Pubdate: Tue, 08 Nov 2005
Source: Washington Post (DC)
Section: Pg HE01
Copyright: 2005 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: John-Manuel Andriote

METH COMES OUT OF THE CLOSET

In Parts Of Washington's Gay Community, Crystal Methamphetamine Is 
Starting To Take A Toll -- And Creating A Demand For Treatment

Special to The Washington Post

Chad Upham had been the kind of kid any parent would be proud of -- 
an Eagle Scout, a good child who didn't cause problems in his 
fundamentalist Christian family. He didn't touch a beer until he was 21.

Jump forward to an early Monday morning this past July. Upham, now 
27, had been up all night after another weekend of drugs and sexual 
hookups with strangers he met online.

But instead of pushing his limits for indulgence again, he made a 
different choice. Around 3 a.m., Upham sent an e-mail to his friends 
and family with some unexpected news.

"Over the past four months," he wrote, "I have become a regular user 
of crystal methamphetamine." He added, "I acknowledge, without shame, 
a concern for my mental, physical and emotional health."

While meth abuse is well-established in the U.S. heartland and 
increasing in New York and Los Angeles, it has had a low profile in 
the Washington area, where crack cocaine and marijuana are still the 
targets of most anti-drug programs run by law enforcement and public 
health agencies.

But meth use is increasing in portions of the gay community, 
according to local health officials, area addiction and mental health 
practitioners, and specialists in gay health issues. The District's 
Whitman-Walker Clinic, which provides HIV/AIDS and other health 
services to a largely gay clientele, reports that 75 percent of its 
new drug treatment clients list crystal meth as their primary drug of 
abuse. Five Crystal Meth Anonymous groups meet near Dupont Circle, a 
neighborhood with many gay residents. Two and a half years ago there 
were none. Suburban treatment centers report an increase in 
meth-related referrals, including some in teenagers. The D.C. 
government has just awarded its first grant for an anti-meth public 
education campaign, which will target the gay community.

The Post reported in July that police in Southern Maryland had found 
a small methamphetamine lab in the bathroom of a La Plata townhouse 
- -- along with a cache of weapons, including grenades and seven 
rifles, some with bayonets. But that close-in lab is an exception. 
Federal drug authorities said in a 2002 report that the few meth labs 
in this region are located in the rural Shenandoah Valley.

Methamphetamine is a homemade, highly impure version of amphetamine, 
a stimulant that was widely abused in the 1950s through the 1970s. 
Its main ingredient is distilled from the pseudoepinephrine found in 
many over-the-counter cold and allergy medications.

Commonly known as crystal, crystal meth and Tina, meth is a potent, 
highly addictive drug that some experts say can cause long-term 
neurological and cardiovascular damage. The drug supercharges the 
central nervous system, causing the brain to churn out dopamine. This 
neurotransmitter affects brain processes that control movement, 
emotional response and the ability to feel pleasure and pain.

"Someone said [meth] is like smoking a cigarette, having an orgasm 
and eating chocolate all at the same time," said Amy Bullock-Smith, 
clinical program manager for the Whitman-Walker Clinic's addiction 
services, "and all that lasting about 12 hours."

Meth induces euphoria almost immediately after the odorless, 
bitter-tasting powder is smoked, the most common way meth is used. It 
takes a few minutes to feel the same rush from snorting, swallowing, 
injecting or, less commonly, dissolving it in water and taking it as 
an enema. This is followed by six to eight hours, and sometimes as 
much as 24 hours, of increased energy, suppressed appetite and other 
stimulating effects.

Meth labs can be set up in homes, motels, apartments, trailers, 
houseboats, cars -- anywhere that heat and basic lab tools can be 
used to cook down cold and allergy medications to extract their 
active ingredients. Other chemicals used to make meth -- according to 
news reports and numerous Web sites that offer "recipes" -- include 
iodine crystals, red phosphorous from the strike pad on matchbooks, 
muriatic acid, acetone, methanol and drain cleaner.

A Local View

Aside from its growing use in gay clubs, meth has made little impact 
in local jurisdictions, officials say.

In its most recent drug threat assessment report, published in 2002, 
the Department of Justice's National Drug Intelligence Center 
described meth abuse as "limited" in Maryland, "a low but increasing 
threat to Virginia," particularly southwestern Virginia, and "not yet 
a serious problem in the District."

The department said that most meth available in this area was 
produced in southwestern states or Mexico. It was distributed to 
users by teenagers and young adults, mostly at nightclubs and raves, 
large dance parties usually held in warehouses or open fields.

Over the past five years there has been a surge in the number of gay 
men in the Washington area seeking treatment for meth abuse. Kevin 
Shipman, manager for special populations in the District's Addiction 
Prevention and Recovery Administration, notes that the number of meth 
referrals to the Whitman-Walker Clinic's outpatient drug programs is 
five times higher this year than in 2000.

Local substance abuse treatment programs for adolescents report 
seeing small but growing numbers of youthful meth abusers.

At the Inova Kellar Center, senior case manager Mary Ellen Ruff said 
this mental health center in Fairfax is seeing a lot of adolescents 
who have experimented with meth, though she does not have specific 
figures. She blames the drug's accessibility, pointing out that teens 
"don't have to go downtown to get it, but can buy it from their 
neighbors." She said some teens who abuse attention-deficit 
hyperactivity disorder (ADHD) drugs -- kids without the disorder who 
get the drugs illegally and use them as stimulants -- move up to crystal meth.

Whitman-Walker's Bullock-Smith said the men turning to her clinic for 
help with meth addiction are typical of Washington's professional 
caste -- Type A personalities in fast-paced jobs that require a lot 
of mental energy. "It's not necessarily the folks who want to party 
all the time," she said.

She points out that people with untreated ADHD seem especially 
attracted to meth because, much like legally prescribed stimulants 
such as Ritalin (methylphenidate), the drug paradoxically calms and 
focuses them. Researchers have suggested that, like crystal meth, 
methylphenidate amplifies the brain's release of dopamine, thereby 
improving attention and focus in individuals who have weak dopamine signals.

Because the drug's effects can include a supercharged libido, 
extended periods of high energy and sleeplessness and a much-reduced 
ability to make sound judgments, unprotected and promiscuous sex is a 
high risk. Recent studies from San Francisco and Chicago confirm that 
gay meth abusers are at significantly heightened risk for becoming 
infected with HIV and other sexually transmitted infections.

A 2003 study in the American Journal of Drug and Alcohol Abuse found 
that meth users are likely to experience increased respiration and 
blood pressure, irregular heartbeat and insomnia.

A report in Psychological Medicine in 2003 said that long-term users 
may experience paranoia, hallucinations, tremors, mood disturbances, 
repetitive motor activities, homicidal or suicidal thoughts and 
irreversible damage to small blood vessels that increase the risk of 
stroke. Children of meth users frequently are at risk for neglect and 
abuse, the authors found.

Researchers reported in the American Journal of Psychiatry in 2001 
that prolonged exposure to even low doses of meth can damage up to 50 
percent of the brain's dopamine-producing cells.

Those who overdose on meth experience hyperthermia and convulsions 
that, if not treated, can result in death.

"While some people enjoy the short-term benefits," said 
Bullock-Smith, "it's the long-term effects, like the psychosis, that 
bring them to me."

Breaking Tina's Spell

The National Institute on Drug Abuse says the only treatment known to 
be effective for methamphetamine addiction is cognitive behavioral 
therapy to modify thinking and behaviors and to increase skills in 
coping with stressors. The agency says that meth recovery groups, 
such as Crystal Meth Anonymous, appear to help sustain drug-free 
recovery, though relapse rates are high.

As for the brain damage meth causes, researchers Gene-Jack Wang and 
colleagues at the Brookhaven National Laboratory in Upton, N.Y., have 
offered evidence that some areas of the brain begin to heal after 
abstaining for as little as two months. Other damage is longer-lasting.

George Kolodner, a board-certified addiction psychiatrist and medical 
director of the Kolmac Clinic in Silver Spring, said his clinic saw 
an increase in crystal meth users beginning about two years ago, but 
the trend has not accelerated since then. He said meth users are the 
most difficult patients to treat because there is no medication to 
prevent craving or treat the protracted post-use symptoms, such as 
dysphoria, or depressed mood.

"With other substances," said Kolodner, "we can help people get off 
and keep off by decreasing their cravings. With meth and cocaine, we 
don't have that."

Randy Pumphrey, executive director of the Washington Psychiatric 
Institute's Lambda Center, which provides substance abuse services to 
gay people, said that in the past four years meth has increased from 
being "something we saw every once in a while" to the third most 
commonly abused substance, after alcohol and crack, among new clients.

If someone is dependent, said Pumphrey, "they are going to need a 
period apart from their environment -- and also need hospitalization" 
to deal with the paranoia, severe depression or even homicidal 
feelings that can accompany the detox process.

After this acute phase, Pumphrey said, patients usually participate 
in a daytime treatment program for several weeks before joining an 
extended support program such as Whitman-Walker's six-month evening 
program for recovering addicts.

Kolodner said the relative newness of meth-specific support groups is 
a challenge to treatment because few have been in recovery long 
enough to serve as mentors.

Bullock-Smith explains that Whitman-Walker's three-phase addiction 
recovery program requires a substantial commitment. To graduate, 
clients must attend one to three meetings a week at the clinic, 
participate in an outside 12-step group, have a sponsor, undergo 
breathalyzer and urinalysis tests to verify that they are not using, 
see a therapist, have a psychiatric evaluation and complete "lots of homework."

Let's Talk About It

A committee including the police department and other District 
agencies, substance abuse professionals, youth organizations, 
nightclub owners and recovering addicts began to meet this summer to 
plan a response to what they view as a growing meth crisis.

Like community-level anti-meth efforts in other cities, the D.C. 
Crystal Meth Working Group is planning a campaign aimed at educating 
the nonusing public, preventing meth abuse among gay men and offering 
treatment referrals to current users. The District health department 
has provided a $42,000 grant for the group to work with 
Whitman-Walker on the campaign.

This is a good start, said group member Bruce Weiss, executive 
director of the Sexual Minority Youth Assistance League, which serves 
gay, lesbian, bisexual and transgendered youth. The group will seek 
$1 million from the D.C. government and try to ensure that fighting 
meth is included in the five-year plan of the task force advising the 
mayor on anti-drug priorities.

Community activist Christopher Dyer, who chairs the group's social 
marketing campaign subcommittee, said the campaign's slogans, "Let's 
Talk About Crystal Meth" and "Crystal Meth Sucks," will be launched 
in nightclubs with posters, pins and T-shirts.

Another group member, Ed Bailey, co-owner of Nation, a Southeast 
Washington dance club, said major club owners across the country 
support anti-meth campaigns like this one. The drug has cut into 
their business because people typically do not drink alcohol when 
they are using meth, he said. Over time they also become increasingly 
isolated and don't go to clubs.

Since deciding to live meth-free after one too many sleepless, 
drug-driven weekends, Chad Upham said he depends mainly on Crystal 
Meth Anonymous groups and constructive activities with family and 
friends to support his recovery. Although he saw a doctor for a 
standard checkup, he -- unlike some of his recovering friends -- 
isn't taking any medications to treat anxiety or depression.

Upham is discovering that Tina continues to tempt.

"I am thinking desirously about the people, places and things that 
were associated with my using," he said. Running into a person he 
knew from those "hot days and nights" revives thoughts of "all that fun."

But he pulls himself back to his new reality -- denying the drug, 
listening to his family, co-workers and new friends in the support 
groups he attends several nights a week.

They have "embraced me in my weakness," said Upham, "continually 
saying that I am brave, courageous and strong for taking the steps to 
get and stay healthy and live independent of drugs for satisfaction."

John-Manuel Andriote, author of "Victory Deferred: How AIDS Changed 
Gay Life in America," is a Washington journalist. To comment on this 
article, send e-mail  ---
MAP posted-by: Beth Wehrman