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Toolkit-On-Chemsex.Pdf 1 Introduction The US government released data in July 2019 on deaths from drug overdoses that at first glance appears optimistic: total drug overdose deaths in America were down by 5% in 2018, the first drop in nearly three decades.i A 5% decrease in drug overdoses is certainly a success, but that number doesn’t tell the whole story. While the data does show that fewer people died from prescription opioids in 2018, it also shows that more people are dying from fentanyl and methamphetamine in the US. In fact, the latest statistics from the Centers for Disease Control and Prevention (CDC) reveal a nearly 21% rise in deaths involving methamphetamine – from 10,749 in 2017 to 12,987 in 2018.ii Correspondingly, data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) in their annual survey on drug use show significant increases in methamphetamine use in adults over the age of 26.iii With much of the federal and state response to the overdose crisis focused on prescription opioids and heroin, many harm reduction-focused organizations find themselves responding to an evolving crisis without the institutional and financial support they need. As trends shift from heroin and fentanyl to cocaine and methamphetamine, it is critical that education and resources be available for people who use drugs as they transition from one substance to the next. As the administrator of the Syringe Access Fund, AIDS United receives information from grantees around the country, including details on what drugs are being used and what participants are asking of service providers. Additionally, staff interact with organizations on a global stage, learning about global trends and responses in other countries. A significant number of Syringe Access Fund grantees have shared concerns about being able to respond to an increase in people who use stimulants in their communities, particularly around sexual activities. We have received questions about booty-bumping and supplies for a kit, how to reach communities of men who have sex with men who are engaged in chemsex, and what supplies and resources to have available for sex workers using stimulants. As providers of harm reduction services, we have an obligation to ensure adequate resources for all clients. Resources on chemsex have mostly come from our friends in Europe. While valuable, their experiences are specific to their communities and the laws of their countries. Additionally, these resources often limit their scope to men who have sex with men, ignoring the fact that other communities also engage in chemsex. This toolkit is designed to give harm reduction organizations and syringe services programs an overview of chemsex, including the communities impacted and the range of use; a description of the different substances being used, including their effects, what to expect when using, and how to stay safe; a summary of education to provide participants, the importance of peers, harm reduction strategies, and the role technology plays in chemsex. We have also designed appendices that include a menu of kits that harm reduction programs can put together for participants, a glossary of common terms used in chemsex, and a guide to chemsex party planning. 2 Table of Contents Introduction ..................................................................................................................................................................................... 2 Chemsex .......................................................................................................................................................................................... 4 What are we talking about? ........................................................................................................................................................ 4 Who is impacted? ........................................................................................................................................................................ 4 What is the range of use? ............................................................................................................................................................ 5 Substances ....................................................................................................................................................................................... 6 Crystal Meth ................................................................................................................................................................................ 6 MDMA ......................................................................................................................................................................................... 6 Alkyl Nitrites (Poppers) ................................................................................................................................................................ 7 Ketamine ..................................................................................................................................................................................... 8 GHB/GBL ...................................................................................................................................................................................... 9 Mephedrone ................................................................................................................................................................................ 9 Service Provision............................................................................................................................................................................ 10 Program Development .............................................................................................................................................................. 10 General Services ........................................................................................................................................................................ 10 Harm Reduction Strategies ............................................................................................................................................................ 12 General Risks ............................................................................................................................................................................. 12 Injection Risk ............................................................................................................................................................................. 12 Smoking Risks ............................................................................................................................................................................ 12 Overdose/Overamping Indicators ............................................................................................................................................. 13 Harm Reduction Strategies for Chemsex................................................................................................................................... 13 Appendix I: Kit Menu ..................................................................................................................................................................... 14 Appendix II: Glossary ..................................................................................................................................................................... 15 Appendix III: References ................................................................................................................................................................ 17 Closing Thoughts ........................................................................................................................................................................... 18 3 Chemsex What are we talking about? Chemsex is the consumption of substances to facilitate or enhance sexual activity. Multiple substances are often combined to shift boundaries, delay orgasm, extend sexual encounters for hours or days, and intensify sex. Commonly used substances include cocaine, ecstasy, MDMA, speed, crystal meth, GHB, GBL, ketamine, mephedrone, alkyl nitrites (poppers), and alcohol. Men who engage in chemsex sometimes also use erectile dysfunction drugs to counter the effects of some of the substances. In Europe and Asia, a public health chemsex response is identified quite plainly as an integral part of HIV prevention. In the US, the primary focus is confined to crystal meth use and infectious disease prevention within that community of people who use drugs. Organizations should consider expanding their resources and educational materials to incorporate all commonly used chemsex substances. It is important to remember that many established forms of support for people who use crystal meth – such as substance use disorder treatment and 12 step support groups – fail to incorporate gay sex, hook-up culture, hook-up apps, gay shame, HIV stigma, and societal or internalized homophobia as part of their care package. For harm reduction community-based organizations, having staff or volunteers knowledgeable in these areas is critical to supporting these communities. Words/Phrases Commonly Who is impacted? Used to Describe Chemsex: There are many different people who may engage in chemsex, with the two primary communities being men who have sex with men (MSM)
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