Nearly one in four men who have sex with men use drugs during sex, including cannabis at 18% | Research

The takeaway

A meta-analysis of 238 studies found that 22% of men who have sex with men engaged in chemsex, with cannabis (18%) being the second most commonly used substance after alkyl nitrites (23%).

Sexual health researchers, LGBTQI+ health advocates, harm reduction professionals, and public health policymakers.

What the researchers found

Pooled prevalence of chemsex was 22% and sexualized drug use overall was 25% among MSM. Cannabis had a pooled prevalence of 18% for use during sex. Other substances: alkyl nitrites 23%, GHB/GBL 13%, cocaine 10%, ecstasy/MDMA 9%, methamphetamine 8%.

Why it matters

Cannabis is often overlooked in discussions of sexualized drug use, yet it ranks second among substances used during sex in this population. Understanding its role in chemsex contexts is relevant for sexual health and harm reduction programming.

The numbers in context

238 studies, 380,505 participants. Chemsex prevalence: 22%. SDU prevalence: 25%. Cannabis for sex: 18%. Alkyl nitrites: 23%. GHB/GBL: 13%. Cocaine: 10%. Methamphetamine: 8%.

How the study worked

Systematic review and meta-analysis of 238 studies covering 380,505 participants. Random-effects model used. Subgroup analyses by MSM population category, region, and time period.

What this study cannot tell us

High heterogeneity expected across 238 studies with different definitions, populations, and measurement methods. Self-reported data subject to social desirability bias. Cannot determine whether cannabis use during sex is associated with the same risks as other chemsex substances.

How to read the evidence

Large-scale meta-analysis with 380,505 participants provides strong evidence of prevalence, though heterogeneity across studies is expected.

When this study was published

2025 publication.

The bigger picture

Chemsex is associated with increased HIV/STI risk, mental health challenges, and substance use problems. Cannabis's high prevalence in sexual contexts among MSM has been underrecognized compared to "harder" substances like methamphetamine and GHB.

Questions still open

Does cannabis use during sex carry similar sexual health risks (reduced condom use, STI transmission) as other chemsex substances?
Should harm reduction programs targeting chemsex include cannabis-specific messaging?

Common questions

What is chemsex?

Chemsex refers to intentional use of drugs before or during sex to facilitate, enhance, or sustain the sexual experience. It is particularly prevalent among men who have sex with men and typically involves stimulants and psychoactive substances.

Why is cannabis included in chemsex research?

Cannabis is one of the most commonly used substances during sex among MSM, ranking second after alkyl nitrites. While less associated with acute risk than methamphetamine or GHB, its high prevalence makes it relevant for sexual health programming.

Read the original research

Prevalence of chemsex and sexualized drug use among men who have sex with men: A systematic review and meta-analysis.

Drug and alcohol dependence, 275, 112800

View on PubMed ↗Publisher’s paper ↗

Citation

Georgiadis, Nikolaos; Katsimpris, Andreas; Vatmanidou, Maria A; Vassilakou, Tonia; Beloukas, Apostolos; Sergentanis, Theodoros N. (2025). Prevalence of chemsex and sexualized drug use among men who have sex with men: A systematic review and meta-analysis.. Drug and alcohol dependence, 275, 112800. https://doi.org/10.1016/j.drugalcdep.2025.112800