CLUB DRUGS Dr Alexander Margetts, Clinical Psychologist David Stuart, Antidote Manager clubdrugclinic.cnwl@nhs.net BAHSHE, York. 06/07/12 1

Talk Overview Why Club Drugs? New Users, New Drugs The Club Drug Clinic LGBT perspectives What to do? Q&A

Heroin and Crack Cocaine use decreasing Change in drug trends Heroin and Crack Cocaine use decreasing Alternatively, in 2010, 300,000 16-24yrs had tried Mephedrone....... 3

Drugs used by ‘clubbers’ Percentage (lifetime) Ecstasy 89.5 Cocaine 84.6 Ketamine 66.1 Benzodiazepines 42.0 Mephedrone 41.3 GHB 15.2 Crack 13.6 Heroin 6.7 Winstock et al. Addiction 2010, 106, 154-161 4

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, Kit-Kat, 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 11

The Team..... Club Drug Clinic Consultant Psychiatrist & 2 Training Drs Clinical Psychologist + 2 Assistants Clinical Nurse Specialist Sexual Health Worker Employment Specialist ANTIDOTE Drug Workers & Volunteers Research Assistant 12

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 13

Referral Process 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

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www.clubdrugclinic.com

Heterosexual Drug Use

LGBT Drug Use

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 24

Normalised Drug/Alcohol use on our Bar and Club Scene 25

From “Huggy” to Hardcore” 26

sex-on-premises venues, 72 hour clubbing, sex-on-premises venues, On-line hook-ups, Crystal sex parties… 27

24 HOUR SAUNAS… 28

The popularity of BareBacking 29

Shame re: sex, intimacy anxiety, internalised homophobia Sexual SHAME

3, 4 + day “benders” of speedy, unboundaried chaotic sexual marathons. 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. 31

MANY more people now injecting.. 32

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, using to aid sleep at bedtime, using for any stress or discomfort, 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 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 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

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 clubdrugclinic.cnwl@nhs.net www.clubdrugclinic.com