BMJ 2015;351:h5790 doi: 10.1136/bmj.
h5790 (Published 3 November 2015)
Editorials
What is chemsex and why does it matter?
It needs to become a public health priority
Hannah McCall senior nurse, genitourinary medicine/sexual and reproductive health , Naomi Adams
1 2
head of sexual health psychology , David Mason specialist substance misuse practitioner , Jamie
3
Willis outreach and training manager
1
Central and Northwest London NHS Foundation Trust, London WC1E 6JB, UK; 2Camden and Islington NHS Foundation Trust, London, UK;
3
Antidote Service, London Friend, London, UK
Chemsex is used in the United Kingdom to describe
intentional sex under the influence of psychoactive drugs, mostly
among men who have sex with men. It refers particularly to the
use of mephedrone, -hydroxybutyrate (GHB), -butyrolactone
(GBL), and crystallised methamphetamine. These drugs are
often used in combination to facilitate sexual sessions lasting
several hours or days with multiple sexual partners.1 2
Mephedrone and crystal meth are physiological stimulants,
increasing heart rate and blood pressure, as well as triggering
euphoria and sexual arousal. GHB (and its precursor GBL) is
a powerful psychological disinhibitor and also a mild
anaesthetic. Anecdotal reports and some small qualitative studies
in the UK find that people engaging in chemsex report better
sex, with these drugs reducing inhibitions and increasing
pleasure. They facilitate sustained arousal and induce a feeling
of instant rapport with sexual partners. Some users report using
them to manage negative feelings, such as a lack of confidence
and self esteem, internalised homophobia, and stigma about
their HIV status.3-5
Quantitative data on drug use in a sexual context in the UK are
lacking, with recent Home Office statistics reporting only on
the use of any illicit drug in the past year.6 The Chemsex Study,5
the first British research project of its kind, used data from the
European Men-who-have-sex-with-men Internet Survey (EMIS)7
to give a quantitative context. Of 1142 respondents in
Lambeth, Southwark, and Lewisham, around a fifth reported
chemsex within the past five years and a 10th within the past
four weeks, suggesting that it is practised by a minority of men
who have sex with men.
Many barriers exist to chemsex drug users accessing services,
including the shame and stigma often associated with drug use
and ignorance of available drug services.2 In the UK, funding
for drugs services is focused on tackling heroin, crack cocaine,
and alcohol dependency, and both chemsex drug users and health
professionals may believe referral to traditional services is
inappropriate.2 Some services are now developing specific
chemsex and party drug clinics. At Antidote, a specialist drugs
Correspondence to: H McCall hmccall@nhs.net
For personal use only: See rights and reprints http://www.bmj.com/permissions
Page 1 of 2
EDITORIALS
1
service for the lesbian, gay, bisexual, transgender community
in London, around 64% of attendees seeking support for drug
use reported using chemsex drugs in 2013-14.3 Of crystal meth
and GHB/GBL users, most reported using them to facilitate sex,
with around three quarters reporting injecting drug use.3
Harms to health
Mental health services are seeing a small but important uptake
in services by chemsex drug users.3 8 Mephedrone and crystal
meth can create a powerful psychological dependence, with
GHB/GBL creating a dangerous physiological dependence.
Mental health effects may require treatment and can become
permanent.5 Some users will need drug treatment to support
detoxification, particularly from GHB/GBL.5
Chemsex drug users often describe losing daysnot sleeping
or eating for up to 72 hours4 5and this may harm their general
health. Users may present too late to be eligible for
post-exposure prophylaxis for HIV transmission. An increased
number of sexual partners1 2 may also increase the risk of
acquiring other sexually transmitted infections. Data from
service users suggest an average of five sexual partners per
session and that unprotected sex is the norm.3 However, Bourne
and colleagues found that not all chemsex was unprotected.6
Kirby has described some chemsex practices, particularly
injecting drug use, as a perfect storm for transmission of both
HIV and hepatitis C virus,9 although strong evidence exists for
sero-sorting among chemsex partners.6 Public Health England
has reported an increase in sexually transmitted infections and
hepatitis C among men who have sex with men10 as well as an
increase in the injecting of amphetamines and amphetamine-like
substances such as mephedrone and crystal meth.11 Nevertheless,
the explanation for these findings is unlikely to be solely, or
even predominantly, the minority of men who participate in
chemsex.
The lack of data limits the advice that clinicians can give. The
National Institute for Health and Care Excellence has provided
only limited advice on psychoactive drug use and no specific
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BMJ 2015;351:h5790 doi: 10.1136/bmj.h5790 (Published 3 November 2015)
recommendations relating to chemsex drugs.12 However, the
Novel Psychoactive Treatment UK Network (Neptune),
supported by the independent charity the Health Foundation,
has published a guidance document for clinicians managing the
harms resulting from the use of club drugs and novel
psychoactive substances.5
Addressing chemsex related morbidities should be a public
health priority.13 However, in England funding for specialist
sexual health and drugs services is waning and commissioning
for these services is complex. English sexual health services
tend to be open access, with costs charged back to local
authorities. Drug services tend to be authority specific with
users having to attend a service within their borough of
residence. Despite the different funding streams, creating centres
of excellence for sexual health and drug services could be a cost
effective solution to diminished resources in both sectors. It
could also be a source of data for further research into chemsex
that would help commissioners in their decision making.
Competing interests: We have read and understood BMJ policy on
declaration of interests and have no relevant interests to declare.
Provenance and peer review: Not commissioned; externally peer
reviewed.
1 Bourne A, Reid D, Hickson F, Torres-Rueda S, Weatherburn P. Illicit drug use in sexual
settings (chemsex) and HIV/STI transmission risk behaviour among gay men in south
For personal use only: See rights and reprints http://www.bmj.com/permissions
Page 2 of 2
EDITORIALS
London: findings from a qualitative study. Sex Transm Infect 2015 Jul 9. [Epub ahead of
print.]
2 Bourne A, Reid D, Hickson F, Torres-Rueda S, Weatherburn P. Chemsex and harm
reduction need among gay men in south London. Int J Drug Policy 2015 Jul 26. [Epub
ahead of print.]
3 London Friend, Antidote. Out of your mind. 2014. http://londonfriend.org.uk/wp-content/
uploads/2014/06/Out-of-your-mind.pdf.
4 Bourne A, Reid D, Hickson F, Torres-Rueda S, Weatherburn P. The Chemsex study:
drug use in sexual settings among gay & bisexual men in Lambeth, Southwark &
5
Lewisham. 2014. www.sigmaresearch.org.uk/chemsex.
Novel Psychoactive Treatment UK Network. Guidance on the clinical management of
acute and chronic harms of club drugs and novel psychoactive substances. 2015 http://
neptune-clinical-guidance.co.uk/wp-content/uploads/2015/03/NEPTUNE-Guidance-March-
2015.pdf.
6 Home Office. Drug misuse: findings from the 2013 to 2014 CSEW. 2014. www.gov.uk/
government/statistics/drug-misuse-findings-from-the-2013-to-2014-csew.
7 EMIS Network. The European Men-Who-Have-Sex-With-Men Internet Survey. Findings
from 38 countries. European Centre for Disease Prevention and Control, 2013.
8 Stuart D. Sexualised drug use by MSM: background, current status and response. HIV
9
Nurs 2013 Spring:6-10.
Kirby T, Thornber-Dunwell M. High-risk drug practices tighten grip on London gay scene.
Lancet 2013;381:101-2.
10 Public Health England. Sexually-transmitted infections. 2014. www.gov.uk/government/
uploads/system/uploads/attachment_data/file/437433/hpr2215_STI_NCSP_v6.pdf.
11 Public Health England, Health Protection Scotland, Public Health Wales, Public Health
Agency Northern Ireland (2014) Shooting up: infections among people who inject drugs
in the United Kingdom 2013. www.gov.uk/government/publications/shooting-up-infections-
among-people-who-inject-drugs-in-the-uk.
12 National Institute for Health and Care Excellence. Tackling drug use. 2014. www.nice.
org.uk/guidance/lgb18.
13 Public Health England. PHE Framework 2013-16. www.gov.uk/government/publications/
healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency.
Cite this as: BMJ 2015;351:h5790
BMJ Publishing Group Ltd 2015
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