Emergency Info

Guidelines on when to call the Emergency Services 999 for unwell recreational drug users

Call 999 if ANY one of the following is present:

Unconsciousness – if the patient does not respond to vocal commands, requires painful stimulus (e.g. pressure across the fingernails) to respond or does not respond at all.

Significant agitation (e.g. pacing around the room) or aggression not settling within 15 minutes.

Seizures (e.g. a convulsion similar to an epileptic fit)

Breathing difficulties such as fast breathing rate which does not settle within 15 minutes.

Heart rate over 140 beats per minute not settling within 5 minutes.

Temperature over 38.5 not settling after about 5 minutes of rest, or if very flushed and feels very hot if no thermometer is available.

Blood pressure – Systolic (“upper pressure”) over 180mmHg, or Diastolic (“lower pressure”) over 110mmHg on two repeated blood pressure measurements.

Other concerns – if there are any other concerns (e.g. severe headache, chest pain).

 
IF IN DOUBT CALL 999

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Concrete advice on how to safeguard the sexual health and protect the safety of customers who use drink and drugs.

One of the reasons people go out to pubs, clubs and festivals is to meet a potential sexual partner. The mixing of alcohol and drugs with sexual activity leads to a number of concerns that owners, managers and promoters as well as Health and Wellbeing Boards and Sexual Health Services can all help to address.

The #MeToo movement has publicised the extent of sexual harassment and assault across all of society. This level of sexual violence means that all agencies, but particularly venue owners and promoters, should consider carefully all the activities set out in this chapter which can protect the sexual health and safety of their customers.

Sex, drugs and alcohol

The links between alcohol and drugs and sexual behaviour are well known.

A recent study1 N Khadr, K G Jones, S Mann, D R Hale, A M Johnson, R M Viner, C H Mercer, K Wellings (2016) Investigating the relationship between substance use and sexual behaviour in young people in Britain: findings from a national probability survey. British Medical Journal
http://dx.doi.org/10.1136/bmjopen-2016-011961″>http://dx.doi.org/10.1136/bmjopen-2016-011961″>http://dx.doi.org/10.1136/bmjopen-2016-011961
investigating the relationship between substance use and sexual behaviour in young people in Britain found that both men and women who said they participated in frequent binge drinking or used drugs recently were more likely to report:

  • unprotected first sex with one or more new partner(s) in the last year,
  • having sex early in a relationship,
  • using emergency contraception use in the last year, and
  • being diagnosed with a sexually transmitted infection (STI) in the past 5 years.

Researchers noted that associations with sexual risk were frequently stronger for those reporting multiple substance use, particularly among men.

Sexually transmitted infections

The high levels of STIs have been well-documented over recent years. The most recent figures for England show that:

  • In 2018, there were 447,694 diagnoses of sexually transmitted infections (STIs) made in England2Public Health England (2019) Sexually transmitted infections and screening for chlamydia in England, 2018. Health Protection Report Volume 13 Number 19 7 June 2019, a 5% increase since 2017,
  • There were 56,259 diagnoses of gonorrhoea reported in 2018, a 26% increase since 2017,
  • There were 7,541 diagnoses of syphilis reported in 2018, a 5% increase since 2017.

Condoms

Other than not participating in any sexual intercourse, the most effective way of reducing the risk of contracting an STI is the use of condoms. Pubs and clubs can help by ensuring that condoms are available, either as part of a condom distribution scheme or through condom machines which should be available in both male and female toilets. It is important to check condom machines regularly to ensure they are still working.

Having CCTV coverage of secluded areas and ensuring that toilet attendants are present at all times can discourage sex acts taking place on premises.

Footnotes   [ + ]

1. N Khadr, K G Jones, S Mann, D R Hale, A M Johnson, R M Viner, C H Mercer, K Wellings (2016) Investigating the relationship between substance use and sexual behaviour in young people in Britain: findings from a national probability survey. British Medical Journal
http://dx.doi.org/10.1136/bmjopen-2016-011961″>http://dx.doi.org/10.1136/bmjopen-2016-011961″>http://dx.doi.org/10.1136/bmjopen-2016-011961
2. Public Health England (2019) Sexually transmitted infections and screening for chlamydia in England, 2018. Health Protection Report Volume 13 Number 19 7 June 2019

The provision of information on sexual health (including location, timings and contact telephone numbers of contraceptive, GUM and abortion services) is a valuable service to pub and club goers. This can be provided via leaflet racks and a permanently displayed poster/sign, and are often best placed next to condom machines, in well-lit areas.

Club owners should contact their local health promotion department or sexual health clinic to access information materials.

hosting outreach workers

Sexual health information and outreach work has always been much more common and culturally acceptable within the gay scene and there are still many organisations involved in this work.

Typically organisations supply free condoms, water based lubricant and sexual health information. HIV and STI testing clinics are also common in some areas as is information on whether to use and how and where to get PReP (Pre-Exposure Prophylaxis) tablets to prevent HIV infection.

Feedback from venues who host sexual health outreach work tends to be very positive with customers appreciating that a business is catering to their non-commercial needs.

The #MeToo movement has publicised the extent of sexual harassment and assault across all of society and the 2019 Global Drug Survey1 Winstock AR, Barratt MJ, Maier LJ, Aldridge A, Zhuparris A, Davies E, Hughes C, Johnson M, Kowalski M & Ferris JA (2019). Global Drug Survey (GDS) 2019 Key Findings Report. asked its more than 120,000 respondents about being taken advantage of sexually while intoxicated.

A deeply troubling 14% survey respondents said this had happened to them. Of those who had been taken sexual advantage of in the 12 months prior to completing the survey, more than two thirds (69%) identified as women, 28% as men and 3% as non-binary or a different gender identity.

Official figures

The numbers of people who are sexually taken advantage of while intoxicated through alcohol and/or drugs are considerable. The most recent official data2 Office for National Statistics (2018) Sexual offences in England and Wales: year ending March 2017  reports that 38% victims of rape or assault by penetration reported that their offender(s) were under the influence of alcohol. The same proportion of victims (38%) said they were under the influence of alcohol themselves. The same official data reveals that victims reported that the offender was under the influence of drugs (8%) and that they themselves were under the influence of drugs they had chosen to take (2%).

Drug-facilitated sexual assaults

Many substances, including alcohol, benzodiazepines, and GHB/GBL, may cause temporary amnesia. While the scale of drug-facilitated sexual assaults is very unclear – some studies suggest that the problem is over-exaggerated, others that it is under-reported – it is clear that such assaults do take place regularly. Indeed, the same official data3 Office for National Statistics (2018) Sexual offences in England and Wales: year ending March 2017 quoted above reports that 6% of rape victims reported that they thought that the offender had drugged them with the proportion rising to 17% when the offender was a stranger.

For this reason venues are asked to display information about the risks of alcohol- or drug-facilitated sexual assault. They should also allow customers to keep their drinks with them, including in toilet areas if so desired and/or encourage customers to monitor their friends drinks when they are elsewhere.
All staff should be trained to look out for suspicious behaviour and seek to offer help and support to anyone about whom they have concerns.

Regular liaison with local police officers is encouraged so that venues can be promptly informed about any particular concerns around the risk of drug-facilitated sexual assault.

Duty of care

Operators are increasingly expected to take a proactive approach to safeguarding customers from sexual harassment and violence. There are three main strands to a safeguarding strategy: providing easy access to help and support; encouraging people who have been victim of sexual aggression to report this and sending clear messages to potential offenders that sexual harassment will not be tolerated and that all customers have a responsibility to challenge offensive behaviour among their social group.

It is important to train staff to be able to respond to customers who are experiencing unwanted attention. One such initiative is the Ask for Angela campaign which encourages customers who feel unsafe or threatened to talk to a member of staff and “Ask for Angela”, a codeword understood by staff who will contact security on the customer’s behalf. Posters giving information about the scheme are displayed in the toilets.

Footnotes   [ + ]

1. Winstock AR, Barratt MJ, Maier LJ, Aldridge A, Zhuparris A, Davies E, Hughes C, Johnson M, Kowalski M & Ferris JA (2019). Global Drug Survey (GDS) 2019 Key Findings Report.
2. Office for National Statistics (2018) Sexual offences in England and Wales: year ending March 2017 
3. Office for National Statistics (2018) Sexual offences in England and Wales: year ending March 2017
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