Dr Selena Singh. Guy s and St Thomas NHS Foundation Trust, London THIRD JOINT CONFERENCE OF BHIVA AND BASHH 2014

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2 THIRD JOINT CONFERENCE OF BHIVA AND BASHH 2014 Dr Selena Singh Guy s and St Thomas NHS Foundation Trust, London 1-4 April 2014, Arena and Convention Centre Liverpool

3 Selena Singh Paul Dargan, Laura Hunter, David Wood, Julie Fox

4 Background Recreational drug use (RDU) is common among MSM Significant public health problem Anonymous survey data showed that both lifetime and last month RDU was more common in MSM than non-msm attending our sexual health clinics 1 1: Hunter et al Recreational drug use in men who have sex with men (MSM) attending UK sexual health services is significantly higher than in non-msm Postgrad Med J :

5 N=2,248 Prevalence of RDU and polydrug use extremely high RDU strongly associated with : Younger age Non-adherence to ARVs High-risk sex, including group sex, multiple sexual partners, unprotected AI

6 Background Increase in injecting use ( slamming ) 2 Increase in injecting use slamming % for users of crystal meth/mephedrone = 80%; 70% reporting needle sharing 75% cohort using crystal, GHB or mephedrone were HIV positive 60% report poor adherence to ARVs

7 Interactions and transmission MDMA, GHB, ketamine and methamphetamine are all partially cleared by cytochrome P450 Evidence that poppers, methamphetamine, GHB and erectile dysfunction drugs e.g. sildenafil may facilitate HIV/STI transmission for a combination of reasons

8 RDU High-risk sexual behaviour Sexually transmitted infections IV use Risk of Hep C Drug-drug Reduced interactions adherence to ARVs Treatment failure Onward transmission of HIV

9 Method Anonymous surveys were distributed to patients attending our HIV service over a 2 month period (August -September 2012) Data were collected on age, gender, gender of sexual partner(s) Main part of the survey was a predetermined list of recreational drugs Participants were asked to indicate both lifetime use and last month use of RDs Completed surveys were returned to a locked box Clinicians not aware of patient participation

10 Results 94 surveys were returned 68 (72%) were completed by men; of which 50 (74%) were MSM Mean age was 41 years Overall 63/94 (67%) reported lifetime RDU 32/94 (34%) reported last month RDU MSM were significantly more likely to report lifetime RD than non-msm (p=0.001)

11 Results Last Month Use Lifetime use MSM Non- MSM p-value MSM Non-MSM p-value Poppers 24% 10.3% % 28.2% <0.01 Cocaine 18% 5.1% % 28.2% <0.01 Cannabis 14% 5.1% % 28.2% 0.02 MDMA pills 8% % 17.9% <0.01 Viagra 14% 7.7% % 17.9% <0.01 Ketamine 10% 2.6% % 15.4% <0.01 MDMA powder 8% % 10.3% <0.01 Mephedrone 16% 7.7% % 17.9% <0.01 GHB 6% 2.6% % 15.4% 0.02 GBL 12% 5.1% % 7.7% <0.01 Crystal 10% 0 < % 7.7% <0.01 Methamphetamine Amphetamine 0 0 n/a 32% 7.7% <0.01 Crack 2% 5.1% % 12.8% NS LSD 0 0 n/a 6% 10.3% 0.03 Heroin 0 0 n/a 6% 5.1% 0.4

12 RDs associated with slamming Last Month Use Lifetime use MSM Non- MSM p-value MSM Non-MSM p-value Ketamine 10% 2.6% % 15.4% <0.01 Mephedrone 16% 7.7% % 17.9% <0.01 GHB 6% 2.6% % 15.4% 0.02 GBL 12% 5.1% % 7.7% <0.01 Crystal 10% 0 < % 7.7% <0.01 Methamphetamine Amphetamine 0 0 n/a 32% 7.7% <0.01

13 RDs associated with slamming Last Month Use Lifetime use MSM Non- MSM p-value MSM Non-MSM p-value Ketamine 10% 2.6% % 15.4% <0.01 Mephedrone 16% 7.7% % 17.9% <0.01 GHB 6% 2.6% % 15.4% 0.02 GBL 12% 5.1% % 7.7% <0.01 Crystal 10% 0 < % 7.7% <0.01 Methamphetamine Amphetamine 0 0 n/a 32% 7.7% <0.01

14 RDs associated with sexual disinhibition / group sex Last Month Use MSM Non- MSM Lifetime use p-value MSM Non- MSM p- value Ketamine 10% 2.6% % 15.4% <0.01 MDMA powder 8% % 10.3% <0.01 Viagra 14% 7.7% % 17.9% <0.01 Mephedrone 16% 7.7% % 17.9% <0.01 GHB 6% 2.6% % 15.4% 0.02 GBL 12% 5.1% % 7.7% <0.01 Crystal 10% 0 < % 7.7% <0.01 Methamphetam ine Amphetamine 0 0 n/a 32% 7.7% <0.01

15 RDs with potential ARV interactions Last Month Use Lifetime use MSM Non- MSM p-value MSM Non-MSM p-value MDMA pills 8% % 17.9% <0.01 Viagra 14% 7.7% % 17.9% <0.01 Ketamine 10% 2.6% % 15.4% <0.01 MDMA powder 8% % 10.3% <0.01 Mephedrone 16% 7.7% % 17.9% <0.01 GHB 6% 2.6% % 15.4% 0.02 GBL 12% 5.1% % 7.7% <0.01 Crystal 10% 0 < % 7.7% <0.01 Methamphetamine Amphetamine 0 0 n/a 32% 7.7% <0.01

16 Comparison to population level data Crime Survey England & Wales (CSEW) collates data annually on illicit and recreational drug use in adults Approximately randomly selected households across England and Wales Not all RDs covered in our survey included in CSEW

17 Comparison to CSEW data Last Month Use MSM Non-MSM CSEW data Cocaine 18% 5.1% 1.9% Cannabis 14% 5.1% 6.8% MDMA 8% 0 1.3% Mephedrone 16% 7.7% 0.5%

18 Key findings Overall, RDU was common, particularly in MSM Use of cocaine and mephedrone by non-msm was higher than background population Although our sample size is small, we were able to show statistically significant difference in lifetime use of cocaine, MDMA, ketamine, mephedrone, crystal methamphetamine, GBL and Viagra in MSM as compared to non MSM

19 Recommendations RDU should be routinely addressed by HIV clinicians Patients should be informed of the risks associated with RDU Links with club drug services Access to risk-reduction counselling +/- injection paraphernalia ( slamming packs ) should be available

20

21 Acknowledgements Patients of Harrison Wing, St Thomas Hospital Harrison Wing reception staff Dr Julie Fox Dr Paul Dargan, Dr Laura Hunter, Dr David Wood

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