The Highs and Lows of Sex on Drugs

It’s best for people who have sex on drugs to exert some effort into minimizing the risks.
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The sober truth about drug-fueled sex. Photo: Uwe Krejci, Getty

Sex, as the saying goes, is like pizza—when it’s good, it’s good, and when it’s bad, it’s still pretty good. But for some people, sex on its own just doesn’t cut it. That’s why they have it while high on drugs


From deliberate “party and play” hookups to long-term couples trying to take their relationships to higher ground, people have been experimenting with drugs to heighten their sexual experience for as long as there have been sex and drugs. Many say the combination increases pleasure, but many are also keenly aware of the practice’s potential pitfalls.

Bart, 40, from Manila, Philippines, regularly uses MDMA while having sex. He also sometimes has sex while high on weed, cocaine, or acid. Bart is a pseudonym used to protect the subject from the legal repercussions of using illicit substances. 

“Sober sex is still fun and it still achieves its purpose—intimacy, sexual expression, all that. But sex on drugs is like doing it in all caps and italics and underline and bold. On acid, it’s Windings,” Bart told VICE. 

He described the feeling of having sex on drugs as having heightened sensations and emotions. There are also fewer inhibitions, but he was careful to note that, at least for him, not a complete absence of them. “I’m still very careful,” he said. “My judgment isn’t impaired. Although I’ve heard so many stories of other people’s judgments being impaired, mine isn’t.”


Staci Tanouye, an obstetrician-gynecologist based in Florida, said that the main risk of having sex on drugs, aside from the ones posed by using the drugs themselves, is that the drugs cloud people’s judgment, potentially making them less likely to practice safe sex through using contraceptives or ensuring enthusiastic consent for all parties. 

There are also non-medical risks that might come from having sex high. Bart said that because it can feel so good and the people involved are bombarded with so many emotions, they could say things during sex that they won’t necessarily mean when they’re sober. They could also do things that the other party could read into as meaning more than they meant. “Chemical romances,” as they’re sometimes called, can turn into complicated sober relationships. 

Ethan, 37, also from Manila, uses MDMA, ketamine, or poppers while having sex. Ethan is also a pseudonym used to protect the subject from the legal repercussions of using illicit substances. 

“The number one reason is that it feels a lot better,” he said.

For him, it’s not just about making a good thing great. It’s about making a usually difficult thing easy. He said that when he bottoms sober, the experience is mostly of pain. But when he’s high, he worries less and becomes less inhibited, which makes it pleasurable. He uses drugs in group sex settings, too, and said they make him more open and comfortable around other people. 


Different drugs affect sex in different ways. Ethan said that both ketamine and MDMA make him hornier, but it’s easier for him to get hard while on ketamine than it is on MDMA. As one might imagine, it’s frustrating for people who use their penis during sex to be so high and horny but unable to get an erection. That’s why Ethan, like others, sometimes turns to drugs like Viagra. They work at times, he said, but not always. 

According to Christopher Hetzer, a nurse and sexual health and harm reduction advocate based in Ohio, having sex on drugs could lead to increased body temperature, heart rate, and blood pressure, as well as seizures, dehydration, and the transmission of diseases like HIV and hepatitis. There are also the risks of dependence and overdose.

But there are more risks, some of which people might not be aware of.

“Folks don’t consider drug interactions when using a combination of substances and erectile dysfunction medications. In these cases, the body has both vasoconstricting and vasodilating chemicals being metabolized. This will increase risk of heart attack, stroke, or other fatal conditions,” Hetzer said. 

While some people will take the risk of mixing substances in order to better enjoy sex on drugs, other people choose to change the way they think of sex while they’re on drugs altogether. 


“A lot of people stress about getting hard when it comes to sex on drugs. I know the chance of getting hard on drugs isn’t very high, so that expectation is out the window,” said Bart. 

Instead of focusing on whether or not he’s hard and actually fucking to completion, he said he’s learned to think of sex on drugs as more about the journey than the destination. He enjoys the increased sensations from physical contact and the heightened emotions without the pressure to penetrate or cum. 

In any case, it’s best for people who have sex on drugs to exert some effort into minimizing the risks. 

Both Bart and Ethan said that while they enjoy themselves when they’re high and having sex, they also take the necessary steps to make sure they avoid harm. Bart sets an intention before he takes the drugs, to help him keep his wits and make good decisions. Both make sure to only have sex with people they know and trust and in places they know are safe. They also both set a “cut-off time” for each hook-up, or a point when they stop taking more drugs and stop having sex, no matter what. 

Tanouye, the obstetrician-gynecologist, said that people can reduce harm by keeping condoms on hand and actually using them, or, for people who can get pregnant, using a long-acting contraception option like an IUD or subdermal arm implant, staying in the company of people they know and trust, and regularly getting tested for STIs. 


Hetzer, the nurse, said that it’s important to learn about how STIs are transmitted, ask a doctor about PrEP, have safe access to fentanyl testing strips, and clean syringe and needle supplies and safe injection kits (for people who inject their drugs).

“[Harm reduction] sites are vital because they create a safe environment for people to come and build relationships with healthcare personnel. This relationship building is beneficial because it creates a trusting relationship for when people need help or when they are ready to change directions in their lives, the foundation has already been set.”

While it’s easy to deride people who use drugs for sex as careless hedonists, it’s also important to remember that sustained substance use, for sex or otherwise, is not always a choice. “It has roots in unresolved trauma and pain, wanting to feel included, increase sexual performance or body image, and increase in confidence,” said Hetzer. 

Bart said that for him, having sex on drugs doesn’t mean abandoning judgment. “It just means a heightened sense of intimacy [and] maybe less biases.” 

The views and opinions expressed in this article are solely that of the interviewees. VICE neither endorses nor encourages consumption of narcotics/psychotropic substances.

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