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Chemsex Substances (Chems)

Page last reviewed 1.10.2026

Globally, the most used substances in chemsex include methamphetamine, GHB, GBL, and mephedrone, often in combination with ketamine, cocaine, MDMA (ecstasy), alkyl nitrites (poppers), erectile dysfunction medications, or alcohol. In Finland, substance preferences in chemsex may differ due to availability. Patterns of substance use also vary across countries, cities, cultures, and time periods.

In Finland, the most used substances in chemsex appear to include amphetamine, methamphetamine, GHB and GBL, MDMA (ecstasy), cocaine, and ketamine. Mephedrone (3-MMC, 4-MMC) and LSD (acid) are also used. Poppers, erectile dysfunction medications, and alcohol are commonly used as well. There are also indications that alpha-PVP is used in chemsex in Finland.

This page contains a separate section for each substance commonly used in Finnish chemsex culture. Each substance is introduced individually, covering its most common desired and undesired effects, the effects of heavy or long-term use, and interactions with other substances. Each section also offers tips for safer use and harm reduction. For more comprehensive information and harm reduction guidance, visit our Safer Chemsex page.

The use and possession of the substances described on this page is illegal in Finland, with the exception of poppers and medications for erectile dysfunction.

Information on chemsex substances

Amphetamine
Metamphetamine
GHB and GBL
MDMA (ecstasy)
Cocaine
Ketamine
Mephedrone (3MMC, 4MMC)
LSD
Alpha-PVP
Poppers
Erectile dysfunction medications

Amphetamine

Amphetamine is a strong psychostimulant. It accelerates the function of the brain and peripheral nervous system.

Amphetamine is found in various forms, including tablets, capsules, powder, solution, and crystals. In illicit markets, its colour may range from white to off-white or yellowish. It can be taken orally, snorted, smoked, injected, or administered rectally.

The effects of amphetamine can last over six hours. When used intravenously, the effect of amphetamine is stronger and begins immediately.

  • Feelings of well-being, energy, and confidence
  • Increased alertness and curiosity, stimulated thoughts and speech
  • Increased endurance and energy, e.g. during sex, with reduced feelings of hunger and fatigue
  • Increased sexual desire and a strong sense of euphoria and power, especially in higher doses
  • Restlessness, impulsivity, unpredictability, hostility, and aggression
  • Increased heart rate and blood pressure
  • Increased body temperature and excessive sweating
  • Rapid, shallow breathing
  • Dilated pupils
  • Reduced feelings of hunger and fatigue
  • Anxiety and paranoia, particularly occurring in higher doses
  • Possible effects of high doses include fever, sweating, headache, blurred vision, dizziness, arrhythmia, chest pain and shortness of breath.
  • In very high doses, there is a risk of amphetamine poisoning or overdose, which may include symptoms such as overheating, cardiac arrhythmia, seizures, loss of coordination and cerebral haemorrhage.
  • Amphetamine use often increases anxiety, paranoia, and violent behaviour, and can cause amphetamine psychosis, prolonged psychosis or the development of schizophrenia.
  • May cause severe fatigue, sleep disorders, malnutrition, weakened immune system and brain damage.
  • Increases the risk of tooth decay, as the substance often causes jaw clenching and teeth grinding.
  • Can cause strong psychological dependence and tolerance to the substance’s effects, often leading to increased doses.
  • Using amphetamine with other stimulants and substances that increase blood pressure, such as cocaine, ecstasy, poppers, and erectile dysfunction medications intensifies the body’s stress response and significantly increases strain on the cardiovascular system.
  • Some antidepressants can cause high blood pressure, increased body temperature, or a condition known as serotonin syndrome when used with amphetamine. Symptoms of serotonin syndrome include abdominal cramps, diarrhoea, impaired consciousness, confusion, speech disorders, compulsive movements, coordination disorders, rapid heartbeat, blood pressure fluctuations, sweating, anxiety, irritability, fever, and increased reflexes.
  • Amphetamine removes the sensation of hunger, thirst, and fatigue; however, these needs should not be neglected. These needs may be even greater when the body is stressed by the effects of substances and sex. Take breaks to eat snacks and hydrate by drinking water, juice, or sports drinks to prevent exhaustion. Taking a cool shower can also help prevent overheating.
  • The increased stimulation and strong sexual desire caused by Amphetamine can make you feel tireless during sex. If using a condom, it should be changed to a new one every 30 minutes, and plenty of lubricant should be used to prevent the condom from becoming brittle and reducing strain on the mucous membranes. Additionally, it is good to take breaks during sex.
  • Amphetamine sold in Finland is often cut with substances whose effects are unknown. There have also been cases in Finland where a person thought they were buying amphetamine but actually received alpha-PVP. Unexpected harm from other substances can be reduced by starting with a lower dose and observing how you feel and how the substance affects you.
  • More tools for harm reduction can be found on our Safer Chemsex page

Metamphetamine

Crystalline methamphetamine is a very strong psychostimulant, meaning that it activates the central nervous system.

Methamphetamine is a relative of amphetamine, often manufactured in illicit laboratories. For this reason, methamphetamine is even more likely to contain unknown, potentially harmful ingredients, which may have unexpected effects.

Methamphetamine is sold as a white, water-soluble powder, crystals, or tablets. It is also known as “tina,” “tea,” and in crystal form as “crystal.” Methamphetamine can be used by smoking, oral ingestion, snorting, rectal absorption (“booty bump”), or intravenously. Sometimes it is swallowed wrapped in paper to prolong the melting time (“bomb”).

The effects of methamphetamine are very similar to but stronger than those of amphetamine. It often causes a stronger rush and euphoria, as well as an increased sexual desire. The effects also last longer. Depending on the composition, dosage, and method of use, the effects can last from 6 to 24 hours. The comedown can also be more intense.

Smoking and intravenous use of methamphetamine are particularly potent and can quickly lead to addiction. Methamphetamine carries a higher risk of addiction and overdose compared to amphetamine.

  • Increased sensations of empathy, euphoria, and hallucinations
  • Strong sexual desire and confidence
  • Heightened energy, curiosity, attentiveness and reduced anxiety
  • Increased heart rate and blood pressure
  • Increased body temperature and excessive sweating
  • Rapid and shallow breathing
  • Dilated pupils
  • Loss of appetite and fatigue
  • Challenges in achieving or maintaining an erection
  • Confusion, impulsive behaviour, reduced judgment, violence, and psychotic symptoms such as delusions and hallucinations
  • Increased anxiety, depression, fatigue, and headaches as the effect of the substance wears off
  • Restlessness, mood swings, insomnia, psychosis, paranoia and hallucinations.
  • Taking higher doses of methamphetamine can cause high blood pressure, chest pain, heart failure, breathing difficulties, fever, paranoia, severe abdominal pain, apathy, seizures, coma, cerebral haemorrhage, or stroke.
  • Long-term methamphetamine use can lead to tooth decay, weight loss, compulsive skin picking, scarring, and recurrent infection.
  • Long-term methamphetamine use can also cause brain tissue damage and difficulties with emotional control, memory, problem-solving, verbal expression, and motor skills.
  • Combining methamphetamine with other substances such as ecstasy, cocaine, poppers, and erectile dysfunction medications is extremely dangerous. It can lead to disruptions in blood pressure regulation, heart attack, or blood clots.
  • Using certain antidepressants (SSRIs) with methamphetamine can cause high blood pressure, increased body temperature, or a condition known as serotonin syndrome. Symptoms include abdominal cramps, diarrhoea, impaired consciousness, confusion, speech disorders, compulsive movements, coordination disorders, rapid heartbeat, blood pressure fluctuations, sweating, anxiety, irritability, fever, and increased reflexes.
  • Methamphetamine use can reduce the effectiveness of antipsychotic and blood pressure medications.
  • Methamphetamine may cause restlessness and increase sexual desire.
  • If using a condom, it should be replaced every 30 minutes, and plenty of lubricant should be used to prevent it from becoming brittle and reduce strain or injury to the mucous membranes. Water-based lubricants are recommended, as other types can weaken the condom material and increase the risk of breakage. It is also advisable to take breaks during sex.
  • Methamphetamine removes the sensations of hunger, thirst, and fatigue; however, these needs remain and may be even greater due to the physical strain caused by sex and methamphetamine. It is important to remember to take breaks, eat, drink, and keeping body temperature at normal levels. For example, taking a cool shower can help prevent overheating.
  • The harmful effects of methamphetamine on teeth can be reduced by using sugar-free gum, drinking water, and brushing teeth, especially if sessions last several days.
  • It is important to take care of skin injuries that may result from scratching, skin picking, and/or injecting. For mild, localized symptoms, antibiotic ointments can be used to ensure the skin heals properly and to avoid more extensive infections. More severe infections should always be treated by healthcare professionals.
  • Methamphetamine-induced psychosis is relatively common. Symptoms often include confusion, paranoia, thoughts of being watched or followed, and auditory and tactile hallucinations. Instructions for mental first aid can be found on the Chemsex and First Aid page.
  • More tools for harm reduction can be found on our Safer Chemsex page

GHB and GBL

Although GHB (gamma-hydroxybutyric acid) depresses the central nervous system, it can also act as a stimulant in small amounts. GHB is produced from GBL (gamma-butyrolactone). GBL is also used individually as a drug and converts to GHB in the human body.

GHB and GBL have similar effects, but GBL is significantly stronger than GHB. For this reason, it is important to identify which substance is involved. Trade names for these substances include G and juice (mehu in Finnish).

GHB is typically an odourless, oily liquid with a slightly salty taste. It is commonly sold as a liquid or in capsules, but sometimes also as a powder.

GBL is usually a liquid with a chemical smell and taste. GBL is stronger than GHB, but its effects last for a shorter time.

GHB and GBL are often drank in combination with juice or another liquid because the substances are unpleasant and corrosive if not diluted. It is less common to snort GHB or GBL or administer them rectally or intravenously.

The effects of the substance begin 10–30 minutes after ingestion and last about 4 hours, depending on the user’s weight and tolerance level.

  • Relaxation, euphoria, sociability, elevated mood and drowsiness
  • Sexual arousal and reduced inhibitions
  • Often used in anal sex due to its relaxing effect which makes sex easier and more pleasurable for the receptive partner (bottom)
  • Dizziness, nausea and tremors
  • Confusion, irritability and restlessness
  • Impaired muscle coordination
  • Hallucinations and memory blackouts
  • Seizures and coma
  • Respiratory arrest and death
  • Signs of GHB or GBL overdose include unexplained sweating, vomiting, irregular or shallow breathing, inability to stand, involuntary muscle contractions, and G-hole state. The risk of overdose is greater when tolerance to the substance is high.
  • GHB or GBL overdose can lead to a coma-like poisoning state called G-hole. Early signs often include confusion, slurred speech, and muscle twitching. A person in a G-hole state loses consciousness and falls into a coma that can last from minutes to hours. This state can also lead to respiratory arrest or heart failure if G is mixed with other substances. There is no single treatment for G-hole; it is treated symptomatically while vital functions are maintained/monitored. In some cases, G-hole states may also lead to death.
  • Repeated G-hole states can cause problems with memory and emotional regulation.
  • In addition to psychological dependence, GHB or GBL causes physical dependence. This can develop quite quickly, even after three consecutive days of use. Withdrawal symptoms, such as insomnia, anxiety, and tremors, can last from a few days to a couple of weeks. Signs of dependence include continued use despite clear harmful effects, the development of tolerance to the substance, and withdrawal symptoms following cessation of use.
  • Long-term use can lead to anxiety, tremors, insomnia, vomiting, rapid heartbeat, confusion, hallucinations, and high blood pressure. Hyperactivity, paranoia, psychosis, and seizures have also been reported.
  • Using GHB or GBL with depressants and substances that affect the central nervous system, such as alcohol, ketamine, opioids, and benzodiazepines, is particularly risky. Combined use can lead to respiratory arrest, overdose, G-hole state, and death. 
  • Using GHB or GBL with stimulants is particularly dangerous for two reasons: 
    • Stimulants prevent the user from feeling the drowsiness caused by the substance. Therefore, one may not realise how much of the substance has been consumed, which may lead to a potential overdose.  
    • Additionally, combining stimulants and GHB or GBL increases the risk of side effects such as paranoia, hallucinations, and aggression. 
  • Combining GHB/GBL with poppers or erectile dysfunction medications can cause sudden blood pressure dysregulation, which may lead to cardiac arrest. 
  • Avoid mixing GHB or GBL with other substances, as the consequences can be unpleasant and even life-threatening.
  • GHB or GBL should be avoided if you have suffered previously from blood pressure problems, neurological seizures (e.g., epilepsy), respiratory problems, depression, or panic disorder.
  • It is important to know whether the substance is GHB or GBL, as GBL is significantly stronger than GHB. A typical dose of liquid GHB can be life-threatening if the actual substance is GBL.
  • If ingesting GHB or GBL, it should be diluted with water, juice, or another non-alcoholic drink. The substance should never be diluted with alcohol. GHB or GBL is corrosive. This means that if drank undiluted, it can cause burns in the mouth, throat, and stomach. Drinking GHB or GBL directly from the bottle also increases the risk of overdose.
  • The difference between an intoxicating and toxic dose of GHB and GBL is small. The doses used are very small, which increases the risk of incorrect dosing.
  • It is important for the user to measure the dose themselves and take it from their own cup. Cups can be different colours or clearly labelled with name tags. The accuracy of the dose is very important to avoid overdose. For example, small syringes are the best way to measure a safe dosage of GHB or GBL, as they can accurately measure millilitres. Spoons and bottle caps are not safe methods for measuring a dosage of GHB or GBL.
  • Use of GHB or GBL should begin with small amounts, typically 0.5–1.0 ml depending on the user’s weight, to prevent overdose.
  • The effects of the substance begin after about 10 minutes. Multiple doses enhance the effect of the substance. Therefore, it is recommended that subsequent doses are always smaller than the previous one. It is also recommended to wait at least two hours before taking a new dose to avoid overdose.
  • GHB or GBL affects the user’s memory, so the times and amounts of doses should be written down on paper or phone.
  • Continuous use for more than 6 hours should be avoided, as it can lead to overdose, dependence, and unpleasant withdrawal symptoms.
  • The substance can be stored safely in bottles that are never used to store other liquids. Clear liquid can be mistaken for water or another colourless drink, and too much may be ingested before realizing it is GHB/GBL.
  • Intravenous or rectal use should be avoided due to the high risk of bladder or vascular damage and overdose. It is also good to carry your own lubricant or individually packaged lubricant sachets so that no one can unknowingly mix the substance into the lubricant.
  • There have been reports of people becoming victims of sexual violence under the influence of GHB or GBL. GHB or GBL should be used in a safe environment with at least one trusted person. Clear consent must always be obtained from sex partners under the influence of GHB or GBL before engaging in sexual activity.
  • If a person is in a G-hole state, ensure they are in the recovery position so that the airways do not become blocked and breathing does not stop. A person in a G-hole state should never be left alone to monitor their condition and prevent them from becoming a victim of sexual violence, for example.
  • Call for help from the emergency centre if you are unsure of the person’s conditions while they are in a G-hole state. It is important to tell healthcare professionals truthfully which substance caused the condition. The task of healthcare personnel is to help, and they will only call the police if a crime is suspected or if the safety of the helpers may be at risk. Call for help boldly.
  • If dependence on GHB or GBL has developed, abrupt cessation should be avoided as it can cause dangerous health problems. Doses should be gradually reduced or medical help sought to obtain appropriate medication. In case of severe withdrawal symptoms, seek emergency care.
  • More tools for harm reduction can be found on our Safer Chemsex page

MDMA (ecstasy)

MDMA, or methylenedioxymethamphetamine, is a central nervous system stimulant better known as ecstasy. Other names used for MDMA in Finland include E, essot, and mämmi.

Ecstasy is often sold either as tablets or as a crystalline powder. Tablets sold as ecstasy often contain also other psychostimulants. Use typically occurs orally and sometimes nasally.

When taken orally, the effect begins after about 30 minutes. The perceived effects last about 6 hours, although the substance continues to affect the body afterward. If the dose is very large, the elimination of the compound from the body may be slower.

The potency of street ecstasy has increased in recent years. A typical dose of MDMA is about 75–150 mg. In recent years, the dosage of MDMA in tablets sold has been closer to 150 milligrams than 75 milligrams. This can affect the strength of MDMA’s effects and therefore, the likelihood of undesired effects. Ecstasy tablets usually contain, in addition to MDMA, various substances belonging to the psychedelic and stimulant categories.

  • Feeling of well-being, elevated mood and alertness
  • Reduced social inhibitions
  • Increased empathy with a sense of connection and/or attachment to others.
  • Feelings of fear and/or anxiety are reduced or become less influential.
  • Changes in sensory perception, such as enhanced colour perception or flashes of light in the visual field
  • Panic, confusion, concentration difficulties, insomnia
  • Increased risk of anxiety and panic attacks
  • Excessive sweating and heart palpitations
  • Nausea, loss of appetite
  • Dry mouth, teeth grinding or jaw clenching
  • Increased risk of seizures, especially in individuals with epilepsy
  • Especially in hot environments and during physical exertion (e.g., sex, dancing), possible serious side effects include a significant increase in body temperature, heatstroke, cardiac arrhythmias, hyponatremia, acute kidney failure, and rhabdomyolysis, i.e., sudden muscle tissue damage caused by muscle overload
  • Risk of heart attack, often due to insufficient water intake. On the other hand, excessive water intake can cause hyponatremia, which can lead to brain swelling, coma, or death.
  • Lowered mood after use, especially with repeated use
  • Development of psychological dependence and tolerance
  • Increased risk of developing health conditions relating to heart valves.
  • Impaired attention, learning ability, logical thinking, and memory. Heavy, frequent, or high-dose use of ecstasy may cause long-term or irreversible changes in the brain.
  • Increased impulsivity and risk-taking behaviour.
  • MDMA should not be used frequently, as the brain’s neurotransmitter stores do not have time to replenish, which may result in depression. Studies have not found evidence that serotonin-boosting antidepressants protect against the serotonin-damaging effects of ecstasy.
  • The perceived or desired effect of MDMA decreases with repeated doses, but the experienced harms increase rapidly. MDMA does not cause a physical dependence on the substance, but its use can lead to a psychological dependence.
  • Using MDMA in combination with methamphetamine is particularly dangerous as it may lead to disruptions in blood pressure regulation, heart attack, blood clots, or stroke.
  • Using MDMA in combination with ketamine may lead to confusion and harmful increases in heart rate, as well as increase the risk of accidents.
  • Using MDMA in combination with serotonin-boosting mood stabilizers is dangerous. Mood stabilizers (especially MAO inhibitors) enhance the effects of ecstasy. The combination is life-threatening as it can cause a condition known as serotonin syndrome, which can lead to death. Symptoms of serotonin syndrome include abdominal cramps, diarrhoea, impaired consciousness, confusion, speech disorders, compulsive movements, coordination disorders, rapid heartbeat, blood pressure fluctuations, sweating, anxiety, irritability, fever, and increased reflexes.
  • Using MDMA in combination with other stimulants (amphetamine, cocaine) can also cause serotonin syndrome. Stimulant use increases the likelihood of panic attacks.
  • Using MDMA in combination with SSRI medications can reduce the effects of ecstasy. A weaker effect can lead to the use of a higher dose of MDMA. This can deplete serotonin stores more than usual, leading to a lower mood in the days following use.
  • The risk of overheating can be influenced by avoiding physical exertion. If exertion does occur, the body should be cooled at regular intervals by taking breaks, by taking a cool shower, etc.
  • Ensure adequate but moderate fluid intake
  • Individuals with cardiovascular diseases should avoid using MDMA due to its stimulating effects
  • Magnesium consumed before and during use can help reduce muscle cramps
  • The neurotoxic effects of MDMA, meaning the harmful effects on the nervous system, can be reduced by using the substance less frequently
  • More tools for harm reduction can be found on our Safer Chemsex page

Cocaine

Cocaine is a common psychostimulant, particularly among occasional users, that activates the central nervous system. It’s not typically classified as a “chem”, but it is often used during sexual activity in combination with other substances.

Cocaine is sold as a white, translucent powder. It is used by snorting, intravenous injection, and sometimes orally, for example, mixed with alcohol.

The potency of cocaine is sometimes enhanced by extracting pure cocaine alkaloid (free base) through a chemical process. Free base is used by smoking it in cigarettes or a water pipe. A simpler chemical process produces crack, which is beige in colour. It is only used by smoking.

The effects of snorted cocaine begin about 3 minutes after use, while the effects of intravenous cocaine appear in about 10–15 seconds. When smoked, cocaine is immediately absorbed into the pulmonary circulation, from which it travels to the central nervous system as quickly as when injected. The effects of intravenously injected and smoked cocaine last only about 10 minutes, while snorted cocaine lasts 20–45 minutes.

The purity and potency of cocaine circulating in Finland varies greatly. Uncertainty about the purity increases the likelihood of unpleasant and unexpected effects.

  • Euphoria, increased energy, stimulated thoughts and movements, elevated mood and talkativeness
  • Increased self-esteem and improved performance
  • Reduction of social fears, inhibitions, and anxiety
  • Increased arousal and stamina during sex, heightened sensitivity, and more intense and prolonged orgasms
  • Irritability, anxiety, restlessness, mood swings, and paranoia
  • Dilated pupils
  • Reduced need for food and sleep
  • Increased body temperature
  • High blood pressure and increased heart rate
  • Increased blood oxygen and glucose levels
  • Regular use of cocaine can reduce the effectiveness of some HIV medications.
  • Prolonged cocaine use can lead to malnutrition, sleep disorders, chronic. fatigue, anxiety, depression, memory and concentration problems, headaches, seizures, and panic attacks.
  • Heavy use also increases the likelihood of paranoid thoughts and other psychotic symptoms. Symptoms can escalate into a state of psychosis lasting several days. Instructions for mental first aid can be found on the Chemsex and First Aid page here.
  • Using cocaine nasally can cause chronic rhinitis, nosebleeds, loss of sense of smell, or lead to perforation (formation of holes) of the nasal septum.
  • Smoking cocaine can cause severe irritation or burning of the respiratory tract.
  • Levamisole is often used as a cutting agent in cocaine. It can cause changes in blood cell production, skin necrosis, vasculitis, vascular blockages, and changes in brain white matter.
  • Cocaine overdose can cause respiratory depression, blood clots, arrhythmias, myocarditis, stroke, and overheating. Additional symptoms of cocaine overdose may include hallucinations, panic attacks, and paranoia.
  • Cocaine use has also been linked to sudden epileptic seizures, although a direct causal relationship has not been fully established.
  • Frequent cocaine use can lead to strong psychological dependence. Stopping use may result in fatigue, exhaustion, depression, suicidal thoughts, and paranoid thinking. With continued use, tolerance to its pleasurable effects increases.
  • Symptoms of cocaine withdrawal can occur after several consecutive doses, often leading to a “crash” characterized by restlessness, depression, sleep disturbances, and fatigue. In heavy users, stopping cocaine use may result in severe depression.
  • Using cocaine with antidepressant medications that affect serotonin function in the brain may be dangerous. It may lead to a condition known as serotonin syndrome. Symptoms of serotonin syndrome include abdominal cramps, diarrhoea, impaired consciousness, confusion, speech disorders, compulsive movements, coordination disorders, rapid heartbeat, blood pressure fluctuations, sweating, anxiety, irritability, fever, and increased reflexes.
  • Benzodiazepines can counteract the effects of cocaine and may lead to overdose when more of the substance is taken to achieve the effects.
  • Using cocaine with GHB or GBL can cause breathing difficulties and, in severe cases, respiratory arrest. Combinations of psychostimulants and central nervous system depressants can increase the risk of overdose and other serious adverse effects.
  • Cocaine may interact with amphetamine and other psychostimulants, potentially altering their effects. At the same time, it places significant strain on the heart, increasing the risk of blood clots and heart failure.
  • The combined use of ketamine and cocaine, also known as “Calvin Klein,” can dangerously increase the toxic effects of ketamine in the body.
  • Paracetamol can enhance the harmful effects of cocaine on the liver.
  • Regular use of cocaine can reduce the effectiveness of some HIV medications.
  • The combination of cocaine and alcohol is quite risky, as it causes the body to produce cocaethylene. This is a compound harmful to the heart and liver which, in severe cases, can even cause death.
  • Cocaine can be tested by tasting a small amount. Cocaine quickly numbs the tongue. If you try to melt impure or counterfeit cocaine, it does not melt evenly and it takes longer to dissolve.
  • Cocaine is best ground into a very fine powder to make use safer and avoid cocaine overdose.
  • Cocaine use should start slowly, and the substance should not be taken too much in a short time. Determining the appropriate dose can be difficult due to the impurity of the substance, but when snorting, the initial dose should be a maximum of 0.5 mg per kilogram of body weight. If injecting cocaine, the dose should be a maximum of 10 mg. The effect of an appropriate dose normally lasts up to 20 minutes, depending on the level of tolerance developed for the substance.
  • Since cocaine increases sexual arousal and stamina, it can make you overly enthusiastic. The intensity of intercourse and the numbing property of cocaine can lead to condom breakage and injuries. If cocaine is administered anally to endure rougher sex, it increases the likelihood of blood-borne infections. For this reason, it is advisable to take small breaks during sex, change to a new condom more often and check that all participants are doing well.
  • If snorting cocaine causes irritation or loss of smell, or if smoking irritates the respiratory tract, it is good to take a break from this method of use.
  • Cocaine should be avoided if you have heart, respiratory, liver, or kidney diseases, or suffer from seizure disorders or mental health conditions.
  • There is no clear consensus on the amount of cocaine that leads to overdose. An overdose can be highly dangerous and sometimes fatal. Symptoms may include confusion, tremors, seizures, breathing difficulties, nausea and vomiting, rapid heartbeat, elevated body temperature, paranoia, hallucinations, and panic attacks. If these signs occur, it is important to stop and call the emergency centre.
  • More tools for harm reduction can be found on our Safer Chemsex page.

Ketamine

Ketamine is known for its anaesthetic, pain-relieving, anti-inflammatory, and antidepressant effects. High doses of ketamine depress the central nervous system, while low doses of ketamine may act as stimulants. 

Ketamine is sold as a colourless, odourless, and tasteless liquid, white powder, or tablets. Ketamine can be mixed into non-alcoholic drinks, snorted, swallowed (“bomb“), injected intramuscularly mixed with water, or absorbed rectally (“booty bump“). The duration of ketamine’s effect is short due to its rapid elimination from the body. 

When taken orally, the effect begins in about 15 minutes and lasts less than an hour. When snorted, the effect lasts 45–90 minutes, and when swallowed or injected, up to 3 hours.

  • Sexual arousal and reduced inhibitions
  • Feelings of pleasure, happiness, and euphoria
  • Relaxation which may facilitate fisting or rough sex
  • Slowed reflexes and an impaired sense of time and space
  • Hallucinations and dissociative experiences (e.g. detachment from the body)
  • Loss of pain sensation and increased sensitivity to stimuli
  • Urination difficulties, erection problems, and difficulty achieving orgasm and/or ejaculation
  • Slurred speech, difficulty coordinating movements and dizziness
  • Rash and nasal irritation
  • Increased salivation, nausea and vomiting
  • Increased heart rate, blood pressure and intracranial pressure
  • Severe confusion, panic attacks, frightening hallucinatory experiences, mood swings, anxiety, nightmares, fear of death and psychosis
  • Reduced pain sensation, which may increase the risk encountering dangerous situations
  • Psychomotor and cognitive impairments, as well as hallucinations, may be more likely and severe in individuals with pre-existing mental health conditions
  • Long-term or frequent ketamine use can cause urinary retention, painful or bloody urination, urinary incontinence, and kidney failure. The effects on the bladder can be painful, and kidney failure can be permanent. Urination usually returns to normal when use is stopped, but sometimes surgical treatment is required.
  • Heavy ketamine use may also cause so-called “K-cramps”, or severe abdominal pain. In addition, heavy ketamine use may lead to psychotic ‘and cognitive impairments, such as memory problems and learning difficulties.
  • Ketamine use can trigger underlying, latent mental health problems. With continued ketamine use, an individual may gradually withdraw from their social and everyday life.
  • A known side effect of ketamine is called the “K-hole“. A K-hole is a coma-like state characterized by confusion and drowsiness. Signs of entering a K-hole state include blurred vision, intense hallucinations, a sense of detachment from one’s body, and a sense of inevitable death. The K-hole state usually ends without problems, except for confusion. However, a person in this state is vulnerable to sexual violence, falls, and other accident.
  • Symptoms of ketamine overdose include seizures, cardiac arrhythmias, and respiratory arrest. There is no single antidote for ketamine overdose as treatment is symptomatic. Ketamine-related deaths are often due to respiratory failure or cardiac arrest.
  • Symptoms of comedown include sadness, anxiety, memory loss, flashbacks, and visions.
  • Ketamine does not appear to cause physical dependence, but it can lead to psychological dependence and compulsive use. Withdrawal symptoms may include anxiety, panic, fatigue, aggressiveness, tremors, sweating, loss of appetite, nightmares, and depression.
  • Using ketamine with central nervous system depressants, such as alcohol or GHB or GBL, is highly dangerous. Depression of the central nervous system can lead to serious respiratory and cardiac dysfunction.
  • Ketamine should not be used with other stimulants such as methamphetamine, cocaine, or ecstasy. These substances can mask both the sedative effects of ketamine and the stimulant effects of ketamine. Therefore, the concentration level of these substances in the body may rise to toxic levels. Combined use can also lead to harmful increases in heart rate and confusion, as well as an increased risk of accidents.
  • Interactions with the antibiotic clarithromycin, herbal products (e.g. St John’s wort), and certain foods (e.g. grapefruit juice) can substantially alter the effects of ketamine, either increasing its potency or reducing its effects.
  • Since ketamine is sold as a powder, take particular care not to mistake ketamine for another powdery substance. The normal dose of ketamine is much smaller than, for example, cocaine or mephedrone. Ketamine tablets can also be mistaken for ecstasy, as they often have similar markings.
  • Use should begin with low doses, and ketamine should not be used too frequently to avoid overdose and the health problems described above.
  • Using ketamine when experiencing depression, anxiety, or other mental health symptoms is risky, as the substance may worsen these symptoms. Individuals with heart, liver, or blood pressure issues should also avoid ketamine.
  • Smoking while under the influence of ketamine can be risky. When entering a K-hole state or when motor function is impaired, there is a risk of burns, as one may not immediately notice skin burning due to the substance’s numbing and pain-relieving effects on the nervous system.
  • Injecting ketamine should be avoided, as it can cause various blood, skin, heart, and vascular problems. The substance should never be injected into a vein, as it may led to death.
  • The pain-relieving effects of ketamine can make intense or rough sex feel easier and more enjoyable. However, reduced pain perception may make it more difficult to notice injuries during sex. It’s important to take breaks and check how everyone’s doing.
  • Using ketamine alone is not advisable. There is risk is that using ketamine could lead to a dangerous experience or entering a K-hole state. It is better to use ketamine in the company of trusted and safe people who can get help and/or provide protection from sexual violence if entering a K-hole state.
  • A person in a K-hole state should be moved to a calm, dimly lit space. The duration of the K-hole state depends on the dose and method of use. If the state lasts more than 90 minutes, those present should be alert when monitoring the user, especially if there are breathing difficulties. If the person does not wake up, call the emergency centre.
  • If ketamine is used to achieve a K-hole state, it is important to ensure the safety of the surrounding environment and to sit or lie down in a place where one cannot accidentally fall or drop.
  • In case of ketamine overdose, it is important to openly inform healthcare professionals about ketamine use so that the person receives appropriate treatment.
  • It is important to disclose ketamine use before surgical procedures to ensure an adequate amount of anaesthesia is administered.
  • More tools for harm reduction can be found on our Safer Chemsex page.

Mephedrone

Mephedrone is a synthetic cathinone that stimulates the central nervous system. Its effects are comparable to amphetamine, cocaine, and MDMA (ecstasy). Trade names for the mephedrone include 3MMC and 4MMC.

Mephedrone is sold as a fine white powder or as yellowish crystalline granules that can be crushed into powder. It is also sold as a mustard or vanilla custard-coloured paste, and the colour variation depends on the composition of the substance. It has been described as having a bad smell and a metallic taste.

Mephedrone is used by snorting, swallowing wrapped in paper (“bombs“), or intravenously. It is also used in pill or capsule form, smoked, or absorbed rectally (“booty bump“).

A reasonable dose taken orally begins to take effect after about half an hour and can last for 3–4 hours. When snorted or injected, the effect begins much faster. When taken intravenously, the effect has been described as a sudden, strong rush before levelling off.

  • Feelings of euphoria, attraction, and emotional closeness with others
  • Increased confidence
  • Increased alertness, sometimes approaching compulsive attentiveness
  • Sexual arousal and increased focus on sex
  • Dehydration, excessive sweating and changes in body temperature
  • Dizziness, headaches and changes in blood pressure
  • Teeth grinding, jaw clenching and muscle twitching
  • Throat and nasal pain or injury
  • Anxiety, hyperactivity, confusion, paranoia, short-term memory impairment, and insomnia
  • A strong urge to take an additional dose, particularly when used intravenously
  • Mephedrone primarily causes psychological dependence. Tolerance can develop relatively quickly, leading to the need for increasing doses.
  • Once dependence has developed, use may result in mood swings, aggression, and psychosis. These symptoms may resemble methamphetamine-induced psychosis and can include auditory (sound), olfactory (smell), and tactile (touch) hallucinations.
  • Long-term use is associated with insomnia, loss of appetite, dehydration, and resulting exhaustion.
  • Continuous use for a day or two can be dangerous as sleep deprivation can easily lead to psychosis.
  • Disruptions in calcium metabolism, along with teeth grinding, may contribute to dental problems.
  • Chronic disturbances in blood pressure regulation can lead to heart damage, blood clots, and visual disturbances.
  • The risk of overdose is higher with intravenous use. Overdose may cause seizures, rapid heartbeat, fever, heart attack, and, in severe cases, death.
  • Mephedrone can cause significant risks when used in combination with different substances and medications. Combining mephedrone with medications, particularly psychotropic drugs and certain antidepressants, can be particularly dangerous.
  • Combining mephedrone with other psychoactive substances, particularly psychostimulants like cocaine and methamphetamine, may increase blood pressure and body temperature. Combined use may also increase the risk of harmful side effects.
  • Mephedrone is often used with GHB, GBL or other central nervous system depressants. These combinations may lead to overdose of one or more of the substances involved.
  • Alcohol should be particularly avoided in combination with mephedrone, as it can cause increased heart activity and a very severe comedown.
  • Mephedrone use should begin with low doses, while also spacing additional doses at sufficiently long intervals. This may help reduce the risk of compulsive redosing, which can occur as a side effect. Higher doses may intensify effects but also increase the risk of adverse outcomes and prolong the duration of action. When snorting mephedrone, doses should be spaced at least 20 minutes apart; when taken orally, at least 40 minutes apart.
  • Doses should be weighed to avoid overdose. Doses over 80 mg are very dangerous.
  • The least harmful method of using mephedrone is swallowing it orally. In this case, the effect begins in about half an hour and lasts 2–3 hours.
  • Snorting can cause nasal damage, inflammation, or bleeding. Using only your own clean snorting equipment can reduce the risk of infection caused by snorting.
  • When smoked, the effect of mephedrone begins quickly, but the comedown is also rapid. Therefore, it is likely to cause a desire to take another dose. It is not recommended to smoke mephedrone more than once every half hour.
  • The nose and mouth should be rinsed after each dose. This protects the nose, teeth, and mouth from the corrosive effects of mephedrone.
  • Mephedrone may trigger toxic effects by its digestion in the stomach. Therefore, when swallowing mephedrone orally, it is important to protect the stomach by eating nutritious food and drinking water. Mephedrone can create a feeling of increased energy, but it depletes the body’s energy reserves. Eating helps replenish energy and staying hydrated helps prevent dehydration. Non-alcoholic drinks are recommended.
  • If you feel too warm, seek a calm and safe place for a while. To cool the body, wear light clothing and drink cold water.
  • Under the influence of mephedrone, it is recommended to protect the eyes with sunglasses. The substance’s effect of dilating the pupils exposes the eyes to the harmful effects of sunlight.
  • More tools for harm reduction can be found on our Safer Chemsex page.

LSD

Although LSD is not typically classified as a substance used in chemsex, there is evidence to suggest that LSD is used in chemsex in Finland.

LSD (lysergic acid diethylamide) is a semi-synthetic psychedelic drug that affects cognitive function and sensory experiences. LSD is classified as a hallucinogen and causes changes in consciousness and sensory illusions. Another common name for LSD is acid.

The effect of LSD begins 30–60 minutes after ingestion and can last up to 16 hours. LSD is usually absorbed into another substance, such as paper or sugar cubes. The dose is taken orally. Other methods of use are rare.

The effects of LSD can be very individual. The size of the dose and the quality of the substance are significant, as are the user’s state of mind, expectations, and environment.

  • Visual sensory experiences
  • Euphoria, feelings of floating, and feelings of detachment from reality
  • Enhanced sensory experiences and ”psychedelic sex” that feels dreamlike
  • Changes in body temperature, increased heart rate, and increased blood pressure
  • Nausea, tremors, dizziness and drowsiness
  • Muscle stiffness, heightened tactile sensitivity and sensory disturbances
  • Dilated pupils and increased sensitivity to light
  • Experience of losing one’s sense of self and the fragmentation of reality, which can lead to anxiety, fear, and, in some cases, panic attacks
  • Unconscious thoughts, feelings, memories, and traumas surfacing
  • Worsening of mental health problems or triggering of psychosis in individuals with a (often unknown) higher risk
  • Typically, an LSD user recognises that sensory changes are caused by the substance and does not mistake them for everyday reality. True hallucinations are relatively rare and usually occur at higher doses.
  • LSD does not cause physical dependence or withdrawal symptoms, and the development of psychological dependence is rare.
  • With repeated use, tolerance to LSD and other psychedelics increases very rapidly if used for several consecutive days. However, tolerance returns to normal within a few days.
  • Combining with stimulants such as amphetamine should be avoided. Combined use increases the risk of psychosis.
  • Different people react very differently to LSD and different doses. Larger doses especially intensify the undesired psychological effects. If you try the substance, it is advisable to start with very small amounts, as the intensity and long duration of the effects may sometimes come as a surprise.
  • LSD amplifies the feelings and thoughts that are most prominent in the mind of the user at the moment of use. The substance should only not be used when feeling anxious, sad, or The substance should not be used when feeling anxious, depressed, or otherwise emotionally distressed.
  • LSD should not be used if there is suspicion of underlying mental health problems and/or risk of psychosis. For a mild panic attack, keeping company, calm conversation, and waiting can help. More information on mental first aid can be found in the Chemsex and First Aid section.
  • A person under the influence of LSD has an altered perception of reality and may be prone hurting themselves or harming their environment. The risk of accidents is high, especially if the drug is used in a public place or without supervision. The substance should be used in a safe, private environment, preferably under the supervision of a sober or less intoxicated person.
  • More tools for harm reduction can be found on our Safer Chemsex page.

Alpha-PVP

There is evidence to suggest that alpha-PVP is used to some extent in chemsex in Finland.

Alpha-PVP is a very strong synthetic stimulant, a cathinone classified as a narcotic. Its effects are similar to amphetamine and cocaine but are often much stronger and more unpredictable. Names for alpha-PVP include PV, flakka, and thumb.

The substance can appear as a white or coloured powder, crystals, or tablets. It is used by snorting, smoking, in capsule form, or intravenously.

Alpha-PVP affects the central nervous system, leading to rapid and strong stimulation. The effects begin quickly and often last from 15 minutes to two hours. The risk of the short effect is repeated dosing and the rapid development of a remarkably strong dependence. The effects of large or repeated doses can last for several hours, sometimes even days.

  • Strongly increased energy and euphoria
  • Strong increase in sexual desire and arousal
  • Increased heart rate and blood pressure
  • Excessive sweating, nausea
  • Muscle cramps, tremors, seizures and decreased level of consciousness
  • Restlessness, compulsive movements
  • Aggression, impulsive or violent behaviour, loss of self-preservation instinct
  • Confusion, panic attacks, and psychotic symptoms like delusions, paranoia, and hallucinations
  • A strong urge to take another dose
  • Alpha-PVP is a highly addictive substance that can lead to dependence very quickly. It can cause addiction and a compulsive urge to take another dose, sometimes even after a single dose.
  • Using alpha-PVP, especially by smoking or intravenously, increases the risk of difficult-to-treat abscesses. Abscesses often occur in the limbs and can lead to tissue damage, even amputation.
  • If the substance is smoked, the combustion residues can irritate the skin and mucous membranes.
  • General deterioration of health and weight loss. Alpha-PVP reduces appetite and depletes the body’s energy reserves. Overall resistance weakens, making the user more vulnerable to infections and slow-healing wounds.
  • With higher doses and prolonged use, there is a strong risk of psychosis.
  • Risk of seizures, heart attack, and cerebrovascular disorders
  • Long-term use can lead to insomnia, self-destructive behaviour, and memory disorders.
  • Strong withdrawal symptoms, such as anxiety and depression
  • Combining alpha-PVP with different substances can lead to unpredictable and difficult consequences. Combined use can result in unconsciousness or, in the worst case, death.
  • An addiction to Alpha-PVP can develop very quickly, even after a single dose. If possible, try to choose other substances instead of alpha-PVP.
  • Alpha-PVP should never be used alone. A psychotic reaction may occur quickly after receiving a dose and the user may not be able to take care of themselves
  • Breaks are important when using alpha-PVP. Overloading the body can lead to a serious reaction.
  • It is important to ensure to adequate fluid and nutrient intake. It’s good to remind the person using alpha-PVP about hydrating and eating. One may forget to take care of basic needs while under the influence of alpha-PVP, and dehydration worsens the undesired effects.
  • If symptoms from alpha-PVP use (for example confusion, aggressiveness, seizures) are uncontrollable, call the emergency number 112 immediately. It is important to tell what substance has been used and in which of method of use, as this helps rescuers provide the appropriate care.
  • Because of the reputation of alpha-PVP and the media discussion surrounding the substance, using alpha-PVP can sometimes cause feelings of shame. For some people, this may even prevent them from seeking advice or support when they feel they need it. Every person is equally valuable and deserves to be treated with respect, regardless of what substances they use. If you would like to talk about chemsex involving alpha-PVP use, you are warmly welcome to our confidential counselling service.
  • More tools for harm reduction can be found on our Safer Chemsex page.

Poppers

Poppers is a general term for a group of inhaled alkyl nitrites. They are not classified as “chems” or substances used in chemsex, but they are often used in chemsex in combination with other substances to enhance the sexual experience, e.g. to relax the anal sphincter muscle.

Poppers are a highly volatile liquid. They are used by inhaling the evaporating substance from an open small bottle through the nose. Poppers should never be swallowed.

Although poppers have been used for a long time, their mechanisms of action and associated risks are still poorly understood. The effect begins almost immediately and ends after a few minutes. Other substances used at the same time may prolong the effect of poppers.

  • Warmth and euphoria
  • Mild intoxication
  • Vasodilation (widening of blood vessels) and lowered blood pressure
  • Relaxation of smooth muscles, such as the anal sphincter, which can make anal sex easier for the receptive partner (bottom)
  • Increased arousal
  • Flushing of the face and neck, headache
  • Heart palpitations (poppers use can be dangerous for individuals with heart problems, such as arrhythmias)
  • Mild allergic reactions
  • Laughing fits
  • Irritation of the respiratory tract and the skin and mucous membranes of the nasal area
  • Mild visual disturbances, with persistent symptoms occurring only rarely
  • Increased risk of accidents
  • Increased risk of panic attacks or epileptic seizures
  • Temporary impairment of oxygen transport in the blood, which in rare cases can become life-threatening
  • Temporary weakening of the immune defence
  • Increased activity of certain cancer-promoting genes for several hours, with repeated use potentially increasing the risk of cancer
  • Development of psychological dependence and tolerance
  • Increased risk of undesired effects with long-term use
  • When used with other substances, the duration of poppers’ effects may be prolonged, and side effects may increase.
  • Using poppers with blood pressure-lowering medications, particularly erectile dysfunction medications such as Viagra, is dangerous and can even lead to life-threatening low blood pressure.
  • Irritation of the nasal area caused by poppers may be reduced by absorbing the substance into cotton balls (so-called cotton filters), which are stored in an empty, sealable bottle. This also reduces the risk of the substance spilling onto the face or other areas of skin. When handling or administering the substance, it is important to avoid direct skin contact. For example, protective gloves may be used.
  • Poppers should never be drunk. When taken orally, poppers are very dangerous and do not produce the desired intoxicating effect.
  • Poppers are easily flammable, so caution should be exercised when handling them, particularly when smoking.
  • More tools for harm reduction can be found on our Safer Chemsex page.

Erectile dysfunction medications

Erectile dysfunction medications are used to treat erectile dysfunction and to enhance or prolong erections. These medications are available as oral tablets or as locally administered products. Most erectile dysfunction medications require a prescription, although over-the-counter self-care products for local use are also available.

Many people use erectile dysfunction medications in chemsex to gain confidence and maintain an erection during prolonged intercourse. Erectile dysfunction medications may also be used because many substances, especially stimulants, can cause erectile problems. Erectile dysfunction may also result from neurological, psychological, or cardiovascular conditions, medication side effects, or the combined effects of different substances. 

Oral erectile dysfunction medications are typically taken 30–60 minutes before sexual activity. The duration of effect depends on the specific medication and usually ranges from approximately 4 to 36 hours. These medications do not cause an erection on their own as sexual arousal is required for them to work. They improve blood flow to the penis and can significantly enhance erectile function.

Locally administered erectile dysfunction treatments include urethral suppositories, erection gels, and injectable medications. Unlike oral medications, these treatments may induce an erection without sexual arousal or stimulation.

  • A prolonged, strong erection
  • Increased confidence
  • Avoidance of erectile problems caused by stimulants
  • The most common side effects of oral erectile dysfunction medications are flushing of the face and upper body, nasal congestion, and headache.
  • Long-acting medications, such as tadalafil, can cause muscle pain.
  • The most common side effect of locally administered urethral medication is local burning or pain in the urethra.
  • The most common side effect of locally administered erection gel is burning sensation to the applied area.
  • Erections caused by injectable erectile dysfunction medications may, in some cases, lead to priapism—a prolonged and sometimes painful erection that occurs independently of sexual arousal or voluntary control. First aid instructions for priapism can be found on the Chemsex and First Aid page.
  • Frequent use of erectile dysfunction medications can cause psychological dependence.
  • Combining erectile dysfunction medications with GHB, GBL, or poppers can cause sudden blood pressure dysregulation. Combined use can, in severe cases, lead to cardiac arrest.
  • The combined use of erectile dysfunction medications with methamphetamine can lead to disruptions in blood pressure regulation, heart attack, or blood clots.
  • Nitrates should never be used at the same time as erectile dysfunction medication. Concurrent use may be life-threatening.
  • Not all erectile dysfunction medications are suitable for daily use. It is advisable to start using erectile dysfunction medications with low doses and follow the medication’s instructions.
  • In addition to erectile dysfunction medications, it is worth exploring non-pharmacological methods to enhance and prolong erections. These can include, for example, cock rings and penis pumps, as well as condoms, gels, and sprays that delay ejaculation.
  • If erectile dysfunction medications cause problems and dependence and you’d like to reduce or quit the use, reducing or taking a break from chemsex may be helpful. Assistance can also be sought from healthcare or sexual health professionals or Hivpoint’s counselling.
  • More tools for harm reduction can be found on our Safer Chemsex page.

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