Earlier this month, the London Ambulance Service said it was “introducing measures” to reduce the risk of harm for people who engage in chemsex, after calls to the service for people using the drugs associated with the scene increased. 

For the uninitiated, chemsex refers to the practice of taking drugs for the purpose of having sex. More specifically, though, chemsex tends to refer to a scene, one that involves sex parties (or chillouts) and four drugs in particular: GHB, GBL, mephedrone and methamphetamine – or, as they’re more often referred to, G, m-kat and crystal meth.

The term chemsex and the scene itself is most commonly associated with men who have sex with men (MSM). But it’s important to remember that people of all genders and sexualities take part in chemsex – and that, while it can be fun, the drugs associated with it can be particularly harmful, especially if they’re injected or not dosed correctly.

Of course, the safest thing is not to do drugs at all, but we know that people will do so even when they’re criminalised, and that abstinence-based approaches don’t work. So Dazed spoke with Dr Benjamin Weil, harm reduction expert and queer drugs and alcohol programme coordinator at The Love Tank CIC, to find out how to engage in chemsex as safely as possible.

GHB/GBL

GHB and GBL, also known as G, liquid ecstasy and Gina, are depressants. The two drugs are essentially the same in that GBL turns into GHB in the liver. However GBL – which has a chemical smell and taste compared with GHB, which is odourless – has a faster onset and is usually stronger. That said, they’re often used interchangeably.

BE PRECISE WITH YOUR DOSAGE

In small doses, people report that G makes them feel euphoric, with a loss of inhibitions, increased confidence, and a higher sex drive. In just marginally higher doses, though, G acts as a sedative. It’s usually mixed with a soft drink or water and ingested.

For a beginner, says Weil, it’s important to start low and go slow. It’s extremely easy to overdose on G. “With G, you’ll see the threshold between being OK and a fatal overdose, or coma that leads to fatal overdose, is really, really small. So it’s really, really important when people take G to dose it accurately and follow doses that are appropriate for their level of experience with the drug,” he says. A light dose of G is 0.3-0.9 ml. A more common dose (for experienced users) is between 0.9-1.5 ml. Many people use a pipette or dropper to measure their G (and some people use the little fish-shaped bottles of soy sauce, which are exactly 1 ml). It’s vital that you pour your own G, so you can keep track of how much you’ve taken. Remember, it’s always better to take too little than too much.

On top of this, it’s also important to time your doses meticulously, and don’t redose until at least an hour has passed. Weil advises setting a timer on your phone or watch so that you can know for sure it’s been an hour. It’s easy to lose track of time when you’re high.

KEEP AN EYE ON YOUR DRINK

Since G is often taken in drinks, it’s important to keep an eye on your drink. “Unfortunately, a very common way of overdosing on G is [accidentally drinking out of somebody else’s drink],” says Weil. “If you’re at a party, and people are using G, never pick up a drink that you didn’t pour yourself a drink. And if you don’t know for sure that the drink you’re holding has no G in it, don’t drink. It may sound over the top, but it’s life-saving.”

“With G, the threshold between being OK and a fatal overdose is really, really small. So it’s really, really important when people take G to dose it accurately” – Dr Benjamin Weil

DON’T MIX G WITH ANY OTHER DEPRESSANTS, INCLUDING ALCOHOL 

Because G is a depressant, the main cause of overdose is respiratory depression – which essentially means your respiratory system becomes so depressed that you stop breathing. It’s vital, then, that you do not mix G with any other depressants. These include alcohol, ketamine, diazepam, benzos, sleeping pills, sedatives, opiates (like tramadol) and even antihistamines. “The best advice I can give with G is just don’t mix it if you can avoid it, and particularly don’t drink, because it massively increases your risk of overdose,” says Weil.

BE WARY OF FORMING A DEPENDENCY

Taking G on a frequent basis can lead to a physical dependency, especially because, as tolerance builds, higher doses are needed to get the same effect. “That means you will have withdrawal symptoms, and those withdrawals can be dangerous,” says Weil. These include severe anxiety, diarrhoea, nausea and vomiting, lack of appetite, hallucinations, paranoia, delirium, depression, suicidal ideation, difficulty sleeping and potentially life-threatening seizures if stopped suddenly.

If you do begin to feel withdrawal symptoms or decide to stop taking G after prolonged use, take yourself to A&E or a local drug and alcohol service to seek urgent medical attention or support. 

IF SOMEONE OVERDOSES ON G

If someone is overdosing on G, explains Weil, they will likely become unconscious, or drift in and out of consciousness. Though they may just look like they’re asleep, it’s important to recognise that they may be overdosing.

“If they stay unconscious for too long, and they are overdosing, they will stop breathing,” says Weil. “So the most important thing to do if someone is passed out on G is to get them somewhere safe and as private as possible and try to wake them. You can do this by shaking them and, if that doesn’t work, firmly squeezing their trapezius muscles (between the neck and the shoulder).” Once they are awake, it’s important to stay with them and try to keep them awake – but do not give them any more drugs, including stimulants, and don’t give them any liquid, including water. The stimulants will add to the toxins in the body that are causing the overdose and water will accelerate the movement of drugs into the bloodstream.

If somebody can be kept awake, the good news is that they will likely be fine. GHB/GBL stays in the bloodstream for three to six hours, so as long as they don’t take anything else, they should feel completely better in that time frame. However, if somebody will not wake up, it’s vital to call an ambulance. Put them into the recovery position and call 999.

MEPHEDRONE 

If you’ve never heard of mephedrone – or m-kat – it’s a synthetic stimulant that rose to notoriety in 2010, when it emerged on the market as a legal high. As a party drug, mcat was most commonly snorted or ingested, and has similar euphoric effects to the likes of MDMA.

USE SAFE INJECTING PRACTICES

In the chemsex scene, it’s more likely that people using mephedrone will be injecting it into their bloodstream. This is called slamming.

Always remember that slamming carries a lot of risks, including overdosing, damage to veins and arteries and the contraction of illnesses like HIV and Hepatitis C from sharing injecting equipment. It’s safer, then, not to inject at all. Snorting, bombing and booty bumping are all alternatives to slamming.

“The most important thing people need to know when it comes to using mephedrone is that there are alternatives to injecting but, if they want to inject, they need to know how to do it safely,” says Weil. This means using only your own equipment and making sure you have clean equipment (you can find local needle and syringe exchanges near you, where you can discard old needles and pick up clean ones) and make sure to use a fresh needle for every injection. This is a lot harder to keep track of when you’re already under the influence, so try to stay vigilant. It’s also important to find a safe injection site and make sure you clean the area before you inject. Here’s a comprehensive guide to safe injection practices.

It’s also important to remember that you don’t have to inject anything if you don’t want to. “No one should feel pressured to take their drugs in a manner that somebody else is taking them,” says Weil. “If someone offers you some, just know that you can take it the way that you're accustomed to, or the way that you think is safest and best.”

CRYSTAL METH

Crystal meth, sometimes known as Tina, is also often injected when used in the chemsex scene, so, as with mephedrone, safe injection practices are a must. There are also some other harms to be aware of when taking meth, particularly at chillouts.

BE AWARE OF ADDICTION

Crystal meth is dangerous in that it is one of the most addictive and destructive drugs on the market today. People who use crystal meth during chemsex often report feeling as though they can no longer enjoy sex without using crystal meth. This causes people to chase the dragon and can ultimately lead to addiction, which is something to be aware of when using it in this context, and make sure to check in with how often you’re using it, too.

LOOK AFTER YOUR MENTAL HEALTH

One of the biggest harms associated with meth, he says, is the toll on your mental health, and the loneliness that follows a chillout. “You go from being in a very social environment to being completely alone and having a comedown whereby you feel anxious, irritable and possibly psychotic,” says Weil. For this reason, he says, staying safe on crystal meth needs a holistic approach.

“When you leave the party, make sure you look after yourself,” says Weil. “Make sure you have a friend that knows you’re at a party and make sure to reach out to people afterwards, especially if you’re having a particularly bad comedown.” It’s a good idea to attempt to prepare before you go to a chillout, for example by booking time off work and making sure people are there to support you the next day.

“When you leave the party, make sure you look after yourself. Make sure you have a friend that knows you're at a party and make sure to reach out to people afterwards”

HOW TO IDENTIFY A PSYCHOTIC EPISODE 

According to the NHS, the three main symptoms of psychosis are hallucinations, delusions and confused and disturbed thoughts. If anyone is exhibiting these symptoms, they may be in psychosis. As The Love Tank’s vital chill out harm reduction guide states: if you notice that somebody else is having a psychotic episode, it’s vital that you don’t touch them without permission, don’t criticise, dismiss or try to rationalise their thoughts. Instead, be understanding, talk to them calmly and listen attentively. You could also try asking them about things you know they enjoy in order to lift their mood. If you’re really concerned about their safety, call an ambulance. 

If you personally start to feel self-conscious and paranoid or have obsessive thoughts while taking crystal meth or other drugs, this could be an early warning sign of a bad episode. Make sure to get yourself to somewhere you feel safe, with people you trust and let them know how you’re feeling. Try to distract yourself and do some wholesome activities, like drinking hot drinks, eating new food, cleaning up or listening to music.

PROTECTION

Finally, chemsex is different to other types of recreational drug use in that it poses a direct risk of sexually-transmitted infection.

PRACTISE SAFER SEX

It’s important to be aware of things like PrEP, (pre-exposure prophylaxis), a prescription drug that protects against HIV. If you’re at risk of acquiring HIV, you can take PrEP every day at around the same time each day and you’ll have a 99 per cent chance of being protected from the virus.

If you don’t take PrEP regularly, you can take it “on demand” which essentially means when you’ll be more at risk of acquiring HIV. This involves taking two pills between two and 24 hours before having anal sex, and then one pill 24 hours later and another 24 hours after that. According to the NHS website, if you’re continuing to have sex over a period of time, carry on taking one pill every 24 hours until you have not had sex for two days.

You can also take HIV PEP  (post-exposure prophylaxis) if you have sex with someone who has HIV. PEP must be started within 72 hours after you had sex, and involves taking treatment every day for a month. You can find local PEP services on the NHS website.

BE COMFORTABLE SAYING NO

It goes without saying, but you should always make sure you get consent, even when taking photos or videos of another person. On the other side of this, make sure you’re comfortable saying no and get to grips with your boundaries before you attend a chillout. “Before you take drugs, think about what your limits are,” says Weil. “If your limits are tested, or pushed after the fact, try not to punish yourself for that.” It’s important to avoid going into a shame spiral, and always talking to someone about how you feel. If you are sexually assaulted during a sex party, you can find a local sexual assault service to seek advice, support and medical assistance. 

You can download The Love Tank’s Little Back Pocket Guide to Chillouts on the Queer Health website. It’s available in English, Spanish, Portuguese, Italian and Polish. 

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