與其他藥愛中使用的藥物相比,甲基安非他命有關的危害更大

 

與其他藥愛中使用的藥物相比,甲基安非他命有關的危害更大

資料來源:Aidsmap News,作者:羅傑·皮特,發布日期:2018424日,財團法人台灣紅絲帶基金會編譯

根據來自上週一間倫敦診所於愛丁堡召開的英國愛滋病協會(BHIVA)和英國性健康和愛滋病協會(BASHH)聯合會上所提交的數據顯示,在性行為場域中的男同性戀者若其性行為時使用甲基安非他命者相較於使用其他藥物,被通報有負向的心理健康影響的可能性有5倍、有15倍住院的可能性,以及感染其他性傳染病的可能性為兩倍。Mark Pakianathan博士表示,於20141月至20179月期間,所有在聖喬治醫院的性健康診所中看診的同性戀、雙性戀和其他男男間性行為者,被問及其精神健康、藥物和酒精使用、以及藥愛行為時,在接受該服務的五名同性戀男子中便有一人透露了有藥愛行為。該診所對藥愛的定義是使用以下任何一種藥物來促進或增強性能力:甲基安非他命、G(GHB / GBL)4-甲基甲基卡西酮(喵喵)、愷他命、搖頭丸、古柯鹼或安非他命。使用了前三種藥物在大多數的藥愛行為中被報告,且經常同時會有使用多種物質。

從事藥愛的男性則被問及其使用藥物所導致的不良後果和相關的危害。比較藥愛期間使用甲基安非他命的男性和使用其他藥物的男性{主要是G水如GHB / GBL4-甲基甲基卡西酮(喵喵)}:

l   任何不良後果:84%的甲基安非他命的使用者比47%的其他藥愛的受訪者

l   任何對心理健康的不良影響:66%比29

l   無法上工之時間:49%比16

l   藥物過量:34%比7

l   人際關係之後果:41%比22

l   住院率:35%比4

l   涉及刑事案件:13%比8

l   財務後果:37%比5%。

在藥愛期間使用甲基安非他命的214名男性相較於使用其他藥物者,通報其中任一危害的可能性達7倍(校正後的相對危險比為7.0,95%的信賴區間為3.7-13.4)。甲基安非他命的使用者在經歷各種危害時增加的風險具有統計學上顯著意義- 例如,發生住院可能性為15倍,發生經濟後果的可能性為13倍,藥物過量可能性為7倍。

他們也在某些行為上如採注射方式施打藥品的可能性為九倍,發生拳交的可能性為六倍和共享性玩具的可能性為四倍 - 而上述任一的行為均與C型肝炎的傳播有關。在藥愛中甲基安非他命的使用者相較其他人其從事購買或出售等交易性行為的可能性是其他人的三倍,而罹患性病的機率是其他人的兩倍。

聖喬治的臨床醫生還報告說,一個經驗證確效的篩檢工具可有效地用於藥愛從事者中,去識別其與藥物有關的問題。 DUDIT(藥物使用障礙識別測試)與AUDIT(酒精使用障礙識別測試)類似,是一系列有十一個問題,涵括詢問使用頻率、自我控制和負面後果的認知等。 DUDIT評分等於或大於6表示可能有問題的藥物使用。

在完成DUDIT問卷調查的116名同性戀男性中,有12人向臨床醫生報告了前面所提到的其中一個危害。在這12人中,11人在DUDIT上獲得了6分或更高分,這表明篩查工具是具敏感性的,即它能正確識別男性藥愛問題。然而,這工具非具特異性 - 另外14名沒有藥愛問題的男性也得分超過六分。

這表明它可能成為性健康診所的一個有用工具,可用於鑑定可能在藥愛上有困難的男性,但對於男性得分高者,則進一步的評估亦至關緊要。

線上的藥愛支持

根據會議上一份已發表的海報顯示,針對那些位於國家中沒有專門服務設施的某些人,線上的諮詢和團隊工作是有希望的方法,具有潛在能力去涵蓋這些涉及藥愛問題的男性,。

使用線上視頻會議軟體提供一對一諮詢會議和團隊工作。顧客可以從任何位置使用手機、平板電腦或電腦訪問該服務,消除地理障礙。該服務由Terrence Higgins Trust的藥愛支持網站www.fridaymonday.org.uk負責,並由倫敦的藥物使用者支持團體Antidote at London Friend提供諮詢師和治療師。

在參加團隊工作中有一半的人和參加諮詢中有三分之一的人,都是來自倫敦以外地區。這些初始參與團隊工作者當中已有四分之三的人完成了它,而初始參與諮詢輔導者中亦有96%的人完成了其過程。

大多數的顧客在針對他們用藥上的控制、性生活和生活質量方面的控制上報告了積極的結果。一位參與團隊工作的顧客說:“我最初對線上會議的工作方式有些懷疑,認為對於真正的討論和聯繫上可能有些無人情味的過於疏離。然而,事實並非如此,實際上我發現在我自己的家中隱私地和安全地進行這些會話,它讓我感覺非常舒適。

 

Far more harms associated with crystal meth than other chemsex drugs

Aidsmap News, Roger Pebody; Published: 24 April 2018

Gay men who use crystal methamphetamine during sex are five times as likely to report a negative impact on their mental health, 15 times as likely to be hospitalised and twice as likely to have a sexually transmitted infection as users of other drugs in sexual settings, according to data from a London clinic presented to the joint British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) conference in Edinburgh last week.

Dr Mark Pakianathan said that all gay, bisexual and other men who have sex with men attending the sexual health clinic at St George’s Hospital are asked about mental health, drug and alcohol use and chemsex. Between January 2014 and September 2017, one in five gay men attending the service disclosed engaging in chemsex. The clinic’s definition of chemsex is the use of any of the following drugs to facilitate or enhance sex: crystal meth, GHB/GBL, mephedrone, ketamine, MDMA, cocaine or amphetamine. Most of those reporting chemsex used the first three drugs and often used multiple substances at the same time.

Men engaging in chemsex were asked about harms and adverse outcomes associated with their drug use. The proportion reporting harms were compared between men who used crystal meth during chemsex and men who used other drugs (mostly GHB/GBL and mephedrone) during chemsex.

  • Any negative consequence: 84% of crystal meth users and 47% of other chemsex respondents
  • An impact on mental health: 66% and 29%
  • Time off work: 49% and 16%
  • Overdose: 34% and 7%
  • Relationship consequences: 41% and 22%
  • Hospital admission: 35% and 4%
  • Involvement with the criminal justice system: 13% and 8%
  • Financial consequences: 37% and 5%.

The 214 men who used crystal meth during chemsex were seven times more likely to report one of these harms than men who used other drugs (adjusted odds ratio 7.0, 95% confidence interval 3.7-13.4). Crystal meth users had a statistically significant raised risk of experiencing each of the harms – for example, 15 times as likely to be hospitalised, 13 times as likely to have financial consequences and seven times as likely to overdose.

They were also nine times as likely to inject drugs, six times as likely to fist and four times as likely to share sex toys – each of these behaviours have been associated with hepatitis C transmission. Users of crystal meth were three times as likely to buy or sell sex, and twice as likely to acquire a sexually transmitted infection as other men engaging in chemsex.

St George’s clinicians also reported that a validated screening tool for identifying people with drug-related problems appear to work well in chemsex users. DUDIT (Drug Use Disorders Identification Test) is similar to AUDIT (Alcohol Use Disorders Identification Test), being a series of eleven questions asking about frequency of use, perception of self-control and negative consequences. A DUDIT score of six or more indicates possible problematic drug use.

Of 116 gay men who completed a DUDIT questionnaire, 12 reported one of the previously mentioned harms to a clinician. Of these 12, eleven scored six or more on DUDIT, suggesting that the screening tool is sensitive, i.e. it correctly identifies men with chemsex problems. However, it was not specific – another 14 men without chemsex problems also scored above six.

This suggests that it could be a useful tool for sexual health clinics to identify men who may be having difficulties with chemsex, but that further assessment of men scoring highly on it is essential.

Online chemsex support

Online counselling and groupwork are promising approaches for men involved in chemsex, with potential to reach men living in parts of the country where specialised services are not available, according to a poster presented at the conference.

One-to-one counselling sessions and groupwork were offered, using online video conferencing software. Clients could access the service using their phone, tablet or computer from any location, removing geographical barriers. The service was hosted on Terrence Higgins Trust’s chemsex support website www.fridaymonday.org.uk with counsellors and therapists provided by Antidote at London Friend.

Half of those who signed up for groupwork and a third of those who signed up for counselling were from outside London. Three-quarters of those starting groupwork completed it and 96% of those starting counselling did so.

The majority of clients have reported positive outcomes in terms of control over their drug use, control over their sex life and quality of life. A groupwork client said, “I initially had some doubts about how the online session would work, thinking it may be a little too impersonal for real discussion and connections. This was not the case at all however, and I actually found that doing the sessions in the privacy and safety of my own home made it feel really comfortable and I felt totally at ease.”