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Methamphetamine: medical implications, HIV & Hepatitis
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What is it, scope of use in USA, long & short term effects, medical implications, risk for contracting HIV and hepatitis, treatment for addiction
"The Beast in the Bathhouse; Crystal Meth Use by Gay Men Threatens to Reignite an Epidemic"
By ANDREW JACOBS, New York Times January 12, 2004
Bob looked haggard but was feeling fabulous. Chewing gum at a manic clip, circling the labyrinthine halls of the West Side Club on a recent Sunday afternoon, he had been awake since Friday, thanks to a glassine pouch of crystalline powder he had tucked beneath the mattress of a room he rented in this Chelsea bathhouse.
The powder, known as methamphetamine, or crystal meth, had helped Bob conquer a half-dozen sex partners during a 35-hour binge. Like many of the men cruising the two-level club lined with closet-size cubicles, Bob, a 37-year-old advertising copywriter, was "tweaking," high on a wildly addictive stimulant that has been sweeping through Manhattan's gay ghettos.
"The stuff is a wonder," he said, taking a pause from his prowling, his scrawny frame wrapped in a white towel. Asked about condoms and the niceties of safe sex, Bob shrugged. "Whatever," he said, turning away.
At the club, there were plenty of condoms for the taking, courtesy of the management, but in conversations with a dozen patrons who acknowledged using crystal, only two men said they were following the rules of engagement in the age of AIDS. "Some guys just throw you out of the room if you pull one out,"said one of the men, James, who, like everyone else, would not give his full name. "To them, rubbers are a killjoy."
Health officials say a sharp increase in the number of syphilis cases in the city indicates an increase in unsafe sex, which they fear may lead to a resurgence inH.I.V. transmission.
For now, researchers say, crystal meth use in the city is largely confined to gay white men in Manhattan, although they fear its eventual spread to the wider gay population and beyond.
There are no numbers, however, to show what health care workers say is the growing role that crystal meth is playing in transmitting H.I.V. Although the evidence is anecdotal, health officials say that crystal, which erases inhibitions and spurs sex marathons with multiple partners, is helping to spread the virus.
According to the city's largest private clinic for lesbians and gay men, Callen-Lorde Community Health Center, two-thirds of those testing positive for H.I.V.since June acknowledged that crystal meth was a factor in their infection.
Dr. Howard Grossman, one of the city's best-known AIDS specialists, said more than half the men who test positive in his private practice blamed methamphetamine. "This drug is destroying our community," he said. "It just seems to be getting worse and worse, and no one is doing anything about it."
Although the city Department of Health does not track crystal meth use among the newly infected, the city's poison control center received four dozen reports of crystal meth overdoses in 2002 and 2003. In the previous two years, there were none, said the city's health commissioner, Thomas R. Frieden. In another survey, the agency found that H.I.V.-positive men were twice as likely as uninfected men to use methamphetamine; those who use the drug were also less likely than other men to wear condoms during anal intercourse. "We're seeing a general increase in risky sexual behavior, and we're concerned," Dr. Frieden said.
Sometimes called crank, ice or tina, crystal meth is not new. For years, it has been cutting a destructive path through working-class communities in the Midwest and among gay men in San Francisco and Los Angeles. The drug found a toehold in New York dance clubs in the late 1990's and quickly spread among gay men who troll the Web for sex. Most start off snorting crystal, progress to smoking and later inject the drug when tolerance mounts. Even a small amount, about a quarter gram for $60, can propel a user through a weekend devoid of sleep, food and self-preservation.
During his eight-year addiction, Devin, a 38-year-old magazine writer, ended up in the emergency room six times from the effects of dehydration or a perilously rapid heartbeat. He lost five jobs, and four teeth began to rot from neglect and speed-induced jaw grinding. "Food, sleep and H.I.V. medication go out the window," he said. "Crystal takes over your life entirely. You don't really care about anything except the next high."
One figure might reveal how entrenched crystal meth has become in New York: Nearly two dozen 12-step meetings are held each week around the city for those trying to shake the drug. In 2002, there were four Crystal Meth Anonymous meetings each week. In 1999, there were none.
"Just a few years ago, we were worrying about the arrival of crystal meth," said Perry N. Halkitis, a psychologist at New York University. "Well, it's finally here."
He and others say that if past drug trends are any indication, crystal will migrate beyond the province of gay men, just as it has in the heartland, where the drug has become symptomatic of rural decline. "It's just a matter of time," Dr. Halkitis said.
It didn't take long for Jim, a 34-year-old freelance editor, to become acquainted with crystal and AIDS. He believes he was infected during his first encounter with the drug in 1999, at the home of someone he met over the Internet. "The guy offered me some. I didn't really know much about crystal and I did it. I got so high, I was essentially having non consensual sex."
A veteran AIDS activist, Jim knows he should have known better. "Once I was diagnosed, I was so embarrassed and ashamed, it fueled my addiction," he said. "I became the beast that eats its own tail."
For four years, Jim handed his life over to meth. What began as a weekend habit quickly became a daily dependence. Old friends were pushed away, jobs went by the wayside, and his credit card debt reached $40,000. He contracted syphilis twice. And coming down was excruciating. "When you're crashing, all you want to do is get high again," he said. "It's single-minded and ugly."
As addiction deepens, crystal meth wreaks havoc on the brain. In advanced cases of addiction, users can become psychotic with effects that mimic schizophrenia, says Dr. Antonio Urbina, a researcher at St. Vincent Catholic Medical Center who studies the drug's impact on neurological function. He says the drug can also compromise immune function and interfere with AIDS medications. "If you're H.I.V. positive, crystal is a disaster," Dr. Urbina said.
Despite what experts describe as an emerging crisis, neither public health officials nor private gay organizations in New York have done much to quell crystal meth's spread. San Francisco, by contrast, will spend $425,000 for education and treatment.
Dismayed by the lack of public attention to the problem, one recovering addict has decided to demonize the drug on his own. Peter Staley, a driving force behind the AIDS activist group Act Up, has spent $6,000 of his own money to place provocative ads on phone booths along Eighth Avenue in Chelsea. He said it took two months to persuade Verizon to accept the posters, which shout "Huge Sale, Buy Crystal, Get HIV Free!"
The ads, which began appearing last Wednesday, will remain up until early February. "My goal is to get the drug the reputation it deserves," said Mr. Staley, who has been sober for 13 months. "My fear is that young gay men think it's the latest party drug. I want crystal to get the stigma that heroin has. It is not glamorous, it is not alluring."
Like many other crystal neophytes, Mr. Staley began using the drug to keep him going at all-night dance clubs. "I've tried every drug in the book and never got addicted, but this one grabbed me by the throat the first time I did it," said Mr. Staley, 43, who has been H.I.V. positive since 1985. "I'm a control freak. i mean, I couldn't get addicted to cigarettes, but I couldn't give crystal up."
Drug experts say there is no methadone, no silver bullet, to treat methamphetamine addicts. For this reason, substance abuse counselors are preaching to "just say no" to crystal. It is a message that many gay men do not want to hear.
"When it comes to crystal, there is no moderation," said Dawn Harbatkin, the medical director at Callen-Lorde, which is conducting a pilot study on ways to treat crystal meth addiction. "I don't have any great treatment options right now. This drug really terrifies me, and I think what we're seeing is the tip of the iceberg."
Methamphetamine: what is it, scope of use in USA, long & short term effects, medical implications, risk for contracting HIV and hepatitis, treatment for addiction
The abuse of methamphetamine –a potent psycho stimulant– is an extremely serious and growing problem. Although use of methamphetamine initially was limited to a few urban areas in the Southwest, several major Western cities and Hawaii have seen dramatic increases in its use, and rural areas throughout the country are becoming more affected by the drug. In addition, methamphetamine use among significantly diverse populations has been documented. As part of our Methamphetamine Research Initiative, the national Institute on Drug Abuse (NIDA) has developed this publication to provide an overview of the latest scientific findings on this drug. Methamphetamine is a powerfully addictive stimulant associated with serious health conditions, including memory loss, aggression, psychotic behavior, and potential heart and brain damage; it also contributes to increased transmission of hepatitis and HIV/AIDS.
One of NIDA's most important goals is to translate what scientists learn from research to help the public better understand drug abuse and addiction and to develop more effective strategies for their prevention and treatment.We hope this compilation of scientific information about methamphetamine will help inform readers about the harmful effects of methamphetamine abuse and will assist in prevention and treatment efforts.
Glen R.Hanson, Ph.D., D.D.S.
Acting Director
National Institute on Drug Abuse
What is methamphetamine?
Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpensive over-the counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse.
Methamphetamine is commonly known as "speed," "meth," and "chalk." In its smoked form, it is often referred to as "ice," "crystal," "crank," and "glass." Its a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol. The drug was developed early in this century from its parent drug, amphetamine, and was used originally in nasal decongestants and bronchial inhalers. Methamphetamine's chemical structure is similar to that of amphetamine, but it has more pronounced effects on the central nervous system. Like amphetamine, it causes increased activity, decreased appetite, and a general sense of well-being. The effects of methamphetamine can last 6 to 8 hours. After the initial "rush," there is typically a state of high agitation that in some individuals can lead to violent behavior.
Methamphetamine is a Schedule II stimulant, which means it has a high potential for abuse and is available only through a prescription that cannot be refilled. There are a few accepted medical reasons for its use, such as the treatment of narcolepsy, attention deficit disorder, and––for short-term use––obesity; but these medical uses are limited.
What is the scope of methamphetamine abuse in the United States?
Methamphetamine abuse, long reported as the dominant drug problem in the San Diego, CA, area, has become a substantial drug problem in other sections of the West and Southwest, as well. There are indications that it is spreading to other areas of the country, including both rural and urban sections of the South and Midwest. Methamphetamine, traditionally associated with white, male, blue-collar workers, is being used by more diverse population groups that change over time and differ by geographic area.
According to the 2000 National Household Survey on Drug Abuse, an estimated 8.8 million people (4.0 percent of the population) have tried methamphetamine at some time in their lives.
Data from the 2000 Drug Abuse Warning Network (DAWN), which collects information on drug-related episodes from hospital emergency departments in 21 metropolitan areas, reported that methamphetamine related episodes increased from approximately 10,400 in 1999 to 13,500 in 2000, a 30 percent increase. However, there was a significant decrease in methamphetamine-related episodes reported between 1997 (17,200) and 1998 (11,500).
NIDA's Community Epidemiology Work Group (CEWG), an early warning network of researchers that provides information about the nature and patterns of drug use in major cities, reported in its June 2001 publication that methamphetamine continues to be a problem in Hawaii and in major Western cities, such as San Francisco, Denver, and Los Angeles. Methamphetamine availability and production are being reported in more diverse areas of the country, particularly rural areas, prompting concern about more widespread use.
What are the immediate (short-term)effects of methamphetamine abuse?
As a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physical activity and decrease appetite. A brief, intense sensation, or rush, is reported by those who smoke or inject methamphetamine. Oral ingestion or snorting produces a long-lasting high instead of a rush, which reportedly can continue for as long as half a day. Both the rush and the high are believed to result from the release of very high levels of the neurotransmitter dopamine into areas of the brain that regulate feelings of pleasure.
Methamphetamine has toxic effects. In animals, a single high dose of the drug has been shown to damage nerve terminals in the dopamine-containing regions of the brain. The large release of dopamine produced by methamphetamine is thought to contribute to the drug's toxic effects on nerve terminals in the brain. High doses can elevate body temperature to dangerous, sometimes lethal, levels, as well as cause convulsions.
What are the long-term effects of methamphetamine abuse?
Long-term methamphetamine abuse results in many damaging effects, including addiction. Addiction is a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use which is accompanied by functional and molecular changes in the brain. In addition to being addicted to methamphetamine, chronic methamphetamine abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin, which is called "fornication"). The paranoia can result in homicidal as well as suicidal thoughts. With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake. In some paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin, which is called "fornication"). The paranoia can result in homicidal as well as suicidal thoughts. With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake. In some Although there are no physical manifestations of a withdrawal syndrome when methamphetamine use is stopped, there are several symptoms that occur when a chronic user stops taking the drug. These include depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug.
In scientific studies examining the consequences of long-term methamphetamine exposure in animals, concern has arisen over its toxic effects on the brain. Researchers have reported that as much as 50 percent of the dopamine-producing cells in the brain can be damaged after prolonged exposure to relatively low levels of methamphetamine. Researchers also have found that serotonin-containing nerve cells may be damaged even more extensively. Whether this toxicity is related to the psychosis seen in some long-term methamphetamine abusers is still an open question.
What are the medical complications of Methamphetamine abuse?
Methamphetamine can cause a variety of cardiovascular problems. These include rapid heart rate, irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to small blood vessels in the brain.Hyperthermia (elevated body temperature) and convulsions occur with methamphetamine overdoses, and if not treated immediately, can result in death. Chronic methamphetamine abuse can result in inflammation of the heart lining, and among users who inject the drug, damaged blood vessels and skin abscesses. Methamphetamine abusers also can have episodes of violent behavior, paranoia, anxiety, confusion, and insomnia. Heavy users also show progressive social and occupational deterioration. Psychotic symptoms can sometimes persist for months or years after use has ceased.
Acute lead poisoning is another potential risk for methamphetamine abusers. A common method of illegal methamphetamine production uses lead acetate as a reagent. Production errors therefore may result in methamphetamine contaminated with lead. There have been documented cases of acute lead poisoning in intravenous methamphetamine abusers.
Fetal exposure to methamphetamine also is a significant problem in the United States. At present, research indicates that methamphetamine abuse during pregnancy may result in prenatal complications, increased rates of premature delivery, and altered neonatal behavioral patterns, such as abnormal reflexes and extreme irritability. Methamphetamine abuse during pregnancy maybe linked also to congenital deformities.
Are methamphetamine abusers at risk for contracting HIV/AIDS and hepatitis B and C?
Increased HIV and hepatitis B and C transmission are likely consequences of increased methamphetamine abuse, particularly in individuals who inject the drug and share injection equipment. Infection with HIV and other infectious diseases is spread among injection drug users primarily through the re-use of contaminated syringes, needles, or other paraphernalia by more than one person. In nearly one-third of Americans infected with HIV, injection drug use is a risk factor, making drug abuse the fastest growing vector for the spread of HIV in the nation. Research also indicates that methamphetamine and related psychomotor stimulants can increase the libido in users, in contrast to opiates which actually decrease the libido. However, long-term methamphetamine use may be associated with decreased sexual functioning, at least in men. Additionally, methamphetamine seems to be associated with rougher sex, which may lead to bleeding and abrasions. The combination of injection and sexual risks may result in HIV becoming a greater problem among methamphetamine abusers than among opiate and other drug abusers, something that already seems to be occurring in California.
NIDA-funded research has found that, through drug abuse treatment, prevention, and community-based outreach programs, drug abusers can change their HIV risk behaviors. Drug use can be eliminated and drug -related risk behaviors, such as needle-sharing and unsafe sexual practices, can be reduced significantly thus decreasing the risk of exposure. Therefore, drug abuse treatment is also highly effective in preventing the spread of HIV, hepatitis B, and hepatitis C.
What treatments are effective for Methamphetamine abusers?
At this time the most effective treatments for methamphetamine addiction are cognitive behavioral interventions. These approaches are designed to help modify the patient's thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Methamphetamine recovery support groups also appear to be effective adjuncts to behavioral interventions that can lead to long-term drug-free recovery.
Glossary
Addiction: a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use and by neurochemical and molecular changes in the brain.
Analog: a chemical compound that is similar to another drug inits effects but differs slightly in its chemical structure.
Benzodiazepines: drugs that relieve anxiety or are prescribed as sedatives; among the most widely prescribed medications,including valium and librium.
Dopamine: a neurotransmitter present in regions of the brain that regulate movement, emotion,motivation, and feelings of pleasu r e .
Psychosis: a mental disorder characterized by symptoms such as delusions or hallucinations that indicate an impaired conception of reality.
Serotonin: a neurotransmitter that has been implicated in states of consciousness, mood, depression,and anxiety.
National Institute of Drug Abuse
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