Intended for healthcare professionals

Letters Chemsex

New health promotion for chemsex and γ-hydroxybutyrate (GHB)

BMJ 2015; 351 doi: (Published 25 November 2015) Cite this as: BMJ 2015;351:h6281
  1. Adam Winstock, consultant addiction psychiatrist and founder, Global Drug Survey1
  1. 1South London and Maudsley NHS Trust, London SE1 8EL, UK
  1. adam.winstock{at}

McCall and colleagues point out the growing problem of chemsex in the UK and the need for a coordinated policy and health response.1 Although there are common sexual behavioural risks associated with the use of any intoxicant that reduces inhibition, few would suggest that alcohol improves performance. This is not the case with γ-hydroxybutyrate (GHB), crystallised methamphetamine, and mephedrone, which can increase arousal, stamina, and pleasure.

These drugs also carry specific route and effect related risks that need to be clearly articulated and managed. Binge use of crystal meth can lead to a temporary drug induced psychotic disorder, with the risk of violence to self and others. “Slamming”—the practice of injecting drugs within chemsex settings—carries risks of HIV and other bloodborne viruses. In addition to dependence, which is comparatively rare, GHB is associated with very high rates of overdose—the Global Drug Survey recently reported that one in five users report passing out each year.

Although specific interventions are needed for each substance, we need to start with effective harm reduction campaigns within the gay community, which have proved effective in the past in relation to HIV transmission. These might most effectively start with the acceptance of these drugs’ sexual function and the pleasure they bring to users. Fact and humour may need to be combined to engage and educate users in how to reduce the risk of harm to themselves and others. In partnership with the Gay Men’s Collective, the Global Drug Survey has just launched such an initiative.

Based on feedback from more than 1000 GHB users who helped created the Highway Code,2 our evidence based safer G video “There’s more to G than cock” is free on YouTube.3 Early feedback suggests once again that the best way to bring about change in drug use is to treat people as adults and accept that while pleasure drives drug use, given the right tools, most people are keen to avoid harm.


Cite this as: BMJ 2015;351:h6281


  • Competing interests: I am the founder of Global Drug Survey, which conducts the annual global drug survey. All our health promotion and self assessment tools are self funded and free.


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