JIM MCMANUS - (@)
The use of some kind of substance to enhance sex is known and common through history (drinks while dating?) But recently the phenomenon of chemsex has become somewhat better known than it was. Chemsex is a term for a complex of behaviours – use of dating apps to have parties where sustained group use of drugs happens, particularly drugs like cocaine, crack, GHB (gamma hydroxybutyrate) and crystal methamphetamine.
Sex is often but not always a given at some of these parties. Slamming – injection of drugs for quicker highs, sometimes happens, and with it sometimes sharing needles. But increasingly use of chems is reported by men using dating apps for 1-1 encounters too. Recent work has shed more light on the multiple motivations and issues at play. Weatherburn et al identify a range of motivations linked to “enhancing the qualities valued in sex” including enhancing attraction, heightening sensation, intensifying intimacy and connection and, for some men, overcoming lack of libido.
The increasing reporting by clinicians and community groups of problems presenting from this is concerning. From understandable motives - socialising, feeling good, enjoying sex and coping with life pressures are reported as factors, certainly in GHB use for some time , the drug use is primarily intended as a facilitator of these. But clinicians are reporting a range of harms including addiction and other sequelae.
Dedicated professionals like David Stuart and others working on this issue, have brought greater light on chemsex. The publication by James Wharton of his chemsex experiences in Something for the Weekend and the associated meda reporting,have gone some way to cast some light on this as an issue which needs addressing.
not the only places, however, where chemsex is becoming an issue. Increasing
use of “chems” with sexual hook ups means some men may rarely have sex sober.
It’s not just physical risk, but psychological. Intimacy may become associated
with being high, and for some, dependent on it.
A 2014 BMJ editorial suggested a minority of men engage in chemsex but community reports suggest this is growing and becoming more prevalent. There are as yet no robust epidemiological estimates. Weatherburn et al report up to 18% of men from three London Boroughs uses cocaine and 10.5% GHB compared to 4.8% and 1.6% respectively of men elsewhere in England.
Wharton quotes estimates that a gay man dies in London from GHB overdose every 12 days but very few have been high profile. Estimates of prevalence vary in recent reports but what is clear is that this is becoming an increasingly prevalent presenting problem in sexual health clinics, and few services as yet seem prepared to address it effectively.
Whether or not this is a minority phenomenon, the harms are significant and the barriers to accessing services also important disablers of helping men deal with harms arising from chemsex.
What we don’t know reliably is how many men engage in chemsex without coming to some form of harm. Most data from clinics and the small amount of research to date identifies some kind of harm. A spectrum of harms across physical, psychological and social health is possible.
|Physical Health||STIs, HIV and
other Blood borne viruses ; Physical
effects of comedowns; Risks to
circulatory system from injection; Respiratory
risk from frequent use; Risk of death
from overdose; Disrupted sleep
patterns, anorexia, weight loss; Impaired immune
|Psychological/Mental Health||Use of chemsex to facilitate social contact and overcome loneliness, isolation; Coping mechanism for stigma and homophobia; Impact on coping skills, sleep, employment, cognitive functioning; Impact on relationships of becoming habituated on having sex while using drugs; Psychological impact of financial problems from financing habit; Impact on identity integration and acceptance; Bereavement from people in social networks dying as a result of G|
|Social health||Group identification; Coping with stigma; Holding down a job and responsibilities; Risk of debt and homelessness; Criminalisation for possession of drugs and sometimes dealing|
Public Health Issues
Chemsex is not just a drugs or an HIV or a sexual health issue. For most men it seems to be linked to a complex manifold of issues. From the physical risks to health, to the psychological risks and impact on lifecourse development, there are significant issues which impact on the populations and individuals who use it.
The mental health impact of being unable to have sex or be
intimate unless high presents a number of challenges. But there is another set
of issues. If some gay men use chemsex to cope with stigma or feelings about
being gay, that must be seen as potentially problematic. It is a commonplace in
psychology of LGBT populations that a key task is identity integration and
Theory and evidence assumes that identity integration and assimilation is
crucial to health and wellbeing outcomes for gay men across the lifecourse,,.
It is assumed to be especially important to ensure inclusion for LGBT people in
education and employment. If chemsex disrupts such processes, or means a
population or sub-population of gay men can only feel good enough about
themselves where mediated through drug use (either individual or in groups),
there may be significant avoidable psychological morbidity as a result. If what
Wharton says about younger gay men finding it easy to get into this scene is
true, then that has worrying implications about the ability of those men to
form attachments and integrate their identity as they grow, with potential
maladaptation and poor coping and mental health across the lifecourse.
Policy frameworks and action
While Chemsex is mentioned in the new UK Drugs Strategy, there has been much criticism of the lack of commitment on what to do about it. There remains no coherent public health response. Community harm reduction approaches including safer injecting kits are most visible interventions with the best available frameworks for clinical response being those developed by David Stuart There is as yet no clear national policy framework or consensus guideline on what can or should be done. Community intelligence
What can be done?
A range of action is needed, and this needs to be revised as we know more:
1. We need as clear a picture of prevalence, service use, harm, morbidity and mortality as can be compiled, nationally and locally
2. We need to work with providers of dating and sex hook-up apps to target information on harm reduction to users engaging in chemsex
3. Agencies working on this should convene with experts on drug use, sexual health and LGBT development to develop some consensus guidelines on harms and issues, and intervention strategies
4. The current good practice (chemsex care plan and harm reduction information and kits) should be rolled out to those areas who identify they have a developing issue
5. Support harm reduction including continued information and kits to reduce harm
6. Agencies could consider safer chemsex courses as a way of helping reduce harm including teaching people skills of what to do about GHB overdoses
7. Agencies should combine efforts to make available a single reliable source of information on reducing harm from chemsex and where to get help
8. Services should consider whether they can recruit people recovering from chemsex harm to work with others
9. Sexual health and drugs services should identify what they can to do ask gay men about, identify and respond to chemsex issues, and develop collaborative approaches to sharing skills
10. Those services should become skilled in particular identity and lifecourse issues facing gay men
11. LGBT community groups who provide social groups or counselling facilities should consider what they can do to continue to support gay men with lifecourse identity development
12. Employers with large numbers of gay men in population centres likely to be affected should consider what resilience and support packages they can put in place for employees with performance issues arising from chemsex
13. Sex venues should consider placing information on chemsex and where users can get help
 Wharton, James (2017) Something for the Weekend: London : Biteback Publishing
 Hammack, P.L (2009) The Story of Sexual Identity: Narrative Perspectives on the Gay and Lesbian Life Course New York: Oxford University Press