Tuesday, March 01, 2005

Recipe For Disaster

I've blogged about the crystal methamphetamine epidemic before, but specifically with regard to its prevalence in rural areas.

Now I see where Andrew Sullivan has, understandably, been blogging about the meth epidemic in gay culture (see here, here, and here, for starters).

In the last link, Sully references a New York Times article about meth's effect on the immune system.

I don't agree with everything that Sully says on the subject, but am in his debt for bringing this to my attention.

I can't think of a group more ill-suited to methamphetamine than the gay community, especially the HIV+ folks among it. Methamphetamine, from my observations, wreaks havoc on even healthy people's immune systems. Sully apparently thinks that the reactions to the meth-AIDS relationship is overblown. I rather doubt it. From the Times article:

Although methamphetamine, often called crystal meth or speed, is most troubling to health officials because of its role in blotting out inhibitions and fueling high-risk sexual behavior, experts say they are also grappling with mounting evidence that the drug by itself may increase a person's susceptibility to infection by crippling immune function and facilitating disease transmission.

"There seems to be something about methamphetamine that predisposes people to H.I.V. infection," said Dr. Grant Colfax, co-director of the H.I.V. epidemiology biostatistics and intervention section at the AIDS office of the San Francisco Department of Public Health. "When we look at why methamphetamine is increasingly responsible for the H.I.V. epidemic, I do think we need to look more closely at whether it is somehow suppressing immunity and increasing viral loads."

[...]

A long-term study of more than 4,000 gay men sexually active with more than one partner recently found that the odds of contracting H.I.V. climb substantially while using crystal meth, independent of other risk factors.

About a quarter of the men who were followed said that they had used crystal meth in the six months before the start of the study. They were all H.I.V. negative when it began.

By the end of the study, called the Explore Project, about 2.1 percent of the men had become infected. Unprotected sex with multiple partners was strongly associated with infection. But even after the researchers controlled for those behaviors and others, like injection drug use, the men who were taking crystal meth were twice as likely to contract H.I.V.

"This was a really surprising finding," said Dr. Colfax, a principal investigator on the study. "There's reason to think there's a combination of factors involved."

One of them may be crystal meth's impact on immune cells. Although research is limited, studies in animals and on cell cultures have found that methamphetamine suppresses killer T cells, a type of white blood cell that fights off pathogens.

That, combined with the drug's tendency to dry out mucosal membranes and cause abrasions in the mouth and rectum, might slightly increase a person's vulnerability to infection, said Dr. Antonio Urbina, the lead author of a study on crystal meth and H.I.V. that appeared last year in the journal Clinical Infectious Diseases.

In those who are already infected, crystal meth may take a greater toll. Studies have found that it can interfere with antiretroviral medications and set off a surge in viral loads, accelerating the progression of the disease and making a person more infectious to others.

[...]

Whatever crystal meth's influence on the immune system and viral replication turns out to be, experts stress that its most alarming impact is on behavior.

"I think that's really the biggest gorilla in the room," said Dr. Steve Shoptaw, a research psychologist at the University of California, Los Angeles, Integrated Substance Abuse Programs. "Being in a sex club for 36 hours on crystal meth and engaging in unprotected anal sex is really the most profound effect."


It's all very intuitive to one who knows what meth does to the psyche, and has observed the altered behaviour as well as physiological transformations in meth users.

But when I say behaviour, I dont mean to be a scaremonger along the lines of "Reefer Madness". Though I know that meth affects a person's judgement as in it makes him more impulsive, I think there's more to it than that.

I'm talking about, for instance, the fact that men using speed often have a difficulty in attaining and sustaining erections. When this is compounded with the other facts of meth use: that speed gives energy and inspiration to attempted "marathon" sex, that it generally stiffles any tendency to caution, that it encourages carelessness and impatience, that it briefly aids strength or gives the illusion of it, that it greatly desensitizes the penis, the recipe here is for disaster. The article mentions that meth dries a person's mucous membranes out, which obviously has sexual repercussions. Add to this the reality that meth's effect on erections makes frequent condom changes necessary, which meth's effect on the psyche may translate into the determination by the user that the condom's not worth the bother. Raw bits, impatience, an ability to fuck for hours once erection is achieved, often a depleted immune system... bad combination.

If you must use meth, don't fuck while you're on it.

Then there's meth's physiological effects. Tweakers eat little if at all, and malnourished people are more likely to be vectors for disease than properly fed ones. Also, the body is not meant to be denied so much sleep for so long a time; it cannot properly repair itself, and falls into ruin. The Times mentions needles, and it's especially true that hardcore tweakers are very likely to shoot meth rather than snort it.

Then there is the subject of hygiene. There is a reason why tweakers have bad teeth if they have teeth remaining at all, and it's not all due to the fact that meth has been heretofore mostly used by the poor. Whether meth itself causes the acne and boil problems of its users or merely inculcates an indifference to hygiene which in turn causes said problems probably matters little, the point is that hardcore users have many open sores.

As I read those links and now as I write this post, I'm reminded of something that has stuck in my head for a long time. Years ago, I read an article in Penthouse, I think, about a radical physician who at the time thought that AIDS had as much or more significant correlation to drug use -- and not merely intraveneous drug use -- than it did with any other group at the time: homosexuals, Haitians, hemophiliacs. The article was from the mid-80s, I think. Obviously, much of it is bunk but something has stayed with me about it, and to my layman mind strikes me as important. The doctor specifically pointed to speed, especially "poppers" (amyl nitrate, which happened to be a drug of choice of gays much more than it was of heteros), as being his major concern for the fact that he believed they were so poisonous to regular users that they alone could account for drastic reductions in the users' bodies of white blood cells and AIDS-like symptoms. Now scientists say meth may be similar.

Anyway, the point is that the gay community above all ought to take care to avoid meth. Sullivan's emailers make some good points about their community's social and cultural losses to the meth epidemic, on the grounds that tweaking is an anti-social enterprise except for the sexual aspect, and one sensibly suggests peer-pressure as a possible weapon against meth. The main concern, of course, is health. Meth is a health disaster for any group. But the gay community can least afford a recreational drug that attacks the immune system with such apparent alacrity.

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