By David S. Bernstein
dbernstein at phx.com
http://bostonphoenix.com/boston/news_features/other_stories/multipage/documents/
04335372.asp
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04335371.asp

  The Boston Phoenix
  Issue Date: December 17 - 23, 2004

  News & Features
  E-Mail This Article to a Friend

  All methed up
  The comeback of HIV and STDs and the drug thats fueling it
  BY DAVID S. BERNSTEIN

  If gay culture sets the style that the straight world
  follows, Boston could be heading for a serious health
  crisis. On the local gay party scene, the hippest and
  hottest must-have accouterment is a bag of colorless,
  odorless, shiny rock-like fragments: crystal
  methamphetamine. And thanks largely to crystal meth,
  Boston is suddenly awash in diseases we thought were under
  control.

  In two years, Bostons syphilis rate has shot from 28th- to
  sixth-highest in the country, due primarily to its spread
  among men having sex with other men, according to the
  Centers for Disease Control and Prevention. The
  Massachusetts Department of Public Health (DPH) reports
  that gay and bisexual men in the state have also
  experienced a huge increase in antibiotic-resistant
  gonorrhea. Most disturbingly, the incidence of new
  HIV/AIDS cases in Boston started increasing in 2002, after
  years of decline and according to DPH numbers released in
  October, sex with another man now accounts for more than
  half of new HIV-infection cases among men, after dropping
  to just 41 percent of cases in 1999.

  The reasons for the problem are surely multiple and
  complex, but health officials and gay-community activists
  point to crystal meth, and the resulting risky sexual
  behavior among its users, as a primary culprit. The states
  Bureau of Communicable Disease Control has specifically
  named crystal meth as a cause of the troubling increase in
  syphilis among gay men in Massachusetts. Research in San
  Francisco has shown a direct link between crystal-meth use
  and recent increases in HIV rates there. In New York City,
  a public-policy task force report released last summer
  linked crystal meth to skyrocketing syphilis rates in the
  city, and added that "emerging evidence also suggests that
  crystal use may be contributing to an increase in new HIV
  infections."

  "Every single person who has come to us with crystal meth
  has also just found out they are HIV-positive," says
  Jonathan Scott, president and executive director of
  Victory Programs Inc., a residential
  substance-abuse-treatment provider in Boston.

  Until about two years ago, crystal meth a/k/a Crissy,
  Tina, glass, crank, tweak, ice, chalk, go-fast was
  virtually unavailable in Northeastern cities such as
  Boston. Long popular among Southern rednecks, Western
  biker gangs, and Midwestern housewives, crystal meth now
  is finally spreading to this region, thanks to its
  popularity on the gay-party circuit and Boston appears to
  be at the forefront. Meth-related emergency-room visits in
  the city tripled from 1998 to 2002, according to the most
  recent data from the Drug Abuse Warning Network (DAWN),
  part of the US Department of Health and Human Services.
  That gives Boston the worst per capita meth problem of all
  the Northeastern metropolitan areas studied in the DAWN
  system, easily ahead of Buffalo, Newark, Philadelphia, and
  even New York City.

  Still, crystal meth is around in far less quantity here
  than in other parts of the country, says Anthony
  Pettigrew, spokesman for the US Drug Enforcement
  Administrations New England office. Pettigrew adds that
  almost no crystal meth is manufactured locally although
  apparently enough is now brought in to feed the habits of
  about eight percent of all gay men in Boston, according to
  an ongoing Harvard study. It remains, to this point, a
  niche drug a club drug for that portion of gay and
  bisexual men who join the roving, all-night "circuit
  party" scene or seek sexual hookups on Internet sites such
  as Manhunt.net.

  But will it remain within that niche? MDMA, better known
  as Ecstasy or X, certainly didnt. "X was big in the gay
  community in the 80s, then hit the club scene in the 90s,"
  says Kevin Kapila, a South End psychiatrist who
  specializes in substance abuse. Already meth is gaining
  popularity as a club drug nationally, according to the
  National Drug Intelligence Center. Here in Boston, meth is
  becoming more readily available at nightclubs as the
  supply increases and partiers search for new highs. Cheap
  club drugs like GHB (commonly used by Boston-area
  strippers) and ketamine have become harder to get locally,
  and Ecstasy use in Boston has plateaued, according to the
  Office of National Drug Control Policy (NDCP), which also
  says that young Boston-area clubgoers are experimenting
  with LSD, PCP, mushrooms, and mescaline. It shouldnt take
  these experimenters long to find out what gay partiers
  like about crystal meth in fact, in a startling finding
  buried in the latest NDCP profile of Boston drug use, more
  ninth-grade students reported having used methamphetamines
  (5.9 percent) than Ecstasy (5.1).

  Once it starts, the spread of crystal meth can be
  explosive. In 1992, Indiana admitted two users into
  methamphetamine substance-abuse treatment for every
  100,000 people in the state roughly the same rate as
  Massachusetts had two years ago. But by 2002, Indianas
  rate had multiplied more than 10 times over, to 23 per
  100,000. In the same time period, Missouris meth-admission
  rate exploded from five to 86 per 100,000; Arkansas from
  seven to 125; Washington from 11 to 150.

  If these rates of increase can spring from housewives
  looking to lose weight and bikers trying to stay awake,
  surely it could happen among clubgoers in Boston. If it
  does, it could bring dramatic public-health risks, perhaps
  including the spread of HIV/AIDS, but certainly other
  sexually transmitted diseases (STDs). "There would be a
  huge epidemic of chlamydia if this drug ever becomes
  popular among college students in Boston," says Sophie
  Godley, director of prevention and education for AIDS
  Action Committee.

  Health officials here are not waiting around to see how
  big the problem gets. In fact, two years ago, the Boston
  Public Health Commission and the Massachusetts Department
  of Public Health joined up with Fenway Community Health
  Center, AIDS Action Committee, and Victory Programs Inc.
  to create a task force that has spawned education
  materials, public-awareness campaigns, and training for
  treatment providers. The task force just received a
  three-year federal grant for crystal-meth-prevention
  efforts targeted at gay men. It is also listening to
  public-health officials in places like San Francisco,
  Atlanta, and Seattle, where the crystal-meth problem is
  far more advanced, says John Auerbach, executive director
  of the Boston Public Health Commission. "They all said to
  us, intervene quickly you dont want to deal with what were
  dealing with. "

  To understand Bostons new meth-fueled STD problem, you
  have to put away any discomfort you may have about the
  kinkier extremes of gay-male sexuality, and any concern
  about stereotyping gay promiscuity. The stubborn fact is
  this: some gay men use party drugs to loosen their
  inhibitions and to increase their stamina so they can have
  wild, all-night sex, sometimes with anonymous or multiple
  partners. This goes on in the straight world as well,
  except that those partiers have yet to catch on to the
  thrill of crystal. It is, by users accounts, a far more
  powerful and pleasurable aphrodisiac. On a meth high, they
  hook up with multiple partners; they forget to use
  precautions such as condoms; they engage in rougher
  intercourse, with more chance of tearing and bleeding all
  increasing the risk of AIDS and other sexually transmitted
  diseases. The drug heightens stimulation (caused by the
  release of dopamine, the brains pleasure chemical), which
  makes sex more pleasurable, which heightens the desire for
  the drug, which speeds the physiological addiction. Sexual
  desire and craving for the drug become psychologically
  intertwined. Impatience with the delayed gratification
  from methamphetamine pills or even snorting can lead to
  switching to crack-style pipe smoking; "booty bumps,"
  inserted anally immediately before sex; and injection. As
  usage continues, the drugs other insidious effects deepen,
  including paranoia and severe weight loss. Users "normal"
  life begins to self-destruct from erratic behavior,
  according to treatment providers like Kapila, and their
  "party" life becomes more meth-centered.

  Issue Date: December 17 - 23, 2004

  E-Mail This Article to a Friend
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04335371.asp

  The Boston Phoenix
  Issue Date: December 17 - 23, 2004

  News & Features
  E-Mail This Article to a Friend

  By David S. Bernstein
  All methed up (continued)

  Two groups of men seem to fall into crystal-meth use,
  according to people tracking it: young men who want to
  party, and middle-aged men who become single after a
  relationship ends. The first group, like other young drug
  users, dont worry about the health effects of their
  behavior. The second group puts aside those concerns
  because the drug (and the partying) makes them feel
  sexier, and wanted.

  Both groups, says Victory Programs Scott, include many
  upper-middle-class men from stable backgrounds, who have
  had little previous addiction in their lives.

  The drug, like many others, starts out as a very positive
  experience for most users. They lose weight, they have
  more energy, and most important, they have great sex.
  "With this [drug] its about the sex," says Kapila. "They
  have wild sex. Sex after meth is just not the same. You
  have to deal with that in treatment."

  Kapila is blunt very blunt, crudely blunt. Terms like
  "booty bump" and "fisting" fly unselfconsciously from his
  mouth. Its probably one reason he is able to work so
  effectively with gay men who have wrecked their lives with
  crystal methampethamine. He is the go-to guy for people
  with this problem; he runs a therapy group and individual
  counseling for them. He estimates that in a typical month,
  between 10 and 15 new meth users come to either FCHC or
  his South End office for help. "Sometimes much more," he
  says.

  Other meth users seek recovery at one of two Crystal Meth
  Anonymous meetings at Fenway Community Health Center
  (FCHC), or living in a residential treatment program at
  Victory Programs Inc. These are among the few providers in
  the area that specialize in treating recovering gay meth
  addicts. But by the time the addict gets to them, they
  say, he is almost invariably HIV-positive, in debt and
  unemployed, alienated from friends and family, and
  experiencing psychotic episodes. He usually has traveled a
  long road of bizarre, paranoid behavior (fueled by the
  same dopamine that gives the high): lying, skipping work,
  fighting with loved ones. "Theyre just not making sense,"
  Kapila says. (He points out that David Arndt, the surgeon
  who in 2002 inexplicably left a patient on a Mount Auburn
  Hospital operating table, was later arrested on charges of
  crystal-meth distribution and enticing a minor with the
  drug.)

  The whole downward spiral takes between six months and a
  year, Kapila says. "The progression from early use to
  late-stage chronic and debilitating addiction is very
  fast" compared with other drugs, agrees Scott. "We have
  seen a very big rise in late-stage addicts, where their
  life situation is in shambles."

  Along the way to the bottom, the addict might find himself
  in an emergency room, jittering, with rapid pulse, raised
  blood pressure, dilated pupils, sweaty skin, and acute
  psychosis. The ER physicians might have to strap him to a
  gurney to control him. He probably wont remember the
  events that brought him there and probably wont stop using
  after he leaves, says Stephen Traub, a toxicologist and
  attending physician at the Beth Israel Deaconess Medical
  Centers emergency department. "I have a standard speech I
  give," Traub says. " Youre using a drug, and thats your
  decision, but I want you to realize you landed in the
  emergency department of a tertiary center and youve just
  spent the last eight hours in restraints. "

  "They really need to bottom out," agrees Kapila. "We have
  a lot of people who come into the drop-in group, and then
  drop out."

  Meanwhile, they often are still spreading their disease,
  to people in their party world and in their home life.

  EVEN WHEN THEY hit bottom, its tough to get meth addicts
  into recovery and its even tougher to help them. They
  often have engaged in behavior they consider humiliating,
  Kapila says, which makes it hard for them to face it
  honestly.

  Few meth addicts come for treatment at Cambridge Health
  Alliance, says Michael Williams, director of CHAs
  addictions program, "in part because we dont see as many
  gay men who are comfortable discussing their problem in
  groups."

  And though the drug clears out of the body within a few
  days to a week, with relatively minor physical-withdrawal
  symptoms, the psychological damage remains. "Withdrawal is
  so fraught with paranoia and depression and serious
  mental-health problems that you see a very high rate of
  recidivism," Scott says.

  The drug does more than spread disease it sends lives down
  the toilet. "This is a bad, bad drug," says Traub at Beth
  Israel. "People have been lulled into thinking that this
  is a drug without consequences, and that is not the case."

  Scotts Victory Program residential program treats
  crystal-meth addicts roughly the same as it does other
  substance abusers at first. Like others who have bottomed
  out, crystal-meth addicts must regain some structure in
  their lives, a schedule that gets them through the day.

  But long-term, Scott and others believe crystal-meth
  recovery poses unique problems. Other health providers
  seem to agree that their techniques for treating other
  drug users arent sufficient for meth addicts recent
  training seminars for service providers on crystal meth
  have had unexpected, overwhelming attendance, Auerbach
  says.

  There is no proven pharmacological treatment for
  crystal-meth addiction like methadone for heroin addicts
  and very little literature on effective treatment of any
  kind, says Michael Botticelli, assistant commissioner for
  substance-abuse services at the Massachusetts Department
  of Public Health. Public funding has gone almost entirely
  to prevention, and very little to research on treatment.

  Such anecdotal evidence strongly suggests that
  crystal-meth use is driving a new wave of HIV infection,
  says Botticell. "That changes the nature of the public
  health intervention."

  Resistance to the spread of crystal meth may lie as much
  with non-users in the gay community, and in the club
  scene, as it does with crystal-meth users themselves;
  those peer groups, experts suggest, establish the pressure
  for or against certain behavior. A task force on crystal
  meth use in New York City recommended in a July report
  efforts to "provoke a reinvigorated, coordinated effort to
  reset community norms for men who have sex with other
  men."

  Unfortunately, public discussion of the problem say, on
  recent public-service ads on the MBTA turns off many in
  the gay community, who have worked hard to replace the
  play-and-party image with more-wholesome (and
  representative) pictures of ordinary, committed, gay
  couples. "Its been hard to talk about it, because it fuels
  the stereotypes about gay men," says Godley.

  Meth use has also spread more through Internet communities
  than in the traditional clubs. "The online experience is
  playing a larger role than ever as a place where gay men
  meet and plan hookup dates and parties," says Godley.

  Club-drug interventions have often centered on a
  particular nightclub, says Auerbach, but that isnt where
  most of the problem lies this time. "When people are
  meeting up over the Internet, its more difficult,"
  Auerbach says.

  That hasnt stopped gay-mens community health providers
  from trying to reach them, however. AIDS Action Committee
  has stepped up its Internet outreach efforts. FCHC just
  launched a dedicated portion of its Web site to
  crystal-meth education
  http://www.fenwayhealth.org/crystalmeth/
  Even the hookup-site providers,
  including http://Manhunt.net the most notorious of
  the sites, now push information to users warning of
  crystal-meth dangers.

  These efforts understandably focus on the gay community,
  where the problem exists now, and not on the larger
  community. As such, the efforts seem puny to some,
  compared to other public-health outreach efforts. And some
  cant help but think that this could be a replay of the
  original response to the AIDS crisis not worth public
  money if its affecting only homosexuals. "I question the
  job were doing in providing health care for the gay
  community," says Williams. "I dont feel that were doing a
  particularly good job of it here in Massachusetts."

  Auerbach, representing Boston, and Botticelli,
  representing the state, are determined not to let that
  happen and to keep Boston from becoming the vanguard of a
  new resurgence of sexual disease.

  David Bernstein can be reached at dbernstein at phx.com

  Issue Date: December 17 - 23, 2004

  E-Mail This Article to a Friend
By David S. Bernstein
dbernstein at phx.com
http://bostonphoenix.com/boston/news_features/other_stories/multipage/documents/
04335372.asp
http://bostonphoenix.com/boston/news_features/other_stories/multipage/documents/
04335371.asp