The hidden abuse of chemsex: ‘It’s like connecting on the edge of the abyss’

Chemsex has always navigated a web of silence — caught between stigma and serious health risks. It refers to the intentional use of drugs to sustain sexual activity over extended periods, and is primarily practiced among men who have sex with men (MSM). It is a high-risk practice — linked to an increased likelihood of contracting sexually transmitted infections (STIs) and the use of potentially addictive substances — but it has also become a way of socializing.

A dozen experts consulted agree that chemsex is a minority practice — prevalence rates vary widely from 3% to 30%, depending on the study — though one that is clearly on the rise. Most individuals who engage in chemsex do so recreationally, without it becoming a life-threatening issue.

However, experts warn that a significant, albeit hard to quantify, proportion develops problematic use — yet there is still no adequate health infrastructure or sexual-affective support to meet their needs.

Problematic chemsex use often manifests through strained relationships, mental health disorders, and addiction — sometimes escalating to fatal outcomes such as overdose or suicide. Activists and experts have long sounded the alarm about the far-reaching consequences of such use, and, most urgently, the glaring lack of resources and comprehensive strategies to effectively address these situations.

They warn of the invisibility of a complex and often overlooked issue, exposing the wide range of harms that can arise when chemsex spirals out of control. One of the primary concerns is addiction to substances commonly linked to the practice — such as methamphetamine, GHB (also known as liquid ecstasy), cocaine, and mephedrone. In clinics and community centers, mental health problems stemming from the abuse of these substances is increasingly evident, with cases of paranoia, psychotic episodes, depression, anxiety, and a growing inability to engage in sex without the aid of drugs.

Toni Gata, a psychologist at the BCN Checkpoint community center, has been seeing the dark side of chemsex for years. In 2024 alone, 340 new clients sought help for related issues. “The problem today is nothing like what we saw in 2017. Back then, injecting was rare. Now, more than half have injected at some point, and that brings much more serious complications. Since 2022, we’ve been seeing a surge in psychotic disorders and delirium — one or two new cases every day,” he says. In response, the center has added a psychiatric service specifically to manage these symptoms.

Regarding the worst-case scenario — deaths — there is no data, only hearsay and word of mouth. Jorge García, head of the Drassanes-Vall d’Hebron STI unit, explains: “We don’t know the number of people who may be dying from chemsex. What we’re seeing here are long-term problems with methamphetamine use, which can lead to suicidal thoughts, or the most acute problem, GHB overdoses.”

In any case, attributing a death directly to chemsex is challenging, as it is a complex phenomenon intertwined with a range of life circumstances that independently carry health risks. “The deaths of users are multifactorial; they can occur during the sessions themselves, from overdoses or suicide, but other factors may be at play, such as the individual’s structural condition or mental health issues,” says Ovi Leonarte, activist and spokesperson for the Alliance for Freedom and Psychoactive and Human Ethics platform.

The scientific literature is peppered with case reports that shed light on some extreme situations of problematic chemsex use: in 2017, for example, a British study warned of a rise in deaths from GHB overdoses, linking it, in part, to chemsex; in 2021, another review in France recorded 13 poisonings related to this phenomenon, six of them fatal.

Emilio Salgado, head of Clinical Toxicology at the Hospital Clínic in Barcelona, admits that “it’s difficult to associate a toxic substance with this practice,” but the cases most often associated with it are GHB poisonings. The hospital sees about five a week, although Salgado says they cannot confirm that all are related to chemsex. What he can confirm is that these numbers have remained stable and have not shown an upward trend in recent years.

“Both drugs and sex are two powers and come with a great responsibility,” says Sandro Bedini, 49, regarding his relationship with chemsex. He began exploring the scene more than a decade ago, initially without drugs, drawn by the desire to experiment sexually within that context. Over time, however, substance use entered the picture and eventually overshadowed everything else in his life.

“There’s an initial phase, called the honeymoon, where you socialize very successfully and enjoy yourself a lot. Then, I went through a long phase of denial, where things happen around you that get out of hand, but you deny it. It’s gradual: you arrive late to work, you lose responsibilities, life plans you once had are eroded, your free time is focused on chill [the colloquial term for chemsex encounters]. The transition from denial to acknowledging that you have a problem is a mystery: you give up when it’s no longer worth it,” he reflects.

Before reaching that point, he admits, there’s a long journey through walls of silence, built in his case by “guilt” and an inability to “recognize one’s own vulnerability.”

Read the full story at EL PAÍS.