By Brent Dorian Carpenter
A new study conducted by the Michigan AIDS Prevention Project has established further links to an increase in the epidemic of crystal methamphetamine use and HIV infections. According to Craig Covey, MAPP's CEO, the 2004 statewide survey showed the number of MSMs who reported crystal meth use jumped to 9 percent, more than double the 4 percent in the previous survey conducted in 1997. It also recorded that 10 percent of meth users were HIV-positive, compared to 9 percent of the overall group.
Crystal meth is also known as "speed", "Tina", "crank", and "ice" among other names.
The survey was racially and geographically balanced to reflect the state's population, and included questions regarding drug and condom use. Whites and Native Americans have the highest percentage of meth users, based on population, with slightly lower numbers for African American and Asian men. These men tend to be in their late twenties and thirties. Oakland County and the northern part of the Lower Peninsula had the highest rates of meth users.
"That was not surprising to us," Covey said, "because the meth use across the country has tended to be a little higher in rural areas." He stresses that the survey doesn't indicate if these meth users are one-time, casual or chronic abusers and that the survey results are not complete.
The MAPP survey echoes other studies from around the nation. There is no firm scientific data showing crystal meth is fueling the rise in HIV infection among U.S. gay and bisexual men. Still, anecdotal evidence from New York doctors suggests the drug plays a role in 50-75 percent of new HIV infections in the city. A link has also been found between meth use and a recently discovered rare, highly-drug resistant strain of HIV.
A new survey from the Center for HIV Educational Studies and Training in New York City stated that, "Crystal meth has physiological effects that suggest it plays a stronger role in HIV infections than even cocaine and alcohol. For example, difficulty achieving and maintaining an erection may make men more likely to forego condom use in order to maximize sensitivity. Also, the longer duration of sexual activity that the drug enables may increase the possibility of ruptured tissue, which then becomes a portal for infections to cross into the bloodstream."
Another study by the San Francisco Health Department last year came to other startling conclusions, including that 25 percent of HIV-negative gay men who tested positive for syphilis also reported recent speed use. It also found that among 63,098 gay and bisexual men tested in 2001 and 2002 at public clinics, 7.1 percent of meth users were HIV-positive, compared to 3.7 percent for nonusers.
Covey stated the MAPP survey found another area of concern.
"There was a correlation between crystal use and Viagra [and other erectile dysfunction drugs]. When you combine them, suddenly you have lots of energy for a long period of time, and the complete ability to have erections for a long time. If you then go to a bath house, then obviously the ability to have sex for long periods of time with multiple partners increases, and we find that the risk of HIV infection and syphilis and other STDs rises with the length of the period of the sexual activity."
It is this potentially dangerous combination that has Covey convinced that meth is predominantly a sex drug. "The reason we're interested in this issue is that we see the increased risk for STDs, including syphilis and HIV infection. Although we don't have that statistical information here, it's being seen in New York, San Francisco, L.A., and Florida."
Methamphetamine is a central nervous system stimulant, with its effects resulting from excitation of the dopamine and norepinephrine receptors in the brain. It can be taken orally, intravenously, nasally inhaled or smoked. The desired acute effects include increased alertness, increased activity, excitement, and decreased appetite. Acute physical effects include elevation of blood pressure, pulse, respiration and body temperature. Medical problems associated with meth include cerebral hemorrhage, stroke, seizure, hyperthermia, arrhythmias, coma and death. There are also indicators that structural changes to the brain may occur resulting in brain damage.
Methamphetamine was originally synthesized from ephedrine in 1893, but it was not widely used until World War II when Japan, Germany and the United States gave it to military personnel to increase and enhance performance.
Intervention and treatment
Phil (real name withheld by request), a bartender at a popular Detroit night club, said that he sees more than a dozen meth users on a busy night. He told a tale of one young patron that, though tragic, offers a glimmer of hope.
"There is this kid I really liked, and I told him that if we were in a relationship, I wouldn't put up with that bullshit. He said, 'I wouldn't deal with you. I'm gonna do what I'm gonna do.' The drugs have burned out his brain cells. He was completely out of control and so his family kicked him out.
"Finally, he stopped around New Year's Day. He was living with his ex and his ex's new partner. He was watching them tweak themselves to death. Even though he was totally strung out, the level of tweaking going on around him where he lived was so intense that even he became disgusted to a level where he felt he had to quit."
A guide called "Harm Reduction for Methamphetamine Users," produced by the Seattle Treatment Education Project, offers innovative insights into treatment methods specifically designed around the challenges presented by meth users. It points out that "a typical meth high lasts 8 to 12 hours (a cocaine high only lasts 15 to 30 minutes) and often stretches into a longer 'run' during which a user maintains a high, usually without sleep, for days or even weeks. Several days of exhaustion, sleep, and acute depression, known as the 'crash,' follow the high. During these extended ups and downs, meth users may be too distracted, exhausted or secluded to engage in clinical interventions. Additionally, the paranoia or psychosis that can result from chronic use or sleep deprivation often keeps users away from services such as needle exchange, drug treatment, and health clinics, all traditional engagement points for users of other drugs."
The guide suggests non-traditional intervention actions to accommodate the meth users' impulsivity and paranoia, such as telephone reminders, flexible "no-show" policies, drop-in hours rather than strict schedules, shortened waiting times, very brief (or no) intake forms, and access to multiple services in one visit. Most importantly, it stresses patience, and methods of developing personalized plans, or "selling points," to help the client step down from addiction incrementally through harm reduction practices.
