Bill O’Loughlin doesn’t fit the stereotype of a crystal meth user.
He is a world removed from the emaciated, scab-scarred face of heavy ice users we frequently see in mug shots in the media.
The 62-year-old consultant has spent much of his career advocating for drug users at various non-profit organisations including the Victorian AIDS Council.
He first smoked ice — also called methamphetamine or crystal meth — by accident in the late 90s. He bought what he thought was speed at a dance party and became sexually aroused for the next few days.
Mr O’Loughlin went on to use the drug ice every few months over a number of years to enhance his sex life.
About 1 per cent of the population report using ice recreationally, according to the latest National Drug and Household Survey. Most Australian ice users — 70 per cent — take the drug less than once a month.
And like Mr O’Loughlin, a number of those who use ice are engaging in chemsex: the practice of deliberately taking certain illicit drugs, such as ice, for the specific purpose of enhancing sexual pleasure.
Ice is ‘still an unsafe drug’
Nadine Ezard, the clinical director of the drug and alcohol service at St Vincent’s Hospital in Sydney, said ice may have a number of effects on the body when users have sex.
“It increases your alertness, your focus, your concentration, your attention. It might increase your libido and because it increases your alertness it does increase your durability, so you can party and engage in sexual relations for longer than you would without it on board,” she said.
“But it does also increase your blood pressure and heart rate and makes people hot and sweaty, so you do need to make sure you are cooling down and drinking enough water.”
The risk of overheating is dose-related, so people can have too much, she said.
“And then they overheat too much, and it may interact with some of the other medications that people are taking, like some of the antidepressants.”
This can put people at risk of serotonin syndrome, where too much serotonin has accumulated in your brain. It can be fatal if not treated.
Some users also experienced changes to their sexual function during prolonged periods of chemsex.
It’s also possible to suffer physical injuries while having chemsex.
“People have come forward with issues around injuries that they’ve sustained while they’ve been partying, or even people that have been engaged with porn and methamphetamine for several days can get injuries related to overstimulation of the genitals … and wounds that can be quite distressing for people.”
Dr Ezard said that those who encountered problems with ice tended to be heavy users over long periods, but warned it was still an unsafe drug.
“We do sometimes in the emergency department see people that may have only ever used methamphetamine once and they have a reaction like a stroke or a seizure from a high dose … or there’s just a particular reaction with their body,” she said.
Sometimes people also mix ice with other drugs such as GHB (gamma-hydroxybutyrate) or its precursor GBL.
“[GHB] is a relaxant, it makes sex more pleasurable according to the people who are taking it. It can decrease your blood pressure, decrease your heart rate,” Dr Ezard said.
However, the level of GHB and GBL required to get your high is very close to the level that results in overdose, which can lead to death.
“When we see people who’ve overdosed, their breathing actually slows down so much that they sometimes need assistance in breathing or intubation.”
‘There’s an intensity of sex’
Chemsex can happen between romantic partners, casual sex partners and at group sex parties.
It’s not just men who have chemsex. Experts strongly suspect that it’s prevalent among heterosexual couples too.
However, most of the research on chemsex focuses on gay and bisexual men. This is because studies show a greater proportion of them use illegal drugs than the rest of the population, and also because of the connection between drug use and HIV.
Adam Bourne, an associate professor in public health at La Trobe University, has interviewed dozens of men across Australia, Asia and in the UK about chemsex.
Between 7 and 10 per cent of gay and bisexual men reported having chemsex around the world. They tended to be in their 30s or 40s, and the drug also helped them “overcome sexual self-confidence issues, worries about body image, and concern about how good you are at sex”, he said.
Sexual pleasure was also a “key motivator”.
“There’s an intensity of sex that is facilitated by crystal meth that makes it different from just being drunk or having taken coke or other kinds of substances that were common in the past,” Dr Bourne said.
Mr O’Loughlin experienced that sense of intensity and freedom.
“There’s a profound, powerfully sensual aspect to using ice that means that you feel like you’ve never had sex like this in your life,” he said.
The drug also alleviated his anxieties about having sex as an HIV positive man.
“The beauty of crystal meth was it just took that away,” he said.
“I was still having safe sex but it took away that little bit of me that was thinking, ‘There’s an element of me that’s just tainted.'”
Garrett Prestage, a UNSW associate professor and sociologist, said that it was difficult to say what proportion of gay and bisexual men having chemsex used condoms.
But increasingly, those who had sex while using methamphetamines were taking the HIV prevention drug PREP (pre-exposure prophylaxis), also known as Truvada, he said.
“The men who are using methamphetamine are more likely than most other [gay] men to be using Truvada. So the men using methamphetamine are actually more protected [from HIV] when they’re engaging in condom-less sex than the men not using methamphetamine.”
Dr Prestage put this down to gay methamphetamine users being more likely to have support and contact within the gay community, which meant they were probably more aware of Truvada and how it could help them manage the risk of HIV.
“For me, it presents a really important opportunity for targeting the men who have typically in the past have been at highest risk [of HIV] because you can speak to them … in ways that they have experience of, and can understand,” he said.
Too much, too often can lead to problems
Heavy and frequent use could lead to negative sexual experiences, including confusion over whether they were consensual, Dr Bourne said.
“Men will sometimes experience anxiety or panic attacks and often these can be quite severe. Sometimes they will actually require medical assistance to help them calm down and come down when they’ve perhaps taken a little bit too much crystal methamphetamine.”
Dr Ezard said that long-term ice users typically experienced mental health problems such as anxiety and depression.
Long-time users also became more tolerant to the stimulant effects of ice, like high blood pressure and staying awake for long periods of time, but less tolerant to its psychotic effects.
“After many years of using regularly, people will often have some degree of perceptual disturbance or psychosis, usually paranoia and suspiciousness. But sometimes they’re quite confused about the whole world and people around them are quite concerned about them,” Dr Ezard said.
Those who became dependent on ice have to re-teach themselves how to experience sexual pleasure without using drugs, with help from a clinical psychologist and drug treatment specialists, she said.
“In the same way that reducing your substance use or disentangling yourself from that takes time, so does reinventing your sexuality.”
Bill O’Loughlin restricted the number of times he used ice each year to avoid slipping into heavy use or dependence. But a number of his friends struggled with heavy use.
“Their use was so heavy that it kind of seared into their sense of themselves and what sex means and they have to work very hard … to actually experiment with going out on a date and meeting someone and getting to know them and having sex without being drug-affected.”
He considered himself lucky he had never experienced the same problems.
“If I was in my 20s or 30s when it came along and I was a little bit more naive and much more excited about the opportunity as a gay man to explore this wonderful world then quite easily I could’ve ended up with a problem with it,” Mr O’Loughlin said.
He said he was no longer interested in using ice or other illicit drugs for sex.
“The drug kicked in and took me somewhere but it was still me, so hypothetically I can still have that level of intimacy and contact with another person … and that’s what I’m more interested in now than having a drug do it for me.”