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The government's former drugs adviser, Prof David Nutt, believes alcohol is damaging society more than heroin. In one report he ranked 20 drugs based on their effects on users and society and said tobacco and cocaine were equally harmful, while ecstasy and LSD, were among the least damaging. In he was sacked after disagreeing with the government's decision to re-classify cannabis. He added: 'In Britain today, alcohol is a leading cause of death in men between the ages of sixteen and fifty, so it is therefore the most harmful drug there is in terms of life expectancy, family disruption and road traffic accidents. His aim, he said, was 'to understand what the right approach should be, based on the science and evidence'. Alcohol 'harms more than heroin'. Getting drunk Audio, Getting drunk Nutt: E-cigs are a 'health advance' Audio, Nutt: E-cigs are a 'health advance'. Mandatory drug testing 'bonkers' Video, Mandatory drug testing 'bonkers'. Positive Action Group. Isle of Man Freethinkers. More on this story. Related internet links. Manx Museum.

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Official websites use. Share sensitive information only on official, secure websites. The age standardized prevalence of any drug use was In all groups, cannabis was the drug most commonly used range from 4. The prevalence of use of drugs associated with chemsex was very low among HIV-negative participants 1. Providers need to be aware of cannabis and cocaine use and its potential link with sexual risk behavior and symptoms of depression and anxiety among heterosexual men and women attending sexual health and HIV clinics. The use of recreational drugs has been linked to depressive symptoms, sexual risk behavior and increased risk of HIV infection Scott et al. In a recent meta-analysis of seven studies one in the UK , cannabis use during adolescence was associated with depression in young adulthood pooled OR 1. In the British National Survey of Sexual Attitudes and Lifestyles Natsal, — , past year use of illicit drugs was strongly associated with reporting two or more condomless sex CLS partners in the past year among both men OR 5. There is a need for drug-specific prevalence estimates and information on associations with sexual behavior and mental health measures among heterosexual men and women in the UK. This includes people living with HIV, for whom there are very limited data. There is also a need to investigate whether the use of drugs associated with chemsex, which have been trending within gay communities over the past decade, have also gained popularity among heterosexual men and women in the UK. The phenomenon of chemsex has been documented since Stuart, A growing number of survey studies have examined the prevalence of chemsex or use of drugs associated with chemsex among HIV-negative and HIV-positive gay, bisexual and other men who have sex with men GBMSM in Europe Daskalopoulou et al. Similar findings have been observed in other recent studies in Europe. There is also some evidence that the prevalence of drug use associated with chemsex is increasing among GBMSM Hampel et al. The extent to which the types of drugs associated with chemsex within gay communities are used among heterosexual men and women is uncertain. It remains unclear whether harm reduction messaging surrounding use of drugs associated with chemsex should also target heterosexuals. This is a particularly pertinent issue given the recent rise in gonorrhoea, syphilis and chlamydia diagnoses among heterosexual men and women in England Mitchell et al. It is acknowledged however, that the phenomenon of chemsex emerged as a means by which to facilitate enjoyment of gay sexuality against the backdrop of a heteronormative and homophobic social environment Stuart, In many respects the practice of chemsex may be unique to gay communities. Among GBMSM, investigating the use of drugs associated with chemsex is thought to be a good reflection of the practice of chemsex itself Stuart, However, this may not be the case among heterosexual populations, for whom these drugs may be used outside of a sexual setting. In this paper, data were analysed from two separate cross-sectional questionnaire studies in England. Individuals aged 18 years or older without diagnosed HIV were eligible for inclusion. Methodological details have been published elsewhere Sewell et al. Methodological details have been published elsewhere Speakman et al. All measures used in this analysis were obtained from the study questionnaire, which was self-administered in both studies. The question on disclosure of sexual orientation to family, friends and workmates was not asked in the ASTRA questionnaire. Other drugs specified were coded to the above categories where appropriate. Participants were also asked whether in the past three months they had injected recreational drugs e. Any recreational drug use: use of at least one of the 18 drugs listed above in the past three months. Poly drug use: use of at least three different recreational drugs from the above list of 18 in the past three months. Information was not collected on whether these drugs were taken concurrently. It should be noted that the questionnaires did not ask about drug use during sex specifically. CLS with a non-regular partner in the past three months, defined as report of more than one CLS partner or one CLS partner who was not a long-term partner. Transactional sex for money or drugs in the past three months. Information on the gender of the client was not obtained. A total score of 10 or greater on PHQ-9 was considered to indicate clinically significant depressive symptoms, according to the standard definition. The remainder of the paper focuses on heterosexual individuals only, with all analyses conducted in the four sample groups separately: HIV-negative and HIV-positive heterosexual men, and HIV-negative and HIV-positive women. Associations of socio-economic and lifestyle factors with any drug use and the two most common drugs taken were assessed among the four sample groups. Given the low prevalence of poly drug use and use of drugs associated with chemsex in our samples, these measures were not investigated further. Modified Poisson regression with a robust variance estimator was used to produce prevalence ratios PRs adjusted for age as a continuous variable Zou, Associations of any drug use and the two most common drugs taken with symptoms of depression and anxiety, and with measures of CLS and self-efficacy for sexual safety were assessed. For some outcome measures, prevalence was low and only unadjusted associations are presented. For HIV-positive sample groups this was the case for all measures of CLS, therefore findings related to this group are presented in the text only. Missing values were incorporated into specific categories for the measures of drug use, depression and anxiety symptoms, CLS, university level of education, being employed, ongoing relationship, current smoking and higher risk drinking missing was taken to mean the absence of the factor. For all other variables, participants with missing data were excluded from analysis. A sensitivity analysis was undertaken excluding missing values when defining all variables. The findings were very similar to the main analysis data not shown. On the self-reported questionnaire, all participants reported that they had not been diagnosed with HIV. Four heterosexual men and one woman tested HIV-positive. These five individuals were retained in the sample for analyses, as they were not diagnosed with HIV at the time of questionnaire completion. For heterosexual men and women respectively, The median age was 29 interquartile range IQR 25—37 and 26 IQR 22—32 years for heterosexual men and women respectively. Overall, Overall p-value for heterogeneity by Wald test in modified Poisson regression, followed by p-value for test for trend for ordered categorical variables age, financial security, and housing. The total score across the five questions for each participant was generated. A total score of was considered to indicate high levels of a supportive network and scores of were considered to indicate lower levels of a supportive network. Ages years; combined age groups due to small cell counts. Age 40 plus years; combined age groups due to small cell counts. All white ethnic groups were categorised as white ethnicity and individuals from all other ethnic groups were categorised as other ethnicity. Babor et al. The proportion of heterosexual men born in the UK, reporting a university degree level of education, and attending a clinic in London was The corresponding percentages for women were Prevalence of drug use is shown in Fig. The prevalence of using at least one recreational drug in the past three months was Five percent of HIV-negative heterosexual men and 3. For HIV-negative men, cannabis was the drug most commonly used in the past three months For HIV-positive men, cannabis and cocaine were again the most prevalent Similarly, for HIV-negative women, cannabis For HIV-positive women, cannabis 4. The prevalence of drug use associated with chemsex in gay communities in the past three months was very low among HIV-negative heterosexual men 1. Figures show crude prevalence; age standardized prevalence for any drug use, poly drug use and use of drugs associated with chemsex are given in text boxes. The numbers of heterosexual men and women who reported injection drug use in the past three months were low: one HIV-negative heterosexual man, five HIV-positive heterosexual men, two HIV-negative women, and one HIV-positive woman. To provide comparative information, Fig. Prevalence of drug use overall, poly drug use, use of drugs associated with chemsex and use of most individual drugs was considerably higher among GBMSM compared to heterosexuals. There was some indication of an association with more unstable housing but this was attenuated after age adjustment. Other socio-economic factors employment, financial hardship, and supportive network were not associated with drug use overall. The associations with cannabis use were similar. Again, a broadly similar pattern of associations was observed for cocaine use, although older rather than younger men were more likely to report using cocaine. In addition, financial security was associated with cocaine use in unadjusted, but not age-adjusted analysis Table 1. Among HIV-positive heterosexual men, non-university degree level of education, non-employment, being single, financial hardship, lower levels of a supportive network, smoking, and higher risk alcohol consumption was associated with any drug use in unadjusted and age-adjusted analysis. HIV-positive heterosexual men of white or any other ethnicity were much more likely to report any drug use than men of Black or mixed African ethnicity, including after adjusting for age Table 1. The pattern of associations with cannabis was broadly similar to that found for any drug use, although employment, supportive network, and higher risk drinking was not associated with cannabis in unadjusted or age-adjusted analysis. There were fewer associations with cocaine use, in particular there was no relationship with education or financial hardship Table 1. Similar associations to that found for any drug use were observed with cannabis use and, with the exception of levels of education and a supportive network, with cocaine use. Being employed was also associated with cocaine use in unadjusted and age-adjusted analysis Table 2. Among women living with HIV, non-university degree level of education and smoking was associated with any drug use in unadjusted and age-adjusted analysis. HIV-positive women of white or any other ethnicity were much more likely to report any drug use than women of Black or mixed African ethnicity, including after adjusting for age Table 2. There was some evidence for an effect of non-employment and higher-risk alcohol consumption but the number of women who reported the latter was small. Similar associations to that found for any drug use were observed with cannabis use. For cocaine use, the pattern was broadly similar but there was no association with age, education and higher risk drinking. Among HIV-negative heterosexual men, the prevalence of symptoms of anxiety and depression was 7. No associations were observed for any drug use, cannabis use, or cocaine use with depressive symptoms or symptoms of anxiety in unadjusted or adjusted analysis Fig. Among HIV-positive heterosexual men, symptom prevalence was much higher: Any drug use and cannabis use was strongly associated with depressive symptoms in unadjusted and adjusted analysis. Any drug use but not cannabis use was associated with symptoms of anxiety in unadjusted and adjusted analysis Fig. Due to small numbers associations with cocaine use were not investigated. Among HIV-negative women, prevalence of symptoms was Any drug use was associated with depression in unadjusted and adjusted analysis. There was no significant association with anxiety Fig. Cannabis use was not associated with depression or anxiety among HIV-negative women. Cocaine use was not associated with depression or anxiety among HIV-negative women. Among HIV-positive women, there was a high prevalence of depression and anxiety symptoms Any drug use and cannabis use was associated with both depressive and anxiety symptoms in unadjusted and adjusted analysis Fig. Cocaine use was not associated with depression or anxiety among HIV-positive women. Among HIV-negative heterosexual men, The prevalence of CLS with a non-regular partner was elevated among those who reported any drug use, cannabis use and cocaine use Table 3. Only associations with cannabis and cocaine remained after adjustment for socio-demographic factors. The prevalence of CLS with two or more partners was elevated among those who reported any drug use and cannabis use Table 3. The association with cannabis use was significant, and there was some evidence for the association with any drug use, in adjusted analysis. For the associations between any drug use and measures of CLS, the observed attenuation in adjusted analysis appeared to be driven primarily by adjustment for the relationship status measure; men not in an ongoing relationship were more likely to report recent drug use and CLS. Evidence of associations with low self-efficacy for sexual safety was found for any drug use and cocaine use in unadjusted analysis, but the association with any drug use was attenuated after adjustment. Two HIV-negative heterosexual men reported transactional sex for money or drugs in the past three months, neither of whom reported any drug use in the past three months. Thirteen individuals 3. There was an association between cocaine use versus no cocaine use and CLS with a non-regular partner Measures of drug use were not associated with CLS with two or more partners or low self-efficacy for sexual safety in unadjusted analysis. Two men reported transactional sex for money or drugs in the past three months, neither of whom reported any drug use in the past three months. Among HIV-negative women, Those who reported any drug use, cannabis use, and cocaine use were much more likely approximately 1. Women who reported any drug use and cocaine use were more likely to report low self-efficacy for sexual safety, in unadjusted and adjusted analysis. Seven HIV-negative women reported transactional sex for money or drugs in the past three months. Measures of any drug use, cannabis use, and cocaine use were all associated with an increased prevalence of transactional sex for money or drugs in univariable analysis: any drug use 4. Thirteen women 2. There was an association between any drug use versus no drug use and CLS with a non-regular partner 6. Two women reported transactional sex for money or drugs, both of whom reported drug use in the past three months not cannabis nor cocaine. This study assessed recreational drug use among HIV-negative heterosexual men and women recruited from sexual health clinics and HIV-positive heterosexual men and women recruited from HIV outpatient centres. Prevalence of use of drugs associated with chemsex in gay communities was very low in heterosexuals. A broadly similar pattern of associations with drug use was apparent across the four sample groups. For cocaine use, the pattern of associations was broadly similar but notable differences were observed with age and socio-economic status. In some cases, cocaine use was more prevalent among older rather than younger people. Prevalence of cocaine use also tended to differ less between education groups, rather than being more prevalent in those with lower levels of educational attainment, and tended to be associated with employment and financial security. In these heterosexual groups, there was evidence of associations of recreational drug use with measures of recent CLS, low self-efficacy for sexual safety and with symptoms of anxiety and depression. In Natsal-3 — , the prevalence of any recreational drug use in the past year among sexually active 16—44 year olds was When standardized by the age distribution in Natsal, the prevalence of any drug use among 16—44 year olds was The equivalent estimates were However, other socio-demographic factors may confound this comparison. This is in line with findings from the current study, for both HIV-negative and HIV-positive heterosexual individuals. Similarly, self-reported drug use prevalence was elevated in people of Black or mixed Caribbean ethnicity and white ethnicity compared to people of Black or mixed African ethnicity in the current study. In the current UK study, the prevalence estimates of use of one or more drugs associated with chemsex in the past three months was very low for HIV-negative heterosexual men 1. HIV-positive heterosexual men and women did not report use of drugs associated with chemsex. Similar findings were observed in the Global Drug Survey GDS , which recruited participants across 23 high-income countries via social media The equivalent prevalence among heterosexual women was 0. Therefore, it does not appear that the phenomenon of chemsex is prevalent among heterosexuals. Other studies suggest that cannabis, MDMA, and cocaine may be used for sexual purposes among heterosexual individuals Bellis et al. It is possible that the motives for sexualized use of drugs among heterosexuals may differ to those for chemsex among GBMSM. For instance, heterosexuals may take drugs to facilitate a sexual encounter or to relax more with a sexual partner Bellis et al. Associations are also apparent after adjustment for socio-demographic factors Bellis et al. Associations were particularly strong for women. For HIV-negative women, reporting any drug use was also associated with low self-efficacy for sexual safety in adjusted analysis. Women may be more susceptible to self-doubt and lack of assertiveness as a result of ingrained sexist norms Abramson, , and may be particularly vulnerable when under the influence of substances. In a recent meta-analysis of seven studies three U. Based on findings from three studies, the pooled OR for the association with anxiety in young adulthood was 1. In the current study, similar associations were observed among HIV-positive heterosexual men and women. Experiencing an HIV diagnosis and living with HIV may, for some people, encompass high levels of comorbid physical and psychological distress Lampe et al. This may to some extent explain the strong associations observed between drug use and poor mental health symptoms among heterosexual men and women living with HIV in the current study, among whom the burden of depression and anxiety was greater. Strengths of this study include the presentation of drug-specific prevalence estimates and their correlates among both HIV-negative heterosexuals and heterosexuals living with HIV in England, over a similar time period. Infrequent drug use might not be captured in these studies. However, the psychoactive effects of drug use may be immediate and short-lived. Investigating associations of recent recreational drug use with recent sexual behavior also in the past three months in this analysis might provide more accurate estimates of this relationship. In terms of limitations, the cross-sectional methodology used in this study prohibits any inferences regarding causality. This study is important in the context of HIV-negative sexual health clinic attenders but these findings cannot necessarily be generalized to all heterosexual men and women in England, given the potentially differing behavioral profiles of these populations. Some analyses may have lacked power among male participants. Social desirability bias in the form of underreporting of drug use and CLS, particularly among HIV-positive participants, may have also affected these analyses, although all questionnaires were self-administered. However, findings indicate that health care providers need to be aware of the relatively high prevalence of cannabis, cocaine, and MDMA use among heterosexual men and women attending sexual health and HIV clinics, and the link with sexual activity and poor mental health symptoms. For HIV-negative women in particular, drug use may be a strong marker of sexual risk behavior. The Study Core Group will review proposals. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Int J Drug Policy. Find articles by Ada R Miltz. Find articles by Alison J Rodger. Find articles by Janey Sewell. Find articles by Richard Gilson. Find articles by Sris Allan. Find articles by Christopher Scott. Find articles by Tariq Sadiq. Find articles by Paymaneh Farazmand. Find articles by Jeffrey McDonnell. Find articles by Andrew Speakman. Find articles by Lorraine Sherr. Find articles by Andrew N Phillips. Find articles by Anne M Johnson. Find articles by Simon Collins. Find articles by Fiona C Lampe. Published by Elsevier B. 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. Enough money e :. Relationship q :. High levels of social support g :. Higher-risk drinking h :. Relationship q. Ethnicity o :.

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