Katherine Fordham

January 1999

This month, I want to concentrate on the issue of drug abuse among gay youth, as this is a topic which is only growing in its importance due to increased prevalence of drug abuse in urban centers and among youth in general. For that reason and because reader questions submitted during December covered many of the same issues I have responded to in earlier columns, I am not including any reader questions in this column. They'll be back (providing that you guys keep sending them in) in my February column. The primary reason for this column, after all, is as a forum for advice to its readers. That said, the column is also a good place for me to explain new health information that may be of interest to the majority of my readers, which is exactly what I plan to do this month.

Drug abuse has probably been something discussed by your teachers, coaches, physicians, parents, and others for as long as you can remember, providing that you are an adolescent or young adult living in the United States. Since the early 1980s, the so-called war on drugs has been a national priority, garnering serious public attention and public (read Federal) funding. Schools in all fifty states are required to provide some form of drug abuse education and prevention curriculum for their students at the high school and middle school (junior high) levels. The determination of what is included in these curricula are left up to the individual states and then to local school boards, but all major categories of commonly abused drugs are covered by the educational programs. In this sense, drug abuse prevention in the public schools is pretty good and these efforts are proactively reinforced by efforts of parents, sports coaches, youth group directors and others. Pediatricians and other physicians serving adolescents are expected to warn their patients of the medical ramifications of illegal/unsanctioned drug use, and there has been quite a lot of debate in the medical literature over the past decade on how best we can accomplish these goals as part of our routine check-ups and exams. So all in all, you have a pretty impressive --and very extensive-- effort to prevent young people from misusing drugs.

Considering the paragraph above, why are so many adolescents in the United States still becoming the victims of drug abuse? Why are so many turning to drugs as a recreational activity/form of escape when the information against these drugs is clear in its message and abundant in its availability? I have been asking myself these questions for a good five years or so, but I have been asking them with greater frequency over the past few months. The abuse of certain kinds of drugs in certain areas and regions seems to be on the rise again while other abused drugs in other locations simply never abated much, despite educational, preventative, and law enforcement efforts to eradicate such abuse. Drug abuse seems especially high among gay youth, primarily among young gay males in urban centers, (although it is difficult to gather accurate epidemiological data on such trends). That's the primary reason I am bringing all this up in Oasis, because I feel that you guys and gals need understand what we're looking at here. This is in no way a trivial matter, nor are there any such things as "minor" or trivial drugs. All drugs that are abused can lead to devastating ramifications; some just get their nasty job done faster than others. The drugs we are seeing young people use are getting more and more serious and sinister, too. Where we once had marijuana and cocaine as major problems in our schools, we now have heroin, crystal meth (methamphetamine) and its variants, and the street drug known as ecstasy (chemically, MDMA or 3,4-Methylenedioxymethamphetamine). These things kill, and those whom they don't kill, they often addict for life.

Young gay males have historically had an affinity for drug abuse; this is not to say that all young gay men or even a majority of them abused drugs, but to say that the subculture of young gay men has been quite conducive to recreational drug use for years and continues to be conducive to such to this day. Traditionally, the drugs of choice have been varied and multiform, but usually not that harmful (with the very notable exception of heroin). The drug scene and the gay club scene have been joined at the hip for some time, especially in large cities with high gay male populations such as San Francisco, New York, Chicago, and Atlanta. Something that is a little new and different now is the presence of raves (which are not always in major cities, either, especially in the American southwest and southern California). Raves draw a multitude of youth including gay youth and often present a multitude of opportunities for these ravers to try drugs, especially psychoactive drugs such as meth and ecstasy. When I say "psychoactive", I want to clarify a couple points about these drugs. These drugs are pharmacologically classified as psychotropic, meaning that they have an effect on the psyche and the ability of the person taking the drug to act within standard psychological parameters. (Drooling on yourself and talking to walls would not be within standard psychological parameters, I would say.) But they are not what we would classically consider as hallucinogens, instead these drugs are considered to be powerful stimulants which also happen to have psychoactive effects. Meth and MDMA (ecstasy) both target the neurological and endocrine system components that produce various chemicals which result in the effects of euphoria and increased energy that users of these drugs experience. In doing so, these drugs are basically forcing the body to go through the physiological processes it would enact if it was threatened by harm or danger of some sort; obviously, the body is not designed to go through such reactions on a no lity to do so for true emergencies, and the introduction of drugs that trick the body into using its own chemical stimulants in this way are doing nothing beneficial for the body at all.

In fact, let's look at some of the things that can go wrong when people take drugs such as ecstasy and meth. While even those who use drugs like heroin and other narcotics seem pretty much aware that those drugs are dangerous (in the potential reactions they can produce), users of ecstasy seem to consider the drug to be extremely safe: they think that it will cause no form of adverse reaction, that an overdose is impossible, that it is not addictive. I am sure such rumors drum up good business for the drug dealers, but they are nothing more than rumors and are quite misleading ones at that. Can ecstasy produce adverse reactions? Certainly, any drug can, dependent on several factors, mainly the purity of the drug and the body chemistry of the individual user. People have adverse reactions to every kind of drug imaginable, though admittedly some are more frequent than others. When a person has a reaction to a prescribed drug that was manufactured in a controlled, commercial setting, however, it is a lot easier to isolate the cause of the adverse reaction and to treat the patient because those responsible for the patient's care have access to reliable information regarding the drug's manufacture, dosage, and composition. We have none of that when someone takes something like ecstasy or meth; although what is called on the street "meth" has a definitive chemical structure, illegal producers and dealers of the drug often cut their supplies with other chemical substances (the same is true with ecstasy and many other illegal drugs). They also often use a variety of amazingly horrible ingredients (drain cleaners and rat poison among other things) in the production of these illegal drugs while legal pharmaceuticals are produced with only the highest standards of chemical reagents (ingredients) and under very tight Federal-level regulations. So point one: can these drugs produce harmful, potentially life-threatening, adverse reactions? Certainly, they can.

But no one has died from taking ecstasy, have they? There's been no overdoses, have there? Well, yes, people have in fact died from complications relating to both ecstasy and meth. Both drugs can induce various cardiac problems which can in turn lead to cardiac arrest and death and this has happened in both the United States and Europe and is well-documented in the medical journals. Something that a lot of people fail to realize about ecstasy (and every other) recreational drug is that when these drugs cause medical emergencies in their users, the presence of the recreational drug in the patient's body often makes it more difficult for those who are treating the patient to provide optimal care because the care-givers are not able to introduce many of the beneficial drugs they would commonly use to counteract the medical problems involved. It's a nasty situation when a young person comes into the hospital emergency room in a state of severe cardiac distress and little can be done to remedy the condition because the illegal drugs taken by that individual (which were also probably the cause of the cardiac problems) prevent the administration of therapeutic drugs. And it is not an uncommon situation in this nation's emergency departments at all. Remember also what I said about the lack of regulation and purity in recreational drugs; often it is not, in way of example, the actual MDMA in ecstasy that causes the most serious adverse reactions but unidentified, toxic, ingredients that the careless producer of the drug either introduced on purpose to cut the amount of expensive, effective, ingredients (and to clear a greater profit) or by accident or via a lack of fundamental knowledge of chemistry. Remember also that pharmaceuticals are not all that easy to produce in your basement: if they were that easy and that safe, why would we spend so much money on testing the quality of legitimate drugs and regulating the companies that produce them?

If ecstasy is really much worse than it has been made out to be in popular discourse, then meth (crystal meth and other variants of the street drug) is still another step beyond that of ecstasy in terms of potential danger and risk of serious health complications. Even most users of meth agree that it is horrible stuff and can lead to not only individual instances of adverse reactions but to a continual, downward spiral of addiction and chronic health problems. The drug is extremely addictive, both mentally and physiologically/biochemically. Even more so than ecstasy, street meth seems to rarely be anywhere near pure metamphetamine but instead often contains a laundry list of poisonous and caustic ingredients. Aside from rat poison and drain cleaners, do I really need to list more toxic substances commonly found in street meth? Yes? How about various strong acids, equally strong bases (such as lye), other noxious chemicals such as red phosphorous, and in at least one instance in California, phenol, which is a very toxic and carcinogenic substance that I would personally not want to hold at arm's length, never mind putting it into my body.

Back to the issue of how drug abuse is tied to gay clubs and other social venues frequented by young gay men. Gay dance clubs and bars have long been wary of police involvement, assuming that legitimate police interest (drug abuse, sales of alcohol to minors) might easily carry over into untoward persecution of patrons for their sexual orientation. The infamous Stonewall riots were caused by such abuses of power on behalf of the "morals squad" of the New York Police Department. Police departments around the country (but especially in New York and San Francisco) have learned that gay clubs, their owners, and their patrons are often extremely hesitant to offer any assistance to valid police inquiries and therefore the police have gradually become less interested in whatever does go on in these clubs, making them perfect havens for the sale and use of illegal drugs. Additionally, many of the drugs popular today are considered to not only be in vogue socially but also to be aphrodisiacs. This is not a new concept, either, stretching back to the use of amyl nitrate "poppers" and less-powerful variants of meth in gay clubs in the 1970s and early 1980s. At the time, the use of amyl nitrate was so prevalent that some epidemiologists investigating AIDS (remember this is back when little was known about the causes of the disease) suspected a connection of some sort between amyl nitrate use and the disease (which proved later to not be the case). Today, amyl nitrate use continues, but it has been joined by much more dangerous drugs such as meth, ecstasy, and a bevy of so-called "designer drugs", which are in fact a variety of chemical combinations that usually have effects on the body similar to meth and pharmacologically act as cardiovascular stimulants. None of these drugs are things that anyone should want to experiment with, considering the great danger for something to go terribly wrong.

The atmosphere of many dance clubs and raves makes these drugs quite available and inexpensive (the latter because sales are so brisk, I would guess) and opportunity to partake in their use seems to many young gay men (and others) too good to pass up. But you know, it's really not: if someone offers you drugs in a club or wants drugs to become part of some other activity, do you think they are really the type of person who is going to care about you? How much do you this person even cares about himself? Especially in the case of meth users, common sense does not typically seem to play a factor in their lives at all; there are reports of meth-heads (and they are called that for a very good reason) dismantling their own stoves, washing machines and other appliances out of a demented desire to see what makes these items tick. Meth: it has to be a strange and sick experience. I simply don't know what else can be said about it. I have seen adolescents who would have been otherwise healthy young people die of cardiac and neurological conditions that they should have (and would have) never encountered had it not been for drug abuse. I have also seen people on meth and other amphetamines take their drug-induced paranoia and anger out on others, and that's not a pretty sight, either.

So for some of my readers, this may be just another long and boring presentation on the dangers of drug abuse, perhaps something that won't make an ounce of difference in your interest or desire to take drugs. But I earnestly hope that for the vast majority of you, this will be a chance to understand the real dangers presented by some of the more popular and prevalent drugs used by gay youth today. Those of you who have read this column for any amount of time are aware that we never over-hype danger here; we don't warn against things that have no factual basis. Take sex for example: we've kept a consistent message of sexual safety, responsibility, and understanding. Sex is something that can be wonderful and can also be lethal, but it is something that most people at some point in their lives engage in and something where a prudent amount of caution and common sense can result in the avoidance of sexually transmitted diseases and other dangers. Recreational drugs, on the other hand, are neither a natural part of our existence nor something for which we can accurately predict the final outcomes of their use. So they are things better left alone, providing that you appreciate the chance to have a long and healthy life and to enjoy other pleasures.

Please send your questions regarding sexual health, safer sex, and related health matters to Dr. Fordham at: kfordham@hotmail.com

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