Harm reduction
Staying safer: chemsex harm reduction
No judgement, just information. If you or someone you know is using, these steps can help keep everyone safer.
G (GHB and GBL)
Dosing and timing
Small, measured doses
The gap between a dose that gets you high and one that makes you pass out is very small. Measure every dose with a syringe or pipette marked in millilitres. Never swig from the bottle.
Measure your own
Always measure your own dose, and don’t let anyone else do it for you. Strength varies, and GBL is stronger than GHB, so if you’re not sure, go lower.
Wait, and time it
G can take from 10 minutes to an hour to kick in. Wait at least two hours before taking any more, and set a timer on your phone.
Write it down
G can affect your memory. Note the time and amount of every dose somewhere you can see it. If you’re not sure whether you’ve taken some, don’t take more.
Never redose early
Doses stack, so a repeat dose can hit harder than the first. Going under can happen with little warning.
Mixing
Never mix G with alcohol or other downers
Sources: NHS Hampshire and Isle of Wight Sexual Health, Public Health Wales, 56 Dean Street.
Not with alcohol
G and alcohol interact, and together they can kill. Alcohol also delays how long G takes to work, which throws your timing out.
Not with other downers
Ketamine, benzos (like diazepam or Xanax), sleeping tablets and opioids all raise the risk of going under and breathing slowing or stopping.
Watch the uppers too
Stimulants like meph can mask how high you are, which can lead to taking too much G.
Free in Wales
Naloxone
Sources: DAN 24/7.
What it does
Naloxone is a medicine that temporarily reverses an opioid overdose (for example heroin, methadone, codeine or tramadol). It doesn’t reverse G, and there is no antidote to G.
Get a free kit
DAN 24/7’s Naloxone Click & Deliver posts a free kit to any address in Wales, after short online overdose-awareness training. It’s for people who use opioids, and their friends and family.
Order through DAN 24/7Still call 999
Naloxone wears off, usually within 30 to 60 minutes, and the overdose can come back. Always call an ambulance, even if you’ve given it.
HIV prevention
PEP and PrEP
Sources: Public Health Wales: PEP and PrEP (includes PrEP clinic numbers for every health board), Public Health Wales: sexual health.
PEP, after sex
PEP is a 28-day course of tablets that can stop HIV after a possible exposure, like when a condom breaks. Start as soon as possible: within 24 hours is best, and no later than 72 hours.
Find a sexual health service through NHS 111 Wales. Out of hours or at weekends, go to an Emergency Department.
PrEP, before sex
PrEP is free on the NHS for Welsh residents who are at risk of HIV. Contact your local sexual health clinic. You’ll have an HIV test and kidney checks first, then regular tests.
PrEP doesn’t protect against other STIs.
Free testing at home
Order a free, discreet test kit for HIV and other STIs from Public Health Wales, plus free condoms and lube.
Sexual health in WalesLook after each other
Looking out for each other
Sources: NHS / St John Ambulance, HSE, Public Health Wales.
Don’t use alone
Use with people you trust, and agree a plan for an emergency before you start.
Never leave them to sleep it off
If someone has gone under, stay with them until help arrives. Don’t give them more drugs or alcohol.
The recovery position
If someone isn’t responding but is breathing, roll them onto their side, top knee bent, and tilt their head back gently to keep the airway open, so any vomit can drain. Then call 999.
Step-by-step guidePoppers
Poppers: staying safer
Sources: FRANK: poppers, ACMD: alkyl nitrites harms assessment (GOV.UK), Moorfields Eye Hospital case series (IOVS), British Journal of Ophthalmology, NHS: sildenafil, NHS: tadalafil, Sildenafil patient leaflet (emc), Terrence Higgins Trust, NHS: vision loss, DrugWise poppers briefing.
Warning: Never mix poppers with Viagra or other erection pills
Together they can cause a dangerous drop in blood pressure. This includes sildenafil (Viagra) and tadalafil (Cialis), and tadalafil can last up to 36 hours, so a pill taken yesterday still counts.
The same goes if you take heart medicines called nitrates (such as GTN spray for angina) or blood pressure medication.
Who should avoid them
Poppers are riskier if you have heart problems, low or high blood pressure, anaemia or glaucoma (an eye condition). They can cause an irregular or fast heartbeat.
Your eyesight
Poppers have been linked to damage to the centre of the retina, called “poppers maculopathy”. Most cases have been linked to products containing isopropyl nitrite, which is now the most common type sold in the UK, but labels don’t always say what’s inside. It can happen after one use or many.
Watch for blurry or patchy central vision, a blind spot in the middle, glare, or flashes of light or colour. If your sight changes, stop using and get urgent help from an optician, your GP or NHS 111 Wales. If you suddenly can’t see, go to A&E or call 999. It often gets better after stopping, but heavy, long-term use has caused lasting damage.
Never swallow them
Swallowing poppers can be fatal. If someone swallows some, call 999 straight away.
Keep it off your skin
Poppers can cause chemical burns and rashes around the nose and mouth, so avoid getting the liquid on your skin.
Keep away from flames
Poppers are highly flammable. Keep them well away from cigarettes, lighters and candles.
Sit down, go easy
The head rush can make you dizzy or faint, and can bring on headaches, sickness or nosebleeds. Your blood pressure drops fast, so sit down, take it slowly when you get up, take breaks, and stop if you feel unwell or get chest pain.
Careful with mixing
Mixing drugs is always risky. Poppers can make you pass out, and with alcohol the risk of choking on vomit goes up. If someone passes out, put them in the recovery position and call 999.
Emergency
When to call 999
- They can’t be woken
- Breathing is slow, noisy or irregular
- Blue lips or skin
- A seizure (fit)
- Vomiting while passed out
- Very confused or collapsing
Stay with them, put them in the recovery position, and tell the paramedics what’s been taken if you know. Paramedics are there to help, not judge. Public Health Wales says police usually only come to a medical call in specific situations, such as a suspected crime or a risk to the crew, and you won’t be arrested just for using drugs. Never let worry stop you calling.
Sources: HSE, NHS Hampshire and Isle of Wight Sexual Health, Public Health Wales.
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