Bay Windows - August 26, 2004
Ethan Jacobs, ejacobs@baywindows.com.

Stephen Boswell, Fenway's executive director, said that there are no concrete statistics on the number of gay men using crystal meth, but anecdotally the situation has health care providers worried.

"I don't think there's any objective data right now to answer the question about what's happening with the prevalence of use of crystal," said Boswell. "I think if you were to ask any of us around this table I think we'd all tell you that our concern is that it's if anything increasing, not decreasing."

Fenway and Boston-area health providers first noticed the increase in crystal meth use among their clients in the fall of 2002, but in other areas of the country crystal use among gay men has been an issue for well over a decade. The drug first took root in the gay communities on the West Coast during the 1990s in cities like Seattle, San Francisco, Los Angeles and San Diego. From there it spread to the Midwest, and in the past few years it has surfaced in cities on the East Coast.

Boswell said crystal, a highly addictive toxic stimulant, is easy to manufacture. The materials needed to make crystal meth are relatively inexpensive, and would-be manufacturers can brew the drug in a space as small as their garage. Many men get turned on to the drug on the circuit party and club scene; others discover the drug during Internet hookups that take place in people's private homes.

Crystal creates feelings of euphoria among users, lowers their inhibitions, and raises their adrenaline levels, increasing their endurance. While the drug is toxic in its own right, health care providers also worry about the combination of increased endurance and lowered inhibitions, which many believe is contributing to an increase in unsafe sex among gay men.

"The data linking multiple types of substances and HIV transmission have been prevalent in the literature for 20 years. So there's a long track record here. There's just starting to be some literature that shows crystal meth to be linked to it," said Boswell. "If you ask any clinicians who see a fair number of patients, they'll, I'm virtually certain, all tell you that it's definitely linked with HIV transmission."

A. Cornelius Baker, executive director of the Washington, D.C.-based Whitman-Walker Clinic, said that his center has found connections between crystal use and transmission of syphilis, which is also on the rise in Boston.

"We evaluate what are the correlating behaviors that people are engaged in with an STD transmission, and while some of the data doesn't point to whether it was specifically crystal versus another party drug, we do have distinctions between crystal and alcohol and marijuana, for example, and so we know that the party [and] club drugs are much more highly correlated with syphilis transmission," said Baker, who attended the Fenway summit.

Health care providers also believe that for people who are HIV positive, addiction to crystal can interfere with their daily medication regimen, putting their health at risk. For people whose HIV is under control, crystal can interfere with a proven drug regimen.

Lorri Jean, chief executive officer of the Los Angeles Gay and Lesbian Center, said health centers around the country have worked to develop treatment and prevention programs to address addiction to crystal meth, and one of the top priorities among the attendees at the summit is to begin evaluating those programs.

"So one of the things we've been talking about is how to get funders like the federal government to pay attention to that and to help us not only get money, but ... actually evaluate some of the things that are being done to see if they're effective," said Jean.

Baker said one of the other priorities among health care professionals is to educate the community on the dangers of crystal meth. Although many view crystal as a light club drug, Baker said it is more addictive than cocaine and heroin. He said the community needs to come together to change people's perception of crystal meth.

"We need to let people know what this is about, we need to know what the consequences are, and we need to be reporting outcomes, whether it's from surveillance data, hospital reports," said Baker. "Just think for a moment if [the gay press] were reporting on crystal like they were reporting on the early AIDS epidemic, so that we had charts that said 'five new cases this week.' What if we had 'five overdoses this week, 10 hospitalizations this weekend,' and that we really had information saying, this is the consequence of doing this. Right now people really don't see the consequence and I think that's what we have to begin conveying and communicating."

Local response

When health providers noticed the rise in crystal use among gay men in the Boston area, they approached the Boston Public Health Commission to facilitate the development of a city-wide response. John Auerbach, executive director of the health commission, said that 18 months ago he joined with state health officials and local organizations like the Fenway, AIDS Action Committee, and Victory Programs, Inc. to form a working group on crystal meth. He said the group developed pamphlets and educational materials aimed at the gay community and health providers, held a forum to educate the provider community, and began exploring treatment options for crystal addiction.

"With treatment the group started pulling money from the city and state to do pilot programs," said Auerbach. He said Victory Programs, which provides residential substance abuse treatment for GLBT people and people living with HIV/AIDS, started a pilot program training substance abuse treatment providers in how to work with people addicted to crystal. The working group provided community members struggling with crystal meth addiction the seed money to start a Crystal Meth Anonymous group. The Fenway created substance abuse counseling groups, including an open drop-in group and a multiple-session group.

Dr. Kevin Kaplila, who runs the multiple-session group, said that the stable group membership and the regular schedule has helped participants in their recovery.

"In my group it's very easy to work on recovery issues because we have the same seven or eight guys coming back," said Kaplila. Once people commit to recovery and start participating in the group they may occasionally relapse and begin using again, said Kaplila, but those relapses are often only a day or two in duration.

Auerbach said the working group is in the process of applying for grant money to develop public education and treatment programs. He said local health officials have used the work of health care providers on the West Coast to inform their own programs.

"I think we learned [from providers on the West Coast] that on education we needed to educate on multiple levels," said Auerbach. He said some messages need to be targeted toward people who have not tried crystal meth, warning them not to start. For those already using, Auerbach said harm reduction messages might be more appropriate, urging people to practice safer sex and informing them of the long term consequences of using crystal meth.

Auerbach also said Boston used the example of programs on the West Coast to learn that people trying to quit using crystal meth may need extended mental health support, unlike people working to quit some other drugs.

"It wasn't a quick detox like what occurs with heroin," said Auerbach.

Crystal and HIV

The health officials at the Fenway summit said that given the recent cuts to state and federal HIV funding, the impact of crystal among people who are HIV positive makes a bad situation worse.

"The federal funding stream for HIV care ... is currently under huge stress because 40 of the most populous cities in the country, they have lost Ryan White funding," said David Shippe, executive director of Baltimore's Chase-Brexton Health Services. "So we're struggling to keep up with that and then we continue to feed the people who need that level of care a drug that is so highly addictive and leads to such continued risky behavior."

Baker said crystal was one of many crises facing the gay community and HIV/AIDS service providers.

"Despite all of our challenges that we have right now in addressing the HIV epidemic, syphilis and the financial situations that all of our organizations struggle with in the current environment, this is one more crisis that we see as something urgent that we're struggling to address," said Baker. "We're layering on all of these mini-crises, and this is one more."

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