The blog of Monty Moncrieff
London Friend Chief Executive
25th July 2013: The Tina arena - the rise of crystal meth in London
This morning sees the second report in 6 months in one of the leading medical journals The Lancet on the link between new HIV infections and the use of party drugs. New cases are up more than 20% on last year, a trend we’ve feared based on the men accessing our specialist support service Antidote for support around their drug use. One drug in particular is dominating in this trend – crystal methamphetamine. It is, our service users tell us, a drug which makes them feel sexually disinhibited and incredibly horny. It allows them to escape some of the more difficult aspects of their lives, many dealing with the conflicting emotions of sexual identity. It’s also a drug they associate with lots of sex, often without condoms, and one which our HIV+ clients regularly cite as a factor in them becoming positive.
I’ve been following this drug in the UK for over a decade since I first set up Antidote in 2002 when it was managed as part of Turning Point’s Hungerford Drug Project. I brought together the 90s collective Project LSD (who had led the LGBT sector’s response by doing outreach in clubs) with the LGB Alcohol Service then a part of ACAPS in Brixton. Together as Antidote we had for the first time a dedicated drug and alcohol service for LGBT people. We began to see very different patterns of drug use than most mainstream substance misuse services; we saw alcohol, powder cocaine, some ketamine and the occasional person who’d been doing too many ecstasy pills. Other services were still largely working with heroin and crack users, though we saw very little of this.
The substance misuse sector – and the LGBT community – began to hear rumblings of a ‘new’ drug: crystal. It had begun to cause significant problems in parts of the world – America and Australia being the worst affected. Gay clubs were swamped by it and the scene had become more introverted and sexually motivated. In wider society the drug had ravaged poor communities. It was, we were told, going to be the next crack.
In the UK the media lapped his up, particularly the gay angle. One of the earliest pieces of research in London carried out with gay men using gyms threw up the shocking newspaper headline “1 in 5 gay men using deadly drug”. (Closer examination of these findings showed the sample to already be high users of other drugs with 90% reporting other use. The 1 in 5, or 20% figure was those of this sample who had ever tried crystal, only 5% had used it more than once, and only 1% were using semi-regularly.) Scare stories started to appear, preferring a sensationalist angle to the facts. I did countless interviews with my input reduced to misquotes or complete omission. HIV organisations came under a barrage of complaints for not responding to a ‘growing crisis’. Well-intentioned campaigners presented a shock-tactics angle, one that has been proven to be ineffective with drug users. But still we hadn’t seen a single service user who had taken the drug. Everyone had now heard about the drug and had an opinion on it (and some were arguably now more interested to try it) but the truth is we just weren’t really seeing it here yet.
I wasn’t about to do nothing though. I educated myself and our staff and volunteers on the drug and the patterns being seen around the world so that we could be ahead of the game should we need to be. Antidote became one of the first UK services providing training courses on methamphetamine, often talking to mainstream drug agencies who like us were yet to see any users but were similarly concerned by global trends. I took part in a Q & A after a screening of the documentary Meth at the Lesbian & Gay Film Festival with little to really say about the UK context. We continued to respond to media requests but with no real news on the drug and no users to parade through their publications mainstream interest dropped off.
Use begins to increase
We began to see the first users trickle in around 2006, at first people for whom their overall drug use had become too much, almost all of whom had been living in the USA or Australia and for whom crystal was just one of several drugs they had used. Around 2009 we began to see patterns forming with men telling us they were using with groups of other men in people’s homes. Soon afterward we were hearing more stories of people injecting the drug, an enormous threshold to cross for a community which had held this as a taboo. As more and more men started coming to the service for support our staff and volunteers found themselves at the forefront of a revolution in drug trends for gay and bisexual men, but with the knowledge we had gained we had a head start at least in delivering support. What we still lacked was the resource to develop an awareness campaign, although we spoke as much as we could to the media and continued to provide training to other substance misuse and sexual health professionals on what we were seeing.
In 2011 we developed a partnership with the Club Drug Clinic which was also responding to increased incidence of drug use in sexual health settings. This innovative new service allowed us to refer our clients into medical and psychiatric support which we were beginning to increasingly see the need for whilst we continued to provide talk-therapies and group support. The Clinic is not LGBT exclusive, but around 75% of their clients are gay or bisexual men. They see virtually no crystal use in heterosexual clients but along with G (GHB/GBL) it is the main problem substance for gay men.
As the trend continued and the sexual link became more pronounced we began to think about new ways to deliver our services. We piloted Code, a clinic for men using drugs for sex with 56 Dean Street. Working in a sexual health setting gave us access to a different group of men. Those coming to our drug services tended to be in crisis, but here their pressing issue was usually a symptomatic sexually transmitted infection or needing to take a course of PEP, the post-exposure treatment after an HIV risk. We had high disclosure of drug use but were able to deliver a preventative intervention, using motivational techniques to help men identify where their drug use and sexual behaviour might become more problematic. This approach has been acknowledged by HIV Prevention England, choosing us to become a delivery partner allowing us to extend the Code approach and expand into work with the Mortimer Market Centre.
The rise in use is now starting to be seen in mainstream drug services, although once again seems to be limited to gay and bisexual men. We’ve been working with many of these services, providing training to help them address the new trends they’re seeing and deliver support in a more LGBT-competent environment. As numbers continue to increase the challenge is now for policy makers, commissioners and local director of public health to find effective solutions which address substance misuse, sexual health and HIV prevention together in LGBT-specific services – only 12% of Antidote clients tell us they would be comfortable accessing mainstream support, citing safety and awareness of LGBT issues as the major factor for choosing us.
London Councils is currently consulting on the future of HIV prevention across the capital. I firmly believe we need to take a pan-London approach to this, the localism agenda does not serve LGBT populations well. Small providers like ours lack the capacity to make the case to 33 local authorities and then manage interventions aimed only at their local residents. Commissioning structures need to find ways of pooling scant resources for specialist centres of excellence that offer expertise, experience and confidence to men already fearful of being judged and stigmatised that their needs will be understood and that they will feel safe within services.