Chemsex-related deaths in the United Kingdom (2017-2022): A review of the Forensic Toxicology data.

BACKGROUND

The colloquial term "chemsex" (or "party and play") has appeared within the media and scientific literature within the past decade or so. It has been described as "sex, sometimes long sessions with multiple partners, under the influence of psychoactive drugs (particularly mephedrone, GHB, GBL and crystal meth). Subjects are reported to be mostly, but not exclusively, men who have sex with men (MSM). The study presents toxicology data from 21 deaths in the United Kingdom (between 2017 and 2022) considered within the "chemsex" scenario.

METHOD

Each case (n = 21) involved the anecdotal report of using drugs with sexual activity. The age of the decedents was 19-62 years (median age = 42). 17 males died after pre-arranged meetings with other males. 2 males died after apparently engaging in sex acts alone. 1 male died after meeting a female. 1 female died after meeting a male. Volatile substance abuse and physical restraints were mentioned in some cases ("poppers", ethyl chloride). Post-mortem samples were analysed in 19 cases. In 2 cases, the subject was found alive, but died later. Ante-mortem blood samples were analysed in these 2 cases. Analysis was carried out for alcohol, drugs of abuse, medicines and a range of sedative substances using conventional chromatographic methods including Gas Chromatography with Flame Ionisation Detector (GC-FID), Gas Chromatography Mass Spectrometry (GC-MS), Gas Chromatography with Tandem Mass Spectrometry (GCMS/ MS), Liquid Chromatography with Tandem Mass Spectrometry (LC-MS/MS) and Liquid Chromatography with High Resolution Accurate Mass Spectrometry (LCHRAM).

RESULTS

Methamphetamine (methylamphetamine, MA, n = 16) and GHB (n = 14) were the most common drugs detected. The concentration range for MA was 0.025-13 mg/L, and for GHB was 22 to > 800 mg/L in blood. 1 case contained mephedrone (0.19 mg/L). Other drugs detected included: sildenafil/tadalafil (n = 9); cocaine/benzoylecgonine (n = 7); alcohol (n = 4); ketamine (n = 4); cannabis (n = 3); diazepam (n = 1); quetiapine (n = 1); diphenhydramine (n = 1). Poly drug use was common. The most common combination was MA and GHB (n = 11). The cause of death was predominantly given as Drug toxicity/Drug-related death. Ischaemic heart disease/coronary atherosclerosis was listed as an additional complication in some cases.

CONCLUSIONS

Methamphetamine and GHB were the most common drugs observed. Poly-drug use is common in deaths associated with chemsex. Little use of mephedrone was found. Volatile use/asphyxia may be a significant factor. We believe this is the first single study providing toxicology data in a series of chemsex-related deaths in the UK.