6. Most commonly reported age for first taking
cannabis was 16 year
For cocaine and ecstasy 18 years
Statistics on Drug Misuse England, 2014
7. The gender gap in illicit substance use continues to
shrink among adolescents
ESPAD-STUDIES/EMCDDA, 2005
8. FEMALES AT GREATER RISK FOR ADDICTION?
No gender difference for intoxications
Transition period from initiation to problem use is
shorter
Ridenour et al, 2006
11. 1 out of 20 people between the ages of 15 and 64
years, used an illicit drug in 2013
(range: 3.4-7.0 %)
Illicit drug use remained stable in the past three
years
12. 1 out of 10 is a problem drug user
1 out of 3 drug users is a woman
only 1 out of 5 drug users in treatment is a woman
13. men: x 3 cannabis, cocaine and amphetamines
women: misuse prescription opioids and tranquillizers
14. Almost 1 in 4 Europeans have tried illicit drugs
Cannabis is the drug most frequently reported as
the principal reason for entering drug treatment by
first-time clients in Europe
EMCDDA, 2015
15. Nightlife is a well defined context where drug use, sex and
socialisation coincide
Hughes, Bellis, Whelan, Calafat, Juan and Blay, 2009; Vidal-
Infer et al, 2009.
16. RECREATIONAL NIGHTLIFE NETWORKS
Males: friends abusing alcohol, using drugs,
antisocial behavior; less affecting own use pattern
Females: when having a sexual relationship more
possibilities of using alcohol and drugs
IREFREA research (Calafat et al, 2010);
Kirke 2004;
Wang et al,1997.
17. UNSAFE AND INVOLUNTARY SEX
Only 21 of 1014 cases (2 %) of alleged drug-facilitated
sexual assault were attributed to involuntary drug ingestion
No flunitrazepam or GHB
3 cases ecstasy
Comprehensive UK Study; Scott-Ham and Burton, 2005
18. “Most people who do recreational drugs also
have sex.”
19. CLUB DRUGS
MDMA, methamphetamine, ketamine, GHB, LSD,
Flunitrazepam
Increasingly common
Under diagnosed
Few health professionals feel comfortable with !
Guerreiro et al, 2011
20. CLUB DRUGS
NPS (Novel Psychoactive Substances) are likely to
be added to drug repertoires
Moore et al, 2013
21. WHICH DRUGS ARE PREFERRED FOR SEX IN
NIGHTLIFE RECREATIONAL SETTINGS?
“These young people have a very precise idea of how
each drug functions within sexuality !”
Alcohol is by far the most popular to initiate sexual
encounter, for more unusual or the "hottest" experiences,
to increase arousal…
Women more than man…
Cocaine the preferred to prolong sex
Ecstasy more for remaining active and enjoying oneself
than for its sexual effects
Calafat et al, 2008
22. IS IT REALLY CRYSTAL CLEAR THAT USING
METHAMPHETAMINE(OR OTHER RECREATIONAL
DRUGS)
CAUSES PEOPLE TO ENGAGE IN UNSAFE SEX?
consistent evidence users are a high-risk group in
terms of sexual behavior
caveat: creating an excuse for engaging in unsafe
sex, thereby increasing its use
Digiusto & Rawstorne, 2013
23. ALMOST 80 PERCENT OF SWINGERS REPORTED
RECREATIONAL DRUG USE, ASSOCIATED WITH RISKY
SEXUAL BEHAVIOR
Nearly half use multiple drugs at once, MDMA (XTC),
laughing gas, marijuana, poppers, meth, cocaine, and LSD
average age was 49
Cross-sectional study in The Netherlands,
Spauwen et al, BMJ 2014
24. Gay or bisexual men: 33.0 % illicit drugs in the last
year
Gay or bisexual women: 22.9 %
Heterosexuals: 11.1 %
Statistics on Drug Misuse England, 2014
25. CANNABIS
>4000 years
Sativa/Indica
THC(active ingredient)
CB1- receptors:
Highest concentrations in the hippocampus, basal ganglia, cerebellum
Lowest in cortex
Not in brainstem
Affects:
Monoamine (reward centers?)
GABA
Endorphins
Smoked onset within minutes, peak in 30 minutes, last 2 to 4 hours
Euphoria, heightens sensitivities, slowed time
Tolerance does develop
Psychological dependence; no strong evidence physiological
Limited withdrawal symptoms (nausea, irritability, restlessness, insomnia,
anorexia)
26. CANNABIS
Sexual performance
Enhances sexual enjoyment in both men and women (83%
and 81% respectively)
Does not affect erection, lubrication, or orgasm
Increases relaxation, sociability, touch, and comfort
High doses = sedation and impaired sexual performance
In animals, decreases sexual activity – general decrease in
physical activity
27. CANNABIS
A.E.
Mild tachycardia, dry mouth, red eye,
orthostatic hypotension, increased appetite
Impairs attention, reaction time, perception,
memory, judgment / consciousness and motor coordination
(8 to 12 hours), social withdrawal
Transient paranoid ideation, anxiety states, hyper/hypomania,
(depressive symptoms), sleep disorders, sexual dysfunction
Bad trips and flashbacks (PCP)
Long term use
CRD/CA
Psychotic disorder
Amotivational Syndrome
Uncertain: cerebral atrophy, seizure susceptibility, impaired
immune reactivity, chromosomal damage, lowers
testosterone, dysregulation menstrual cycle
28. AMPETHAMINES
Methamphetamine, Dextroamphetamine, Methylphenidate…
“Speed”, “Ice”, “Crystal meth”
Enhanced release and block reuptake of Norepinephrine,
and at higher doses Dopamine (reward circuit: VTE, cerebral cortex, limbic
area)
Less addictive than cocaine, virtually same picture
Orally onset within 1 hour; IV/snorting immediate
Sense of well-being: elation, euphoria, friendliness
Decrease in fatigue, heightening pain threshold
Sharpening of focus, increased performance attention
Tolerance develops
Withdrawal: “crash” ( anxiety, tremulousness, dysphoric mood, fatigue /
lethargy, nightmares, headaches, sweating, muscle cramps, stomach
cramps, hunger) peaks in 2 to 4 days, resolved in 1 week
Caveat: severe depression, suicidal ideation
29. AMPETHAMINES
Sexual Performance
Increased libido (increased energy)
Erectile failure / vasoconstriction genital tissue; prolonged
erection (up to 18 hours!)
Anorgasmia; multiple orgasms
Long term use: loss of interest in sex
30. AMPETHAMINES
A.E.:
Flushing, pallor, cyanosis, pupillary dilatation, headache,
tachy-/brachycardia, hyper/hypotension, palpitations,
shortness of breath, chills/perspiration, psychomotor
agitation/retardation, tremor, bruxism, dystonia, ataxia,
nausea, vomiting
Stereotyped behaviors , impaired judgment, affective
blunting, irritability, interpersonal sensitivity, paranoid
delusions, (visual) hallucinations, anxiety states (panic and
phobic disorders, OCD), manic or mixed mood, hostility,
anger, confusion, delirium
CVA, MI, ischemic colitis, tetany, seizures, coma
Long term use:
Loss of interest in sex, weight loss
Impact on social and occupational functioning
31. COCAINE
Alkaloid 1860
Local anesthetic 1880
Inhibits reuptake of Dopamine (D1,D2,D3?),
Norepinephrine, Serotonin
Immediate effect, lasting for 30-60 minutes
(snorting, tooting, freebasing, IV, SC)
Tolerance or sensitivity due to many factors
Wellbeing, euphoria
Decrease in fatigue, less need for sleep
Alertness, improved performance
Decreased hunger
32. COCAINE
Powerful addictive, psychological
dependence after one single use
Environmental cues associated with rush
reawakens craving
Physiological dependence mild
Withdrawal: “crash” (depression, dysphoria, anhedonia,
anxiety, irritability, fatigue, hypersomnolence, sometimes
agitation) ends within 18 hours, peaks in 2 to 4 days when
dependence, sometimes weeks and months, suicidal ideation
Caveat: self-medication! (alcohol, sedatives, BZD)
33. COCAINE
Sexual performance
Increased sexual desire
Arousal:
Men:
Low doses – prolonged erection, delayed orgasm
High doses – erectile failure (potent vasoconstrictor)
Women:
Reports of both increased and decreased subjective arousal
Delayed or absent orgasm
34. COCAINE
A.E.:
Paranoid and auditory hallucinations, (formication),
inappropriate sexual and bizarre behaviour, violent or
homicidal actions
CVA (nonhemorrhagic and hemorrhagic), TIA; seizures
usually single events, status possible (partial complex
status)!
36. MDMA
Sexual performance
Subjective ratings:
Desire: moderately to profoundly increased
Erection: impaired in 40%
Orgasm: delayed but more intense
Satisfaction: moderately to profoundly increased
Laboratory studies?
37. MDMA
A.E.
Tachycardia, palpitation, increased blood pressure,
sweating, hyperthermia, bruxism
Difficulty concentrating, anxiety, dysphoric reactions,
agitation, psychosis
Long term use
toxicity to serotonin system (MDA)
38. GHB-LIQUID ECSTASY/ GBL
1874/1961 GABA-like anesthetic,
analgesic
Onset after 15 to 30 minutes, lasting
for 3 to 4 hours
Narrow therapeutic dosage range
In low dosage: euphoria, desinhibition,
relaxed, empathogenic state,
enhanced libido
To speed up recovery after using
speed, ecstasy
Withdrawal: insomnia, anxiety,
depression, tremor, muscle aches; can
be severe, seizures, psychosis,
delirium
Usually resolving within 3 to 21 days
39. GHB-LIQUID ECSTASY/ GBL
A.E.
Impairs spatial memory, working
memory, learning
Neurotoxicity? more in lower
doses in hippocampus, prefrontal
cortex
Caveat: combination with
alcohol and other depressants
42. PHENCYCLIDINE (-LIKE)
PCP, Angel Dust (1926/1963): commonly as additive (powder, liquid, blotter)
Ketamine, Special K (1962) (powder/solution: intranasal, oral, sublingual, rectal,
inhalation, IM, IV)
NMDA-antagonist (Glutamaat-receptor), reuptake inhibitor Dopamine, Serotonin,
Norepinephrine
Smoked onset PCP within 5 minutes, plateau in 30 minutes, lasts 3 to 6 hours; half-life
20 hours
Onset K within seconds (IV); analgesia lasting 40 minutes, dissociative effects for hours,
K-hole; half-life 2 hours
Hyperacusis, speedy feelings, euphoria, warmth, tingling, floating, isolation, distortion
space and time perception, active fantasy
Sympathetic, sociable, talkative; negative and hostile at an other moment
Narrow window!
Tolerance occurs
Physical dependence rare
Psychological dependence common !!!
Withdrawal symptoms rare
43. PHENCYCLIDINE (-LIKE)
Sexual functioning
Purported to be “ultimate sex drug.”
Sexual pleasure enhanced (all pleasure enhanced; e.g.
watching paint dry is equally pleasurable)
Sexual performance
Premature ejaculation
Moderate to high doses precludes any sexual activity
44. PHENCYCLIDINE (-LIKE)
A.E.
Belligerence, assaultiveness, unpredictability, psychomotor agitation,
impaired judgment, little concern for environment (stripping, public
masturbation, urinary incontinence, violence) manic-like, anxiety,
crying, inappropriate laughing; can last for several days
Cardiovascular status should be monitored, nystagmus, dysarthria,
dystonic reactions, repetitive chanting, vomiting (R/Cannabis),
hallucinations, flashbacks, delirium, seizures, coma
Long term use
Dulled thinking, impaired concentration, loss of memory, loss of
impulse control, depression, lethargy, “crystallized”
Ketamine bladder
PCP neurotoxic (motor, cognitive impairment)
48. SEXTASY
Combining Viagra with ecstasy, “hammerheading”
Headache, prolonged erection (priapism)
High risk sexual behavior
Long-term heart damage
Viagra with
Crystal methamphetamine
Amyl nitrate
Any drug that produces erectile dysfunction
Viagra and illegal recreational drugs (40%)
49. CHEMSEX IS NOT THE SAME AS
RECREATIONAL DRUG USE (SEXTASY)
Involves using meth, meph and G in any
combination, to facilitate or enhance sex, with or
without other drugs
Methamphetamine (crystal/crystal meth/Tina/meth)
Mephedrone (meph/drone)
GHB/GBL (G, Gina)
50. MORE EXTREME BEHAVIOR AND RISK!
Extended sex for many hours, several days. It is common to
not sleep.
Sometimes just two people for an extended period, or multiple
partners, multiple times, new people might join and leave a
party.
Extreme sexual disinhibition, to do things they don’t usually
do; safe sex less or not important.
Extreme sexual focus.
Side effects include overdose (fatal), paranoia, psychosis and
black-outs.
Not being able to consent to sex.
Drug interactions can be serious and difficult to predict (i.e.
between alcohol and GBL/GHB).
Serious short and long term impact: chronic depression,
anxiety, weight-loss, paranoia, psychosis.
Loss of lifestyle stability in terms of employment, debt,
housing, partnerships and friendships.
53. DRUG DETECTION
Alcohol 5 tot 24 uur
Tabak Tot 2 dagen
Cannabis Tot 5 dagen bij incidenteel gebruik, tot een maand bij frequent gebruik
Cocaïne / coke 2 tot 4 dagen bij incidenteel gebruik, tot 8 dagen bij intensief gebruik
XTC 1 tot 3 dagen
Amfetaminen 2 tot 4 dagen
4-fluoramfetamine 2 tot 4 dagen
Paddo’s 1 tot 2 dagen
GHB Tot 12 uur
Ephedra Tot 3 dagen
LSD Tot 2 dagen
Heroïne 2 tot 5 dagen
Morfine 2 tot 3 dagen
Opium 2 tot 3 dagen
Methadon 2 tot 5 dagen
Benzodiazepine 3 dagen bij therapeutisch gebruik, bij chronisch gebruik 4 tot 6 weken
Mescaline Tot 72 uur
DMT Tot 72 uur
PCP 2 tot 3 dagen
Kat / qat Tot 3 dagen
Lachgas Niet aantoonbaar
Ketamine 48 uur
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