Chemsex as a challenge for emergency medical teams: a narrative review

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.