Dear Dr Laura,
I know my New Year week is going to be lots and lots of sex parties and lots of chemsex. I enjoy the parties and the sex and I don’t want to stop, but how can I best keep a check on things and look after myself.
Chemsex is associated with 3 drugs: GHB, mephedrone and crystal meth; it’s linked to geospatial apps like Grindr and Hornet, making hook-ups easy to arrange.
GHB, and the similar GBL, are sedatives so can cause drowsiness, but make you disinhibited and horny. They’re clear, colourless salty-tasting liquids. Issues include:
1. Avoid with alcohol. Alcohol affects your nervous system like GHB; the combination makes you more likely to pass out or stop breathing.
2. It’s easy to take too much and strength varies; use a syringe to measure small amounts (0.5-1.5mL) and wait at least an hour between doses. Take less if you’re on the HIV medications ritonavir or cobicistat as they boost GHB levels. Overdose symptoms include dizziness, vomiting and confusion.
3. If someone collapses on G they’re unconscious, not asleep! Put them on their side in case they vomit, check pulse and breathing. Some clubs have first aid areas otherwise it’s best to call an ambulance.
Mephedrone is a stimulant sold as a powder to be snorted, swallowed or injected. It makes you energetic, talkative and affectionate but can overstimulate the heart (palpitations) and nervous system (agitation, hallucinations and fits).
Crystal is a form of methamphetamine that can be smoked, swallowed, snorted, ‘booty bumped’ (up the bum), ‘hot railed’ (inhaled through a heated glass tube) or injected. Injecting is the riskiest and injecting into muscle or under the skin (“skin popping”) can cause abscesses. Injecting any drug risks infection and overdose. Crystal increases alertness and arousal but with a significant comedown. Risks include psychosis, heart attack and strokes – long-term use can damage many organs including the brain.
The chemsex circuit is hard to leave
While chems can be enhancing, helping people lead their desired sex lives, they can have negative effects like low mood, insomnia, paranoia and anxiety. Some people use chems to cope with negative feelings such as low self-esteem, internalised homophobia, and stigma but drugs don’t address the underlying problem. The chemsex circuit is hard to leave: if your friends are your hook-up buddies, you haven’t had sober sex in ages and everyone you know uses crystal it’s tough to change, even if you want to.
All three drugs are illegal to possess, give away or sell risking prison sentences or fines. All are addictive and regular GHB users can get dangerous withdrawal symptoms. It’s illegal to drive while impaired from drugs and prosecution can make travel difficult, especially to the US.
Drugs can increase your pain threshold
Sex on chems can be very pleasurable, but there are two important issues: disinhibition may mean taking risks you wouldn’t usually and drugs can increase your pain threshold.
Sex with multiple partners increases exposure to STIs; small tears in the penis or anus increase STI risk, including hepatitis C, and traumatic sex can cause rectal tears.
It may help to set boundaries first. If you’re HIV-negative you cannot get HIV from a positive person with undetectable virus on treatment, which applies to most people but not all, and 1 in 12 with HIV don’t know it. If you’re HIV-negative you can take PrEP: see iwantprepnow.com. PrEP’s only effective if taken as advised. PEP, available at sexual health and emergency departments, can be taken up to 72 hours after possible HIV exposure. Get regular sexual health checks and ensure you’re immune to Hepatitis A and B.
Keep safe, avoid alcohol and set boundaries first
So, keep safe, avoid alcohol and set boundaries first. Ensure someone knows what to do if things go topsy-turvy, get regular sexual health checks, including hep C, and remember to take your HIV meds (if you’re positive) or PrEP (if you’re negative). If your chems use is problematic speak to your sexual health clinic or your GP. GRIP and Antidote are great services and some London boroughs offer specialised clinics. As ever, 56 Dean Street’s website offers excellent advice.
The Boyz Doc is Dr Laura Waters, an HIV and sexual health consultant at the Mortimer Market Centre in central London. Dr Laura answers your questions every week in Boyz. If you have a question for Dr Laura please email her at firstname.lastname@example.org