Patterns of Drug Use Across Social and Sexual Contexts in Spain: Insights From the European Web Survey on Drugs 2024.

Drug use is a global public health issue. Sexualized drug use (SDU) involves intentionally using substances to enhance sexual activity across diverse contexts, but it lacks a unified definition. Chemsex is a specific SDU subset that features stimulant use (methamphetamine, GHB/GBL, mephedrone) in prolonged sex group sessions, predominantly among men who have sex with men (MSM). We analyzed data from 6,399 valid participants residing in Spain who completed the European Web Survey on Drugs. Our focus was on sex-related drug use, including chemsex. Recreational use was the most common reason for drug consumption (78.01%). Cannabis and heroin were frequently used to relax or manage stress (49.73% and 30.14%, respectively), improve sleep (26.66%), and cope with anxiety and/or depression (26.35%). Drug use to enhance sexual performance and pleasure was reported by 13.66% of participants, while chemsex use was lower at 3.31%. Though historically associated with MSM, chemsex use is increasingly reported among women. Methamphetamine, cannabis, and MDMA were more frequently used by men to enhance sexual experiences, with methamphetamine and new psychoactive substances being primarily linked to chemsex parties. Illicit drug use in Spain is predominantly recreational and typically occurs at home, festivals, or nightlife venues. Chemsex, particularly among MSM, is an emerging issue associated with sexual, physical, and mental health risks. Addressing this requires targeted prevention strategies, including health education, harm reduction, inclusive care services, and professional training to reduce associated harms and improve health outcomes.