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在倫敦的藥愛(chemsex)危機中:救護人員每天都在呼叫救

在倫敦的藥愛(chemsex)危機中:救護人員每天都在呼叫救護車時分發建議卡

一個阻止人們死於藥多愛約會的開創性計畫正在進行中,因為救護人員在藥愛遭遇中分發了減少傷害的卡片

資料來源:Patrick Strudwick /The i報章特約記者 / 2023 年 5 月 10 日

 

高級救護人員彼得•金斯利在夜班期間處理一起重大事件(圖片來源:

CJ Clarke/London Ambulance Service)

 

 

倫敦救護車服務中心推出了一項開創性計畫,試圖減少遭受藥愛藥物災難性影響的人數——因為新數據顯示,僅在首都,救護人員每天都會被召集到以物質助燃的約會活動中。

當救護車到達並發現因服用冰毒甲基安非他命、GHB 或4-甲基甲基卡西酮(用於增強性能力)等藥物而處於醫療或心理危機中的人時,工作人員現在會分發帶有二維條碼的卡片。 這連接到一個網站,該網站將患者引導至求助熱線和成癮慈善機構,同時提供有關安全性行為和減害技術的信息,包括如何使吸毒過量的人復甦。

倫敦救護車服務中心臨床主管兼高級救護人員彼得•金斯利 (Peter Kingsley) 編製的令人震驚的數據促成了這種以前從未在任何地方嘗試過的卡片計畫。 在接受The i報章獨家採訪時,金斯利透露,透過搜尋自 2021 年 1 月以來所有救護車出勤記錄(每年大約一百萬次),然後彙整每一個引用藥愛藥物(例如甲基安非他命)的記錄,並將其與在現場記錄在案的信息進行交叉引用,他便能夠估計出救護人員已經治療了 764 人——在倫敦這幾乎是每天都會發生的數量。

在面臨發生藥為愛時,需要緊急救護車的類型包括服藥過量、外傷、呼吸問題和藥物引起的精神疾病。

藥愛 (Chemsex),作為一個術語,主要用來描述男人為了性而相遇,通常是透過約會應用軟體,並依賴於甲基安非他命、GHB/GBL 和4-甲基甲基卡西酮等關鍵藥物來助燃和維持相遇。 但是,雖然這樣的會面通常沒有發生任何事故,但來自記者、慈善機構、醫生和警方的證據越來越多地揭示了它對身心健康的風險。在金斯利的數據顯示,現在女性在性行為中亦使用這些藥物並需要救護車。

然而,到目前為止,救護車服務部門從未提供過前線這一場景中突發衛生事件的快照。 倫敦是第一個這樣做的。 金斯利說,這些數字讓他、他的同事和研究藥愛的學者感到震驚。「這比大多數人想像的要多」。

然而,即使是每天一次的總數也可能被低估了,因為公眾和救護人員的報告都不足,金斯利在瀏覽記錄時只能依靠患者報告中的關鍵字搜索作為依據。「如果參加的工作人員沒有在筆記中寫下其中一個關鍵詞,那麼這就是一個遺漏的統計數據。例如,如果他們寫下「崩潰——查詢原因」,並且不承認服用藥物,那將永遠不會出現在我的數據中。”

 

圖片:彼得•金斯利(照片:CJ Clarke/倫敦救護車服務中心)

 

他描述了可能導致漏報的兩種典型情況。

「假設是星期天早上 4 點,在 Vauxhall [倫敦南部] 發現一名半裸的年輕人衣冠不整——心煩意亂——意識水平下降。 一些救護人員經驗豐富,他們會識別中毒綜合症 [特定毒素的症狀],例如 GHB 過量的特徵,並說「可能是 GHB」。 只要他們說「GHB」,它就會出現在我的數據中。 更多時候,他們會說「崩潰——酣醉中毒狀況,原因不明」。 救護人員也可能將與藥愛相關的藥物誤認為不是。「如果有人服用了冰毒並且表現得非常過度興奮,那麼因為它看起來與可卡因非常相似,而且因為可卡因比冰毒更常見,所以救護人員可能會傾向於將其標定為可卡因而不是冰毒」。

但他說,導致整體情況存在潛在差距的其他原因是參與藥愛的民眾可能:不告訴救護人員發生了什麼,在救護理人員到達之前離開,延遲呼叫救護車,或者根本不這樣做。「有人擔心,當你打電話叫救護車時,警察也會到場」。 這種恐懼會導致患者被遺棄。

「我的一位同事最近進入了一處 Airbnb 房產。 地板上有一個不省人事的裸體男人,其他人都走了,前門開著,但他們把他身體放在復甦位置上,把他的頭向後仰,撥通了 999 就離開了。 我寧願他們這樣做,也不願他們不這樣做 [撥打電話 999] 」。 然而,延遲呼叫救護車或未能呼叫救護車可能意味著可能可以治療的過量服用藥物會致命。

「我們對報警的認知比實際情況要根深蒂固得多」,他說,並解釋說道除非有人死亡,或者除非有強烈懷疑涉及違規行為,否則不會通知警方。

他說,這些數據結合金斯利的臨床救護人員工作以及他去年研究期間與同事的談話,提供了對 藥愛影響的獨特見解,因為救護人員是醫療服務中唯一進入發生狀況現場的成員。 它涵蓋了導致撥打 999 電話的各種情況和一些更常見的情況。

「如果你服用一種 GHB 藥物 [GHB 或 GBL,它們幾乎相同] 加上冰毒,我會看到這是一種典型的組合,會磨牙,嘔吐到呼吸道。我最近參與的一個案例;合作夥伴最終進行了胸部按壓,因為他們認為[他]心臟驟停。他們有癲癇發作,這可能會非常混亂」。

「在天平的另一端——也是我們招募心理健康諮詢護理人員和心理健康護理人員領導這個計畫的原因——是因為他們看到患者長期以來對 GHB 或甲基安非他命上癮」。

成癮和戒斷問題會引發精神和身體危機。 例如,在沒有醫療監督的情況下停用 GHB(一種強效鎮靜劑和麻醉劑)可能會危及生命,因為患者可能會發作癲癇發作。

「我還看到冰毒導致的急性行為障礙。 由於我的專長,這一項對我來說並不少見的工作,就是見到一個裸體或半裸的男人在穿過沃克斯豪爾或伊斯靈頓的大街上奔跑,熱、汗、過度刺激、過度激動,並且有冒險行為。 他們最終可能會受到外傷,因為他們會變得像精神病發作並跳出窗戶或跑到車流中」。

但金斯利說,不僅僅是單身的男性透過約會應用軟體要救護車進行匿名約會。 已婚同性戀伴侶也在使用 GHB 等藥物並意外服用過量。 令金斯利驚訝的是女性也出現在這個場景中,而多年來這狀況一直與男同性戀和雙性戀男性密切相關。

「一位同事告訴我他參與的一次任務,其中一男一女透過 Tinder 相遇,為了服用 GHB 並發生性關係,其中一人服用過量。 這位年輕的女士最後赤身裸體,昏迷不醒。 電話打進來了」,他說。

儘管他之前還沒有計算過他數據中的人口統計因素,但金斯利在被追問時表示,到目前為止,他的印象的是女性約佔藥愛救護車出勤人數的 10%。

 

四驅車取代救護車,偏遠小鎮事故黑點仍在爭取緊急救護

 

數據還顯示,倫敦的藥愛熱點地區是救護人員參與的事件數量最多的地區:沃克斯豪爾、肯寧頓、威斯敏斯特、卡姆登、伊斯靈頓和橢圓形區域。 在倫敦市中心,工作人員現在將接受專門培訓,學習如何識別藥愛藥物的症狀,以及如何敏感地對待處在這些情況的人。 下個月,金斯利還將與英國救護車服務部門的領導人和 LGBT 工作人員會面,介紹這一概念並向同事通報他的發現。

但開發供救護人員發放的卡片的出發點是意識到,希望當他們到達現場時,有一個較大的機會與在場的人互動。

金斯利說:「如果你玩得很開心,每個人都玩得很開心,然後突然出現問題,這是一個令人難以置信的清醒時刻」。「如果你看到你的朋友或搭檔必須進行氣道管理、氣道抽吸,或者必須面對與你發生性關係的人進行胸部按壓,你就會意識到,你正在做的作為可能會有負面影響」。

作為專門處理這些案件的資深工作人員,他多次目睹過這樣的場景。

「你會看到清醒的伴侶因剛剛發生的事情而身體發抖。 他們從快樂、飢渴、興奮變成了身體顫抖和害怕。 那是一個『觸手可及的時刻』。 那個人可能只是想獲得一些建議、一些信息」。此時將提供該卡。

「我們會對他們說,『你想拿卡嗎? 當你準備好後,看看它——明天早上吃早餐時,或者一個月後。 其中有一些您可能會感興趣的信息,或者可能會幫助您處理發生的事情』。」

必須仔細考慮卡的物理外觀。 倫敦救護車服務中心與慈善機構男同性戀健康團體合作,後者資助並開發了該卡和網站。 他們一起意識到上面不可能有任何文字。 由於涉及標籤污名、保密和非法行為,它不能提及性、毒品或藥愛。 它不能指任何性別,因為現在所有性別都參與。 出於同樣的原因,它也不能指代性行為。 相反,它必須是沒有任何指標或與其分離的,顯示如果它從某人的口袋裡掉出來或被其他人發現,可能會將他們置於危險之中。「例如,如果他們住在家裡,而他們的媽媽在他們的口袋裡發現了它,我可能就會造成把他們揭發」,金斯利說。 因此,卡上唯一的東西就是二維碼。

這也是救護人員現在唯一發放的的一張卡片。 對於其他健康問題從糖尿病到高血壓等,工作人員只需使用 iPad 即可將患者轉診至專科診所。 但金斯利說,圍繞藥愛的敏感性,以及有各種物質使用問題的人在準備好需要尋求幫助時的知識意味著保存身體的目的是最好的選擇。 據男同性戀健康團體創始人帕特里克•蓋爾 (Patriic Gayle) 稱,當藥愛過程中出現問題時,它還可以去協助以避免要去否認某些經歷。「使用卡片去進行聯繫就是去處理所發生的事情及其意涵的一個步驟」,他說。

它連接的網站提供了一系列選項和提示。 使用者可以指出讓他們感到非常震驚的經歷,並被轉接到危機求助熱線,例如撒瑪利亞人(樂善好施者)或 LGBT+ 總機。

如果有人想學習減害的技術,他們可以點擊按鈕詢問更安全的選擇,包括在哪裡可以找到免費的針具、性傳播感染測試以及最大限度地減少藥愛風險影響的具體建議。 如果使用者想要完全戒除,可以指導他們尋求專業服務,以戒除冰毒、GHB 和4-甲基甲基卡西酮。 如果有人需要有關遇到其他緊急情況時該怎麼做的建議,這裡有關於如何急救、如何讓某人處於復甦姿勢、何時應撥打 999 以及在救護車到達之前應該做些什麼的信息。

還有一個按鈕可以表明您是犯罪受害者,如果您願意的話,可以鏈接到警察,還可以鏈接到女性強姦危機中心或男性受害者組織。

「所以它並沒有說,『你是個白痴,你需要停止』」,金斯利說,他解釋說,簡單地告訴有物質使用問題的人去戒除是無效的,而且可能會導致民眾和救護人員之間信任的破裂。 特別是當他們感到受到評判時。 使用該網站的任何人都不會記錄任何信息,並且一切都是匿名的。

他說,到目前為止,這些卡片很受歡迎,隨著他的研究的繼續,這些卡片將繼續無限期地分發。 但在服務延伸的時代,有些人可能會質疑這樣做的合理性,甚至對相關人員的行為進行道德勸說。

「我們正在為每個人、所有倫敦人提供服務」,金斯利回答道。「我們來這裡不是為了對任何人的生活做出評判」。 他說,相信某些情況比其他情況更值得幫助是危險的。「如果你騎電動滑板車,你比步行面臨的風險更大。那難道我不關心他們嗎? 還是對於吸煙者? 還是飲酒者? 我所觀看到的與酒精相關的劇碼遠比我觀看到的 GHB 或冰毒的還要更多」。

但這張卡片,他補充說逍,「將會對一群他們為何會這樣做有自己理由的人產生改變,並且有自己的故事去闡述」。

 

 

 

 

 

 

 

Inside London’s chemsex crisis: paramedics to hand out advice cards as ambulance is called every day

A groundbreaking project to stop people dying at hook-ups is now under way, as paramedics give out harm reduction cards at chemsex meetings

描述: author avatar imageBy Patrick Strudwick / Special Correspondent / May 10, 2023

 

Advanced paramedic Peter Kingsley attending a critical incident during a night shift

 (Credit: CJ Clarke/London Ambulance Service)

 

The London Ambulance Service has launched a pioneering scheme to try to reduce the number of people suffering catastrophic effects of chemsex drugs – as new figures show paramedics are called out to substance-fuelled hook-ups every single day in the capital alone.

When ambulances arrive to find people in crisis, medically or psychologically, from drugs such as crystal methamphetamine, GHB or mephedrone – used to enhance sex – staff will now hand out cards with a QR code. This connects to a website that signposts patients to helplines and addiction charities, while providing information on safer sex and harm reduction techniques, including how to resuscitate someone who is overdosing.

The card scheme – which has never been tried anywhere before – was prompted by alarming data compiled by Peter Kingsley, a clinical supervisor and advanced paramedic practitioner in the London Ambulance Service. In an exclusive interview with i, Kingsley revealed that by trawling through records of all ambulance callouts since January 2021 (roughly a million a year), then collating each one that references chemsex drugs such as meth, and cross-referencing that with information documented on the scene, he was able to estimate that paramedics have treated 764 people – a roughly daily occurrence in London.

The types of emergencies ambulance are being called to amid chemsex encounters include overdoses, trauma injuries, breathing problems, and drug-induced psychosis.

Chemsex, as a term, has mostly been used to describe men meeting each other for sex, often through dating apps, and relying on key drugs such as meth, GHB/GBL and mephedrone to both ignite and sustain the encounter. But while such meetings often occur without incident, evidence from journalists, charities, doctors, and police has increasingly revealed the risks to physical and mental health. And now women are using these drugs during sex and requiring ambulances, Kingsley’s data shows.

Until now, however, the ambulance service has never provided a snapshot of the frontline of health emergencies within this scene. London is the first to do so. The figures, said Kingsley, jolted him, his colleagues, and academics who study chemsex. “It’s more than most people thought it would be.”

Even the once-a-day total, however, could be an underestimate, because of both underreporting from the public and from paramedics, with only keyword searches on patient reports for Kingsley to rely upon as he trawled through the records. “If the attending crew didn’t put one of those key words in the notes, then that’s a missed statistic. If, for example, they write ‘collapse – query cause’, and don’t commit themselves to a drug, that would never show up in my data.”

Advanced paramedic Peter Kingsley (Photo: CJ Clarke/London Ambulance Service)

 

He described two typical scenarios that could lead to underreporting.

“Let’s say it’s 4am on a Sunday morning, and a semi-clothed young man is found in Vauxhall [south London] in a dishevelled state – distressed – with a reduced level of consciousness. Some paramedics are experienced enough that they will recognise the toxidrome [symptoms of a particular toxin], for example the characteristics of a GHB overdose, and say, ‘likely GHB’. As soon as they say ‘GHB’ it’ll come up in my data. More often, what they’ll say is ‘collapse – intoxicated, unknown cause’.” Ambulance crews might also mistake a drug associated with chemsex for one that it is not. “If somebody has taken meth and is presenting as very overly stimulated, then because that looks quite similar to cocaine, and because cocaine is far more common than meth, paramedics might be tempted to pin it to coke rather than crystal meth.”

But other reasons for potential gaps in the overall picture, he said, are members of the public engaging in chemsex may either: not tell paramedics what has happened, leave before paramedics arrive, delay calling for an ambulance, or not do so at all. “There is concern that when you phone for an ambulance, the police will also attend.” This fear can result in patients being abandoned.

“One of my colleagues recently attended an Airbnb property. There was an unconscious naked man on the floor, and everybody else had gone and left the front door open, but they put him in the recovery position on his side, and tilted his head back, phoned 999 and left. I’d rather they do that than not [phone 999].” A delay in calling for an ambulance, or a failure to do so, however, can mean that overdoses that might be treatable become fatal.

“The perception that we call the police is far more ingrained than the practice,” he said, explaining that unless someone has died or unless there is a strong suspicion that there was foul play involved, then the police will not be notified.

The data, combined with Kingsley’s clinical paramedic work and conversations with colleagues during his research over the last year, provide a unique insight into the impact of chemsex, he said, as ambulance crews are the only part of the health service that enters the situations where it occurs. It captures both the range of circumstances that lead to a 999 call and some of the more common scenarios.

“If you take one of the GHB drugs [GHB or GBL, which are almost identical] plus crystal meth, that’s a typical combination that I will see, with grinding teeth, vomiting into their airways. One that I attended recently; the partner ended up doing chest compressions because they thought the [other] was in cardiac arrest. They had seizures. It can be quite a mess.”

“At the other end of the scale – and the reason why we recruited our consultant mental health nurse, and mental health paramedic lead into this project – was because they see patients chronically addicted to GHB, or to meth.”

The problems of addiction and withdrawal can trigger mental and physical crises. Withdrawing from GHB (which is a powerful sedative and anaesthetic) without medical supervision, for example, can be life-threatening, as seizures can erupt in the patient.

“I also see acute behavioural disturbance as a result of crystal meth. A not uncommon job for me, because of my speciality, will be a naked or semi-naked guy running down the high street through Vauxhall or Islington, hot, sweaty, overstimulated, overagitated, with risk-taking behaviour. They can end up with trauma injuries, because they get psychotic and jump out of a window or run out into traffic.”

But it’s not only single men having anonymous encounters through dating apps requiring ambulances, said Kingsley. Married gay couples are also using drugs such as GHB and having accidental overdoses. More surprising to Kingsley was the emergence of women in this scene, which for years has been closely associated with gay and bisexual men.

“A colleague told me about a job he attended where a man and a woman met up through Tinder, in order to take GHB and have sex, and one of them overdosed. The young lady ended up naked and unconscious. And the phone call came in,” he said.

Although he hasn’t yet formerly calculated demographic elements within his data, Kingsley, when pressed, said his impression so far is that women make up roughly 10 per cent of chemsex ambulance callouts.

 

Remote town in accident blackspot still fighting for emergency care as 4×4 replaces ambulance

 

The data also indicates the areas in London that are chemsex hotspots, with the highest number of incidents attended by paramedics: Vauxhall, Kennington, Westminster, Camden, Islington and Oval. In central London, staff will now be provided specific training to learn how to identify symptoms of chemsex drugs, and how to treat people in these situations with sensitivity. Next month, Kingsley will also be meeting leaders and LGBT staff from across Britain’s ambulance services to introduce the concept and advise colleagues of his findings.

But the starting point in the development of the card for paramedics to hand out was the realisation that when they arrive on the scene there is a huge opportunity to engage with those present.

“If you’re enjoying yourself and everybody’s having a good time, then suddenly something goes wrong, it’s an incredibly sobering moment,” said Kingsley. “If you see your friend or hook-up partner having to have airway management, suctioning the airway, or having to do chest compressions on the guy you’re having sex with, it makes you realise that there can be a downside to what you’re doing.”

As a senior member of staff who specialises in these cases, he’s witnessed these scenes many times.

“You’ll see the sober partner physically shaking with what’s just happened. They’ve gone from being happy, horny, and high to physically shaking and scared. That’s a ‘reachable moment’. That person might just want to engage with some advice, some information.”

This is when the card will be offered.

“We would say to them, ‘do you want to take a card? When you’re ready, have a look at it – tomorrow morning over breakfast, or a month from now. It’s got some information on there that you might find interesting, or might help you process what’s happened.’”

The physical appearance of the card had to be carefully considered. The London Ambulance Service worked with the charity Gay Men’s Health Collective, who funded and developed the card and website. Together, they realised that there couldn’t be any words on it whatsoever. It couldn’t mention sex, drugs or chemsex due to the stigma, secrecy and illegality involved. It couldn’t refer to any gender because all genders now participate. And it couldn’t refer to sexuality for the same reason. Instead, it had to be discrete and devoid of any indicators that if it were to fall out of someone’s pocket or be discovered by someone else, might put them in danger. “If they live at home, for example, and their mum finds it in their pocket, I’d have outed them,” said Kingsley. The only thing on the card, therefore, is the QR code.

It’s also the only card that paramedics now hand out. With other health issues, from diabetes to hypertension, staff simply use an iPad to refer patients to specialist clinics. But the sensitivities surrounding chemsex, and the knowledge that people with substance problems of all kinds need to seek help when they are ready means a physical object to be kept was the best option, said Kingsley. According to Patriic Gayle, the founder of the Gay Men’s Health Collective, it can also help bypass the denial some experience when things go wrong during chemsex. “Using the card to reach out is a step to processing what has happened and what it means,” he said.

The website it connects to provides a series of options and prompts. Users can indicate that they’re extremely shaken up by what they’ve experienced and be taken through to crisis helplines such as the Samaritans or LGBT+ Switchboard.

If someone wants to learn harm reduction techniques, they can click on the button asking for safer options, including where to find free needles, STI testing, and specific advice to minimise any risky effects of chemsex. If a user wants to give up completely, they can be directed to specialist services for coming off meth, GHB and mephedrone. And if someone wants advice on what to do if faced with another emergency, there is information about first aid, how to put somebody in the recovery position, when to phone 999, and what to do before the ambulance arrives.

There is also a button to say you’ve been a victim of a crime, with a link to the police – if you want that – but also women’s rape crisis centres or organisations for male victims.

“So it doesn’t say, ‘you’re an idiot, you need to stop’,” said Kingsley, explaining that telling people with substance issues to simply quit isn’t effective and risks trust breaking down between the public and paramedics – particularly if they feel judged. No information is recorded on anyone using the website, and everything remains anonymous.

So far, the cards have been well received, he said, and will continue to be dispensed indefinitely, as his research continues. But in an era of stretched services, some might question the justification for doing this, or even moralise about the behaviour of those involved.

“We’re providing a service to everybody, to all Londoners,” replied Kingsley. “We’re not here to pass judgement on anyone’s lives.” To believe that some conditions are more worthy of help than others is dangerous, he said. “If you ride an e-scooter you’re more at risk than if you walk. Do I not attend to them? Or to smokers? Or drinkers? I attend far more alcohol-related dramas than I ever do GHB or crystal meth.”

But this card, he added, “will make a difference to a group of people who have their own reasons why they’re doing it – and have their own story to tell.”

 

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