When Life magazine wrote in 1969 that sex, drugs, and rock-and-roll were the sacraments of the counterculture, the article was describing three ingredients of great pleasure and acute danger. The phrase retains its double edge today, referencing advances in reproductive medicine, pain relief, and the healing power of music — but also declining fertility rates, substance abuse, and lyrics celebrating violence. Such contradictions are widespread. Even as opioids are becoming highly stigmatized, marijuana is a legal buy in many places and psychedelics are being studied to ease mental illness. People are having less sex, yet sexually-transmitted diseases are on the rise. Access to contraception remains a global battleground issue as #MeToo revelations roil sexual norms. How do we handle it all?