Chemsex—or the use of GHB, methamphetamine or mephedrone in sexual settings in the queer and trans community—provides a means for many to experience intimacy that is otherwise hindered by shame and stigma. But chemsex encounters bear risks and potential harms, exacerbated by this stigma, which are most often addressed—if at all—with a focus on prevention.

That’s why two London sexual health professionals wrote Chemsex First Aid, a booklet (see below) that spells out “how to react when things go wrong in a chemsex session,” according to one of its authors, Ignacio Labayen de Inza. Along with co-author David Stuart—who also provides ChemSex support services in London and who first coined the term “chemsex” in the early 2000s—de Inza identified a need for Chemsex First Aid because many chemsex-related care providers knew “what to do to prevent problems, but there was practically nothing until now about what to do when things are already going wrong.”

The booklet takes the harm reduction approach of recognizing that queer men practice chemsex, and will continue to do so. Three in 10 HIV-positive UK men who have sex with men (MSM), for example, engage in chemsex activities. Many who engage in chemsex find it a means to cope with the conflicts queerness poses for “toxic masculinity” and some “religious or cultural attitudes,” says de Inza. “Getting high on the right drugs can be a great ‘solution’ to these problems. Chems provide a great disinhibition from these issues.”

The guide has four sections, respectively addressing: GHB/GBL-related emergencies; methamphetamine- and mephedrone-related emergencies; other emergencies that occur in chemsex environments; and a summary of first aid situations.

Many of the interventions proposed for chemsex drugs are similar to those suggested for opioids. For example, the booklet advises bystanders to look for problematic breathing and “firmly squeez[e] their trapezius muscle,” when assessing whether someone has fallen into “G-sleep,” a state of unconsciousness that could lead to death—similar to “nodding” in a potential opioid overdose. Working at “a sexual health clinic that has thousands of gay men who engage in chemsex every month coming through its doors,” de Inza has seen “hundreds who overdose monthly” from chemsex drugs.

The guide also considers withdrawal, particularly from GHB/GBL, and the risks of intravenous drug use, such as intravenous infection, HIV infection or introducing a large amount of air into a vein.

But chemsex also features unique risks and harms. Consent during a meth/meph high can be problematic, because of the drugs’ tendency to null inhibitions and ability to calculate risk. Additionally, meth and meph carry the risk of drug-induced psychosis. The guidelines advise that both issues require active support, and a negotiation between an individual’s agency and the harms caused to themselves or others.

Other chemsex situations potentially requiring first aid interventions include “lodged objects” in the anus, HIV infection, priapism (long-lasting, painful erections), and allergic reactions to substances cut into drugs.

For de Inza, Chemsex First Aid is a part of queer men’s “long history of activism… of sharing information and stories, and of looking out for each other.” The booklet joins a harm reduction ecosystem of both institutional resources and the “word-of-mouth amongst guys that engage in chemsex.” De Inza aimed “to highlight the best tips and advice for the most extreme of circumstances, the most potential[ly] fatal.”

“This was the inspiration behind this resource,” de Inza continues. “There are some seriously complicated judgement calls to be made in dangerous chemsex environments, that many health organisations struggle to get right. We had to create this resource for our communities.”

Check out the guide below:

Image: Courtesy of Mitch Marion, from the short film “G O’Clock”