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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, don’t 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] it’s 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. It’s 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. "They’re 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 won’t remember the events that brought him there — and probably won’t stop using after he leaves, says Stephen Traub, a toxicologist and attending physician at the Beth Israel Deaconess Medical Center’s emergency department. "I have a standard speech I give," Traub says. " ‘You’re using a drug, and that’s your decision, but I want you to realize you landed in the emergency department of a tertiary center and you’ve 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, it’s tough to get meth addicts into recovery — and it’s 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 CHA’s addictions program, "in part because we don’t 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."

Scott’s 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 aren’t 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. "It’s 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 isn’t where most of the problem lies this time. "When people are meeting up over the Internet, it’s more difficult," Auerbach says.

That hasn’t stopped gay-men’s 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 (www.fenwayhealth.org/crystalmeth/). Even the hookup-site providers, including 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 can’t help but think that this could be a replay of the original response to the AIDS crisis — not worth public money if it’s affecting only homosexuals. "I question the job we’re doing in providing health care for the gay community," says Williams. "I don’t feel that we’re 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[a]phx.com

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Issue Date: December 17 - 23, 2004
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