Chemsex refers to the intentional consumption of specific substances, Gamma Hydroxybutyrate/Gamma Butyrolactone (GHB/GBL), Crystal Methamphetamine and/or Cocaine to facilitate or enhance the sexual experience. However, there was a plethora of associated problems ranging in severity to complex, life-threatening situations. Since its inception in 2014, The Club Drugs Clinic Ireland, the first outpatient-based clinic for GHB/GBL Detoxification in Ireland, had evolved to include managing problematic chemsex.

The Chemsex Working Group Ireland is a collaborative response from governmental and non-governmental agencies. Details of current medical and psychiatric management along with preliminary outcome findings on detoxification, relapse risk and associated factors will be presented.

Data collected include socio-demographic variables, gender and sexuality, detoxification setting, relapse history and attendance for counselling or aftercare. Descriptive analyses were conducted on referral counts, drug trends, success of first treatment episode, subsequent relapse rate, and uptake of counselling and aftercare.

There have been over 200 referrals to the Club Drugs Clinic Ireland. A number of predisposing and precipitating factors, contributed to the relapse rate (up to 70%) both in Ireland and internationally. The salutogenic, biopsychosocial-based model of addiction recovery produced the best outcomes. This integrated Dual Diagnosis Psychiatry, Sexual Health Medicine, Emergency Medicine and external services for a more comprehensive care.

The pattern of referrals reflects population trends in chemsex, despite the COVID-19 restrictions. While detoxification is largely successful, the high relapse rate highlights the challenge of maintaining abstinence. In order to competently address problematic chemsex, service coordination across various medical professions and ongoing monitoring of the substances consumed is quintessential.

No significant relationships.

Global concern around over the counter availability of codeine containing products and risk of misuse, dependence and related harms are evident. A phenomenological study of lived experiences of codeine misuse and dependence was undertaken in Ireland, following the Pharmaceutical Society of Ireland’s 2010 guidelines for restricted supply of non-prescription codeine containing products.

In-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n=21), both actively using, in treatment and in recovery. The narratives were analysed using the Empirical Phenomenological Psychological five-step method (Karlsson, 1995). A total of 10 themes with 82 categories were identified. Two concepts at a higher level of abstraction above the theme-level emerged during the final stage of analysis. The concepts identified were ‘emotional pain and user self-legitimization of use’ and ‘entrapment into habit-forming and invisible dependent use’. These concepts were reported in different ways by a majority of participants.

Findings are presented under the following themes: (1) profile and product preferences; (2) awareness of habit forming use and harm; (3) negotiating pharmacy sales; (4) alternative sourcing routes; (5) the codeine feeling; (6) the daily routine; (7) acute and chronic side effects; (8) social isolation; (9) withdrawal and dependence and (10) help-seeking and treatment experiences.

There is a public health and regulatory imperative to develop proactive responses tackling public availability of codeine containing medicines, risk minimisation in consumer self-treatment for pain, enhanced patient awareness of potential for habit forming use and its consequences and continued health professional pharmacovigilence.

To examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital.

All adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy.

There were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74).

Changes in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.