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Living Well

To Party or Not to Party

November 1998

I want to take time this month to discuss "partying," specifically with drugs. There has been much talk of late about the use of drugs at circuit parties and the bars, especially the drug GHB.

At Operation: Survive! a year or so ago, a participant asked Dr. Edith Biggers, "Is Special K bad for you if you are HIV positive?" Her response was a clever one, "It's not good for you if you are not HIV positive!" Let's face it, those of us on antiretrovirals and protease inhibitors are on a toxic mix anyway. Why add even more toxic substances to this?

AIDS Survival Project in no way condones or promotes in any manner the use of any illicit drug, but does recognize that there are those people with HIV who decide to use them. I am not here to judge anyone's informed decision to use or not to use. We are big girls and boys and we can make our own choices. I do, though, want these choices to be informed ones and I want those who do choose to use drugs to know how to reduce the harm these drugs will cause.

Unfortunately, there is little research about the interactions of recreational drugs with protease inhibitors or other antiviral drugs. Why? Simply put, the pharmaceutical companies are not likely to do such research for three reasons. First, they would have to get FDA approval. I doubt any administration would allow such a clinical trial to take place for fear of being perceives as "soft on drugs." The second reason is the legal liability to which the pharmaecutical companies would expose themselves. Finally, this is impractical because there is no way of finding a consistent supply of "pure" street drugs. These drugs vary in ingredients depending on who cut them and with what they were cut. Some street drugs contain little or none of the ingredients for which they are advertised. In other words, one may be snorting Bon Ami or Old Dutch Cleanser.

So we have a problem here. There is little information regarding risk/danger out there other than anecdotal. You may remember back in 1997, there was a young man with AIDS from Europe who died after mixing ritonavir with ecstasy (a/k/a "X, MDMA, Vitamin E, XTC, Adam or Essence"). He reportedly took "no more than 2 tablets." The blood levels at his death measured 4.6 mg of MDMA. That is the equivalent of 22 tablets of ecstasy. Scary isn't it?

Additionally, what happens when one uses a mind-altering drug? Your mind is altered and so are your inhibitions. In fact, they seem to go away. What does this spell? R-I-S-K. It is proven that the use of alcohol and/or drugs prior to having sex increases the likelihood of participating in unsafe behaviors. In other words, you may not be able to make an informed decision. Thus, if information = power, then this choice = increased risk.

Below is a partial list of recreational drugs and how they might interact with all those "other pills" we take. This list is drawn from Gabi Horn's article in the June '98 issue of POZ and the GMHC pamphet, "Drugs in Dreamland."

Drug Interaction and Effects: How to Reduce the Harm

Ecstasy 3-to-10-fold buildup of MDMA in blood. More teeth grinding, palpitations, joint stiffness, dehydration. Greater chance of liver and kidney damage. May be deadly: Britain's Philip Kay died under a disco ball, the casualty of a ritonavir/ecstasy mix. Divide the dose. Take 1/4 or 1/2 a tablet and wait to see how you feel. Since X is often cut with ketamine, speed, ephedrine or even caffeine, which mimic MDMA's effects, factor in these risks. Crixivan users: Guzzle H2O the day after to reduce chance of kidney stones.
Speed/Meth 2-to-3-fold buildup of meth in blood.

Increased anxiety, manic behavior, shortness of breath, racing heart beat, dehydration.

Don't be greedy. Dab a little and see what effect it has. If injecting, use clean equipment; if sharing needles, first flush syringe with undiluted bleach for one minute, then with cold water. Repeat three times with new bleach.
Heroin Heroin metabolized more quickly.

Less hit, less buzz, withdrawal symptoms.

Take the normal dose initially and increase it only if you experience less hit and less buzz. As always, safe injecting is essential. Heroin is an especially bad mixer with other drugs and will only make the chances of unconsciousness, vomiting and choking greater.
Special K Buildup of ketamine likely.

Increased sedation, disorientation and hallucinations. Effects last longer.

Less is more. Take 1/3 or 1/2 of usual dose. Wait for effect. Only re-K if you feel OK. The difference between a pleasantly-out-of-it sensation and landing in a semicatatonic K-hole is a matter of dose. Once you're baked, you may forget about the half-dose rule.
Cocaine Little is known about coke's interaction with protease inhibitors -- no studies. But if you have HIV, smoking, shooting or even snorting cocaine is no party for your immune system: In one test-tube study, coke made HIV reproduce 20 times faster than normal. When it comes to binge drugs, coke is it. The higher you fly, the faster you fall -- and to keep from crashing, you do bump after bump after bump. A lost weekend is a ticket to nonadherence. If you do miss a med or three, don't double your dose the next time! Follow the scrip.
GHB Combining GHB, aka Grievous Bodily Harm, with the anti-protease drugs is another unknown. Like many party favors, GHB may suppress the immune system. Don't assume a bottle of "liquid X" equals a dose. Start with a teaspoon, and give it half an hour to work before taking more. The right amount may make you feel electric; a little more, you may slip into a deep sleep; even more can cause coma or death. Avoid mixing with alcohol.

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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
See Also
Ask Our Expert, David Fawcett, Ph.D., L.C.S.W., About Substance Use and HIV
Using Safely/Dealing With Addiction