Living'Chemsex', another epidemic out of control

'Chemsex', another epidemic out of control

 

What is chem -sex?

The term chemsex arises from the union of the words chems ( chemicals, chemicals) and sex . According to the Ministry of Health, it is defined as: ” the intentional use of drugs to have sexual relations for a long period of time (from several hours to several days) among gay, bisexual men and other men who have sex with men”.

When drugs are administered intravenously it is known as ‘ slamming’ or ‘ slamsex’ . Session, stoned, vice, party, chill, guarrihill, sweets , are expressions of the slang with which chemsex is known.

Heterosexual people and women also have sex with drug use. But chemsex is a different concept in which relatively new substances and less frequent routes of consumption come into play . In addition, there is a characteristic part of this practice that the guide of the Ministry of Health indicates as gear and support of this practice. I am referring to the idea of a session, its duration and what it encompasses: “ the collective imaginary of sexual references, codes, morbidities and fantasies of those who participate” .

How and where is chemsex practiced?

Chemsex sessions can be for couples, threesomes or group sex. Most commonly, chemsex takes place in private homes . Other scenarios are saunas, parties in private premises or hotels, places with dark rooms, cruising areas, etc. There is even a solo mode, but with group online interaction with webcams, viewing pornographic material.

Geosocial contact applications facilitate these meetings for various reasons, according to Martín Herrero, a nurse at the Arganzuela Drug Addiction Care Center. These reasons are:

  • Knowledge of the physical proximity of potential sexual partners favors the success of the encounter with less effort and increases the number of these.
  • Greater visibility of certain sexual practices ( fisting , bareback …) or fetishisms, quickly accessing men with the same interests.

What drugs are the most consumed?

Dolengevich-Segal refers that there are 3 substances that are the most consumed, and describes the following characteristics about them:

  • Mephedrone is the most consumed. In the slang they call it mefe, meow meow, bath salts . It has effects similar to amphetamines and, in addition, it has sensory enhancement , increased sociability, disinhibition and sexual arousal, and a high addictive potential (especially when used intravenously).
  • GHB: is a CNS depressant that has a disinhibitory effect perceived as an aphrodisiac and a mild analgesic action . Its anesthetic effect favors aggressive sexual practices such as fisting (brachial-rectal sex) as it relaxes the smooth muscle of the anal sphincter and lowers the pain threshold. In the slang they call it g, liquid ecstasy, chorri, potes .
  • Methamphetamine : Increases sexual confidence , duration, and intimacy. It also facilitates participation in high-risk behaviors, such as group sex, with multiple partners, or aggressive sexual practices. Chronic methamphetamine use is associated with a high potential for dependence , mental health problems such as depression and/or psychosis, and transmission of blood viruses, mainly HIV. In slang it is known as tub or crystal meth . It is also consumed intravenously.

Redondo states about these three drugs that “they have recently spread among this group, they have been little studied and very little is known about their toxicity and problems derived from their long-term consumption” . There is no specific antidote for any of them.”

Mefredone, methamphetamines and GHB are cheaper than MDMA ( ecstasy, em, crystal ), cocaine and amphetamines ( speed ). But the latter are also consumed, along with ketamine (potent hypnotic), amyl or butyl nitrite ( poppers ), sildenafil and derivatives (Viagra) and alcohol .

The routes of consumption are diverse and each drug can have several: sniffed, drunk, taken in pill form, diluted and administered rectally, etc.

Those that can be consumed via injection are: methamphetamine, mephedrone, ketamine, cocaine, MDMA, speed and some other new substances known as Research Chemicals .

Chemsex : lethal cocktail of drugs

This is one of the great problems of chemsex : the mixtures between drugs and between these with the antiretroviral drugs that some of these people take as treatment for HIV. According to the Ministry of Health, “these interactions can increase or decrease the perceived/intended effect and this leads to excessive consumption.”

In turn, this favors the appearance of serious intoxication or overdose with psychological consequences (in addition to physical ones) such as: psychotic episodes, depression, suicidal behavior, which have been observed more frequently in people who practice slamming , in addition to polydrug use of substances.

Some of these dangerous mixtures and interactions and their consequences are:

  • Sildenafil, tadalafil, vardenafil (Viagra and “relatives”) together with poppers : can cause severe hypotension due to their powerful vasodilator effect.
  • GHB with alcohol and benzodiazepines : respiratory depression, coma and death due to accumulation of GHB.
  • Methamphetamine with mephedrone : hyperactivation of the central nervous system producing tachycardia, hyperthermia, dehydration, cardiovascular events, psychosis, agitation.
  • Antiretrovirals : the mixture of these drugs used as treatment against HIV with any of the above drugs can cause their levels to increase in the body, producing an overdose.

Not everything is an overdose: other consequences of chemsex

Overdoses, intoxications or addictions are not the only consequences. Martín Herrero, a nurse at the Arganzuela Drug Addiction Care Center, also describes problems in sexual life such as loss of interest in sexual practices in which drugs are not used. There is also a risk of acquiring sexually transmitted infections, abuse and rape.

At a social level, some men have economic problems , decreased academic or work performance, which can lead to job loss , abandonment of other forms of leisure, legal problems and stigmatization.

In addition to sexually transmitted infections, there is the possibility of contracting hepatitis C and HIV due to risky practices without a condom, use of syringes, snorting tubes, etc…

Why is chemsex practiced?

Most studies describe multiple motifs at the individual, contextual, community, and structural levels that interact and coexist simultaneously.

For example, one of these motives is the instrumental use of drugs to achieve more sensory powerful sexual experiences . Specifically, they highlight the effect of substances accentuating the intensity of desire, excitement, orgasms, greater sexual performance by being able to have better erections or delay them; or recover very quickly and be able to have more sex with the same or other partners.

Others use drugs because it facilitates sexual euphoria and disinhibition , the realization of sexual fantasies or certain extreme practices that could be painful

The improvement of self-esteem and the increase in sexual confidence when flirting and relating to other men in a sexual context, feeling physically more attractive, are more reasons described.

The Ministry of Health guide also includes factors of a psychological and/or social nature that have been related to drug use for sexual purposes:

  • Escape route to difficult or painful personal situations.
  • Strategy to face internal conflicts due to their homosexuality or feelings produced by the stigma associated with HIV infection.
  • Group pressure when contemplating that the vast majority of participants use or report positive sexual experiences using drugs.

Magnitude of the problem: chemsex , public health problem

The U-SEX Study GeSIDA is a study that was carried out in 22 hospitals in the Community of Madrid with a sample of 511 patients with HIV belonging to the group of men who have sex with men (MSM). With this study they tried to evaluate the dimension of the problem and the associated factors. The results indicate that we are facing a public health problem:

  • 70% of the sample admitted having used drugs at some time in their life and, of these, more than half (54%) reported having used drugs during sexual intercourse ( chemsex ) in the last year.
  • 62% of the patients reported having been diagnosed with a sexually transmitted disease . The most frequent was syphilis (64%). In fact, 43% had more than one episode. Behind syphilis are gonorrhea (29% of cases), hepatitis B (18% of cases) and hepatitis C (10%; with more than one episode in 8% of them)

More training is needed for health professionals in general, and specifically in emergency services, to take advantage of the visits of these patients and offer them correct help without judging. The studies consulted reveal that more research studies are necessary that include the psychosocial plane, that of sexually transmitted infections, and the toxicological one.

Possibly this phenomenon has no solution and the only thing that can be done is risk reduction with information , but not only for the group of men who have sex with men, but for the entire population.

If you have been wanting to know more about this topic, you think you have a problem or you need more information, I recommend you read this document of frequently asked questions and answers about chemsex from the Ministry of Health.

References:

Dolengevich-Segal, H., Rodríguez-Salgado, B., Bellesteros-López, J., & Molina-Prado, R. (2017). chemsex. An emerging phenomenon. chemsex. An emerging phenomenon. Addictions, 29(3), 207–209. https://doi.org/10.20882/addictions.894

JLM blacksmith. What is chemsex? Practice, consequences and treatment [Internet]. PAD service. 2018 [cited 2022 Jun 27]. Available at: https://serviciopad.es/que-es-el-chemsex-practica-consecuencias-y-tratamiento/

Muriel T. The magnitude of chemsex, in a sample of HIV-infected MSM [Internet]. GeSIDA Newsletter. 2016 [cited 2022 Jun 27]. Available at: https://boletin.gesida-seimc.org/la-magnitud-del-chemsex-una-programa-hsh-infectados-vih/

Redondo Domínguez, D., Picazo, L., Docavo Barrenechea-Moxo, ML, & González Del Castillo, J. (2018). Chemsex: are we prepared? Chemsex: are we ready? Addictions, 30(2), 158–159. https://doi.org/10.20882/addictions.1062

Soriano R. (2020). Technical document on approaching the phenomenon of chemsex. Secretariat of the National Plan on AIDS. Ministry of Health. [Internet]. [cited 2022 Jun 27]. Available at: https://www.mscbs.gob.es/ca/ciudadanos/enfLesiones/enfTransmisibles/sida/chemSex/docs/DocumentoDEF.pdf

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