DRP0038

Written Evidence from LGBT Foundation

This response focuses on drug use in LGBT (lesbian, gay, bisexual and transgender) communities.

This response is set out in the following way:

1. Health and harms: Statistics on drug use in LGBT communities.
2. Prevention and early intervention: Reasons for high prevalence.
3. Barriers to accessing support.
4. Examples of best practice and recommendations.
5. Sexual orientation and trans status monitoring.

About LGBT Foundation

LGBT Foundation is a national charity delivering advice, support and information services to lesbian, gay, bisexual and trans (LGBT) communities. With a history dating back to 1975, we campaign for a fair and equal society where all LGBT people can achieve their full potential. We serve over 40,000 people each year and provide online information to over 365,000 people.

LGBT Foundation runs a substance misuse service. This service offers: one to one support, chemsex support, telephone and online support, referral for specialist GBL/GHB detox and rehab and access to mutual aid and peer support groups.

1. Heath and Harms: Drug use in LGBT Communities

1.1 LGBT people are more likely to use illicit drugs compared to the general population contributing towards increasing health inequalities faced by LGBT communities.

• Combined data from the 2011/12, 2012/13 and 2013/14 Crime Survey found that 28.4% of LGB adults took illicit drugs in the last year compared to 8.1% of heterosexual adults.[1]
• Gay and bisexual men were three times as likely to use drugs in the last year compared to heterosexual men (33% compared to 11.1%). [2]
• LGBT people are often early adopters of new drugs, such as club drugs and novel psychoactive substances.[3]

• There is little to no evidence on drug use in trans communities in the UK. However a study in Northern Ireland found that 52% of trans people displayed a sign of drug abuse in the last year and 10% indicated severe drug use. These figures were 25% and 6% for all LGBT respondents.

LGBT Foundation’s own evidence shows that 27% of LGBT people accessing our building reported that they had used drugs on a (semi)regular basis[4].

Of those that reported using drugs:

●       15% said that either they or another had been hurt as a result of their drug taking.

●       50% stated that they used more than one type of substance on at least a monthly basis.

●       22% stated that they experienced the feeling of being unable to stop

●       19% stated that they had experienced the need to use drugs in the morning.

There is limited evidence on the health impact of drug use specifically in LGBT communities, this is in part due to a lack of routine sexual orientation and trans status monitoring.

1.2 Chemsex

Chemsex is a term that is used when people are having sex, which involves using one or more of three specific drugs (chems) in any combination. These drugs are usually crystal methamphetamine, mephedrone and GHB/GBL. People take part in Chemsex for a number of different reasons, some find it increases sexual stimulation, for other people it can reduce their inhibitions.

Chemsex use has been increasing in prevalence:

• 6.6% of men who have sex with men (MSM) in England have used chemsex drugs in the last 4 weeks. This rises to 21.9% of HIV positive MSM.[5]

• Manchester and Brighton have the fastest growing chemsex scenes in the UK.[6]

Engaging in chemsex is highly dangerous and can be fatal:

• A 2011-2015 study found that numbers of people dying after taking GHB in London rose by 119% in just a year. It is believed that this is linked to the increasing prevalence of chemsex. Of the 61 people who died from GHB in London over this time 60 were men and a third were HIV positive. More than two thirds had other drugs in their system.[7]

At LGBT Foundation, over a third of attendees using our Drug & Alcohol clinics presented chemsex related issues[8]. In addition 11% of LGBT Foundation’s sexual health clinic service users said they engaged in chemsex.

Of those that said they engaged in chemsex:[9]

●       3 in 4 said they had unprotected vaginal or anal sex within the last three months

●       Just over 2 in 5 said they used condoms less than half the time or not at all.

2. Prevention and early intervention: Reasons for higher prevalence of drug use in LGBT communities

There are a number of reasons why drug use in higher in LGBT populations.

2.1 Minority Stress and Discrimination

Some LGBT people may use drugs as a coping mechanism for discrimination and stress experienced as a result of this discrimination.[10] [11] [12]

LGBT people still face discrimination and prejudice as a result of their sexual orientation or trans status.[13] There is still a significant prevalence of homophobia, biphobia and transphobia in places such as schools,[14] the workplace,[15] and healthcare services.[16] LGBT people may not be out to their family or may be estranged from their family because of their sexuality.[17] LGBT people still face unacceptably high levels of hate crime, most of which goes unreported.[18] [19]

These experiences can result in high stress levels, this kind of stress is sometimes referred to as minority stress.[20] Drugs are used by some as a way of attempting to cope with this stress.[21] [22] [23]

In the 2017 National LGBT Survey 117 people mentioned substance misuse in the free text section. A number of respondents wrote that negative experiences of being LGBT can cause alcohol and substance misuse. Trans respondents also said that they used drugs as a coping mechanism to deal with the difficulties of transitioning, particularly related to long waiting times for accessing Gender Identity Clinics.

One respondent wrote ‘The waiting lists for GICs [Gender Identity Clinics] need genuine change… I have personally used alcohol, cannabis, cocaine and self-harm to survive the last year and a half since referral, and I have now been told I will have to wait several more months because of the backlog’. (Trans man, 18-24, North West)

2.2 Mental Health

There is significant evidence to say that LGBT people have poorer mental health compared to the general population, something that can lead to drug use.

• LGB people are twice as likely as the general population to commit suicide[24] and half of all trans people have attempted suicide.[25]

• In 2012 3% of gay men and 5% of bisexual men attempted to take their own life in the previous year. This compares to just 0.4% of men in general over the same time period. [26]

• In a 2015 survey of trans people Greater Manchester 78% reported suicidal thoughts and 76.4% reported having experienced depression.[27]

2.3 The ‘Scene’

Many LGBT spaces are bars and clubs, for example Manchester’s Gay Village, where alcohol and drugs use is prevalent.

Amongst the general population people who use the night-time economy, especially nightclubs, are more likely to use club drugs. This is the same for LGBT communities, with the highest rates of drug use reported by those who attend gay specific venues and clubs.[28] [29]

3. Barriers to Accessing Support

LGBT people may be more reluctant to seek support for a substance misuse problem.

LGBT Foundation’s Part of the Picture research found that:[30]

• Just under 20% of LGB people would not seek information, advice or treatment if they were worried about their drug or alcohol use.

• Of those who were experiencing three or more indicators of dependency ‘shame / stigma/ embarrassment’ was the most commonly given reason for not seeking help. ‘Deal with it on own’ and ‘not knowing where to go’ were the second and third most commonly given reasons respectively.

This may be linked with a general unwillingness to access healthcare services due to fear of discrimination: 

A 2017 Survey carried out by LGBT Foundation found that:[31]

• 21% of LGBT people had experienced discrimination or unfair treatment based on their sexual orientation or gender identity from a primary care service.
• Trans patients were over 30% more likely to experience discrimination or unfair treatment at their GP.
• 33% of people reported that their GP did not meet their needs as an LGBT person and 72% said they thought GP practices could improve services they offer their LGBT patients.
• 10% of LGBT people reported not being registered with a GP and almost 40% of LGBT people do not access dentistry, optometry or community pharmacy. 

4. Best Practice and Recommendations

4.1 Best Practice: LGBT Foundation provides a range of LGBT specific substance misuse support. Including one to one, telephone and online support; chemsex support; referral for specialist GBL/GHB detox and rehab and access to mutual aid and peer support groups. In 2016-17 our drug and alcohol programme helped people 378 times.

These support groups include:

• A weekly group called ‘Here and Now’ where LGBT people affected by substance misuse can meet and support each other in a safe space.

• A drop in monthly group for LGBT women to access support.

• ChemSafe: a weekly group peer support group for men affected by chemsex.

• SMART recovery: A Cognitive behaviour therapy based programme that supports people to manage recovery from any type of addictive behaviour.

• Queers Without Beers: social events that provide drug and alcohol free spaces for LGBT people to meet and socialise.

LGBT foundation also provide LGBT inclusion training to mainstream substance misuse service providers in Manchester. In 2016-2017 61 staff and volunteers within Manchester’s drug and alcohol services received this training.

Recommendations:

• The positive impact of LGBT Foundation’s substance misuse service demonstrates the benefit of specific services provided by the Voluntary and Community Sector (VCS). LGBT people who are unwilling to access mainstream services may be willing to access LGBT Foundation’s services. This reinforces the need for the government to continue to commission and partner with the VCS.

• The NHS has recognised this need in the NHS Long Term Plan which committed to the continuation of NHS work with local charities and community interest companies that provide services to vulnerable groups.

4.2 Best Practice: Pride in Practice is LGBT Foundation’s quality assurance and social prescribing programme for primary care services and LGBT communities. It develops and strengthens relationships between clinicians and patients, and enables primary care services to link with community assets and utilise strength based approaches to community healthcare delivery. In 2017-18 the service trained 1680 professionals on LGBT issues & health care needs.

As a result of our training, attendees reported 99.2% satisfaction, with 99.8% reporting a greater understanding of LGBT issues. (https://lgbt.foundation/who-were-here-for/pride-in-practice)

Recommendations:

• Section 2 indicated that LGBT people face discrimination from healthcare services and this can make them reluctant to access support, this could mean LGBT people are not accessing support for a substance misuse issue. Therefore the Pride in Practice programme should be implemented across the country with the aim of making all primary healthcare services more LGBT inclusive and accessible.

• Additionally, all those working in substance misuse services should undertake specialist LGBT inclusion training to ensure they can provide person-centred care for LGBT people.

• Pride in Practice also promotes better LGBT visibility in health services. In an LGBT Foundation survey 62% of LGBT people mentioned the importance of improving LGBT visibility in healthcare, for example having a Pride in Practice award displayed. [32] This is something that healthcare and substance misuse services need to act on to improve the experiences of LGBT people accessing these services. LGBT Foundation’s Greater Manchester Action Plan promotes a range of initiatives that can be adopted by health and social care services to improve LGBT visibility.[33] (https://lgbt.foundation/actionplan)

5. Sexual Orientation and Trans Status Monitoring

Current understandings on the prevalence of drug use, the contributing factors to higher levels of drug use and the harmful impact of drug use in LGBT communities are still limited. There is a particular dearth of evidence surrounding substance misuse in trans communities. A vital way in which the evidence base can be expanded is by implementing sexual orientation monitoring (SOM) and trans status monitoring (TSM) across the health and social care sector. The implementation of SOM and TSM is vital in working towards high-quality, evidence based responses to the high prevalence of drug use in LGBT communities.

The NHS Long Term Plan has made commitments to better understand at risk groups and highlight inequalities in order to improve person centred care. Widespread implementation of SOM and TSM is a vital step in increasing understanding of the LGBT population and making evidence based steps to improving person centred care for LGBT people.

It is important to note that sexual orientation and trans status are different and should be asked as separate questions on demographic monitoring forms.

• Sexual orientation monitoring guidance- LGBT Foundation has helped to develop the NHS England Information Standard which offers advice and practical tips for organisations on how to best monitor sexual orientation. This guide can be found here: https://lgbt.foundation/resources-and-information/policy/guidance/monitoring/guide
• Trans status monitoring guidance - LGBT Foundation have produced a briefing sheet on implementing TSM this guide can be found here: https://s3-eu-west-1.amazonaws.com/lgbt-media/Files/733001ca-5a3f-40de-81ac-bcac5cf88c2e/TSM%2520Briefing%2520Sheet.pdf