THE RECENTLY LAUNCHED National Drug Strategy was welcomed by community activists this week. Having being renamed “Reducing Harm, Supporting Recovery — a health-led response to drug and alcohol use in Ireland 2017-2025”, it heralds a move away from a punishment approach to one of harm reduction and care.
While many news outlets ran with the possible decriminalisation of drugs for personal use and the introduction of legislation for supervised injecting sites, both of which are deserving of the positive attention they have attracted, there were many other positive moves included in the strategy.
We at the Gay Health Network (GHN) welcomed the strategy for being the first of its kind in Ireland to specifically mention the need for targeted harm-reduction, education and prevention measures that are tailored towards the Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) community.
Finding solace in escapism
The LGBT Ireland study released last year showed that whilst 27% of the general population have reported using any illegal drugs in their lifetime, just over half of the LGBT Ireland study sample had taken drugs recreationally during their life.
There are a multiplicity of reasons for why this is the case. Minority stress from facing societal barriers such as discrimination, stigma and family rejection is a prime example of why LGBTI people may find solace in the escapism that alcohol and drug use can offer.
Historically, bars and clubs have played a central role as a safe meeting place for the LGBTI community and have the potential to create easy access to substances also.
However, substance misuse services in Ireland are not currently properly equipped for the unique needs of our community. The typical patterns of using by LGBTI people show low levels of opiate use, which is the traditional focus of most services. Use of “club drugs” and other novel psychoactive substances (NPS) is more common among the community.
The needs of drug users from specific communities
To this end, it is particularly welcomed that the new strategy offers a commitment to improve the capacity of services to accommodate the needs of drug users from specific communities, of which LGBTI people are included. The strategy also includes an action point for the need to provide addiction supports in non-traditional settings.
Services need to ensure that LGBTI people know their service is accessible by them, and that they will be welcomed, their issues understood and their needs met. They need to know that practitioners will be experienced in working with the drugs they are more commonly using, and that they will be aware of the LGBTI cultural factors that may be associated with their using.
Staff need to feel confident in discussing drug and alcohol use connected with sexual behaviours and cultural contexts they may be less familiar with, as well as competent in addressing emerging need with less familiar drugs and NPS.
Sexualised use of drugs
The sexualised use of drugs is not particularly a new element of LGBTI life, however, the rise in popularity of a more potent set of drugs has seen the issue of chemsex arise in drug services and sexual health clinics across the country.
The Gay Men’s Health Service, Ireland’s only dedicated sexual health service for men who have sex with men, conducted a survey of attendees to create a sense of the extent of the issue among their service users.
Of the nearly 500 respondents, 27% had used at least one of Crystal Meth, GHB/GBL (“G”), Mephedrone or other NPS to facilitate sex. While 75% of men engaging in chemsex said that they enjoyed and were in control of their sex lives, 1 in 4 reported that chemsex was having a negative effect on their lives with the majority of these highlighting the need to have supports available in-house in order for them to tackle the issue.
In the same survey it was shown that “G” was the most commonly used drug for chemsex with 57% of those engaging in chemsex having used the substance within the past 12 months.
Investment is needed now
It was heartening therefore to see these statistics quoted in the strategy alongside a commitment to strengthen early harm reduction responses to current and emerging trends and patterns of drug use. Specific reference is made to the G harm reduction campaign, a joint partnership of GHN, GMHS, Drugs.ie, HIV Ireland, Gay Switchboard Ireland and HSE Sexual Health and Addiction as an example of successfully highlighting drug use patterns and issues among high-risk groups.
Similarly, inroads have been made already with HSE addiction services making both inpatient and outpatient G detoxification programmes available.
While we are pleased to see chemsex included as a topic for consideration as part of a working group examining the evidence base for early harm reduction responses to current and emerging trends, and the signalling of a widening of resource provision for services attempting to bridge the gap between sexual, mental and addiction health – the strategy as a whole does not come packaged with a budget.
In order to genuinely tackle the issues that we and other activists from disproportionately affected communities are experiencing, the government needs to properly resource the commitments they have made on paper in order to make them a reality for those who need them.
Adam Shanley is the Communications Manager with Gay Health Network, National Sexual Health Outreach worker with the Gay Men’s Health Service, he runs the KnowNow Rapid HIV testing project and is the director of Ireland’s longest running LGBT+ support service, Gay Switchboard Ireland.