Crystal meth use, a longtime and still prevalent health concern in the LGBTQ community, started to become an issue in the late 1990s when gay and bisexual men in New York began using the drug as an aphrodisiac. A stimulant which releases dopamine and norepinephrine in the brain, Meth is a powerful, addictive drug that comes with damaging side effects, and health workers say its use among MSM has become intertwined in nightlife and sexual culture.

“It's almost like some people kind of see it as, "that's just what we do,” said Amber Heiler, clinical supervisor on the Behavioral Health team at Mazzoni Center. “Obviously not all men who have sex with men are using drugs, they're not using meth. But there is a small portion of the community that is kind of like, "that's just what we do, it makes sex fun."

Heiler believes that the interconnection between sex and meth use has to be addressed in its own right, she said.

“The two are so closely intertwined,” Heiler said. “That's not getting addressed. Or it's kind of lumped into, "well, when people are using, they engage in risky behaviors, it's just part of it." But it's really unique to this specific drug, this specific population. I think less people are recovering. I do see people all the time who will get a few weeks away from the drug and then they're right back in it.”

Side effects from meth use include decreased hunger, insomnia, anxiety, paranoia, hallucinations, and elevated heart rate and blood pressure, among others. Long term use can result in irreversible brain, liver, or kidney damage, severe tooth decay, and a higher chance of suffering from a stroke.

Jim Mangia, president and chief executive of St. John's Well Child and Family Center in California, said that he has seen an uptick in MSM patients struggling with meth addiction. The center hired two additional substance use counselors to help accommodate the increase in patients.

In terms of why meth use seems to disproportionately impact MSM, Mangia said there are numerous factors. “I think this latest surge is related to the recent political attacks being leveled against the LGBTQ+ community. These political attacks, like “Don't Say Gay” [laws], create a level of insecurity and despair among the gay community and can result in an increase in risky behaviors within our community. I also think the culture of sex in the gay male community makes some of us vulnerable to a sex-enhancing drug like crystal meth. After generations of having our sex lives criminalized, we are more susceptible to sex and drug addictions.”

Beyond its prevalence among MSM, meth use is becoming a nationwide epidemic, Heiler added. “We've focused so much time and money and energy on the opioid epidemic. We can't treat methamphetamine dependency the same way we've treated opioid dependency. I think that we need to start shifting our focus to how we can successfully treat folks that are using meth.”

Chad Gurdgiel, medical social work coordinator at Prevention Point Philadelphia, said that he doesn't feel comfortable saying there's an uptick in meth use. However, he contextualized meth use among Prevention Point patients, many of whom experience homelessness, as related to shifts in Philadelphia's opioid drug supply, “away from morphine derivatives and to fentanyl analogues. And now on top of that the shift is from fentanyl mixtures with xylazine or “tranq” dope.” Xylazine is a powerful tranquilizer that doesn't cause an overdose, but leaves users unconscious.

“I think where stimulant use comes into play is that's a survival mechanism,” Gurdgiel said. “For folks that are living on the street, they need to stay awake, they need to stay alert. As soon as they fall asleep, they're at risk for being robbed, at risk for being assaulted.”

In Gurdgiel's experience, some people who use other drugs like fentanyl might add cocaine to it, but unbeknownst to them the cocaine will be laced with meth.

“I've definitely experienced that before where somebody reports that they're injecting a bundle of fentanyl a day and they're adding cocaine two times a day to their cooker for their injection,” he said. “But there's no cocaine, there's just methamphetamine, or there's methamphetamine and cocaine.”

One method of lessening the negative effects of doing meth, as well as the stigma that's often attached to it, is to take a harm reduction approach to doing the drug.

“We should be teaching people how to be safe, how to take care of their bodies, how to stay physically well,” said José de Marco, founder of Black and Latinx Community Control of Health, and organizer with ACT UP Philadelphia. “It needs to be harm reduction like with any other drug. It doesn't need to be stigmatized, people don't need to be made out to be pariahs. It's all about compassion and harm reduction for people who are using [meth.] People really need education on how not to become HIV positive, and if you do become HIV positive, what you can do.”

De Marco also criticized the approach of coercing drug users into treatment. “That's not part of harm reduction. People will come to treatment when they're ready. You can't force people into treatment, it's going to make them run away.”

Unlike treatments for opioid use disorder, such as methadone, there is no medication for stimulant use disorder, Gurdgiel pointed out. “It's just approached differently in clinical settings. There is no classical physical dependency to methamphetamine, it's more psychological, habitual than anything else.”

Gurdgiel communicated that one way to address meth addiction is to ensure that their basic needs are met, which includes stable housing.

“I think reaching stability in other areas of your life, like the biopsychosocial model of having a safe place to lay your head at the end of the day, really can make some drastic improvements in your life,” he said. “I think those very simple bedrock things of a person's life can make some improvements in their recovery.”

Another prevention method for meth addiction, Mazzoni's Heiler posited, is to have people with lived experience educate youth about the perils of using the drug, and addiction in general.

Kevin Hyer, founder and CEO of the Hyer Calling Foundation, Inc., who himself is in recovery from meth addiction, said, “I had heard that meth had a highly euphoric effect. Getting caught up in the moment at 39 years old, I made a mistake and it changed the course of my life. Now I'm out speaking about this, trying to help others.” Through his foundation, Hyer fights the stigma associated with people who experience addiction and helps people in recovery regain employment.

“With this particular issue I think it helps to hire staff that are in recovery, whether their role is a certified recovery specialist or education,” Heiler said. “I think that this is an issue that needs to be targeted--just addiction across the board--when folks are young, when they're teenagers. Having a queer person with lived experience who's recovered be able to really engage the younger community.”

Mangia put the onus on healthcare systems for failing to address the meth addiction epidemic, and called for collaboration among LGBTQ leaders.

“Just like they're slow to communicate and develop prevention strategies for monkeypox, the institutionalized homophobia in our health departments and agencies has still not adequately addressed the meth crisis. And I think the gay leadership has to take some responsibility here. We're not out there screaming from the mountain tops about this crisis. We're not collaborating and developing collective strategies to engage in prevention and communication strategies.”