Prevention

Chemsex: Sexualised Substance Use

Chemsex: base information

Information taken from the THT site www.fridaymonday.org.uk and drugscouts.de

The use of drugs is never without risk. Among other things, there is a danger of becoming dependent on the drug being used. Also, it may be harder for the user to keep to their safer sex strategy.

The term ‘chemsex’ can be used differently by different people. In general it means sexual activity performed while under the influence of psychoactive drugs, in some definitions limited to specific substances, in particular Crystal Meth, GHB/GBL, Poppers, Mephedrone and Ketamine. Substances used in chemsex are often called ‘chems’.

Chemsex use is happening at some level across most of Europe. Even if the number of gay and other MSM engaged in chemsex is quite small (see EMIS2017 data), it is important for the work of Community Health Workers to know about what is happening and how to provide important information to support men who engage in chemsex. 

Many chemsex users are able to control their consumption. But there are also a high number of chems users whose substance use gets problematic. Many chems carry a high risk of dependency developing in the user, which means that it is not always easy to control the consumption. Knowledge about risk reduction around drug use and ‘Safer Use’ of drugs is not widely-spread among gay and other MSM. It may become difficult for the user to keep to their Safer Sex or risk reduction strategy when under the influence of chems (being ‘high’).

Forms of consumption and their risks

Snorting

Drugs like cocaine, Crystal Meth, Mephedrone, Speed and Heroin can be sniffed or snorted through a tube into the nose. The risks of overdosing and any risks of picking up or passing on any infections are reduced when snorting.

Tiny nasal mucosal lesions that are easily formed by snorting drugs can allow hepatitis or HIV in blood to be transferred to the tubes being used and then transferred to others. A user should only use their own tube when snorting drugs and banknotes should never be used.

Smoking

Smoking Crack Cocaine or Metamphetamine creates high temperatures in the pipe being used that can cause lip and mucous membrane damage in the mouth. Due to the numbing effect of the drugs the user often only feels these injuries much later on in their use, and can therefore be transferring blood between users without knowing about it. In order to avoid Hepatitis C infections it is important not to share the pipe with others.

Injecting (slamming)

Because of the inevitable contact with blood, intravenous use (called ‘slamming’) is the most risky form of consumption in regards of HIV and Hepatitis C.

Blood residues on and in the needle as well as in the syringe and other user items such as spoons, filters or water can contain HIV and other viruses as well as bacteria in high concentrations, even if the blood is not visible to the naked eye.

This is why it is strongly recommended for users to only use their own syringe and own utensils and never share these things. Ideally, a new syringe should be used for each “shot”.

In many cities, there are facilities where sterile syringes can be acquired for free or for a very low price or where you can trade old syringes for new ones.

Other forms of consumption

Pills and some liquids are swallowed. The main risks here are irritation to the lining of the mouth, esophagus and stomach. Swallowing drugs in drinks or food can mean users have less control over the amount taken, but much of the damage caused by taking drugs in other ways, such as through the nose, lungs or veins is avoided.

Sometimes other forms of consumption are used such as anal ingestions also known as a “booty bump”. This means injecting the substance (in liquid form or dissolved in water) via a syringe without needle up into the rectum. Drugs taken anally are absorbed faster than if swallowed and tend to have a stronger effect. This form of consumption tends to cause small injuries, irritations and bleeding and the risk of HIV, Hepatitis C or STI infections rises significantly.

Safer use

When injecting, snorting and smoking drugs, Hepatitis viruses can be transmitted, as well as HIV. To minimize the risk, its best to advise users to always only use their own items such as syringes, pipes or tubes. Used utensils, including water and filters should never be shared.

Risk reduction

It is not possible to use drugs without their being some level of risk. However many things can be done to minimize the risks: providing accurate information about the effects and interactions of the substances, suggesting that users avoid using new substances whilst on their own and advising them to be careful around dosing and supplementing their doses.

This information could look something like this:

Use substances only when you are in a good mood and with people you trust. When using chems at a party or in a group, there should be someone around who stays sober. Tell each other what you swallow, sniff or squirt – in an emergency this helps a lot. And when going to a party together, it is also recommended that you leave together. Do not leave anyone behind if they have used drugs. If you have not seen a friend for a long time, look for them – they may need help.

Preparation: good preparation helps to support low-risk consumption: a personal tube and sterile syringes, and possibly filters and water for intravenous use. GHB/GBL rations should be put into small syringes or other containers whilst you are at home and sober, to avoid overdosing later when you are ‘high’. If you are taking HIV treatment or PReP, you should take enough medication with you to last a while longer than you think you’ll be partying as it could be that you’ll be there longer than you planned for.

Breaks between use: it is important to plan your breaks between each dose of the drug or drugs you are taking. The effect of the drugs may come on later than expected and may differ, depending on the how your body is dealing with things that day. For example,  there should be a minimum break of two hours between any two doses of GHB/GBL you are using.

Setting: the reaction you have to the drugs you are using can differ a lot in different settings. A downer, like GHB/GBL or Ketamine used in a Sauna can cause problems much faster than if you are using them in a private setting, because of the heat of the sauna and the drugs effects on your body. It is always important to remember to drink water and to have eaten beforehand, as drugs often mask any feelings of thirst and/or appetite and therefore the risk of dehydration or energy loss is higher.

Safer way home: You should never drive a car or bike when high – even if you think you are able to. You also need sufficient recovery time after partying as the drugs can be hard on your body.

Safer sex

When under the influence of any substances that affect your ability to think clearly whether its drugs or alcohol, things can often happen that would not normally happen when you are sober. 

Clarify to yourself and with any sexual partners beforehand what you want to do or not want to do and which safer sex method you want to use.

It might be difficult for you to use a condom properly when being ‘high’ so a useful Safer Sex strategy should be discussed and agreed on beforehand.

Information about major substances used for chemsex:

Next module: GBL/GBH

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