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Why we take drugs

The short answer is because they’re fun and because we can. They give pleasure, make us feel less inhibited, make us feel horny and more intimate sexually, and intensify feelings of friendship and togetherness when socialising.

They take us out of ourselves and away from our everyday lives, for a while at least. They take us up and down, sideways, and through the middle. If this wasn’t the case millions of people wouldn’t take them, so there’s absolutely no point saying they don’t do something when they do.

However, these are not the only reasons. Scratch the surface and there’s experimentation, unhappiness, rebellion, relaxation, escape, fitting in, loneliness, peer pressure, boredom, and the ease of availability of drugs, particularly in London.

And we’re not just talking about chemsex. Who hasn’t had a drink or two before plucking up the courage to go a chat with a guy or meet him on a date for the first time? Alcohol remains the social lubricant for many, particularly on the gay scene.

The variables

If you use drugs, you’ll probably say that you know your limits and can handle them. Some people can… maybe you can… but whether you know what you’re doing or not, you often increase the risk of HIV/ STI transmission, accidents and other injuries. If you are feeling ill, tired, worried or depressed, are on your own or have something important to do in the near future (like go to work) their effects may not be what you want, or expect. Whilst they may make you feel better in the short-term they may also make you feel worse. The effects of any drug can depend on a number of factors:

• The drug itself
• How much you take
• Where you do it
• Who you do it with
• What you think the drug will do
• What you’ve mixed your drugs with
• How you’re feeling at the time
• What you’ve eaten that day
• Any other drugs you’ve taken (prescription or not)

The illusion

Much as we would like to think otherwise, recreational drug use, party drugs or chemsex don’t create energy, they allow us to borrow it from tomorrow’s supply. And then, when tomorrow comes, it’s payback time. The key is to minimise the impact of the ‘weekend cocktail’ on the week.

Try and avoid doing any drugs in the week, particularly if you’re working. A weekend without much sleep, few meals, hours of endless dancing and drugs won’t be good for the immune system. Hardly surprising that, come Monday morning, we’re feeling a bit trashed/ completely fucked/ disco damaged (delete as applicable).

After the highs of Friday night/ Monday morning, there’s nothing like a heavy dose of reality, and the misery this entails, to bring on the midweek blues. It’s therefore key that if and when we take drugs on the weekend we do what we can to reduce their harms and ensure the impact doesn’t carry over.

The harms

Recreational drug use has the potential to damage your mental and physical health and sense of well-being, sometimes permanently by which time you may have lost your job, credit, your home, family, friends, boyfriends, and partners.

Granted, factors include which drugs you’ve taken, in what dose, and for how long (a one-off or sustained use), but it’s quite the smörgåsbord:

• Hard-ons can be a non-starter and we become sexually incapable
• Paranoia, psychosis, depression, anxiety and/ or flashbacks
• Increased risk of developing schizophrenia
• The inability to concentrate, and memory loss
• Sleep problems and insomnia, a loss of energy and/ or weight loss
• Bringing up the rear: collapse, unconsciousness and death.

The connection between drug use and our mental health is substantial. In fact, the writing has been on the wall for some time. When we’re young and spunky and invincible these sorts of issues matter little, but those feelings of kinship are as loyal as the last G dose!

Guys lose their homes and their jobs. They no longer meet life insurance criteria and their ability to travel aboard and/ or get visas is adversely affected. Also, It may be harder to get a new job and, in some cases, a criminal record may exclude you from applying altogether.

For seasoned drug users reading this it may not be tomorrow… or next week… or next month… or next year… but a crash, an overdose, a burn, a crisis, a breakdown, a day of reckoning usually comes with all the inherent mess that comes with it.

Reducing drug harm and risk

The basics

• Use recreational drugs consciously not casually
• Check out and learn about individual drugs at DRUGS A-Z | MEN R US
• Be aware of your vulnerability to dependency and addiction
• The more you like it the longer you should wait to do it again
• Regularly test your ability to stop using by taking a break for a week or two, or a month
• Keep an eye on developing patterns and ask for help before there’s a problem, even if it’s just a chat with friend

Basic harm reduction | Release

Legal

• Most recreational drugs are illegal and often carry heavy penalties for possession, using, and selling or buying. So, don’t share or deal openly, or get twatted in public.

Drugs and the law | Release

Mixing and tolerance

• Using drugs involves risks and taking more or mixing drugs increases the risks. Don’t take more drugs than you need – give them about an hour before taking more.
• Mixing drugs (particularly with alcohol) may make the effects of other drugs seem different or weak, which could lead to you taking too much, and some drug combinations are deadly.
• We quickly develop tolerance to party drugs and our bodies will appreciate the chance of a break to recover. You’ll get more out of your drugs if you don’t take them every week.

Safer injecting

• Use your own injecting kit and do not share needles, syringes.

Safer injecting | MEN R U S

Calling 999

• Wherever you are, if someone gets ill and you have to call an ambulance, don’t mess about. Be sure to tell the medics what’s been going on. Don’t be afraid, it could save a life – maybe yours!

Medications

• If you’re taking a prescribed medicine, it’s only sensible that your drugs don’t mess that up. It’s important not to miss or change doses set by your doctor, particularly with HIV and Hepatitis C medication. You may also find it helpful to use the HIV drug interaction checker, a rather cool tool from the University of Liverpool.

HIV Drug Interaction Checker | University of Liverpool

Be prepared: clubbing, partying and chillouts

• There is no shame in taking a ‘disco-nap’ before going out
• Eat something: something high in carbohydrates for energy (eg: pasta) and vitamin-packed (such as fresh fruit and veg) will help prepare your body
• Wear lightweight (non-nylon) clothes, don’t wear hats or caps and, if you can, take warmer clothing/ change of clothes with you for when you leave
• Clubs can get very crowded and extremely hot. This can cause you problems like dehydration, serious over-heating, and heat exhaustion – all of which are dangerous. Sweating is how bodies keep cool and stop hypothermia, so drink non-alcoholic sugary drinks to replace lost fluids
• Take regular chill-out breaks to help avoid over-heating and dehydration
• Sip about a pint of water per hour (but don’t go mad)
• Try to avoid alcohol which will only dehydrate you more and NEVER mix G with alcohol
• When you’re ready for sleep, drink something sugary and eat something salty. However much you don’t feel like it, eating really helps to start replacing all those lost salts and minerals

• It’s all very well going to someone’s place, particularly if you’ve not been there before, but do you know the way out?
• Be aware that drinks could be spiked
• Be prepared to take a taxi home (or back to civilisation) and that includes having a card that works or cash in your pocket. It may sound a little old-fashioned but the consensus at MEN R US is a £20 note tucked in the back of a wallet
• While we’re talking old fashioned … it can still be a good idea to tell a mate where you’re going just in case things go wrong

Sex and drugs

• Drugs and alcohol have a pain-killing effect so you may not be aware of damage being done to your body, particularly your cock and arse
• Dehydration and raised temperature makes delicate skin more likely to tear and bleed. Snorting or dabbing speed or coke, and chewing gum all night, can cause ulcers and bleeding in your mouth, which may increase the risks of infection
• Drugs and alcohol can alter your perception of risk and can make you less able to get the sex you want. When you’re mashed up it can be difficult to be assertive, to say no, or to insist on condoms

Talking drugs

Talking Drugs is one of the few online platforms dedicated to providing unique news and analysis on drug policy, harm reduction and related issues around the world. It delivers geographically diverse coverage of the important issues, with a level of topic expertise often lacking in the mainstream media.

Talking Drugs gives people the opportunity to become engaged in the debate and encourages those who wish to contribute to get in touch with about either volunteering or submitting a piece of work for publication. In particular, Talking Drugs is keen for people to tell their stories of how drugs and/ or policies have affected their lives or their communities.

The law

Drugs and the law is a complicated subject and if you find yourself in trouble you should get legal advice at the earliest opportunity. If the police have reason to suspect that you’re carrying an illegal drug they have the right to search you and make you empty your pockets.

They can also take you to the police station and search you there. If drugs are found you could be charged with one of two offences: possession which means being caught with an illegal drug for your own use, and possession with intent to supply drugs which means if you had any intention to deal (sell), give away or share drugs.

Y-Stop

Y-Stop aims to give you the tools to interact with the police safely, equipping you with all the skills and knowledge you need to handle a stop and search.

Instead of giving you too much information about the law and the police, it focuses on really practical information and tips to help you manage what is often a confusing and stressful encounter, ending it as quickly, confidently and smoothly as possible. We call this a harm reduction approach.

Legal Aide App

Thousands of people are prosecuted for simple drug possession every year in the UK – with no legal aid available. Furthermore, at MEN R US, it’s our experience that gay men’s understanding of drugs law, arrest, cautions and the criminal justice system is poor. There’s a wealth of anecdotal evidence to say that when things go wrong we don’t know who to call or what to do.

The new Legal Aide app from Release aims to help people navigate the criminal justice system. The app has been launched to help people who have been arrested for the personal possession of controlled drugs. The app was created by lawyers at Release, the UK’s centre of expertise on drugs and drug laws.

For those without a smartphone, guidance is available in a downloadable PDF.

 
Arrest, legal advice, and your options in a police interview | Release | Apr 2018 | 3m 51s
Getting a caution, or being charged, for a class B or C drugs that aren’t cannabis/ khat | Apr 2018 | 2m 22s
Getting a cannabis/ khat warning, or penalty notice for disorder | Release | Apr 2018 | 2m 57s
Going to court, representing yourself, and sentencing | Release | Apr 2018 | 4m 25s
Criminal records, and their effect on jobs and travel | Release | Apr 2018 | 3m 3s

Release

Release provide a free, confidential, non-judgemental national information and advice service in relation to drugs and drug laws. Its drugs and legal teams are highly knowledgeable lawyers and drug professionals, and are on-hand to help and advise you and respond to queries. Release don’t use guides or frequently asked questions as each query will depend upon a unique set of facts and circumstances, so don’t be embarrassed to ask a question.

If you are unsure whether you have a drugs or legal inquiry don’t worry – their teams work in collaboration, so you can be assured you will receive a response to your query.

Read me first

In this section you will find:

• support services in London
• chemsex support outside London
• drug service directories

Updated regularly, we believe it to be the most comprehensive listings of its kind but email us here if you know of a service we should add, or if we’ve got something wrong. 

Your GP

While your GP may not have specialist knowledge about recreational drug use (or chemsex) they should be able to point you to a service that does. Furthermore, they may be able to refer you directly, and can usually connect you to other support should you need it.

It’s a good place to start if you feel you can have a conversation with them.

Finding the right service

Some guys prefer to use gay or gay-friendly services which (as a rule) have a much better understanding of the issues affecting our lives, and the context. Others are happy to access mainstream services.

Most services aim to be welcoming, respectful, knowledgeable, and understanding. The thing is to find a service that’s right for you (as best it can) and “gets the job done.”

You might want to phone first to check if the vibe feels right. Some of these questions may be more important than others, or you may have some of your own:

• Do you have an alcohol, drugs, or chemsex service for gay/ bi men?
• Do your workers have knowledge of health issues specific to gay/ bi men?
• Are there service times for gay/ bi men?
• Is your service LGBT+ friendly?

• And why not check out the service’s website?

Coding services and lifebuoy icons

We have coded services as best we can:

A = Alcohol
D = Drugs
C = Chemsex

Services with a lifebuoy icon are:

• LGBT+ specific or LGBT+ friendly
• an established service serving the LGBT+ community
• known to/ visited by the Gay Men’s Health Collective

Email us here if you know of a service we should add, or if we’ve got something wrong. 

London services restricted by area

Some services are restricted by geographical area or borough. This has to do with the way they are commissioned (bought) though it’s pretty nuts for you: a guy in need of support being told a service can’t help because you don’t live in the borough. Fortunately, front-line staff tend to be helpful so if you’re in crisis contact any of the organisations listed below who will point you in the right direction. And feel free to contact MEN R US though we only signpost services.

Hours of service

Hours of service change so please click on the appropriate link for up to date information.

London drug and alcohol support

After Party Outreach Service

It is with sadness … and irritation … we report that this service has closed (March 2018). CGL took over After Party in late 2017 when Lifeline Project collapsed. However, it has chosen not to continue funding the project even though need remains. As to why it has done this, we suggest you contact Mark Moody its chief executive or complete CGL’s contact form. Short answer: disappointing and spectacularly short-sighted.

Antidote @ London Friend | A D C

Axis Clinic | A D C

Burrell Street Sexual Health Clinic | A D C

Chemclinic (Lambeth) | A D C

Camden Community Drug Service | A D C

Club Drug Clinic | A D C

CODE Clinic | A D C

Dean Street | A D C

Antidote @ Turning Point | A D C

Homerton University Hospital | C

Lewisham New Directions | A D C

GRIP | A D C

Narcotics Anonymous | D C

Alcoholics Anonymous | A

Terrence Higgins Trust (Online Support) | A D C

Queers Without Beers | A

Queers Without Beers brings some of the most exciting alcohol-free drinks together at its exclusive pop-up bar in the heart of Bloomsbury. Craft beers, distilled botanicals, cider, wines, gin and tonic and crafts sodas all available to try on this friendly LGBTQI+ night. Syrup of Soot provides amazing food and lower sugar cakes as well as their normal offering of tea and coffee for those who need a caffeine kick. This is a sophisticated social space for LGBTI+ queers of all persuasions that doesn’t revolve around booze. Everyone is welcome – whether you have never drunk, don’t want alcohol tonight, are looking to change your drinking, or have actively quit. Free to attend, although QFB asks for a £3 donation to help with organisational costs.

One Too Many (Alcohol) Quiz | A

Other Support

Chemsex support outside London

A working progress from November 2017, this is a new section, responding to enquiries about chemsex support outside London. If you cannot find a service near you, contact your nearest LGBT, HIV organisation or sexual health service who may have local knowledge.

Birmingham

Brighton

Bristol

Corby

Luton

Liverpool

Manchester

Northampton

Wirral

Watford

UK Drug Service Directories

England

Scotland

Wales

Northern Ireland

Republic of Ireland

A little bit about alcohol

Alcohol (chemical name ethyl alcohol or ethanol) is a colourless liquid in its pure form, usually found as a beverage, and is both powerful and addictive.

Ethanol is produced by fermentation – the chemical reaction between bacteria and starch such as maize, barley, rice, potatoes, hops and grapes. Malt and barley make beer, and grapes make wine, but only a 10-15% level of alcohol is possible by this method. Spirits such as gin, brandy, vodka, whisky and liqueurs which have a higher alcoholic level require distillation as well as fermentation.This means that the water is evaporated, leaving the alcohol in greater concentration. Distilled alcohol is also added to fermented drinks to strengthen them, eg: sherry, port and other fortified wines.

Alcohol by volume (ABV)

The strength of alcohol is denoted by the term ABV (alcohol by volume) and this describes what percentage of total liquid is alcohol. Alcoholic drinks can be divided by strength into three categories:

• Beers: up to 7-8% ABV (alcohol by volume)
• Wines: up to 20% ABV
• Spirits: up to 40% ABV (in the UK)

What it does

Alcohol affects the body in several ways.

• It depresses and slows down the central nervous system; this is what leads to a reduction in tension, anxiety, and inhibitions.
• It provides energy… but also tons of calories that usually head for the waist. Burn it off through exercise and you’re OK but from a nutritional perspective, it’s pretty useless.
• It affects liver function. After heavy drinking, as much 50% of the liver can be ‘immobilised’ although it usually recovers within a few days.
• It makes you piss. With heavy alcohol intake the body loses more water than it takes in and you become dehydrated.

The liver

The digestive system absorbs around 30% of any alcohol drunk. This is carried around the body by the bloodstream and reaches the liver, one of the largest and most important body organs.

The liver makes and regulates many of the body’s chemicals and helps break down and eliminate toxins and other poisonous substances from the blood. It is here that alcohol is broken down, at a rate of 1 pint of beer or 30cc (1oz) of whisky per hour.

This process breaks down around 90% of the alcohol into carbon dioxide and water, the remaining 10% being processed through the lungs and as sweat (which is why you may smell rotten the morning after).

Units and limits

Units are measurements of alcohol consumption and can be used to help calculate the amount of alcohol contained in a drink. However, although most of us have heard of them, surprisingly few people actually know how to calculate them

• Your average pint of beer (4% strength) is 2.3 units, a stronger beer (5%) is 2.8 units, while a pint of strong cider (8%) is 4.5 units
• A standard glass of red or white wine (125ml) is 2.1 units while a large glass is 3 units
• A single shot of spirits (25ml) is 1 unit

Drinks poured at home are usually more generous and should be scored double. Also, score twice as much for extra-strength beers.

Weekly limits

As of January 2016, the first new guidance since 1995 recommends weekly intake for men is reduced from 21 to 14 units of alcohol a week.

The Chief Medical Officers’ guidelines for both men and women who drink regularly or frequently (ie: most weeks) are as follows:

• You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level
• If you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more. If you have one or two heavy drinking sessions, you increase your risks of death from long-term illnesses and from accidents and injuries
• The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis
• If you wish to cut down the amount you’re drinking, a good way to help achieve this is to have several drink-free days each week

14 units of alcohol roughly equate to:

• 6 pints of ordinary lager, beer or cider (at 4% strength)
• 14 single spirit drinks (at 40% strength)
• 7 glasses of wine (at 12% strength)

Spread your allowance

Spread your allowance throughout the week at this level and frequency of drinking is not likely to harm your health. However, people’s tolerance to alcohol varies enormously and even the recommended amounts may be too much.

Alcohol-free days

You should aim for at least 2 or 3 alcohol-free days a week. Don’t save up your allowance to blow it over one night at the weekend because it puts excessive strain on the body and liver especially.

The more you drink

The risk to your health and safety increases, the more you drink. If you drink 30+ units a week you are running the risk of liver damage, accidents and alcohol dependency. It’s not only your physical health that’s affected: your drinking could lead to social and legal difficulties, eg: drink/driving offences, problems with your friendships and relationships or the loss of your job. It’s when we’re tanked like this that we may behave badly at parties, become aggressive and argumentative and take risky decisions when it comes to sex.

How behaviour changes

Even small quantities of alcohol have effects on the body which are noticeable (particularly in someone who doesn’t drink often or hasn’t done so for some time). It’s surprising how after a single drink – 20-30 minutes later – people can become more relaxed. Problems occur when people don’t take into account the effects of alcohol on behaviour when socialising, or tasks requiring co-ordination such as talking, walking, or driving.

When you are drunk

When you are drunk, you are also more susceptible to assault, non-consensual sex, theft and abuse. Prolonged heavy drinking that stops short of dependence may still cause liver and health problems. Dependence (alcoholism) can cause early death and is a major factor in absenteeism from work, accidents and relationship breakdowns. Changes in behaviour depend on the amount of alcohol reaching the brain, which are determined by several factors apart from the quantity of alcohol drunk.

• The rate at which the alcohol is drunk.
• The size of the person, eg: the larger the person the greater the diluting effect of the blood on the alcohol consumed and the more it takes to produce the same effect.
• Whether alcohol is consumed on an empty stomach or not. The effect will be much more immediate (as little as five minutes) if the stomach is empty. Food in the stomach slows down the rate at which alcohol is absorbed into the bloodstream.
• The size and condition of the liver.

Worst case scenario

Taking into account the above factors, your behaviour from a first to last ever drink might look something like this:

A sense of warmth – friendliness – flushed face – talkativeness – increased social confidence – reaction time slows – further sense of mental relaxation and general well being – trip over words – tendency to be loud and talkative – inhibitions about to jump out the window – confused and disturbed thinking and co-ordination – irritability – reduced self-control – irresponsible talk and behaviour – unsteady on feet – slurred speech – unpredictable, exaggerated emotions or (aggressive) behaviour – extreme confusion and disorientation – difficulty remaining upright – drowsiness – nausea – shitting yourself – delayed or incoherent reaction to questions – coma (a state of deep unconsciousness from which you cannot be aroused) – followed by death.

The gay scene and alcohol

For many years, gay pubs were the only places where we could meet other men without fear of abuse or assault. Today, while we can meet guys through a much wider range of places and activities, pubs, clubs and bars are still central to the gay scene. Also, since the main reason for going to bars is quite often to meet other guys, you’d be forgiven for not thinking about the risk of alcohol dependence. It’s not difficult just to have a few beers – three or four times a week – and you’ve reached the recommended limit before the weekend has even started.

Loneliness at the bar

A drink or two can dull the sense of loneliness as you stand by yourself in a bar trying to look confident. A drink or two will often provide the necessary confidence to go up to another guy and ask him whether… he’d like a drink. A further drink or two will also dull the sense of rejection after he tells you that he’s not interested or he’s got a boyfriend. Meeting mates for a drink can help reduce any sense of rejection, inferiority or loneliness but – on a regular persistent basis – can lead to a steady increase in the amount you drink. After all, who’s going to have ‘just the one’ or have orange juice?

Alcohol and sex

Even if you’ve found yourself a man, alcohol – even in small quantities – can reduce the enjoyment of sex. Alcohol can make it difficult to get or maintain an erection – hence the phrase ‘brewer’s droop’. It can also interfere with your judgement so you may take risks sexually that you wouldn’t find acceptable if you were sober. Guys have been assaulted, raped and murdered for less! When we are younger our bodies give us the impression that they can cope with any drink we throw down our neck. The reality, however, is that the body is storing up problems for later life.

A fine line

Of course, there is always the option not to drink alcohol or to drink low alcohol versions of beer or wines. However, the choice is usually limited and they don’t always taste particularly good. In moderation, drinking can and should be a pleasant experience, helping us to feel that little bit more relaxed, comfortable, and sociable. But despite its acceptability on the gay scene and its normalisation on TV and film, alcohol is still a drug with the potential of being highly addictive. Being selective when using it is vital if we are to enjoy the benefits but not become subject to the harm it causes. Despite protestations that ‘I know my limit’, there’s a fine line between drinking socially and becoming dependent. Anyone who drinks alcohol can become an alcoholic and the more we drink the more we increase the risk of dependency and health problems.

Gay men drink more

Stonewall’s Gay and Bisexual Men’s Health Survey 2013 concluded “eight in ten (78 per cent) gay and bisexual men had a drink in the last week compared to seven in ten (68 per cent) men in general. More than two in five (42 per cent) gay and bisexual men drank alcohol on three or more days in the previous week compared to 35 per cent of men in general.”

A 1,000,000+ hospital admissions

More generally in England (so not gay men only) the Health and Social Care Information Centre Statistics on Alcohol in England 2016 says there were an estimated 1,008,850 hospital admissions in 2012/13 related to alcohol consumption where an alcohol related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis. The estimated cost of alcohol harm to society is £21 billion per year. Information on estimated cost to the NHS of alcohol misuse shows that it costs £3.5 billion every year, which is equal to £120 for every taxpayer.

The hangover

The body reacts to large quantities of alcohol in several ways, although this usually takes several hours. The lining of the stomach and lower parts of the digestive system are irritated; the body is dehydrated while the level of alcohol in the blood stream exceeds the livers ability to process it; and the nervous system is shocked and needs time to recover.

Symptoms and what to do

Symptoms include headache, nausea, stomach-ache and cramps, vomiting, dizziness, and irritability. This is the twilight world of the hangover. We’ve all been there: stumbled into a cab… staggered on to a bus… rolled into bed… and fallen into a nauseous sweaty sleep. The next day you wake up with a throbbing headache, a furry tongue, a mouth which tastes… interesting, and breath you could bottle and sell as paint stripper. The best cure is not to have got in to this sorry state in the first place. When you get a hangover you have in effect poisoned the body – albeit temporarily – and it needs time to recover. However, there are practical steps you can take to ease symptoms and aid recovery:

• Drink as much water as you reasonably can throughout the day. This rehydrates the body and helps you to piss out the toxins.
• Drinking other liquids can help the body re-hydrate, tea and coffee which contains caffeine will stimulate the nervous system but are also dehydrating. Sugar can be taken to provide energy. Fruit juices, honey and a vitamin C are also known to help and fizzy drinks may have a soothing effect upon the stomach.
• Drag your sorry arse out of bed, take a shower or bath. Take a walk to get the blood circulation going. This will help provide fresh supplies of oxygen and sugar to the brain and stimulate endorphins, the body’s natural painkillers.
• Settle down in front of the TV or a video and relax.
• The stomach can be relieved by something to eat but anything fatty or rich may make you feel nauseous.
• Aspirin or other pain relievers should only be taken after you have eaten something. Your body will be further irritated if they are taken on an empty stomach.

The hair of the dog

Another alcoholic drink, sometimes referred to as the hair of the dog, will kick start the nervous system and can make you feel better… for a while. BUT this only postpones the original hangover with a second one hot on the heels of the first.

Safer drinking

Alcohol is unlikely to harm your health if you drink only small amounts and avoid drinking every day. Steps to get the best out of drinking and avoid problems include:

• Keeping to the recommended weekly intake
• Aiming for 1 or 2 (even 3) alcohol-free days a week
• Drinking slowly instead of gulping
• Alternating alcoholic drinks with non-alcoholic drinks
• Experimenting with low alcohol or alcohol-free drinks
• Not drinking on an empty stomach
• Not drinking by yourself when you are unhappy or morose
• Not having ‘one for the road’
• Not drinking to relieve anxiety, tension depression or loneliness
• Not keeping your home stocked with alcohol

Alcohol dependence

While there does not appear to be a single cause of alcohol dependence, personality, environment and the addictive nature of alcohol contribute to the development of the illness. It is also thought that genetic factors probably play a part in causing dependence, and any person can become alcoholic if he drinks heavily for a prolonged period. Some symptoms can appear over a period of weeks and months, but alcohol dependency usually occurs over a period of years, sometimes decades. Symptoms fall into two categories which can include any combination of the following:

Physical symptoms

• Bad breath
• Confusion
• Hangovers and headaches
• Flushed appearance or redness in the face
• Forgetfulness and memory lapses
• Incontinence (pissing or shitting yourself)
• Nausea
• Shaking in the morning
• Stomach or tummy cramps
• Unsteadiness
• Vomiting
• Weakness, numbness or tingling in the legs and hands
• Severe shakes, hallucinations, and convulsions may occur after the sudden withdrawal of alcohol which can be life threatening.

Behavioural symptoms

• Secretive drinking, eg: at work
• Aggressive, dramatic, or grandiose behaviour
• Personality changes such as irritability, jealousy, uncontrolled anger, and/ or selfishness
• Lying to yourself and others about giving up
• Changes in drinking pattern, eg: changing from evening to early morning drinking, or changing from beers to spirits
• Neglecting food and nutrition
• Neglecting personal appearance
• Long periods of drunkenness
• Frequent changes of job

Unfortunately, most men who drink too much are either unaware that they have a problem or refuse to admit it. If you or someone close to you is drinking in excess, contact the family doctor or a helpline for advice. It is worth trying to reason with the person when he’s sober.

In severe cases it may be necessary to admit an alcoholic to hospital for a period of detoxification with medication prescribed to control the withdrawal symptoms. Even then, long-term treatment to prevent a return to previous drinking habits is invariably required and can include behavioural therapy and psychotherapy. Occasionally the drug known as Disulfiram is prescribed, which induces unpleasant side-effects when alcohol is taken.

About smoking

While cigarettes account for the bulk of tobacco consumption there are also cigars, pipe tobacco, snuff and chewing tobacco. According to The Tobacco Atlas, the tobacco leaf is grown in at least 124 of the world’s countries.

In 2012, nearly 7.5 million tonnes of tobacco leaf was grown on almost 4.3 million hectares of agricultural land, an area larger than Switzerland. China is the world’s leader in tobacco production, with 3.2 million tonnes of tobacco leaf grown in 2012.

How times have changed

Wrong on so many levels, advertisements like this today are unconscionable, and are illegal in many countries, but here’s a typical TV commercial for cigarettes from the 1950s:

More doctors smoke Camels than any other cigarette | graficsfx | 11 Nov 2016 | 1m

How nicotine works

The major active ingredient in tobacco is nicotine, a stimulant that acts on the body by causing it to increase its production of adrenalin, a chemical produced by the body in response to stress, fear or excitement, which acts by increasing the heart, pulse and breathing rates.

Every time you draw on a cigarette it delivers a burst of nicotine to the body and brain and therefore stimulates adrenaline – giving smokers a buzz or high. By working in this way on the nervous system, nicotine can reduce tiredness and improve concentration, but you should never forget it is also the reason why smokers become dependent on tobacco.

Smoking also provides rituals – lighting up, sharing a cigarette with friends – as well as providing a diversion in a stressful situation by giving smokers something to do with their hands. Nonetheless, smoking is still thought by many as sexy, cool, stress-relieving, a confidence boost, a tool with which to meet people and a tradition after a shag.

Smoking tobacco (in varying forms) has a long history but it is only in the last century, with the advent of the cigarette, that it achieved its status as a social activity (even to the extent of being promoted by doctors as a remedy to breathing problems in the 1950s). Today, however, smoking is widely accepted as being a major health hazard, with tobacco companies paying out billions in lawsuits to people who have suffered lung disease and cancer as a result of their habit.

The damaging effects of smoking are often gradual, taking many years to appear, which is why the harm it causes can often seem inconsequential to young smokers.

What’s in a cigarette

Smoke enters the lungs as gases and solid particles which condense to form a thick brown tar; this lines the passages down which the smoke travels and then collects in the lungs. Tobacco is made from several hundred chemical compounds that fall into five main categories:

• Nicotine – one cigarette can deliver between 0.5mg and 2mg depending on how it was cured and how it was smoked (up to 90% if inhaled, and 10% if not).
• Gases – carbon monoxide at 300-400 times the level considered safe in industry and hydrogen cyanide at 160 times the safe level.
• Carcinogens, or chemicals capable of causing cancer – there are anything between 10-15 in a single cigarette.
• Co-carcinogens, or chemicals which don’t cause cancers directly but which accelerate the growth of cancer.
• Irritants – substances which disturb and inflame the bronchial passages to the lungs, increase mucus secretion and damage the process of getting rid of it.

Today, the majority of cigarettes are filter-tipped which removes many of the harmful substances from cigarette smoke. Low-tar and low nicotine cigarettes will reduce the amount of nicotine and tar entering the body but some filter-tipped cigarettes allow more poisonous carbon monoxide into the lungs.

The Origins of Tobacco: Addicted to Pleasure | BBC | 29 Aug 2015 | 4m

Does smoking damage my health?

Around 50% of smokers will die from smoking-related diseases including lung cancer, heart disease, strokes, arterial disease, chronic lung disease and cancer of the bladder, stomach, mouth and throat. Smokers’ skin ages more quickly, they get indigestion and ulcers while their partners get lung cancer through passive smoking. However, here are the details of three particularly unpleasant and threatening conditions:

Lung cancer is probably the best known harmful effect of smoking but there are other forms including mouth, lip, and throat cancer. For those of you who don’t know, cancer is abnormal cell growth and can develop for a wide variety of reasons, smoking being one of the main triggers. Normal cells have certain limits to their growth, but cancerous cells continue to grow without controls, eventually causing serious and life-threatening damage to body tissues and organs.

Coronary heart disease is the most common cause of death in middle-aged men in Western countries, and the risk to a young man who smokes over 20 cigarettes a day is about three times that of a non-smoker. Chemicals contained in cigarettes enter the bloodstream through the lungs and encourage the build-up of fatty deposits. These deposits narrow or block the arteries supplying blood to the heart, which has increasing difficulty in pumping blood.

Eventually, you feel like shite as the heart struggles to do its job. Sometimes it stops and that’s it: a heart attack. If that wasn’t enough, the deposits also damage arteries in other parts of the body including the brain (which can result in a stroke) and the legs which, in severe cases, can lead to amputation.

Inhaling cigarette smoke damages the lungs and can severely reduce their capacity to function properly. Firstly, it irritates the passageways to the lungs which narrow, produce mucous and are more susceptible to infections. Secondly, the lungs are covered with millions of little sacs (alveoli) which are responsible for passing oxygen into the bloodstream and ridding the body of carbon dioxide. Smoke inflames the alveoli causing the lungs to become less elastic and efficient.

Once carbon monoxide passes from the lungs into the bloodstream – where it competes with oxygen – it combines with the blood and interferes with oxygenation of tissues. In the short term, this leads to shortness of breath, wheezing, coughing, and recurrent chest infections. In the long term, persistently high levels of carbon monoxide in the blood lead to a hardening of the arteries which, in turn, greatly increases the risk of a heart attack.

Passive or secondary smoking

Passive or secondary smoking is breathing in air contaminated with others’ cigarette smoke. There is an increasing body of evidence that those in the vicinity of smokers (eg barmen) are at an increased risk of developing tobacco-related disorders, such as heart and circulatory diseases, bronchitis, emphysema and lung cancer. They also suffer from considerable immediate discomfort from eye irritation, sore throats, coughs, headaches, asthma and other allergic reactions, increased heart rate and breathing difficulties. Just thought we’d tell you.

Benefits of breaking the habit

If you need a cigarette when you wake up then it’s more than likely that you’re addicted and should make a serious effort to give up. If you’re a social smoker – say one or two at weekends or at parties – you should still try and give up completely. The good news is that the benefits of giving up smoking start immediately.

• After 30 minutes circulation improves, blood pressure and pulse rate return to normal.
• Eight hours later, oxygen levels in the blood return to normal, chances of heart attack start to fall.
• 24 hours later, carbon monoxide is eliminated from the body, lungs start to clear out mucus and other crap.
• 48 hours later, nicotine is no longer detectable in the body and the ability to taste and smell improves.
• 72 hours later, bronchial tubes relax and breathing becomes easier, energy levels increase.
• Two to 12 weeks later, circulation improves throughout the body, making physical activity easier.
• Three to nine months later, breathing problems such as coughing, shortness of breath and wheezing decrease, overall lung function increases by 10 to 15%.
• After five years, the risk of heart attack falls to half that of a smoker. After ten years, the risk of lung cancer falls to half that of a smoker, and the risk of heart attack falls to the same as a non-smoker.

Quitting smoking

Breaking any habit is difficult, and success depends on determination, planning, and willpower. The benefits to health far outweigh the possible discomfort of a week or two, and the additional rewards of considerable financial savings should also keep you going when things get tough.

Many smokers are physically dependent on nicotine and so when they stop smoking the craving to have a cigarette continues and will take time to die down. Withdrawal symptoms are varied and can include mood swings, depression, restlessness, anxiety, difficulty in concentrating, and sweating.

Some people find that they put on a few pounds after they give up smoking. This is partly because they are no longer taking in nicotine (which stimulates the body’s metabolism) and because their appetite has increased. However, if you only nibble on healthy snacks, you’re unlikely to put on more than a few pounds which are not as bad for your health as continuing to smoke.

There are many different ways you can give up smoking: group sessions, individual medical care (through your GP), therapy, acupuncture and hypnotism, although the act of self will is probably the most popular method used.

Nicotine replacement therapies (NRT) such as Nicotinell and Nicorette don’t stop you from smoking but provide a much-reduced level of nicotine to help control the physical withdrawal symptoms. NRT supplies controlled levels of nicotine that allow you to gradually reduce your intake. NRTs are usually supplied as chewing gum, patches, or as a nasal spray available through your chemist. A prescription medicine available only from your GP, it helps reduce the urge to smoke, lessens symptoms of withdrawal and makes quitting more bearable.

What Happens When You Stop Smoking? | AsapSCIENCE | 2 Feb 2017 | 3m 28s

Ten-point plan

1. Make a date to stop smoking and stick to it. Let others know and get as much support as you can. Maybe a friend might like to give up with you.
2. Bin your ashtrays, lighters and fags.
3. Drink plenty of fluids (not vodka) and keep a glass of water or juice close by.
4. Get more active. Increased exercise helps clear the shit from your system.
5. Expect withdrawal to be irritating. It’s a sign your body is recovering from the effects of tobacco. Irritability, urges to smoke, and poor concentration is common – don’t worry, they usually disappear after a couple of weeks.
6. Change your routine, eg try to avoid the shop where you usually buy cigarettes.
7. Bear in mind any drama in your life might get you reaching for just one fag to get you over it. How are you going to cope with that?
8. Reward yourself. Use the money you are saving to buy something special.
9. Be careful what you eat: snack on fruit, raw vegetables, sugar-free gum or sugar-free sweets, not fatty foods.
10. Take one day at a time. Each day without a fag is good news for your health and your pocket, remember to celebrate your success. If this doesn’t work, don’t beat yourself up, you can always try again later.

Quit smoking support

Chemsex

Chemsex is shorthand for gay men taking drugs during sex, first appearing on apps like Grindr, Bareback Real Time (BBRT), Gaydar, and Scruff (and yes, there are lots of others). However, it’s not the same as recreational drug use (eg: popping a pill or smoking a joint), rather it is a specific form of recreational drug use and here are two definitions which overlap:

Chemsex: a working definition | Reshape

“Chemsex is a common term used by gay men on sexual networking sites and smartphone Apps. Chemsex is not the same as recreational drug use. It’s a specific form of recreational drug use. Chemsex is defined by the use of three specific drugs (‘chems‘) in a sexual context. These three drugs are meth, meph and G.

• Methamphetamine (crystal/ crystal meth/ Tina/ meth)
• Mephedrone (meph/ drone)
• GHB/ GBL (G, Gina)

Chemsex involves using one or more of these three drugs, in any combination, to facilitate or enhance sex, with or without other drugs. Chemsex commonly refers to sex that can sometimes last several days. There is little need for sleep or food. The heightened sexual focus enables more extreme sex, for longer, often with more partners and with less fear of STIs including HIV and HCV. Sharing injections is common.”

Chemsex: a working definition | Reshape

The Chemsex Study | Sigma Research | Mar 2014

“The term ‘chemsex’ or, to a lesser extent, ‘Party and play’, has entered the vocabulary of certain sections of the gay population is a behaviour that has attracted significant media attention. Chemsex is commonly understood to describe sex between men that occurs under the influence of drugs taken immediately preceding and/ or during the sexual session.

The drugs most commonly associated with chemsex are crystal methamphetamine (hereafter referred to as ‘crystal meth’), GHB/GBL, mephedrone and, to a lesser extent, cocaine and ketamine. All except ketamine, have stimulant properties in that they typically increase heart rate and blood pressure and trigger feelings of euphoria, but crystal methamphetamine, GHB/GBL and mephedrone also have a common effect of facilitating feelings of sexual arousal. These drugs are often taken in combination and are commonly associated with sexual sessions occurring over extended periods of time, sometimes involving large numbers of sexual partners.”

 The Chemsex Study | Sigma Research | Mar 2014

The chemsex narrative

Gay men have been taking drugs for years and it wasn’t so long ago we were dropping ‘E’s. Today it’s ‘chemsex’ and professionals are over it like a rash with opinions, forebodings perspectives, predictions, and reports. What is new, however, is that if and when guys eventually crash and burn the consequences are more damaging, more lasting, and require more complex and comprehensive intervention recovery and support.

However, “…the needs of men engaged in chemsex are not best served by suggesting chemsex is universal. In fact, suggesting that it is universal runs the risk of giving the impression that it is both inevitable and impossible to escape. Most gay men in Britain, even in its gay centres, are not having chemsex.” [Ford Hickson, The Conversation, 21 Jun 2016].

The truth is the ‘chemsex’ narrative is still unfolding, and we have a way to go before we have a more rounded understanding its its true extent and (long term) implications for gay men and our community.

Terms you may have heard

• Slamming is another word for injecting and the practice of dissolving crystal meth or mephedrone in water before injecting it into yourself or someone else
• PnP is shorthand for ‘Party and Play’ used to arrange ‘sex and drugs’ hook-ups online where there will be drugs, or you may be expected to bring some
• parTy means the use of Tina aka crystal meth (which is smoked or injected
• HnH means high and horny
• Chem friendly means they use any combination of Methamphetamine (crystal/ crystal meth/ Tina/ meth), Mephedrone (meph/ drone) or GHB/ GBL (G, Gina) … though others drugs may be used.

Unfortunately these and other terms are often lumped together which is not necessarily helpful in understanding what is happening and why.

Finding out more

P{an Zero

Further reading on chemsex

Published articles, reports, studies and news

We’ve pulled together a selection of published articles, reports, studies and news. It’s not perfect or complete so please let us know if there’s something you think we should include.

2017

2016

2015

2014

2013

2010

Books and plays

Something for the Weekend | James Wharton | Biteback Publishing | 2017
“When James Wharton leaves the army, he finds himself with more opportunities than most to begin a successful civilian life – he has a husband, two dogs, two cars, a nice house in the countryside and a book deal. A year later he finds himself single, living in a room and trying to adjust to single gay life back in the capital. In his search for new friends and potential lovers, he becomes sucked into London’s gay drug culture, soon becoming addicted to partying and the phenomenon that is ‘chemsex’. Exploring his own journey through this dark but popular world, James looks at the motivating factors that led him to the culture, as well as examining the paths taken by others. He reveals the real goings-on at the weekends for thousands of people after most have gone to bed, and how modern technology allows them to arrange, congregate, furnish themselves with drugs and spend hours, often days, behind closed curtains, with strangers and in states of heightened sexual desire. Something for the Weekend looks compassionately at a growing culture that’s now moved beyond London and established itself as more than a short-term craze..” Biteback Publishing

Methamphetamine (crystal meth/ tina)

Mephedrone (meow meow/ m-cat)

GHB/ GBL

One person dies from “G” in London every 12 days

Deaths related to GHB/ GBL (“G”) rose by 119% in London between 2014 and 2015 according to an Imperial College London  study which analysed data from 2011 to 2015 (collected from coroners across London). Deaths from “G” has more than doubled in just 12 months to 29 and so (on average) one person has been dying from “G” every 12 days.

There’s More to G Than Cock | Global Drug Survey

Ketamine

About this guide

With some minor edits, this guide is a transcript of a 36 page booklet produced by PIP PAC, one of our other projects, in August 2017 (4th editiion). As MEN R US and PIP PAC collaborated on the text you may find some content duplicated elsewhere on the website.

Contact us if you would like us to send you a copy of the booklet.

These words are our take on the risks and harms associated with ‘slamming’ and ‘chemsex’ or—if these words are new to you: using and/ or injecting (multiple) drugs for sex and/ or partying.

We are not doctors or substance misuse professionals, but a group of rather gorgeous informed gay men, passionate about sex and their health, with direct experience of drug use, addiction, withdrawal, and recovery. Some of us are living with HIV and/ or Hepatitis C so—in some ways—this is our narrative and our story.

Good to know

Mixing drugs

Mixing drugs is not a good idea as you may not know what you are getting and how the strength and/ or combination will affect you. Mixing increases the chances of interactions, overdose, passing out and/ or a trip to A&E.

Know your chems

Whenever you can, test your drugs and/ or use an accurate scale to measure the proper dose. When using an unknown substance, build up your dose in small increments.

Eat

Make sure you eat enough. Even if you’re not hungry, try to eat small amounts regularly. Soft food is easier to swallow. Fruit, smoothies, protein shakes, porridge, yoghurt and soups are nutritious and provide new energy.

Take your HIV meds

Are you on medication such as anti-virals? Set an alarm on your mobile so that you take your meds on time, and carry a spare dose with you just in case.

Drink water

To prevent dehydration, it’s important to drink water, herbal tea or sport drinks regularly. Coffee and alcohol are not good options.

Get rest

Recreational drugs often delay tiredness and exhaustion. Take regular breaks outside the sex setting and chill out. And if you can’t sleep, find a quiet dark space to help you relax better.

Freshen-up

Take a shower at least once every 24 hours. It’s relaxing and energizing. Wash your hands regularly. If you are going to brush your teeth do so gently or use a mouthwash instead. Chewing gum helps protect teeth and gums.

Coming down

You may be physically and mentally exhausted, feel empty, moody and grumpy. Watching movies and listening to music is a good way to chill. Good food speeds up recovery and consider taking multivitamins. If you feel up to it, engage in some light activity by going for a walk or playing some sports.

Support and help

If things are bad make sure you can call a mate and know where to get help, should you need it.

Connection and consent

Great sex should be about connection, intimacy, affirmation, and fun, as much as it is about being safer. However, some of the choices we make during sex and chemsex can have serious consequences and can cause lasting harm.

Sexual consent is about having the ability and freedom to agree to sexual activity. This is something that must be clearly established between two people before any kind of sexual act or behaviour, and you can change your mind at any time.

Sex without consent is rape, and rape and sexual assault is a crime.

Talking about this stuff is not easy, particularly when we’re high and horny. If something has happened to you, you may not even have found the words yet, but whether it’s just a feeling or a hazy memory: talk to a close friend, go to a sexual health clinic, or phone a helpline.

Safer slamming

Needles

To reduce possible damage to the veins use thin short needles. Short needles meant for injecting insulin are the most suitable.

Avoid ever re-using or sharing equipment

If this booklet is included in a PIP PAC pack you should notice we have specifically colour coded the syringes, spoons and straws to reduce the risks of sharing (yellow/ green or red/ blue). If you find yourself in a situation where you have to re-use, make sure you only use your own and no one else’s. Get into the habit of marking your own syringes (scratch a letter/ number on the side) to ensure you know which is yours.

Sterile cups and spoons and filters

Sterile packaged cups or spoons with filters are the best choice for dissolving chems in water, but avoid torn filters or exposed fibres as they can end up being injected and can cause problems. Dissolving chems in a regular teaspoon is the best alternative but, before use, disinfect the spoon in boiling water or soak in 1 part thin bleach to 10 parts water (remembering to rinse off thoroughly).

Sterile water

Sterile water, available in small ampoules, is best for dissolving and injecting. The best alternative is freshly boiled tap water, letting the water cool down before use. Use sufficient water to completely dissolve the drugs. If you are re-using syringes do not share water. Whether you are using ampoules or boiled water, throw away leftovers after use as bacteria build up quickly.

Washing your hands and cleaning the site

Wash your hands before you inject and clean the injection site with an alcohol pad. Alternatively, clean the site with a cotton ball and alcohol, or by washing it with soap and water, drying with clean kitchen roll/ tissue.

Choose a quiet place

Choose a quiet, safe and clutter-free place to slam, ensuring surfaces are clean.

Alcohol pads/ swabs

Alcohol pads are sterile-packed and suitable for one-time use. By wiping the slam site firmly once with a pad, you disinfect the needle’s point of entry. Alternatively, you can disinfect the site by washing it thoroughly with soap and water or use a cotton ball and alcohol.

Where to inject

The inside of the elbow is by far and away the safest place to inject. Injecting anywhere else (eg: the neck, cock or groin) is potentially very dangerous and we advice you to seek advice from a drugs service. Aim to slam at least 1cm away from your last slam location and rest injecting sites by not injecting in the same place. If possible, learn to swap arms.

Tourniquets

Used properly, tourniquets raise veins and can be helpful for some when injecting. However, “a badly used tourniquet introduces many new risks and it would be safer not to use one at all rather than to use a tourniquet badly.” For example, some guys don’t like the practicalities of having a needle and syringe ‘flapping around’ while they release the tourniquet which is why they release it after injecting. This is not advisable as it puts pressure on the veins (which can burst) and can cause serious circulation problems if you pass out with the tourniquet tight around your arm.

Cotton wool swabs and folded kitchen roll/ tissue

Immediately after slamming, press on the injection site with a cotton wool swab or folded kitchen roll/ tissue to help the site close quickly. This also helps reduce bruising and helps the veins heal faster. Don’t us alcohol pads for this as it slows down the healing of the wound.

Needle (sharps) disposal

Use a sharps bin or sharps disposal unit whenever possible. These come in a variety of shapes and sizes and don’t have to be bulky. Only recap a needle if it’s your own. Some guys improvise by sealing used equipment in plastic drinks bottles with screw caps then throw away as domestic waste. Be aware this could present a risk to refuse collectors so it’s important to dispose of equipment as safely as possible. So, at the risk of repeating ourselves: use a sharps bin or disposal unit whenever possible and take it to a needle exchange for safe disposal.

Back-loading (barrel-mixing chems)

Some guys dissolve their chems in warm water inside the syringe barrel, giving it a vigorous shake before slamming. However, tiny particles that don’t dissolve can cause problems. We strongly recommend you dissolve chems in sterile water, or freshly boiled water, in a sterile cup and draw the solution through a filter.

Crystal meth dissolves easily in water, while mephedrone and other drugs can be more difficult to dissolve. Bottom line: whatever you inject into your vein needs to be fully dissolved, as pure as possible, and not contain any unnecessary crap.

Booty bumps (chems up the arse)

Booty bumps (chems up the arse)chems taken up the arse using a syringe without the needle (mixed in the barrel and squirted up) or put up there using a finger. The chems are absorbed through the lining of the anal canal and rectum.

Some chems taken this way can act faster than if swallowed or snorted and feel much stronger, but this can cause irritation, bleeding and/ or inflammation, increasing the risk of infection, and cause lasting damage to the arsehole and rectum.

Remember to wash your hands and use a new syringe each time, and lube the arsehole and the syringe barrel before inserting gently.

Sexual health check-ups

Regular sexual health check-ups every 3-6 months are essential for a responsible and enjoyable sex life. Sexual health or GUM services:

• Screen, detect and treat sexually transmitted infections (STIs) including HIV—with results often within hours
• Offer ‘PEP’—a course of HIV medication if you have been at risk of HIV infection, effective for up to 72 hours after exposure
• Provide information, support and advice on maintaining a healthy sex life
• Provide a point of contact in the event of future problems

Post Exposure Prophylaxis (PEP)

PEP is a course of medication after a potential exposure, designed to reduce the risk of HIV infection. It is the same meds that are used to treat HIV.

The course of medication lasts 28 days and may be able to prevent you becoming infected with HIV if you start taking it within 72 hours of being at risk of HIV exposure; eg: a condom breaks during fucking or barebacking someone with a high viral load.

If you think you may need PEP don’t spend the next 72 hours wondering, or searching the Internet for the right advice. The right advice is go to a sexual health clinic now as time is of the essence. The sooner you start treatment the more likely its success. You can also obtain PEP at Accident and Emergency (A&E) departments of some hospitals. A&E are especially important at weekends because most sexual health clinics are closed.

Pre-Exposure Prophylaxis (PrEP)

PrEP is the use of anti-HIV medication, taken regularly, to keep HIV negative people from becoming infected. The evidence for is the PROUD study which reported in February 2015 that PrEP reduced the risk of HIV infection by 86% for gay men and other men who have sex with men. It measured the effectiveness of daily PrEP for those recruited during the 2 year study.

Access to PrEP on the NHS varies in the UK, so check out the PrEP section under STIs at menrus.co.uk You can buy PrEP privately on-line for around £40/ month and the section includes links to organisations which explain what you should consider before you buy.

There are serious concerns by some (including us) that widespread use of PrEP will reduce the number of people using condoms and therefore increase the number of exposures with those who don’t know of their HIV infection, and who are potentially very infectious. And even if PrEP is the game-changer many are hoping for, it offers zero protection against other STIs which are on the rise at a time when antibiotics are starting to fail.

Hepatitis C and douching

There has been a marked increase in Hepatitis C (Hep C) among gay men, which raises additional issues if you are already living with HIV. Fucking, fisting, and sharing douche kits, dildos and snorting straws can all put you at risk of catching Hep C, HIV and other STIs. You reduce risks by:

• Using condoms for fucking or getting fucked
• Using sterile syringes and needles when slamming
• Using sterile syringes for booty bumps
• Using latex or non latex gloves when fisting or getting fisted
• Using your own supply of lube and not sharing
• Using a new condom on dildos every time they are used
• Using your own straw when snorting drugs

Disinfecting douche heads
Keeping douche heads and douche kit clean is an important part of reducing risks, especially at sex parties where they may be shared. Use a commercially available sex toy cleaner, or you can make up your own solution of 1 part thin bleach to 10 parts water, making sure you clean and rinse the douche head well before each arse.

About ‘G’ and withdrawal

GHB (gamma hydroxybutyrate) or GBL (gamma butyrolactone) are chemical drugs that guys take for clubbing and/ or during sex. GHB and GBL are ‘depressant’ drugs, which means they slow you and your body down. GBL turns into GHB inside your body, and so its effects can be stronger or more unpredictable than when taking GHB. GHB is a clear, salty, odourless liquid, and also comes as a powder that’s added to drinks. GBL has a sharp, acidic taste and chemical odour. And remember: GBL is much stronger than GHB. Today GBL is much more common in its use than GHB.

Withdrawal
For users physically dependent on G one of the biggest risks is rapid onset of ‘withdrawal syndrome’, which can be potentially fatal. Within a few hours of their last dose they start to develop cravings for more G and can become anxious, sweaty, agitated, and confused. In a matter of hours, withdrawal can rapidly escalate, progressing to hallucinations, delirium and life threatening seizures. Users experiencing these symptoms are likely to require admission to A&E.

Reducing ‘G’ risks

• Best to use a syringe to precisely measure doses
• Make sure you can read the measurements as ‘G’ removes the markings which are then hard to read
• If you prefer to use a pipette or soy sauce ‘fish’ bottle make sure you can measure accurately. They look similar but different bottles and different pipettes hold different amounts
• Mixing ‘G’ with alcohol or ketamine increases the risks of overdose. It can impact the effect of the ‘G’, making safer dosing more difficult. Stick to soft drinks to mix
• Safer use is about the right dose at the right time
• Dosage intervals and results vary from person to person. Go slow, build up or STOP if you are uncertain
• It’s easy to make up a dose in a drink, but then forget whether you’ve put it in there. If in doubt: chuck it out and start again
• Make a note of when you take your ‘G’ using your phone’s notepad, or stopwatch to keep time between doses. Keeping track of the time between doses can help reduce your risk of needing a wakeup call in A&E

Finding the right support

Gay men needing chemsex support require specialist help and advice. Some of the organisations you may have heard of have been pioneers, like Burrell Street Sexual Health Centre, Antidote @ London Friend, Club Drug Clinic, and 56 Dean Street. But chemsex support across the thirty-three London Boroughs, for example, is patchy at best and finding the right support when you need it outside London can be frustrating and confusing—assuming it’s there at all.

When guys ‘crash’ or are in crisis, they often require multiple services simultaneously (eg: recovery, mental health, legal, housing, debt) and mainstream (and local authority) services are not always geared up to work together, though some are trying to improve.

Issues like this affect many LGBT+ people accessing support generally, at a time when there is less funding and more cuts than ever before. The situation is worsened by the closure of LGBT+ services—like Pace (2015) and Broken Rainbow (2016) which also raises concerns that we are being ‘shoe-horned’ into mainstream/ generic services which simply don’t meet our health, well-being, and cultural needs.

The response to chemsex and slamming by mainstream drug services is understandably slower we would like. However, some are starting to respond positively, and we have found some encouraging signs that they are becoming LGBT+ friendlier in the process—something which is long overdue.

Safer injecting

• Wash your hands and clean the injection site
• Choose a quiet, safe place to inject
• Ensure the surfaces you prepare on are clean
• Whenever possible, use a sterile spoon and dry, clean filter available from needle exchange services and PIP PAC
• Avoid torn filters or exposed fibres as they can end up being injected and cause problems
• Never share your injecting equipment
• If you have to re-use equipment make sure it’s yours
• Use a sharps bin whenever possible. If not available improvise; eg: use a plastic drinks bottle with cap
• Only recap needles if a sharps bin or alternative is not available
• It’s always best to only recap your own needle to avoid risk of infection
• Take your sharps bin to a needle exchange for safe disposal

Safer injecting crystal meth

Safer injecting mephedrone

Needle and syringe supplies

Some NHS sexual health clinics are providing needles and syringes; eg: 56 Dean Street/ Dean Street Express (Soho) and Burrell Street Clinic (Southwark).

Tourniquets

Used properly, tourniquets raise veins and can be helpful for some when injecting. However, “a badly used tourniquet introduces many new risks and it would be safer not to use one at all rather than to use a bad tourniquet badly.”For example, some guys don’t like a needle and syringe ‘flapping around’ while they release the tourniquet which is why they release it after injecting. This is not advisable.

Section 9A of the Misuse of Drugs Act

Under Section 9A of the Misuse of Drugs Act 1971, it is a criminal offence to supply or offer to supply articles for administering or preparing controlled drugs. The Act says an offence will be committed if the following circumstances exist:

• An article is supplied or offered to be supplied.
• The article may be used or adapted to be used (whether by itself or in combination with another article or articles) in the administration of a controlled drug.
• The person supplying or offering to supply the article did so in the belief that the article would be so used by any person, whether to administer the drug to themselves or another, in circumstances where that administration would be unlawful.

Articles such as crack pipes, grinders, spoons, bongs and tourniquets could fall within this prohibition. However, prosecutions under section 9A – even of headshops clearly promoting drug use – are now virtually unheard of, and there has never been an employee of a drug service tried for this offence.

Injecting other people

We’ve had several queries about injecting other people and the law so we asked Release, who said this:

There are possible serious outcomes for someone who injects another person with drugs.

There is a risk of prosecution for administering a drug to someone, if it can be proved that there was an intention to cause injury [1] or endanger life [2]. Depending on the offence charged, the maximum sentence is 5 or 10 years in prison.

Anyone prosecuted for one of these offences could argue that the intention didn’t exist because they were giving the drug to help someone and increase safety, rather than harm them. But this probably won’t protect them from at least being arrested initially and potentially having to go through a court case where that argument can be made.

Also, if someone dies as a result of one of the offences above, then the person doing the injecting might be charged with manslaughter.

A charge for manslaughter might also happen if the police and prosecution say the death happened because the person doing the injecting was negligent. This would be on the grounds that someone injecting another person takes on a duty of care to that person, so where that duty is breached (either by doing something or failing to do something), and this causes or significantly contributes to the person’s death, that is gross negligence and so a crime.

The maximum sentence for manslaughter is life in prison.

Anyone advising someone to inject other people also risks being prosecuted for encouraging or assisting an offence [3]. These offences can be committed even where the main offence isn’t committed – so even if no one follows the advice that is published (or at least the police aren’t aware/have no evidence of this) you could still be guilty of an offence.

The maximum sentence is whatever the maximum prison sentence is for the offence which is encouraged/assisted, or a fine.

[1] Section 24 Offences Against the Person Act 1861
[2] Section 23 Offences Against the Person Act 1861
[3] Serious Crime Act 2007

Hepatitis C and chemsex

Chemsex and slamming are largely believed to be responsible for a marked increase in Hepatitis C among gay men. This raises additional issues if you are already living with HIV.

Fucking, fisting, sharing douche kit, sharing lube, and sharing dildos and snorting straws can all put you at risk of catching Hepatitis C, HIV and other STIs. You can reduce your risk by:

• Using condoms for fucking or getting fucked
• Using sterile syringe and needles when injecting
• Using latex or non latex gloves when fisting or getting fisted
• Using your own supply of lube and not sharing
• Using a new condom on dildos every time
• Using your own straw when snorting drugs

Disinfecting douche heads

Keeping douche heads and kit clean is an important part of reducing risks, especially at sex parties where they may be shared. Use a commercially available sex toy cleaner or you can make up your own solution of 1 part thin bleach to 10 parts water. Make sure you clean and rinse well before each use.

Hepatitis C treatment

Use the links below to find out about treatments:

London accident and emergency departments

King’s College Hospital | Denmark Hill, London SE5 9RS | MAP
020 3299 9000 (Switchboard)

Better known drugs

Acid (LSD)

Alkyl nitrites (also listed under Poppers)

Alcohol

Amphetamines (also listed under Speed)

Benzodiazepines

Cannabis

Cocaine

Crack cocaine

Crystal meth (also listed under Methamphetamine)

GHB/ GBL

Heroin

Legal highs

Ecstasy

Ketamine

Mephedrone

Methamphetamine (also listed under Crystal Meth)

Magic mushrooms

Poppers (also listed under Alkyl Nitrites)

Speed (also listed under Amphetamines)

Steroids

Tabacco

More drugs

AMT

Alprazolam

Betel and areca

BZP

Codeine

Diazepam (Valium)

DMT

Fentanyl

Khat

Lorazepam

MCPP

MDAI

Methedone

Methoxetamine

Methylone

Morphine

Naloxone

Naltrexone

NRG-1, NRG-3, naphyrone

Opium

Phenazepam

Piperazines

PMMA/ PMA

Rohypnol (flunitrazepam)

Salvia

Solvents

Subutex/ Suboxone

Synthetic cannabinoids (cannabis)

Temazepam

TFMPP

Valium (see Diazepam

Xanax

Ya Ba

Zopiclone, Zaleplon and Zolpidem

2CB

4MTA