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Meth Isn't Only a Rural Problem. Neither Are Solutions.

Upwards of 1 in 4 urban gay men use meth to escape. Too many become enslaved.

It seemed too much a caricature to be true. In July, West Virginia state police reported that wasp spray was being used in the state as an alternative to methamphetamine.

Inhaled or injected (injecting wasp spray?!), offering a brief escape from whatever needed escaping, the liquid poison provided a rush like meth. Some even used it with meth to intensify it.

Three deaths had been reported so far.

Meanwhile, NPR the same month reported that seizures of meth spiked 142 percent between 2017 and 2018. “If seizures have more than doubled, it probably means more than double trafficking in methamphetamines,” said John Eadie, public health coordinator for the federal government’s National Emerging Threats Initiative, part of the High Intensity Drug Trafficking Areas program. “And with that go additional deaths.”

In fact, the Centers for Disease Control and Prevention (CDC) reports that overdose deaths from meth or other psychostimulants last year rose 21 percent from 10,749 in 2017 to 12,987. Half of all those who died after a meth overdose in 2017 also had an opioid in their system.

Meth has long been associated with America’s impoverished rural areas where jobs are few and unhappiness runs deep. But meth abuse is hardly limited to isolated regions of the country.

In fact, there is a meth abuse epidemic in New York City at this moment. And not only in the Big Apple, but in major cities across the country, too.

Instead of affecting poor country folk, the urban meth epidemic is mainly afflicting gay men—young and not-so-young.

PixelSquid dot com
Loose pile of crystal methamphetamine.
Source: PixelSquid dot com

A second-wave meth epidemic among urban gay men

David Fawcett, Ph.D., is a substance abuse expert, certified sex therapist and psychotherapist in Ft. Lauderdale. The author of Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery, Fawcett is nationally noted for his work with gay men around issues of substance misuse and sexual addiction. He is also the producer of a just-released 90-minute documentary titled Crystal City.

“Meth use among gay men in New York City has risen 400 percent,” says Fawcett in the film, noting that the meth today is more pure, and there are more synthetic versions that present new dangers—just as there are with fentanyl for those who struggle with opioid addiction.

With an estimated one in four gay men in major urban areas using meth, Fawcett says, “It’s at epidemic levels in the gay community.”

Why does such a large minority of urban gay men find meth so appealing?

In an interview about Crystal City, the film’s New York City-based director Terrence Crawford said his own past meth use was a way to “deal with internalized homophobia.”

In the film, Fawcett points out the interrelated history between meth and HIV, particularly in a city like New York. “From the mid-80s to 1996, HIV was a death sentence,” he says, “people were dying all the time. My own AA recovery support group lost 80 percent of our members.”

Fawcett says that in the “early dark days” of the HIV-AIDS epidemic “people were looking for a way to check out. And meth, because of its powerful punch...was kind of a natural for that time. Around 1995-1996, there was a change in the mortality rate. People stopped dying, there were a lot of people on disability. People realized they’re not going to die after all and started celebrating. Meth came along and people feel like they can live again.”

But isolation and loneliness are acute in the gay community, said Fawcett in an interview about Crystal City. Besides, one of meth's big appeals is it lets someone dissociate from what he is doing so that, for example, he doesn't apply what he knows about the risks of certain sexual behaviors to the sex he is actually engaged in.

Among the men whose stories Crystal City follows is a slender blond man named Kristian. He blithely describes how his “young” appearance and willingness to do “whatever they [other men] want” is what keeps him supplied with meth. “Meth is freedom,” he says. “No other drug took me to that type of oblivion.”

Unfortunately for Kristian, by the film’s end he has become enslaved to the daily regimen of pill-taking required of those of us living with HIV who wish to remain healthy and live well. It’s not clear, though, that Kristian is much interested in living. “I’m not trying to live some long life,” he says. “I’m not trying to reach 90. Whatever my life will be, will be. It will take its course.”

Kicking the meth habit

Meth works on the brain’s limbic system, the reward circuitry. To understand how highly addictive it is, Fawcett references studies showing that while “natural rewards, things that give us little bursts of dopamine” provide 100 units in the case of food and 200 units for sex, meth cranks out 1,300 units. “That makes it highly addictive to almost anybody,” he says.

Besides the potentially deadly medical effects—stroke, heart attack, liver and kidney failure, and even rotted teeth—meth use is actually counterproductive because, says Fawcett, it destroys the brain’s dopamine receptors. This has huge implications for recovery because people can get highly depressed, impulsive, and even suicidal.

For someone who is used to combining meth and sex, the return to sex that isn’t fueled by chemicals can be such a letdown that it can lead to relapse. “Typically about 90 percent relapse on the way to recovery,” says Fawcett.

Working with fellow therapist Rob Weiss through a practice called Seeking Integrity, Fawcett told me in our interview about Crystal City that among men—gay and nongay—meth use is strongly connected to porn and sex addiction because sex and meth operate similarly in the brain. “We approach it as an intimacy disorder, an intensity disorder, an increasing need for intensity,” he said.

Twelve-step abstinence-based recovery programs are the most widely practiced approach to addressing meth addiction. Fawcett emphasizes the importance of a supportive community. “Any recovery solution must have a communal aspect,” he said.

Building structure and organization into the day so there aren’t opportunities to use meth is another step. So is finding a sense of meaning and purpose—one of the most important ingredients of resilience.

Terrence Crawford points out that there are more meth-specific support groups today than there were when I reported for the Washington Post way back in 2005 on the meth epidemic in Washington, DC's gay community. "One of the themes we cover in Crystal City is the quality of 12-step mentorship for newly sober crystal meth addicts and the importance of community-based support groups," he said. "Thankfully, CMA [Crystal Meth Anonymous] has evolved quite a bit since 2005."

It’s not coincidental that one of the country's still-most stigmatized populations also happens to feel the greatest need for analgesia. As David Fawcett said in our interview, “The meth epidemic is no coincidence.”

At a time when "deaths of despair" are rising in America, and the entire country seems awash in anxiety and depression because of its current political paroxysms, Fawcett makes it clear that the gay men seeking escape in meth are hardly alone. "This is not just a gay problem," he says in Crystal City. "It's a problem for our whole society that we really need to start to think about and address."