The evolution of the Chemsex scene in Madrid, Spain (2018-2023): Perspectives of GMSM engaged in Chemsex and professionals working in support services

J Subst Use Addict Treat. 2026 May 30:210039. doi: 10.1016/j.josat.2026.210039. Online ahead of print.

ABSTRACT

BACKGROUND: More than a decade after chemsex was conceptualized as a distinctive form of sexualized drug use among European gay communities, its evolution remains underexplored. This study examines perceived changes in the chemsex scene in the Madrid Region, Spain, between 2018 and 2023.

METHODS: This qualitative study is based on semi-structured interviews conducted in 2023 with 13 gay and other men who have sex with men (GMSM) engaged in chemsex and 13 professionals involved in chemsex-related support, prevention, healthcare, addiction, HIV, and LGBTQ+ services. Six participants from each group had also taken part in a 2018 study, enabling comparison over time. Interviews were transcribed, anonymized, and analyzed thematically.

RESULTS: Participants described substantial transformations since 2018. COVID-19 was perceived as accelerating chemsex practices, while PrEP reduced fear of HIV and reshaped negotiations of sexual risk. Interviewees reported more diverse user profiles, including younger GMSM, Latin American migrants, sex workers, and non-binary and trans people. Chemsex was also described as expanding beyond group sessions to include one-to-one encounters, solitary practices, online sex, and semi-commercialized events. Harms were increasingly framed around drug dependence, slamming, physical deterioration, and mental health.

CONCLUSIONS: Chemsex in Madrid should be understood as an evolving cultural practice shaped by changing health infrastructures, sexual cultures, drug markets, inequalities, and LGBTQ+ community dynamics.

PMID:42219040 | DOI:10.1016/j.josat.2026.210039