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

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

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

4. 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, 4

5. LGBT Drug use
UKDPC: Drugs and diversity 2010

6. New Users, New Drugs GBL/GHB Crystal Methamphetamine Ketamine
Mephedrone
Legal Highs

7. 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

8. 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

9. 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

10. 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.

11. Club Drug Clinic: ‘One Stop Shop’
Psychiatry
Psychology
Peer Support
Sex Health/HIV
Hepatology
Urology
A&E/ICU
Clinical, Research, Consultation 11

12. 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

13. 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

14. Referral Process Remove barriers to treatment ‘Sexual Health’ model
Any borough, any/no GP
Confidential & Non-Judgmental
Self – phone, (<30 secs!)
Staff and Clinicians – Referral form

15. QR Codes: 423 hits (& counting!)

20. Heterosexual Drug Use

21. LGBT Drug Use

22. 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

23. “Club Drugs” are Problematic Drugs

24. Our scene highly sexualised24

25. Normalised Drug/Alcohol use on our Bar and Club Scene25

26. From “Huggy” to Hardcore”26

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

28. 24 HOUR SAUNAS… 28

29. The popularity of BareBacking29

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

31. 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

32. MANY more people now injecting..32

33. 2 Distinct Issues
Toxicity/Overdose
Dependency/

34. 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.

35. 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

36. 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?"

37. 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, , etc.

38. 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

39. 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

40. 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

41. Questions & Reflections