We have few hard data on
current trends, only increases in demand noticed by some London agencies.
Flick Thorley is the clinical
nurse specialist for HIV and mental health at the Chelsea
and Westminster Hospital
in London. A
soon-to-be published survey found that 25% of gay men attending the Chelsea and Westminster
Hospital’s sexual health
clinic said they had used crystal. More data will be published soon.
She doesn’t feel that much
could have been done to prevent the current increase in use, but sees an urgent
need for new types of services to help increasing numbers of meth casualties.
“I don’t see people until
they’re really on their knees,” she says. “By the time people come here they
may be displaying overt psychosis or their social network has completely
disintegrated.
“Drug projects in the main do
not see many gay men, and they’re also not used to dealing with a situation
where sex and drug addiction are reinforcing each other.”
She is also concerned that
gay meth users are moving rapidly from smoking the drug to injecting it – as
happened in Australia.
One co-infection specialist told HTU he
thinks that a significant proportion of hepatitis C co-infections in gay men
may be due to injecting drugs.
The message has now got
through to health charities. Gordon Mundie, gay men’s group worker at the
Terrence Higgins Trust (THT), is one
of a new generation of gay men’s health workers who have started to witness
increasing damage.
“THT was running a group for
gay men with drug problems called Are You
Losing Control? till the end of last year, when it lost funding. It wasn’t
aimed at meth users but suddenly they started to dominate – at one point we had
a group of eight, five of whom were injecting meth users.
“Men are not reporting
problematic use till it’s way out of control. They don’t believe they can talk about drugs to HIV workers,
they don’t want it on their records, and criminalisation of HIV transmission
comes up regularly as a reason not to talk. I think there’s a clear discrepancy
between the numbers…reporting problems and actually having ones.”
A particular problem,
explains Mundie, is combined use with the drugs GHB and GBL
(gamma-hydroxybutyrate and gamma-butyrolactone). You can’t sleep on crystal but
you may be able to if you add GHB, and it can take the edge off meth paranoia. Unlike
methamphetamine, GHB and GBL produce physical dependency and withdrawal
symptoms. Some of the symptoms experienced by meth users in crisis may be
caused by GHB withdrawal.
There are signs that
statutory agencies are now responding and THT
is putting together a proposal for funding for a much more comprehensive
counselling, support and recovery programme for gay men, which will include
measures not previously considered necessary for the gay community, such as
residential drug rehabilitation. “Should we have anticipated this before?”
Mundie asks. “Absolutely.”
The proportion of gay men
turning up at Antidote, the LGBT service at the Hungerford Drug Project in London, who cite crystal
as their main problem is increasing. The project has been in talks with the
police and the Home Office about how to handle the growing problem and, like
THT, are hopeful of more government support.
I talked there to Monty
Moncrieff, client services manager, and David Stuart, a volunteer who works
with men with meth problems.
Between 2005 and 2008, the
number of men contacting Antidote with drug problems increased by 42%. 2005 was
the first year any of them cited meth as the problematic drug: 5% of the total.
By 2008 this had tripled to 15% and by September 2009 this had gone up to 20%
of clients. Since then, the proportion with meth as their main problem has continued
to climb.
David explains: “Meth is not
a drug men use to deal with shyness or social unease, as they might with
cocaine. It’s all about gay men’s feelings of sexual inadequacy.” The ‘benefit
trap’ generation of HIV-positive gay men, dealing with unprocessed grief,
deskilling, lost opportunities and stigma, is particularly vulnerable.
Antidote thinks there’s room
for differing, harm reduction messages in meth education and doesn’t support
the ‘total abstinence and nothing but’ line.
“You need information on meth
for people contemplating its use, not glamorising it or frightening people, but
emphasising its dangers. But once someone has started using, no amount of horror
stories in themselves will stop people using it. Users will feel it doesn’t
apply to them. They’ll think ‘I know more about this drug than any pharmacist’.
In gay society there’s a stigma about not being able to ‘handle your drugs’,
and they’ll just think ‘No way am I one of those sad losers’.”
The method Antidote has
adopted so far is essentially a slow process of socialisation.
David says: “Gay men take it
initially so they can lose their inhibitions about connecting with other gay
men and yet ironically, more than any other drug, meth isolates its users. Our
users usually turn up sober – and devastated. Shame is a major barrier.”
Monty says: “What we do is
provide a space where they can experience being normal and calm again. We offer
support groups, massage so they can experience non-sexual touch, just a space
for people to be. At first many users are paranoid and don’t want to socialise.
Gradually they’ll start talking about their experiences. There will likely be
many relapses before people stop using. We help them plan for trigger times
like public holidays.”
Learning to have
non-drug-fuelled sex is the worst problem facing many users, because sexual
attraction will set off cravings. “Many people abstain and only slowly learn
about being able to combine sex with an intimacy they might never have had,”
says David.
They don’t see shortcuts to
reducing meth use. “Ultimately, the only answer is to have a more esteemed and
confident gay community.”