meth 2006/7
• Crystal users tended to have lived outside UK
• One of several drugs, not the focus at first
• Mephedrone from 2008
• G dependence from 2008/9
• Sexual link
Other services
• Sexual health, GUM clinics

22. Initial Response
• Methamphetamine training (Antidote, COCA)
• Methamphetamine Watch (COCA)
• Senior-level Police Working Group (ACPO)
• G researcher: South London & Maudesley NHS
Hospital (G detoxes)
• Government (Home Office Drugs Diversity
Group, Drugs Strategy Team, other depts.)
• UK Drugs Policy Commission review 2010

23. Recent trends – Antidote clients
Issue 2005/6 – 179 clients 2013/14 – 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%

24. Perspective
• Only a subset of gay, bi and MSM
• Not all MSM using drugs are engaged in chemsex
• Not all engaged in chemsex will experience
problems
• Users can perceive it to be more widespread
• Disproportionate amount of harm relating to the
chemsex drugs
• Not sufficient evidence on new trends in LB
women or trans people
• Don’t overlook the role of alcohol

25. Why is it suddenly prominent?
• Combination of factors
• Change in drug availability & use
• New technologies to meet and filter for sexual
partners
• Changes to LGBT social scene & community
• Increasing sexualisation of scene (& society?)

26. What we’re seeing
• Sexualised using, multiple partners
• Meeting & trading drugs through apps
• Private sex parties, sex on premises venues
• High level of current sexual risk
• ‘Slamming’ - Injecting (crystal meth &
mephedrone)
• Association with being HIV+
• Association with HIV transmission & other STIs

27. What role does chemsex play?
• Disinhibitor
• Anxiety about sex and sexual identity
• Identity and belonging
• ‘Ritual’, sometimes associated with slamming
• Intimacy
• Sexual experimentation
• Some subsequent regret
• Problematic use association with poor self
esteem

28. The rise of geo-social apps

29. Chems online

30. How things have changed
• Different drugs being used with different routes
of administration
• Context of using has become mainly sexualised
amongst men
• Different harms – injecting, dependence (G),
mental health (psychosis)
• Interventions need to include substance use,
sexual behaviour & HIV prevention
• Interventions delivered in different settings –
GUM clinics (motivational, preventative)

31. Recent UK responses
• Antidote partnership with NHS Club Drug
Clinic – ‘centre of expertise’ approach
• Drug interventions in GUM clinics: Antidote
sessions in 56 Dean Street, Mortimer Market –
other GUMs developing approach
• Early intervention: preventative, motivational
• Training: drug treatment & sexual health

32. Recent UK Responses
• Out Of Your Mind report
• Chemsex Study
• Project NEPTUNE clinical guidance
• Public Health England (PHE) working groups &
briefings
• NPS Advisory Groups to Government & PHE
• Training development for Public Health Wales
• Police training

33. Recent UK responses
• Media hot topic
• Chemsex documentary
• Medical journal articles: Lancet, BMJ
• Radio, TV and print-media features
• Community responses including activism
• London Sexual Health Transformation Project

34. Resources – LGBT drug use

35. London Friend report
• Appraisal of provision
• Practical toolkits – LGBT
audits and guidance
• Recommendations for
Public Health England,
local commissioners,
providers, front-line
staff
• www.londonfriend.org.
uk/outofyourmind

36. Resources
• London Friend: http://londonfriend.org.uk/
• Antidote: http://londonfriend.org.uk/antidote
• Out Of Your Mind report: http://londonfriend.org.uk/outofyourmind/
• Antidote/Orange Nation G-Aware campaign: http://londonfriend.org.uk/get-support/g-aware/
• London Friend CEO Blog : http://londonfriend.org.uk/montys-thoughts/
• Chemsex Study: www.sigmaresearch.org.uk/chemsex
• Public Health England Chemsex Briefing: http://www.nta.nhs.uk/uploads/phe-substance-misuse-services-for-msm-involved-
in-chemsex.pdf
• Project NEPTUNE Clinical Guidance: http://neptune-clinical-guidance.co.uk/
• Project NEPTUNE LGBT Club Drugs supplement: http://neptune-clinical-guidance.co.uk/wp-
content/uploads/2016/02/neptune-club-drug-use-among-lgbt-people.pdf
• NTA Club Drug Report: http://www.nta.nhs.uk/uploads/clubdrugsreport2012[0].pdf
• UK Drug Policy Commission Report: http://www.ukdpc.org.uk/publication/the-impact-drugs-different-minority-groups-lgbt-
groups/
• UK Drug Policy Commission Policy Briefing: http://www.ukdpc.org.uk/publication/drugs-diversity-lgbt-groups-policy-
briefing/
• LGBT Foundation Part of the Picture: http://www.lgbt.foundation/potp
• Lancet article of crystal meth rise in London (Jan 2013): http://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(13)60032-X/fulltext
• CNWL Club Drug Clinic: http://clubdrugclinic.cnwl.nhs.uk/
• LDAN News Nov/Dec 2012 (Club Drugs & Antidote articles): http://www.ldan.org.uk/PDFs/LDANNewsDec12.pdf
• Public Health Outcomes Framework LGBT Companion: http://www.lgbt.foundation/phof

37. Contact details
• www.londonfriend.org.uk
• www.londonfriend.org.uk/antidote
• antidote@londonfriend.org.uk (monty@ )
• www.facebook.com/londonfriend
• Twitter: @lgbtfriend @montymoncrieff
• 020 7833 1674