Synopsis
Assess sexualised drug use without stigma, recognise overdose and dangerous withdrawal, address consent and safeguarding, and integrate sexual health, HIV prevention, injecting harm reduction and substance treatment.
- Ask which substances are used, dose and route, frequency, mixing, injecting equipment, sexual context, last use, overdose, withdrawal and what the person wants to change.
- Chemsex commonly refers to planned sexual use of GHB or GBL, methamphetamine and mephedrone among gay, bisexual and other men who have sex with men, while sexualised drug risk can affect anyone.
- Treat reduced consciousness, abnormal breathing, seizure, hyperthermia, chest pain, severe agitation or psychosis as an emergency; monitor because apparent recovery may reverse.
Key red flags
GHB or GBL overdose can cause abrupt unconsciousness and respiratory depression, with deterioration after a small additional dose.
Frequent dependent GHB or GBL use can produce rapidly emerging severe withdrawal with agitation, delirium and seizures that needs urgent specialist management.
Methamphetamine and stimulant toxicity can cause hyperthermia, chest pain, arrhythmia, severe agitation, psychosis or stroke.
Loss of memory, inability to consent, unexpected intoxication or coercive administration raises concern for sexual assault and time-sensitive toxicology.
Injecting or sharing needles, syringes, filters, water or other equipment increases HIV, hepatitis and bacterial-infection risk.
Prolonged sessions, sleep deprivation, dehydration and repeated dosing can compound physical illness, trauma and impaired decisions.
Unrousable consciousness, snoring or irregular breathing, cyanosis or vomiting after GHB or GBL needs emergency airway and breathing support.
Dosing every few hours, waking to dose or previous hallucinations and seizures on stopping predicts dangerous withdrawal.
Hyperthermia, chest pain, severe agitation, psychosis, seizure or focal neurology after methamphetamine or mephedrone is an emergency.
Unexpected amnesia, covert administration or unwanted acts during incapacity warrants SARC, forensic-toxicology and safeguarding options.
Reasoning priorities
Identify acute toxicity, dependence and the danger of abrupt cessation from dose, route, frequency and last use.
Frequent GHB or GBL dosing and previous withdrawal complications lower the threshold for urgent supervised care.
Worked reasoning
A patient uses GBL every two hours through multi-day sessions and wants to stop immediately at home.
- Clarify last dose, current observations, prior tremor, hallucinations, seizures, delirium, concurrent depressants and whether the patient is safe now.
- Explain that frequent GHB or GBL dependence can cause rapidly severe withdrawal and arrange urgent supervised specialist or emergency assessment.
- Assess HIV, hepatitis, STI, injecting, assault and mental-health risks without delaying withdrawal care.
- Coordinate substance and sexual-health follow-up with an overdose plan, safer use advice and explicit ownership of test results.