What is chemsex, and why is it a concern for healthcare professionals?
The term chemsex refers to the intentional use of psychoactive substances to facilitate, intensify or prolong sexual activity, mainly among men who have sex with men (MSM).
In this context, you may come across terms such as ‘chems’, referring to the substances being used; ‘session’ or ‘chill’, describing sexual encounters that can last for many hours; and ‘slamming’, which refers to injecting substances and which carries additional health risks.
When can chemsex become a problem?
Not everyone who engages in chemsex will necessarily experience health problems or develop an addiction. There is a spectrum that ranges from experimentation or occasional use to situations involving increasing levels of risk and, in some cases, a loss of control.
Experts highlight that combining stimulant substances with prolonged sexual activity can increase the risk of losing control over substance use or sexual behaviour.
Why do people engage in chemsex?
Chemsex cannot be explained simply as a combination of drug use and sexual activity. Healthcare professionals point out that chemsex can be influenced by a wide range of personal, social and emotional factors, and that the reasons for engaging in it can vary from one person to another.
Factors that may contribute to chemsex include:
- Seeking greater disinhibition and increased confidence during sexual encounters.
- A desire for acceptance, connection or a sense of belonging.
- A desire for longer or more intense sexual encounters.
- Easy access to certain substances in some social settings.
- The use of dating apps, which can make it easier to arrange encounters and connect with people with similar interests.
- Loneliness or social isolation.
- Experiences of discrimination, stigma or rejection, particularly related to sexual orientation or personal identity.
- Emotional distress, including anxiety, low self-esteem or other psychological difficulties.
For this reason, specialists emphasise the importance of looking beyond substance use itself and understanding the role chemsex plays in each person’s life, including the needs they may be trying to meet through it. Taking this broader approach can help healthcare professionals identify risk factors more effectively and provide appropriate, personalised support.
Substances associated with chemsex
Substances associated with chemsex can have stimulant, disinhibiting or dissociative effects. There is no single pattern of substance use, and the substances used can vary depending on the situation. The substances most commonly associated with chemsex include GHB/GBL, methamphetamine and synthetic cathinones. These are often combined with ketamine, cocaine, poppers, alcohol or medicines for erectile dysfunction.
- GHB/GBL: A central nervous system depressant that can cause disinhibition, euphoria and relaxation. However, it can also cause loss of consciousness, respiratory depression and overdose, particularly when combined with alcohol, benzodiazepines, opioids or other depressant substances.
- Methamphetamine (crystal meth): A powerful stimulant that increases energy, sexual arousal and wakefulness. It can also increase impulsivity and contribute to long sexual sessions.
- Mephedrone and other synthetic cathinones: Stimulant substances that can intensify sensations but may also contribute to compulsive patterns of use.
- Cocaine: A stimulant that increases alertness and confidence, but also carries a risk of dependence and cardiovascular complications.
It is important to be aware that people may use several substances during the same session. This pattern of multiple-substance use increases the risk of adverse effects, poisoning, overdose and physical and mental health problems.
Effects of chemsex on physical and mental health
After a chemsex session, some people may experience extreme tiredness, low mood, sadness or other physical and emotional effects that can make recovery difficult.
According to the HOMOSALUD 2021 study, around three in four participants who had engaged in chemsex during the previous 12 months needed at least one day to recover. Of these, 19.7% needed more than two days, while 8.7% needed more than a week.
Cases of overdose have also been reported, with the risk increasing particularly when several substances are combined or sessions last for long periods.
Repeated chemsex may, over time, be associated with sleep problems, persistent tiredness, anxiety, irritability, depression, difficulties controlling substance use or an increasing urge to repeat the experience. However, experts stress that not everyone will experience these effects. The risks can be increased by factors such as sleep deprivation, repeated substance use and combining different substances.
Sexual health and consent
Chemsex may be associated with specific sexual health risks. Long sexual sessions, reduced awareness of risk or difficulties negotiating safer sex practices can increase the likelihood of sexually transmitted infections (STIs) and physical injuries.
Substance use can affect a person’s ability to give or understand consent, particularly in situations involving severe fatigue, intoxication or loss of consciousness.
When substances are injected (slamming), sharing injecting equipment increases the risk of transmitting infections such as HIV and viral hepatitis.
Recognising the warning signs
Recognising the early signs of problematic substance use can help prevent more serious problems. Some warning signs that may indicate a loss of control or an increased level of risk include:
- Needing to use increasing amounts of substances to achieve the same effects.
- Finding it difficult to have sex without using substances.
- Experiencing episodes of paranoia, severe distress or overdose.
- Noticing that substance use is affecting work, studies, relationships or other areas of everyday life.
- Starting to use substances alone.
- Using substances by injection (slamming).
When substance use becomes difficult to control and starts to affect a person’s decisions, it is advisable to seek professional support.
If you have any concerns or are experiencing distress, speaking to specialist addiction or sexual health services can help identify problems early and ensure that appropriate support is provided.
What to do in an emergency
Call 112 immediately if someone is unconscious, unresponsive, or has slow, irregular or difficult breathing.
Until the emergency services arrive:
- Put the person in the recovery position.
- Do not leave them alone.
- Keep monitoring their breathing.
- Do not give them any more substances or anything to drink.
A comprehensive response to a complex issue
The way problematic chemsex situations are addressed has evolved towards more comprehensive and less stigmatising approaches. The aim is not to judge people, but to understand their circumstances, identify potential risks at an early stage and provide appropriate, personalised support.
Understanding the circumstances surrounding chemsex, recognising signs of risk and timely access to healthcare services can make an important difference to the wellbeing of those affected. For a complex issue such as chemsex, combining knowledge, prevention, listening and support is essential to promoting health and wellbeing.
The Clínic’s approach: comprehensive care
The Addictive Behaviours Unit at Hospital Clínic Barcelona has highlighted the emergence of new patterns of substance use and the need of continually adapting healthcare services. The latest toxicology report identified 233 cases involving new psychoactive substances. These included synthetic cathinones, such as metylmethcathinone and chloromethcathinone, which are frequently used during chemsex sessions.
Healthcare professionals emphasise the importance of a comprehensive approach that brings together addiction, sexual health, mental health and emergency care, while also addressing wider social and healthcare needs through a coordinated care pathway.
INFORMATION DOCUMENTED BY:
Dr. Emilio Salgado, Emergency Department, Clinical Toxicology Unit. Hospital Clínic Barcelona.
