Poly-club-drug use among gay and bisexual men: A longitudinal analysis

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Abstract

Objective

We sought to delineate patterns of poly-club-drug use among gay and bisexual men. Data were drawn from a large-scale 12-month longitudinal investigation of club drug use and sexual behavior among 450 racially, ethnically, and geographically diverse sample of gay and bisexual men in New York City.

Methods

Using community-based sampling, we recruited the sample from numerous venues and assessed the self-reported use of five drugs and their relation to one another: cocaine, ecstasy, GHB, ketamine, and methamphetamine. Multivariate hierarchical linear modeling (HLM) was utilized to examine associations of usage over the 12-month data collection period.

Results

Use of the five club drugs was highly related as noted by both parametric and non-parametric analyses of the cross-sectional data. Patterns of use over time also indicated significant longitudinal associations. Specifically, the use of methamphetamine over time was related to both the use of ecstasy and GHB.

Conclusions

The analyses suggest that usage patterns of individual club drugs such as methamphetamine, ecstasy, and GHB among gay and bisexual men are highly related across time. These findings hold implications for the treatment approaches that are utilized to address substance abuse in this segment of the population, and suggest that practitioners focus on the totality of the substance abuse behaviors and not necessarily individual drugs which are administered.

Introduction

In the last decade the use of “club drugs” such MDMA (“ecstasy”), ketamine, powdered cocaine, gamma-hydroxybutyrate (GHB) and methamphetamine (“crystal meth”) has become increasingly popular within many gay and bisexual male social circles (Halkitis et al., 2001, Schilder et al., 2005). Use of these substances initially was linked to dance clubs (Ross et al., 2003), but use has been documented to be more widespread and evidenced in numerous other contexts including but not limited to bars, commercial and public sex environments, and private residences (Gowing et al., 2002, Halkitis et al., 2005, Parks and Kennedy, 2004, Romanelli et al., 2003). This more pervasive use of club drugs among gay and bisexual men is perhaps explained by the sexual sociality engendered by the use of these substances (Green and Halkitis, 2006).

The majority of club drug using gay and bisexual men are “poly-club-drug users” (Halkitis et al., 2005, Lee et al., 2003, Patterson et al., 2005) indicating that within this population, use is characterized by the direct combination of multiple substances simultaneously or “in tandem,” as has been noted by Gorman et al. (2004), or the use of multiple drugs within a more extensive period of time, not necessarily concomitantly. Numerous other studies have documented the phenomenon of poly-club-drug use (Barrett et al., 2005, Degenhardt et al., 2002, Degenhardt and Topp, 2003, Halkitis et al., 2005, Palamar and Halkitis, 2006, Uys and Niesink, 2005), which has been shown to transgress ethnic and racial lines (Fernandez et al., 2005, Operario et al., 2006), as well as age/developmental stage (Lampinen et al., 2006, Patterson et al., 2005).

Club drug combinations are considered “favorable” by users to achieve a particular type of “high” or to balance stimulant and depressive effects of particular substances (Degenhardt and Topp, 2003, Palamar and Halkitis, 2006). However, in terms of public health considerations, the behavior of poly-club-drug use increases the health risks confronted by gay and bisexual men since the use of multiple drugs may increase the risk of overdose through drug synergism, may decrease cognitive function and inhibition, and may exacerbate associated risk behaviors such as unprotected sex, which could lead to the transmission of HIV and other bacterial and viral pathogens (Fernandez et al., 2005, Halkitis and Parsons, 2002, Mattison et al., 2001, Operario et al., 2006, Palamar and Halkitis, 2006, Patterson et al., 2005).

The patterns of poly-club-drug use are complex and most of the previously noted studies have relied on cross-sectional data to document the associations of use. For example, Patterson et al. (2005) as well as Operario et al. (2006) document the cross-sectional relations between usage variables in the previous six months; Fernandez et al. (2005) utilized similar cross-sectional measures for data relating to a 3-month period of assessment, while others have utilized a 4-month (Halkitis et al., 2005, Palamar and Halkitis, 2006) or year-long period of assessment (Lampinen et al., 2006) to document associations. To this end, it is difficult to ascertain the extent to which the relations between usage of the substances covary over time or whether the associations are spurious in nature. For example, while Lee et al. (2003) suggest that the use of ecstasy is associated with use of ketamine, methamphetamine, and cocaine, these non-parametric associations were established using a cross-sectional sample of 173 men.

Thus, the overriding purpose of our analyses was to consider patterns of club drug use over a year-long period of time using a panel cohort. Specifically, we assessed the usage of five club drugs over this period of assessment, and sought to determine the extent to which the patterns of use were longitudinally related. In this paper, we describe the patterns of usage for ecstasy, ketamine, powdered cocaine, GHB and methamphetamine, and consider the extent to which poly-club-drug use is evidenced in a sample of 450 gay and bisexual men.

Section snippets

Design and procedure

Project BUMPS (Boys Using Multiple Party Substances) was a mixed methodology longitudinal investigation of 450 club drug using men in New York City. Four waves of data were collected over the course of a year, which consisted of quantitative and qualitative assessments (at baseline, 4, 8, and 12 months post baseline). Participants were compensated for time and travel at the end of each assessment: $30, $35, $40, and $50, respectively. The aims of the study were (1) to investigate the individual

Patterns of club drug use: bivariate relations

Table 2 provides a summary of use of each of the five club drugs (ecstasy, ketamine, powdered cocaine, GHB, and methamphetamine) at each of the four assessment points in terms of percentage of the sample which indicated at least one instance of usage in the 4-month period of assessment, as well as the mean and median days of use for those who indicated usage. As can be noted, the significant number of “zero-counts” suggest non-normal distributions of the drug usage variables. Despite the

Discussion

We undertook an analysis of a longitudinal data set of club drug use based on a sample of 450 gay and bisexual men in New York City. Our work examined patterns of use for five specific club drugs that are highly prevalent in this metropolitan area: cocaine, ecstasy, GHB, ketamine, and methamphetamine (Goldsamt et al., 2005, National Institute on Drug Abuse, 2004, Ompad et al., 2004). In recent years, this class of drugs has garnered increased attention in the media and in academic research (

Acknowledgements

This research was funded by the National Institute on Drug Abuse Contract # R01DA13798. We thank Martin McDonough for his assistance with our mapping analysis.

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