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Drug and Alcohol Review (March 2006), 25, 111 – 113 The rise of Viagra among British illicit drug users: 5-year survey data JIM MCCAMBRIDGE1, LUKE MITCHESON1,2, NEIL HUNT2,3 & ADAM WINSTOCK3 1National Addiction Centre, Institute of Psychiatry, King’s College London, London, UK, 2South London and MaudsleyNHS Trust and KCA, UK, and 3South West Sydney Area Health Services and National Drug and Alcohol Research Centre,University of New South Wales, Australia AbstractViagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has sincebeen little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men.
Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectionalcomparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use arereported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appearsincreasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic andepidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent ofpossible harms. [McCambridge J, Mitcheson L, Hunt N, Winstock A. The rise of Viagra among British illicit drugusers: 5-year survey data. Drug Alcohol Rev 2006;25:111 – 113] Key words: illicit drug use, sexual behaviour, Sildenafil, Viagra.
among illicit drug users and non-users, is somewhat Sildenafil (Viagra) was licensed as a treatment for erectile dysfunction in the United Kingdom in 1998.
There is, however, one substantial exception to this Shortly afterwards, the first report of non-prescribed lack of study: examination of patterns of risk among use by recreational drug users in nightclubs appeared men who have sex with men (MSM). Although almost [1]. In the years since then, uninvited direct marketing all these studies have taken place within the United of Viagra has become a regular feature of internet States, an early British study identified a lifetime access and usage. Offered without prescription and at prevalence rate of 15% among MSM recruited in low cost, it would be surprising if such access has not London gyms [5]. Swearingen & Klausner [6] have contributed to a rapid expansion of recreational use, in recently reviewed 14 studies reporting data on the light of the much-vaunted effects of this drug within sexual risks associated with Viagra use. Viagra users were found to be approximately four times as likely Nightclubbers constitute a sentinel population of to have engaged in unprotected anal sex with a partner illicit drug users, among whom early evidence of wider of unknown or serodiscordant HIV status [odds trends among young people may be obtained [3,4].
ratio (OR) range 2.0 – 5.7 unweighted mean 3.9]. In A further report on the originally reported small sample addition, Viagra use was found to be elevated among (n ¼ 15) described patterns of experimental drug use HIV positive men reporting newly diagnosed sexu- among nightclubbers experienced in the use of a wide ally transmitted infections [6]. One relatively small range of illicit drugs [3]. The subsequent lack of study study not included in this review found no evidence of the evolution of patterns of use of this drug, both of increased sexual risk among MSM Viagra users, Jim McCambridge, National Addiction Centre, Institute of Psychiatry, King’s College London, 4 Windsor Walk, Denmark Hill, London SE5 8AF,UK, Luke Mitcheson, National Addiction Centre, Institute of Psychiatry, King’s College London, 4 Windsor Walk, Denmark Hill, London SE58AF, UK and South London and Maudsley NHS Trust and KCA, UK, Neil Hunt, South London and Maudsley NHS Trust and KCA UK, AdamWinstock, South West Sydney Area Health Services and National Drug and Alcohol Research Centre, University of New South Wales, Australia.
Correspondance to Jim McCambridge, National Addiction Centre, Institute of Psychiatry, King’s College London, 4 Windsor Walk, DenmarkHill, London SE5 8AF, UK. E-mail: Received 5 May 2005; accepted for publication 28 September 2005.
ISSN 0959-5236 print/ISSN 1465-3362 online/06/020111–03 ª Australasian Professional Society on Alcohol and Other DrugsDOI: 10.1080/09595230500537167 but did find much higher prevalences of ecstasy and Rising lifetime and recent use prevalence is evidentfrom the table for both men and women, withapproximately one in seven having ever tried this drug in the latest sweep of the survey. The ratio of last month Since 1999 an annual survey of nightclub drug users to lifetime prevalence has been approximately 30% in has been conducted in conjunction with Mixmag, a 3 – 5 years. Mean age of first use has declined from 27.7 specialist dance music magazine [4]. Readers are years in 1999 to 25.1 years in 2003. Although men are invited to return by freepost a questionnaire printed more likely to have used Viagra, women are younger in the magazine itself. In 2003 this option was sup- at first use (23.5 vs. 26.8 years, t ¼ 4.28, p 5 0.0001).
plemented by online access to the questionnaire. This For most, use is not frequent: of 53 reporting use innovation apart, data collection procedures have been within the last month in 2003, 33 used once, 11 twice, identical across the years, permitting cross-sectional seven on three to five occasions and two on most days comparisons over time [8]. Ethical approval for this study was obtained from the Maudsley/Institute of The time trends were found to be robust to potential confounding when the data were modelled. Lifetime These data share a fundamental weakness with and last month prevalence were both found to be previous studies of Viagra use in that they have not increasing by approximately 70% per year [OR 1.70 resulted from probabilistic sampling and hence their (95% CI 1.51 – 1.91), p 5 0.001; OR 1.70 (1.38 – generalisability is inherently problematic [6]. However, 2.10), p 5 0.001, respectively]. Similarly, age of first in the present study it is not being claimed that data use is reducing over time, by approximately 0.23 years from any 1 year represent a reliable estimate of pre- each year (0.002 – 0.47, p ¼ 0.048).
valence in any wider population. Rather, repeated Sexual orientation was specifically considered only in measurements over time, however, specifically allow the 2003 sample, as these data were not available in all inferences to be made on time trends where data earlier years. Prevalence was found to be elevated collection procedures and other threats to the reliability among those describing themselves as homosexual or of data can be shown to be constant or be effectively bisexual. Lifetime prevalence findings were: hetero- Between 1999 and 2003, 1151, 795, 988, 491 and homosexual 37.5% (21/56); w2 29.84, 2 df, p 5 0.001.
1134 UK responses (736 web, 398 post) have been This sexuality gradient was also detected for last month received, respectively (total n ¼ 4559). Approximately prevalence: heterosexual 3.5% (33/939); bisexual 8% 15% (n ¼ 686) reported prior study participation. Mean (8/100); homosexual 16% (9/56); w2 22.08, 2 df, age of respondents was 24 years and approximately p 5 0.001. When these analyses were repeatedly sepa- 40% were women, with little variation in the age and gender profile of the sample in each year. Prevalence significant findings results were obtained. However, data were modelled using logistic and multiple regres- there was one difference between men and women.
sion in STATA version 8 to control for potential Among men, prevalence was elevated among those confounding by age, gender, data collection method describing themselves as homosexual [lifetime and (post/web), number of responses per year and prior last month prevalence 42% (19/45) and 20% (9/45) respectively], with bisexual and heterosexual men Table 1. Lifetime and last month prevalence of Viagra use In 2001 and 2003 there were an additional four and five cases who had ever used this drug, for whom gender data were missing. Ofthese, one and two had used within the previous month, respectively.
Rise of Viagra among British illicit drug users being similar. Among women, while heterosexual and difficult to undertake. Study of the diffusion of Viagra homosexual women were similar, prevalence was across different populations of drug users needs also to elevated among those describing themselves as bisexual incorporate investigation of patterns of use by gender. It (lifetime and last month prevalence 29% (18/62) and seems plausible that female illicit drug users, as well as their male counterparts, may be more confident aboutdrug experimentation than non-users. Epidemiologicalstudy of patterns of use, including associations with other drug use and high-risk sexual behaviours, and Notwithstanding the limitations of this survey [4,8], monitoring of adverse consequences, is now also over a recent 5-year period Viagra does appear to have needed to fully appreciate the extent of actual use and associated harms. This will assist efforts towards the repertoires of British nightclubbers, and wider diffusion of use among young people and other adults may beexpected to occur. Although most use appears to be infrequent or transient, the advent of Viagra use withinthis population and beyond raises a number of public We are grateful to Selina Lovell for data entry and other support, and to the staff and readers of Mixmag. The Drug interactions with prescribed drugs have been first author is supported by a Wellcome Trust Health reported previously [9]. Potential cardiovascular inter- Services Research Fellowship. The comments of the actions with illicit drugs are also of specific concern [1,4]. This drug is not licensed in the United Kingdomfor women [10], so all female use would appear to be on an unprescribed basis, carrying with it unknownconsequences. Unfortunately, no data are available on [1] Aldridge J. Measham F. Sildenafil (Viagra) is used as a recreational drug in England. BMJ 1999;318:669.
the proportion of men in this sample who obtained this [2] Alpert JS. Viagra: the risks of recreational use. Am J Med drug on prescription, nor on other sources of this drug, apart from the original reports of sales alongside other [3] Measham F, Aldridge J, Parker H. Dancing on drugs: risk, health and hedonism in the British club scene. London: Plausible mechanisms linking Viagra with other [4] Winstock AR, Griffiths P, Stewart D. Drugs and the dance recreational drug use and sexual risk are straightfor- music scene: a survey of current drug use patterns among a ward to discern. Temporary erectile incapacity asso- sample of dance music enthusiasts in the UK. Drug Alcohol ciated with alcohol or stimulant drugs, for example, may be ameliorated with Viagra. Greater friction may [5] Sherr L, Bolding G, Maguire M, Elford J. Viagra use and occur during sex as a result of enlarged erection, sexual risk behaviour among gay men in London. AIDS2000;14:2051 – 3.
heightening the risk of sexually transmitted infections.
[6] Swearingen SG, Klausner JD. Sildenafil use, sexual risk Associations between Viagra use and risky sexual behaviour, and risk for sexually transmitted diseases, behaviours and sexually transmitted infections may including HIV infection. Am J Med 2005;118:571 – 7.
extend more widely than those reported previously for [7] Crosby R, DiClemente RJ. Use of recreational Viagra men who have sex with men [6]. We are at an early among men having sex with men. Sex Trans Infect 2004;80:466 – 8.
point in the development of the study of interactions [8] McCambridge J, Mitcheson L, Winstock A, Hunt N. Five with drugs used for recreational purposes. Although it year trends in patterns of drug use among people who use is somewhat surprising that reports of adverse effects are so limited, there is also much scope for concern that there are unevaluated public health risks [2].
[9] Goldmeier D, Lamba H. Prolonged erections produced by dihydrocodeine and sildenafil. BMJ 2002;324:1555.
Elevated prevalence among particular groups, as [10] Mayor S. Pfizer will not apply for a license for sildenafil for well as study of the broader trends, may also benefit from ethnographic and other qualitative data. Targetedstudies intended and unintended consequences, may not be


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