Slamsex in The Netherlands among men who have sex with men (MSM): use patterns, motives, and adverse effects
Leon Knoops
A * , Jan van Amsterdam B C , Thijs Albers D , Tibor Markus Brunt B C and Wim van den Brink A B C
+ Author Affiliations
- Author Affiliations
A Mainline, PO Box 58303, 1040 HH Amsterdam, The Netherlands.
B Department of Psychiatry, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
C Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity and Attention, Amsterdam, The Netherlands.
D Interdisciplinary Social Science, Social Policy and Public Health, University of Utrecht, Heidelberglaan 8, 3584 CS Utrecht, The Netherlands.
Sexual Health 19(6) 566-573 https://doi.org/10.1071/SH22140
Submitted: 3 May 2022 Accepted: 6 September 2022 Published: 26 September 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: This paper describes an online survey of men who have sex with men (MSM) and use drugs before or during sex (‘chemsex’) via injection (‘slamming’ or ‘practising slamsex’). Approximately 15–30% of the MSM population in The Netherlands have practiced chemsex at some point, and 0.5–3.1% of them ever had ‘slamsex’. This study investigates which substances are used in The Netherlands during slamsex, the motives for slamming and the health risks involved.
Method: In total, 175 MSM from The Netherlands, who had used substances before or during sex via injection completed an ad hoc online questionnaire designed for this study.
Results: Mean age of respondents was 47.8 years. During chemsex, almost every substance was used; the most common substances that were injected (slammed) were 3-methylmethcathinone (3-MMC), methamphetamine, ketamine, 4-methylethcathinone (4-MEC) and mephedrone (4-MMC). Reasons for slamming were mainly to experience a more intense rush and longer sex. Virtually none of the respondents used a condom during slamsex, but needles were almost never shared or used only once. Slammers reported health problems associated with injecting drugs (skin problems, collapsed veins and infections). Of most concern were the psychological symptoms reported by about three-quarters of respondents (e.g. insomnia, sadness, depressed mood, anxiety, suicidal tendencies). About half of respondents reported some degree of loss of control or concerns about their slamming behaviour.
Conclusion: Results show that slamsex is associated with consciously chosen sexual risk behaviours and risk-avoidance slam behaviours. This study may contribute to the reinforcement of accessible, non-judgmental and well informed prevention and harm reduction activities to support MSM practising slamsex.
Keywords: cathinones, chemsex, injection, methamphetamine, MSM, slamming, slamsex.
References
[1] Milhet M, Shah J, Madesclaire T, Gaissad L. Chemsex experiences: narratives of pleasure. Drugs Alcohol Today 2019; 19 11–22.| Chemsex experiences: narratives of pleasure.Crossref | GoogleScholarGoogle Scholar |
[2] Pakianathan MR, Lee MJ, Kelly B, Hegazi A. How to assess gay, bisexual and other men who have sex with men for chemsex. Sex Transm Infect 2016; 92 568–70.
| How to assess gay, bisexual and other men who have sex with men for chemsex.Crossref | GoogleScholarGoogle Scholar |
[3] Race K, Murphy D, Pienaar K, Lea T. Injecting as a sexual practice: cultural formations of ‘slamsex’. Sexualities 2021; 1363460720986924
| Injecting as a sexual practice: cultural formations of ‘slamsex’.Crossref | GoogleScholarGoogle Scholar |
[4] Evers YJ, Hoebe CJPA, Dukers-Muijrers NHTM, Kampman CJG, Kuizenga-Wessel S, Shilue D, et al. Sexual, addiction and mental health care needs among men who have sex with men practicing chemsex – a cross-sectional study in the Netherlands. Prev Med Rep 2020; 18 101074
| Sexual, addiction and mental health care needs among men who have sex with men practicing chemsex – a cross-sectional study in the Netherlands.Crossref | GoogleScholarGoogle Scholar |
[5] Graf N, Dichtl A, Deimel D, Sander D, Stöver H. Chemsex among men who have sex with men in Germany: motives, consequences and the response of the support system. Sex Health 2018; 15 151–56.
| Chemsex among men who have sex with men in Germany: motives, consequences and the response of the support system.Crossref | GoogleScholarGoogle Scholar |
[6] Tan RKJ, Wong CM, Chen MI-C, Chan YY, Bin Ibrahim MA, Lim OZ, et al. Chemsex among gay, bisexual, and other men who have sex with men in Singapore and the challenges ahead: a qualitative study. Int J Drug Policy 2018; 61 31–7.
| Chemsex among gay, bisexual, and other men who have sex with men in Singapore and the challenges ahead: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[7] Van Hout MC, Crowley D, O’Dea S, Clarke S. Chasing the rainbow: pleasure, sex-based sociality and consumerism in navigating and exiting the Irish Chemsex scene. Cult Health Sex 2019; 21 1074–86.
| Chasing the rainbow: pleasure, sex-based sociality and consumerism in navigating and exiting the Irish Chemsex scene.Crossref | GoogleScholarGoogle Scholar |
[8] Wang Z, Yang X, Mo PKH, Fang Y, Ip TKM, Lau JTF. Influence of social media on sexualized drug use and chemsex among chinese men who have sex with men: observational prospective cohort study. J Med Internet Res 2020; 22 e17894
| Influence of social media on sexualized drug use and chemsex among chinese men who have sex with men: observational prospective cohort study.Crossref | GoogleScholarGoogle Scholar |
[9] Edmundson C, Heinsbroek E, Glass R, Hope V, Mohammed H, White M, et al. Sexualised drug use in the United Kingdom (UK): a review of the literature. Int J Drug Policy 2018; 55 131–48.
| Sexualised drug use in the United Kingdom (UK): a review of the literature.Crossref | GoogleScholarGoogle Scholar |
[10] Batisse A, Peyrière H, Eiden C, Courné M-A, Djezzar S. Usage de psychostimulants dans un contexte sexuel: analyse des cas rapportés au Réseau français des centres d’addictovigilance. Évaluation des risques liés à la pratique du SLAM [Use of psychostimulants in a sexual context: analysis of cases reported to the French network of addictovigilance centers. Risk assessment related to the practice of SLAM]. Therapies 2016; 71 447–55.
| Usage de psychostimulants dans un contexte sexuel: analyse des cas rapportés au Réseau français des centres d’addictovigilance. Évaluation des risques liés à la pratique du SLAM [Use of psychostimulants in a sexual context: analysis of cases reported to the French network of addictovigilance centers. Risk assessment related to the practice of SLAM].Crossref | GoogleScholarGoogle Scholar |
[11] Maxwell S, Shahmanesh M, Gafos M. Chemsex behaviours among men who have sex with men: a systematic review of the literature. Int J Drug Policy 2019; 63 74–89.
| Chemsex behaviours among men who have sex with men: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
[12] Sewell J, Cambiano V, Miltz A, Speakman A, Lampe FC, Phillips A, et al. Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013–2016. Sex Transm Infect 2018; 94 494–501.
| Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013–2016.Crossref | GoogleScholarGoogle Scholar |
[13] McCall H, Adams N, Mason D, Willis J. What is chemsex and why does it matter? Br Med J 2015; 351 h5790
| What is chemsex and why does it matter?Crossref | GoogleScholarGoogle Scholar |
[14] Scheibein F, Wells J, Henriques S, Van Hout M. “Slam Sex” – sexualized injecting drug use (“SIDU”) amongst men who have sex with men (MSM)—a scoping review. J Homosexuality 2021; 68 2344–58.
| “Slam Sex” – sexualized injecting drug use (“SIDU”) amongst men who have sex with men (MSM)—a scoping review.Crossref | GoogleScholarGoogle Scholar |
[15] Whitlock GG, Protopapas K, Bernardino JI, Imaz A, Curran A, Stingone C, et al. Chems4EU: chemsex use and its impacts across four European countries in HIV-positive men who have sex with men attending HIV services. HIV Med 2021; 22 944–57.
| Chems4EU: chemsex use and its impacts across four European countries in HIV-positive men who have sex with men attending HIV services.Crossref | GoogleScholarGoogle Scholar |
[16] Daskalopoulou M, Rodger A, Phillips AN, Sherr L, Speakman A, Collins S, et al. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV 2014; 1 e22–31.
| Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study.Crossref | GoogleScholarGoogle Scholar |
[17] Schreck B, Victorri-Vigneau C, Guerlais M, Laforgue E, Grall-Bronnec M. Slam practice: a review of the literature. Eur Addict Res 2021; 27 161–78.
| Slam practice: a review of the literature.Crossref | GoogleScholarGoogle Scholar |
[18] PHE. Public Health England (PHE), Health Protection Scotland, Public Health Wales, Public Health Agency Northern Ireland. Shooting up: infections among people who inject drugs in the United Kingdom 2013; 2014. Available at www.gov.uk/government/publications/shooting-up-infections-among-people-who-inject-drugs-in-the-uk [Accessed 7 January 2022]
[19] Knoops L, Bakker I, van Bodegom R, Zantkuijl P. Tina en slammen. MSM, crystal meth-gebruik en het injecteren van drugs in een seksuele setting [Tina and slamming. MSM, crystal meth use and the injection of drugs in a sexual setting] 2020; 2021. Available at https://mainline.blogbird.nl/uploads/mainline/Chemsexreport_pdf1.pdf [Accessed 29 December 2021]
[20] Marillier M, Batisse A, Richeval C, Labrouve V, Martinez M, Allorge D, et al. CHEMSEX, NPS et réduction des risques et des dommages: résultats préliminaires d’une étude pilote [CHEMSEX, NPS and risk and harm reduction: Preliminary results from a pilot study]. Tox Anal Clin 2017; 29 S52
| CHEMSEX, NPS et réduction des risques et des dommages: résultats préliminaires d’une étude pilote [CHEMSEX, NPS and risk and harm reduction: Preliminary results from a pilot study].Crossref | GoogleScholarGoogle Scholar |
[21] Achterbergh RCA, van Rooijen MS, van den Brink W, Boyd A, de Vries HJC. Enhancing help-seeking behaviour among men who have sex with men at risk for sexually transmitted infections: the syn.bas.in randomised controlled trial. Sex Transm Infect 2021; 97 11–7.
| Enhancing help-seeking behaviour among men who have sex with men at risk for sexually transmitted infections: the syn.bas.in randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[22] Bui H, Zablotska-Manos I, Hammoud M, Jin F, Lea T, Bourne A, et al. Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: results from the FLUX study. Int J Drug Policy 2018; 55 222–30.
| Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: results from the FLUX study.Crossref | GoogleScholarGoogle Scholar |
[23] Evers YJ, Levels L, Dukers-Muijers N, Hoebe C, Knoops L, Pelsser S, et al. Chemseks onder MSM: Informatiebrochure voor Centra Seksuele Gezondheid. GGD Zuid Limburg [Chemsex under MSM: Information brochure for Centers Sexual Health. GGD South Limburg]; 2020. Available at https://www.ggdzl.nl/fileadmin/files/ggdzl/Documenten/Informatiefolder_Chemseks.pdf [Accessed 3 January 2022]
[24] Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev 2008; 27 253–62.
| Major physical and psychological harms of methamphetamine use.Crossref | GoogleScholarGoogle Scholar |
[25] Drevin G, Rossi LH, Férec S, Briet M, Abbara C. Chemsex/slamsex-related intoxications: a case report involving gamma-hydroxybutyrate (GHB) and 3-methylmethcathinone (3-MMC) and a review of the literature. Forensic Sci Int 2021; 321 110743
| Chemsex/slamsex-related intoxications: a case report involving gamma-hydroxybutyrate (GHB) and 3-methylmethcathinone (3-MMC) and a review of the literature.Crossref | GoogleScholarGoogle Scholar |
[26] Peters CMM, Evers YJ, Dukers-Muijrers NHTM, Hoebe CJPA. Sexually transmitted infection and chemsex also highly prevalent among male sex workers outside Amsterdam, The Netherlands. Sexually Transm Dis 2020; 47 e15
| Sexually transmitted infection and chemsex also highly prevalent among male sex workers outside Amsterdam, The Netherlands.Crossref | GoogleScholarGoogle Scholar |
[27] Achterbergh RCA, de Vries HJC, Boyd A, Davidovich U, Drückler S, Hoornenborg E, et al. Identification and characterization of latent classes based on drug use among men who have sex with men at risk of sexually transmitted infections in Amsterdam, The Netherlands. Addiction 2020; 115 121–33.
| Identification and characterization of latent classes based on drug use among men who have sex with men at risk of sexually transmitted infections in Amsterdam, The Netherlands.Crossref | GoogleScholarGoogle Scholar |
[28] Achterbergh RCA, Drückler S, van Rooijen MS, van Aar F, Slurink IAL, de Vries HJC, et al. Sex, drugs, and sexually transmitted infections: a latent class analysis among men who have sex with men in Amsterdam and surrounding urban regions, The Netherlands. Drug Alcohol Depend 2020; 206 107526
| Sex, drugs, and sexually transmitted infections: a latent class analysis among men who have sex with men in Amsterdam and surrounding urban regions, The Netherlands.Crossref | GoogleScholarGoogle Scholar |
[29] Drückler S, van Rooijen MS, de Vries HJC. Chemsex among men who have sex with men: a sexualized drug use survey among clients of the sexually transmitted infection outpatient clinic and users of a gay dating app in Amsterdam, The Netherlands. Sex Transm Dis 2018; 45 325–31.
| Chemsex among men who have sex with men: a sexualized drug use survey among clients of the sexually transmitted infection outpatient clinic and users of a gay dating app in Amsterdam, The Netherlands.Crossref | GoogleScholarGoogle Scholar |
[30] Evers YJ, Van Liere GAFS, Hoebe CJPA, Dukers-Muijrers NHTM. Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: a cross-sectional study in the Netherlands. PLoS One 2019; 14 e0216732
| Chemsex among men who have sex with men living outside major cities and associations with sexually transmitted infections: a cross-sectional study in the Netherlands.Crossref | GoogleScholarGoogle Scholar |
[31] Íncera-Fernández D, Gámez-Guadix M, Moreno-Guillén S. Mental health symptoms associated with sexualized drug use (Chemsex) among men who have sex with men: a systematic review. Int J Environ Res Public Health 2021; 18 13299
| Mental health symptoms associated with sexualized drug use (Chemsex) among men who have sex with men: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[32] Dolengevich-Segal H, Gonzalez-Baeza A, Valencia J, Valencia-Ortega E, Cabello A, Tellez-Molina MJ, et al. Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): data from the U-SEX GESIDA 9416 Study. PLoS One 2019; 14 e0220272
| Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): data from the U-SEX GESIDA 9416 Study.Crossref | GoogleScholarGoogle Scholar |
[33] Dolengevich-Segal H, Rodríguez-Salgado B, Gómez-Arnau J, Sánchez-Mateos D. Severe psychosis, drug dependence, and hepatitis C related to slamming mephedrone. Case Rep Psychiatry 2016; 2016 8379562
| Severe psychosis, drug dependence, and hepatitis C related to slamming mephedrone.Crossref | GoogleScholarGoogle Scholar |
