What is chemsex and why does it matter?

Chemsex refers to the practice of combining sex with certain drugs, primarily among men who have sex with men. These drugs are used to enhance pleasure, increase stamina and lower inhibitions.

HIV activist David Stuart claims to be the person who coined the term chemsex .He drew on his own experiences with substance misuse and difficult sexual experiences early in life to help other men who have sex with men, working within the fields of harm reduction, substance misuse and sexual health and wellbeing until he died in 2022. His work aimed to reduce the risk and stigma surrounding chemsex, which still continues to this day.

Chemsex is a complicated topic because there’s not a lot of high-quality data about the practice. This means healthcare professionals may not be properly informed about it and how to help. Additionally, because chemsex is considered taboo, and the drugs involved are not the more common ones seen in drug services such as crack and heroin, many people may find it hard to get specialist support when they’re seeking help.

Why the phrase ‘MSM?’

In epidemiology, researchers use the acronym ‘MSM,’ short for ‘men who have sex with men’ when talking about sex in the gay male and bisexual male community. This is because researchers wanted a neutral phrase to use while studying HIV – they wanted to reduce AIDS stigma. The phrase also recognises that men experiment with their sexuality, bisexual men exist and there are celibate or asexual gay men. The term gained prominence in the 90s and is widely used in research that examines same-sex sexual behaviour in men to this day.

What drugs are used for chemsex?

The most commonly used drugs used in chemsex are GHB, GBL, ketamine, mephedrone, cocaine and methamphetamine/crystal meth. These drugs can be roughly divided into stimulant drugs (mephedrone, crystal meth) and more sedating or dissociative drugs (ketamine, GHB/GBL). Many of these drugs also promote sexual arousal.

GHB (gamma hydroxybutyrate) and GBL (gamma-butyrolactone) are very similar drugs that are often referred to using the same term – ‘G’. Their effects are extremely similar – GBL is the precursor to GHB, meaning it is converted to GHB in the body. However, GBL is more potent and has a faster onset, so it’s important to know which version of G you’re taking.

Both stimulating and sedating drugs are usually used in combination to produce the desired effects for chemsex. Stimulants like mephedrone and crystal meth are used to promote stamina, euphoria and arousal, and to prolong sex sessions. Sedative drugs are used to lower inhibition and increase pleasure.

Many men also report that these drugs are used to manage negative feelings, such as anxiety and low self-esteem, and counteract a lack of confidence and internalised homophobia.

What are the physical risks of chemsex?

Substance misuse in itself is dangerous – but chemsex is also associated with riskier sexual practices.

Chemsex sessions are prolonged by the stimulating drugs that are taken to facilitate it and can involve multiple partners. Chemsex is also associated with riskier sexual acts due to lowered inhibitions and with reduced condom usage. All of these factors elevate the risk of HIV and other STIs.

The drugs themselves all pose health risks – and because they’re being taken in combination, the user opens themselves up to negative health outcomes from multiple substances.

GHB and GBL, for instance, are easy to overdose on. There is very little difference between a recreational dose and too much – the difference can be as little as one millilitre. It’s also dangerous to mix GHB and GBL with alcohol – both are downers, and this severely increases the risk of overdose.

Riskier drug-taking practices can also make chemsex more dangerous. Not everyone who engages in chemsex injects, but some do – and this can open you up to all of the risks found in injecting, particularly if you’re sharing needles.

What are the mental health risks of chemsex?

Clear sexual consent is difficult during chemsex, and this can cause numerous issues. Sexual assault can happen – but it’s also possible that you can end up consenting to something while intoxicated that you wouldn’t when sober. This can induce powerful feelings of shame and trauma afterwards.

Consistently using drugs, especially with another powerfully reinforcing behaviour like sex, also means that you run the very real risk of developing an addiction. Any drug is capable of being habit-forming, but cocaine and crystal meth work powerfully and directly on the brain’s dopamine reward system and are particularly addictive.

Impact on relationships

Gay men in the UK grew up in a homophobic culture – and while this is changing, there is still a way to go. Many men who have sex with men internalise the idea that there is something wrong with them or that they are unloveable.

Chemsex gives the illusion of addressing this – it can make you feel uninhibited, desirable and free. But the illusion is false, and over time it can lead to feeling disposable, and unloveable and can serve as a barrier to genuine intimacy. The shame and anxiety that melt away in the moment return with intensity during the comedown.

Public awareness

Public awareness around chemsex is low. This is not surprising – chemsex happens mostly within a subset of people, men who have sex with men, and is considered a risky and taboo practice even within this subset. Most people will be unaware of what chemsex is – and if they do encounter any information about it, it’s usually in the form of public health warnings, which does little to defuse the stigma surrounding the practice.

Getting help

Struggling with an addiction to chemsex can feel extremely lonely, and services that understand the practice and can treat you appropriately can be rare. If you’re struggling with chemsex and feel like you have nowhere to turn, we can help.