Meth-sex. Chemsex. Party and play. By any name, the use of certain drugs, such as methamphetamine, GHB, ketamine, and mephedrone, in conjunction with sex is exacting a painful toll on the lives of many gay men. Chemsex (the term I prefer) is responsible for overdoses, arrests, acquiring HIV and hepatitis C, the life-shredding destruction of addiction, and even death. It occurs, of course, among other populations, as well. The transgender community is particularly impacted, as are bisexuals and heterosexuals. But it is the seductive appeal of chemsex to mitigate shame, loneliness, the search for connection, and even boredom among gay men that I believe is particularly disturbing and that our community must directly confront.
Mood-altering drugs, including alcohol and harsher substances like meth, have long cycled through the gay community, but the tsunami of stimulants hitting us in the new millennium has been different. HIV meds and AIDS fatigue changed the sexual landscape, new production methods courtesy of the Mexican cartels made drugs purer and cheaper, and technology in the form of websites and apps made it easier than ever to connect socially and sexually with other men. To be sure, not everyone who uses meth and other drugs with sex experiences such harmful effects, but an honest look around one's gay social network in any urban center around the globe will reveal no shortage of men who are struggling.
I believe chemsex in the gay community is a syndrome encompassing behaviors and characteristics that go far beyond the effects of specific drug molecules on the brain. Gay men have always sought heightened sexual experiences. But sex on chems can quickly deteriorate into empty, sometimes abusive, and often unfulfilling high-risk sexual behavior that leaves the user feeling more disconnected and lonely than before. While chemsex can serve as a sort of social leveler, allowing men from a variety of racial and socio-economic backgrounds to interact, such opportunities can open the door to the exploitation of power and privilege, especially notable in the marked rise of chemsex among young black and Latinx men. It is true that chemsex momentarily wipes away self-doubt, low self-worth, and shame, replacing them with a sense of reckless invincibility and an insatiable sex drive. But with continued use, such intensity resets the amount of stimulation the brain requires for arousal, resulting in an intensification of behaviors (usually toward more high-risk and taboo) to trigger the rush of dopamine.
It greatly concerns me that, despite the known risks, so many gay men continue to use chemsex regularly. Here are some actions I feel are necessary to address this serious concern.
- Conduct open community dialog: There is a reluctance to speak openly about chemsex, perhaps because drug use (in the U.S.) is conflated with moral failure. An open dialog not only elicits community solutions but effectively reduces stigma, as well. Many men I know who use chemsex experience shame and stigma and gradually tighten their social networks to include only other users. We need to engage the community for this problem, just as we did for HIV.
- Provide accurate information: Facts alone are not the only solution, but they could surely save lives. Gay men deserve safe, non-judgmental sources of accurate information about various drugs, their effects and risks, and how to intervene when necessary. Harm-reduction practices should be discussed for those wishing to make their drug use safer or, for those contemplating abstinence, information should be provided to help with that decision and, if necessary, to find community resources for treatment.
- Improve treatment capacity: The unique aspects of chemsex and the properties of its component drugs require specialized knowledge and treatment, which is still lacking. Methamphetamine, for example, uniquely hijacks the brain's reward system and destroys its ability to distribute dopamine, damage that requires up to 24 months to repair. During that time, an individual is likely to experience persistent depression, poor cognitive performance, and increased impulsivity. These factors heighten risk for relapse unless both clients and professionals understand them.
- Foster opportunities for connection: The issue of loneliness and isolation in the gay community, a problem compounded for those living with HIV, has begun to receive well-deserved attention. Chemsex is a broader issue than any group of men or social divide based on physical appearance, income, or ethnicity. We need to actively create communities that are welcoming to everyone, including those men who can find little sense of worthiness or compassion for themselves. We all need to belong.
- Remain sex positive: Any discussion of chemsex in the gay community must be open and tolerant of sexual behaviors. The goal is not to define acceptable sexual behavior or put limits on kink, but rather to support men as they define what works for them. For those seeking a change in self-defined problematic sexual behavior, open dialog with peers and professionals can be instructive. Men who give up chemsex often fear they are doomed to a life of vanilla sex or no sex at all, yet many men with sustained recovery from chemsex describe far more rewarding intimacy and sexual connection than they ever experienced with drugs.
- It can't be done alone: Moving beyond problematic chemsex requires abundant support. While few treatment facilities have developed competence treating chemsex among gay men, both outreach and treatment resources are starting to be found in urban areas. Support groups such as Crystal Meth Anonymous and SMART Recovery are often available and, for those who are concerned about stigma or can't access support groups, an increasing number of online resources exist, such as In the Rooms.
A friend whom I respect once told me that chemsex, and methamphetamine in particular, is the "HIV" of this generation. That saddens and terrifies me, but drives me toward action and advocacy, as well.