Sex, drugs and total disinhibition: What is “chemsex”?

“Chemsex” represents a complex challenge that transcends the individuals involved in the practice, becoming an issue of public health, human rights and social justice.

“Yesterday was crazy and I don’t have a hangover. Look! The drug dish is still on the table. What a crazy night. Inhibitions fled and sexual pleasure had no limits.”

For many, this is the promise of chemsex.

However, behind this affirmation of freedom and fun, there is a reality of health risks, vulnerability and dependence.

Chemsex refers to use of psychoactive substances specific to achieve ecstasy during sexual intercourse and prolong its duration.

According to , it is practiced mainly by homosexuals, bisexuals and men who have sex with men.

The most frequently used substances are methamphetaminesa mephedronea ketamine or acid gamma-hydroxybutyric (GHB, commonly known as “squirt”).

Physical and psychological risks

The practice of chemsex can have the following negative consequences:

• Implications for physical health – It is associated with an increase in risky sexual behaviors, which can increase transmission rates of HIV and other sexually transmitted infections (IST). Participants often have sex with multiple partners at the same time and sometimes for prolonged periods, which increases the likelihood of transmission.
• Poor mental health – People who engage in sex work are often stigmatized, suffer from stress or even guilt or feelings of loneliness. On the other hand, the reasons for joining chemsex must be evaluated.
• Substance use and dependence – The use of psychoactive drugs can lead to acute intoxication and long-term dependence problems, complicating physical and mental health.
• Users may suffer from physical and mental fatigue, suicidal ideationpsychosis, aggressive behavior or overdose due to loss of control over substances.

Why don’t people ask for help?

Often, those who engage in chemsex do not feel sufficiently accompanied or understood. We thus find what we can call barriers to healthcare:

• O stigma and discriminationwhether due to drug use, sexual orientation or practices. The judgment and lack of cultural competence of healthcare professionals themselves are at the root of this situation.
• Legal and social barriers due to the use of legally processed substances, which leads to social stigma.
• Lack of knowledgeboth by consumers and health professionals. The first, due to lack of knowledge of the effects that these substances and activities can have, and the second, due to lack of knowledge of emergency situations resulting from overdoses of methamphetamine or GHB.
• Accessibility, financing and lack of multidisciplinary services. Each professional is in charge of their specialty and there are no structures that bring together the knowledge of all of them. And if they exist, they lack funds to be able to act.

What is our social duty?

As citizens, we can help and we can do a lot, but we have to take different factors into account:

• Coordinated interventions are needed. There is a lack of joint public health interventions tailored to the specific needs of chemsex users. They must be provided safe, competent and ethical care.
• Harm reduction strategies are essential and must focus on the individual’s self-efficacy. They can be multidisciplinary or targeted online or group therapies. However, these tools are currently underdeveloped.
• There is need for education and awareness. Sexual safety and drug use must be taught, and education about the risks of chemsex and its importance to health must be initiated.
• It is necessary to encourage community support, with people sharing information and support based on your experiences.
• Health policies must address drug use as a health problem and not as a crime. Stigma must be minimized and demonstrated empathy to support and accompany the people involved. This includes all healthcare professionals.

Ultimately, chemsex represents a complex challenge that transcends the individual to become a issue of public health, human rights and social justice.

Addressing the risks of this practice requires not only health and legal interventions, but also a shift in how we understand and support affected communities. THE education, harm reduction and empathy are essential to move towards real and sustainable solutions.