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Mephedrone, 3-methylmethcathinone (3-MMC), and 4-methylethcathinone (4-MEC) are the most commonly substances used in slam ( 10, 21), but new synthetic cathinones appear monthly on the illicit drug market, making knowledge of these substances and their impact on users even more complex. Nevertheless, cathinone use is not without risks, since fatalities have been associated with the consumption of various cathinones ( 20). ( 19) identified motivations for combining sex and these drugs they increase libido, confidence, disinhibition, and stamina, enhance qualities of the sex, and make other men seem more attractive, increase physical sensations, intensify perceptions of intimacy, and facilitate a sense of sexual adventure. Synthetic cathinones are used for their stimulant and entactogenic effects desired effects include euphoria, intensification of sensory perceptions, increase in sociability, increase in energy, and increase in sexual performance, which is precisely why they are used in slam ( 16). Animal studies have shown that synthetic cathinones have reinforcing properties and abuse liability ( 18). The pharmacological properties of synthetic cathinones differ from molecule to molecule, but they exert their effects by increasing the concentration of catecholamines such as dopamine, serotonin, and norepinephrine in the synaptic cleft ( 16).
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The molecular structure of cathinone can be modified in various ways to produce a series of compounds chemically related to it, and this technique has been used to circumvent international drug laws ( 17).
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Synthetic cathinones are a large group of stimulants chemically related to cathinone, a phenethylamine that is the most potent amphetamine-like compound naturally present in the khat plant ( Catha edulis, Peter Forsskål, 1775) ( 16). In Europe, and more particularly in France, this practice is associated with the use of specific psychostimulant substances in the synthetic cathinone family. For several years, there has been emerging evidence focusing on high-risk sexual practices and infectious harms ( 11– 15) but not on the substances used in this specific context. According to the French Monitoring Centre for Drugs and Drug Addiction (OFDT), slam is a form of chemsex defined by (i) the use of psychostimulants (ii) through the intravenous route of administration (iii) in a sexual context ( 10). Slam has emerged as a new phenomenon in Western Europe ( 1, 2) among men who have sex with men (MSM) since 2008 and has also emerged in Southeast Asia ( 3– 5), North America ( 6, 7), and Australia ( 8, 9), where it is called “party and play” or “intensive sex partying”.