Methamphetamine use dates to post-WWII era
Drug little-known risk factor in early AIDS days
Originally manufactured by the Germans in the 1880s and later used by the Japanese to keep military personnel awake on long shifts, methamphetamine first was a significant presence in the Western United States in the late 1940s. "After the second World War, there were vast stores of methamphetamine released in the Japanese black market, and methamphetamine use reached epidemic proportions in post-WWII Japan," says E. Michael Gorman, PhD, MPH, MSW, an assistant professor in the College of Social Work at San Jose (CA) State University.
"Supposedly, Americans then were exposed to it and brought it back to the West Coast," Gorman says. For decades, methamphetamine use was limited to the West Coast and Hawaii, becoming popular at various times in a multitude of groups, including Hells Angels, he says. "In the early days, crystal meth was bikers’ coffee, literally put into people’s coffee and drunk."
Since meth use didn’t pose as many law enforcement and social problems as cocaine use, the drug remained under the radar screen and was rarely studied or analyzed, he explains. "But there were a couple of methamphetamine epidemics. One was in the late 1940s and early 1950s, and the other was in the 1970s in San Francisco."
The latest epidemic began in the late 1990s and has continued into the 21st century, this time spreading across the nation. Gorman, who has been an AIDS researcher since the beginning of the epidemic, first saw a problem with methamphetamine use in San Francisco’s early days of AIDS, before the virus was identified as the culprit behind a rash of strange diseases and deaths. While working on the first HIV/AIDS studies in San Francisco through the University of California, San Francisco and the San Francisco Health Department, Gorman interviewed gay and bisexual men who were sick with symptoms of AIDS, before the syndrome was named.
These men told Gorman and co-investigators that they had frequented a bathhouse called the Barracks in the late 1970s and early 1980s. "The Barracks was a methamphetamine emporium," he says. "The drug was prevalent in this institution, which was subsequently shut down, and a lot of people who had histories of this drug were among the earliest AIDS cases."
Casting a wide net
Researchers were able to document this drug connection to AIDS because of the wide net of questions they asked early AIDS patients. Since the disease’s cause was unknown, the virus’ first victims were asked questions about every facet of their lives, Gorman says. However, once researchers discovered that the virus was transmitted sexually and through shared needles of heroin users, the connection with meth-amphetamine was mostly forgotten, he adds.
"Jump forward to 1993-1994: When working in a treatment clinic, I recognized that these are some of the same crowd I interviewed in the early 1980s," Gorman says. "It was troubling to me, and I saw this HIV connection to methamphetamine and didn’t understand how it worked." After interviewing HIV-positive men who had histories of methamphetamine use, including injection drug use with meth, Gorman realized that meth users were a very diverse population, even among homosexuals. "One of the things going on is that this drug for men had a heavy sexual aspect to it. It seemed to be an aphrodisiac," he says.
However, the link between HIV and methamphetamine use largely was ignored until later in the 1990s when meth used spread to the Midwest, rural Western areas, and most recently the East Coast. The availability of methamphetamine on the East Coast is only beginning to be recognized, and it’s still not being identified by many clinicians, says Michael C. Clatts, PhD, medical anthropologist and associate professor of public health in the Department of Sociomedical Science at Columbia University in New York City. Clatts also is the director of the Institute for International Research On Youth At Risk at the National Development Research Institutes in New York City.
Drug monitoring systems in New York do not even include specific questions about methamphetamine, which is grouped with cocaine and other stimulants, Clatts says. "So if someone shows up at a drug treatment center all jazzed up and nervous and fidgety, it’s assumed the person’s a cocaine user."
As a result of public indifference the growing trend of meth abuse, researchers have witnessed a new wave of drug users among young gay men who are making the same risky behavior mistakes that were made by their counterparts 20 years ago before HIV was identified.
"The new generation of gay men is going to witness the same kind of losses as the older men who saw thousands of their friends and lovers die from AIDS," Clatts says. "The amount of anxiety that exists in the gay community around HIV is very substantial, and that’s what in part is fueling some of this methamphetamine use."
If it’s been difficult for clinicians and public health officials to recognize methamphetamine use as a problem on the East Coast, the problem is even more invisible in rural and Midwestern communities, where methamphetamine use has become a part of daily life for many. "The reality is: It’s part of the rural economy," Gorman states.
Besides being prevalent in some pockets of the gay and bisexual community, methamphetamine use now has been studied in women, who in some Midwestern states comprise 50% of admissions for methamphetamine treatment.1 Working class, Latino, and rural populations have been drawn to the drug for different reasons than the gay population, he says.
"I’m struck by the fact that people do meth for reasons such as they want to work harder, juggle two jobs, and in some cases, to have better sex," Gorman says. "They can do tasks like clean their house, and it’s very much an action drug, unlike heroin." Plus, methamphetamine is cheap, giving users a longer and more intense high, and is a favorite drug at youth "rave" parties, he adds. "It’s a poor man’s cocaine, and there are parallels with the crack epidemic, which occurred in vulnerable inner-city populations," he says.
Nonetheless, heterosexual men and women who use methamphetamine also are at increased risk for HIV infection, particularly if they inject the drug.2 Those who inject methamphetamine may share routes of HIV transmission indirectly, such as test water, Gorman says.
Now that methamphetamine use has spread across the United States and to heterosexual populations, it will require concerted private and public health efforts to treat and prevent the problem from causing a resurgence in HIV infection. He suggests that HIV clinicians begin by asking patients whether they use methamphetamine and whether this use includes injecting the drugs. This is a good start since traditionally prevention programs have focused on asking at-risk individuals about their crack and heroin use, but have ignored methamphetamine, particularly when presented with middle-class, white, professional clients, Gorman says.
"Clinicians fail to understand methamphetamine use," he adds. "If someone is a middle-class male on the West Coast or in a Western U.S. city, the idea that the person also is an injection drug user is mind-boggling, and clinicians wouldn’t think to ask."
References
1. Pach AP, Gorman EM, Topolski J, et al. Contextual and environmental aspects of methamphetamine abuse in U.S. women and HIV risk. Presented at the 14th International AIDS Conference. Barcelona, Spain; July 2002. Abstract: ThPeE7863.
2. Gorman EM, Pach AP, Clark C, et al. Women at risk: Ethnographic perspectives on methamphetamine use and HIV risk in two U.S. sites. Presented at the 14th International AIDS Conference. Barcelona, Spain; July 2002. Abstract: WePeG6902.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.