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Ups and Downs: Party Drugs and HIV Medications

Community Forum Summary

July 2001

Speakers: Danny Carragher, Ph.D., Center for HIV/AIDS Educational Studies and Training (CHEST)
Ed Cheslow, M.D., Board Certified Internist

The July Community Forum on party drugs and HIV medications was well attended, indicating great interest in the community about the interactions between these various drugs. It's a tough topic, however, because there is little concrete evidence from clinical trials on the interactions, and not all of the anecdotal evidence is useful to all people. In their presentations, Drs. Carragher and Cheslow provided background information on the party drugs, discussed the psychological aspects of party drug use and addressed special issues for HIV-positive people using party drugs.

What We're Learning from BUMPS

Dr. Carragher heads a project called BUMPS, which stands for Boys Using Multiple Party Substances. BUMPS is funded by the National Institute of Drug Abuse, and the project's goal is to describe the role of party drugs in the lives of gay and bisexual men in New York. The target substances under study are crystal methamphetamine, cocaine, GHB, ecstasy, and ketamine. Both HIV positive and negative volunteers who have used any of the party drugs listed above are included in BUMPS. A preliminary study leading to the more intensive BUMPS study showed that in a sample of 460 gay/bisexual men in NYC, about half had used one of the party drugs in the three previous months. The high rate of drug use merited further study.

Through BUMPS interviews with men who are using party drugs, Dr. Carragher and his colleagues have begun to examine some of the motivating factors behind party drug use in the gay and bisexual male populations in New York. These factors include lowering inhibitions and increasing comfort in social situations. Dr. Carragher commented on the specific effects of each drug.

  • Crystal Methamphetamine
    Crystal meth, or Tina, is primarily used for its sexual effects. It's a pure form of speed (a stimulant) with a long high, and gives users increased physical stamina and confidence. Several problems can stem from its use. First, crystal is known to have an "instant bottom" effect, and users may have multiple partners and may have unprotected sex, putting them at risk for STD transmission. Also, the length of the high may influence adherence to HIV medications -- crystal users may decide to skip their HIV meds while they are high. Finally, the mental and physical side effects of crystal can include anxiety, paranoia and dehydration. Dependence is acquired rapidly and the long-term effects are serious -- depression, psychosis and high blood pressure are possible.

  • Cocaine (powdered form)
    Dr. Carragher distinguished between powdered cocaine and crack cocaine, stating that the motivations for their use are often quite different. In his study, he has found mixed feedback on the sexual effects of cocaine, with the primary reason for use being increased confidence and euphoric feelings. Cocaine is a powerful stimulant that is readily available, although it can be quite expensive. The side effects of cocaine include paranoia and anxiety, and dependence is often acquired rapidly. Overdose may lead to heart attack and strokes.

  • Gamma-Hydroxybutyrate (GHB)
    GHB is a sedative that slows the central nervous system. Users are drawn to GHB for its purported sexual effects, but the drug may cause sleepiness, disorientation, coma or trouble breathing if it is taken in large amounts. If mixed with alcohol, the double-sedative effect can be especially dangerous. Dr. Carragher stated that there might be alternatives to GHB, such as SOMA or blue nitro, which have similar effects and may not be as dangerous, although the danger increases if substances are mixed.

  • Ecstasy
    Dr. Carragher reported that participants in his study view ecstasy as a drug that induces feelings of sensuality, not sexuality, and that the drug is widely used in clubs to enhance the experience. While the highs may be very high, the side effects are numerous, and include achiness, dizziness, paranoia, dehydration and, with long-term use, liver damage. Ecstasy can also deplete natural serotonin levels and cause subsequent depressive side effects. Some studies also show poorer working memory after even moderate use.

  • Ketamine
    Also known as Special K or K, ketamine is an anaesthetic that may make a user feel "trippy." It is not usually used for sexual effects but more often is taken before going to a club. It may cause hallucinations or vomiting and can cause a "K hole" if taken in high doses, which may include temporary paralysis, tunnel vision, frightening hallucinations and poor coordination. Overdose may also lead to death.

Dr. Carragher is interested in the psychologic variables that lead gay and bisexual men to use party drugs. What leads men, or anyone for that matter, to seek a high? At the top of the list are self-esteem issues. Low self-esteem may lead to needing a drug to have a good time. Common self-esteem issues are poor body image and internalized homophobia among gay and bisexual men. Dr. Carragher has also identified "sensation seekers" through his study -- men who are looking for new experiences and decide to try party drugs. Finally, party drugs often lead to disinhibition, which may be necessary for some people who wish to participate in the club scene but need to loosen up in order to join in.

A Physician's Perspective

In Dr. Cheslow's experience, patients may feel uncomfortable discussing recreational drug use with their doctors. This discomfort can stem from uncertainty regarding the doctor's perspective on drug use. Doctors may also feel uncomfortable discussing recreational drugs with a patient because they don't want to appear to sanction drug use. Additionally, doctors are not able to offer concrete, evidence-based advice on the effects of combining antiretrovirals and recreational drugs. Many doctors would prefer not saying anything to offering uninformed opinions. As a result, the decisions that HIV-positive people make about taking HIV meds and recreational drugs together are based on stories they have heard from friends or in the news (like the highly-publicized story of a young man who overdosed on ecstasy when used in combination with Norvir) and guesswork.

Dr. Cheslow focused his comments at the Forum on ecstasy and ketamine. Ecstasy was developed in Germany in World War I to decrease the appetite of soldiers, then abandoned, and was "rediscovered" in the 1950s by the CIA through research on psychological warfare. It is a relatively easy chemical to synthesize, and its use in the United States has become more widespread since the 1980s. Dr. Cheslow stated that ecstasy is a non-violent drug. He expressed his concern that there is potential for violence surrounding ecstasy as the substance is driven further underground by stricter law enforcement surrounding distribution and use. He noted that alcohol, which is legally available in the United States and heavily taxed, causes more death and destruction than all the other drugs combined.

Ketamine is part of any good anesthesiologist's repertoire. It is widely used at times of natural disasters because it is easy to administer, acts rapidly, and does not impair respiratory drive or gag reflex. Because of its clinical use, we know more about ketamine than about many other drugs that are used recreationally. Dr. Cheslow explained that ketamine causes rapid increases in blood pressure, heart rate and adrenaline release. He cautioned that K (or any other recreational drug) purchased on the street may contain a mixture of substances, and that you never know what you will get or how you may react.

Several audience members at the Forum encouraged participants to educate themselves further on party drug use alone and in combination with HIV medications. There is an informative pamphlet entitled "Drugs in Partyland: Think Thru the Buzz" available from GMHC (call 1-212-337-3343 to obtain a copy). In addition, Positive Health Project produces a variety of literature and offers counseling on the effects of recreational drugs on HIV medications. Contact Positive Health Project toll free at 1-888-465-8304. As with any choice in life, your choice of if, when, and how to use party drugs with HIV medications should be as informed as possible.

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This article was provided by AIDS Community Research Initiative of America. Visit ACRIA's website to find out more about their activities, publications and services.
See Also
Ask Our Expert, David Fawcett, Ph.D., L.C.S.W., About Substance Use and HIV
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