The document discusses the phenomenon of "chemsex" among gay, bisexual, and other men who have sex with men (MSM) in the UK. Chemsex refers to using drugs like mephedrone, GHB/GBL, and crystal methamphetamine in order to enhance sexual experiences. It has become a significant issue, leading to increased risk-taking, addiction, and rising STI/HIV transmission. The document outlines the drugs commonly used, trends observed in MSM communities and support services, and recent responses from health organizations to address chemsex and promote harm reduction.

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