Chemsex: The association between drugs and sex has alarmed experts

Having sex while under the influence of drugs isn't a new behavior, but it's increasingly attracting the attention of experts and health authorities. This habit has even earned a name: chemsex , an abbreviation of the English expression "chemical sex ," which refers to sexual intercourse associated with the use of psychoactive substances.

In general, the practice is linked to the consumption of alcohol, cannabis, ketamine ("key"), ecstasy ("bullet"), LSD ("sweet"), methamphetamine ("crystal" or "tin"), GHB ("good night Cinderella"), or alkyl nitrite ( poppers ). These drugs act directly on the brain, intensifying feelings of pleasure, relaxation, and disinhibition.

The use of these substances adds to the ease of finding partners in an increasingly connected world. "Drug use in sexualized contexts is not new. But the combination of this with new technologies, substances, and even diseases differentiates chemsex from this historically well-known behavior," explains psychologist Marina Del Rei, a specialist in assisting alcohol and other drug users who is investigating the phenomenon for her doctorate at the University of São Paulo (USP).

Although research is still needed to understand this behavior in greater depth, recent studies help shed light on the practice. A meta-analysis published in April in the journal Healthcare indicates a global prevalence of 12.66% for chemsex , considering different countries, genders, and sexual orientations. A Brazilian study published in March 2024 in the journal Public Health Nursing shows that 19.42% of same-sex men (gay, bisexual, pansexual, among others) have experienced chemsex in the country.

As early as 2007, the Ministry of Health recognized this practice in a document called the National Plan to Combat the AIDS and STD Epidemic among Gay Men, MSM, and Transvestites . "Alcohol is possibly the most commonly used drug in these contexts, but the use of recreational drugs (ecstasy, crystal meds, speed, ice, poppers, Viagra) and crack cocaine has been reported in some of these settings. In these contexts, the disinhibition caused by drug use may be linked to engaging in sexual practices without condom use," the text states.

But scientific interest in the topic grew especially since 2019, driven by the growing use of dating apps and the effects of social isolation during the COVID-19 pandemic. And also by the associated risks. "The practice can favor the development of serious psychological conditions, increase vulnerability to sexually transmitted infections, and, without knowledge of harm reduction strategies, lead to substance use disorder," notes Marina Del Rei.

Motivations and risks

Several factors can lead to this practice. Starting with the effects of the drugs themselves: cannabis, for example, can cause a sensation of time dilation, making the sexual experience seem longer and more intense; while inhaling poppers increases arousal and relaxes muscles, facilitating vaginal and anal penetration.

There are also social aspects. "Many LGBT+ people experience discrimination and the feeling of inferiority and social marginalization from a young age. In adulthood, some may try to overcome their trauma by pursuing an intense and 'perfect' life: having the best body, the best company, and the best sex. In this process, many end up encountering these substances," observes psychiatrist Saulo Vito Ciasca, from Einstein Hospital Israelita.

However, this relationship is always subjective: motivations vary from person to person. Some people may consume these products to reduce their inhibitions and increase their ability to socialize; for others, it's out of curiosity or a desire to experience different sensations.

But side effects don't take long to appear. After a chemsex session, users can experience a kind of "chemical hangover," with intense symptoms. Methamphetamine, for example, is known to trigger anxiety, depression, insomnia, paranoia, and even psychosis.

Furthermore, continued drug use can cause serious physical harm, such as an increased risk of stroke, cardiac arrhythmia, liver damage, and burns. Sudden mood swings are also common.

Another worrying factor is the origin of the substances. Since many of the drugs used in chemsex are illegal, there is no quality control. Impurity in the products increases the risk of overdose and unpredictable adverse reactions.

Vulnerability to risky behaviors, such as unprotected sex, also increases. The lack of combined prevention strategies—such as PrEP, DoxiPEP, regular testing, and condoms—increases exposure to viruses such as HIV, herpes, and MPOX, as well as other sexually transmitted infections (STIs).

When use goes from sporadic to dependence, the effects deepen. Withdrawal symptoms—such as sweating, agitation, insomnia, nausea, and headaches—can progress to what's known as Hedonic Homeostasis Dysregulation Syndrome. This condition is characterized by an imbalance in the brain's reward system, which begins to recognize the drug as the only possible source of pleasure—making everyday activities incapable of generating satisfaction.

Furthermore, there's the possibility that the dose required to achieve that same euphoria may gradually increase. "The threshold between the intended recreational effect and the threshold for that substance to become toxic, posing risks of overdose and other health problems, is very close depending on the substance, for example, GHB," emphasizes the Einstein psychiatrist. "That's why it's so important to talk about harm reduction; the difference between medicine and poison is in the dose."

A safer path

Harm reduction is a strategy that assumes that it's not always possible (or realistic) to achieve abstinence, but it's possible to minimize the risks. This includes access to reliable information about the effects of substances, safe dosages, dangerous combinations (such as alcohol and ketamine), and, most importantly, what to do if something gets out of control.

Seeking help from qualified professionals is essential—both for safe guidance and to address any potential consequences of use. Services such as Testing and Counseling Centers (CTAs) and Psychosocial Care Centers (CAPSs) are gateways to this process. "Paying attention to your own limits and reflecting on your experience with substances, especially with the help of a professional, are practices that help you use these products more consciously and informedly," advises Marina Del Rei. "This can help avoid a problematic relationship with drugs."

Source: Einstein Agency

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