Drug Information

What’s on the menu?

According to studies of gay men in Vancouver, the following substances are the most commonly used:

Alcohol and Marijuana

Alcohol and marijuana are both widely accepted in society. They are the most common drugs used by gay men, and many other Vancouverites for that matter. But just because they pose a relatively low risk and we all think they are okay, that does not mean you shouldn’t know ways to use them safely and responsibly.

Drinking at home can be a relaxing activity. After a long day at work, it can be nice to sit back and enjoy a beer or two. And that’s fine. It is when it becomes a physical dependency that alcohol can be an issue. When we feel like we need to drink to feel relaxed or to fall asleep, it becomes problematic.

Social anxiety is another reason why we drink. It could be to get courage to meet someone new, handle the fear of rejection, or just to have fun. Be aware of how much alcohol you’re consuming, because it can turn into a physical dependency. Drinking too much can affect your responsibilities, sleep, relationships, and work.

Marijuana is almost as common as alcohol, and it is used for some of the same reasons: to relax, to increase sensation, and increase feelings of pleasure. For some, casual recreational use does not pose much risk. However, marijuana has been known to reduce motivation. People who suffer from depression or other mental health disorders can also find that marijuana exacerbates their condition. Also, some users get paranoid, isolated, or inappropriately giggly.

Remember to stop and think about what your motivations are for drinking alcohol or taking marijuana, to assess whether they are getting in the way of living your life.

Mixing alcohol with GHB, K, and/or various prescription meds can be deadly. When mixing alcohol with MDMA or Ecstasy, we are at a higher risk of dehydration, so be sure to drink lots of water!

Cocaine (Coke, Blow, Snow, White)

Cocaine is made from coca plants. This stimulant comes in a flaky, white, odourless powder and is usually snorted in small amounts (in a line or a bump) through a straw or a rolled-up bill. You can also spread it on your gums (which is less common), heat and inhale it, or inject it intravenously when diluted.
Cocaine is commonly used by gay men in Vancouver but in recent years its quality has decreased as it is often mixed with other substances. Taking a few lines of coke will often make you feel wide awake, chatty and confident, or aggressive, agitated and anxious. It’s also known to make users horny but it’s more difficult to stay hard when high on coke.

Health Risks

Having a line from time to time is not a big deal and many gay men in Vancouver use coke. Some people take it further and use coke regularly, which can lead to a psychological addiction. Some guys find they make unhealthy choices about condom use and sexual risk taking when high on coke. Coke acts as an anaesthetic and some gay men put it up their ass, which makes them able to get fucked for longer. If you are not using condoms and enough lube, this can increase the chance of picking up or passing on HIV and Hep C.

Regular cocaine use can also lead to anxiety, paranoia, depression and insomnia, especially in the “comedown” period a day or two after using it. Snorting cocaine too frequently can also damage your nasal cavity.


Many gay men mix coke with alcohol with few side effects but because cocaine counteracts the effect of alcohol, it makes you think that you can drink more. Mixing too many drugs together also adds extra strain to your heart and brain, which could potentially be dangerous.

Safer Use

Taking coke occasionally is not especially dangerous. The problem comes if you start using it too often. If you are going to take coke, keep track of how much you take, start with smaller lines at longer intervals, and perhaps ask a friend to keep an eye on you. If you are using a straw or a bill, don’t share it: use your own and only your own. This will reduce your risk of picking up or passing on Hep C if there is infected blood residue on the straw or bill. If you are planning to inject coke, don’t share needles, to avoid transmission of HIV and Hep C. Drink plenty of water and try not to stay up for too long because your body needs time to recover.

Crystal Meth (Speed, Tina, Crystal, Ice, T, Methamphetamine)

Crystal meth is a powerful stimulant, which gives you lots of energy and a euphoric feeling. It may make you feel more self-confident, but can also make you more aggressive. Guys who use crystal report feeling all-powerful, very horny and highly compulsive. The effects can last between two hours and two days.

Crystal is an odorless, bitter powder that you can snort, bump, smoke, swallow, hoop or inject (slamming). It’s safest to swallow.

Health Risks

Crystal meth makes guys horny, very horny. With lowered inhibitions, you might end up having the kind of sex you wouldn’t normally have: perhaps rougher, more intense or condomless.

If you share needles to inject crystal, you also risk picking up or passing on HIV or Hep C.

Because crystal keeps you awake for a long time, your body can suffer from lack of sleep or nourishment. Lack of sleep can cause you to experience mild hallucinations or think you hear whispers, which can become more profound the more regularly you use.

Crystal is addictive. One reason is that withdrawal symptoms can be intense and include insomnia, irritable moods and depression. It can also have a negative impact on your immune system and metabolism. Some guys experience short-term psychosis for a few days after they’ve stopped using. Sometimes guys who use get a sensation of insects crawling on their skin, and can scratch their skin so hard that they end up wounding themselves. For guys wanting to cut back their use, our friends at ACT in Toronto have created a great resource for Staying Off Crystal.


Many people mix crystal with alcohol and other drugs with few side effects but you should know that the more stimulants you take, the more strain you put on your heart. Some people may experience panic attacks, while others may have no adverse effects at all. If you are mixing crystal with G, you could be awake for a very long time, become tired and find it harder to dose your G correctly, which can lead to overdoses. If you are HIV-positive, you may also forget to take your medication if you get too high, which can affect your health and also put your sexual partners at risk. Getting high can also affect the choices you make about your sexual behaviour.

“Crystal dick” — the inability to maintain an erection — is common for men using crystal. Some men counter crystal dick by taking an erectile dysfunction medication such as Viagra or Cialis. Mixing crystal and erectile dysfunction meds puts a strain on the heart. When the two are mixed with poppers (amyl-nitrate) the combination can cause heart failure.

Safer use

Swallowing meth in pill or tab form is the safest way to take the drug. Injecting meth is the most dangerous method.

If you are planning to take crystal, it’s a good idea to set some boundaries before you start your party. Think about what you want to do, how long you want to stay awake for and what your sexual limits are. You can refer to these when you are high. Always have a plan to manage your come-down / crash.

Crystal can blur the sexual choices we make, making us forget about safety, or find it harder to care in the heat of the moment. On crystal, we are more willing to take chances we wouldn’t normally take. Remember to have condoms with you to reduce the spread of HIV and other STIs.

If you choose to inject crystal, make sure you get clean needles and equipment, and learn how to use them correctly. Using clean needles and equipment is important to protect yourself from HIV and Hep C. There are several locations to access free needles and syringes. If you have shared needles with someone you suspect to be HIV-positive, or have been exposed to HIV during sex, you should visit your health clinic or Emergency Room for a course of PEP, a tool to help prevent HIV.

If you are using crystal regularly, take calcium and multi-vitamin supplements, and keep an eye on your body weight. Staying awake for two or more days may cause a drug-induced psychosis that can last up to 10 days after stopping use of crystal. In some cases, these symptoms can include feeling unsafe, watched, followed or paranoid; hearing voices or experiencing visual hallucinations. If this is the case, you may want to consider reducing your use.

Injecting/Slamming Crystal Meth — slam safer

There is a lot of stigma attached to injection drugs, meth and risky behaviours. Stigma and judgement do not help — being informed and planning ahead do!

Slamming is high risk for the transmission of HIV and other blood-born infections like Hepatitis C. Injecting meth can cause serious damage to your veins and cause them to tighten, shrink or collapse.

An additional risk comes from sharing your works, which people do for different reasons. Perhaps they didn’t plan ahead and bring their own works, or they thought it would make the experience more intimate. Maybe they were already drunk or high, or just didn’t care. Sharing works puts you at risk of HIV and Hep C.

There are things you can do to reduce the harm if you slam meth:

  • Never share your works. Never lend or borrow any used injecting equipment including water, cookers, cotton and tourniquets.
  • Use new needles and equipment every time you inject. Cleaning used syringes and needles, even with bleach, may not kill HIV and hepatitis.
  • Rotate your injection sites to reduce the possibility of damage to your veins. Each time you shoot up, move one inch closer to your heart from your previous hit or move to a different site altogether.
  • Don’t inject into damaged veins.
  • Clean your injection area thoroughly with hot water and soap.
  • Wipe the site with a fresh alcohol pad to cut down bacteria that causes abscesses.
  • A vein takes a couple of days to heal. Vitamin E oil or aloe vera helps you to heal. Drinking lots of water re-hydrates your skin and also speeds up healing.
  • Don’t inject alone. This helps avoid overdosing.
  • Dispose of your used equipment carefully. Sharps containers are essential to keeping others safe.
  • You can get clean, unused works at Insite Vancouver (139 E Hastings St) and other locations in the city.

Erectile Dysfunction Meds (Viagra, Cialis, Levitra, blue pill)

Many gay men use erectile dysfunction (ED) drugs. Some of them suffer from erectile dysfunction; others use these drugs to counteract the affects of alcohol, crystal or cocaine dick (the inability to get hard because of substance use).

A word of caution: there are counterfeit ED drugs out there. If you bought your medicine online, or from someone other than a pharmacist, you have no way of knowing what’s in it. It’s always best to get your medicine from a pharmacy.

Health Effects

Erectile dysfunction drugs are prescribed to improve or enhance sex. When used properly, the health effects of these prescriptions are minimal (sinus congestion, headaches, redness of the skin due to increased blood flow). Problems arise when ED drugs are mixed.


As with all medicines, you’ve got to be careful about certain combinations. Some prescription drugs – and some recreational drugs – can be very dangerous when mixed with ED drugs.

This is important: never take ED drugs if you’re receiving nitrate therapy, have low blood pressure, experience chest pain while you’re having sex, or have had a heart attack or stroke recently. If you’re not sure, it’s best to check with your doctor.

If you’re using recreational drugs while partying or having sex, adding something like Viagra® into the mix can be dangerous… or even deadly. Some recreational drugs – cocaine and especially poppers – may cause dangerous interactions with ED drugs.

If you’re going to “party and play” with ED drugs, make sure you’ve spoken to a doctor about possible drug interactions or serious side effects, and don’t ever take more than one ED drug at once.

If you’re living with HIV and taking HAART (Highly Active Antiretroviral Therapy) medications, talk to your doctor or pharmacist about side effects and interactions between HIV medication and ED treatments.

GHB (G, gammahydroxybutyrate, liquid E, liquid X, liquid ecstasy)

GHB is a liquid drug that gives you a similar feeling to alcohol. The high lasts for about two hours but, unlike alcohol, doesn’t give you a hangover. G is great for dancing and for sex because it’s one of the few drugs that doesn’t interfere with erections. It makes users confident and horny. GHB comes in various concentrated forms, so it can be easy to overdose if you don’t know the strength. Start slow and monitor your alcohol intake as it does not mix well with GHB.

Health Effects

Like many other drugs, G increases the desire for sex and reduces inhibitions. For some guys, that means condomless sex. It is easy to overdose on G and become unconscious, leaving you vulnerable to sexual assault. Some people use G to take the edge off crystal, which decreases your inhibitions, increasing the likelihood of sexual risk-taking. Getting the dosage right is difficult because the strength of G varies with each bottle; therefore, it is easy to take more than your body can handle, which could result in overdose, coma, respiratory collapse or even death. Most people wake up from overdose with no side effects whatsoever, but there are a few who do not, so if you use G, it’s important to dose correctly and do not mix it with alcohol.

GHB can be physically addictive: some users find themselves dosing many times a day, just to avoid difficult and dangerous withdrawal symptoms. You can become addicted within a week if using regularly. Stopping “cold turkey” can cause confusion, anxiety, panic, hallucinations and delirium and, in some cases, respiratory collapse. People who have become dependent on G should seek medical support before attempting to stop using it. If you have been using G regularly for a week or more and begin to feel anxious or confused between doses, seek medical attention.


Drinking alcohol while under the influence of GHB can slow down the central nervous system and affect your respiratory system, which is dangerous. Taking other drugs with GHB is likely to increase its effectiveness but could also prove dangerous for the same reasons.

Safer Use

It’s very difficult to measure the correct dose of G. As with all party drugs, there are no quality control standards for G; therefore, each dose could be different every time you take it. If you are planning to take G, take small doses to avoid overdosing or falling into a G-induced coma. Wait at least three hours between each dose, or you could overdose or fall into a coma.

Don’t drink alcohol or take other depressant drugs when you are on G because the combination can increase your risk of overdose. If you or any of your friends start to feel unwell or vomit, you may want to consider calling 911.

You can sometimes get so high on G that you may be seem very ‘touchy’ or sexual but you might not neccessarily be inviting consent. It’s important to be open about your substance use with your partners and have people that you trust around you.

HIV Antiretrovirals (HAART, treatment for HIV)

Guys with HIV should talk to their doctor or pharmacist about possible interactions with other substances, including alcohol and party drugs. While there isn’t a lot of research about combining party drugs with HIV medications, clinicians at Columbia University have put together a guide to help you determine any adverse reactions. The guide is called Recreational Drugs and HIV Antiretrovirals (2014).

Ketamine (K, Special K)

Ketamine is a strong general suppressant and anesthetic that is used during surgery on humans and animals. It is also used recreationally to get high. When taking ketamine, you are likely to feel as though your body and mind have been separated and you are having an out-of-body experience. Hallucinations and loss of feeling in parts or all of the body are also common. How you are going to react to ketamine depends on your mood and environment that you are in at the time when you take it. K is usually taken in small doses, like in a bump off a key or a bumper (a device that premeasures the amount).
Health Effects

Occasional use of K is not too harmful but when it is used regularly or on a daily basis, it can become as dangerous as any other addictive drug. People often start taking it to forget their problems or cope with stress. Heavy use of ketamine can lead to bladder damage, which is irreparable in some cases.

Although it can give you a trippy feeling, K is actually a tranquilizer that numbs your body, which means that you can seriously injure yourself without realizing it until much later. If you take too much K, you can go into a “K-hole,” an experience involving hallucinations, feelings of paralysis, and a loss of a sense of time and space. However, there have been no reported cases of anyone not coming out of it. Like other chemicals, K could lead to decreased inhibitions; you may forget about using condoms and put yourself at risk of picking up or passing on an STI or HIV. Similar to G, if you are in a vulnerable situation, this could leave you open to sexual assault.

K is also used for fisting because it’s an anesthetic and makes your brain dissociate from pain. K does not work topically, so if you put it on your asshole, as some gay men do, it’s not going to numb it.

Mixing K with G or alcohol can cause respiratory failure as they are all central nervous depressants.

MDMA/Ecstasy (E, Molly)

Ecstasy and MDMA (3,4-methylenedioxymethamphetamine) have been commonly used on the gay scene for many years. Even though many people still take the drug, its quality has decreased significantly in the past 20 years. Ecstasy is far less harmful than many other club drugs. Ecstasy is probably used for dancing more than for sex, although ecstasy usually causes guys to feel more intense and experience stronger feelings of passion, love and excitement. It increases the sensations experienced from listening to music and intensifies the senses, especially touch, sound and colour.

Health Effects

Even though ecstasy is more of a dance drug, some people also use it for sex. It tends to loosen your sexual inhibitions, sometimes increasing the likelihood of condomless sex. Ecstasy can also make it hard for users to get and sustain an erection.

Some users may experience paranoia and anxiety attacks when getting high, and depression and tiredness for a number of days when “coming down.” There have been cases where bad batches of ecstasy, usually made from impure ingredients, have caused serious problems.


People often mix ecstasy with other drugs and alcohol, often without any side effects. You should still be aware that dangers do exist when you combine too many powerful drugs, which can strain your heart and brain. If you combine ecstasy or MDMA with alcohol there is a chance of dehydration, so remember to drink other liquids than just alcoholic ones. Marijuana can mellow the rushes and help bring on the high effect of ecstasy. It can also help with the comedown. However, taking too many chemicals is strenuous to your body, so pace yourself, know your limits and don’t overdo it.

Safer Use

If you are going to take ecstasy or MDMA, try to avoid taking it with alcohol or other uppers like cocaine, as that will add extra strain on your heart and brain. Drinking alcohol while on E can leave you dehydrated. You should drink non-alcoholic beverages including fruit juices or sports drinks during regular intervals in order to avoid overheating or dehydrating, especially if you are dancing for a long time.

Not all ecstasy pills contain MDMA and some may contain other substances; this means that you cannot be entirely sure how your body will react, so pace yourself. Sometimes the high doesn’t hit you until 30 to 60 minutes after you’ve popped the pill, so wait a bit before taking another one.

Prescription Drugs (Opiates, Benzos, Oxy, Xanax, Valium, Ativan, downers)

Opiates and benzos (including Oxy, Valium or Diazepam), are sometimes used recreationally by gay men to manage comedowns resulting from other drugs (like crystal or cocaine) or to help guys relax or to fall asleep.

Health Effects

Opiates like Oxy can be as addictive as heroin (another type of opiate) and you can build up tolerance quite quickly. Stopping opiates after having taken them for a long time is best done under medical supervision because they are physically addictive and quitting ‘cold turkey’ can be dangerous.


Combining opiates with alcohol can be dangerous as both substances slow down the respiratory system. Taking alcohol with sleeping pills or benzos can be lethal — remember all those lost celebrities — so avoid mixing booze and pills when possible.

Poppers (Amyl Nitrate, Jungle Juice, Leather-cleaner)

Poppers usually come in a small bottle as a white or clear liquid with an odour like paint remover or turpentine. Inhaling the liquid’s vapour causes a high from feeling a sudden rush of blood to the head.

Health Effects

Poppers are highly acidic and will burn surfaces including your skin, especially around your nostrils, if you sniff them too close to the nose. Popper burns are a common side effect. Poppers are sometimes linked to risky sexual behaviour and, because of the intensity you feel when sniffing them, you may get caught up in the moment (and pleasure) and opt for condomless sex. Because poppers expand the blood vessels inside the ass, the chance of tearing increases, which makes it easier for HIV or Hep C to enter the bloodstream. Poppers can also lead to rougher sex, like fisting, which also increases the chance of tearing or bleeding.


Mixing poppers with ED drugs like Viagra or Cialis can add extra strain to your heart, which can be dangerous. Many people don’t experience this but it’s important to know the risk in mixing the two. Other side effects include headaches, dizziness and nausea.