“New” drugs associated with chemsex? 2C-B in sexual context. A case report and review

A patient who used 2C-B during chemsex—intentional drug use before or during sex—arrived at an emergency room with psychotic symptoms and was diagnosed with stimulant acute intoxication and acute psychotic symptoms induced by stimulants. 2C-B increases dopamine, serotonin, and norepinephrine, producing both stimulating and hallucinogenic effects. Men who have sex with men (MSM) are especially vulnerable to problematic drug use in sexual contexts. Chemsex users face mental health problems including psychotic symptoms, suicidal ideation, encephalopathy, and delirium. Polysubstance use is common in chemsex, making identification of specific drugs during acute intoxication challenging, but psychiatrists should investigate use of drugs beyond classic chemsex substances like mephedrone, GHB, and methamphetamine, including 2C-B, cocaine, MDMA, ketamine, and other cathinones.

Study at a glance

Abstract

Introduction The intentional use of drugs before or during sexual intercourse (chemsex), due to its impact on mental health, is a phenomenon of high importance in men who have sex with men. Objectives We report the case of a patient with polysubstance acute intoxication, including 2C-B, in order to review the evidence about the mechanisms of action of 2C-B, its efects on sexual pleasure, toxicity, patterns of abuse and somatic and mental health related consequences it may present. Methods Case report and narrative review. Results We present the case of a patient using 2C-B as a substance in chemsex practice. As the patient presented in our emergency with psychotic symptoms, he was diagnosed with “stimulant acute intoxication” and “acute psychotic symptoms induced by stimulants”. 2C-B increases dopamine (DA) serotonin (5-HT) and norepinephrine (NE) and cause stimulating and hallucinogenic effects. Conclusions MSM is a group vulnerable to the problematic use of drugs in a sexual context. Several mental health problems have been associated with chemsex users such as psychotic sypmptoms, suicidal ideation, encephalopaty, delirium. Polysubstance use is common in chemsex practice and it can be difficult to identify the drugs used in states of acute intoxication but psychiatrists must explore the use of differents drugs from the “classic chemsex drugs” (mephedrone, GHB and metanphetamine) including 2C-B and other substances such as cocaine, MDMA, ketamine, and other cathinones different from mephedrone.