Tina took the life of Robert, a rising network-television executive, at the age of 32. After years of insidious contretemps, Tina sent Kevin, a former department-store dresser, into a depression from which he has never recovered.
Tina tried to get Michael, a financial expert, and she gets the better of him once in a while.
Tina is short for Christina, which is a name for crystal methamphetamine, which is the '90s version of speed. Depending on whom you ask, Tina is either the greatest sexual elixir gay man has ever known, or the fuel that threatens to compound and re-ignite the AIDS epidemic.
Crystal is, at face value, a great bargain. At an estimated cost of $40, it will create a "high" that can last the entire weekend. It makes its user incredibly sexual, energetic, euphoric and confident. It is very easy to obtain (and equally easy to manufacture). But until recently, the escalating abuse of methamphetamine and its dangers have been topics begrudgingly and rarely discussed within the gay community.
The people who will discuss the drug with great enthusiasm are its devotees, according to a Southern California therapist who treated dozens of crystal addicts during a 10-year period. "They just love to talk about it because it is makes them so euphoric," says Dr. Larry Clayton (not his real name). Increasingly frustrated and overwhelmed by what he saw and heard from his addicted patients, Clayton closed his private practice last year.
The latest quarterly report by the Office of National Drug Control Policy reports that Los Angeles, San Francisco and San Diego now lead the nation's cities in the numbers of deaths associated with methamphetamine use. Although crystal is used by gays on the East Coast, the predominant drugs of choice there are "fantasy" drugs such as ecstasy.
So who uses crystal? Many of the patients Dr. Clayton saw were upper-middle-class, high-powered, affluent gay males who are part of what's known as "the circuit." Many were high-level executives or men who owned their own businesses and would call in sick on Monday to recover from weekend partying. If they had to be at work first thing Monday, they would simply take 2 mg of Zanax on Sunday, which would bring them down from their high. "And then they begin looking forward to Thursday night, when they start the cycle all over again," Clayton says.
Easy as it may be to say that crystal is a problem that belongs solely to the circuit crowd, it's actually far more insidious and is used by gays of all socio-economic levels. "What's incredible is the bonding that occurs among crystal addicts," observes Clayton. "The minute they gather and start bumping (the term that refers to the taking of the drug), they are all equals. A D-level gay can be on par with the A-levelers, as long as he's part of the crystal circuit."
In San Francisco, crystal-users' demographics are broadening, says Joe Neisen, executive director of New Leaf, a nonprofit formerly known as Operation Concern/18th Street Services, which offers help to gay, lesbian and transgender substance abusers, as well as those with mental-health problems and/or HIV. Because of methamphetamine's low cost, Neisen says, more young people in the lower Haight are making it their drug of choice. He has also noticed an increase in crystal use in the lesbian community.
An FDA employee who lives in San Francisco says he is disgusted by what he's noticing lately: "I go to the YMCA at Golden Gate and Leavenworth; one doorway at the Y is constantly frequented by crack dealers and speed dealers any time of day and night. And I see gay men getting their stuff there all the time." Even around the Castro, he sees crystal addicts "wandering around, babbling and talking to themselves."
Martin Delaney, founding director of Project Inform, sees crystal as a tremendous problem for the gay community: "Crystal is a simple, cheap and chemically dirty high. I've observed and participated in many of the drug crazes that go on in our community. In the long run, no drug does more harm than crystal and other forms of speed, primarily because [they are] so good at convincing the user that it isn't a problem. People don't feel wasted or drugged out. Most of the time they're on crystal, they think they feel great. It's only when the whole picture of chronic crystal use sets in--loss of sleep and jobs, loss of sanity--that we see the damage done. But to the person in the middle of it, life seems fine, even great, until that last fraction of a second before hitting bottom."
Low Maintenance, High Flying
Crystal is easy to manufacture since its main ingredients are actually compounds used in the photo-development process. There have been reports during the past few years of police raids on trailers in outlying areas where methamphetamine is being produced.
Since crystal is a synthetic pharmaceutical, the FDA does not have direct regulatory authority over the drug. It had been, until recently, very easy to obtain the main ingredients for methamphetamine production from photo-development suppliers, as well as drug stores (one of the ingredients, pseudoephedrine, is contained in over-the-counter cold pills). More recently, the Drug Enforcement Agency (DEA) has started requiring suppliers to keep records of any purchases of large amounts of photo-developing supplies. But even if US drug officials continue crackdowns on stateside meth labs, the Mexican drug cartel is virtually unchecked in its meth operations south of the border. In California, it is estimated that in 1996 more than 1,200 meth labs were busted, about a quarter of which were believed to have been run by Mexican drug lords.
Saying, "We have to stop meth before it becomes the crack of the 1990s," President Clinton signed legislation in October 1996 that increases penalties for those manufacturing methamphetamine and tightens control on the chemicals used in the process.
But controlling the flow of the drug does little to control the demand. In a recent letter to Dr. Clayton, Michael, an investment-banking marketing and communications specialist for the world's largest investment-banking firm, wrote, "Crystal is great stuff. It wakes you up, makes you feel perky, vibrant and alive--gives you that boost you need to keep on going during those long circuit weekends." Explaining the drug's main draw, Michael added, "Sex on crystal? Flawless, insatiable, nonstop fucking. Who could ask for anything more?"
Crystal vs. Safe Sex
A tremendous part of the problem of crystal addiction is the sexual component, especially as that relates to safer sex. Clayton explains, "When crystal addicts are worried only about nonstop sex, the last thing they think of is safe sex. Condoms? What condoms?"
"We're finding that people under the influence of crystal are not maintaining safer sex practices. They're having more sex, and much riskier sex with many individuals, which is a bad combination," says Neisen of New Leaf.
The Center for AIDS Prevention Studies at UCSF reports that gay and bisexual men who use speed are up to four times more likely to become infected with HIV than non-users, as a result of both injection-drug practices and the increased likelihood of high-risk sexual practices when using stimulants.
Neisen, Clayton and other community leaders worry that as crystal use increases, there will be a new surge in the number of HIV infections. Ironically, most of Clayton's crystal patients were HIV-positive men. "They took the position that they were facing a death sentence, and they were going to have fun going to their graves."
All Clayton's seropositive patients addicted to crystal are now dead. Health officials are concerned that methamphetamines have a very specific and quite debilitating impact on men already infected with HIV and AIDS. It is likely the chemical compound of methamphetamine interacts negatively with protease inhibitors and other anti-HIV drugs. Even more frightening is the possibility that crystal accelerates HIV replication even in those who use methamphetamines on a recreational basis.
Neisen has seen some HIV-positive crystal addicts take the drug in response to lethargy and fatigue. "It gives them an initial energy boost, but it's a false sense," he says. "They lose their appetite, don't eat properly and therefore lack proper nutrition. The drug keeps them up till the middle of the night, and they're barely eating, and that's leading to major medical problems."
Ron Patton, a psychiatric social worker in the Gay/Lesbian HIV clinic at San Francisco General, is noticing growing numbers of patients with mental problems clearly resulting from drug abuse. "With those who are positive, if HIV has gotten into the brain, it appears that they're more sensitive to the effects of speed and, therefore, speed-induced psychoses," he says.
What Patton is seeing at SF General is absolutely correct, says Dr. Wallace Winters, a retired professor of pharmacology and toxicology. One of the secondary phenomena brought on by methamphetamine use is "brain rotting." According to Winters, crystal use by even reasonably young and healthy people results in the continuous elevation of blood pressure, which leads to the breakdown of blood vessels. "The result is that circulation in some of the vital organs becomes impaired. There's a noticeable degradation of the functional capacity of the liver, kidneys and brain."
Dr. Winters, who is the current medical officer of the regional office of the FDA in the Bay Area, also says methamphetamine use causes damage in the lungs, possibly leading to pulmonary edema or pulmonary hemorrhage. Sometimes, there are cardiac arrests in crystal-users who have gone to the gym for a workout, flush with drug-stimulated energy.
For everything that is known, many questions remain about the effects of crystal, particularly for those with compromised immune systems. Clayton laments, "In 1997, we have no idea how damaging crystal is on cognitive, psychological and scientific levels because there aren't enough studies."
Patton notes that even if studies are finally designed to study the effects of methamphetamine, it will be difficult to come to any solid conclusions because "folks with active drug use don't show up for appointments." He adds that, from what he and others have seen, there are no doubts that crystal has negative side effects over the long term, even for recreational users of the drug. "It absolutely does affect the brain," he emphasizes, "and you're not going to function as well at the age of 40 as someone who didn't do the drug at all."
The Gift That Keeps on Giving
Even for those who come clean, like Kevin, the former department-store dresser, the drug's effects never go away. Kevin has been clean for several years, yet often remains too depressed to leave his home. He lives in a small corner of a home cluttered with garbage.
Dr. Clayton has seen evidence of brain impairment in some of his patients who were often unable to focus on their work and whose jobs began to suffer. "They experienced 'dual focus,' where one part of the brain concentrates on the task at hand while the other is worrying, 'Where's my next bump?'" he says.
In research studies using low doses of the drug in animals, scientists were able to induce epileptic-like seizures in the brain. Those frightening responses in animal studies have already occurred in humans.
Remember Robert, the young television executive? "He was incredibly talented and headed for a major career," Clayton says of his former patient. "Robert started doing crystal at age 25, a few years after he'd begun his career ascent. He was handsome, worked out Monday through Friday, was blue-eyed, blond and tanned. He was very out to his supportive family, was financially successful, and even set up a scholarship for gay men." Positive and asymptomatic for many years, Robert's addiction to crystal began affecting his life. Everything outside of work revolved around the drug.
Dr. Clayton recalls one episode in which Robert missed his flight for the East Coast where he was headed for a major circuit party on Fire Island. Robert was so desperate to be there that he chartered a private jet. On another party weekend, this one in Key West, he had his first seizure and was hospitalized for three weeks. Returning home, Robert went cold turkey, but the seizures recurred every few weeks. He began to go blind and ultimately died at his parents' home at the age of 32 last year. Doctors confirmed that crystal abuse caused his death.
Project Inform's Delaney says thought and action are needed immediately. And courage, too. "We are all too quick as a community to defend drug abuse as an inalienable political right that is somehow vaguely connected with being young and gay. Dare to speak out against it, or against the endless and mindless sexual addiction that often accompanies it, and you're some kind of Uncle Tom. If we as a community fail to recognize the damage done by speed--past, present and future--we'll see a segment of another generation of gay men and women waste their lives. Far too many tweakers wake up from the crystal haze and suddenly realize they're not 20 anymore, but 40 years old with no career, no friends, no personality and no values."
Reprinted by permission of San Francisco Frontiers Magazine, Volume 16, Issue 7, July 31, 1997.
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