Gaseous molecules and ions, and even dust grains, can accumulate charge in the interstellar medium (ISM) by harvesting the energy of UV photons, cosmic rays, helium ions and metastable atoms. This Perspective views the various modes of gas-phase formation of multiply-charged cations and the possible impact of their reactions on the chemical and ionization structure of the ISM, in the light of what is still very limited knowledge. Emphasis is given to gas-phase reactions of multiply-charged cations with atoms, molecules and electrons that lead to charge reduction, charge separation and chemical bond formation and these are examined for multiply-charged atoms, small molecules, hydrocarbons, polycyclic aromatic hydrocarbons and fullerenes, primarily as dications but also as a function of charge state. The increased electrostatic interaction due to multiple charge is seen to promote bonding to individual charge sites on large molecules (e. g. fullerenes) and allow ensuing "surface'' chemistry under the influence of Coulomb repulsion. The unique ability of multiply charged cations to undergo charge separation reactions, either unimolecular or bimolecular, can feature in the production in the ISM of internally cold, but translationally hot, cations of lower charge state or hot atoms that may provide the driving force for subsequent chemical reactions in what is otherwise an ultracold environment. Available chemical kinetic models that account for the role of multiply-charged ions in the ISM are few and of limited scope and the observation of these ions in the ISM has remained elusive.
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