As a primary care physician for more than 20 years, I've witnessed the ravages of many diseases and been privy to the colorful details of patients' private "recreational" drug use - from the hippie days of Quaaludes, marijuana, LSD and mushrooms to the more recent designer drugs of today, including Ecstasy, GHB and ketamine. Traditionally, I've had an enlightened caveat emptor ("let the buyer beware") attitude toward most of these activities, as I've witnessed only modest self-destruction as a consequence of their use. All of that has changed since crystal methamphetamine (crystal meth) hit the scene.

Despite drug-users' arguments to the contrary, there is no such thing as "recreational use" of crystal meth. It has been scientifically proven to be so dangerously addictive that it is deemed one of the few "party drugs" to be avoided at all costs. I've witnessed crystal-using patients lose their physical and mental health, their jobs, their relationships, and their financial stability, with an unwitting arrogance that defies logical explanation. Unfortunately an ever-increasing number of people of every ethnic and economic background across the United States seem to have embraced crystal meth as their party drug du jour.

Meth, speed, crank, glass, crystal, ice, Tina - it comes with no shortage of cute monikers that often sound like the latest cosmopolitan cocktail. It enters most people's lives quite insidiously during good times - on the dance floor, at a party, during sex. Snorted, smoked or injected, the first experience is overwhelming and powerfully euphoric - like falling in love, winning the lottery, and having all the pizza, ice cream and french fries you could want, all at once. It is equivalent to having your brain flooded with over 1,200 times the normal amount of the "happy" brain chemical dopamine. You feel great - "better than great", in fact. These euphoric effects are long-lasting (up to 24 hours) and seductive. For those on a budget, the first hit is cheap since crystal methamphetamine retails on the "street market" for less than 25 percent of the cost of a hit of cocaine. 

Unfortunately, crystal meth becomes the ultimate bait-and-switch scam. One never gets to repeat that first high; you just get to chase it. It causes irreversible damage to the brain cells that produce serotonin and dopamine, leaving you in a perpetual state of neurochemical deficit. Most ominously, crystal is so appallingly addictive that the vast majority of those who start as "recreational weekend users" become unwitting addicts.

Medically, the effects of crystal meth are wide ranging and ultimately tragic. Initially, users feel energized, talkative, and happy. People often display a (false) sense of confidence and heightened sexual drive and power, leading to multiple sexual partners and sexual risk taking.

Since the Internet has greatly facilitated casual sexual "hookups" for anonymous encounters, the crystal meth-using "Party and Play" ("PNP") crowd is burgeoning in chat rooms worldwide. Lured by the quick, intense high of crystal meth and the heightening of their libidos, people are often seduced into going on protracted meth runs. Meth causes these folks to become sexually-disinhibited to the point where they willingly have unprotected sex with multiple partners. At the conclusion of these episodes, these patients predictably come to me depressed, anxious, severely fatigued, dehydrated and, more often than not, with newly-acquired STD's, most ominously HIV infection. In Los Angeles, one HIV testing center recently reported that 33 percent of new HIV infections were directly linked to crystal meth use.

The risk of new HIV infection more than doubles if a person is having sex while on crystal meth. This is most likely due to the aforementioned sexual disinhibition coupled with more aggressive and protracted sexual encounters (during which injury and condom breakage is more likely), non-use of condoms, multiple sexual partners and often shared IV injections.

For people already infected with HIV, even occasional use of crystal meth can lead to a lapse in taking HIV medications, which ultimately leads to broad drug resistance, immune system failure and ultimately all of the known consequences of AIDS - all completely avoidable in this modern medical era of powerful antiretroviral drugs and omnipresent safer sex and meth warning messages.

For now, the currently accepted modes of talk-therapy-based rehabilitation are inadequate because they do not address the profound neurochemical disturbances that occur with prolonged meth use. Current rehabilitation strategies are like advising an obese diabetic patient to exercise, go to Weight Watchers, avoid going near any fast food restaurants, and to monitor their own calorie intake closely without supplying the patient with the insulin and other medications that their bodies need to make these lifestyle changes effective.

Promising new strategies to treat crystal meth addiction are being developed that incorporate traditional 12-step, analytic and cognitive-behavioral therapies with novel medically-based treatments. The National Institute on Drug Abuse (NIDA) currently is studying at least 10 FDA-approved medications for off-label use to treat crystal meth dependence, the results of which are all still pending.

Proprietary treatment strategies like the Prometa^TM protocols (licensed by a publicly traded health services company, Hythiam) incorporate multiple triple-drug treatment sessions with a comprehensive psychosocial and nutritional approach to crystal meth dependence. Like the NIDA medication studies, this off-label medication-based approach is still being developed, fine-tuned and evaluated for safety and effectiveness. However, early reports from physicians and meth-dependent patients experienced with the Prometa^TM protocols have been dramatically and nearly universally encouraging. In terms of eliminating drug cravings and improving mental clarity, they are reporting rapid and robust effects from Prometa that are long-lasting. These successes, if confirmed by ongoing scientific studies, may represent a new bright light in our otherwise discouraging record of long-term success utilizing traditional meth treatment methods.

Based on everything now known about the science of meth addiction, I must reiterate: "There is no such thing as the "recreational use" of crystal methamphetamine." Users, however well intentioned, cannot limit their intake voluntarily. Just as "friends don't let friends drive drunk," friends must not condone their friends doing crystal.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2006, v.7, n.5, pp.51-52.

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