David Stuart from Antidote comments for PinkNews on a recent report concerning the increased use of crystal meth throughout London’s gay scene.

The data published recently from London Friend’s Antidote drug and alcohol service about gay men, sex, drugs, and the sexual health consequences has caused some stir amongst health services as well as in the press, with responses ranging from alarm and concern to criticisms of alarmist, biased monitoring of data. There’s one thing that cannot be disputed however, and which bonds in common the gay communities in all the larger cities in the western world; crystal meth is arguably becoming a normalised part of the gay sexual experience, and is wreaking havoc on individual lives, communities, infiltrating our online “hook-up” experience, impacting sexual health services and contributing the spread of HIV and Hep C.

There are other concerns too, that are perhaps more London-focused; GHB/GBL (while also used for sex) is also becoming normalised in our dance clubs, with ambulances parked outside Vauxhall venues becoming a normal sight, and (as reported last year) deaths in saunas and clubs being far too frequent. Mephedrone too, is becoming a more commonly used drug, and we are still learning of some of the more dangerous consequences of this; most worryingly, (short-lived) psychotic episodes, and longer term depression.

While crystal meth is a social problem beyond the gay scene in America, Australia and South Africa, in the UK it is used almost exclusively by gay men, and almost exclusively in a sexual context. An average user will be awake for two days plus, pursuing (though not always achieving!) uninhibited sexual marathons with numerous partners and very often without concern for their own health or well-being, forgetting to eat, use condoms, or take HIV medicines on time. Smoking (from a glass pipe) or, increasingly injecting, many new users are discovering this drug through hooking-up online. Though not physically addictive (a person can use crystal every day and stop suddenly without their body going into dangerous shock or needing urgent medical care), this drug has enormous potential for psychological dependency; needing the drug to feel confident, needing the drug for energy after an exhausting “bender”, needing the drug to feel horny. (Many regular users find sober sex to be a virtual impossibility without therapy.)

Similarly, Mephedrone is not physically addictive, but psychological dependency is very common. It is usually snorted as a powder in a club, but more and more people are now injecting it and using it in non-clubbing environments, increasing the amount of harms and A&E visits. Heart palpitations, panic attacks, psychosis, and extreme depressions can be common with this type of injecting use.

GHB/GBL is physically addictive; if someone uses G a few (or more) times a day for a week or so, stopping suddenly (or running out) can be fatally dangerous; at the very least, the withdrawal symptoms (panic, anxiety, delerium tremens) can be unmanageable. Urgent medical care needs to be sought, and a medicated detox regimen prescribed. G is a liquid, bought (very cheaply) online and drunk in small, measured amounts, and taken at exact time intervals to avoid a very easy overdose where a user can fall into a (sometimes) dangerous sleep. Some people even use GBL as a sleep aid, unaware that they are in fact putting themselves into a coma that they will (in most cases, but not all) wake up from without any hangover the following morning. There have been too many deaths in clubs, saunas and homes from accidental overdoses from GBL.

Three years ago, these drug problems were small in number, and I’ve been watching the epidemiology of these trends as they have increased to the worrying level they are currently at; there seems to be no sign that these trends are stabilising, but in fact increasing. The CODE clinic at 56 Dean St (for gay men who have sex on drugs) sees increasing numbers of men seeking help with drug use, PEP courses and HIV tests (from drug-fueled unsafe sex experiences); the Club Drug clinic (set up to help users of non-traditional drugs) has been getting more and more referrals of gay men from sexual health clinics and A&E departments; they will be soon broadening their services to a satellite clinic at Mortimer Market GU Centre to address this growing problem. And Antidote (LGBT drug and alcohol service) continues to see more and more gay men struggling with sex and drug problems, increased injecting use, increased HIV/Hep C diagnoses and other harms (relationships failing, debt, missing days at work, depression, isolation…)

Grouping these drugs together as a single cause of a single “gay scene” problem is unwise and too simplistic. Are the gay scene’s problems a result of the easy-availability of these drugs, or are the gay scene’s problems driving people to drugs? Is uninhibited sex a problem for gay men, and is crystal meth tapping into that? Is dancing sober a problem for gay men? Is there a lack of community cohesion that encourages us to seek hedonism and commune on a dancefloor, or are we responding to three decades of mixed messages about HIV and how we feel about sex? Does growing up gay and different somehow make us less able to sustain intimacy in relationships, and a life of drug-fueled sexual marathon sex with strangers become an alternative?

Though partying is not always self-destructive, and there’s no argument that drugs don’t simply feel good and sometimes make for better dancing and sex; at an anthropological level, I see a community self-harming, and I’m empassioned and emboldened to ask questions of ourselves and seek more holistic solutions than just simply solving a drug problem. I see Pride organisers re-grouping and re-focusing their efforts and agenda, I see sexual health services, councils, night-time economy venues, voluntary and public health organisations communicating more effectively and thinking outside traditional boxes in order to address these problems. There’s much to be inspired by and reasons to be hopeful, and I’m excited by the increased attention to these issues I see in the press; but current trends and data also provide us with a great deal to be concerned about, and I look forward to more holistic work and collaboration from our community to restore the culture of progress the global gay community has enjoyed over the last 40 years, that sadly, appears to be unraveling.

David Stuart is an Addictions Specialist at London Friend’s Antidote Substance Use service, CODE Clinic (56 Dean St NHS) and Club Drug Clinic (CNWL NHS)