Health | Dr Shay
The Dangers of Recreational Drug Use in ‘Slamming’ This month, Dr Shay Keating talks about the dangers of a new trend sweeping across the UK & Ireland Since qualifying as a medical doctor almost 25 years ago, I have had two special clinical and research interests. They are HIV and sexual health, particularly in gay men, and hepatitis C in injection drug users. I have been used to some overlap - treating drug users infected with HIV - but now it would seem that I may shortly be treating another cohort, gay men who are injecting drugs, and who are acquiring hepatitis C as a consequence. ‘Chem-sex’ refers to the use of recreational drugs during sex. The term ‘slamming’ refers to the use of drugs, often by injection, during group sex parties, where gay men take drugs such as crystal meth or mephedrone to help enhance and prolong sexual activity. The drugs cause an intense high and increased libido, prolong sex, and are powerful disinhibitors, wherein users lose their inhibitions. When so disinhibited, users are more likely to engage in unprotected sex, often anal, with multiple partners. There has also been a rise in nonconsensual sex. Just as worrying, many share needles and syringes, 70 EILE Magazine
thereby facilitating the spread of blood borne viruses such as HIV or hepatitis C. Anecdotally, while actively slamming, those who are HIV positive and on HIV medications, who would have not been infectious, often stop taking their meds, and are theoretically infectious again. In the recent months, there have been reports of an increase in gay men accessing addiction services in the U.K., particularly in London, to address their chemsex drug use. The intense highs of crystal meth and mephedrone are followed by intense lows. Users describe staying awake for days at a time while coming down from the drugs, feeling paranoid and depressed. Suicides related to chem-sex drugs have been reported. Where there may not be a physical addiction to crystal meth or mephedrone, the psychological addiction is immense, and many report that ‘sober sex’- sex without chemicals - is no longer achievable. Just as worrying as the psychological morbidity are the medical consequences of intravenous crystal meth and mephedrone use. At slamming parties, many who are using these drugs do not have access to sterile needles and syringes,
even if they wanted it, and they resort to sharing with other men, often strangers. This sharing of needles and syringes has resulted in an unprecedented high in new HIV cases diagnosed in the gay community in London. It has also led to a rise in hepatitis C, an infection hitherto rarely acquired in a sexual context, apart from aggressive or invasive sex, such as fisting, which results in traumatic bleeding in the rectum and colon. Chem-sex drug use, like smoking cigarettes or drinking alcohol for the majority, is a lifestyle choice, at least in the early pre-addiction stage. As a doctor, I would like those who are slamming do so with their eyes open, informed of the clinical and psychological consequences. I would like to believe that the decision to ‘slam’ is made without duress or peer pressure. Ask any heroin user, in Ireland, how to access needle exchange programmes, and my belief is that they will all know the locations. Ask a gay man the same question, and my guess is that they will have no idea how to get their injection equipment. Ireland’s gay community needs to be ready for the wave of slamming which is, potentially, heading this way, if its not here already. Be prepared to adopt a harm minimisation policy to help halt the further spread of infection.
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