Community pharmacy professionals in France reported substantial gaps in chemsex-related knowledge, training, and prevention resources in a cross-sectional survey published in BMJ Open.
Chemsex refers to the intentional use of psychoactive substances to initiate, intensify, or prolong sexual activity, often over extended sessions. Researchers surveyed pharmacists, pharmacy technicians, and pharmacy students working in community pharmacies in the Auvergne-Rhône-Alpes region of France between February and March 2025.
Among 276 respondents, 261 completed the full questionnaire and formed the basis for most outcome analyses. Participants were predominantly female, pharmacists, aged 18 to 29 years, and practicing in urban or near-urban settings.
Although 80% of respondents had heard of chemsex, only 67% said they could provide an exact definition. Just 11% reported learning about chemsex through formal education or continuing training.
The mean knowledge score was 13.8 on a theoretical 29-point scale. Most respondents recognized stimulants such as cocaine, amphetamines, and synthetic cathinones as substances associated with chemsex contexts, but fewer identified gamma-hydroxybutyrate/gamma-butyrolactone or ketamine. More than two-thirds incorrectly classified cannabis, lysergic acid diethylamide, or hallucinogenic mushrooms as chemsex substances.
Knowledge gaps were especially notable around medication safety and harm reduction. Nearly 69% of respondents reported being unable to manage potential chemsex-related drug interactions, and only 6% of respondents could identify an example of a clinically relevant interaction. Just 1% named a dedicated interaction database. Researchers noted that many chemsex-related substances are metabolized through cytochrome P450 pathways and may interact with antiretroviral therapy, selective serotonin reuptake inhibitors, and other psychoactive medications.
Nearly 90% of respondents recognized intranasal drug use in chemsex settings, but only 18% identified “slamming,” or intravenous injection. Researchers noted that limited recognition of injection practices could reduce opportunities for counseling regarding overdose and bloodborne infection risks.
Only about one-third of respondents could cite prescription drugs associated with chemsex contexts, including benzodiazepines, pregabalin, amphetamines, or phosphodiesterase type 5 inhibitors.
Attitudes toward chemsex prevention were mixed. Nearly half of respondents reported apprehension discussing chemsex with patients at the pharmacy counter. The most commonly cited barriers were insufficient knowledge or training, the taboo or intimate nature of the topic, and fear of negative patient reactions.
About 24% of questionnaire completers agreed with the statement that patients engaging in chemsex were “problematic patients,” which the researchers said reflected persistent stigma. Still, 56% believed pharmacists should help initiate chemsex prevention discussions.
Professionals practicing in city centers or near urban areas had more favorable attitudes toward chemsex prevention than those practicing in rural settings.
Direct experience with chemsex-related counseling was uncommon. Only 4% reported receiving chemsex-related requests for advice in the pharmacy setting. However, 84% considered currently available informational and referral tools inadequate, and 88% rated available prevention information for patients engaging in chemsex as poor.
Despite those concerns, 66% said they felt capable of referring at-risk patients to appropriate services, and 74% reported willingness to support patients with HIV pre-exposure prophylaxis, vaccination, and infection-risk reduction strategies.
Professional training was the most frequently proposed strategy for improving care, cited by 57% of respondents. Other recommendations included broader prevention campaigns, educational materials, nonjudgmental communication, referral pathways, confidential consultation spaces, multidisciplinary care, and risk-reduction support.
In exploratory regression analyses, higher knowledge scores were associated with male gender, prior chemsex-related requests for advice, personal experience as a source of chemsex knowledge, and more favorable attitudes toward prevention. Increasing age was associated with lower knowledge scores. Researchers emphasized that these analyses were exploratory and should not be interpreted causally. The regression models explain more variance in knowledge than in attitudes or perceived resource adequacy, suggesting additional unmeasured factors may contribute to those outcomes.
The study used a newly developed questionnaire that underwent face and content validation and cognitive debriefing but did not undergo full psychometric validation. The study was limited by its cross-sectional design, self-reported data, and convenience and snowball sampling.
The investigators noted that because recruitment relied partly on university-affiliated pharmacy training networks, respondents may have been more academically engaged than the broader pharmacy workforce, suggesting the observed knowledge gaps could underestimate deficiencies in routine practice.
The findings suggest community pharmacy staff may have limited chemsex-specific training and counseling resources for patients seeking pre-exposure prophylaxis, sexually transmitted infection-related care, or harm-reduction services.
“These findings highlight the need for training community pharmacy staff in chemsex prevention to strengthen their primary care role,” the researchers wrote.
The researchers reported no competing interests and no specific funding for the study.
Source: BMJ Open