MANY PEOPLE WHO take drugs to enhance their sexual experiences are not aware of how addictive certain substances are, an expert has warned.
Chemsex has become more common in Ireland in recent years. It involves the use of drugs such as G, crystal methamphetamine, cocaine, ketamine and mephedrone to enhance and prolong sexual activity.
The practice is usually, but not exclusively, associated with men who have sex with men (MSM).
Slamsex is the term used when the drugs are injected for a more intense high.
Experts in Ireland have raised concerns about the use of G in particular – it’s highly addictive and its potency varies greatly, increasing the risk of passing out or overdosing.
G – short for GHB (gamma hydroxybutyrate) or GBL (gamma butyrolactone) – is used socially and for the purposes of chemsex. It typically comes in a liquid form and people usually drink it.
Every year dozens of people seek help to detox from G at the Club Drugs Clinic in Dublin. Patients there are often also taking other substances, but G is the biggest issue in terms of addiction.
There have been a number of overdoses related to G in recent years but it’s very difficult to get an accurate figure as the drug usually only shows up in a person’s system for a few hours and most toxicology tests don’t screen specifically for it.
As previously reported by The Journal, it’s thought that a number of men have died after taking G but thankfully this is rare.
G clinic referrals
The Club Drugs Clinic is sometimes referred to as the G clinic as this particular drug is the most common substance patients there are trying to quit.
In 2021, 39 people attended the G clinic, 80% were male and 20% were female. The age range was 23 to 61 years.
Of this, 90% of patients took drugs at sex parties, including crack cocaine, powder cocaine, benzodiazepines, ketamine and ecstasy tablets.
In 2022, 24 people attended the G clinic, 78% male were male and 22% were female. The age range was 24 to 62 years.
Over 90% of patients used G at parties for the purpose of chemsex. Other drugs used were crystal meth, crack cocaine, cocaine powder, benzos and ketamine.
The figures for 2023 are currently being collated.
Dr Fiona Fenton, Consultant Psychiatrist in Substance Misuse at the National Drug Treatment Centre, said the vast majority of patients treated at the Club Drugs Clinic are trying to stop using G.
Many patients at the clinic started to use G recreationally but became addicted to it over time.
Fenton told The Journal: “People use it for a while and get caught up in it and don’t realise how addictive it is, that they have a problem. It’s so accessible now that they can be using it for a while before they realise. They think they can manage it, but the withdrawals are very severe.
“There are people who hold down jobs. There are people who use it at home, who use it just to relax before they go out for a night out because they find that it’s a very cheap and easy way to get a buzz or to be in a very relaxed state going out. It’s not all to do with sex parties.”
100 times worse than alcohol withdrawal
When people try to kick a serious G habit, the withdrawal symptoms can be very intense.
“It’s like a very severe alcohol withdrawal but multiply it by about 100. So it’s very severe – sweating, shaking, abdominal cramps, muscle cramps, nausea, vomiting, all of those,” Fenton explained.
“In its most severe form, they can get psychiatric problems, even psychosis. It’s what we would call an agitated delirium. When people are in that space, they need to be in hospital,” she added.
The G clinic treats people from different walks of life and backgrounds. The initial programme takes about 14 days to complete, and individualised care plans are devised depending on a person’s needs.
Fenton told us: “Normally they’d be seen on a Monday or a Tuesday, they have to attend daily. We like to start to detox at the beginning of the week, so it’s not running into the weekend – that’s a tricky time.
“They have an assessment maybe the week before, we can prepare them, we can prescribe other medication, or we can also give them advice on reducing their G use gradually themselves. We only start them on benzodiazepines to detox them if they’re in withdrawal.”
Typically, Diazepam is prescribed for those dealing with withdrawal symptoms. Aside from medical intervention, people sometimes also need therapy and social care.
“Psychosocial interventions are really important, essentially people have to change everything about their lifestyles. So the medication is really just a physical or physiological detox. The psychological support in the community is very, very important,” Fenton said.
“We offer counselling, psychotherapy, here in the National Drug Treatment Centre, and also social work. A proportion of people have needed social work involvement around welfare and housing. Sometimes people don’t participate in counselling and psychotherapy here because they have access to it elsewhere.”
Many people who attend the G clinic are referred by the Rialto Community Drug Team and receive additional support from this service.
Harm reduction
The safest approach is to not take illegal drugs but, Fenton said, simply telling people this is not effective.
“People don’t respond to you saying ‘stop using it’ so that’s not going to work, ” she said.
In terms of harm reduction, people who choose to engage in chemsex are advised to not use G or other drugs when they are alone, and to increase the dose very slowly.
“Don’t use on your own, start low and go slow, use with a friend, look out for each other,” Fenton said.
When helping people who develop an addiction, she noted that peer support is vital.
“Engaging with support, particularly the peer-to-peer support, particularly people who used it before – say, gay men who have used it before and have stopped and come out the other side – is actually what really works.”
As well as the overdose risk, she said there are obvious risks associated with having sex with unknown people and anyone engaging in chemsex should use condoms to prevent sexually transmitted infections (STIs).
Fenton and her colleagues are part of a wider Chemsex Working Group that meets every quarter. Its members include various medical experts, people who work in addiction services and groups which work specifically with individuals more likely to engage in chemsex.
Fenton said this cross-community collaboration is “essential” in responding to chemsex trends and ensuring people are getting the support they need.
HIV Ireland is a member of the working group. Adam Shanley, Programme Manager of MPOWER at HIV Ireland, said the organisation is currently developing new services related to chemsex and has hired a chemsex project coordinator.
“It’s great that we’re able to have someone dedicated to this and, with that kind of dedicated focus, be able to properly understand what the community needs and build upon that,” Shanley said.
MPower is a programme that involves peer-driven community-level interventions which aim to achieve a reduction in the acquisition of HIV and STIs, and an overall improvement of sexual health and wellbeing among gay, bisexual and men who have sex with men (gbMSM) including trans men and non-binary people.
Part of the new chemsex project will involve updating harm reduction guides and ensuring correct information is available, as well as providing support and referrals to other services as needed.
Non-judgemental services
Shanley said many people engage in chemsex and it’s important to upskill them in terms of harm reduction and recognising “potential impacts or triggers around sexual health and mental health and wellbeing”.
While Fenton and her colleagues treat people who are often in “emergency or really difficult situations”, Shanley said the MPower team is well placed to help people reduce harm at an earlier stage in the process.
The group runs workshops “where people can better understand their triggers and their use, and it allows for there to be a skill base to recognise when it’s not just the odd weekend anymore”, Shanley said.
People often get in touch with MPower or similar groups to get information and advice about their sexual health. Shanley said it’s vital that this work is done in a non-judgemental way.
The whole basis of all the work that we do is to be non-judgmental, and meet the person where they’re at. And be sex positive as well, recognising that people have a wide interest in pleasure.
“All of our staff are well skilled and best placed to offer that support and make sure that any of the referral pathways that we put people on, that we’re connecting them with culturally-competent services.”
Shanley said it’s difficult to gauge how many people overdose on G.
MPower works with a number of bars and clubs who inform the group if and when there is an overdose. This figure has remained relatively stable in the last couple of years, at least anecdotally.
However – due to the lack of research and data in relation to chemsex and G use – Shanley said there are no exact figures to work with.
In terms of any G-related deaths, he added: “Thankfully, we haven’t heard of deaths for a good while now. We’re very, very hopeful that remains the case.”
Advice and support
If someone passes out while on G:
MPower’s Sex Party First Aid Guide can be read here.
Want to talk about G use or chemsex? Here are some of the support services available:
If you’d like to speak to me about your experience of G use or chemsex, email orla@thejournal.ie
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