Cathy J. Reback

The effects and consequences of selected club drugs

Ecstasy (MDMA), gamma-hydroxybutyrate (GHB), ketamine, and methamphetamine are 4 examples of club drugs that are increasing in popularity. Although the pharmacological classifications of these drugs vary, MDMA has structural similarities to both amphetamine and the hallucinogen mescaline. Ketamine and GHB are anesthetic agents and methamphetamine is a long-acting psychostimulant. Medical visits for club drug-related toxicity have sharply increased across the country. This article provides a brief review of the literature on club drugs.

Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men

Medication adherence among persons with HIV infection is important not only because of the effect of non-adherence on an individuals health but also because non-adherence can lead to medication-resistant viral strains. However, adherence to HIV medications is difficult due to complex dosing regimens and side effects. This paper is a qualitative analysis of HIV medication adherence among gay and bisexual methamphetamine-abusing men enrolled in an outpatient drug treatment research project. As part of an open-ended, semi-structured interview, 23 HIV-infected men discussed the effects of their methamphetamine use on their medication adherence. Substance-use barriers to adherence were coded into two main themes: (1) planned non-adherence and (2) unplanned non-adherence. Planned non-adherence was a strategy for coping with demanding HIV medication schedules, or was linked to sexual behaviours while using methamphetamine or to fears of interaction effects from mixing methamphetamine with HIV medications. Participants did not define their medication regimen adjustments as non-adherence but as a way to achieve a sense of control over their lives. Unplanned non-adherence was linked to methamphetamine-related disruptions in food and sleep schedules. Findings are helpful in designing culturally specific HIV medication adherence interventions for this population.

Changes in the Meaning of Sexual Risk Behaviors Among Gay and Bisexual Male Methamphetamine Abusers Before and After Drug Treatment

Methamphetamine is widely used among gay and bisexual men in the West Coast of the United States, and is often used in combination with high-risk sexual activities. This study combined quantitative and qualitative research methodologies to examine sexual risk behaviors among gay and bisexual male methamphetamine abusers as they entered treatment and at 1-year follow-up evaluations. Findings from the quantitative follow-up data demonstrate that gay and bisexual men reduce sexual risk behaviors and sustain those reductions following substance abuse treatment, and qualitative data reveal the meaning of these behavior changes from the perspective of the participant. At 1-year evaluations, associated behaviors of methamphetamine use and sexual risk behaviors were lessened. Although condom use decreased slightly, participants reported fewer anonymous sexual partners, reductions in episodes of both receptive and insertive anal intercourse, and an increased sense of responsibility to disclose their HIV status. This study further demonstrates the value of coupling quantitative with qualitative data in understanding the meanings behind reductions in high-risk behaviors.

Patient Characteristics, HIV Serostatus, and Risk Behaviors Among Gay and Bisexual Males Seeking Treatment for Methamphetamine Abuse and Dependence in Los Angeles

Abstract Methamphetamine, a drug used at alarming rates among gay/bisexual males in the West, is often combined with sexual activities, thereby increasing HIV-related risks in an already high-risk group. Findings from 68 gay/bisexual men seeking treatment for methamphetamine dependence in Hollywood, California were analyzed to predict HIV serostatus based on demographic, drug use, or sexual behavior variables. Results showed that more HIV-infected participants than non-infected men reported medical problems (97.6% versus 46.2%; X2 = 24.7, df = 1, p < .0001), histories of genital gonorrhea (59.5% versus 26.9%; X2 = 6.9. df= l, p< .01), use of injection methods (45.2% versus 19.2%;X2 = 4.8; df = 1, p < .03), and more sexual partners with unprotected receptive anal intercourse in the 30 days prior to intake (5.9 versus 0.7; separate t =3.5, df = 43.7, p < .001). More non-infected participants (19.2%) reported suicidal thoughts than HIV-infected men (0%; X2 = 4.8, df = 1, p < .03). Discriminant function analysis correctly classified 74.6% of cases into serostatus groupings based on presence of suicidal thoughts, history of gonorrhea, number of sexual partners with unprotected receptive anal intercourse and prior methamphetamine treatment. Findings provide information that may prove helpful in tailoring culturally relevant treatment and prevention messages.

Associations between Methamphetamine Use and HIV among Men Who Have Sex with Men: A Model for Guiding Public Policy

Among men who have sex with men (MSM) in Los Angeles County, methamphetamine use is associated with high rates of HIV prevalence and sexual risk behaviors. In four separate samples of MSM who differed in the range of their intensity of methamphetamine use, from levels of recreational use to chronic use to those for MSM seeking drug abuse treatment, the association between methamphetamine use and HIV infection increased as the intensity of use increased. The lowest HIV prevalence rate (23%) was observed among MSM contacted through street outreach who mentioned recent methamphetamine use, followed by MSM who used at least once a month for six months (42%), followed by MSM seeking intensive outpatient treatment (61%). The highest rate (86%) was observed among MSM seeking residential treatment for methamphetamine dependence. The interleaving nature of these epidemics calls for comprehensive strategies that address methamphetamine use and concomitant sexual behaviors that increase risk of HIV transmission in this group already at high risk. These and other data suggest that MSM who infrequently use methamphetamine may respond to lower intensity/lower cost prevention and early intervention programs while those who use the drug at dependence levels may benefit from high intensity treatment to achieve goals of reduced drug use and HIV-risk sexual behaviors.

HIV Risk Behaviors of Gay and Bisexual Male Methamphetamine Users Contacted through Street Outreach

This paper describes the characteristics of 908 gay and bisexual male drug users contacted over a 12-month period through a street outreach HIV risk-reduction program in Hollywood, California. Over one-third (37 percent) of the contacted individuals reported using methamphetamine in the previous 30 days; over half of these (58 percent) reported injection drug use. Compared with the non-methamphetamine users, the methamphetamine users were more likely to be white, to engage in sex work, to inject drugs, and to have sex partners who injected drugs. The methamphetamine users were also less likely to have used condoms when engaged in high-risk sexual behavior and were more likely to have used other drugs within the previous 30 days than the non-users. Methamphetamine use among gay and bisexual males compounds risk for HIV, and risk-reduction interventions to this population should address both high-risk drug and sexual behaviors within the broader context of gay male communities.

Sustained reductions in drug use and depression symptoms from treatment for drug abuse in methamphetamine-dependent gay and bisexual men.

Methamphetamine abusers often complain of feelings of depression that can complicate accurately diagnosing these individuals during treatments for methamphetamine abuse. This article presents an examination of temporal associations between documented methamphetamine use and reported ratings of depression among 162 gay and bisexual male methamphetamine abusers who participated in a 16-week randomized clinical trial of four behavioral therapies for methamphetamine abuse. Methamphetamine use was measured using thrice-weekly urine samples analyzed for drug metabolite. Self-reported depressive symptoms were collected weekly using the Beck Depression Inventory (BDI). At treatment entry, 73.2% of participants rated their depressive symptoms as mild or higher in severity (BDI≥10), with 28.5% reporting BDI scores in the moderate to severe range (BDI≥19). All participants reported significant decreases in depressive symptoms from baseline through the end of treatment, regardless of treatment condition, HIV status, or mood disorder diagnosis. A mixed regression model showed methamphetamine use for up to 5 days prior to the BDI score strongly predicted depressive symptoms (F1,968=18.6, P<.0001), while BDI scores had no significant association with subsequent methamphetamine use. Findings show that behavioral methamphetamine abuse treatment yields reductions in methamphetamine use and concomitant depressive symptom ratings that are sustained to 1 year after treatment entry.

Outcomes using two tailored behavioral treatments for substance abuse in urban gay and bisexual men

This project evaluated two behavioral therapies for substance abuse and concomitant sexual risk behaviors applied to primarily stimulant-abusing gay and bisexual men in Los Angeles. One hundred twenty-eight participants were randomly assigned to 16 weeks of a gay-specific cognitive-behavioral therapy (GCBT, n = 64) or to a gay-specific social support therapy (GSST; n = 64), with follow-up evaluations at 17, 26, and 52 weeks after randomization. No overall statistically significant differences were observed between conditions along retention, substance use, or HIV-related sexual risk behaviors. All participants showed a minimum of twofold reductions in substance use and concomitant sexual risk behaviors from baseline to 52-week evaluations. Among methamphetamine-using participants, the GCBT condition showed significant effects over GSST for reducing and sustaining reductions of methamphetamine. Findings replicate prior work and indicate that GCBT produces reliable, significant, and sustained reductions in stimulant use and sexual risk behaviors, particularly in methamphetamine-abusing gay and bisexual men.

A public health response to the methamphetamine epidemic: the implementation of contingency management to treat methamphetamine dependence

BackgroundIn response to increases in methamphatemine-associated sexually transmitted diseases, the San Francisco Department of Public Health implemented a contingency management (CM) field program called the Positive Reinforcement Opportunity Project (PROP).MethodsMethamphetamine-using men who have sex with men (MSM) in San Francisco qualified for PROP following expressed interest in the program, provision of an observed urine sample that tested positive for methamphetamine metabolites and self-report of recent methamphetamine use. For 12 weeks, PROP participants provided observed urine samples on Mondays, Wednesdays and Fridays and received vouchers of increasing value for each consecutive sample that tested negative to metabolites of methamphetamine. Vouchers were exchanged for goods and services that promoted a healthy lifestyle. No cash was provided. Primary outcomes included acceptability (number of enrollments/time), impact (clinical response to treatment and cost-effectiveness as cost per patient treated).ResultsEnrollment in PROP was brisk indicating its acceptability. During the first 10 months of operation, 143 men sought treatment and of these 77.6% were HIV-infected. Of those screened, 111 began CM treatment and averaged 15 (42%) methamphetamine-free urine samples out of a possible 36 samples during the 12-week treatment period; 60% completed 4 weeks of treatment; 48% 8 weeks and 30% 12 weeks. Across all participants, an average of

Depression Ratings, Reported Sexual Risk Behaviors, and Methamphetamine Use: Latent Growth Curve Models of Positive Change Among Gay and Bisexual Men in an Outpatient Treatment Program

159 (SD =