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.
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.
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.
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.