oThe day after the Bush administration announced its latest initiative to attack the use and abuse of methamphetamine, more than 900 scientists, researchers, doctors, prevention and treatment providers, harm reduction workers, and law enforcement personnel came together in Salt Lake City for the country's first national conference on meth and its links to HIV and Hepatitis C. Organized by the Salt Lake-based Harm Reduction Project and the New York-based Harm Reduction Coalition, the conference provided a timely, science- and evidence-based response to the steady drumbeat of meth horror stories that are driving public policy today.
Attacks on the conference last week by Rep. Mark Souder (R-IN), who confuses harm reduction with drug legalization, not only failed to convince the Department of Health and Human Services to pull its token funding for the event -- HHS kicked in $3,000 -- they also failed to convince Utah state substance abuse and other officials to pull out, despite a flurry of phone calls from Souder's people urging them to do so. In fact, Souder's attacks paradoxically gained exposure for the conference, as newspapers across the county reported the tussle.
Salt Lake City is the scenic capital of one of the country's most conservative states, but Mayor Rocky Anderson is a prominent supporter of drug policy reform, and the healthy contingent of state and local officials who participated in the conference showed that for those in the trenches, good, solid information was more important that dogmatic rhetoric. Still, there were culture clashes. Mormon social workers, for instance, had a hard time coming to grips with gay speed freak sex (and no doubt the gay speed freaks were equally bemused by the Mormons).
"Our agenda was to put together people from various disciplines who don't usually work together and try to create a new model for these conferences on drug policy and harm reduction and substance abuse in general," Colonna told DRCNet. "This was not really a drug reform conference or even a harm reduction conference. Most of the people here were direct service providers -- people doing prevention and treatment and law enforcement -- and it is primarily substance abusers they are dealing with."
Indeed, harm reductionists probably accounted for only 200 of the more than 900 people who showed up, Colonna said. Scientists and researchers accounted for another hundred or so. "The rest were from all different disciplines, from Indian reservations and small-town health workers, who we have never before seen commingling with the scientists and researchers," he said.
There was plenty of good, solid science presented at the conference, with researchers funded by the National Institute on Drug Abuse or linked to the Centers for Disease Control having a heavy presence. But given the hostility toward the conference expressed by Rep. Souder, it is not surprising that those scientists were consistently careful to point out that their presentations represented their own views -- not those of the federal institutions.
Dr. John Grabowski, director of the Substance Abuse Research Center at the University of Texas Health Science Center in Houston, raised more than one pair of eyebrows with his discussion of amphetamines as a treatment for cocaine dependence and even methamphetamine dependence. While the use of opiate agonists such as methadone is increasingly non-controversial, that can't be said about amphetamine therapy. Why not? asked Grabowski. "Along with behavioral therapy, medications can be therapies for drug abuse," he said, pointing to the example of methadone.
Citing a handful of studies on the use of amphetamines for cocaine dependence, he said the findings were positive. "If you look at these data sets from around the world, they all end up with the same result: some benefit from giving speed to coke users," he noted. "NIDA is really looking at agonist-type drugs now," Grabowski said. "There is a low abuse liability when they are used with a good treatment modality. Older clinicians realize these aren't such bad drugs, but we have to educate the public and depoliticize the issue," he said.
While there is "no magic bullet" for meth addiction, there are therapies that work and modalities that will motivate users, said Yves Michel Fontaine, the coordinator of Substance Abuse Counseling and Education for the Michael Palm Center at Gay Men's Health Crisis in New York City. "Meth users seek care when they are most unstable," Fontaine said, "so treatment providers need to be flexible in early engagement with them. Create a safe space, have respect, be sex positive and non-judgmental -- you're going to see a lot of esoteric sex behaviors that might not appeal to you," he warned.
A panel of experts from Hawaii, where the current wave of methamphetamine use began more than a decade ago, shared their insights on its impact and treatment. Heather Lusk, Hep C Coordinator for the Hawaii Department of Health, said, "There is little hard evidence, but everyone agrees that injection drug users are at high risk for viral hepatitis."
Her department addresses the problem by offering harm reduction and prevention messages to all drug users, she said. "We need to provide Hep C education to all drug users, we need to offer immunizations for Hep A and B and testing for Hep C, we need to support the sexual health of meth users, and we need to pound home the message that they should use clean equipment at all times," she said. "Our message is: 'Don't share anything but aloha.'"
Another Hawaii panelist, Don Des Jarlais, director of research for chemical dependency at Beth Israel Medical Center in New York, reported that needle exchange programs have been "quite successful" in controlling HIV among injection drug users in Hawaii. "We are seeing only 2% infected with HIV now, down from 5-8% when the program started," he said.
In there is one complaint that could be directed at the conference it is that there was simply too much, too many sessions, too many panelists. In the late afternoon time-slot Friday, for example, there was a session on "HIV and Active Drug Use," another entitled "We Don't Need a War on Methamphetamine," another on "Law Enforcement," another on "Methamphetamine Use and Pregnancy," one on "Native American Projects," one on "The Importance of Knowing About Injection Drug Use," one on "Social Marketing," one on "Innovative Internet Innovations," and last but not least, a discussion of "Stimulant Use in the MACS and WIHS Cohorts and Current Efforts to Understand the Effects of Methamphetamine Use on HIV Seroconversion and Natural History of Infection."
The scientists and researchers reported links between meth use and risk of HIV and other infections. One study funded by the Utah Department of Health last year found that injection meth users were more likely to have sex when high than the overall sample of more than 400 respondents. Other researchers reported on meth users' ability to engage in extended, rough sex, and the risks of infection deriving from it.
"Meth is everywhere, it's all over the country, but what we are hearing about is those godawful gay men who are taking speed and fucking like bunny rabbits," said Dr. Michael Siever, head of the Stonewall Project in San Francisco. "Although meth is in all populations, because of its connection with HIV, that's where the research is."
To understand the nexus between meth and HIV, people need to get beyond distorted and demonized depictions of the drug, said Siever. "The drug is not unremittingly evil -- it's actually fun!" he said. "There are reasons people do this drug. It's a lot of fun, at least in the beginning, and it's the best antidepressant available on the street. To deny this is disrespectful of users. They are not crazy."
Siever's opinion was seconded by Weber State University professor Mark Biggler, who presented the Utah Department of Health study mentioned above. To fail to address the sexual pleasures available from meth is to fail to understand the problem, he said. "There is a pleasure that bridges meth and sex. To recognize pleasure as a central theme keeps us from lying about why it is appealing," he said.
There were also several history lessons, as conference speakers attempted to debunk the horrorific myths that make up so much of what passes for discourse on methamphetamines these days. In the conference keynote address, Patricia Case of the Harvard Medical School Department of Social Medicine provided an introductory lesson. Meth is not "epidemic" but endemic, she said as she charted the use of amphetamines for the past century. They were gobbled up by servicemen in major wars, used by housewives in the 1950s and 1960s ("mother's little helpers"), and popularized again in the late 1960s by a rising counterculture.
"America has always loved stimulants. People take stimulants to accomplish things. It's chemical software and plays perfectly to our shared American qualities: the desire to be perfect, work harder, be smarter, be thinner... and win at all costs," said Case. Case was one of several presenters at the conference who outed herself as a former amphetamine user, a move she said was necessary to demonstrate that not all users were the stereotypical tweaker.
Case also noted that in the laser-like focus on the chemical compound methamphetamine, we may be missing the larger point. "Is the intervention with the drug or with ourselves?" she asked.
That was a point reiterated by Dr. John Morgan of the City University of New York Medical School. Emphasizing the drug and not the social and personal circumstances of the drug user amounts to "pharmacocentrism," he said. "Eschew pharmacocentrism, the idea we should focus on the drug," Morgan advised. "The prohibitionists get much of their power by focusing on the drug. Every seven years we get a new horror drug. We need to focus on the people, not the drug. Pharmacocentrism is our enemy," Morgan said.
While the discussion of drug prohibition was limited, the panel that directly grappled with that question ripped into the notion that law enforcement is the answer. "The war on drugs is an absolute, unmitigated failure," said Salt Lake Mayor Rocky Anderson. "It has failed by every benchmark. If this war had been successful, we would see fewer drugs on the street and higher prices. We would see fewer people incarcerated and fewer people taking drugs. We want to prevent substance abuse, but for those who do want to use drugs, we want to reduce the harm. We need to do that and not take the cowardly way out that is the war on drugs."
"We have seen this before, and it hasn't worked," said Corinne Carey of the US Program for Human Rights Watch, another presenter who outed herself as a former amphetamine user. The parallels with the crack hysteria of the 1980s are ominous, she said. "This isn't the first time people have experienced problems with stimulants, nor is it the first time political leaders have seized on the tragedies of drug users. Reprising Morgan's theme of pharmacocentrism, Carey noted that, with meth, like crack, "the government ignores the poverty, the racism, the feeling of civic and political powerlessness. Instead of alleviating that pain and providing therapeutic intervention, the federal government instead focuses on the effects of the drug on non-users and communities. We have to look to the public health system instead of the criminal justice system for a response to meth," she said.
The Drug Policy Alliance's Ethan Nadelmann was blunt. "Nobody deserves to be punished simply for what they put in their bodies if they don't hurt anyone else," he told the audience. "That's the bottom line."
"We've got thinkers here in Utah," said a pleased Colonna after the conference. "We've got Rocky Anderson, we've been working with Salt Lake City prosecutor Sim Gill for years, we get funds from the Division of Substance Abuse. These people believe in harm reduction," he said.
Rep. Souder's attacks on the conference backfired, Colonna said. "When people became aware we were being attacked and Souder claimed this was some sort of legalization strategy, it almost became a harm reduction conference. People were saying, 'Enough is enough. You can't lie to us about everything,'" he said. "People at the conference were not hearing what Souder told them they would hear."
Colonna is now seeking a meeting with Souder, he said. "I'm not going to argue with him about his belief system -- he can still be a fundamentalist Christian who has problems with some of the groups we work with -- but I would like him to understand that harm reduction is something he might be able to get behind."
Colonna's mentor and colleague Alan Clear was less charitable toward Souder. "If I want to find out how to deal with methamphetamine, I would rather listen to a treatment provider from Los Angeles or an epidemiologist from Harvard than to an ideologue from Indiana," he said.
Now, some 900 people have had the chance to do just that. Treatment providers and prevention specialists who had never really confronted harm reduction got to see how it works in various break-out sessions. Scientists and researchers provided a surfeit of good, hard data on how meth works and what works to help people get off it. And attendees left with a better understanding of meth and implications than they had when the conference began.
"The challenge now is the follow-up," said Clear.