The study, published in Archives of Sexual Behavior, was conducted by a team including Lucia Gallego-Deike, Marcos Bella-Fernández, and Hilario Blasco-Fontecilla, working with data from the Spanish Observatory on Drugs and Addictions. The EWSD is a multinational, web-based survey coordinated every three years by the European Union Drugs Agency across 30 European and neighboring countries. Spain has participated since 2021, and the 2024 edition collected data between May and June. To qualify, participants had to be 18 or older and report having used at least one of several substances in the previous year, including cannabis, cocaine, ecstasy/MDMA, amphetamine, methamphetamine, heroin, or any new psychoactive substance. The questionnaire spanned 225 questions and took roughly fifteen minutes to complete.

The technical detail in the new paper is considerable. Respondents were classified by both sex assigned at birth and gender identity, allowing the researchers to distinguish cisgender men, cisgender women, and transgender or non-binary participants. A respondent was counted as using a drug if they had consumed it within the previous 12 months, and they were categorized as engaging in chemsex if they identified a chemsex party as a context of use for at least one substance in that period. Statistical comparisons between subgroups used t-tests for quantitative variables and chi-square tests for qualitative ones, with all analyses performed in R version 4.3.2.

The most striking findings concern why people use drugs at all. Cannabis and heroin stand apart from the general recreational pattern. Nearly half of cannabis users, 49.73 percent, said they used it to relax or manage stress, as did 30.14 percent of heroin users. About a quarter of users of each substance reported taking them to improve sleep, and 26.35 percent reported using them to cope with anxiety or depression. This self-medication profile contrasts sharply with substances such as ecstasy/MDMA, where 73 percent of users reported purely recreational motives. The researchers note that comparable proportions of cannabis and heroin users reported consumption driven by dependence, despite the two substances carrying very different social perceptions of risk.

Context matters as much as motive. Across the board, drugs were most often consumed at home, but music festivals and parties emerged as the most frequent public settings. This aligns with a well-established body of evidence: wastewater analyses in several countries have documented spikes in psychostimulant concentrations during festivals featuring rap, house, dance, pop, or rock music, and surveys of festival attendees have repeatedly identified MDMA and cannabis as the most common illicit drugs in those environments. Clubs and bars ranked slightly lower. Only cannabis and heroin appeared across an unusually wide range of environments, including schools, supervised drug use rooms, and natural settings.

The sexualized drug use findings carry the most public health weight. Sexualized drug use, or SDU, is an umbrella term for the intentional use of substances to enhance or facilitate sexual activity, practiced across genders and orientations but disproportionately represented among sexual-orientation and gender minorities. The paper emphasizes that no unified definition of SDU exists, and chemsex, its most specific subset, is likewise not recognized as a distinct diagnostic entity in the ICD-11. Chemsex conventionally involves stimulants, methamphetamine, GHB/GBL, and mephedrone, used before or during prolonged group sexual sessions, historically among men who have sex with men, often facilitated by geosocial networking apps and hosted in private residences or sex-on-premise venues.

The new data show that among the 874 respondents reporting drug use for sexual enhancement, 81.46 percent used only one substance, while 12.93 percent used two or more, and use of five or more drugs was rare. Male respondents reported sexual enhancement use at roughly twice the rate of female respondents. Cisgender men reported higher rates of sexualized use of cocaine (crack), heroin, and MDMA than cisgender women, while transgender or non-binary participants reported higher MDMA use for sexual purposes than cisgender women. Cannabis was the most frequently used substance for sexual enhancement across all gender groups, a finding consistent with its overall status as the most widely used illicit drug.

Chemsex itself remained a minority practice but displayed a distinctive signature. Of the 206 respondents who attended at least one chemsex session in the past year, the vast majority, 170 or 81.33 percent, were cisgender men, followed by 22 cisgender women (10.53 percent) and 14 transgender or non-binary individuals (6.70 percent). Methamphetamine and new psychoactive substances were primarily linked to chemsex parties, and the route of administration differed markedly from general drug users: injection and rectal insertion were far more prevalent among chemsex attendees, as was smoking in pipes. Injection within chemsex contexts, sometimes called slamsex, is a particularly high-risk variant associated with elevated likelihood of addiction, psychosis, neurological harm, overdose, and sexually transmitted infections.

The sociodemographic profile of sex-related drug users also diverged from the rest of the sample in statistically significant ways. Sex assigned at birth and gender identity both differed between groups, with p-values of 0.004 and below 0.001 respectively, and sex-related drug users were slightly younger, more often students, and included a modestly higher proportion of transgender or non-binary individuals, 3.66 percent versus 2.38 percent. Employment status also differed significantly. Notably, living situation, income, residency, and education showed no significant differences, echoing review literature that has found inconsistent sociodemographic correlates of SDU beyond gender and age.

Perhaps the most consequential implication of the study is its suggestion that chemsex epidemiology is shifting. Though the practice is traditionally associated with men who have sex with men, the presence of women among chemsex participants in this sample suggests the phenomenon may be expanding into heterosexual populations, a trend supported by emerging but still limited research on heterosexual men and women in party and club subcultures. Chemsex carries substantial risks, including unsafe sexual practices that raise HIV and hepatitis C transmission, drug-induced disinhibition that can lead to non-consensual encounters, and long-term mental health problems such as depression, anxiety, sleep disorders, psychotic symptoms, and cognitive decline. The authors argue that prevention campaigns, which have until now focused primarily on MSM communities, must adapt. They call for targeted strategies including health education, harm reduction, inclusive care services, and professional training, measures they say are essential to reduce harm and improve health outcomes as the landscape of sexualized drug use evolves.

Subject of Research: Sexualized drug use and chemsex patterns among illicit drug users in Spain

Article Title: Patterns of Drug Use Across Social and Sexual Contexts in Spain: Insights From the European Web Survey on Drugs 2024

Article References: Gallego-Deike, L., Bella-Fernández, M., López-Sánchez, L. M., Brime-Beteta, B., Ruiz-Medina, S., & Blasco-Fontecilla, H. (2026). Patterns of Drug Use Across Social and Sexual Contexts in Spain: Insights From the European Web Survey on Drugs 2024. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03525-y

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03525-y

Keywords: chemsex, sexualized drug use, European Web Survey on Drugs, methamphetamine, cannabis, MDMA, public health, men who have sex with men, harm reduction, Spain, new psychoactive substances, drug use patterns