L’apparition au cours des dix dernières années des « nouvelles substances psychoactives » appelées également « NPS » modifie pour la première fois, de façon profonde, le monde des drogues qui passe d’une dizaine de produits à près d’une centaine. La veille sanitaire représente un outil de surveillance de ce phénomène : une augmentation de l’utilisation des cathinones de synthèse (méphédrone, NRG3, 4-MEC…) a été observée et pose de nouveaux défis aux cliniciens. Le CEIP de Paris et le centre Marmottan ont voulu dresser un tableau de la consommation de cathinones en Île-de-France et alerter la communauté des services de santé concernant les problèmes liés à l’identification des abus et les risques associés. Nous présentons la relation entre sexe et drogues en raison de l’effet spécifique que les cathinones pourraient avoir sur les pratiques sexuelles. Le point marquant est l’apparition d’une pratique de consommation de stimulants par voie intraveineuse appelée « slam » au sein des hommes qui ont des rapports sexuels avec des hommes (HSH). Le « slam » comprend trois caractéristiques : injections, dans un contexte sexuel et usage de drogues psychostimulantes. Le risque sanitaire s’inscrit à la fois dans le syndrome de dépendance/abus, impliquant un « craving » important, des symptômes psychiatriques prolongés, et dans le risque infectieux (VIH, VHB, VHC…). Il semble important de moins dissocier les réseaux sexuels, des réseaux d’addiction pour la réduction du risque.

The pattern of recreational drug use has changed over the last decade and now includes a multitude of substances sold as “research chemicals” or new psychoactive substances, “NPS”. In France, synthetic cathinones emerged in 2008 (while first mentioned by the French police force in 2007 first alerts among users appeared in 2008) and have grown to be popular drugs of abuse. Under the Official Journal dated 11th June 2010, only mephedrone has been listed as narcotics but “designer drugs” have synthesized new substitute cathinones in order to avoid anti-drug laws. However, since July 2012, in France, all synthetic drugs from the cathinones family have been banned and listed as narcotics following the example of United Kingdom. Despite their recent classification and inclusion on narcotic list, they are readily available on Internet and used widely. Paris Addictovigilance Centre observed a signal of derivate cathinones abuse (21 cases over a two-year period).

Paris Addictovigilance Centre and Marmottan Hospital wanted to describe the use of cathinones in the Paris area and alert the health care community about the abuse identification and risk assessment problems of these compounds. After a review of derivated cathinone's chemical structure, pharmacology and toxicology, this article seeks to provide patricians with a clinical description and treatment's modality.

Most users of synthetic cathinones will experience euphoria, increased energy, talkativeness, openness and increased sexual arousal. Signs and symptoms of toxicity are consistent with a sympathomimetic toxidrome. The main reasons for care access are psychiatric (hallucinations, psychotic symptoms, agitation) and addiction disorders. Somatic complications were described with various patterns of symptoms such as headache, tachycardia, confusional states, rhabdomyolysis with renal failure or serotonin syndrome. The most important fact is the apparition of the “slam” phenomenon among men who have sex with men (MSM). The “slam” is a compound of three characteristic elements: injection, sexual party and psychostimulant drug. According to users, “slam” is convenient for group sex and is used it to put them into a good mood and a disinhibition state. These compounds cause fast dependence syndrome with strong craving and prolonged psychiatric symptoms and increase infectious risk (HIV, VHC, VHB…). The cathinones family is not detected in conventional urine drug screenings. We point out the lack of confirmatory analytic testing data which remains the only way to determine the actual etiology of the clinical effects observed since drug users do not always know exactly what they took. These substances can be identified by special analyses using gas chromatography or liquid chromatography and mass spectroscopy technology.

This injection drug is used in order to increase sexual desire, delay orgasm and decrease sexual inhibition and is prevalent in many studies on MSM samples. Cathinones would popularize the “slam”. Harm reduction policy requires specific MSM interventions on both sexual and drug addiction networks.