ChemSex and Sexualized Substance Use)

"The term “chemsex”, coming from the contraction of “chemical sex” was coined to indicate the voluntary intake of certain psychoactive and non psychoactive drugs in the context of sex parties and sexual intercourses with the intention of facilitating and/or enhancing the sexual encounter mostly among men who have sex with other men (MSM) [1].

"According to different studies, mainly homosexual and bisexual male partygoers use one or more drugs in combination to facilitate prolonged sexual sessions possibly with multiple sexual partners [2], although MSM are more prone to use sex enhancer drugs in comparison to non-MSM. A serious harmful behaviour related to this latter evidence is that those MSM, who are aware of being HIV positive and take anti HIV medication (e.g. Highly Active Anti-Retroviral Therapy, HAART) more commonly use “chemsex” drugs than the ones who are HIV negative or with an unknown status [3-5]. This is mainly done to potentiate physical performance impaired by the disease and to counteract the effects of consequent pharmacological treatment [6].

"Whereas in the nineties of the last century the most common abused drugs in the “party and sex” contest were: cannabis, ecstasy, amphetamine and cocaine, more recently “chemsex” has been associated to new psychoactive drugs and sex enhancers such as, γ-hydroxybutyric acid (GHB) and congeners, mephedrone, methamphetamine (commonly called crystal methamphetamine or chrystal meth), erectile dysfunction agents and alkyl nitrites (or poppers) [5, 6]."

"Alkyl nitrites are a chemical class of substances colloquially known as “poppers” (Rush, Bolt, Locker Room, Bullet, Aroma of Men, Dr. Bananas, Cum, Heart-On), whose basic pharmacological action of the nitrites is relaxation of vascular smooth muscles [39]. The route of administration is inhalation of the vapour of the volatilized organic liquid. Indeed, for their rapid onset, short-acting potent vasodilators, disinhibiting effect, poppers have been consumed in recreational and sexual settings since the 1970s [40].

"In the 1990s the popularity of alkyl nitrites significantly increased for both heterosexual and homosexual sexual intercourses. Interestingly, among the “chemsex” drugs, these ones are frequently used by youngsters too, for the misperception of the products harmlessness. Nitrites have been reported by many women to be useful for abandonment to a full sexual experience. Furthermore, anal penetration becomes easier, probably from a combination of nitrites actions on the anal sphincter and decreased pain perception [40]. These two actions plus mild hallucinatory sensations (e.g. “visions of bright colours, often containing symbolic representations of the sexual moment”) made the products highly popular in gay discos to enjoy at most music, lights, other drugs and social-sexual excitement [40].

"Among poppers, the most common sold are: amyl nitrite (isoamyl nitrite, isopentyl nitrite), but also cyclohexyl nitrite, isobutyl nitrite (2-methylpropyl nitrite), isopropyl nitrite (2-propyl nitrite), and less frequently butyl nitrite.

"Pharmacologically, alkyl nitrites act inducing relaxation of vascular smooth muscles, with an indirect effect on heart, by systemic arterioles relaxation resulting in a decrease of blood pressure, reflex tachycardia and a drop in the activity of the left ventricle. The peak action in blood pressure occurs in 30 seconds, with an average increase of 30 mm of systolic pressure, returning to normal within two minutes. When using these substances individuals feel different sensations like warmth, dizziness and an altered heartbeat and facial blush. This response can range from high pleasure to moderate nausea and headaches according to the scenario and the expectations [40]."