Response ‘Slamming’ among men who have sex with men accessing general drug services, in response to Schmidt, AJ et al., 2016, Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS) Rachel Glass a, *, Vivian D. Hope a,b , Claire Tanner a , Monica Desai a a National Infection Service, Public Health England, London, UK b Public Health Institute, LJMU, Liverpool, UK Schmidt et al. (2016) findings suggested high levels of sexualised drug use among men who have sex with men (MSM) in a number of UK cities, namely Brighton, Manchester and London. The extent of the use of various drugs, including those associated with sexualised drug use, among MSM found in the study is likely to be overestimated due to the potentially leading nature of questions asked about drugs (“When was the last time you consumed . . . ”) which could be perceived to be presenting drug use as normal. Additionally, the online sample approach may have over-sampled higher risk groups using the internet, as identified in the study’s limitations, for example those using it to meet others for sex (Schmidt et al., 2016; Platt et al., 2015). However, of concern, the recent UK’s ‘Shooting up’ report highlighted a high prevalence of the injection of drugs associated with sexualised drug use, particularly among MSM who had recently started injecting and attending general drug services (Public Health England et al., 2016). This sexualised injecting drug use, or ‘Slamming’, has previously been reported among some groups of HIV positive MSM primarily attending sexual health and specialist LGBT drug services (Mohammed et al., 2016; Kirby & Thornber-Dunwell, 2013; Erica et al., 2016). The Unlinked and Anonymous Monitoring (UAM) survey of people who inject drugs (PWID) is a surveillance system conducted in general drug services (including needle and syringe pro- grammes) across England, Wales and Northern Ireland. Since 2000, the proportion of male PWID recruited who reported sex with men has increased (4.4% in 2000/01 to 8.4% in 2014/15, p < 0.001), as has prevalence of HIV among this group (2.2%–8.3%, p = 0.22). Drug use patterns have altered, with increasing stimulant injection (57%–77%, p < 0.001) and decreasing opiate injection (80%–65%, p < 0.001) among MSM. Comparing MSM (n = 323) with the other men (n = 3497) recruited into the UAM Survey between 2013 and 2015 suggests they have a distinct profile: MSM were more often recent injecting initiates (13% vs 8.2%, p = 0.004) and a greater proportion injected mephedrone and ketamine (12% vs 6.4%, 9.3% vs 3.8%, p < 0.001), two drugs associated with ‘slamming’ (Daskalopoulou et al., 2014). MSM report higher injecting and sexual risk (needle/ syringe sharing 15% vs 11%, p = 0.07; having 10+ sexual partners 25% vs 4.0%, p < 0.001), and should not be assumed to form a discrete sexual network to the heterosexual population as 44% reported a female sexual partner. Among MSM injecting both mephedrone and ketamine (n = 18) which are used in ‘slamming’, 67% also injected heroin and crack. This suggests the possibility that either MSM who are ‘slamming’ have started injecting other psychoactive drugs, or MSM who inject other psychoactive drugs are now injecting drugs associated with ‘slamming’. The MSM recent initiates (n = 42), when compared to the other MSM (n = 281), more often were HIV positive (19% vs 3.9%, p < 0.001), injected mephedrone and ketamine (41% vs 8.2%, p < 0.001; 24% vs 7.1%, p = 0.001) and had more sexual partners (33% vs 24% reported 10+ partners, p = 0.17). Around 46% of the HIV positive MSM in 2015 were recent initiates (6/13), all of whom reported injecting mephedrone and were aware of their HIV infection. Our data suggest that ‘slamming’ is now evident among MSM accessing general drug services. However, there would currently appear to be a lack of information on the extent of sexualised drug use among MSM accessing general drug services across Europe. If the number of MSM using the ‘4-chems’ is as large as suggested in the Schmidt study, the potential for the injection of these drugs to increase among MSM exists. Worryingly, our recent data indicating an increase in presentations to services by MSM who are new initiates to injecting, suggests that such an increase in injecting among MSM might now be emerging. This re-enforces the ongoing concerns over the elevated HIV risk among MSM populations. Although limited by small numbers, our data also suggest that those MSM who are ‘slamming’ may be merging with the longer * Corresponding author. E-mail address: rachel.glass@phe.gov.uk (R. Glass). http://dx.doi.org/10.1016/j.drugpo.2017.07.028 0955-3959/Crown Copyright © 2017 Published by Elsevier B.V. All rights reserved. International Journal of Drug Policy 49 (2017) 24–25 Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.elsevier.com/locat e/drugpo