1 2 Sexualised Drug Use and Other Addiction Issues Journal Club 7 Oct 2020 Loretta Healey, Senior Counsellor Yen Li Lim, Registrar RPA SHC 3 Sexualised Drug Use (SDU) - Definition Use of drug in a sexualized context Any illicit drug just before or during sex Alcohol and Drug Foundation (ADF) “ Drug Wheel” https://adf.org.au/drug- facts/#wheel 4 Chemsex (subset of SDU) Socially constructed concept Subject to preferences of participants, popularity and availability of specific drugs Chemsex behaviours are described as the use of specific drugs before or during planned sex to facilitate, initiate, prolong, sustain and intensify the encounter (Public Health England, 2015) 5 Chemsex has negative connotations for many health workers Associated with : High risk drug/sexual behaviour & increased transmission risk of HIV, STI and BBV Use of crystal associated with our problematic HIV patients 6 Articles Associations with drug use and sexualised drug use among women who have sex with women (WSW) in the UK: Findings from the LGBT Sex and Lifestyles Survey. Hibbert M.P., Porcellato L.A., Brett C.E., Hope V.D. Int. J Drug. 2019. Chemsex behaviours among men who have sex with men: A systematic review of the literature. Steven Maxwell, Maryam Shahmanesh, Mitzy Gafos. Int J Drug Policy 2019 Jan;63:74-89. Destabilising the ‘problem; of chemsex: Diversity in settings, relations and practices revealed in Australian gay and bisexual men’s crystal methamphetamine use. Kerryn Drysdale et al International Journal of Drug Policy, 78 (2020): 1-7. ‘Sex, drugs and social connectedness: wellbeing among HIV-positive gay and bisexual men who use party-and-play drugs.’ Jennifer Power et al, Sexual Health, 2018, 15, 135-143 The sexualised use of cannabis among young sexual minority men: “I’m actually enjoying this for the first time” Natasha Parent et al, Culture, Health & Society May 2020 1-16. 7 Substance Use in Women Research Report. National Institute on Drug Abuse, Apr 2020. M > F M = F F > M All types of illicit drugs Develop More susceptible to craving and Illicit drug use -> ED substance relapse. visits/OD deaths abuse disorder Higher rates of dependence Similar Stimulants : More sensitive to effects on illicit drugs & ETOH increases in of cocaine & reinforcing effects. aggression Taken to inc energy, dec exhaustion, with MDMA weight loss High rate of co-occuring depression Marijuana use higher. Assoc Marijuana taken for panic attacks, with other substance anxiety. use/personality disorders Alcohol binge drinking Self-medicate with prescription opioids (w/o prescription) for pain, anxiety. Misuse of CNS depressants ?sec inc prescriptions 8 9 Articles Associations with drug use and sexualised drug use among women who have sex with women (WSW) in the UK: Findings from the LGBT Sex and Lifestyles Survey. Hibbert M.P., Porcellato L.A., Brett C.E., Hope V.D. Int. J Drug. 2019. Chemsex behaviours among men who have sex with men: A systematic review of the literature. Steven Maxwell, Maryam Shahmanesh, Mitzy Gafos. Int J Drug Policy 2019 Jan;63:74-89. 10 Associations with drug use and sexualised drug use among WSW Aim : factors assoc with drug use & SDU among WSW Study : observational, cross-sectional. (Can’t determine causal r/p) Method : UK participants 6/52 Apr-Jun 2018. Survey advertised online through social media (Fb) with entry to competition for Amazon voucher. Univariate and multivariate analysis used Inclusion criteria : UK residents, >age 18, WSW, Drug use. Bias : self selection bias – cohort IT savvy, reward motivated, English 1st language. 11 Groupings Participants were first asked if they had taken any of the 14 listed substances in the past 12 months. SDU : had stated they had been under the influence of cannabis during sex in the past 12 months OR stated having taken amphetamine, cocaine, crack cocaine, ecstasy, heroin, GHB/GBL, ketamine, mephedrone, methamphetamine, Viagra or other erectile dysfunction drug, poppers, OR another unspecified drug just before or during sex in the past 12 months. Chemsex : grouping created for the drugs associated with chemsex - ie those reporting the use GHB/GBL, ketamine, mephedrone and/or methamphetamine just before or during sex. 12 Results Total Completed Survey Participants : 3676 WSW : N=1501 (mean age = 28.9, 97% white ethnicity). Any drug use (DU): N= 583 (39% of total) SDU : N = 258 (17% of total) 13 Results - Factors associated with drug use identifying as queer (aOR = 1.86, 95%CI 1.08, 3.23), younger age (aOR = 0.96, 95%CI 0.95, 0.98) being born outside the UK (aOR = 1.75, 95%CI 1.15, 2.66) recent sexual assault (aOR = 2.35, 95%CI 1.43, 3.86) > = 5 female sexual partners (aOR = 3.81, 95%CI 1.81, 8.01) and psychological distress (aOR = 1.75, 95%CI 1.15, 2.67) 14 Results - Factors associated with SDU identifying as bisexual (aOR = 2.55, 95%CI 1.69, 3.86) > = 5 female sexual partners (aOR = 4.50, 95%CI 1.91, 10.59) highest education achieved at 16 yo or lower (aOR = 2.46, 95%CI 1.24, 4.90) 15 Discussion Most common drug – cannabis Higher levels of ecstasy & cocaine use vs Australian LBQ women (Mooney-Somers et al, 2019) No methamphetamine use Smaller proportion of WSW use drugs assoc with chemsex vs MSM WSW range of negative experiences in relation to DU & SDU Research not representative of all LBGTQI people Be aware of potentially compounding factors related to drug use among WSW (SA & psychological distress) 16 Chemsex behaviours among men who have sex with men: A systematic review (2019) 1st systematic review on chemsex behaviour Exclusively incorporates and examines research on chemsex drug use before or during sex AIM Comprehensively analyse the behaviours involved in chemsex activities including risks to participants. inform the development of evidence-based risk reduction strategy provide recommendations for further research. 17 PICO Population – MSM Intervention – Chemsex Comparator – No chemsex Outcome – Assess ABC of chemsex behaviour 18 Topics + ABC framework to structure results Prevalence and type of non-injective drugs Prevalence and type of injecting drug Drug use settings Sexual behaviour Biomedical risk reduction interventions Socio-demographics of participants Role of HIV status Expectations of the event Biological impact Psycho-social impact 19 Methods – Eligibility & Search studies of chemsex behaviours that involve drug use before or during sex any one of the following drugs: methamphetamine, mephedrone, GHB/GBL, cocaine and ketamine. studies of primary research from high income countries published in peer review journals in the English language between 1st of January 2000 and 1st of September 2018 4 databases : Medline, CINAHL, Web of Science and CENTRAL. 3 researchers applied inclusion & exclusion criteria Study data extracted onto structured data extraction template. 20 N = 38 Qualitiative = 8 Cross section = 26 Case note = 2 Observational cohort = 1 Exploratory = 1 21 Positives Clear objectives Defined sample being recruited Defined exposures/outcomes Appropriate methodology for data analysis. Clear recruitment strategy Justified the data collection methods Secured ethics approval Described a rigorous analysis methodology Provided the findings in a clearly structured format 22 Negatives Quantitative cross-sectional and case note review studies Risk of bias assessment in individual studies Difficult to assess heterogeneity across the studies due to quantitative cross-sectional nature Unable to determine causal relationships Did not provide a sample size justification Only measured the exposures once Excluded low/middle income countries Excluded non-English articles 23 Discussion HIV is a key influencer Affects likelihood of engagement in chemsex Affects the event behaviour HIV transmission can be a potential consequence Prevalence of chemsex ~ 15% But this varies between & within countries Drugs used vary by geographical location Limiting our ability to generalise findings 24 Discussion 2 MSM who combine chemsex drugs with sex are engaging in high risk sexual behaviours, including CAI and esoteric acts. substantive evidence in this review to demonstrate that some HIV negative MSM who participate in chemsex will engage in CAI. correlates with the review’s findings MSM who combine drugs with sex are more likely to engage in high risk sexual practices when compared to MSM who do not combine drugs with sex 25 Discussion 3 Studies in this review did not focus on injecting drug use. Evidence is that this is a small minority in SDU high risk chemsex behaviours puts participants at increased risk of acquiring STIs/HIV the majority of the evidence base regarding the risk of STIs and HIV is associative 26 Discussion 4 between 14%–25% of chemsex participants have experienced a negative impact on their psycho-social functioning. Wider literature provides evidence demonstrating – higher frequency of the drug use -> more detrimental the impact is on psycho-social well-being of the user (esp if poly-drug use) biological risk for poly-drug users who use different substances which can create highly toxic and dangerous reactions in the body. evidence for the impact of chemsex behaviours on psycho- social well-being is weak 27 Discussion 5 V limited evidence suggests chemsex participants are more likely to access PEP and PrEP compared to MSM who do not engage in chemsex “The new MTV generation” (Australian study, (Hammoud, Vaccher et al., 2018) - highlighted that the concurrent