When Leo Jimenez was 16, he wanted to go to his first gay bar, but he ended up starting a crystal meth habit instead. “I was underage, so I couldn’t go inside the bar,” he said. “I was hanging around outside, and two guys came up and invited me to their apartment and gave me some crystal and said it would help get rid of my toothache. I didn’t feel anything the first time, but after that, [meth] gave me energy, made me feel good.”
For Jimenez, who lives in the high desert city of Hemet, California, the drug was intertwined with sex, gay communion, and even identity. He recalled it was everywhere—and cheap or free—among gay and bi men, and after a while it was hard to imagine having sex without it. “When you’re high, it’s a different world, and all you see is alleys and parks and hookups with other guys who are high. You recognize each other when you’re an addict.” After 20 years and multiple cycles of “I can handle it,” “I can’t handle it,” and one stint in rehab, Jimenez said he has finally shrugged the meth monkey from his back. He’s been sober for 14 months, has a good job, respects himself more now, and doesn’t need meth to feel a connection to the community.
Jimenez’s experience is not unique. “People don’t usually pay for meth, because it’s often free when men are partying, and although it starts as a social drug, people quickly progress to doing it alone,” said Guilmar Perdomo, community organizer of the Act Now Against Meth campaign at The Wall Las Memorias (TWLM), at a virtual roundtable hosted by TWLM July 21.
More than 130 health and addiction experts, policy makers, and members of the LGBTQ community in Southern California joined the Zoom meeting to discuss the extent of the meth problem in Los Angeles—it’s big and getting bigger—and what can be done about it. TWLM has experience in this area: In 2008, its founder and executive director, Richard Zaldivar, along with other community leaders, got 10,000 signatures demanding that the county recognize the crisis, leading officials to commit $1.6 million to community groups for prevention and treatment. “Back then, the LA County office of AIDS found that out of every five cases of HIV, three could be attributed to meth,” Zaldivar said Tuesday. After some early success in reducing meth use and meth-related HIV transmission, “we’ve taken our foot off the accelerator,” he added.
The addictive nature of methamphetamine can draw users into a spiral of deteriorating relationships, lost jobs, and even homelessness, advocates and community members testified.
Gary Tsai, M.D., interim director and medical director of Substance Abuse Prevention and Control at the LA County Department of Public Health, noted that meth contributes to the most violent crimes of any drug and the second most property crimes. Tsai pointed to nationwide statistics showing the number of meth overdose deaths rose more than 700% between 2008 and 2017. In California, emergency hospital admissions for meth rose just over 600% over the same period.
Other LA County officials outlined the scope of the problem. Cheryl Barrit, M.P.I.A., executive director of the LA County HIV Commission, said the intersection of meth and HIV, exacerbated by COVID-19, was disproportionately affecting Black and Latinx Angelinos. Mario Perez, M.P.H., director of the Division of HIV and STD Programs in LA, noted that meth was exacerbating not only HIV transmission but a rapid rise in other STDs, including syphilis.
Cathy Reback, Ph.D., a senior research scientist at the Friends Research Institute, which in LA focuses on outreach and treatment of meth addiction in the LGBTQ community, said she’s disappointed that prevention advocates have “hardly made a dent” in reducing HIV among meth users.
“Several years ago, when we started seeing biomedical intervention, like PrEP [pre-exposure prophylaxis] and PEP [post-exposure prophylaxis], I started to think it would bring the HIV positivity rate down,” Reback said. “But at our clinic, where we used to see a 64% positivity rate at our outpatient clinic, it went down only to 58%. That’s not a significant difference. That tells us meth use interrupts adherence. You’re up all night, partying, not paying attention to time [when on meth].”
And for people with HIV, even for those who use antiretrovirals, meth use could accelerate HIV progression, according to a 2018 study published in Brain, Behavior, and Immunity.
COVID-19 May Be Accelerating, Not Diminishing, Meth Use
One of the roundtable speakers, Steve Shoptaw, Ph.D., director of UCLA’s Center for HIV Identification, Prevention, and Treatment Services, presented some findings from a long-term study funded by the National Institute on Drug Abuse to examine the connection between substance abuse and HIV infection among men of color who have sex with men. One of the most alarming recent findings: While COVID may have curtailed sex-party venues where meth is present, meth use hasn’t diminished. Respondents in the early weeks of the COVID-19 crisis reported a sharp increase in meth use, even though the substance was harder to find and more expensive. And of those with HIV who used, a significant percentage reported missing HIV care appointments.
Charles Hawthorne, a trainer for the Harm Reduction Training Institute and Outreach Project in San Francisco, agrees that there has been a rise in meth use throughout urban California, but that it’s taking a different form under COVID: more people using alone, and, tragically, more overdose deaths due to stronger, imported meth.
“It’s not basement meth labs anymore, but enormous operations, and it’s cheap,” Hawthorne told TheBody. “Here in San Francisco, people are getting a bag [of meth] for $5. Sometimes sellers will throw it in for free when people buy fentanyl.” He said there’s a lot of misinformation going around about meth; for example, that it’s a harm reduction solution to prevent fentanyl overdoses, when the science doesn’t support that at all.
But Hawthorne doesn’t put the blame on people for using meth now, and using it alone. “The world is very messed up right now, and drugs are an easy way to escape.” He points out that the situations that led people to use—lack of access to jobs, housing, medical care, and mental health care—are exacerbated by the forced isolation of shelter-in-place and an economy where the bottom has dropped out.
“I want to create a world where people don’t have to use drugs to survive. But we have all been taught that drugs are the problem. The reality is, drugs have always been intimately tied to oppressions perpetrated in the United States.”
Harm Reduction Requires Connection First
Panel members posed some risk reduction and harm reduction strategies, including medications like mirtazapine and using social connections as a way of intervening in meth use. Tsai announced a recent initiative, Meth-Free LA County, to educate the general public and those most vulnerable on the risks and harm of methamphetamines. Campaign spots started running in the spring on local airwaves, social media channels, and billboards, in English and Spanish. And Tsai said a Meth Task Force, comprised of public health, prevention, and mental health providers and homeless advocates, would soon be launched.
Noting that meth risk is largely behaviorally defined and starts for many users as a means of connecting, Tsai said strategies for risk and harm reduction must be based in social connection. What, exactly, those strategies will look like in addressing the many LGBTQ communities throughout Southern California—and other U.S. hotspots—is not entirely clear yet. Participants said the July 21 virtual roundtable was just the start of a renewed effort to share and strategize.
Shoptaw said that for 80% of men who have sex with men in Los Angeles, standard biomedical, behavioral, and risk reduction approaches to HIV care and prevention are effective. The other 20%, beset with poverty, mental health, and substance abuse issues or inability to access health care resources, or all of the above, require more innovative and comprehensive intervention.
Harm reduction strategies, whether to keep people safe on meth, or to prevent HIV transmission during meth use, are even more challenging in a time of social isolation, Hawthorne said. To prevent HIV transmission, people need to be clear about what sexual protections they choose to use while on meth, he said. And harm reduction advocates need to find ways to open conversations about what activities lead up to sex and what health practices work for them. “It’s about meeting people where they’re at,” he said.
“We have to be more imaginative in how we engage people now,” Hawthorne added, noting that some of the best harm reduction tactics include talking with friends and family, checking up to see if everyone’s alright, and asking what they need. And technology helps, especially now. “Everyone in the country should be able to access a smartphone now, even if they have to be provided by the government.”