Louisa Degenhardt, David McGuigan & Stevie Clayton Rapid assessment of crystal methamphetamine and GHB use in the gay, lesbian, bisexual and transgender community in New South Wales NDARC Technical Report No. 235 RAPID ASSESSMENT OF CRYSTAL METHAMPHETAMINE AND GHB USE IN THE GAY, LESBIAN, BISEXUAL AND TRANSGENDER COMMUNITY IN NSW Louisa Degenhardt, David McGuigan and Stevie Clayton NDARC Technical Report No. 235 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia and The AIDS Council of New South Wales (ACON) ISBN 0 7334 2290 X ©NDARC 2005 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. All other rights are reserved. Requests and enquiries concerning reproduction and rights should be addressed to the information manager, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. TABLE OF CONTENTS List of figures.................................................................................................................................ix Abbreviations..................................................................................................................................x Acknowledgements.......................................................................................................................xi 1. Introduction...........................................................................................................................1 1.1. GHB ..............................................................................................................................2 1.1.1. Changes in availability of GHB ........................................................................2 1.1.2. Epidemiology of use...........................................................................................3 1.1.3. Acute negative side effects ................................................................................5 1.1.4. Overdose..............................................................................................................6 1.1.5. Dependence.........................................................................................................9 1.1.6. The use of GHB in suspected cases of sexual assault................................ 10 1.2. Crystal methamphetamine....................................................................................... 11 1.2.1. Changes in availability of crystal methamphetamine.................................. 12 1.2.2. Epidemiology of use........................................................................................ 13 1.2.3. Desired effects.................................................................................................. 14 1.2.4. Acute negative side effects ............................................................................. 14 1.2.5. Neurotoxicity.................................................................................................... 15 1.2.6. Psychosis ........................................................................................................... 16 1.2.7. Dependence...................................................................................................... 17 1.2.8. Sexual risk behaviours..................................................................................... 18 Changes in the availability of methamphetamine ..................................................... 19 Effects of the drug ........................................................................................................ 20 Motivations for use ....................................................................................................... 20 Individual factors........................................................................................................... 20 Changes in HIV epidemiology and perceptions of HIV risk ................................. 21 1.2.9. Impact upon HIV positive persons .............................................................. 22 Motivations for use ....................................................................................................... 22 Interaction with antiretroviral medication ................................................................. 23 Impact upon treatment effectiveness ......................................................................... 23 Synergy of neurotoxic effects ...................................................................................... 24 2. Trends in use in the GLBT community in NSW.......................................................... 25 2.1. Trends in GHB use .................................................................................................. 26 vi 2.2. Trends in GHB-related harm.................................................................................. 28 2.2.1. Overdose........................................................................................................... 28 2.2.2. Dependence...................................................................................................... 29 2.3. Trends in crystal methamphetamine use............................................................... 30 2.4. Trends in crystal meth-related harm ...................................................................... 34 2.4.1. Psychosis ........................................................................................................... 34 2.4.2. Dependence...................................................................................................... 35 2.4.3. Sexual risk behaviours..................................................................................... 36 Trends in sexual risk behaviours................................................................................. 36 Trends in drug use and sexual risk.............................................................................. 37 Trends in sexually transmitted infections .................................................................. 39 Trends in HIV notifications ........................................................................................ 41 2.4.4. Impact upon HIV positive persons .............................................................. 42 3. Interventions....................................................................................................................... 43 3.1. GHB ........................................................................................................................... 43 3.1.1. Demand reduction and harm reduction....................................................... 43 3.1.2. Management of overdose ............................................................................... 46 3.1.3. Treatment of dependence and withdrawal................................................... 48 3.2. Crystal methamphetamine....................................................................................... 49 3.2.1. Education and harm reduction ...................................................................... 49 3.2.2. Management of psychosis............................................................................... 53 3.2.3. Treatment of dependence............................................................................... 53 Current treatment provision in NSW......................................................................... 54 4. Implications and future directions................................................................................... 57 4.1. Research ..................................................................................................................... 59 4.1.1. Epidemiology of use........................................................................................ 59 4.1.2. Related harms................................................................................................... 60 4.2. Demand reduction and harm reduction................................................................ 61 4.2.1. GHB .................................................................................................................. 61 4.2.2. Crystal methamphetamine.............................................................................. 62 4.3. Capacity and skills increase for health professionals ........................................... 63 4.4. Treatment options .................................................................................................... 64 5. Summary and conclusions ................................................................................................ 65 6. References........................................................................................................................... 67 vii Appendix A: Forums addressing crystal meth........................................................................ 83 September 29th 2004: Community forum............................................................................ 84 November 3rd 2004: Community forum II......................................................................... 87 November 4th 2004: Service Providers and General Practitioners forum...................... 89 May 19th 2005: Family and Friends forum.......................................................................... 90 Appendix B: Contacts and web links ......................................................................................