PolyDrug Use and ChemSex

"The most commonly reported desired effects of sex under the influence of drugs include enhanced emotional connection, intense bodily sensations, disinhibition, and increased lust (1). The most studied form of sexualized drug use is chemsex, a term specifically describing the intentional use of particular drugs to intensify sexual experiences, primarily among gay, bisexual, and other men who have sex with men (gbMSM). Additional characteristics of chemsex include the use of geolocation apps, and its link with a range of physical, psychological, and social harms from both individual and societal perspectives (2). Chemsex has become a significant public health issue that warrants attention (3). Initially, the term chemsex was defined by the use of mephedrone (4-MMC), methamphetamine (crystal meth), γ-hydroxybutyrate (GHB), and γ-butyrolactone (GBL) (4). However, more recent studies have suggested a broader understanding of chemsex, with modified definitions and revised categorizations of substances (2, 5) based on regional differences (6, 7) and variations in user populations (8). To capture this variation, the term ‘pharmacosex’ was coined as a way to describe how wider populations experiment with a range of illicit substances that modify and enhance their sex lives (1).

"As prevalence of chemsex differs depending on the used definition, it is hard to assess a reliable prevalence. Data from the EMIS-study in 2017 revealed lifetime prevalence of 15, and 10% in the past 12 months (9). A recent meta-analysis and review article estimates the prevalence of chemsex among gbMSM in Europe at 16% (95% CI: 11–21%) (5). However, higher prevalence rates have been observed in specific subpopulations. For example, 39.8 and 63% of gbMSM using pre-exposure prophylaxis (PrEP) for HIV prevention in France (10) and Spain (11) respectively reported engaging in chemsex. Additionally, 30.6% of users of gay dating platforms (12), 41% of men who have sex with men (MSM) attending sexually transmitted infection (STI) clinics (13), 36.1% of HIV-negative MSM (14), and 48.5% of gbMSM living with HIV (15) reported similar behaviors.

"The most recent Drug Report by the European Monitoring Center for Drugs and Drug Addiction highlights an increase in polydrug use (16). Polydrug use refers to the simultaneous or sequential use of two or more psychoactive substances, either by deliberately combining different drugs or by using substances that contain multiple active ingredients (16). A specific increase in polydrug use for sexual purposes has been observed among gbMSM engaging in chemsex (17–20). Individuals often combine various substances either to mitigate negative side effects or to enhance their sexual experience through synergistic effects. Therefore, polydrug use in a sexual context is conceptually part of chemsex."