What is Chemsex?

Drug use in a sexual context, meaning the use of any legal or illegal psychoactive substance before or during sex, is not new. In fact, throughout history, various substances have been and are used to enhance pleasure and overcome inhibitions in many cultures.

The word chemsex was coined by David Stuart, social worker, activist, researcher, LGBTQ+ rights advocate. Stuart wanted not only to define this phenomenon along with its specific characteristics, but also to give the people involved a term that would denote their lived experiences and promote a model of assistance and support.

So, according to Stuart’s definition, chemsex is the voluntary use of specific psychoactive substances, often in combination with each other, by gay, bisexual and other men who have sex with men (GBMSM), trans and non-binary people, the purpose being to disinhibit, enhance and prolong the sexual experience, and to explore and process queer sexuality. Chemsex usually involves multiple partners and sexual activities that can last from hours to days. Dating apps play an important role in this practice.

The substances most commonly used in chemsex, which are often referred to as chems, are methamphetamine (Crystal Meth), GHB/GBL (gamma-hydroxybutyric acid/gamma-butyrolactone), cathinone (mephedrone, 3MMC, 4MMC), usually in combination with ketamine, cocaine, alcohol, erectile dysfunction drugs, MDMA, poppers and antidepressants. Ketamine and cocaine are also sometimes considered chems.

However, preferred substances can vary significantly due to cultural factors, geographical contexts, drug control measures or supply and demand in each country.

Why do some people involve in chemsex?

Chemsex is more than just sex and drugs, according to the position paper of the second “European Chemsex Forum” in March 2018:

“Chemsex is uniquely connected to gay sex in the context of how the pleasure experienced during sex has been affected by:

  • Society’s attitudes towards LGBTQ+ people and sex between men.
  • The traumatic effect the HIV/AIDS epidemic has had on LGBTQ+ people and gay sex.
  • Harassment (bullying) experienced by LGBTQ+ people.
  • Explicit as well as indirect pressure felt by members of the LGBT community, pressure related to physical appearance, sexual behavior, party attendance, etc.
  • The importance of shared ‘ritual’ activities in a stigmatized group.
  • Community tensions about behavior and binary male/female expression (or people’s gender identity), especially in terms of how sexual pleasure and sexual fantasies are viewed.
  • Dating apps and gay saunas.
  • Widespread accessibility and availability of chems for GBMSM, trans and non-binary people through dating apps.
  • The reality that GBMSM, trans and non-binary people who practice chemsex may also be sex workers, racial and ethnic minorities, migrants, refugees and/or prisoners. They may also have mental health diagnoses, other addictive disorders, disabilities, live with HIV and/or HCV, etc.
  • Current trauma arising from the deaths of many GBMSM, trans and non-binary men as a result of chemsex.”

Contrary to what some may think/say, there is no clear evidence that engaging in chemsex is caused by trauma. However, some may process traumatic experiences through chemsex. In this way, the experience becomes an enjoyable one and they may feel more accepted.

Chemsex and health

There is evidence that engaging in chemsex makes the risk of getting sexually transmitted or blood-borne infections high to very high. This is due to the effect of the substances involved on decision-making, but also to behaviors such as injecting and sharing injecting equipment.

However, narrow thinking that focuses only on HIV and the transmission of other sexually transmitted infections can contribute to the stigma already faced by people involved in chemsex, while ignoring other important aspects of the problem.

Chemsex “problematic”

We need to bear in mind that not all forms of involvement in chemsex are problematic, at least not at all times. In fact, many people keep their use under control through various techniques: self-reflection, planning immediate or long-term activities, support from friends/family, etc.

On the other hand, there is no clear information on when involvement in chemsex becomes clearly problematic. What each person considers ‘problematic’ for themselves is highly subjective and influenced by many factors. In addition, not all problems arising from involvement in chemsex are equally serious. And people who experience these problems are not always aware of them, even if the problems affect their lives.

Some clues that should warn us that involvement in chemsex is likely to be problematic:

  • Difficulty having “sober” sex, sometimes on the basis that it has been a long time since the person has had “sober” sex…
  • Difficulty enjoying things and activities you previously enjoyed.
  • Difficulty finding new activities or doing new things that seem interesting or generally difficulty finding motivation to do things other than chemsex.
  • Chemsex involvement consistently taking longer than planned.
  • There are hours or even days when the person systematically misses work or other activities considered important.
  • Decreased time spent with friends, family, or significant others (who are not involved in chemsex).
  • Attending chemsex parties and “weekend fun” are the only motivation during the week, i.e. it gives meaning to the rest of the days or makes everyday life bearable.
  • Mental health problems arise. Often quite mild at first and gradually more intense and long-lasting, whether or not substances are used. These problems include sadness, anhedonia (inability to feel pleasure from basic things – food, social interaction, etc.), irritability, undue anxiety, intense suspicion, emotional outbursts, social anxiety and, in more severe cases, hallucinations, paranoia and psychosis.

People at different points in their ‘chemsex journey’ will need and require different types of intervention and thus have the opportunity to experience moments of reflection, self-care and personal development. For these reasons, it is extremely important as a specialist to be open to meeting each individual where they are and to listen carefully to their perspective.