A Guide to Chemsex: What Is It, and How Can You Make It Safer?

Crystal methamphetamine is a common drug used in PnP and chemsex around the world, from San Francisco, CA, to Delhi, India.

Smoking tends to be the most popular form of consuming crystal meth in these scenes, though injection is also common, according to a 2019 scientific literature review.

Boofing, or squirting drugs up your butt, is another common form.

The central nervous system depressants GHB and GBL, amyl nitrates (“poppers”), and Viagra are also popular. More common in Europe, and less so in North America, is mephedrone, a synthetic cathinone that acts as a stimulant.

Additionally, cocaine, ketamine, MDMA, and alcohol all can be found in PnP and chemsex scenes.

These drugs are referred to as “chems,” instead of simply drugs, by experts. That’s because their effects all have a common denominator: being sexually disinhibiting. This was explained by David Stuart, the British harm reductionist recognized to be the originator of the term chemsex, in a 2019 journal article.

Chemsex is a cultural phenomenon: It’s more than just drugs and sex, and it’s unique to gay men, Stuart says.

He identifies a few forces that have shaped queer culture around drugs and sex, including:

• gay hook-up apps and their body-shaming tendencies
• internalized homophobia
• the trauma of surviving the AIDS crisis

“It’s intimately and culturally related to the way in which the HIV epidemic has influenced the experience and enjoyment of homo-sex,” Stuart says. “Gay sexual liberation has a unique history and flavor that includes bathhouses, Grindr, and a particularly widespread availability of certain drugs that can enhance or medicate the sexual experience.”

The historical narration of chemsex and PnP often centers around white cisgender gay men. In early 2000s New York City, for example, that demographic (known as “Chelsea Boys”) used meth in the highest proportions, in terms of race, according to city health data.

That’s since changed, with Black and Latino gay men now taking the lead. Black queer filmmaker Michael Rice illustrated the rise of PnP culture among gay men of color in his 2017 documentary “parTyboi.”

Trans women, who use meth and other drugs at high rates, continue to be under-recognized for their participation in chemsex and PnP by the public health establishment. This may be partly due to the unique circumstances of their participation.

“For many, there’s a huge survival element,” says Vivian Veronica, a methamphetamine specialist at Project Neon, a harm reduction organization, and a trans woman participating in the Seattle PnP scenes.

“Many girls started doing crystal just with sex work as more of a coping mechanism, and it became more common.” Crystal meth can be a performance enhancer for sex workers, boosting energy, enhancing libido, and eliminating nerves — especially for those without an alternative way to put food on the table.”

Stuart notes that authorities who misunderstand the importance of culture for chemsex could impact those in the scenes. “If the cultural uniqueness [is] whitewashed out of a public health response, there are worse health outcomes for these communities.”

There’s no question about whether cisgender heterosexuals use drugs when having sex.

Online, there are instances of straight people using the PnP label to describe their activities. But the term chemsex, at least, was coined to describe a uniquely queer phenomenon. And Stuart believes it should stay that way.

“There’s a time to educate, and there’s a time to listen,” Stuart says. “It’s appropriation to apply the word chemsex to a different behavior or culture. That’s sometimes a respectful thing, a great compliment. [But] sometimes it’s a disrespect to a people and culture and history.”

The phrases substance-linked sex or sex-while-intoxicated are two ways straight practices have been described in the research literature.

The risk for HIV transmission is often the focus of public health responses to chemsex and PnP.

There’s good reason: A 2020 study found queer men and trans people who “persistently” use meth have a higher risk for contracting HIV. This is a trend that the authors called “the crisis we are not talking about.”

Some 2018 research suggested people recently diagnosed with hepatitis C (HCV) were more likely to have engaged in chemsex.

Both queer and trans chemsexeurs and parTiers (PnP participants) tend to make higher-risk decisions. This includes engaging in barrier-free penetration, which can increase someone’s risk for contracting HIV.

Injecting chems, called “slamming” in the scenes, carries both HIV and HCV risks if supplies — syringes, needles, mixing cups, drug solutions — are shared.

But that’s not to say HIV and HCV infection is inevitable for those in the scene.

There’s some research from 2018 and 2019 (from New York and California) that PnPers might forget to take their prescribed preexposure prophylaxis (PrEP) medication — a medication designed to prevent HIV transmission — while partying.

However, the New York researchers also found that they were no more likely to miss a dose than people who don’t use chems. More 2019 research suggested that chem users are actually more likely to remember, which researchers attribute to having a better sense of their risk.

If you’re in the scene, the following steps can help you reduce your risk for infection:

• Set an alarm on your phone to remember to take your PrEP, especially if you’re partying for days at a time.
• Find a medical professional who can give of postexposure prophylaxis (PEP) medication, sometimes called the morning-after pill for exposure to HIV, so you can access it within the brief window of opportunity (72 hours) to prevent infection.
• Use a condom as frequently as possible.
• Use new, sterile consumption supplies every time.

In addition to bloodborne infections, like HIV and HCV, chemsex carries a few other potential risks.

Bacterial infections

Bacterial infections, like gonorrhea and chlamydia, are a risk for chemsexeurs and parTiers who don’t use condoms.

Additionally, for those who inject, especially just below the skin instead of in a vein, soft tissue and skin infections can be an issue.

Anal injuries

A hallmark of chemsex and PnP scenes is “marathon sex,” or sex, often in groups, that last for hours or days. Behaviors, like fisting and rough sex, are associated with these prolonged sessions, which can result in damage to the anal tissues.

Resulting anal fissures and hemorrhoids may be an issue, causing pain that can go undetected during the originating session due to intoxication. Both can make you more vulnerable to sexually transmitted infections.

Overamps and overdoses

Using crystal meth, cathinones, or other stimulants puts you at risk of an overamp, otherwise called a stimulant overdose.

In contrast to overdoses caused by downers (including opioids), overamps aren’t dose-dependent and can occur even after using a small amount.

Overamping can show up in many different forms, including:

• cardiac arrest
• stroke
• overheating
• mental health crises

Overamp-related mental health issues, including psychosis and paranoia, often accompany the loss of sleep after multi-day sessions.

Even without experiencing an overamp, you’ll likely experience some kind of comedown after using meth or cathinones. This comedown is often marked by symptoms of depression or anxiety. Longer, more intense periods of use often exacerbate the issue.

It’s also possible to overdose on GHB and GBL.

The signs of a GHB or GBL overdose include:

• vomiting
• shallow breathing
• making a snoring-like noise
• passing out

Choking on vomit appears to be a driving cause of some fatal overdoses involving GHB. If you suspect someone’s experiencing an overdose, turn them on their side (known as the rescue position) to prevent this from happening.

You can reduce your chances of experiencing an overamp or overdose by:

• pacing your consumption
• being aware of any risk factors, like high blood pressure, existing heart problems, or mental health issues
• getting enough sleep
• staying hydrated and eating
• ensuring you and everyone around you knows the signs of an overdose or overamp, so they can call for emergency medical attention if needed

Substance use disorders

Substance use disorders (SUDs) may be an issue for chemsexeurs and parTiers.

According to the American Psychiatry Association, SUDs involve:

• loss of control over substance use
• social problems due to substance use
• physical dependence on a substance
• substance use in high-risk scenarios

It’s important to consider that the risk for developing a problematic relationship with drugs isn’t universal or equally distributed across communities.

As psychiatrist Norman Zinberg demonstrated, in his classic work “Drug, Set, and Setting,” how the factors shaping whether someone misuses substances go far beyond drug chemistry and include things, like:

• your unique psychology, including experiences of trauma
• external circumstances, like being unhoused

You can reflect on your relationship to chems with this self-assessment tool designed by Australian experts.

If your chemsex and PnP participation is causing you problems, you can devise a plan to improve your habits with David Stuart’s customizable “Chemsex Care Plan.”

You can also contact the Substance Abuse and Mental Health Services Administrations 24/7 at 800-662-HELP (4357).

Accurate information can be key to enjoying chemsex and PnP, especially if you’re new to the scene.

“Some people choose drugs from a well-informed esteemed place, always mindful of self-care. Others use drugs in a reactive way, trying to medicate an experience they’re not otherwise enjoying, or not always mindful of self-care and consequences,” Stuart explains.

“Be informed. spend time with a chemsex advisor or drug-use support worker who can help you weigh the pros and cons and make a well-informed decision.”

Finding this kind of advisor is easier said than done, but consider asking others in the community if they have any recommendations.

Staying on top of things can also make a big difference, Veronica says.

Her top harm reduction tip? “Stay on your feet.” For her, that means maintaining meaningful relationships, looking after your body, and thinking ahead to have control over your chemsex and PnP supplies.

The following tips are informed by participants in research studies and various harm reductionists around the world.

How to prepare

• Schedule your involvement around your obligations, leaving ample time to recover from the likely comedown.
• Determine how long you want to be partying and how much you want to consume. The longer you go without sleep, the more you risk experiencing paranoia and psychosis.
• Share sexual boundaries and preferences, as well as HIV and HCV status, with partners.
• If you’re HIV positive, check to see if your medications interact with the chems you may be using. The University of Liverpool offers a helpful tool for this.
• Prepare your body by washing up, eating nourishing food, and drinking plenty of water. Veronica recommends making a smoothie. Her recipe is peanut butter, banana, strawberry, plain yogurt, almond milk, and a dash of superfood powder.
• Secure your own chems and safer use and sex supplies from your local harm reduction center or by mail via NEXT Distro. This should include naloxone, an opioid-overdose reversal medication. Even if no one plans on consuming opioids, fentanyl is increasingly turning up in methamphetamine, cocaine, and ketamine.
• Get on the same page about how you would respond in case of an overdose or overamp, ideally by reviewing chemsex-specific first aid responses.

If you’re hosting a party

• Decide if the session is going to be held via Zoom, an already-popular platform for parTies that’s proving useful during the COVID-19 pandemic.
• Decide the number of attendees. Keeping it on the smaller side with people you know makes it easier to monitor everyone’s well-being.
• Chat with party invitees about which chems, consumption methods, and types of sex will be part of the equation.
• Pick up snacks to keep attendees fed, which can be easily forgotten when high on crystal meth. Grapes are a great option, providing vitamins and hydration.

If you have a paid date

• Tell a friend the location, as well as start and finish times, of your date, so they can check in afterwards to ensure your safety.
• Secure your chems ahead of time, and not from your date. Veronica warns, “It’s incredibly easy to get stuck in unsafe situations, because the [person] going a little bananas from no sleep has the sh*t: You’ll be glued to that bag and that’s OK. But if you have your own, you can bounce.”
• If you prefer to inject, brush up on safer injection practices with staff at your local harm reduction center. Relying on clients to do so for you can make you vulnerable to exploitation.
• Test your batch before you see the client. You want to make sure you won’t be blind-sided.
• Make a plan about how you would handle a date who’s experiencing meth-related mental health issues, like paranoia, psychosis, or aggression.
• Establish your sexual boundaries and expected rates ahead of time.

During the session

Once the PnP or chemsex session gets under way, there are strategies for having the most fun while watching out for yourself and others.

For any situation

• Avoid mixing GHB or GBL with alcohol, or poppers with Viagra. Be mindful about how many stimulants you’re combining.
• Don’t share consumption supplies for injection, smoking, and boofing –– including syringes, needles, mixing and cups –– and generally practice safer injection techniques.
• Take breaks during the session by going to a calm, uneventful part of the space or stepping outside for fresh air.
• Brush your teeth when you normally would, and chew sugar-free gum. Crystal meth can dry out your mouth, and, if unchecked, could lead to tooth decay.
• Munch on snacks, and keep water nearby.

For sex parties

• Consider keeping a logbook of the chems and dosages used by each attendee. This might include name, chem(s) taken, dosages, and time taken. It’s particularly important for GHB and GBL, where just one-half milliliter can mean the difference between a high and an overdose. Using a 3-mL syringe helps measure precise doses.
• Watch out for others who may seem unable to consent.

For paid dates

• Measure and administer your chems yourself.
• Feel for the condom once the client has penetrated you (if you agreed to use protection). Chems will disinhibit your date, and you want to make sure they stick to their word.

After the session

After the session, you’re likely going to need some time to recover.

Here are some strategies to make it through the comedown:

• Rest and sleep. This may prove difficult if you’re still wide awake from stimulants. First, consider taking a warm shower, sipping chamomile tea, or popping a melatonin supplement. If you’re prescribed a muscle relaxant or benzodiazepine as a harm reduction measure for your stimulant use, consider taking your medication as prescribed to help with sleep.
• Take a walk in a calm area.
• Invite a close friend over to keep you company.
• Do mindless activities, like watching television.
• Practice yoga or mindfulness activities.
• Continue to regularly eat and drink, even if you’re not hungry.

Chemsex and PnP are meaningful cultural scenes in the queer and trans community. However, as Stuart succinctly summarizes: “It’s an undeniable reality that chems enhance the sexual experience — but not without side effects.”

Sessi Kuwabara Blanchard is an independent drug journalist and transgender critic. She was formerly a staff writer at Filter, one of the only online journalistic publications dedicated to covering harm reduction. Follow her on Twitter, @SessiBlanchard.