Substance-linked sex in heterosexual, homosexual, and bisexual men and women: An online, cross-sectional "Global Drug Survey" report (2019)

Introduction: Substance use in sexual contexts has received recent attention, but it has mostly been restricted to men who have sex with men and the so-called “chemsex” phenomenon.
Aim: To explore the use of licit and illicit substances in combination with sex in heterosexual, homosexual, and bisexual men and women; to explore substance-linked sex (SLS) differences across sexual orientation and sexes.
Methods: An international online self-selecting cross-sectional drugs survey, the Global Drug Survey 2013 (n = 22,289), was conducted. Respondents were asked about which drugs (including alcohol) they had had sex while on; how frequently they used drugs to enhance sex; and how different drugs changed different aspects of the sexual experience. We report descriptive statistics and test differences between men and women and between different sexual orientations.
Main Outcome Measures: The following outcome measures were recorded: (i) Percentage of each group reporting last-year use of each drug with sex, (ii) Mean subjective rating (-10 to +10) from each group for each drug on each aspect of the sexual experience.
Results: SLS occurred across sexual orientations and in both men and women. All groups reported that alcohol, cannabis, and 3,4-methylenedioxymethamphetamine (MDMA) were the most while commonly used drugs with sex. Larger proportions of homosexual and bisexual men had sex while on most drugs than heterosexual men (P < .001); and larger proportions of bisexual women had sex while on most drugs than heterosexual women (P < .004). >=20% of each group reported having used drugs with the intention of enhancing a sexual experience; larger proportions of homosexual and bisexual men reported this behavior than heterosexual men (P < .001). There were clear dissociations between the effects of different drugs on different aspects of the sexual experience; although gamma-hydroxybutyric acid/gamma-butyrolactone and MDMA were rated consistently highly.
Clinical Implications: Men and women of different sexual orientations must be considered when forming harm reduction and treatment strategies. However, "chemsex" drugs were most commonly used by homosexual men; targeted messages to this group should continue.
Strength & Limitations: Our study is highly novel; no previous study has investigated the combination of sex with this range of drugs. However, our survey is self-selecting, and some groups have a small sample size.
Conclusions: All groups reported SLS to some degree. However, differences in SLS between men and women and sexual orientations were found. Alcohol, cannabis, and MDMA were most commonly used with sex. "Chemsex" drugs were more commonly used by homosexual and bisexual men than heterosexual men.