Heterosexual chemsex?

Much in the news at the moment is a recent study (Palamar & Cleland) of nonmedical opioid drug use amongst you people on the electronic dance music (EDM) ‘scene’ in New York. But the phenomenon is by no means confined to that city (Kurtz & Surratt).

To appreciate what all the fuss is about, we need to see this more specific issue in the context of the current concern in the US about the misuse of non-medical opioids more generally. According to Compton & Baldwin things are very worrying indeed. 10.3 million Americans reported misuse of opioids in 2014, emergency admissions involving opioids rose 153% between 2002 and 2012, and – most worrying of all – rates of death from overdose quadrupled between 2000 and 2014 from 1.5 to 5.9 deaths per 100,000. There is talk of an opioid epidemic. Apparently, opioids have an undeserved reputation for being relatively safe drugs. Furthermore, there is evidence of a frequent transition from other opioids to heroine – facilitated by the current relatively low street value of that drug. That transition is often followed by the adoption of risky injection practices (Mateu-Gelabert & Teper), especially among new injectors (generally in the 16-30 age range). These practices are, of course, themselves a risk factor for HIV and Heptitis C; they are also frequently accompanied by high-risk sexual behaviour. ‘As participants’ opioid dependence progresses, their drug-using networks typically expand to include older injectors; because their drug-use and sexual networks tend to overlap, the likelihood of participants having sex with HIV-infected individuals may likewise increase over time’ (Mateu-Gelabert & Teper).

In the light of these concerns, especially as they apply to young ‘new injectors’, we can begin to understand the disturbing implications of nonmedical opioid use at EDM venues, investigated by Palamar & Cleland. So what did they discover? Of the 954 party-goers surveyed (aged 18-40): almost a quarter (23.9%) claimed to have used opioids non-medically sometime in their lives; nearly one in ten (9.8%) to have done so in the past year; 5% to have done so in the last month; 16.4% to be willing to take opioids in the next 30 days, if offered them by a friend. To put this in some sort of context, prevalence of nonmedical opioid use over the last year in the general population in 2016 was 7%.

While these figures are perhaps not higher than might have been expected, there is good reason to regard these young EDM party attendees as potentially a population at risk of HIV and Hepatitis C, as well as of drug dependence. The association of drug taking and sexual risk that seems to be a characteristic of the EDM scene may remind us of the Chemsex parties discussed in earlier posts (So how much do we actually know about the risks posed by chemsex (STI/blog); Chemsex and HCV transmission among UK MSM (STI/blog)). The level of risk-taking may be less extreme; nevertheless in the case of opioid use at EDM venues we are confronted with a phenomenon that already seems relatively common, and with considerable potential to spread in future.