What Is Chemsex? Risks and Non-Judgmental Harm Reduction

I see more patients with experience of chemsex than many people imagine, and most of them do not come to be lectured. They come because they are exhausted, worried about HIV, or feel things are starting to slip out of control. So this article is written from a harm-reduction perspective: whatever you choose today, my first goal as a doctor is to keep you as safe as possible.

What is chemsex?

Chemsex means using certain drugs before or during sex to feel relaxed, lose inhibitions, make sex last longer or intensify sensations. It is most common among men who have sex with men (MSM), but it can happen with people of any gender. It is sometimes called "PnP" (party and play). Commonly used substances include:

This article is the overview. The details are in separate articles: crystal meth, yaba, ketamine and G in chemsex, cannabis and sex and poppers and the dangers you need to know.

Why do some people use drugs for sex?

The reasons I hear most often are wanting to ease anxiety about their body, shame about their sexuality that has built up since childhood, loneliness, or fear that sex without drugs won't be as good. Some people worry about erections or have performance anxiety, and use drugs as a crutch. Research in England (The Chemsex Study, 2014) found that many men used drugs to cope with low confidence and stigma. Understanding these reasons matters, because if we only deal with the "drug" and not the "mind", people often go back to using.

The risks you should know

• Sexual health. Decision-making changes, there may be multiple partners, and long sessions cause small tears, all of which raise the chance of HIV, syphilis, gonorrhoea and hepatitis C.
• Physical health. Dehydration, going days without sleep, irregular heartbeat and overdose.
• Mental health. The comedown often brings depression and anxiety, and some people have thoughts of harming themselves.
• Consent. People who are unconscious or very intoxicated cannot give consent, so there is a risk of being assaulted and of unintentionally assaulting someone else.
• Dependence. Many people start to feel they can no longer have sex without drugs.
• Drug interactions. Erection medicines, poppers, some HIV regimens and psychiatric medicines can add to the dangers. Read more in crystal meth, yaba, ketamine and G in chemsex.
• The law. Most of these substances are illegal in Thailand, although the Narcotics Code (2021) has opened more pathways into treatment. Cannabis law is changing; read cannabis and sex.

Chemsex

Sexual health

• HIV, syphilis, gonorrhoea, hep C
• Tears and broken condoms

Body

• Dehydration, days without sleep
• Irregular heartbeat, overdose

Mind

• Low mood during comedowns
• Thoughts of self-harm

Consent

• Unconscious people can't consent
• Risk of assault, either way

Dependence & meds

• Sex without drugs feels impossible
• Interactions with your medicines

The law

• Most substances are illegal
• Pathways into treatment exist

Details for each substance are in the dedicated articles in this series.

Harm reduction principles

I am not encouraging drug use. But harm reduction lowers the chance of something serious happening to people who are still using.

1. Don't use alone. Have someone clear-headed keeping an eye on everyone, who knows when to call 1669 (Thailand's medical emergency number).
2. Don't mix depressants, especially GHB/GBL with alcohol or sleeping pills. This is the most common cause of passing out and stopping breathing.
3. Never use poppers with erection medicines, because blood pressure can drop to the point of shock (read about PDE5 inhibitors).
4. Don't share any equipment, to reduce the risk of HIV and hepatitis C.
5. Protect against HIV and STIs in advance: condoms, lubricant and PrEP. If something goes wrong, start PEP within 72 hours, and for some people a doctor may consider doxy-PEP.
6. Agree on consent while everyone is still sober, and stop immediately if anyone stops responding.
7. Drink water, eat and rest, and tell your doctor honestly about your regular medicines.

This series does not give information on doses, timing or how to use any substance. For harm-reduction advice tailored to you, talk confidentially to a doctor or a drug service.

1. 1Don't mix depressantsNever mix GHB/GBL with alcohol or sleeping pills
2. 2Poppers + erection pillsNever together; blood pressure can crash into shock
3. 3Don't use aloneHave a clear-headed person watching, who knows when to call 1669 (Thailand emergency medical services)
4. 4Protect in advanceCondoms, lube, PrEP; if something goes wrong, start PEP within 72 h
5. 5Agree on consentWhile everyone is clear-headed; stop at once if anyone stops responding

Can't be woken, slow breathing, seizure, chest pain: call 1669, roll them onto their side, never leave them alone.

When to get help

• You are using more often, or larger amounts.
• You don't want sex without drugs.
• You are missing work, losing money or relationships are breaking down.
• You feel terrible during comedowns or have thoughts of harming yourself (call 1323, Thailand's mental-health hotline, open 24 hours; Thai language, ask for English support).
• There have been events you cannot remember, or you are unsure about consent.
• Your sexual behaviour overall feels out of control. Read more about compulsive sexual behaviour disorder (CSBD).

A 2024 systematic review found that accessible, non-judgmental harm-reduction care, such as education and peer-support groups, tends to help, although the evidence is still limited, and you do not have to wait until you "can stop" before seeing a doctor.

Where to get help in Thailand

Voluntarily seeking treatment is supported by the Thai public health system, and treatment records are medically confidential. Foreign visitors can also contact their embassy or travel insurer for help finding English-language services.

How Dr. Kris can help

At Dr. Kris Clinic we provide non-judgmental, confidential care. You do not have to stop first.

• HIV prevention and testing. Planning PrEP, starting PEP after a risk, and STI testing that matches your risk.
• Checking your medicines to see whether combining them with substances is risky.
• Counselling on cutting down or stopping, care for your mental health, and the issues that often sit underneath, such as long-held shame or LGBTQ+ health.
• Your sex life after cutting down. At first desire may be lower or erections harder to get; this is common and usually improves gradually.
• Referral to drug-treatment services, a psychiatrist or a urologist when needed.

If you go to group parties, also read consent and safety in group sex. Consultations are available at the clinic and online, including in English.