Several pieces of research suggest that lesbian, gay and bisexual people have a higher risk of substance misuse problems and dependence. A few weeks ago we saw the publication of a piece of research looking at the context, harms and implications of the practice of ‘chemsex’ by examining a survey of over a thousand gay and bisexual men in a part of London. The average age was 36. Nearly six percent of the sample ‘had ever’ injected drugs other than steroids, a much higher rate that the general UK population.
The paper defines the term:
‘Chemsex’ is a term commonly used by gay or bisexual men to describe sex that occurs under the influence of drugs, which are taken immediately preceding and/or during the sexual session. The drugs most commonly associated with chemsex are crystal methamphetamine, GHB/GBL, mephedrone and, to a lesser extent, cocaine and ketamine.
What’s the problem? The authors explain:
These drugs are widely known to facilitate pleasure or euphoria but are also associated with a range of harms. Particular concern has been raised regarding the role of crystal meth, GHB/GBL and mephedrone in sexual HIV or STI transmission risk behaviour. The link between drug use and risk taking behaviour is complex, but there is a clear association between the two. These drugs can facilitate long sexual sessions with multiple partners and the likelihood of STI transmission may be increased due to rectal trauma or penile abrasions. There are also harms associated with drug overdose, especially in relation to GHB/GBL, which is typically administered in small, carefully timed doses. Within the last two years there have been a number of drug related casualties among gay men…
The researchers studied data from a very large European survey, ran some focus groups and did a series of 30 interviews with volunteers to further examine emerging themes. They found that:
- There were public health concerns around chemsex, particularly with regard to the spread of HIV and Hep C. A third of men who were HIV negative reported unprotected anal intercourse while having chemsex,
- There were mental (including psychosis), physical, social and relational harms
- Overdose was a concern
- Sexual assault though rarely reported did happen
On the harms generally, the researchers write:
Chemsex occupied a large amount of time for many men, both in terms of actual engagment and recovery. A significant number of those we interviewed lamented the lost opportunities for social connection, career progression or relationship development, which they believed was a consequence of their drug use. Participants expressed concern about the impact of chemsex on the gay scene in London with concern expressed that geo-spatial networking apps may further normalise it within the community.
I had a few reflections on the study. One was around the normalisation of drug use in sexual settings. One interviewee described drug use in gay men in London as:
Rampant. It’s just everywhere. I mean, even if you go to – you think – no, it’s everywhere. I mean I can’t think of anywhere I’ve not seen drugs being taken Yeah, that’s the reality.
We can expect to see more problems arising as a result.
Another reflection was on the fairly exclusive harm reduction focus of the study. You can’t argue with any of the recommendations; they are commendable, but they focus on education and information. It would have been helpful to discuss the issue of mutual aid and treatment explicitly.
Despite some worrying evidence only a tiny minority of men identified themselves as in need of help. If we apply DSM IV (diagnostic) criteria, a significant number of men in the study will meet the brief for addiction and would probably benefit from treatment. By definition, insight is likely to be impaired in these guys and if many around are engaging in the same behaviour it won’t be clear how unhealthy it potentially is. Part of the response needs to be giving clarity and information on when recreational or even problem drug use has crossed the line to dependence. Screening may be helpful. One man’s experience (Rob) is described:
He has had two semi-psychotic episodes where he had had to go to the hospital to get something to bring him down because he hadn’t slept for days and was panicking. Rob hasn’t had sex without drugs for quite a few years now, but doesn’t feel addicted.
Then we need identification of what treatment options are available. To be fair the authors do recommend access to gay-friendly drug services to address psychosocial needs. I’d have liked to have seen this developed a bit. There will be groups of gay men in recovery from addiction whose experience and support would be invaluable. They will often be members of mutual aid groups like Cocaine Anonymous, Narcotics Anonymous or SMART Recovery.
Another interesting theme is the relationship between sexual compulsion and the use of euphorogenic drugs. Did compulsive behaviour precede drug use? What about the effect of chemsex on intimacy and relationship?
I have a question that lingers in my mind about the increased incidence of addiction in LGBT populations and the harmful consequences of chemsex in this paper. It’s: ‘why has the phenomenon developed?’ Another recent peer-reviewed paper put forward a theory that touches on this.
In a study of 389 gay, lesbian and bisexual men and women it was found that problematic alcohol and substance use were positively related to shame and internalised heterosexism. This has been found before, and even if it is relevant in this context, it won’t be the only issue. However if stigmatisation, shaming and marginalisation of LGBT groups are at least in part related to substance use and related harms then part of the solution will lie in addressing them.
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