[Interview to be found in the spring issue of Têtu, on newsstands or by subscription.] A psychiatrist at the public hospital and cofounder of the Pop & Psy festival, Dr. Jean‑Victor Blanc publishes on April 3 Des amours chimiques (Seuil), a didactic book about “the scourge of chemsex”, nourished by clinical cases, recent studies, as well as cultural references.
You open your book, Des amours chimiques, le fléau du chemsex, with a question: “Are gay men okay?” Why is this essential for understanding the phenomenon?
For two reasons. First, because it’s my job, as a psychiatrist, to take an interest in people who are not doing well. My view of chemsex starts from specialized consultation for patients who have become unwell because of it. Second, because the chemsex epidemic, in my view, is a mirror of the mental health of gay men. A mirror that returns a fairly worrying image of a community that is not faring well: chemsex exacerbates distress and vulnerabilities that were already present.
Where, in your view, do these vulnerabilities come from?
Distress often traces back to childhood, with questions and anxieties related to sexual orientation or gender identity. The men I see, who are on average around forty, have for many of them felt very early on a shame tied to their desire for boys or to a masculinity that differed from prevailing stereotypes. Many of them have been victims of harassment and/or family violence. Their coming out has, moreover, often brought about a form of rejection. Finally, a third of them experienced sexual violence during childhood.
The men you see come from different backgrounds and have followed diverse paths. Is there anything that ties them together beyond the groundwork you just described?
All these men share a certain solitude. We also frequently observe a mourning, a breakup, or a job loss at the moment they enter chemsex, or at the moment the practice becomes problematic. For many, this may have been the confinements during the Covid pandemic. Studies also show that many are more vulnerable than average: the most precarious, the racialized men, the oldest, in short, all those who are the most marginalized, or even excluded.
Beyond individual factors, you also describe chemsex as a social phenomenon.
Chemsex is emblematic of societal dynamics that go far beyond the gay community: the effects of social networks on human and romantic relationships, the cult of appearance and performance… In terms of drugs, it is also the arrival of new synthetic products in Europe, and the normalization of injection. This phenomenon is emblematic of many things that are at work in our society.
In the clinical cases you relate, the themes of shame and silence frequently reappear, which bring back memories…
If the issue of chemsex took so long to emerge, it is precisely because it touches three taboos: sexuality in general, homosexuality in particular, and drugs. This cocktail delays seeking care. It is no accident that some draw a parallel between the chemsex scourge and the HIV/AIDS epidemic: both proliferated because of silence, discrimination, and taboos, before a collective rally.
The “happy chemsexer” — is it a myth?
In my psychiatry and addiction consultation, I do not, by definition, encounter happy chemsexers. But indeed, not every drug use is pathological. In the case of chemsex, nearly half of users report a negative impact of their consumption. This is often the case when it responds to despair, distress, or a desire to escape from a reality too difficult to bear. The fact remains that chemsex wreaks havoc and has already claimed too many lives.
When does chemsex become pathological?
Use becomes problematic when there is a loss of control over consumption and when it affects mental or physical health, social life or romantic life, work, etc. There are other severity criteria, such as the practice of slam (injecting the product), more addictive, or the loss of the ability to have sexual relations without using products.
What message would you like to send to those who recognize themselves in problematic use?
First: do not stay alone. Shame only worsens the problem. The entry points to care are multiple: associations like Narcotics Anonymous or AIDES, health professionals in infectious diseases, who are increasingly well trained, and, of course, professionals in mental health.
As is often the case with addiction, the idea of having to stop all consumption can hinder seeing an addiction specialist. Is abstinence a compulsory step?
It is up to each individual to define their project: risk reduction, reduction of consumption, or total sobriety. This is a fundamental principle of addiction medicine. But it is true that with drugs as addictive as 3‑MMC and GHB, it is easier to stop completely than to achieve mastery over one’s consumption.
Beyond the consumers, you also address their entourage…
This book is not a care manual; I wanted to present the complexity of the phenomenon. But indeed, anyone can be affected, at least as a close one. Between 10% and 20% of gay or bisexual men practice chemsex: that represents many families, friends, partners… We cannot therefore confine this issue to the users alone.
You call for a community surge in response to chemsex. Is that a sine qua non condition to reverse the trend?
It would be naïve and dangerous to think that things will change solely through political actions, external to the community. We must foster attention to others, look after the most vulnerable, rebuild mutual support. It is also a means of fighting sexual violence that occurs during chemsex plans and that affects nearly 40% of users. I see evolving signs within the community already, notably an increased attention to mental health. What I aimed to convey with this book is a better understanding of the phenomenon, but also hope about our ability to face it.
