Chemsex can’t be ignored

Words by Dr Stephen Naulls - a psychiatry doctor in Brighton. 

When the latest figures from the Office for National Statistics (ONS) were released, they barely made a ripple in the mainstream. Yet they should have caused outrage. The data show that lesbian, gay and bisexual people are almost three times more likely to die from a drug-related cause than heterosexual people. That is not a small disparity. It is a sign that our communities are still being sidelined when it comes to drug harm, mental health and care.

This did not come out of nowhere. For decades, LGBTQ+ people have been treated as an afterthought in addiction research and services. Our lives are often reduced to “lifestyle factors” or quietly excluded from mainstream models that were never built with us in mind. When harm occurs, it is framed as individual failure rather than a predictable outcome of systems that lack cultural competence and curiosity.

Chemsex sits right at the centre of this problem. And yet it is still routinely ignored, minimised or misunderstood. Chemsex refers to the use of drugs such as GHB, mephedrone and methamphetamine in sexual settings, most commonly among gay, bisexual and other men who have sex with men. For some people it is episodic and controlled. For others it becomes chaotic, compulsive and dangerous. The difference is rarely acknowledged.

For decades, LGBTQ+ people have been treated as an afterthought in addiction research and services. 

What makes chemsex uncomfortable for services is that it does not fit neatly into existing boxes. It involves pleasure, intimacy, identity and community alongside risk. Many clinicians are not trained to talk about sex between men, let alone sex on drugs. As a result, chemsex is often avoided altogether. People present with overdoses, psychosis or suicidality, but the context is missed. The dots are never joined.

The result is predictable. Individuals bounce between A&E, sexual health clinics and mental health services, retelling their story each time, often feeling judged or dismissed. Support is fragmented or absent. By the time someone is taken seriously, they are already in crisis. This is not because people are unwilling to engage. It is because the system is not built to understand them.

My research exists because of this gap. I am interested in what is happening beneath the surface: how drugs, sex, environment and minority stress interact, and why some people are pushed towards harm while others are not. The goal is not to pathologise our communities but to generate evidence that leads to safer, more competent care. Evidence is what forces systems to change.

I do not want to read another headline saying that we need to take action. We are already taking action. LGBTQ+ clinicians, researchers, community organisations and people with lived experience have been shouting about this for years. What is missing is meaningful engagement from those with power.

The ONS statistics are not just numbers. They are a reminder that being sidelined has consequences. Chemsex cannot be ignored because ignoring it is costing lives.