 | 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
The Boston Phoenix
Issue Date: December 17 - 23, 2004
News & Features
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All methed up
The comeback of HIV and STDs and the drug thats fueling it
BY DAVID S. BERNSTEIN
If culture sets the style that the straight world
follows, Boston could be heading for a serious health
crisis. On the local 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 with other men, according to the
Centers for Disease Control and Prevention. The
Massachusetts Department of Public Health (DPH) reports
that and biual 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, 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 -community activists
point to crystal meth, and the resulting risky ual
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 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 -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 men in Boston, according to
an ongoing Harvard study. It remains, to this point, a
niche drug a club drug for that portion of and
biual men who join the roving, all-night "circuit
party" scene or seek ual 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
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 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
ually 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 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 -male uality, and any concern
about stereotyping promiscuity. The stubborn fact is
this: some men use party drugs to loosen their
inhibitions and to increase their stamina so they can have
wild, all-night , 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 ually transmitted
diseases. The drug heightens stimulation (caused by the
release of dopamine, the brains pleasure chemical), which
makes 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 ; 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
http://bostonphoenix.com/boston/news_features/other_stories/multipage/documents/04335372.asp
http://bostonphoenix.com/boston/news_features/other_stories/multipage/documents/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
ier, 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 .
"With this [drug] its about the ," says Kapila. "They
have wild . 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 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 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
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 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 with other
men."
Unfortunately, public discussion of the problem say, on
recent public-service ads on the MBTA turns off many in
the community, who have worked hard to replace the
play-and-party image with more-wholesome (and
representative) pictures of ordinary, committed,
couples. "Its been hard to talk about it, because it fuels
the stereotypes about 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 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 -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 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 homouals. "I question the
job were doing in providing health care for the
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 ual 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
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