Chemsex

What is chemsex?
Chemsex refers to 'chemical sex'. It involves the intake of psychoactive drugs to enhance sex, increase desire, and reduce inhibitions during parties. Chemsex parties can last a few hours or even days. Using drugs for chemsex is different from taking drugs recreationally or drinking alcohol.

What are these 'chems'?
The three main drugs used for chemsex are GHB, mephedrone and crystal meth. Every drug has its own side-effects, both physically and psychologically. These drugs can be taken alone or in combination to facilitate prolonged sexual sessions, possibly with multiple partners. These parties and drugs are mostly reported by men who have sex with men.

Chemsex can be dangerous and involves high risks of contracting HIV and other STIs. Partygoers are encouraged to take preventative measures by making use of PrEP and condoms.

Is chemsex safe?
Chemsex is not safe.

• Injecting or having drugs is always risky for yourself. Injecting drugs leads to increased risk of injection-related infection and blood-borne viruses like HIV, Hepatitis C and Hepatitis B.
• Unsafe sex - chemsex increases the chances of having sex with multiple partners without a condom which increases the risk of contracting HIV, Hepatitis B or C and STIs.
• You may be unable to consent to the sex that is happening as you might feel out of control.
• PrEP is often forgotten to be taken as advised.

Can chemsex be addictive?
Involvement with chemicals and sex may lead to dependency to both. Chemsex sessions may last for hours, or even days. People may even forget to drink or eat. Participation in chemsex may also have an impact on your appointments, work, and relationships.

How can I keep myself safe?

• Always use condoms and lube.
• Set ground rules while you're sober about what you do and don't want.
• Don't share needles or other equipment used by others.
• Take PrEP to protect against HIV (note: PrEP prevents you from getting HIV, but does not protect against other STIs).
• Get tested regularly for sexually transmitted infections (STIs).

Why do people take these drugs?
The aim of these drugs is to facilitate or enhance the sexual encounter and have sex last for several days with little need for sleep or food. Chemsex can take place between multiple partners, a couple, or lone masturbation.

The drugs usually increase sexual pleasure and psychological experiences. They are most common among gay men, but straight people often make use of drugs and alcohol to enhance sex as well.

Methamphetamine aka Crystal Meth
Methamphetamine is a powerful stimulant that can keep you awake for very long periods of time. It's also known as crystal meth, crystal, meth, tina and crank.

Crystal meth can be swallowed, snorted, injected, or smoked. The way it is taken determines the effect and how quickly one gets high. It makes you feel alert and aroused, but can also make you feel agitated, paranoid, and psychotic. A complication of Methamphetamine is that it increases your heart rate and blood pressure, which may lead to cardiac problems.

Many people claim that crystal meth can make you feel 'super horny', causing extreme arousal and euphoria - 'an out of this world experience'. These effects can make having sex more appealing, attractive, and extremely psychologically addictive. Crystal meth gives confidence to the user and reduces their inhibitions.

Mephedrone
Mephedrone (also known as m-cat, MCAT, meow, meow-meow, plant food/feeder) is part of the amphetamine family and is a stimulant.

Mephedrone can be snorted, swallowed, smoked, or injected. It is highly addictive. It makes people feel alert, confident, talkative, and euphoric.

Side-effects of Mephedrone include vomiting and headaches. It can also cause hallucinations, insomnia, reduction in appetite, dizziness, and sweating. Feelings of euphoria, alertness and affection may be present. You may become very talkative, confident, and very sensitive to touch that makes you sexually aroused. This drug makes you feel very anxious or on edge. Heart palpitations (as if your heart is jumping out of your chest) and sweat may be very prominent. Like other drugs used during chemsex, Mephedrone increases sexual arousal.

GHB (gamma hydroxybutyrate) and GBL (gamma butyrolactone) - referred to as 'G'
GHB and GBL are sedatives. Their full names are gamma hydroxybutyrate and gamma butyrolactone, and they're also known as G, gina, geebs and liquid ecstasy.

GHB and GBL are usually an oily liquid that people mix with a drink (not with alcohol) and swallow.

G can last for about 2 hours and increases desire for sex and reduces inhibitions. Effects of G include euphoria, a sense of relaxation, and tiredness. It is the most common drug used during chemsex because it makes you feel extremely sexually excited and decreases inhibitions. It reduces the ability to consent. This is also used as a drug during a sexual assault.

GHB should be taken according to a recommended amount for every individual. Since it is in a liquid form, it is very easy to get overdosed.

Other drugs which might be used during chemsex include:

• Ketamine: This drug causes hallucinations and a feeling of floating or even being separated from your body. When taken in low doses, it can cause impaired attention and memory. In high doses, it can cause delirium, high blood pressure, depression, and even death due to respiratory failure. It is either swallowed or evaporated so that one can snort the powder. It is known as special K, super K, and vitamin K. It has no odour and no taste. When added to a drink it can cause amnesia and hence can be used to sedate, rendering the victim incapacitated. In fact it is also known as a 'date rape' drug. Since it is an anaesthetic, it may relieve you from pain, making it easier to endure heavier sex such as fisting.
• Cocaine: This is a stimulant and hence makes you feel good, euphoric, more mentally alert, and hypersensitive to touch, sound, and sight. It is not specifically used for chemsex, but it makes you very horny and more confident, and hence facilitates sex with people you generally would not have sex with. It is a white, fine, crystal powder. Cocaine is either injected or snorted.
• Viagra: This is used to treat impotence (an inability to get or sustain an erection). It is commonly used to counteract the effect of other drugs which cause impotence.

Other important notes:

• Sometimes the drugs are injected, which is known as 'slamming'. Sharing needles to inject drugs into a vein increases the chance of getting HIV or Hepatitis B or C.
• Mixing with HIV drugs - Apart from HIV drug interaction with other drugs, being high can make you less likely to take medication to prevent HIV.

Why Chemsex?
At parties and chillouts you might be meeting several people over a night or a weekend. The sexual environment during these parties and meeting the same persons over a period might make you feel that you are in a 'safe bubble'. This environment makes you feel more relaxed and connected to this group, especially if drugs are shared and passed around. This situation induces feelings of positivity and self-confidence, which can lead you to put aside lots of doubts or fears for that moment in time.

These drugs usually increase sexual pleasure, remove barriers of self-esteem and stigma, and make users feel sexually free. 'Chems' allow users to have sex for several days, with little need for sleep or food. Apart from dependency on these drugs, one of the biggest risks can be their effect on your ability to consent and be aware of what you are doing or what you have done. Chemsex also leads to multiple sex partners for a long duration, or rough sex. This increases the risk of condom breakages or slip-off, leading to increased risk of acquiring STIs.

Sexual health
Chemsex is associated with high risk-taking behaviours including having more sexual partners, group sex, fisting, sharing sex toys, injecting drug use, and higher alcohol consumption. Any unprotected sexual activity increases the risk of HIV, Hepatitis B and C, and other sexually transmitted infections such as Chlamydia, Gonorrhea and Syphilis.

PrEP (Pre-Exposure Prophylaxis) and condoms are prevention methods for HIV and other STIs. PrEP medication can provide you with a high level of protection before any sexual exposure against HIV, but not for other STIs. PrEP cannot be taken right before sex. Prescriptions for PrEP can be obtained from the GU Clinic following a test screening. To continue taking PrEP, you will need to go for a follow-up every 3 months. Remember to always use condoms. Condoms should be used with one person only and should be changed if they break.

If you have had chemsex and are worried you have put yourself at risk of HIV infection, get advice from a medical professional as soon as you can. PEP medication may be recommended. PEP (Post Exposure Prophylaxis) ought to be sought within 72 hours to prevent the exposure to HIV. PEP can be prescribed either from the GU Clinic or from Mater Dei Hospital Emergency Department out of hours.

How can you protect yourself during chemsex parties from STIs?

• Use condoms and lube.
• Set ground rules while you're sober about what you do and don't want.
• Don't share needles.
• Get immunised for Hepatitis A and Hepatitis B.
• Take PrEP to protect against HIV (it is important to set reminders to take PrEP).
• Get tested regularly for sexually transmitted infections (STIs).
• Don't pool drugs in a shared pot. There is danger of contaminated blood getting into the drugs you are sharing.
• You should also avoid mixing drugs with alcohol or any other drugs.
• Know your status and get checked regularly.
• Limit how long you party and how frequently you participate in such parties, to avoid becoming dependent on these drugs.

What should you do in an emergency?
During chemsex, it is important to protect each other.

• Know basic first aid.
• Is the person unconscious or responding? If not, do not give more drugs and do not induce vomiting. If a person is unconscious or you think that he has overdosed, put him in recovery position** and call 112 for an ambulance for help immediately. Continue talking to him and do not let him dose off if still responsive. Always keep in mind consent about the amount of drugs that one would like to take.

**
1. Place nearest arm at right angle.
2. Put the back of other hand next to the cheek closest to you and hold it there.
3. Bend the far knee, grasp the far leg and roll them onto their side.
4. Open airway (mouth).
5. Call 112.

Chemsex and mental health

• If you experience hallucinations, anxiety, or paranoia, stop immediately.
• After chemsex parties you may feel regret, depression, and fear. Seek help if you are concerned about your mental health.
• If you already suffer from mental health issues, these may worsen once you start making use of chemsex drugs.
• Do not engage regularly in chemsex parties to decrease the chances of developing mental health problems.
• If you make use of such drugs on a regular basis, you may add up addicted to them. Seek help.

Chemsex may put you in a lot of financial, emotional, mental, and stress pressure. Seek support and help for advice and information on services that are available.

Where can I find help?
You can call:

• Sedqa on 179 available 24/7 or Sedqa St Venera on 2226100 during office hours.
• Sexual Health Malta: sexualhealth.malta@gov.mt or message us with confidentiality on SexualHealth Malta Facebook & Instagram.
• Crisis Intervention at Mater Dei Hospital on 25453950. Available from Monday to Sunday between 7am and 5:30 p.m.
• GU Clinic on 25457494/1 for more information from Monday to Friday between 7am and 4pm or send an email to: guclinic@gov.mt.

Reference List:
Sewell J, Cambiano V, Speakman A, Lampe FC, Phillips A, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Rodger AJ. Changes in chemsex and sexual behaviour over time, among a cohort of MSM in London and Brighton: Findings from the AURAH2 study. Int J Drug Policy. 2019 Jun;68:54-61. doi: 10.1016/j.drugpo.2019.03.021. Epub 2019 Apr 15. PMID: 30999243.

Changegrowlive.org. 2020. Chemsex. [online] Available at: <https://www.changegrowlive.org/advice-info/alcohol-drugs/chemsex-drugs> [Accessed 5 August 2020].

Giorgetti, R., Tagliabracci, A., Schifano, F., Zaami, S., Marinelli, E. and Busardò, F., 2017. When “Chems” Meet Sex: A Rising Phenomenon Called “ChemSex”. Current Neuropharmacology, 15(5).

Glyde, T., 2015. Chemsex exposed. The Lancet, 386(10010), pp.2243-2244.

Priorygroup.com. 2020. What Is Chemsex? | Priory Group. [online] Available at: <https://www.priorygroup.com/blog/what-is-chemsex> [Accessed 5 August 2020].

S-x.scot. 2020. What Is Chemsex?. [online] Available at: <https://s-x.scot/sex-drugs-chemsex/chemsex/what-is-chemsex/> [Accessed 6 August 2020].