Post – Revue Psychotropes

English

Chemsex is defined as the use of psychoactive substances before or during sexual relations to enhance sexual performance, duration, and pleasure. This practice can have major health consequences for individuals (addictive and somatic complications) and the population (transmission of viral or bacterial infections). Chemsex emerged in France in 2009, following the appearance of new psychoactive substances (NPS) and the internet (where users can buy drugs and connect to dating websites). The population most affected by chemsex is men who have sex with men (MSM). The Addictovigilance network plays an important role in monitoring the health complications of chemsex practice, using clear indicators. It monitors medico-legal complications (via spiking records and the annual DRAMES register showing changes in death rates) and serious events such as addictive-psychiatric, neurological, and cardiovascular disorders and infectious diseases (via spontaneous notifications). This article offers updated addictovigilance data, showing a significant and worrying increase in complications and deaths linked to chemsex since 2008 (the number of cases increased by a factor of three in five years). The low-level persistence of chemsex using injectable drugs has been noted in the data, leading to the transmission of infectious diseases, which may be complicated by septic arthritis. However, among the chemsex population, previous medical history of HIV, HCV, or other STIs is declining. The substance class most reported is still synthetic cathinones, used with or without cocaine and GHB/GBL. Cathinones are evolving with the emergence of chlorinated derivatives of the 3-CMC/4-CMC type. The main complications are substance-related disorders, infections (mainly abscesses, hypodermatitis, and necrosis), neurological disorders most often involving G-holes (overdose linked to GHB/GBL), psychiatric disorders (psychoses with hallucinations, delirium, anxiety, and depression) and cardiovascular complications linked to the toxicity of the products. Sexual assaults and cases of possible spiking highlight the greater risk of sexual abuse or non-consensual sexual relations in chemsex situations. The introduction of multidisciplinary interventions has enabled health practitioners to treat chemsexers with a holistic (addicto-psycho-socio-sexological), step-by-step approach. PrEP and risk reduction in terms of sexual behavior and consumption of psychoactive substances form part of this treatment. The reduction in the number of previous infections among users should be highlighted. Initiatives on all fronts, from health care professionals to civil society, must continue in order to tackle this phenomenon.