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BackgroundChemsex is defined as the use of psychostimulants (GHB/GBL, synthetic cathinones and crystal methamphetamine) during sexual intercourse, particularly among MSM. These drugs are often used in combination with other substances varying by geographical contexts.A previous 2024 survey conducted in two STI services in Milan reported a high prevalence of drug use (33%) among PrEP users, with 16% engaging in chemsex.The aim of our study is to assess changes in substance use over the past year and, secondly, evaluating the proportion of problematic use.MethodsFrom January to March 2025, we conducted an anonymous online survey among PrEP users attending two STI services in Milan: one hospital-based and one community-based. Data collected included drug use, frequency and type, chemsex practices, use of PDE5 inhibitors and physical enhancers, perceptions of problematic use, and requests for psychological support.For descriptive statistics, continuous variables are expressed as median and IQR, and categorical variables as absolute numbers and percentages. Changes in chemsex and drug use prevalence between 2024 and 2025 were analyzed using two-proportion z-tests.Results376 PrEP users completed the questionnaire. The median age was 38 years (IQR 33 – 45), 98% (370/376) were assigned male at birth, and 365/376 (97%) identified as GBMSM.In the past year, 119/376 (32%) reported drug use (110/376, 29% in the past 6 months) and 22% (81/376) reported chemsex practice (74/376, 20% in the past 6 months).5% (6/119) reported using substances >1/week, 16% (19/119) weekly, 31% (37/119) >1/month, 11% (13/119) monthly and finally 37% (44/119) <1/month.Among chemsex-specific substances, mephedrone was the most commonly used (38%, 45/119), followed by GHB/GBL (22%, 26/119), MDPV (13%, 16/119) and crystal meth (8%, 9/119). Among other substances, cocaine was the most frequently reported (23%, 27/119; crack 8%, 10/119), secondly MDMA (21%, 25/119) and ketamine (14%, 17/119). Table 1 and figure 1 show the proportion of specific substances use.20/376 (5%) of respondents reported using physical enhancers (testosterone, SARMs), of whom 55% (11/20) co-used chems.54% (44/81) of those who engaged in chemsex also used PDE5 inhibitors.Problematic use was reported by 30% (24/81) of chemsex practicing, with 29% (7/24) seeking psychological support.Compared to 2024, overall substance use remained stable (32% in 2025 vs. 33% in 2024, p = 0.6). However, the prevalence of chemsex increased significantly from 14% (52/365) in 2024 to 22% (81/376) in 2025 (p =0.01).Abstract OC56 Table 1Differences in chems, chemsex practice and specific drug use in 2024 and 2025 (MDPV: methylenedioxypyrovalerone; GHB/GBL: gamma hydroxybutyrate/gamma butyrolactone; MDMA: 3,4- methylenedioxymethamphetamine)Abstract OC56 Figure 1Differences in the prevalence of chems use, chemsex practice and specific substance use between 2024 and 2025. (No dataregarding crack use in 2024 because data was collected along with cocaine)[Figure omitted. See PDF]ConclusionsOur survey found a high prevalence of chemsex among PrEP users, with an increasing trend since last year. It also revealed problematic drug use among a significant proportion of chemsex users (30%).These findings highlight the urgent need to raise awareness among healthcare professionals, enabling them to screen for problematic drug use and facilitate referrals to specialized support services.

\"San Francisco is about to receive the biggest delivery of MDMA to hit the West Coast in years. Raymond Gaspar, just out of prison, is sent to the city to check in on the increasingly erratic dealer expected to take care of distribution. In Miami, the man responsible for getting the drugs across the Pacific has just met the girl of his dreams--a woman who can't seem to keep her story straight. And thousands of miles away in Bangkok, someone farther up the supply chain is about to make a phone call that will put all their lives at risk. Stretching from the Golden Triangle of Southeast Asia to the Golden Gate of San Francisco.\"--Jacket.

\"The two Muslim poets featured in Scott Kugle's comparative study lived separate lives during the eighteenth and early-nineteenth centuries in the Deccan region of southern India. Here, they meet in the realm of literary imagination, illuminating the complexity of gender, sexuality, and religious practice in South Asian Islamic culture. Kugle argues that Sun and Moon expressed through their poetry exceptions to the general rules of heteronormativity and gender inequality common in their patriarchal societies. Their art provides a lens for a more subtle understanding of both the reach and the limitations of gender roles in Islamic and South Asian culture and underscores how the arts of poetry, music, and dance are integral to Islamic religious life. Integrated throughout are Kugle's translations of Urdu and Persian poetry previously unavailable in English\" -- Provided by publisher.

Noribogaine (noribo) is the primary metabolite from ibogaine, an atypical psychedelic alkaloid isolated from the root bark of the African shrub Tabernanthe iboga. The main objective of this study was to test the hypothesis that molecular, electrophysiological, and behavioral responses of noribo are mediated by the 5-HT[sub.2A] receptor (5-HT[sub.2A]R) in mice. In that regard, we used male and female, 5-HT[sub.2A]R knockout (KO) and wild type (WT) mice injected with a single noribo dose (10 or 40 mg/kg; i.p.). After 30 min., locomotor activity was recorded followed by mRNA measurements by qPCR (immediate early genes; IEG, glutamate receptors, and 5-HT[sub.2A]R levels) and electrophysiology recordings of layer V pyramidal neurons from the medial prefrontal cortex. Noribo 40 decreased locomotion in male, but not female WT. Sex and genotype differences were observed for IEG and glutamate receptor expression. Expression of 5-HT[sub.2A]R mRNA increased in the mPFC of WT mice following Noribo 10 (males) or Noribo 40 (females). Patch-clamp recordings showed that Noribo 40 reduced the NMDA-mediated postsynaptic current density in mPFC pyramidal neurons only in male WT mice, but no effects were found for either KO males or females. Our results highlight that noribo produces sexually dimorphic effects while the genetic removal of 5HT[sub.2A]R blunted noribo-mediated responses to NMDA synaptic transmission.

Abstract Introduction 3,4-Methylenedioxymethamphetamine (MDMA) affects monoaminergic pathways that play a critical role in sleep-wake cycles. Dopaminergic mechanisms are thought to mediate the sleep-disrupting effects of stimulant drugs. However, the mechanisms underlying the effects of MDMA on sleep-wake cycles and the effects of R(−) MDMA, a stereoisomer that lacks dopaminergic activity, on sleep remain unknown. The aim of the present study was to investigate the effects of racemic MDMA and R(−) MDMA on daytime activity and sleep-like parameters evaluated with actigraphy in adult rhesus macaques. Methods Actiwatch monitors were attached to the monkeys’ collars (Macaca mulatta, n = 6) and actigraphy recording was conducted during baseline conditions and after the administration of acute intramuscular injections of saline (vehicle), racemic MDMA (0.3, 1.0 or 1.7 mg/kg) or R(−) MDMA (0.3, 1.0 or 1.7 mg/kg) at 9h or 16h (3h prior to “lights off”). Results Morning treatments had no effects on sleep-like parameters. Racemic MDMA decreased general daytime activity during the 1st hour after injection and increased daytime activity at 3 hours post-treatment. Although afternoon administration of racemic MDMA increased sleep latency for all subjects, it improved other sleep parameters for subjects with poor baseline sleep, decreasing wake time after sleep onset (WASO) and increasing sleep efficiency. Afternoon treatment with R(−) MDMA improved sleep measures for all subjects, increasing sleep efficiency and decreasing sleep latency and WASO, while having no effects on daytime activity. Conclusion Our findings suggest that the stimulant and sleep-disrupting (increase in sleep latency) effects of racemic MDMA are likely mediated by dopaminergic mechanisms, while serotonergic pathways appear to be involved in the sleep-promoting effects of MDMA. Support (If Any) USPHS grants DA010344 (LLH), DA031246 (LLH), and ODP51OD11132 (Yerkes), AFIP, FAPESP grants 2015/16109-7 (LFB) and 2015/25482–3 (LFB), UMMC Institutional Funds (LFB).

The authors concluded that increased putaminal uptake after an abstinence of >3 y suggests that effects on nigrostriatal dopaminergic function are long lasting and that use in conjunction with other recreational drugs is a factor to be considered in further longitudinal studies.

The top nine best abstracts from the biennial Southern African HIV Clinicians Society Conference, held in September 2014, are provided here.

Post-traumatic stress disorder (PTSD) presents a major public health problem for which currently available treatments are modestly effective. We report the findings of a randomized, double-blind, placebo-controlled, multi-site phase 3 clinical trial (NCT03537014) to test the efficacy and safety of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of patients with severe PTSD, including those with common comorbidities such as dissociation, depression, a history of alcohol and substance use disorders, and childhood trauma. After psychiatric medication washout, participants ( n  = 90) were randomized 1:1 to receive manualized therapy with MDMA or with placebo, combined with three preparatory and nine integrative therapy sessions. PTSD symptoms, measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5, the primary endpoint), and functional impairment, measured with the Sheehan Disability Scale (SDS, the secondary endpoint) were assessed at baseline and at 2 months after the last experimental session. Adverse events and suicidality were tracked throughout the study. MDMA was found to induce significant and robust attenuation in CAPS-5 score compared with placebo ( P  < 0.0001, d  = 0.91) and to significantly decrease the SDS total score ( P  = 0.0116, d  = 0.43). The mean change in CAPS-5 scores in participants completing treatment was −24.4 (s.d. 11.6) in the MDMA group and −13.9 (s.d. 11.5) in the placebo group. MDMA did not induce adverse events of abuse potential, suicidality or QT prolongation. These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation. Results from a phase 3, double-blind, randomized, placebo-controlled trial demonstrate that MDMA-assisted therapy is safe and effective in treating severe post-traumatic stress disorder.