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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. This document is also available as a PDF. People who use drugs face the same risks as those of the general population and therefore need to be aware of the appropriate advice to reduce their risk of infection. They can be exposed to additional risks, however, that require developing assessment and mitigation strategies. These are linked to some of the behaviours associated with drug use and to the settings in which drug use take place, or where care is provided. Risks are increased by the high level of physical and psychological comorbidity found among some people who use drugs, the fact that drug problems are often more common in marginalised communities, and the stigmatisation that people who use drugs often experience. The current public health crisis raises serious additional concerns for the wellbeing of people who use drugs, ensuring service continuity for those with drug problems, and the protection of those offering care and support for this population. The purpose of this briefing is to highlight emerging risks linked to the COVID pandemic for people who use drugs and those providing services for them from a European perspective, and where necessary to encourage planning, review and adaption of frontline and specialist drug interventions. National and local level service reviews and updates will need to take place within the context of country-specific guidelines and rules for responding to the COVID outbreak, and the advice provided by ECDC and WHO. Top of page. Recreational drug use often takes place within settings in which individuals congregate together and drugs or drug equipment may be shared. More generally, the stigmatisation and marginalisation associated with some forms of drug use may not only increase risk but also create barriers for promoting risk reduction measures. Because of the high prevalence of chronic medical conditions among PWUD, many will be at particular risk for serious respiratory illness if they get infected with COVID Examples of this include:. The main life-threatening effects of any opioid, such as heroin, are to slow down and stop a person from breathing. Because COVID like any severe infection of the lung can cause breathing difficulties, there may be an increase in the risk of overdose among opioid users. The antidote naloxone blocks the effect and reverses the breathing difficulties caused by opioids and is used in both clinical and community settings as an overdose prevention measure. The characteristics of some of the settings frequented by people who use drugs may put them at an increased risk of exposure to COVID Prevalence of drug use and infectious disease is high in prisons. These are closed environments, where over-crowding, poor infrastructure and delayed diagnosis has been documented European Centre for Disease Prevention and Control and European Monitoring Centre for Drugs and Drug Addiction, In order to reduce the transmission of COVID, sharing drugs or drug equipment should be strongly discouraged and appropriate social distancing and hygiene measures promoted. Communication strategies need to be developed to appropriately target different behaviours and user groups including marginalised groups, such as the homeless, recreational drug users and cannabis users. PWUD should be encouraged to consider where it is possible to stop or reduce their consumption of drugs as a protective measure, and actions are needed to ensure professional support and help for those seeking access to services. As practiced by other health and social services, drug services, homeless shelters and prisons should disseminate clear messages on how to reduce the risk of infection and make appropriate materials available to both service users and their staff. These should include:. It will be crucial to guarantee the continuity of core health services to drug users. In this context, it is vital to ensure services are properly resourced, staff protection measures are in place and service planning is prioritised. The EMCDDA is compiling examples of advice being issued to people who use drugs and service providers by some national bodies and different associations, networks and NGOs. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. COVID and people who use drugs. Last updated: 25 March Context — the coronavirus outbreak COVID in the EU People who use drugs face the same risks as those of the general population and therefore need to be aware of the appropriate advice to reduce their risk of infection. Underlying chronic medical conditions are associated with some forms of drug use and increase the risk of developing severe illnesses Because of the high prevalence of chronic medical conditions among PWUD, many will be at particular risk for serious respiratory illness if they get infected with COVID Examples of this include: The prevalence of chronic obstructive pulmonary diseases COPD and asthma are high among clients in drug treatment, and smoking of heroin or crack cocaine can be an aggravating factor Palmer et al. There is also a high incidence of cardiovascular diseases among patients injecting drugs and people using cocaine Thylstrup et al. Methamphetamine constricts the blood vessels, which can contribute to pulmonary damage, and there is evidence that opioid misuse can interfere with the immune system Sacerdote, The prevalence of HIV, viral hepatitis infections and liver cancers — leading to weakened immune systems — is high among people who inject drugs. Tobacco smoking and nicotine dependence are very common among some groups of PWUD and may increase their risks of experiencing more negative outcomes. The risk of drug overdose may be increased among PWUD who are infected with COVID The main life-threatening effects of any opioid, such as heroin, are to slow down and stop a person from breathing. Sharing drug-using equipment may increase the risk of infection While sharing injecting material increases the risk of infection with blood-borne viruses, such as HIV and viral hepatitis B and C, the sharing of inhalation, vaping, smoking or injecting equipment contaminated with COVID may increase the risk of infection and play a role in the spread of the virus. The virus causing COVID spreads mainly from person-to-person, between people who are in close contact with one another, and through respiratory droplets produced when an infected person coughs or sneezes. The virus can also survive for relatively long periods of time on some surfaces. Whereas harm reduction messages usually focus on risks associated with injecting, less attention is often paid to other routes of administration. The COVID outbreak may present additional risks that are currently not widely recognised, for example the sharing of cannabis joints, cigarettes, vaping or inhalation devices or drug paraphernalia. Crowded environments increase the risk of exposure to COVID The characteristics of some of the settings frequented by people who use drugs may put them at an increased risk of exposure to COVID Recreational drug use often takes place in groups or in crowded settings, thus increasing the risk of exposure to COVID This can, to some extent, be mitigated by social distancing, following established safety guidelines or other measures to reduce the use or access to high risk environments. Drug treatment centres, low-threshold services and social support services for people who use drugs may have areas were social distancing is difficult, such as waiting rooms or community facilities. As with other settings, introducing appropriate distancing and hygiene practices are critically important. PWUD experiencing homelessness often have no alternative but to spend time in public spaces and lack access to resources for personal hygiene. Self-isolation is very challenging for homeless people and access to health care is often very limited. Addressing the needs of PWUD who are homeless or in unstable housing will be important for responses in this area. Risks of disruption in access to drug services, clean drug-using equipment and vital medications Continuity of care for PWUD using drug services may be a challenge in the face of staff shortages, service disruption and closure, self-isolation and restrictions placed on free movement. In this context, contingency and continuity planning are essential. Drug services — especially small, locally funded and NGO-run services operating alongside the formal structures of the public health systems — may be particularly vulnerable and lack access to the additional resources needed to ensure continuity of care. There is a risk of reduced access to opioid substitution therapy and other essential medications as well as clean drug use equipment, especially if community pharmacies are required to reduce their opening hours and services and stop supervising methadone. Access to medication is likely to be particularly challenging for those self-isolating, under lock down or in quarantine. Restrictions on movement in some localities due to COVID may also lead to the disruption of drug markets and a reduced supply of illicit drugs. This could have a range of repercussions especially for dependent drug users and could potentially result in an increased demand for drug services. Top of page Ensuring effective drug services during the pandemic — important considerations Implementing prevention measures against transmission of COVID in settings used by PWUD In order to reduce the transmission of COVID, sharing drugs or drug equipment should be strongly discouraged and appropriate social distancing and hygiene measures promoted. These should include: Personal protective measures: promoting proper hand hygiene and risk reduction practices such as, coughing and sneezing in your elbow. Ensure bathrooms are stocked with soap and drying materials for hand washing. Environmental measures: frequently clean used surfaces, minimise sharing objects, ensure proper ventilation. Current practice in communicating to PWUD on the risks of sharing drugs and drug equipment needs to be reviewed to ensure it is appropriate to the demands of reducing COVID exposure risks in the light of possible transmission modes droplets, surfaces. Current practices in providing clean injecting and other drug use equipment for example smoking and inhalation equipment to limit sharing among drug users need to be reviewed and adapted, if necessary, to ensure they remain fit for purpose. Scaling up the level of provision of equipment for clients in self-isolation is likely to be necessary. Social distancing measures need to be promoted and introduced for PWUD and those working with this group. These include avoiding close contact handshakes and kissing , standing an appropriate distance away from each other, and limiting the number of people that can use the services at the same time. Particular attention should be paid to supporting and providing the necessary means to clients of drug services, users of homeless shelters and prisoners to allow them to protect themselves and others from infection. These are likely to include provision of masks to those showing respiratory symptoms cough, fever , establishing an isolation area, and appropriate referral and notification procedures in line with evolving national guidelines. ECDC has published a technical report on infection prevention and control for COVID in health care settings, including long-term care facilities General guidelines and information for specific groups such as patients with chronic diseases and with immunocompromising conditions is available on the ECDC website. Guaranteeing continuity of care during the pandemic It will be crucial to guarantee the continuity of core health services to drug users. Ensuring service continuity: Drug treatment services and low-threshold harm reduction services for PWUD are essential health services, which will need to stay in operation under restricted conditions. Ensuring the ongoing provision of drug treatment services, including opioid substitution medications and other essential medicines to clients, will therefore be a paramount consideration. Contingency plans will be needed for potential medication and equipment shortages. Services will need to plan for the likelihood of staff absences by developing flexible attendance and sick-leave policies, identifying critical job functions and positions, and planning for alternative coverage by cross-training staff members. Services may need to plan for temporary alternatives in the event of any necessary closure of fixed sites e. Based on national guidelines, there may be a need to suspend, reduce, or implement alternatives to face-to-face, individual and group appointments during the pandemic. The availability and accessibility of service provision for PWUD who are homeless will be an important consideration, as this may be a group with limited resources to self-protect and self-isolate. Providing the necessary protective equipment for staff and introducing protocols for reducing the risks of transmission to both staff and patients, including the use of physical barriers to protect staff who interact with clients with unknown infection status. Minimising the number of staff members who have face-to-face interactions, and introducing appropriate risk management policies and procedures for clients with respiratory symptoms. Reviewing working practices for staff and volunteers at high risk of severe COVID those who are older or have underlying health conditions , including introducing remote working arrangements where possible. Establishing regular virtual meetings to allow a rapid response to issues arising in the local situation and the rapidly changing measures taken by local and national governments. Palmer, F. Sacerdote, P. Schwartz, B. Thylstrup, B.

COVID-19 and people who use drugs

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Official websites use. Share sensitive information only on official, secure websites. Correspondence to this article should be addressed to Joseph J. Telephone: 1 , Fax: 1 , joseph. Club drug use is often associated with unsafe sexual practices and use remains prevalent among gay and bisexual men. Although epidemiological studies commonly report the risk of engaging in unsafe sex due to the effects of particular club drugs, there remain gaps in the literature regarding the specific sexual effects of such substances and the context for their use in this population. We examined secondary data derived from interviews with club drug using gay and bisexual males in New York City and qualitatively describe subjective sexual effects of five drugs: ecstasy, GHB, ketamine, powder cocaine and methamphetamine. Differences and commonalities across the five drugs were examined. Although some common perceived sexual effects exist across drugs, the wide variation in these effects suggests different levels of risk and may further suggest varying motivations for using each substance. This study seeks to educate public health officials regarding the sexual effects of club drug use in this population. Keywords: club drugs, gay and bisexual men, HIV, sexual risk taking, methamphetamine. Extensive research has linked these drugs to sexual risk taking, particularly in gay and bisexual men Colfax et al. Despite the plethora of studies documenting the use, prevalence, and public health implications of club drug use in men who have sex with men, little is documented about the unique sexual effects of each drug. This paper seeks to begin to fill this void by 1 providing a brief summary of the general and sexual effects of each club drug and 2 characterizing the subjective sexual effects of each drug using a qualitative descriptive method of inquiry with tones of thematic analysis Sandelowski, However, use can also bring about anxiety, paranoia, and loss of appetite. For example, Buffum reported that some men in his study experienced spontaneous erections, prolonged sexual arousal and orgasms, and multiple orgasms after using cocaine. However, sexual stimulation reportedly decreases with greater cocaine use, and most frequent or heavy users tend to report no effect or a negative impact on sexual arousal and function Gold, Users can also experience acute adverse effects such as anxiety, restlessness, fear, confusion, and paranoia. Although frequent ecstasy use is associated with unsafe sex at parties Mattison et al. Ketamine, commonly referred to as Special K or K, is a dissociative anesthetic with hallucinogenic properties. Ketamine use also reportedly leads to feelings of numbness or a feeling that the user or world is not real. Ketamine can be ingested or injected, but is most often administered intranasally in powder form. It has been suggested that high doses of ketamine are not compatible with sex; however, lower doses may increase the desire to engage in sex Jansen, Although the effects are not known to be highly sexual, ketamine has been shown to increase the odds for unprotected anal sex at a higher level than other club drugs Rusch et al. GHB is usually ingested orally, in liquid form, and users report that it induces a state of relaxation, tranquility and euphoria McDowell, However, it has a steep dose-response curve so small increases in GHB dosage result in greatly increased effects Galloway et al. Use has been associated with adverse reactions such as drowsiness, nausea, myoclonic seizures, unconsciousness and coma of short duration Freese et al. Other positive subjective sexual effects include increased feelings of sexual intimacy, hypersensitive sensation to touch, and increased euphoria associated with sexual orgasm. Use is also associated with increases in subjective effects including confidence, alertness, and talkativeness; however, reported adverse effects include fatigue, hallucinations and paranoia Halkitis, ; Shoptaw, Routes of administration include snorting, smoking, or injecting. Despite negative subjective sexual effects, methamphetamine has an astonishing effect on sexual risk taking behavior Halkitis, Methamphetamine users report an increased desire for sex and a greater aggressiveness during sexual activity Frosch et al. Few studies have examined the specific subjective effects of each drug and how such effects may relate to risky sexual behavior. Likewise, few investigations consider whether drug use occurred directly preceding or in conjunction with sex, and few studies are descriptive or qualitative in nature and thus lack the ability to obtain rich information regarding specific situations and associated effects. This descriptive qualitative study examines and compares the subjective sexual effects of five club drugs among gay and bisexual men. Secondary data were drawn from a longitudinal, mixed methods study, funded by the National Institute on Drug Abuse. The study examined club drug use and sexual behaviors associated with use. Participants were assessed via quantitative and qualitative measures during four waves of data collection over the course of 12 months. A random sample of qualitative interviews derived from participants was transcribed the year they were collected, but the cassette tapes of both transcribed and non-transcribed cassette tapes have consequently been destroyed, leaving us unable to examine the full sample. The sample consisted of club drug using men residing in New York City. In terms of educational attainment, The majority of the sample identified as gay Recruitment was conducted from February through October Participants were recruited though passive e. Potential participants were screened for eligibility via telephone interviews. Eligibility requirements included being 18 years of age or older, identifying as gay or bisexual, and reporting at least six instances of club drug use in the year prior to assessment. Potential participants also had to report at least one instance of club drug use before or during sex within the prior three months. Those who met eligibility requirements were scheduled for a baseline interview, when the initial assessment, informed consent, and confirmation of HIV status also occurred. A total of club drug using gay and bisexual men completed baseline assessment. Quantitative assessments were administered via an Audio Computer Assisted Self-Interview ACASI , using a computer and voice recording so that the participants heard and saw each question and response list. After completing the quantitative portion of the assessment, trained staff members conducted semi-structured qualitative interviews covering a variety of topics related to club drug use and sexual behavior. All participants were asked to both self-report and confirm their HIV status. Frequency of recent drug use number of days used within the previous four months was assessed for each of the following club drugs: cocaine, ecstasy, ketamine, GHB, and methamphetamine. Semi-structured interviews assessed a variety of topics related to club drug use and sexual behavior. Questions relevant to this analysis assessed whether club drugs were used in sexual circumstances and whether they used for sexual reasons. Each participant reported using different combinations of drugs, and not all drugs were consistently discussed with regard to sexual activity because interviews were only semi-structured and questions focused mainly on their most frequently used drug. Upon review, transcripts were first coded for whether each participant indicated use of a drug for sexual reasons e. Coding included whether participants mentioned if drug effects were related to sensual or sexual behaviors, whether the drug was used for sexual reasons or in sexual contexts, and whether the drug affected the kinds of partners they had. When a participant mentioned use of a drug for any of these sexual reasons, they were coded as affirming sexual effects of use. If the participant mentioned that the drug was not related to any of the sexual circumstances aforementioned he was coded as reporting no sexual effects with regard to use of that drug. Those who stated that they were unaware of any of the above sexual effects were coded as reporting no sexual effects. If the participant did not discuss use of a drug with regard to sex he was not coded for that drug; therefore, coding only represents those who discussed use of the specific drug with regard to sex. The richest data often came from those who discussed their most frequently used drug, but valuable information was able to be obtained by examining discussions about other drugs, which were not always discussed at length. Although participants did not consistently discuss effects of each drug, we believe data saturation achieved through those who did discuss their experiences. Two authors independently identified recurring themes across drugs discussed by the participants. Quotations that fit with such themes were catalogued with the corresponding theme in order to form a more comprehensive picture. After a complete consensus was reached regarding the occurrences and classification of such themes, data were further catalogued and examined separately for each drug. Themes were then compared across drugs in order to determine how the subjective sexual effects of such drugs differ. At baseline, As is seen in Table 1 , the majority of the sample had used cocaine, ecstasy, ketamine, or methamphetamine within the four months prior to baseline. Fewer participants reported recent use of GHB Likewise, cocaine was used most frequently and GHB was used the least often. The majority of participants reported increased sexual effects in response to use of ecstasy, GHB, and methamphetamine. Two-thirds reported increased sexual effects in response to cocaine use and only about a third reported increased sexual effects in response to ketamine use. Recent use is defined as use within the four months prior to baseline assessment and frequent use is defined as use on 16 or more days in four months prior to assessment. Days used is number of days used in that four month period. A participant could have reported use in a sexual context without reporting recent use. Analysis yielded results suggesting various themes with regard to each drug and its subjective sexual effects. Although some themes and points varied between drugs, three main themes emerged across all drugs: 1 the sexual sensation associated with use, 2 disinhibiting effects that lead to sex or occur during sex, and 3 atypical sexual interactions resulting from use. The majority More specifically, ecstasy was commonly described as being a sensual drug that increased sensation to touch. So it just enhances the feeling that you get. White, 24, HIV-negative, non-frequent user. With ecstasy my body sensations are just all in full effect. Getting touched, just anything kind of stimulates it. White, 23, HIV-negative, non-frequent user. Along with the enhanced bodily sensation associated with ecstasy use, participants commonly reported an increased feeling of affection or sensuality. This was sometimes reported as a sexual feeling, although physical encounters were often limited to touching, massaging, or kissing. I would just be like more touchy, feely and sensual; not sexual. I just want to touch. I did have sex the first time, but it was more about the touch and the feeling and kissing and that kind of stuff. I feel like I am making love. I hold the person even more; the kisses are more conducive; the warmth is there. Hispanic, 42, HIV-negative, non-frequent user. The feeling of sensuality derived from use was sometimes reported to lead to sex in the course of the interaction. White, 45, HIV-positive, non-frequent user. Black, 31, HIV-positive, non-frequent user. I can't get an erection when I'm on ecstasy. It's just nothing happening down there. And it still feels great to be touched, but since such a major part of the sensation factory is just not working down there, it's sex never been the purpose of why I've done ecstasy. White, 22, HIV-negative, non-frequent user. If somebody put Viagra and ecstasy in one pill they would make a fortune. White, 40, HIV-negative, non-frequent user. However, although users commonly reported impotence as a result of ecstasy use, some participants did in fact report enjoying sex while high on it. This may be due, in part, to when the actual sex occurred. Hispanic, 21, HIV-negative, frequent user. As I was coming down I got real sexually aroused…it was when I was coming down off it that it made me want to have sex. In addition, the context and type of ecstasy pill ingested also reportedly influenced the mood of the user and the type of sexual encounter. Since the majority of ecstasy pills contain adulterants and varying levels of MDMA, some pills appear to provide different sexual effects. Sometimes I take a pill and I really don't feel like having sex. It takes the sexual pleasure away and I just want to party, have fun, and dance. And sometimes it makes me very horny; it makes me want to have sex; it really depends on the pill and my mood. White, 20, HIV-negative, non-frequent user. It depends on the E. Like if you're taking something speedy, generally you don't want to be a bottom. If you're taking something really dopey, generally you just want to lay there. Ecstasy, like most other club drugs, tended to leave users socially and sexually disinhibited. Since participants reported feeling more outgoing and sensual while high on ecstasy, they often sought affection from other individuals, often strangers, in the nightclub. Hispanic, 22, HIV-negative, non-frequent user. A common theme associated with such disinhibition was atypical sexual interactions. Specifically, they tended to report that they engaged in sexual interactions with individuals they would not normally be attracted to if sober. Hispanic, 39, HIV-negative, non-frequent user. Hispanic, 19, HIV-negative, frequent user. Although only a third of participants reported use of GHB, we were able to examine themes. Users commonly reported the feeling derived from GHB as being sexual Unlike the sensual feeling that often results from ecstasy use, the GHB high was often described as a more purely sexual feeling that is more intense. The first time I did GHB it was great because you could feel this warm energy emanating up your body and you just feel sort of tingling and very sexual. Asian, 28, HIV-negative, non-frequent user. It \[GHB\] is more aggressive. If two people are attracted to one another and GHB is involved then it gets very sexually intense. Asian, 36, HIV-negative, frequent user. While GHB tends to provide users with a sexual feeling, the drug also reportedly makes individuals sexually disinhibited. Participants often reported that GHB made them feel like a sexual predator, a savage, or an animal. So unlike the emotion and affection commonly associated with ecstasy use, GHB use was described as being more animalistic. That drug is just so sexual it's sickening. As soon as I take that drug my mind is there on sex. I really felt like a savage. There was like no interior monologue…just totally connected, feeling like an animal. White, 39, HIV-positive, non-frequent user. I just become an animal…\[I\] definitely go crazy on it, just sexually. I get extremely aggressive, any masculinity is kind of heightened…I get rough sometimes and controlling. Similar to ecstasy, while GHB lowered sexual inhibitions, participants commonly reported sexually connecting with individuals they would not normally be attracted to while sober. White, 32, HIV-negative, non-frequent users. White, 37, HIV-positive, non-frequent user. While only about half of participants reported recent use of ketamine, strong themes emerged. Unlike the sensations that result from the use of ecstasy or GHB, ketamine, a dissociative anesthetic, tends to lead to a feeling of numbness and passiveness, socially and sexually. Due to this effect, only However, this feeling was sometimes reported to be associated with the user taking the anal-receptive role during sex. You can't have a sexual relationship. When I'm there high on ketamine I don't care. It numbs me. White, 24, HIV-negative, frequent user. If I am a little high on K I just prefer to sort of take the more passive role—just sort of get all kind of spacey and mental about it. White, 25, HIV-positive, non-frequent user. Although some participants reported that ketamine use led them into a more passive role during sex, the majority mentioned that the drug, unlike other club drugs, inhibited sex. It whacks me out too much to have sex. White, 32, HIV-negative, non-frequent user. I do not get horny when I am on K. Black, 20, HIV-negative, frequent user. I would never have sex on K. While no participants commented on the dose or type of ketamine used prior to potential sexual encounters, like other drugs, these factors likely played a role. For example, since ketamine is a dissociative anesthetic, smaller doses or weaker concoctions may not inhibit sex as much as larger doses or stronger formulations. Although ketamine is not a very sexual drug, the passivity associated with use can in fact lead to sexual disinhibition. So unlike the more social and assertive disinhibition associated with use of other club drugs, ketamine tended to leave participants more vulnerable to others making sexual advances. Participants also reported engaging in sexual interactions with individuals they normally would not connect with. You just kind of transcend a little bit and you just let your guard down and maybe you'll start making out with anyone. It's kind of scary. It ketamine makes me less able to control what is going on. While Research was needed to help determine whether or not cocaine enhances sexual activity because current evidence is conflicting. Cocaine tends to lead to social disinhibition and is often used for social reasons e. The social lubrication effect derived from cocaine use appears to influence sexual contacts, more so than club drugs with more direct sexual effects. White, 30, HIV-positive, frequent user. The specific sexual effects of cocaine were rarely discussed other than the fact that it commonly led to impotence or decreased sexual interest. It restricts a lot of things sexually. Black, 22, HIV-negative, frequent user. Others have resorted to anal receptive intercourse, a more risky sexual behavior than insertive intercourse, as a result of impotence that resulted from cocaine use. Then I would be the bottom. Hispanic, 29, HIV-positive, frequent user. Some participants, however, clearly were able to obtain an erection and reported enjoying sex while high on cocaine due to heightened sensation related to use of the drug. It really arouses me. It heightens the sexual stimulation. Hispanic, 35, HIV-negative, frequent user. It keeps me hard for hours. I enjoy it. Hispanic, 42, HIV-negative, frequent user. Similar to ecstasy, the ability to have sex on cocaine appears to be dependent on when during the high the sex occurs. I think in the beginning it might intensify it sexual desire and heighten arousal. When it comes to the actual sex, it is pretty much fizzled. White, 28, HIV-negative, non-frequent user. Black, 37, HIV-positive, frequent user. Black, 34, HIV-positive, frequent user. Sexually, cocaine was commonly reported to disinhibit users, and it allowed them to engage in sexual activities they felt they would normally not engage in. It just sort of really makes you horny; well coke makes you horny, period. Asian, 23, HIV-negative, non-frequent user. Similar to other club drugs, another theme involving disinhibition was that users often reported lowering their sexual standards and seeking partners they would not normally be attracted to when sober. I feel like I want to have sex and you are here, so why not just let me use you. Guys will get boys really high on cocaine in order to get them into bed, which has worked on me before. White, 21, HIV-negative, frequent user. Methamphetamine was most commonly reported to be associated with a perception of increased sexual effects Unlike ecstasy, methamphetamine was commonly reported to lead to sex without emotion. However, this emotional numbing is reported in a sexual context different than the general emotional numbing related to ketamine use. It made me sexually veracious. My emotional feelings are in the back seat if not in the trunk, or being dragged behind the car on the road. White, 59, HIV-positive, frequent user. Despite the increase in libido, many users reported impotence during or after use of methamphetamine. Hispanic, 20, HIV-negative, non-frequent user. Like cocaine, the impotence associated with use was sometimes reported to leave participants resorting to anal receptive intercourse. White, 33, HIV-negative, non-frequent user. Therefore, the ability to have sex on methamphetamine, like cocaine, appears to be dependent on when it was taken. It just like makes you really horny, and you can just go again and again and again. White, 21, HIV-negative, non-frequent user. Black, 22, HIV-negative, non-frequent user. Methamphetamine was most commonly discussed in terms of sexual disinhibition. Not only did participants become more disinhibited after use, but mentally and physically, it often allowed them to engage in sexual encounters for hours or days at a time. It makes you extremely horny. Our sexcapades probably extend for a longer period than they would when we are not using it. If he asks me to do something then certainly I would do it. White, 48, HIV-negative, non-frequent user. Sex always comes with it. It definitely prolongs the time of sex. Hispanic, 23, HIV-negative, frequent user. It releases my inhibitions and intensifies my sexual appetite. It allows me to be freer and freakier…and it takes away any awkward or uncomfortable feelings that I might have about engaging in certain sexual activities. White, 40, HIV-positive, non-frequent user. Similar to other club drugs, the use of methamphetamine also was associated with having sex with individuals that participants would not normally have sex with when not high. Hispanic, 19, HIV-negative, non-frequent user. White, 27, HIV-positive, non-frequent user. This qualitative descriptive analysis investigated the subjective effects of five club drugs among a diverse sample of gay and bisexual club drug using men. Epidemiological survey results tend to report a high association between club drug use and unsafe sex Colfax et al. This is among the first studies to investigate and compare the subjective sexual effects of five club drugs: ecstasy, ketamine, GHB, cocaine, and methamphetamine. While effects differed across each drug, results from analysis yielded three main themes. The first theme was subjective sexual sensation related to use of each drug. Ecstasy was most commonly described as a sensual drug, associated with increased physical sensation and a desire to touch or be touched. Similarly, methamphetamine was frequently associated with an increased, emotionless drive to have sex, often for extended periods of time. Participants reported mixed results with regard to sexual effects associated with cocaine; specifically, use inhibited sexual desire or sex for many, but it increased sensitivity and sexual desire in others. Ketamine was most often reported to be associated with a numb, passive or dissociated feeling and was less often used in conjunction with sex. This theme also reflects our quantitative findings in that among recent users, methamphetamine Ecstasy was commonly used in a sexual context Cocaine was used in a sexual context The second theme was the disinhibiting or inhibiting effects of each drug. Disinhibition appeared to have allowed users to meet other individuals more freely and often facilitate physical, sensual interactions such as kissing and touching. GHB reportedly disinhibited users in a more animalistic or aggressive sexual nature. Methamphetamine use also appeared to have disinhibited users in an almost animalistic sense, and was commonly associated with extreme sexual acts that participants reportedly would not normally engage in. Cocaine subjective effects were sometimes similar; however, cocaine use reportedly most often facilitated sociability, which can lead to sex, although it was often associated with a decreased desire for sexual intercourse. Ketamine reportedly most often disinhibited its users who rarely associated use with the desire to have sex. Therefore, unlike the disinhibition associated with use of the other drugs, ketamine appears to leave users more passively disinhibited, possibly in a more vulnerable sense. The lowering of sexual standards, the third theme, was commonly discussed with regard to the use of each club drug. Use of each drug was associated with physical or sexual connections that reportedly would not have occurred if the participant was not on the drug. Such encounters were sought out, although ketamine reportedly sometimes left participants more vulnerable or passive to unwanted counters. It should be noted that effects of some drugs were reportedly related to impotence or the inhibited ability to have sex, but some participants noted that this was dependent on when in relation to the encounter the drug was administered or how much was administered. Ecstasy use, and heavier cocaine or methamphetamine use was reported to be associated with decreased ability to have sex; however, increased sexual effects tended to increase as the drug effects wore off. The GHB high tended to be associated with increased sexual effects and ketamine use tended to be associated with decreased sexual effects, especially when taken in larger doses. The semi-structured interviews pose limitations because users of multiple drugs were not always assessed consistently about the sexual effects of each substance. The sample was also comprised of gay and bisexual males who reside in New York City. Although subjective effects are thought to be consistent in males, gay and bisexual club drug users report high rates of club drug use and use with sex; therefore, heterosexual male users may not experience the same effects due to different contexts. No females were assessed so sexual effects cannot be generalized across gender. Sexual effects were not consistently assessed between all drugs and effects were subjective and not measured in a quantitative fashion. Effects were not tested in a controlled environment; therefore, dose, purity, length of use, mindset, motivation, experience with use, and context were all potential confounders. Use of legal drugs i. Poly-club-drug use and use of alcohol was common Halkitis et al. Another limitation from this secondary analysis is that the interviews were conducted prior to Therefore, even though pharmacological responses should remain the same, social contexts associated with use might have changed. Interviews were semi-structured so true qualitative analysis could not be conducted. It should be noted that while these data come from a study finished in , we believe the findings to remain relevant due to the sustained prevalence of club drug use in this population, and due to unchanging biological effects of each drug. Finally, missing data is a limitation of this secondary analysis. Although there was a great variation of sexual effects associated with each of the drugs, all club drugs in this study were associated with a risk of increased sexuality or vulnerability to sexual advances. Public health officials should recognize the wide range of these effects and the varying landscape of context. In conclusion, it is well known that club drug use is associated with risky sexual behavior, but this study was among the first to differentiate and compare the effects in a qualitative manner. Each club drug clearly has different sexual effects, and sexual risks, thus public health officials should consider the contexts of club drug use, the variation of sexual effects, and not just the sexual risk within itself. As a library, NLM provides access to scientific literature. Psychol Sex. Published in final edited form as: Psychol Sex. Find articles by Joseph J Palamar. Find articles by Mathew V Kiang. Find articles by Erik D Storholm. Find articles by Perry N Halkitis. Issue date Apr 1. PMC Copyright notice. The publisher's version of this article is available at Psychol Sex. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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