The growing healthcare challenges associated with chemsex were the focus of a dedicated session during the Albatros International Congress on Addiction 2026, held on June 9-11.

Presentations by Iris Bichard, head of services at Checkpoint Paris, and Robin Drevet of the Modus Vivendi Association in Belgium emphasized the need for comprehensive, patient-centered care that integrates sexual health, harm reduction, and mental health services.

Sexual Health

During the session, Bichard noted that sexual health extended beyond the absence of disease or dysfunction. In line with the World Health Organization’s definition, it also encompasses sexual pleasure, comfort, intimacy, pain, discomfort, and a lack of desire, all of which contribute to overall well-being. She emphasized that sexual health should be considered an integral component of care for individuals who engage in chemsex.

Chemsex refers to the use of psychoactive substances during sexual activity, often to enhance sexual pleasure or performance. Approximately 85% of the individuals who engage in chemsex are men who have sex with men.

According to Bichard, these substances bypass the phase of sexual desire and directly lead to sexual arousal. They may also delay or prevent orgasm. Consequently, individuals who stop engaging in chemsex often need to relearn how to experience desire, arousal, intimacy, and sexual satisfaction without substance use.

Bichard recommended that clinicians routinely address the following four key questions during consultations:

• Do you enjoy sex?
• Do you experience pain during sexual intercourse?
• Do you feel free to say yes or no to sex?
• What measures do you take to prevent sexually transmitted infections (STIs)?

She also recommended STI screening every 3 months.

Bichard also highlighted FormaSantéSexuelle, an online sexual health training platform for healthcare professionals.

Common Substances

Drevet reviewed the substances most commonly used for chemsex in Belgium.

• Cathinones are synthetic stimulants with amphetamine-like properties that include dozens of different compounds. The previously dominant 3-methylmethcathinone (MMC) has been replaced by 2-MMC, 4-chloromethcathinone, and N-ethylnorpentedrone (NEP).
• Cathinones act as stimulants and entactogens, thereby increasing the feelings of emotional closeness and physical intimacy. NEP is estimated to be approximately seven times more potent than MMC compounds, although many users are unaware of its greater potency. Adverse effects include severe tachycardia, cardiac arrhythmias, acute anxiety, paranoia, hallucinations, psychotic episodes, and insomnia that may persist for several days after use.
• Gamma-hydroxybutyrate and gamma-butyrolactone are central nervous system depressants that promote disinhibition. Combining either substance with alcohol or benzodiazepines carries a high risk for fatal overdose because the margin between the desired effect and overdose is very narrow.
• Methamphetamine is widely used in Belgium but is less common in France. It is often administered intravenously, increasing the risk for infections, injection-related wounds, and other complications. The drug produces intense, long-lasting effects, has a high potential for dependence, and is associated with a substantial psychiatric risk.

Ongoing Challenges

According to Drevet, one of the greatest challenges in Belgium is the limited capacity of specialized services and the ongoing need to strengthen harm reduction policies.

He identified three priorities for improving care.

• Long-term funding for specialized services.
• Stronger community surveillance to detect emerging substances, changing patterns of use, and to adapt prevention strategies accordingly.
• Integrating harm reduction initiatives into health services, sexual health, and mental health services.

This story was translated from Univadis France, part of the Medscape Professional Network.