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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 crystal meth or G. 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 Saturday night/ Sunday 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 risks and harms

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

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.

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, etc. More about this here.

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 treatment drugs such as protease inhibitors.

Clubbing and partying

• 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.

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

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.

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.

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 equates 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 as 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.

Alcohol support and advice

LGBT+ and LGBT+ friendly support

One too many quiz

Generic 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 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 is 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 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

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 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 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.

‘Slamming’ and ‘parTy’

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’ often used to arrange meets online. And ‘parTy’ means the use of Tina aka crystal meth (which is smoked or injected). Unfortunately these and other terms are often lumped together which is not necessarily helpful in understanding what is happening and why.

Further reading

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

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 a 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 a few edits, this safer chemsex guide is a transcript of a 24 page booklet produced by PIP PAC in September 2016, and one of our other projects. 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.

HIV treatment interactions

HIV Drug Interactions from the University of Liverpool. provides a clinically useful, reliable, comprehensive, up-to-date, evidence-based drug-drug interaction resource, freely available to healthcare workers, patients and researchers. The HIV iChart app gives easy access to our drug interaction information on mobile devices.

HIV Drug Interaction Checker | University of Liverpool

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

Safer slamming

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

Never share equipment
Do not share your injecting equipment, but if you have to re-use equipment make sure it’s your own. We like the Nevershare system because its 1mm fixed syringes come in 5 colours. If this not an option, mark or label your own syringe.

Sterile cups or spoons and filters
A sterile packaged cup or spoon with filter is the best choice for dissolving your chems in water. Ideally use the sterile filter with the cup, but avoid torn filters or exposed fibres as they can end up being injected and can cause problems. Dissolving chems in a spoon is the best alternative but disinfect the spoon in boiling water before use, or bleach (remembering to rinse off).

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
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 using a cotton ball and alcohol.

Where to inject
Aim to slam at least 1cm away from your last slam location (moving towards the heart), to give the used veins time to heal and so the previous site is not irritated twice.

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 use 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. Needle exchange outlets are still left with the problem of transferring the contents of bottles to their clinical waste system. 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 are 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 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.

Connection and consent

Great sex should be about connection, affirmation, and fun, as much as it is about being safer. Some of the choices we make during sex and chemsex can have serious consequences, and can cause lasting harm. Sexual consent is about a person having the ability and freedom to agree to sexual activity. Sex without consent is rape, and rape and sexual assault is a crime. Being men ‘n’ all, talking about this stuff is never easy; in fact you may not even have found the words yet if something has happened to you. But if it has—even if it’s just a feeling or a hazy memory—talk to a mate, go to sexual health clinic, or phone a helpline.

Sexual health MOTs

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 departments (A&E) 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. The campaign to get PrEP on the NHS (in a nut shell): At the time of writing this (August 2016) the NHS won’t pay for PrEP though gay men (and many organisations) have been campaigning for it to be available (though you can buy it privately online for around £45/ month). The National AIDS Trust launched a judicial review challenging the NHS’ decision and in early August 2016 the High Court ruled the NHS can fund PrEP. However, the NHS is appealing so there’s a way to go yet (at the time of writing this). However, it’s worth asking your sexual health clinic for an update the time you’re there.

Condoms and antibiotics
There are concerns (and that includes us) that widespread use of PrEP could 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

When it comes to response, chemsex and slamming are still relatively new and support services continue to play catch up at a time when there is less funding and more cuts than ever before. Some services are pioneers —like Burrell Street Sexual Health Centre, Antidote @ London Friend, Club Drug Clinic, and 56 Dean Street—but chemsex support across the 33 London Boroughs is patchy at best and finding the right services is often frustrating and confusing (assuming it’s there at all).

For example, guys who ‘crash’ often need multiple support services simultaneously, for help with drug use, mental health, legal, housing, and debt—but the services are not necessarily there, accessible, or geared up to work together, though some are trying to improve.

In our own small way, we are trying to do something about this, which why we have built MENRUS.CO.UK—a continually updated website which puts the information we need in one place and joins up the dots of our health and well-being needs.

We know issues like this affect all LGBT+ people in need help and support. And the closure of Pace (2015) and Broken Rainbow (2016) raises concerns we are being ‘shoe-horned’ into using mainstream/ generic services which simply don’t meet our health and well being needs—but the Gay Men’s Health Collective (which coordinates MEN R US and PIP PAC) is working to change things for the better.

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 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 others

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:

Drugs and chemsex support

We have pulled together organisations in London where you will find support, advice and information on recreational drug use and chemsex.

If you do not live in London, use these links or your nearest HIV organisation or sexual health service may have local knowledge.

Contact us if you are an organisation wishing to be added, or you know of an organisation you think should be included here.

Access restricted by geographical area

Some chemsex support services are restricted by geographical area and this has to do with they way health services are commissioned (bought) in London and, frankly, it’s pretty nuts for you the guy in need of help. Fortunately, front-line staff and workers are very helpful so if you need help or are in crisis contact any of the organisations listed below. If they can help you directly they will, if not they’ll point you in the right direction. And feel free to contact MEN R US though we only signpost services.

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

Drugs, the law and legal help

Consent, assault and abuse; and dealing with the police

Consent and clear communication (campaign)

Online information, help, and resources

London A&E

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

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