Sexualized drug use (chemsex and methamphetamine) among men who have sex with men

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Questions

• What is the impact of sexualized drug use (specifically of chemsex and methamphetamine) on the health of men who have sex with men?
• What are effective interventions and/or services that address chemsex and methamphetamine use among men who have sex with men (including prevention, harm reduction, engagement in care and treatment)?

 Key take-home messages

• Risk behaviours associated with sexualized drug use among men who have sex with men include engaging in condomless anal intercourse (1–5), having multiple partners (3, 6), participating in group sex (3, 5), and sex in exchange for drugs or money (1, 3, 5).
• Men who have sex with men engaging in sexualized drug use have a greater likelihood of being diagnosed with HIV, bacterial sexually transmitted infections (STIs), and hepatitis C (7).
• A range of mental health issues are reported among men who have sex with men engaging in sexualized drug use, including depression (6, 8, 9), anxiety (6, 8, 9), psychosis (5, 9), and suicidality (6, 10).
• Sexual violence among men who have sex with men appears to be associated with sexualized drug use (6, 11) and is characterized by non-consensual sex (11), non-consensual drug administration (11), coercion (6), and assault (6).
• In general, evidence for the effectiveness of pharmacologic interventions for problematic methamphetamine use is limited in the research literature (12–14).
• Contingency management interventions may have some effectiveness in reducing methamphetamine use among men who have sex with men (15).

The issue and why it’s important

Sexualized drug use refers to the planned and purposeful use of drugs before or during sexual events with the intent of modifying sexual experiences (16). One subtype of sexualized drug use is chemsex, which includes the use of methamphetamine and other drugs (including but not limited to cocaine, mephedrone, ketamine, and gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL) (17) with the intention of facilitating, enhancing, prolonging, and sustaining the sexual experience (4, 18). A systematic review on methodological characteristics of chemsex research found that methamphetamine was the drug most frequently operationalized in studies of chemsex, followed by GHB/GBL (19). The increased popularity of geo-social internet networking applications (“apps”) has contributed to the growing trend of chemsex (19-22). Smartphone technology has created conditions that facilitated the relatively anonymous sexual and drug use networking among men who have sex with men (19).

The aforementioned description of chemsex is not an official definition; many review articles state that the definition of the term can vary (4, 16, 19, 23) depending on the substances used (1, 2, 8, 21) and the degree and frequency of use (8). One systematic review suggests that researchers should consider how varying definitions may impact the validity of study results (19).

The prevalence of chemsex is difficult to estimate as research study designs differ widely (4, 5, 24). Nonetheless, several attempts have been made to determine the prevalence of chemsex on a national (23, 25), regional (1, 26, 27), and global scale (4, 24). A recent global estimate based on a 2024 meta-analysis of chemsex prevalence among men who have sex with men who use methamphetamine suggests that approximately 13% engage in chemsex (24). In contrast, the prevalence of chemsex in Canada is estimated to be slightly higher: Canadian data from the 2017 European Men who have sex with men Internet Survey (EMIS) suggest that just over one in five (21.5%) Canadian men who have sex with men engage in chemsex (28) and a smaller 2021 study found that roughly one in four men (24%) who have sex with men seeking pre-exposure prophylaxis (PrEP) at a sexual health clinic in Montreal reported chemsex in the past year (29).

Specific motives for sexualized drug use among men who have sex with men are complex and varied (3). Qualitative data from a 2021 systematic review identified six mechanisms that promote chemsex-related behaviours (30):

• dealing with painful emotions or stressful events
• normalization and risk minimization of sexualized drug use
• giving in to interpersonal pressure or fulfilling desire for community belonging
• increasing intimacy or connectedness
• enhancing sexual performance and functioning
• lessening interpersonal and sexual inhibitions (30).

Results from a 2023 systematic review align with these data: men who have sex with men engage in chemsex to enhance sexual sensations and performance, achieve hedonic mental and emotional states, address negative thoughts and feelings, and for social reasons (e.g. to meet new partners, develop social relationships, and manage loneliness) (16). Recent findings from the Ontario Project on Trends in the Initiation of Crystal Meth (OPTIC) had similar findings: men who have sex with men were initiating crystal methamphetamine for sexual enhancement, to connect with other community members, for perceived mental health benefits, and to meet social expectations (31). The findings of a systematic review (2024) examining how and why men engage in specific practices to enhance potential benefits and reduce risks of chemsex were similar in that men who have sex with men associate various benefits and risks with chemsex (18). Additionally, chemsex participants appear to act at the individual, interpersonal, and community levels to reduce risks associated with chemsex (18). For example, personal use of PrEP and antiretroviral therapy is an individual way to mitigate harms; having one partner stay more lucid to watch out for the other is an example of interpersonal safety; and a chemsex session organized by a host who determines what drugs are used and route of administration to reduce risk of overdose is an action taken at the community-level (18). This review focuses on two important aspects of sexualized drug use (specifically chemsex and methamphetamine): the impact it has on the health of men who have sex with men, and interventions and/or services that address sexualized drug use. Of note, our search resulted in a large number of studies conducted since 2019, when our initial Rapid Response on sexualized drug use (32) was published. As a result, this review primarily includes systematic reviews published on this topic. We also included recently published primary studies that were not part of the identified systematic reviews.

What we found

Impact of sexualized drug use among men who have sex with men

Since 2019, there have been a large number of primary studies and systematic reviews published on sexualized drug use among men who have sex with men. Table 1 describes systematic reviews that examined the impact of sexualized drug use among men who have sex with men. The majority of studies included in these reviews are from high-income settings. Two chemsex-focused meta-analyses were not included for the following reasons: Eustaquio et al. examined chemsex in low- and middle- income countries (27) and Wang et al. focused on chemsex in Asia, where included studies were mostly from low- and middle-income settings (26).

We identified 13 systematic reviews, published since 2019, that examined the impact of sexualized drug use among men who have sex with men: one review included qualitative studies (6), four reviews included quantitative studies (1, 2, 7, 8), and eight reviews included both qualitative and quantitative studies (3–5, 9, 11, 33–35). The characteristics and main findings of all 13 studies are described in Table 1.

Sexual behaviours

Five reviews identified an association between sexualized drug use and engaging in unprotected sex (1-5). One meta-analysis among men who have sex with men in Europe found that chemsex was associated with engaging in unprotected sex and having a high number of encounters, but authors were not able to extract specific data due to the heterogeneity of included studies (1). Three other systematic reviews explicitly stated an increased risk of engaging in condomless anal intercourse when drugs were used in a sexual context (2, 4, 5). In one review that examined slamsex (intravenous drug injection before or during planned sexual activity), authors had the same finding: men who reported injecting drugs in the context of sex were more likely to engage in unprotected anal sex (3).

The only systematic review of qualitative studies we identified on this topic sought to understand the chemsex experience of men who have sex with men, and reported that participants described engaging in chemsex in different ways: in groups, with multiple partners, and with individual partners (6). This finding is supported by two other reviews of quantitative studies, which reported that men who have sex with men who engage in chemsex are more likely to participate in group sex (3, 5). Additionally, the aforementioned review on slamsex found that men who have sex with men who inject drugs in a sexual context were more likely to have a high number of sex partners (3). Transactional sex is mentioned briefly in some systematic reviews (1, 3, 5). A 2019 review found that in six of 38 included studies, individuals engaging in chemsex were more likely to have exchanged money or drugs for sex (5). The review on slamsex had a similar finding, based on data from two jurisdictions (Australia and the UK) where men who have sex with men who inject drugs were more likely to engage in transactional sex (3).

Health outcomes

An expectation among men who have sex with men engaging in chemsex is that drugs will have a positive impact on their sexual encounters (4). This notion is supported by a review of  qualitative studies, which found that drugs enhanced sexual experiences of men who have sex with men: sex “…lasted longer, felt better, and there was a sense of the overall experience as more intense, physically, psychologically, and sexually” (6). Participants described improvements in physical performance, noting increased libido, greater stamina, and increased energy levels (6). A minority of participants suggested that chemsex enabled them overcome health-related challenges affecting their sex lives, such as pain and fatigue, the impacts of aging, and negative side-effects from HIV medication (6).

Despite these seemingly positive perceived aspects of chemsex, a large body of literature describes negative health impacts of chemsex (2, 4, 5, 7). A meta-analysis of 19 studies found that sexualized drug use was associated with higher odds of HIV diagnoses, higher odds of bacterial STI diagnoses, and higher odds of hepatitis C virus (HCV) infection diagnoses (7). This is supported by other reviews which found that men who have sex with men who engage in chemsex are at increased risk for acquiring HIV (4), STIs (2, 4, 5), and HCV (5). However, one meta-analysis of eight studies among men who have sex with men living in Europe did not identify an increased risk of STIs associated with chemsex; authors suggest this was due to heterogeneity in the samples of included primary studies (1).

A 2019 systematic review reported that while some men who have sex with men who engage in chemsex experience negative mental health outcomes, the overall evidence is limited (4). Another systematic review from 2019 reported similar findings: chemsex may be associated with poor mental health outcomes—such as depression, anxiety, or psychosis—but it remains unclear whether this relationship is causal (5). However, evidence in this area is emerging: a 2022 systematic review found that sex in the context of polydrug use, smoked methamphetamine, and injection drug use (i.e. slamsex) increased the risk of psychosis up to three times (9). Additionally, a 2021 systematic review found that men who have sex with men who engaged in sexualized drug use were more likely to experience depression, anxiety, or substance dependence (34). Engaging in slamsex also increases the risk of bloodborne viruses, such as HIV and HCV, due to the sharing of injection equipment (34). In a 2025 systematic review of qualitative studies, participants reported a range of mental health problems associated with the aftermath of sexualized drug use, including vulnerability, feeling on edge, heightened anxiety, depression, suicidal feelings paranoia, and psychosis (6). A 2023 systematic review examining suicidality (suicidal ideation and attempts) and chemsex found some evidence that suicide could be an issue of concern among men who have sex with men; however, authors ultimately concluded that the association between chemsex and suicidal symptoms was poorly investigated (35).

A systematic scoping review from 2025 sought to characterize consent and violence in the context of sexualized drug use (11). The  authors observed an association between men who have sex with men who engage in sexualized drug use and sexual violence (11). Specifically, they found that sexual violence appears to be common in the context of sexualized drug use and contributed to impaired mental health and suicidality (11). Moreover, the administration of drugs without consent was also common and led to overdose and non-consensual sex (11). These findings are similar to that of another 2025 systematic review which found that men who have sex with men engaging in chemsex experienced and/or witnessed sexual violence, coercion, assault, and ambiguity in terms of consent (6). Participants also expressed loss of control, characterized by escalating and excessive drug use that had negative impacts on their life (6).

Recent primary studies—none which have been included in the aforementioned systematic reviews—continue to demonstrate that negative health outcomes are associated with chemsex.

• Chemsex and compulsive sexual behaviour disorder (CSBD) co-occur and are associated with sexual risk behaviours and negative mental health outcomes (36). In a sample of U.S. men who have sex with men (n=289), recruited through the dating/hookup app Grindr, participants who reported chemsex were more likely to experience depression and anxiety (36).
• Sexualized methamphetamine use among men who have sex with men can impact consistent engagement in HIV PrEP care (37). In a cohort of men who have sex with men (n=149) in Los Angeles, inconsistent PrEP engagement was more than twice as likely when one partner reported methamphetamine use, and nearly four times as likely when both partners reported methamphetamine use (37).

Given the negative health outcomes associated with chemsex, it is important to understand how men who have sex with men perceive the risks and consequences of sexualized drug use as well as their readiness to engage with support services (38). This understanding is essential to inform the development of more effective and targeted public health interventions (38). In a study of 2,449 gay, bisexual, and other men who have sex with men across three Canadian cities (Montreal, Toronto, and Vancouver), around 30% (n=727) reported use of amphetamine-type stimulants in the previous six months (38). Interestingly, approximately 85% of study participants who reported amphetamine use did not believe that they needed help in reducing their substance use, and those who perceived their use as problematic were less likely to reduce their use (38). At the same time, men who have sex with men with moderate to severe anxiety symptomatology, group sex participants, and those with greater financial strain had greater odds of reporting needing help reducing their substance use (38).

Interventions to address chemsex among men who have sex with men

Table 2 describes systematic reviews that examined the interventions and/or services that address chemsex/methamphetamine use among men who have sex with men. A total of seven reviews were identified, with the majority of included studies from high-income countries (12–15, 39–41). Three reviews focused exclusively on men who have sex with men (13, 39, 41), one review focused on sexual- and gender-minority populations (15), and three reviews did not limit studies by population (12, 14, 40).    One review was not included in Table 2: Rodriguez-Gonzalez et al. only included two studies; though one was from a high-income setting (France), only 9% of participants engaged in chemsex (42).

Pharmacologic interventions

One scoping review (2023) identified four studies that examined the clinical benefits of pharmacologic interventions for men who have sex with men who have methamphetamine use disorder/problematic methamphetamine use (12). Authors reported that findings for mirtazapine, naltrexone, and bupropion were mixed; additionally, some results were unclear due to study limitations (12). A 2019 systematic review included four randomized controlled trials comparing pharmacologic intervention to placebo for methamphetamine use disorder among men who have sex with men (13). Three of these four studies were also included in the aforementioned systematic review (12). Authors concluded that use of pharmacologic agents (mirtazapine, naltrexone, and bupropion) had limited efficacy for the treatment of methamphetamine use (13). Similar results have been observed in studies involving the general amphetamine/methamphetamine-using population (14). A 2020 review assessed 43 randomized controlled trials on amphetamine or methamphetamine dependence or use disorder across individuals of any age or any sex, and found that no pharmacotherapy demonstrated convincing results (14).

Psychosocial interventions

A systematic review from 2019 identified 20 studies that assessed psychosocial interventions among men who have sex with men: interventions included motivational interviewing, contingency management interventions, and therapy (cognitive and behavioural) (13). The authors suggested that psychosocial interventions “tend to hold more promise” than pharmacologic interventions, as they appear to have some utility in addressing methamphetamine-related and/or sexual health related outcomes (13).

Contingency management is a behavioural intervention where material incentives (e.g. vouchers) are provided contingent on biological confirmation (e.g. urine testing) of abstinence (40). Contingency management was examined in a 2020 systematic review which analyzed 27 studies and concluded that the existing literature provides strong supports for the use of this intervention (40). Across all included studies, only one found that contingency management did not effectively reduce methamphetamine use (40). However, not all included studies were exclusively among men who have sex with men (40). Generally, contingency management interventions appeared to have broad benefits, including greater drug abstinence, higher utilization of medical services, and reductions in sexual risk behaviours (40). This finding is supported by a 2023 scoping review, which reported that studies on contingency management showed evidence of potential effectiveness: among men who have sex with men specifically, contingency management interventions were favoured over interventions that utilized cognitive behavioural therapy (12). A 2022 scoping review focusing on sexual and gender minority populations suggested that contingency management interventions were effective in reducing methamphetamine use among men who have sex with men and transgender women (15). A 2020 systematic review examined the impact of mobile phone-based interventions on methamphetamine use and high-risk sexual behaviours among men who have sex with men (39). Five studies were identified, all conducted by the same author in California between 2008 and 2016 (39). It was concluded that short-term interventions based on text messaging could decrease the rates of methamphetamine use and the high-risk sexual behaviours associated with HIV infection among men who have sex with men (39). This text-message intervention was also discussed in a systematic review of e-health interventions that target sexual risk behaviour, substance use, and mental illness symptoms among men who have sex with men (43). The text messages delivered to participants as part of the intervention were grounded in social support theory, social cognitive theory, and the health belief model—theoretical principles that have proven to be effective in multiple studies (43).

Harm reduction

There is limited evidence that harm reduction strategies impact methamphetamine use among men who have sex with men (13), though there is evidence that individuals engaging in chemsex do employ certain strategies (e.g. seeking out medical information) to reduce associated harms (18, 41). These strategies can be organized according to their timing relative to the chemsex session (before, during, or after the session) (17, 41). For example, suppressive antiretroviral therapy or PrEP can be adhered to before the session; intoxication and overdose management can be addressed during the session; and post-exposure prophylaxis (PEP) or STI treatment can be sought out after the session (17).

Of interest, a small 2024 study (n=10) from Belgium, not included in any of the seven reviews from Table 2, evaluated the effectiveness of a mobile app (“Budd”) in promoting harm reduction practices in the context of chemsex (44). The intervention had two main components: an information component (included information on chemsex drugs, harms reduction, safer sex, personal testimonies, local health services and supports) and an individual support and planning component (included a preparation and planning tool for chemsex sessions, a check-in/out feature that allowed for tracking of drug consumption and timing, and a page for reflecting on experiences and comparing pre- and post-session intentions) (44). Ten participants were included in the study (44). Post-intervention, all participants demonstrated increased knowledge of chemsex substances; however, outcomes related to behavioural intention, self-efficacy, and awareness of risk behaviour were mixed (44).

Table 1. Systematic reviews that examine the impact of sexualized drug use among men who have sex with men (published 2019 and later)

Author & year of publication	Evidence synthesis focus	Year of last search	Location of included studies*	Key findings related to health impacts of engaging in chemsex
Connolly et al., 2025 (11)	To examine the current state of knowledge surrounding violence amongst MSM in the context of SDU	2025	Included studies (n=28) U.S. (n=7) UK (n=6) International, multi-site (n=2) Australia (n=1) Bangladesh (n=1) Botswana (n=1) Finland (n=1) Germany (n=1) Mongolia (n=1) Netherlands (n=1) New Zealand (n=1) Peru (n=1) Singapore (n=1) Spain (n=1) Thailand (n=1) Ukraine (n=1)	• SDU was associated with sexual violence victimization • Sexual violence was common in the context of SDU and directly associated with impaired mental health and suicidality • Administration of drugs to SDU participants without their consent was common and led to overdose and non-consensual sex • Overdose-related loss of consciousness was commonly reported and led to participants being penetrated without consent
Mundy et al., 2025 (6)	To explore the chemsex experiences of MSM in the context of substance misuse and addictions	2022	Included studies (n=43) Western Europe (n=11) U.S. (n=10) UK (n=9) Canada (n=5) Australia (n=3) China (n=1) Malaysia (n=1) Singapore (n=1) South Africa (n=1) Thailand (n=1)	• Combining drugs with sex allowed participants to have increased pleasure and satisfaction with sex • Participants acknowledged that chemsex comes with potential risks and harms (to oneself and others) that varied in severity • Participants experienced and witnessed sexual violence, ambiguity in terms of consent, coercion, and assault • Participants expressed loss of control, characterized as escalating and excessive drug use that had a negative impact on their life • Participants reported a range of problems including difficulties associated with the aftermath of drug use: lethargy, feeling run down, vulnerable, along with feeling on edge, highly anxious, depressed, suicidal, paranoia, psychosis, auditory and visual hallucinations, and psychosis
Coronado-Muñoz et al., 2024 (1)	To characterize chemsex practices and behaviours	2023	Included studies (n=8) Europe, multi-site (n=2) Netherlands (n=2) Spain (n=2) Ireland (n=1) UK (n=1)	• Chemsex was associated with engaging in unprotected sex and having multiple sexual partners • No clear increase in the risk of STIs was identified
Connolly et al., 2023 (33)	To describe changes in sexualized drug use among MSM since the beginning of the pandemic and to explore associated factors	2021	Included studies (n=9) Netherlands (n=2) Australia (n=1) China (n=1) France (n=1) Germany (n=1) Israel (n=1) UK (n=1) Singapore (n=1)	• Increased chemsex participation was associated with loneliness, and cravings • Some studies reported an increase or maintenance of chemsex participation, while some studies reported a decrease • Decreased chemsex participation was associated with COVID-19-related fear
Strasser et al., 2023 (35)	To evaluate if the psychological impact of chemsex includes suicidal ideation and suicidal attempts	2022	Included studies (n=12) Spain (n=3) France (n=2) Germany (n=2) UK (n=2) Canada (n=1) Norway (n=1) Singapore (n=1)	• Suicidality could be an issue of concern for MSM who engage in chemsex, though a direct association could not be drawn
Moreno-Gámez et al., 2022 (9)	To analyze the relationship between the practice of chemsex and the development of psychotic symptoms and disorders	2022	Included studies (n=10) Spain (n=5) France (n=2) UK (n=2) Germany (n=1)	• Chemsex was associated with developing psychosis • SDU (specifically slamsex, polydrug use, and smoked methamphetamine) was associated with up to a threefold increase in the risk of psychosis
Hibbert et al., 2021 (2)	To investigate the associations between SDU and specific health outcomes (HIV status, STI diagnoses and condomless anal intercourse) among sexual minorities	2020	Included studies (n=71) U.S. (n=20) UK (n=17) China (n=8) Australia (n=5) Canada (n=4) Europe, multi-site (n=2) Ireland (n=2) France (n=2) Netherlands (n=2) Asia, multi-site (n=1) Belgium (n=1) Chile (n=1) Cyprus (n=1) Germany (n=1) Italy (n=1) Mexico (n=1) Spain (n=1) Taiwan (n=1)	• Sexualized drug use among MSM was associated with living with HIV, STI diagnosis, and condomless anal intercourse
Íncera-Fernández et al., 2021 (8)	To clarify the currently identified mental health problems associated with drug use for sexual purposes among MSM	2020	Included studies (n=12) Australia (n=3) Canada (n=2) France (n=2) UK (n=2) Belgium (n=1) Germany (n=1) Spain (n=1)	• MSM who engaged in SDU were more likely to experience depression, anxiety, or a substance dependence • Individuals who practiced slamsex had mental health symptoms that were more severe
Schreck et al., 2021 (3)	To better describe slamsex and characterize the population that engages in chemsex	2020	Included studies (n=26) UK (n=11) France (n=6) Australia (n=2) Ireland (n=2) Germany (n=1) Malaysia (n=1) Spain (n=1) Thailand (n=1) U.S. (n=1)	• Individuals who engaged in slamsex were more likely to engage in group sex, transactional sex, unprotected anal sex, and have a high number of sex partners
Guerra et al., 2020 (7)	To quantify associations between SDU and sexually transmitted and bloodborne infection diagnoses in MSM	2019	Included studies (n=19) UK (n=6) Netherlands (n=4) U.S. (n=3) U.S. & Canada (n=1) France (n=1) Ireland (n=1) Spain (n=2) Portugal (n=1)	• SDU use was associated with higher odds of bacterial STI diagnoses, higher odds of HCV diagnoses, and higher odds of HIV diagnoses
Scheibein et al., 2020 (34)	To establish what is known about MSM’s sexualized injection drug use	2019	Included studies (n=53) UK (n=27) Australia (n=4) France (n=4) Spain (n=3) Ireland (n=3) Canada (n=2) Netherlands (n=2) U.S. (n=2) Thailand (n=1) France & Canada (n=1) Germany (n=1) Denmark (n=1) Portugal (n=1) South Africa (n=1)	• There was an increased risk of exposure to bloodborne viruses, such as HIV and HCV, through the sharing of equipment
Maxwell et al., 2019 (4)	To identify the biopsychosocial impact of chemsex behaviour on participants and identify bio-medical risk reduction interventions	2018	Included studies (n=38) U.S. (n=13) Australia (n=5) Netherlands (n=3) UK (n=10) Canada (n=2) Europe, multi-site (n=1) Germany (n=1) Israel (n=1) Ireland (n=1) Scotland, Wales, Ireland (n=1)	• MSM who engage in chemsex were more likely to participate in condomless anal intercourse • MSM who engage in chemsex had an increased risk of acquiring HIV and STI • Some MSM who engaged in chemsex experienced negative mental health outcomes, but evidence was limited
Tomkins et al., 2019 (5)	To identify and review evidence of recreational drug use in the context of sexual intercourse among MSM	2017	Included studies (n=38) UK (n=15) U.S. (n=7) Australia (n=3) Germany (n=2) Netherlands (n=2) Spain (n=2) Vietnam (n=2) France (n=1) China (n=1) Europe, multi-site (n=1) Malaysia (n=1) Mexico (n=1) Spain (n=1)	• Chemsex led to increased risky behaviour, including condomless anal intercourse, group sex, and exchanging sex for money or drugs • Chemsex may be associated with mental health issues, including depression, anxiety, or psychosis

*Study jurisdiction grouped by country (or region, where applicable)

SDU: sexualized drug use

MSM: men who have sex with men

HCV: hepatitis C virus

STI: sexually transmitted infection

Table 2: Systematic reviews of interventions and/or services that address chemsex/methamphetamine use (published 2019 and later)

Author & year of publication	Evidence synthesis focus	Year of last search	Location of included studies*	Key findings related to interventions and/or services	Rating of overall confidence in the results of the review appraised using AMSTAR-2 tool (45) ‡
Lemain et al., 2024 (41)	To identify and describe the existing treatments (pharmacologic or not) and risk/harm reduction strategies for MSM who engage in chemsex	2021	Included studies (n=19) UK (n=6) Germany (n=2) Australia (n=1) Belgium (n=1) Canada (n=1) France (n=1) France & Canada (n=1) Italy (n=1) Ireland (n=1) Netherlands (n=1) Malaysia (n=1) Singapore (n=1) Sweden & Germany (n=1)	• No studies identified specific treatment programs or strategies for MSM who engage in chemsex • MSM seek harm-reduction strategies when engaging in chemsex (e.g. information-seeking)	Critically Low
Hersi et al., 2023 (12)	To conduct a scoping review of systematic reviews, clinical practice guidelines, and primary studies of psychosocial and pharmacologic treatments for methamphetamine use disorder/problematic methamphetamine use†	2022	Included studies (n=57) A. Clinical practice guidelines (n=1) • Germany (n=1) B. Systematic reviews (n=2) C. Primary studies (n=54) • United States (n=33) • Iran (n=11) • Australia (n=6) • China (n=1) • Germany (n=1) • South Africa (n=1) • Thailand (n=1)	• Contingency management was the therapy most commonly associated with evidence of potential effectiveness • Outcomes for pharmacotherapies was mixed among MSM	High
Kidd et al., 2022 (15)	To identify prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use conducted with sexual and gender minority adults†	2019	Included studies (n=71) U.S. (n=64) Australia (n=2) Canada (n=1) China (n=1) Switzerland (n=1) South Africa (n=1) Vietnam (n=1)	• Contingency management interventions appeared to be effective in reducing methamphetamine use among MSM and transgender women • Group/dyadic interventions to reduce stimulant use had mixed results among MSM • Technology-assisted interventions had mixed results on methamphetamine use among MSM • Medication combined with psychotherapy/counselling had limited efficacy	Critically Low
Ameri et al., 2020 (39)	To examine the effects of mobile phone-based interventions on methamphetamine use and/or high-risk sexual behaviours among MSM	2019	Included studies (n=5) U.S. (n=5)	• Short-term interventions based on text messaging could decrease methamphetamine use and high-risk sexual behaviors among MSM	Critically Low
Brown et al., 2020 (40)	To focus on contingency management as an intervention for methamphetamine use†	2020	Included studies (n=27) U.S. (n=27)	• The use of contingency management as an intervention for methamphetamine use is strongly supported by the literature • Broad benefits include greater drug abstinence, higher utilization of medical services, and reductions in sexual risk behaviours	Critically Low
Siefried et al., 2020 (14)	To provide a summary of the current status of research on pharmacologic treatment of amphetamine/ methamphetamine dependence†	2019	Included studies (n=43) U.S. (n=23) Iran (n=7) Australia (n=4) Malaysia (n=2) Thailand (n=2) Finland (n=1) Finland and New Zealand (n=1) Iceland (n=1) Russia (n=1) Sweden (n=1)	• No pharmacotherapy yielded convincing results for the treatment of amphetamine/methamphetamine dependence	Critically Low
Knight et al., 2019 (13)	To review the status of research on the efficacy of interventions that address harms among MSM who use methamphetamine	2017	Included studies (n=28) U.S. (n=27) Australia (n=1)	• Use of pharmacologic agents had limited efficacy • Psychosocial interventions appear to have some utility in addressing methamphetamine-related and/or sexual health related outcomes	Low

*Study jurisdiction grouped by country (or region, where applicable)

†Not all studies included in the review were exclusively among MSM

SDU: sexualized drug use

MSM: men who have sex with men

HCV: hepatitis C virus

STI: sexually transmitted infection

‡ Rating overall confidence in the results of the review (45):

High: No or one non-critical weakness: the systematic review provides an accurate and comprehensive summary of the results of the available studies that address the question of interest.

Moderate: More than one non-critical weakness: the systematic review has more than one weakness but no critical flaws. It may provide an accurate summary of the results of the available studies that were included in the review.

Low: One critical flaw with or without non-critical weaknesses: the review has a critical flaw and may not provide an accurate and comprehensive summary of the available studies that address the question of interest.

Critically low: More than one critical flaw with or without non-critical weaknesses: the review has more than one critical flaw and should not be relied on to provide an accurate and comprehensive summary of the available studies.

Factors that may impact local applicability

This review is an update of a previous Rapid Response published in 2019; thus, it includes studies published in 2019 and after. Only reviews and primary studies that focused on high-income settings where substances were used in situations associated with sexual activity were included in this review.

The term men who have sex with men as used in this review is broad; it includes those who identify as gay or bisexual, as well as those who identify as heterosexual but have sex with other men. The findings from this review are aggregated across studies therefore, they may not accurately reflect the experiences of specific subgroups within the broader population of men who have sex with men. This is relevant given that the prevalence of chemsex behaviours (as well as patterns of substance use) can vary across different regions and subpopulations.

Additionally, not all of the systematic reviews of interventions (listed in Table 2) were exclusively focused on men who have sex with men who practice sexualized drug use. Thus, their findings may not be generalizable to the men who have sex with men engaging in sexualized drug use.

In most cases, the overall confidence in the results of the systematic reviews appraised using AMSTAR 2 tool (45) was “low” or “critically low”, meaning that they should not be relied on to provide comprehensive summary of the available studies. Finally, because of its methodological limitations, the AMSTAR 2 appraisal tool could only be applied to the systematic reviews of interventions listed in the Table 2, and not to the systematic reviews examining the impact of sexualized drug use listed in the Table 1.

What we did

We searched Medline (including Ovid MEDLINE and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations) using text terms (chemsex or chem sex or crystal meth or Methamphetamine* or Party and play or PNP or GHB or gamma-hydroxybutyrate or gamma hydroxybutyrate or mephedrone or ketamine or slamming or sexualized drug use*) and (men who have sex or MSM or gay* or gbMSM*). Searches were conducted on April 3, 2025 and results limited to articles published in English since 2019. Reference lists of identified articles were also searched. The searches yielded 533 references from which 45 were included.

Systematic reviews of interventions included in the Table 2 were appraised using AMSTAR 2, a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both (45). The AMSTAR 2 tool is a questionnaire which contains 16 items, including seven considered critical items. Critical items include aspects such as adequacy of the literature search, risk of bias of individual studies included in the review, appropriateness of meta-analytical methods, and consideration of risk of bias when interpreting the results of the review.

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Reference list

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2. Hibbert MP, Hillis A, Brett CE, Porcellato LA, Hope VD. A narrative systematic review of sexualised drug use and sexual health outcomes among LGBT people. International Journal of Drug Policy. 2021;93:103187.
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Suggested citation

Rapid Response Service. Sexualized drug use (chemsex and methamphetamine) among men who have sex with men. Toronto, ON: The Ontario HIV Treatment Network; June 2025.

Prepared by

Danielle Giliauskas and David Gogolishvili

Photo credit

Liberty House UK