Substance Use: Methamphetamine
When basic needs and drives like hunger, sex, or thirst are satisfied, the brain’s natural reward system stimulates a release of a neurochemical, like dopamine, that makes us feel pleasure. Methamphetamine (a.k.a. crystal methamphetamine, crystal, meth, tina, T, ice), as a strong central nervous system stimulant, activates the same system in the brain, causing an influx of dopamine and other pleasure-inducing chemicals that artificially "reward" the user with an initial rush and prolonged high. Eventually, dependent users come to rely on crystal for the influx of dopamine, and the corresponding emotional rewards, rather than on natural sources of happiness. This lends itself to meth addiction since users experience withdrawal effects when not on the drug and may also need increasing amounts of the drug to get back to the synthetic reward-based happiness.
By artificially satiating needs with crystal, the brain’s hunger, sleep, and thirst centers shut down, bypassing the body’s natural survival instincts. Heart rate and blood pressure increase, arterial walls constrict, the pupil’s dilate, respiration rate increases, and blood sugar increases. Users feel energized, more awake, and less hungry. Crystal’s stimulation of the amygdale, the part of the brain responsible for a "flight or fight" response, leads to an increase of adrenaline in the system leading to “super-human” feelings of strength and alertness. Users experience more acute mental awareness and increased focus with a lack of any symptoms of fatigue for anywhere from 2-24 hours. The user may feel powerful, intelligent, and overall euphoric.
After the high, however, the levels of dopamine and other "feel-good" neurochemicals plummet below baseline level (the normal amount present in the brain), causing the initial one to two day "come down" or "crash." The fact that the body has been blind to hunger, exhaustion, and nutrition also contributes to the crash since a meth user’s system depletes stored energy supplies in the body leaving little left for the recovery period. A user becomes more susceptible to disease during this period as the body is completely run down.
For 7-10 days afterward, the body attempts to get back to the baseline level leading to feelings of exhaustion or the inability to concentrate/focus. Stimulant withdrawal gives rise to depression especially once the meth has burned out the cells that naturally produce dopamine making the brain unable to produce the good-feeling neurochemicals without the drug. If the user gets high during this period, his dopamine levels may be depleted even further since the body has not completely recovered. Frequent meth use can therefore cause the levels of dopamine and other neurochemicals to remain low for a long period of time, resulting in continual hangovers. People end up needing the drug to feel any pleasure, and lead a life of a high/hungover pattern with no natural pleasures left to make them feel good. This is the reality of meth addiction. Over time, meth may lead to lead to irregular heartbeat, extreme anorexia, or respiratory problems possibly leading to cardiovascular collapse and death. It may also cause the onset of psychosis and extreme paranoia, with these symptoms occurring either with extensive use, one large dose, or a small dose for a person with schizophrenic tendencies.
Amphetamines were first synthesized in 1887 with methamphetamine production starting in Japan in 1919. In the late 1920’s a British chemist studied the ability of crystal to produce the "fight or flight" response and realized the potential of meth for increasing alertness and decreasing fatigue. For these energizing and antidepressant qualities, amphetamines were put to use under government sanctions during WWII. Post-war, a notable number of American soldiers reported abusing amphetamine inhalers. The first intravenous injection of Benzedrine occurred in 1959, and in 1971 under the Controlled Substances Act of 1970, the last non-prescription inhaler was removed from the US market.
Three epidemics of methamphetamine use have plagued the US. The first occurred in the 1950s, the second in the late ‘60s and the third began in the mid-1990s. The third is thoroughly concerning due to its relationship to the spread of HIV via changes in sexual patterns of users.
Methamphetamine, commonly know as "crystal meth" or "glass," is a member of the family of synthetic stimulants, amphetamines. Amphetamines exist in three main forms: amphetamine sulphate ("speed" or Benzedrine), dextroamphetamine (Dexedrine or "Dexy’s Midnight Runners"), and methamphetamine. The three types are differentiated by purity, with speed being the most impure.
Speed’s appearance ranges from powder to paste to larger crystals, all of which have a brown, orange, or reddish appearance. "Base," which comes in a white/brown/pink paste, is yet another form of speed, and it is usually the purest form available. Methamphetamine, at its purest, takes the form of a prescription pill, sold under the name of Desoxyn. This is the only guaranteed pure form of methamphetamine. On the other hand, any form of street meth is often cut with non-psychoactive or psychoactive drugs, but in some cases, may actually be pure like Desoxyn. Typically, street meth exists as a colorless crystalline solid, known commonly as "crystal meth," "crystal," "tina," "glass," or "ice." When sold under the name of "dope" or "tweak," however, it may appear in a crystalline rock form. "Yaba," Thai for "crazy medicine," usually contains a mixture of meth and caffeine in pill form. The most impure meth is a crumbly brown or off-white rock know as "peanut butter meth."
Methamphetamine can be swallowed, snorted, smoked and injected by users. The effects usually last from four to eight hours or more, depending on dosage.
Since meth puts a great deal of stress on the heart and increases blood pressure, it is important to minimize additional strain. The following guidelines are experiential and may have different effects in your own body. Just be careful.
Alcohol: Meth allows for extended binge drinking which is bad for the liver and kidneys. The likelihood of an aggressive or irresponsible reaction increases.
Marijuana: There are no known additional negative effects.
Cocaine: Cocaine is very similar to crystal to begin with, so the two are a very unlikely combination. Additional strain to the heart and increased toxicity are both dangerous repercussions of using both at the same time.
Ecstasy: Meth extends the E high, which in turn increases energy and euphoria. As there is additional strain on the heart and the risk of overheating, they should only be combined in moderation.
Heroin: This is common due to the grounding nature of heroin versus meth’s psychotic influence among heavy users. It can be a very deadly combination as the effects of opiates (like heroin) are generally longer than the stimulant’s (meth’s) effects, leading to possible overdosing.
LSD: The compounded speed effect is dangerous to the heart.
Poppers: (liquid amyl or butyl nitrite): The increased stress on your heart can lead to higher risk of heart attack or stroke. Chest pain and change in blood pressure are common.
Viagra: Chest pain and sudden change in blood pressure may occur. The combination may also lead to heart attack or stroke.
Meth, due to its weight loss/lack of eating/exhaustion effects, harshly affects the immune system while reducing the efficacy of anti-retroviral HIV meds and increasing the rate at which HIV replicates. Using meth even occasionally may cause a person to forget to take his meds making it more likely that treatment will fail.
Taking HIV meds while on meth also increases the risk of overdosing due to drug interactions. HIV therapy, if started before the use of meth, can elevate the level of drugs/alcohol in your blood as the liver processes the HIV meds while leaving the other drugs circulating in the blood. This can lead to an overdose. You may need to use much less crystal to get high. If on HIV meds, you should talk to your doctor about these potential drug interactions. HIV meds can also decrease the effectiveness of methadone. You may need the amount of methadone you are taking adjusted.
In addition, just because you are HIV+ and your partner(s) is HIV+ does not mean that you are not at risk when having unsafe sex (with or without meth). Superinfection, which results when partners have two different strains of the HIV virus and may infect each other with the different strains, may accelerate HIV progression since the newly introduced strain may be more virulent or drug-resistant. This may render HIV treatment ineffective.
The primary reason gay men use crystal is simply because it feels good, especially in regards to sexual pleasures. Crystal increases sex drive, keeps sex going longer, makes sex more intense, and reduces sexual inhibitions. Not to mention the fact that meth often makes the user feel more powerful and confident, which helps them in meeting and connecting with other gay men.
There is also the issue of meth as a weight loss method, which boosts certain users’ self-images and gives them more confidence. Of course, in the long run, meth can make a user look sickly and emaciated.
HIV infected men also find relief from their state in meth as they forget about the problems related to their illness. Of course, the fact that people are forgetting about such a serious illness results in a larger issue, especially because sexual inhibitions are at an extreme low. Users find themselves in a drug-induced sexual frenzy where they try to get as much sex as possible without concern for safety. Quantity becomes more important than quality, and ultimately, a regular user of meth increases his chances of getting HIV by 400%.
Men with HIV, while forgetting about their illness temporarily, also have a tendency to forget to take their HIV meds. In addition, the lack of sleep and nutrition takes a toll on their bodies leading to further immunosuppression.
The problem of "crystal dick," or the inability to achieve or maintain an erection while high on meth, occurs in some men as well, which makes condom use impossible and sex difficult although the drive is still there. Men use viagra in some cases to counteract the impotence, often endangering themselves. Viagra opens the blood vessels in the penis allowing blood to flow in and maintain an erection. However, blood pressure drops and the heart speeds up resulting potentially in dizziness, flushing, headaches, or tinted vision. If too much Viagra is taken, it is even possible to black out or get an erection that won’t go down, which causes damage to penile tissue.
Since meth reduces the ability to sense pain the ability to have sex for hours many ultimately result in injury, especially when bottoming during anal sex. This leaves the body exposed to HIV infection on an even greater scale than practicing sober unsafe sex.
The bottom line is that meth reduces sexual inhibitions and often leads to unsafe practice and an increase in the number of partners a person has in one evening. The chance of getting HIV is four times greater for regular meth users, and the likelihood of getting syphilis or other STI’s greatly increases as well. Bottom line: when using meth, practice safe sex and prepare for it ahead of time. Leave condoms and lube out before you get high, and put them in a place where you are sure to see them once you get high (like with your drugs, wallet, or keys). Also, remember to change condoms frequently with extended use or between partners as condoms or lube may wear out.
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