Methamphetamine Addiction and HIV Disease: A Concurrent Spread of Two Epidemics

David E. Smith, MD

Our California Senator Dianne Feinstein, in her decade-long effort to help the government crack down on the nation’s growing methamphetamine epidemic, introduced a bill to limit an individual’s purchases of drugs containing pseudoephedrine to 7.5 grams a month from about 250 capsules. Similarly, retailers would be required to send computer records of purchases to state databases to ensure that no individual exceeds the purchase limit. The bill also sets up a national methamphetamine treatment center to research the best ways of helping addicts kick their habits. Senator Feinstein has described the methamphetamine epidemic as the single worst drug threat that any of us has faced in our lifetime. She cites national data showing that the number of meth labs raided jumped to 15,994 in 2004, from 7,438 in 1998. She also says that in <ST1:PLACE w:st="on"><ST1:CITY w:st="on">San Francisco</ST1:CITY></ST1:PLACE> the use of methamphetamine, with its associated compulsive sexuality, has led to a spike in sexually transmitted diseases, including a resurgence of HIV disease among gay men. This was demonstrated by the increase of new infections of HIV (which are resistant to current medications) in gay men using methamphetamine and participating in high-risk sex. Thus emerge the twin epidemics of methamphetamine addiction and HIV disease. They coalesce to spread drug- resistant strains of the virus. Dr. Marti Fensterscheib, Santa Clara County Public Health Officer, confirmed the increase likelihood of multiple strains of new HIV infection with the increased probability of  drug-resistant strain of the HIV virus.

The epidemic of methamphetamine and HIV was eloquently described in the addiction medicine publication New Times by Mark Gillard in an article entitled “Methamphetamine and HIV.�?He described the typical pattern of abuse of methamphetamine in association with high-risk sexual practice, followed by the comedown or crash, in which the individual feels depressed while attempting to lead a normal life outside of the South of Market “gay speed scene�?in San Francisco.

In a major <ST1:PLACE w:st="on"><ST1:CITY w:st="on">Los Angeles</ST1:CITY></ST1:PLACE> study this last year, nearly one in three gay and bisexual men who tested positive for HIV acknowledged using crystal methamphetamine. This is almost triple the rate of methamphetamine use in HIV-positive men in 2001. Officials at the Los Angeles Gay and <ST1:PLACE w:st="on"><ST1:PLACENAME w:st="on">Lesbian</ST1:PLACENAME> <ST1:PLACETYPE w:st="on">Center</ST1:PLACETYPE></ST1:PLACE> presented data based on 19,300 tests over four years at the National HIV Prevention Conference. The general agreement is that the methamphetamine problem is a growing threat to gay and bisexual men. Dr. Jeffrey Klausner, director of sexually preventive disease control in <ST1:PLACE w:st="on"><ST1:CITY w:st="on">San Francisco</ST1:CITY></ST1:PLACE>, likewise emphasizes how serious this growing problem is. Quentin O’Brien, the Gay and Lesbian Center’s Director of Health and Mental Health Services, calls the increase “startling,�?believes it is now inching upward, and says it is uncertain when the peak will occur. The likelihood of unprotected sex has long been associated with methamphetamine abuse by increasing arousal and reducing inhibitions, the drug often also prompts users to seek sex with multiple partners, thus heightening the risk of contracting HIV. Increasing high-dose methamphetamine abuse is associated with increase in sexual fantasies, but as noted in our 1980 study titled “High-Dose Methamphetamine Adult Sexual Dysfunction,�?the result has been not just sexual enhancement but also erectile dysfunction. Consequently, many gay men are combining methamphetamine and Viagra. In fact, a recent presentation indicated that the highest per-capita sales of Viagra were in the Castro district of San Francisco. A recent Robert Woods Johnson project was commissioned to study the growing misuse of Viagra in young gay males abusing methamphetamine because of the public health concerns over this drug combination and its relationship to the spread of HIV/ AIDS. However, when these drugs are mixed to overcome the sexual dysfunction effects of methamphetamine, safe sex is often left by the wayside. And as Gillard

describes, the rectal chafing from compulsive sexuality increases the likelihood of viral transmission, and combining the drugs also raises the incidence of heart attacks and stroke. “We’re losing people to the effects of multiple methamphetamine drug use as well as to HIV disease,�?he writes. There is also an increase in serious cardiovascular disease with this younger population abusing methamphetamine.

Dr. Terry Neill of the UCSF department of neurology recently reported methamphetamine-induced strokes in 30- to 40-year-old males and females that were longlasting and difficult to treat because of the associated toxic periarteritis.

A GLOBAL PROBLEM

The twin epidemic of speed and AIDS is not confined to the <ST1:PLACE w:st="on"><ST1:COUNTRY-REGION w:st="on">United States</ST1:COUNTRY-REGION></ST1:PLACE>, but is now global in nature. Walter Ling and Richard Rawson of UCLA, leaders in methamphetamine research and treatment, have described a rapidly increasing methamphetamine epidemic in <ST1:PLACE w:st="on"><ST1:COUNTRY-REGION w:st="on">Thailand</ST1:COUNTRY-REGION></ST1:PLACE> and other Southeast Asian countries. There methamphetamine addiction has fueled both IV drug abuse and unsafe sexual practices, including widespread prostitution relating much more to heterosexual activity and also contributing to the rapid spread of HIV disease. JVR Prasoda Rao, regional director of the United Nations AIDS Support team for <ST1:PLACE w:st="on">Asia</ST1:PLACE> and the Pacific, posted the second highest increase in HIV/AIDS rates in a region home to more than one half the world’s population. At the 2005 Seventh International Congress on AIDS in <ST1:PLACE w:st="on">Asia</ST1:PLACE> and the Pacific, he described this epidemic surge as the “silent tsunami,�?potentially killing many more people than the thunderous December 2004 disaster in southeast Asia.

TREATMENT OPTIONS

 The development of specialized treatment, including research into new medications, is crucial for dealing with this methamphetamine epidemic. Kathy Jett, at the 38th Anniversary Conferenc of our Haight Ashbury Free Clinics, indicated that Proposition 36, the Diversion to Treatment in the Criminal Justice System program, placed more than 30,000 drug offenders in treatment during the first year—more than half of them being treated for the first time. Jett indicated that although specialized treatment is needed for methamphetamine addiction, effective treatment can be quite successful as demonstrated by many of the recovering methamphetamine abusers who attended our Haight Ashbury Free Clinics Conference and are participating in our stimulant recovery groups.1 Cathy Reback, a researcher and director of prevention at the Van Ness Recovery House in Hollywood, stressed that in the past, addiction recovery and HIV treatment programs did not collaborate, but that now there’s a big move toward expanding collaboration between them—an integration that’s long been emphasized at programs like the Haight Ashbury Free Clinics. To be effective, specialized treatment for methamphetamine addiction must deal with the methamphetamine-related sexual issues, including sexually transmitted diseases as well as comorbid psychiatric disorders. It is hoped that the national specialized methamphetamine treatment center proposed by Senator Feinstein will emphasize the integration of treatment for methamphetamine addiction with comorbid medical and psychiatric disorders. Gabrielle Antolovich, editor of New Times, has published a list of specialized treatment programs for methamphetamine abuse, including Gateway House in the <ST1:PLACE w:st="on"><ST1:CITY w:st="on">San Jose</ST1:CITY></ST1:PLACE> area, (800) 488-9919.

Information also can be obtained from the National Council on Alcoholism and Drug Dependence’s Information Clearinghouse at <ST1:ADDRESS w:st="on"><ST1:STREET w:st="on">1415 Koll Circle, Suite 101</ST1:STREET>, <ST1:CITY w:st="on">San Jose</ST1:CITY>, <ST1:STATE w:st="on">CA</ST1:STATE> <ST1:POSTALCODE w:st="on">95112</ST1:POSTALCODE></ST1:ADDRESS>. The Haight Ashbury Free Clinics offer specialized methamphetamine recovery group programs as well as inpatient and outpatient treatment, focusing on some of the special needs of methamphetamine abusers.

MISPLACED PRIORITIES

We in addiction medicine applaud Senator Feinstein’s heroic leadership in dealing with the methamphetamine epidemic, including reduction of the availability of pseudoephedrine (which is well known for being converted into methamphetamine) and the development of a national specialized methamphetamine treatment center. The question is why the current administration’s White House Office on Drug Abuse Policy hasn’t paid more attention to the surging methamphetamine epidemic and its association with the growing HIV problem. At a recent White House Office on National Drug Control Policy (ONDCP) visit to the state of <ST1:PLACE w:st="on"><ST1:STATE w:st="on">California</ST1:STATE></ST1:PLACE>, we posed that question to representatives of the ONDCP. They persisted in putting their emphasis on the issues of medical marijuana as a higher priority. While medical marijuana may be a political and ideological priority for this administration, and is a significant medical practice issue (which has been thoroughly reviewed by the American Medical Association), it is far from being the number-one drug problem in the United States and pales in comparison to the methamphetamine epidemic in terms of urgency.2 I posed a similar question to a congressional representative at a meeting in Washington, D.C., recently and he stated that the methamphetamine problem, which started in California and spread to the rural areas of the United States, is considered a “fly-over zone�?problem in the Beltway. He explained that rural <ST1:PLACE w:st="on">middle America</ST1:PLACE> is called the “fly over zone�?by our leaders in the Notheast corridor and that until the methamphetamine epidemic hits the Beltway, it will not be a priority for this administration.

In a recent article by the Center for Substance Abuse Research, the headline read, “Methamphetamine Named Top Problem by Majority of County Law Enforcement Agencies in western <ST1:PLACE w:st="on"><ST1:COUNTRY-REGION w:st="on">U.S.</ST1:COUNTRY-REGION></ST1:PLACE>—Will the East Follow?�?The article states that more than one-half of 500 county law enforcement agencies in the <ST1:PLACE w:st="on"><ST1:COUNTRY-REGION w:st="on">U.S.</ST1:COUNTRY-REGION></ST1:PLACE>  report that methamphetamine is their primary drug problem, according to a recent survey conducted by the National Association of Counties. Three-fourths of law enforcement agencies in the Northwest and Southwest regions reported that, based on drug-related arrests in the last year, methamphetamine was the biggest problem in their county. More than one-half of responding agencies in the upper Midwest (67 percent) and lower <ST1:PLACE w:st="on">Midwest</ST1:PLACE> (57 percent) reported the same. In contrast, around one fourth of agencies in the Southeast and only 4 percent of those in the Northeast reported methamphetamine as their number-one drug problem. While these findings support previous research indicating that the West and Midwest have been hit hardest by methamphetamine use, they also suggest that the eastern <ST1:PLACE w:st="on"><ST1:COUNTRY-REGION w:st="on">U.S.</ST1:COUNTRY-REGION></ST1:PLACE> should be vigilant for any increase in methamphetamine-related problems.

Until the methamphetamine epidemic hits the Northeast and becomes a political priority for members of this current administration, they will continue to be out of touch with the nation’s addiction priorities and therefore will provide an ineffective response to this current epidemic. It is hoped that Senator Feinstein’s leadership can redirect national priorities to the true public health and safety needs of our country, including targeting the serious twin public health epidemics of methamphetamine addiction and HIV disease. We in the medical community have a responsibility to support political leaders like Senator Feinstein, who base their policies on scientific fact and public health priorities, rather than on political ideology.

Dr. Smith is the founder, president and medical director of the Haight Ashbury Free Clinics, Inc. He is also past president of the American Society of Addiction Medicine and associate clinical professor at UCSF and medical director for CA State Drug and Alcohol Programs.

REFERENCES

1.   Smith, D & Heilig, S. Addiction as a brain disease:

Methamphetamine as a case study. <ST1:PLACE w:st="on"><ST1:CITY w:st="on">San Francisco</ST1:CITY></ST1:PLACE> Medicine, Volume 77 (5 ), pp. 13�?5, May, 2004.

2.         Smith DE, Heilig S, Editors. Marijuana at the millenium: medical and social implications. Journal of Psychoactive Drugs, Volume 30(2), 1998.

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