Chemsex

In this page we use the term ‘substances’ to mean several things. In most instances, the term is used to describe drugs, but not only. Other more commonly available substances, such as alcohol and poppers (alkyl nitrites) are also substances that can be dangerous when mixed with other substances.

Understanding names helps you recognise what’s being discussed. This does not mean any of these substances are safe-  all carry risks, especially when mixed.

• Methamphetamine - often called Tina, Crystal, Meth, T

• Mephedrone - known as Meow Meow, Meph, 3-MMC, 4-MMC, 3M, 4M

• GHB/GBL - known as G, Gina, Liquid E

• Ketamine - often called K, Special K

• Cocaine - Coke, Charlie

• MDMA - Ecstasy, Molly

• Monkeydust - Monkey, Bath Salts, MDPV

• Amyl Nitrate: Poppers

If you are unsure about the effects of a substance, look out for reputable harm reduction sources to understand the effects, including risks to health. 

Consuming an unregulated substance carries heightened risks due to potentially unknown adulterants mixed with the substance (adulterants are substances that are added, which make the primary substance impure or toxic). Although no full drug checking services are available in Malta, a suggestion is to purchase a Reagent Test Kit online and carry out this basic test at home. However beware that these tests only give an indication of the active substances and not the adulterants. Always follow the golden rule, start slow-go low.

Street names can be misleading, particularly due to the chance of added adulterants..

Consent must always be clear, voluntary, and ongoing, even during a session. Because consent is ongoing, there are situations where it ends, especially if a person becomes unable to provide this continued consent.

Therefore;

• If someone is too intoxicated to communicate clearly, they cannot give consent.

• Discuss limits and expectations before using substances.

When intoxicated, it’s easy to lose track of doses, condoms, or PrEP schedules.
As a safety baseline:

• Use your own PrEP - not anyone else’s.

• Always behave in a way where your assumption is that you are at risk of HIV for protection purposes

• Use condoms when possible- PrEP protects against HIV alone, but it does not protect against other STI’s

• Test for HIV 28 days after the last sexual encounter that involved risk.

• Get regular STI screening.

Is it impossible to have sex without drugs? Are the comedowns too much, but you still can’t let go?

In Malta, there are services that can help. In particular, we recommend the below organisations which are trained and equipped to address sex and pleasure across different genders.:

LGBTIQ+ Wellbeing Service: +356 99042015
Rainbow Support Service: +356 79430006

While there are no specialised services foreople who engage in Chemsex, the following can be contacted for assistance with substance addiction:

Sedqa: 23885110

• Do your research on the substances you wish to consume. Focus on onset / duration-comedown / effects / interactions.

• Plan ahead and test your substances. Do not leave it to the spur of the moment. 

• Know your limits and do not approach this as a competing event. Dosage is directly related to a number of factors, including weight, tolerance, and other aspects related to metabolisation so you do not need to match anyone’s dose.

• Know your surroundings and who you are with.

• Have a plan for getting home safely.

• Keep your phone charged and your valuables in a secure place.

• Start low, go slow. Potency and purity may vary, so never assume you can handle a substance, until you tried a lower dose.

Mixing substances is one of the biggest risks during chemsex. Mixing drugs can be risky, and whilst there are charts that show how drugs interact with each other, it is always a risk irrespective if engaged in sex or not.

Mixing is risky because:

• Substances affect your brain, breathing, heart, and awareness.

• When two substances have similar effects, they can multiply each other.

• When they have opposite effects, they can trick you into thinking you’re “fine”, leading to taking more than intended.

• In chemsex spaces, people may not realise what they’ve taken, making reactions harder to manage

In order to stay safe, it is important to have access to harm reduction equipment, such as pipettes to measure GHP, or rulers to monitor lines of powdered substances. Ensure that you use your own lubes to avoid the risk of using lube which has been mixed with GHB/GBL which could increase the risk of mixing substances unknowingly.

Drug testing kits are legal to purchase.

GHB + Alcohol = One of the most dangerous combinations
Both depress your breathing and consciousness. Mixing them greatly increases the risk of:

• Blackouts

• Vomiting and choking

• Loss of consciousness

• Fatal overdose requiring emergency help. Mixing GHB and Alcohol is a fatal combination.

We cannot emphasise this enough: If you choose to use G, avoid alcohol completely and make sure the dose is lower than 1mg per 1.5hours. GHB and Alcohol are a FATAL COMBINATION and carry a very heightened risk of loss of life.

GHB + Ketamine (K)

Both slow the body and brain. Combining them can lead to:

• Sudden loss of awareness

• Confusion

• Falling or injury

• Breathing difficulties

GHB + Benzos (Etc. Xanax, Valium)

Another high-risk combination. These drugs reinforce each other’s sedative effects and dramatically increase fatal overdose risk.

Meth (Tina) + Mephedrone (3MMC/4MMC/Meow Meow)

Both are strong stimulants. Mixing them can cause:

• Racing heart / high blood pressure

• Anxiety, panic, or paranoia

• Overheating and dehydration

• Heart strain

Stimulants don’t “cancel out” depressants and vice versa- they just make your body work harder.

Meth (Tina) + Erectile Dysfunction Medication (Viagra/Kamagra/Cialis)

This mix puts strain on the heart and blood vessels, especially during long sessions. People over the age of 40 are particularly at risk.

Monkeydust + Alcohol
Can mask warning signs like overheating or agitation. Increases risk of dehydration, blackouts, and loss of control.

Monkeydust + GHB
A very dangerous mix. Stimulants can hide how sedated someone is becoming, raising the risk of overdose, breathing problems, or sudden collapse.

Monkeydust + Cocaine/Mephedrone (3M/4M/Meow)/Meth (Tina)
Greatly increases the risk of heart problems, panic, paranoia, overheating, and psychosis.

Cocaine + Alcohol

Your body creates a chemical called cocaethylene, which is more toxic to the liver and heart than cocaine alone.

Cocaine/Coffee/Energy Drinks + Ketamine

Caffeine (found in coffee and energy drinks) and cocaine are stimulants. People assume that if someone is experiencing a K-overdose, cocaine or caffeine will get them back. This is a very risky combination that must be avoided. 

Poppers (Amyl Nitrite) + Erectile Dysfunction Medication (Viagra/Kamagra/Cialis) Extremely dangerous combination.
Both relax and widen blood vessels. Mixing them can cause:

• Sudden and severe drop in blood pressure

• Fainting or collapse

• Heart attack or stroke

• Loss of consciousness

This combination can be fatal, even in otherwise healthy people.

Poppers (Amyl Nitrite) + Stimulants (Cocaine / Meth / Mephedrone / Monkeydust)
Poppers increase heart rate and cause a rapid drop in blood pressure, while stimulants raise heart rate and blood pressure. Together this can cause:

• Irregular heartbeat

• Chest pain

• Dizziness or fainting

• Increased strain on the heart

The push-pull effect puts significant stress on the cardiovascular system.

Poppers (Amyl Nitrite) + Alcohol
Alcohol also lowers blood pressure and affects coordination. Mixing can lead to:

• Light-headedness or fainting

• Falls or injury

• Vomiting while disoriented

• Increased dehydrationCheck out this link to know more about interactions.  

• Avoid sharing equipment.

• Do not share snorting tools.

• Do not share injecting equipment - sharing carries a high risk of HIV, hepatitis C, and bacterial infections.

• If someone is injecting in the space, avoid reusing anything, even once.

• If someone is unresponsive, breathing slowly, or losing consciousness, call 112 immediately (emergency). Unless the overdose is fatal, there is no risk of legal consequences. This means that you should not leave it until it is too late, and call for an ambulance immediately. 

• Share the ‘presumed substances’ that you believe the person has taken. This could save time, and save a life.

Losing track of time, or even the amount of substances consumed, is common in chemsex. Set phone reminders to check in on yourself and anyone else. If other people do it, it will decrease the risk of incidents.

Especially if stimulants are involved- overheating is a common risk. Drink plenty of water, and fruit are your friends.

• Stimulants increase sweating and reduce the feeling of thirst

• Long sessions + dancing + sex raise body temperature

• Dehydration increases strain on the heart and kidneys

• Dry mouth and tissue increase risk of injury and infections

Good hydration basics

• Sip water regularly rather than chugging large amounts at once

• Take breaks to cool down if you feel overheated

• Avoid forcing fluids if someone feels nauseous
  

Helpful drinks

• Water

• Electrolyte drinks (especially after sweating)

• Diluted fruit juice
  
  

Be cautious with

• Alcohol, which increases dehydration and overdose risk

• Energy drinks, which add extra stimulants and strain the heart
  

Eating supports energy, mood, and recovery.

Before

• A balanced meal with carbohydrates, protein, and some fat

• Examples: rice or pasta with vegetables, eggs, yogurt, fruit
  

During

• Small, easy snacks if appetite allows

• Fruit, soup, crackers, smoothies

After

• Rehydrate first

• Eat when appetite returns

• Include protein and electrolytes to support recovery
  

Not eating for long periods can increase dizziness, anxiety, and crash symptoms.