Chemsex as a challenge for emergency medical teams: a narrative review
8 affiliations
- 1Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University
- 2Group for Research in Healthcare (GRUPAC), Faculty of Health Science, University of La Rioja
- 3Institute of Neurosciences of Castile and León (INCYL), University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL)
- 4Faculty of Nursing and Podology, Nursing Care and Education Research Group (GRIECE), University of Valencia
- 5Care Research Group (INCLIVA), Hospital Clínico Universitario de Valencia
- 6William F. Connell School of Nursing, Boston College
- 7Faculty of Finances and Management, WSB MERITO University in Wrocław
- 8Department of Anaesthesiology and Intensive Care, Antoni Jurasz University Hospital No. 1 in Bydgoszcz
Abstract
Chemsex, defined as the intentional use of psychoactive substances before or during sexual activity, has emerged as an important public health concern and an increasingly relevant challenge for emergency medical services (EMS). Although most frequently described among men who have sex with men, sexualized substance use is increasingly reported among heterosexual men and women, indicating a broader at-risk population. Commonly used substances include methamphetamine, mephedrone, gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), alkyl nitrites, and other psychoactive agents, frequently used in combination during prolonged sexual sessions. Such practices are associated with a wide spectrum of acute complications, including agitation, psychosis, hyperthermia, cardiovascular instability, respiratory depression, altered consciousness, and mixed toxidromic presentations. This narrative review examines current evidence regarding chemsex-associated emergencies from a prehospital and emergency medicine perspective. Particular attention is given to syndromic clinical presentations, including hyperstimulatory syndromes, behavioral disturbances, acute GHB/GBL toxicity, and polysubstance-related emergencies. Operational challenges relevant to EMS teams, including scene safety, communication barriers, stigma, occupational risks associated with slamsex, and management of agitated patients, are also discussed. Chemsex-related emergencies share many clinical features with other substance-related emergencies. However, recognition of the sexualized substance use context may provide additional information relevant to prehospital assessment, including intentional drug combinations, repeated dosing, potential drug interactions, communication barriers, and occupational safety considerations. A syndromic approach focused on recognition of dominant clinical patterns rather than identification of individual substances may therefore provide the most practical framework for prehospital assessment and management. Although chemsex-associated emergencies are documented, evidence regarding their frequency and trends remains limited, particularly in prehospital settings. Further research is needed to support the development of evidence-based prehospital protocols, educational initiatives, and integrated care pathways.
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BibTeX
@article{czapla2026chemsex,
title = {{Chemsex as a challenge for emergency medical teams: a narrative review}},
author = {Michał Czapla and Krzysztof Griesmann and Raúl Juárez-Vela and Antonio Martinez-Sabater and Christopher S. Lee and Piotr Karniej and Łukasz Pietrzykowski and Aleksander Mickiewicz and Kamil Kędzierski and Jakub Wojciechowski and Andrzej Raczyński and Jacek Smereka},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1921570},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1921570/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Chemsex as a challenge for emergency medical teams: a narrative review
AU - Michał Czapla
AU - Krzysztof Griesmann
AU - Raúl Juárez-Vela
AU - Antonio Martinez-Sabater
AU - Christopher S. Lee
AU - Piotr Karniej
AU - Łukasz Pietrzykowski
AU - Aleksander Mickiewicz
AU - Kamil Kędzierski
AU - Jakub Wojciechowski
AU - Andrzej Raczyński
AU - Jacek Smereka
PY - 2026
DA - 2026/10/26
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1921570
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1921570/full
AB - Chemsex, defined as the intentional use of psychoactive substances before or during sexual activity, has emerged as an important public health concern and an increasingly relevant challenge for emergency medical services (EMS). Although most frequently described among men who have sex with men, sexualized substance use is increasingly reported among heterosexual men and women, indicating a broader at-risk population. Commonly used substances include methamphetamine, mephedrone, gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), alkyl nitrites, and other psychoactive agents, frequently used in combination during prolonged sexual sessions. Such practices are associated with a wide spectrum of acute complications, including agitation, psychosis, hyperthermia, cardiovascular instability, respiratory depression, altered consciousness, and mixed toxidromic presentations. This narrative review examines current evidence regarding chemsex-associated emergencies from a prehospital and emergency medicine perspective. Particular attention is given to syndromic clinical presentations, including hyperstimulatory syndromes, behavioral disturbances, acute GHB/GBL toxicity, and polysubstance-related emergencies. Operational challenges relevant to EMS teams, including scene safety, communication barriers, stigma, occupational risks associated with slamsex, and management of agitated patients, are also discussed. Chemsex-related emergencies share many clinical features with other substance-related emergencies. However, recognition of the sexualized substance use context may provide additional information relevant to prehospital assessment, including intentional drug combinations, repeated dosing, potential drug interactions, communication barriers, and occupational safety considerations. A syndromic approach focused on recognition of dominant clinical patterns rather than identification of individual substances may therefore provide the most practical framework for prehospital assessment and management. Although chemsex-associated emergencies are documented, evidence regarding their frequency and trends remains limited, particularly in prehospital settings. Further research is needed to support the development of evidence-based prehospital protocols, educational initiatives, and integrated care pathways.
SN - 2296-2565
ER -