Chemsex is having a bit of a moment. A bit of a being-talked-about-everywhere moment. The alleged serial killer who used chemsex drugs to poison young men. The hysteria around Charlie Sheen’s HIV status. There are stage plays, radio documentaries, features films and plenty of column inches being devoted to the pros and cons of chemsex. But, what is it and why does it matter?
Sexual Health Nurse Hannah McCall , whose BMJ article on chemsex recently sparked headlines, writes for PRN about the subject on everyone's lips.
Illustrations by Grace Russell.
In the UK, chemsex is a term commonly used to describe the intentional act of sex under the influence of psychoactive drugs. In the chemsex context, the drugs of choice are mephedrone, gamma-hydroxybutyrate [GHB], gamma-butyrolactone [GBL] and/or crystallised methamphetamine [crystal meth]. In other parts of the world, the terms “wired play”, “party and play” or “PnP” describe similar behaviour, with similar drugs.
I know what you might be thinking: sex and drugs is hardly a new phenomenon. People have probably been doing it for as long as they’ve been Doing It. However, let me be clear, chemsex isn’t people going out partying, getting high and then ending up having sex together. Or people having sex parties and dabbling in a bit of drug use on the side. Chemsex is people deliberately using these drugs, often in combination, over extended periods, to facilitate sexual sessions lasting for several hours or days, with multiple partners.
So, who is having chemsex and how do you get invited to the party? In theory, quantitative data on drug use in a sexual context in the UK is sorely lacking, we don’t have enough evidence to make robust conclusions about who or how. In reality, most of the research is focussed on the gay community; however, lots of straight people are probably having chemsex too, but nobody is asking them about it. In practice, at our central London clinic most of the clients who do talk about chemsex are gay men, of all ages and professions, and they often link chemsex to hook-up apps, like Grindr and Tinder.
There are lots of reasons why a person might have chemsex: first off, it feels great! Anecdotal reporting and some small-scale qualitative studies in the UK agree that people engaging in chemsex report a significantly improved experience of sex. The science backs them up: mephedrone and crystal meth provide psychological stimulus, triggering feelings of euphoria, sexual arousal. The drugs reduce inhibitions and increase pleasure, facilitate sustained erections and give a feeling of instant chemistry with sexual partners. GHB/GBL is a powerful disinhibitor and can cause reduced experience of pain.
Alongside these positive aspects, some people report using them to manage negative feelings, such as a lack of confidence and self-esteem. Some people talk about using the drugs to stop them worrying about things, like internalised homophobia, HIV or pregnancy risk. Those can be pretty powerful, unsexy thoughts to be having when you’re trying to be utterly gorgeous and concentrating on not falling over whilst you take your socks off.
Improved sex, more confidence, no worries- hakuna matata! Except life isn’t a Disney movie and chemsex can have some pretty bad side-effects too. Chemsex users often describe “losing days”, getting so immersed in sessions that they don’t sleep or eat for up to 72 hours. At the risk of sounding like Old Lady Killjoy, not sleeping or eating for three days isn’t good for you.
Most research into chemsex agrees that an average of five sexual partners per session and unprotected sex [without condoms] is the norm. Both these factors may increase a person’s risk of acquiring sexually-transmitted infections, including HIV and hepatitis C. There is also widespread reporting of injecting drug use, also called “slamming”, becoming normalised in the chemsex scene.
Mental health services are seeing a small, but significant uptake in services by the chemsex population. Short and long term mental health effects of chems include panic, anxiety, confusion, psychosis, depression and cognitive impairments, which can become permanent.
Some users will need emergency intervention or medically supported detoxification. Ask any A&E or critical care nurse you know if they’ve nursed someone coming down, or up, and they’ll probably have a story to tell. My story involves rescuing a colleague from being strangled, a chair flying through the air as the patient tried to break out via the window and several burly men having to restrain him whilst he was sedated for his own (and our) safety.
Aside from emergencies, many barriers exist to chemsex users accessing services, including the shame and stigma associated with drug use and a lack of knowledge of drug services available. Both chemsex users and health professionals might feel referral to traditional opiate-focussed services is inappropriate. Responding to this, some services are setting up specialist chemsex drug services.
Additionally, a lack of data limits the availability of guidance for clinicians. To date, NICE have produced limited advice on psychoactive drug use and the British Association of Sexual Health & HIV [BASHH] released a short statement on “club” recreational drug use in 2014; neither have provided detailed advice for managing drug use in a sexual context.
As nurses, what then can we do? Firstly, get comfortable talking about drug use with your patients: A good history always includes social factors like smoking and alcohol intake, try adding “any recreational drug use? What drugs are you using, how are you taking them, how often?” This will help you to identify potentially problematic use, and those at immediate risk. Secondly get informed about simple safety advice and services you can refer people to: Good advice includes easy information, try “do you know there is a risk of hepatitis C transmission when sharing banknotes, straws or needles?” and offer to refer them to a local needle exchange. Some sexual health services are now offering colour-coded, clean needle kits, also called “slamming packs”. And in emergencies, always, always, look out for chairs flying through the air.
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