The International Monetary Fund published a departmental paper assessing how wider adoption of foreign currency stablecoins could affect recipient countries and outlining policy responses under its existing capital flow and macroeconomic frameworks. While stablecoins could lower cross-border payment costs and expand competition and financial access, large-scale adoption could weaken capital flow management measures, increase currency substitution, disrupt bank funding and monetary transmission, and heighten exposure to financial shocks. These risks are greatest in countries with weak macroeconomic frameworks, limited regulatory capacity, legal uncertainty and significant data gaps. Stablecoins reached a market capitalization of USD 317 billion in June 2026, nearly 50 times their level at the start of 2020, and foreign currency stablecoins account for 99% of the market. Estimated gross cross-border flows in Tether and USD Coin reached USD 6.3 trillion in 2025, with activity concentrated in emerging markets and developing economies relative to traditional cross-border payments. Current macrofinancial effects remain limited, but broader use as a foreign currency store of value, payment instrument or funding source could accelerate de facto capital account liberalization and dollarization, particularly where users can bypass regulated intermediaries through offshore platforms or unhosted wallets. The paper calls for sound monetary and fiscal frameworks, more efficient payment systems, deeper local currency markets, comprehensive regulation aligned with international standards and stronger reporting by issuers, exchanges, custodians and wallet providers. Countries facing widespread circumvention of existing capital controls may need larger foreign exchange reserves and greater use of foreign exchange intervention when shocks occur, while new outflow controls should generally be reserved for imminent or actual crises and implemented as part of a broader adjustment package. International regulatory coordination and data sharing will be needed because domestic reporting may not capture activity conducted through foreign platforms and unhosted wallets.