Journal Article

OC56 Rising chemsex trends among PrEP users in milan: a 2024–2025 study

Petri, F, Caruso, E, Caruso, F, Gori, A, Cernuschi, M, Giacomelli, A, Vinti, P, Moschese, D, Repossi, R, Fusetti, C, Frattini, N, Riva, A, Cossu, M V

2025

Overview

BackgroundChemsex is defined as the use of psychostimulants (GHB/GBL, synthetic cathinones and crystal methamphetamine) during sexual intercourse, particularly among MSM. These drugs are often used in combination with other substances varying by geographical contexts.A previous 2024 survey conducted in two STI services in Milan reported a high prevalence of drug use (33%) among PrEP users, with 16% engaging in chemsex.The aim of our study is to assess changes in substance use over the past year and, secondly, evaluating the proportion of problematic use.MethodsFrom January to March 2025, we conducted an anonymous online survey among PrEP users attending two STI services in Milan: one hospital-based and one community-based. Data collected included drug use, frequency and type, chemsex practices, use of PDE5 inhibitors and physical enhancers, perceptions of problematic use, and requests for psychological support.For descriptive statistics, continuous variables are expressed as median and IQR, and categorical variables as absolute numbers and percentages. Changes in chemsex and drug use prevalence between 2024 and 2025 were analyzed using two-proportion z-tests.Results376 PrEP users completed the questionnaire. The median age was 38 years (IQR 33 – 45), 98% (370/376) were assigned male at birth, and 365/376 (97%) identified as GBMSM.In the past year, 119/376 (32%) reported drug use (110/376, 29% in the past 6 months) and 22% (81/376) reported chemsex practice (74/376, 20% in the past 6 months).5% (6/119) reported using substances >1/week, 16% (19/119) weekly, 31% (37/119) >1/month, 11% (13/119) monthly and finally 37% (44/119) <1/month.Among chemsex-specific substances, mephedrone was the most commonly used (38%, 45/119), followed by GHB/GBL (22%, 26/119), MDPV (13%, 16/119) and crystal meth (8%, 9/119). Among other substances, cocaine was the most frequently reported (23%, 27/119; crack 8%, 10/119), secondly MDMA (21%, 25/119) and ketamine (14%, 17/119). Table 1 and figure 1 show the proportion of specific substances use.20/376 (5%) of respondents reported using physical enhancers (testosterone, SARMs), of whom 55% (11/20) co-used chems.54% (44/81) of those who engaged in chemsex also used PDE5 inhibitors.Problematic use was reported by 30% (24/81) of chemsex practicing, with 29% (7/24) seeking psychological support.Compared to 2024, overall substance use remained stable (32% in 2025 vs. 33% in 2024, p = 0.6). However, the prevalence of chemsex increased significantly from 14% (52/365) in 2024 to 22% (81/376) in 2025 (p =0.01).Abstract OC56 Table 1Differences in chems, chemsex practice and specific drug use in 2024 and 2025 (MDPV: methylenedioxypyrovalerone; GHB/GBL: gamma hydroxybutyrate/gamma butyrolactone; MDMA: 3,4- methylenedioxymethamphetamine)Abstract OC56 Figure 1Differences in the prevalence of chems use, chemsex practice and specific substance use between 2024 and 2025. (No dataregarding crack use in 2024 because data was collected along with cocaine)[Figure omitted. See PDF]ConclusionsOur survey found a high prevalence of chemsex among PrEP users, with an increasing trend since last year. It also revealed problematic drug use among a significant proportion of chemsex users (30%).These findings highlight the urgent need to raise awareness among healthcare professionals, enabling them to screen for problematic drug use and facilitate referrals to specialized support services.

• Publisher: BMJ Publishing Group LTD
• Subject: Cocaine / Drug use / Ecstasy