Substance-Linked Sex in Heterosexual, Homosexual, and Bisexual Men and Women: An Online, Cross-Sectional “Global Drug Survey” Report

Abstract

Introduction Substance use in sexual contexts has received recent attention, but it has mostly been restricted to men who have sex with men and the so-called “chemsex” phenomenon. Aim To explore the use of licit and illicit substances in combination with sex in heterosexual, homosexual, and bisexual men and women; to explore substance-linked sex (SLS) differences across sexual orientation and sexes. Methods An international online self-selecting cross-sectional drugs survey, the Global Drug Survey 2013 (n = 22,289), was conducted. Respondents were asked about which drugs (including alcohol) they had had sex while on; how frequently they used drugs to enhance sex; and how different drugs changed different aspects of the sexual experience. We report descriptive statistics and test differences between men and women and between different sexual orientations. Main Outcome Measures The following outcome measures were recorded: (i) Percentage of each group reporting last-year use of each drug with sex, (ii) Mean subjective rating (–10 to +10) from each group for each drug on each aspect of the sexual experience. Results SLS occurred across sexual orientations and in both men and women. All groups reported that alcohol, cannabis, and 3,4-methylenedioxymethamphetamine (MDMA) were the most while commonly used drugs with sex. Larger proportions of homosexual and bisexual men had sex while on most drugs than heterosexual men (P < .001); and larger proportions of bisexual women had sex while on most drugs than heterosexual women (P < .004). ≥20% of each group reported having used drugs with the intention of enhancing a sexual experience; larger proportions of homosexual and bisexual men reported this behavior than heterosexual men (P < .001). There were clear dissociations between the effects of different drugs on different aspects of the sexual experience; although γ-hydroxybutyric acid/γ-butyrolactone and MDMA were rated consistently highly. Clinical Implications Men and women of different sexual orientations must be considered when forming harm reduction and treatment strategies. However, “chemsex” drugs were most commonly used by homosexual men; targeted messages to this group should continue. Strength & Limitations Our study is highly novel; no previous study has investigated the combination of sex with this range of drugs. However, our survey is self-selecting, and some groups have a small sample size. Conclusions All groups reported SLS to some degree. However, differences in SLS between men and women and sexual orientations were found. Alcohol, cannabis, and MDMA were most commonly used with sex. “Chemsex” drugs were more commonly used by homosexual and bisexual men than heterosexual men.

Attitude and beliefs about the social environment associated with chemsex among MSM visiting STI clinics in the Netherlands: An observational study

“…Previous data on associations between chemsex and socio-demographics, i.e. age, ethnicity and educational level, have been inconsistent [1,8,14,[16][17][18]. Concerning the use of other substances, tobacco use has been associated with chemsex, but no association has been found between regular alcohol consumption and chemsex [14,15].…”

Making and Communicating Decisions About Sexual Consent During Drug-Involved Sex: A Thematic Synthesis

“…"Drugs" refer to substances with psychoactive properties, although, for the purposes of this review, we will use the term "drugs" to refer to substances other than alcohol, nicotine, and caffeine, including any illicit drug and non-medical use of prescription drugs. Like broader trends of illicit drug use, cannabis/marijuana and 3,4 methylene-dioxymethamphetamine (MDMA; ecstasy) are the most commonly reported drugs consumed prior to sex (Lawn, Aldridge, Xia, & Winstock, 2019). However, people's gender and sexual orientation may account for some of the differences in the specific drugs that individuals are likely to have ever "had sex" on.…”

“…However, people's gender and sexual orientation may account for some of the differences in the specific drugs that individuals are likely to have ever "had sex" on. Men who have sex with men, for example, are more likely to have ever had sex following gamma-hydroxybutyrate (GHB) compared with their heterosexual counterparts (Lawn et al, 2019). To date, there has been no review on people's experiences of sexual consent in the context of drugs.…”

“…Understanding how individuals conceptualize and practice sexual consent in drug-taking scenarios may inform future recommendations concerning sexual consent education, as well as harm-reduction approaches for individuals that use drugs in sexual contexts. Given the evidence that different subgroups are more likely to consume certain drugs prior to sex than others (Lawn et al, 2019), understanding what consent looks like across the broad range of drugs that people consume (e.g., cannabis, ecstasy, cocaine, ketamine) is important for tailored harm-reduction initiatives.…”

Links between chemsex and reduced mental health among Norwegian MSM and other men: results from a cross-sectional clinic survey

“…The use of recreational substances for sex is not a new phenomenon. Sex while intoxicated or high occurs in both men and women and across sexual orientations, although there is mounting evidence that such drug use is more common among sexual minorities [1,2]. These days, according to a global drug survey, the most commonly used drugs with sex are alcohol, cannabis, and MDMA (methylenedioxymethamphetamine) [1].…”