Dr Alexander Margetts, Clinical Psychologist David Stuart, Antidote Manager

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

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 Alternatively, in 2010, 300,000 16-24yrs had tried Mephedrone.......

4. Drugs used by ‘clubbers’ Winstock et al. Addiction 2010, 106, 154-161

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

12. The Team.....

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

14. ReferralProcess • 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

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

16. www.clubdrugclinic.com

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 sexualised 24

25. Normalised Drug/Alcohol useon our Bar and Club Scene 25

26. From “Huggy” to Hardcore” 26

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

28. 24 HOUR SAUNAS… 28

29. The popularity of BareBacking 29

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

31. 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, leading to.. using to aid sleep at bedtime, leading to.. using for any stress or discomfort, leading to.. 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, email, 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. 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: Keywork

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