MORE WORK TO DO When DDN spoke to him more than a decade ago( April 2015, page 12) he was already highlighting the fact that people didn’ t feel comfortable talking to mainstream services about their issues around chemsex – has there been much progress over the last decade?‘ I think there has, and I think more people working in services have had to improve their knowledge because chems are increasingly coming through the door,’ he says.‘ But it really varies. In our survey of healthcare professionals there was a wide range of scores when we asked people to rate their knowledge and confidence – some rated themselves at eight or nine, even some tens, but we had just as many rating themselves at one, two, three or four out of 10, so it feels like there’ s still a lot of work to do.

‘ Sadly though, I think one of the reasons more professionals are having to work with chemsex is that the health and social issues people are experiencing related to their chems use are so much more complex,’ he continues.‘ So they’ re having to use services to access more specialist and clinical help that’ s beyond the psychosocial support we can offer at Antidote. Just like we did when we first started seeing chemsex and these newer drugs emerge, professionals are having to learn and adapt. Because the people are right there in their services.’

LGBTQ + services for drugs and chemsex in London and Examining the drug, alcohol and chemsex experiences of LGBTQ + people and the healthcare staff supporting them are available at https:// londonfriend. org. uk / chemsexreport2026

The risks associated with chemsex are well documented – increased likelihood of sexually transmitted infections, challenges around consent, sleep deprivation, dependency, and the psychological strain that can follow extended sessions. But focusing solely on risk misses the point. People who engage in chemsex often describe unmet emotional needs, experiences of stigma, or difficulty accessing mainstream services that understand the cultural and relational context of their lives.

Effective support begins with recognising chemsex as a health and wellbeing issue, not a moral one. It requires practitioners who understand both substance use and sexual health, who can speak openly about shame, trauma, pleasure, and identity without pathologising the person in front of them. It also requires services that are flexible enough to meet people where they are – whether they want to reduce harm, take a break, stop entirely, or simply talk to someone who understands.

This is why structured, evidence‐based pathways matter. At Forward Trust, we

now have clear clinical and psychosocial pathways specifically designed for people engaged in chemsex. These pathways bring together specialist substance use clinicians, sexual health expertise, and psychosocial practitioners who understand the broader emotional and social factors that shape chemsex experiences. They provide safe spaces for honest conversations, comprehensive assessments that consider both physical and psychological wellbeing, and tailored plans that respect each person’ s goals.

Our approach includes harm‐reduction guidance, support around consent and boundaries, relapse‐prevention strategies, and links to sexual health services. It also includes psychosocial interventions that explore loneliness, identity, trauma, and relationship patterns – factors that often sit beneath the surface but profoundly influence behaviour. Crucially, our pathways are designed to be accessible and stigma‐free, ensuring that people feel able to reach out without fear of judgement. Supporting people who engage in chemsex isn’ t about telling them how to live. It’ s about recognising that behind every behaviour is a person with a story, and that meaningful change – whatever form it takes – happens when people feel heard, respected, and supported. Forward Trust’ s dedicated pathways reflect this belief, and they ensure that no one has to navigate chemsex‐related challenges alone.

Darren Lacey is inclusion coordinator at The Forward Trust

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