When we think about drugs and sexual activity, most existing research has focused on specific communities, particularly men who have sex with men. But recent evidence reveals a broader picture that’s been largely overlooked.

Dr Thomas Norman, a research fellow at La Trobe University’s Australian Research Centre in Sex, Health and Society, recently presented findings that challenge our assumptions about who engages in sexualised drug use and why.

What Is Sexualised Drug Use?

Sexualised drug use refers to the intentional use of substances to enhance, prolong or modify sexual experiences. This goes beyond someone having a few drinks before a date: it’s about deliberately using substances as part of sexual activity.

The practice has been well-documented among men who have sex with men, often referred to as ‘chemsex’, typically involving methamphetamine, GHB and mephedrone. However, Dr Norman’s research reveals this isn’t the full story.

The Hidden Pattern Among Heterosexual Adults

Through a systematic review of 23 studies across multiple countries, Dr Norman uncovered striking findings. Between 20-30% of heterosexual adults reported engaging in sexualised drug use: rates that surprised many researchers.

“Sexualised drug use appears to be pretty common among heterosexual people,” Dr Norman explained during his webinar presentation. “It’s driven predominantly by alcohol, cannabis and cocaine rather than GHB, mephedrone and methamphetamine.”

The Global Drug Survey, involving over 21,000 participants, found that 29% of heterosexual men and 21% of heterosexual women reported this behaviour in the past year. Similar patterns emerged across French, Norwegian and Italian studies.

Different Substances, Different Contexts

What stood out most was how different sexualised drug use looks among heterosexual populations compared to the chemsex profile. Alcohol featured prominently: something often overlooked in research on this topic.

Among Norwegian clinic attendees, 79% of those reporting sexualised drug use mentioned cocaine, with only 7% using GHB or methamphetamine. French students primarily combined alcohol with cannabis, and attendees at erotic events reported using psychedelics, MDMA and cannabis alongside alcohol.

“There’s this alcohol exceptionalism that creeps into research in this area,” Dr Norman noted. “Alcohol just doesn’t really get asked about for people using it specifically for sexual purposes.”

Why People Engage in Sexualised Drug Use

The research identified two distinct motivational pathways. The first centres on enhancement and connection: people seeking increased pleasure, intimacy or improved performance. The second involves coping and regulation: using substances to manage stress, anxiety or shame.

Women more frequently cited disinhibition and sensation as motivations, whilst men more often reported using substances to enhance their sexual performance. However, these patterns weren’t absolute, with considerable variation among individuals.

Young men described alcohol as serving contradictory purposes: simultaneously impairing physical function whilst encouraging riskier behaviour. Some participants spoke about MDMA and psychedelics as tools for deepening emotional connection and exploring intimacy.

The Consent Question

One of the most concerning gaps in current understanding relates to consent. Dr Norman emphasised that consent issues rarely appeared in quantitative research but emerged powerfully when participants could speak freely in qualitative studies.

“Consent actually very rarely comes into the picture,” he observed. “It was only really mentioned in the qualitative research when participants had the opportunity to speak about it themselves.”

Some participants described willingly engaging in drug use during sexual encounters but finding themselves completely incapacitated: highlighting how sexualised drug use can blur boundaries around consent, even when initially consensual.

Health Implications Worth Noting

The research revealed several health considerations associated with sexualised drug use among heterosexual adults. Those who engaged in this behaviour typically reported higher numbers of sexual partners and less consistent condom use compared to those who didn’t.

Studies found links between sexualised drug use and increased STI rates. Chinese female sex workers engaging in this practice had over four times the odds of being diagnosed with an STI, despite no change in their condom use patterns.

Mental health connections also emerged. Spanish research linked sexualised drug use to slightly elevated depression rates, whilst Norwegian data showed roughly one in ten participants wished to stop the behaviour. Women with depressive symptoms were more likely to report lifetime engagement in sexualised drug use.

The Information Gap

Perhaps most significantly, Dr Norman’s review revealed that heterosexual individuals engaging in sexualised drug use lack access to relevant information and support.

Participants in UK studies described having “limited practical guidance about sex on drugs”: information about dosage, managing adverse effects, and staying safe. Despite abundant general drug information available online, sex-specific guidance remains scarce for this population.

Dr Christa Siefried, who joined the webinar discussion, reflected on similar challenges even in communities where sexualised drug use has been acknowledged longer. “Service providers are confused about where they should address certain issues,” she noted. “I don’t think they’re the ones to elicit the conversation or initiate that dialogue.”

Why This Matters

Understanding sexualised drug use among heterosexual adults isn’t about promoting these practices. Rather, it’s about acknowledging a reality that affects a substantial portion of the population and ensuring people have accurate information.

Dr Norman emphasized the need to move away from abstinence-only approaches that fail to reflect how people actually behave. “Abstinence just isn’t necessarily going to work for people who are on purpose engaging in drug use for sexual purposes,” he explained.

The research also challenges us to think differently about drug education. Current approaches often frame any sex under the influence as inherently risky, failing to distinguish between intentional practices and incidental overlap between substance use and sexual activity.

What We Still Don’t Know

This emerging research area reveals significant gaps in our understanding. Most studies relied on convenience samples: clinic patients, university students, or people attending specific events, rather than general population surveys. The definition of sexualised drug use varied widely across studies, making comparisons difficult.

Dr Norman emphasised the need for clearer terminology and measurement. “There’s no one terminology being used even though they’re all relating to a similar concept,” he noted. Future research needs to distinguish between intentional sexualised drug use and broader substance-linked sexual activity.

Questions remain about partnered versus casual encounters, the role of relationship dynamics, and how gender shapes both motivations and experiences. As one webinar attendee asked, “What about drugs being used amongst stable partners to enhance sexual experiences?”: a question the current research can’t adequately answer.

The Broader Picture

What’s clear from Dr Norman’s work is that sexualised drug use among heterosexual adults represents a distinct phenomenon that requires its own understanding, separate from chemsex practices in other communities.

The substances differ. The contexts differ. The social dynamics differ. And yet, the rates suggest this affects a significant minority of the heterosexual population.

As research in this area develops, the focus must shift from judgment to understanding. Only by acknowledging these practices can we begin to address the genuine health and safety considerations they raise, whilst respecting that adults make their own choices about their bodies and relationships.

The conversation is just beginning, but it’s one worth having.

Source: UNSW