Series: Part 8 Of 8

OFFICIALS WANT UNIFIED EFFORT TO COMBAT DRUG

The problem is undisputed - and overwhelming. The solution is unclear.

Health experts and policymakers are searching for ways to release crystal
meth's stranglehold on Long Beach and urban and rural communities across
the map.

Some say the solution requires more collaboration among providers of
substance abuse and HIV prevention. Some contend it lies in treatment
designed specifically to serve gay men. And others say it calls for
increased awareness citywide.

One of the first legislative targets: expanding a California law that
prohibits any retailer from selling a customer more than three packages of
products, like many common cold medicines, containing pseudoephedrine, a
main ingredient in crystal meth.

Senators Dianne Feinstein, D-Calif., and Jim Talent, R-Mo., have proposed
legislation that would take this a step further and clamp down on the drug
nationwide.

The bill, which cleared the Senate judiciary committee July 28, would put
cold pills containing pseudoephedrine behind the pharmacy counter and
restrict the amount a person can buy to 7.5 grams a month.

It is modeled after a similar Oklahoma law that passed last year, and has
since led to an 80 percent drop in meth lab seizures in that state.

"We're trying to create a national standard," said Howard Gantman,
spokesman for Feinstein. Expected to reach the Senate floor by September,
the bill also calls for creating a national meth treatment center and
authorizing $43 million for enforcement, training, and research on the drug.

On the local level, the battle against the dangerous drug takes many
different forms.

Various health agencies in Long Beach have programs to tackle crystal meth
and its link to HIV and other STDs. The Comprehensive AIDS Resource
Education (CARE) program at St. Mary Medical Center and the Gay and Lesbian
Center have counseling services for addicts. Being Alive Long Beach, a
coalition for people living with HIV and AIDS, and the Cal State Long Beach
Center for Behavioral Research and Services provide condoms, counseling and
referrals to users on the streets and in bars.

But the main element missing in Long Beach is leadership, said Steven
Shoptaw, a UCLA-based psychologist and a pioneer in HIV and meth research.
"There's no one with big guns coming in," he said.

Nettie DeAugustine, preventive health bureau manager at the Long Beach
Health Department, agrees that the issue calls for more sharing of resources.

"We've all got bits and pieces of the research, but we really haven't
addressed it together," she said.

More collaboration among the agencies would reduce the risk of duplication
of services and could also lead to more seamless referrals and a stronger
support network for addicts, "where we operate as one big, healthy group of
providers," DeAugustine added.

Merrill L. Irving, director of programs at the Long Beach Gay and Lesbian
Center, has teamed up with city activist John Kirby and HIV specialist Todd
Stevens to design a task force that he hopes will do just that. The group
would address the problem of crystal meth in Long Beach's gay community.

"I know the statistics and know how closely tied (crystal meth) is to HIV,"
Irving said. "There's a gap within our own programs. The mission would be
to address what are the needs, what are the gaps."

The task force would be made up of health providers, researchers,
counselors and political leaders from agencies such as CARE, the health
department, Redgate Memorial Recovery Center and the Center for Behavioral
Research and Services, Kirby said.

"We want former users, people in recovery, sensitive mental health workers,
sensitive police officers ...," Kirby said. "We want moms and dads. We want
kids whose moms are in jail because of this stuff. We want counselors who
work with kids in high schools and middle schools. We want discharge
planners from emergency rooms and hospitals."

'Logical Vehicle'

City Councilman Dan Baker called the Gay and Lesbian Center "an appropriate
vehicle and a very logical vehicle for that type of leadership."

Baker has asked the health department to brief the City Council on crystal
meth at its Aug. 16 meeting.

"I'm going to stress that the city plays a unified role in bringing service
providers together," he said. "I'm going to have the health department
brief the council on exactly the status of the crisis, their perception of
what's happening in Long Beach, what they are doing and what we can do to
address it," he said.

C.J. Derby, a longtime leader in Long Beach's gay community, wants to see
an increase in citywide awareness of crystal meth, especially among gay men.

"I think a lot of people are in denial about how strong it is," Derby said.
"Our city needs to bring it out in every public venue it can, so that the
addiction itself isn't hidden and so that recovery options aren't hidden.

Awareness could take the form of fliers, postcards or even billboards
addressing the problem, such as those that sprung up in New York in January
2004.

"Having billboards out there helps friends and families say, ^iThis is a
big problem,'^i Derby said. "They would, therefore, be more likely to see
signs and symptoms of people they love. For the family, it gives them cover
and permission to bring up the subject. For an addict, it lets them know
that this is a real problem, and they're not only ones addicted."

Elizabeth Eastlund, substance abuse and mental health coordinator at the
CARE program, has used an $8,500 grant from the Kaiser Foundation to train
six peer support counselors to work with crystal meth addicts and to launch
a small social marketing campaign. The campaign consists of a series of
postcards: "The doc says I have to stop using crystal if I want to survive,
but speed and sex are the only pleasures I have left," reads one. "Got HIV?
Still Using Crystal?" says another.

The postcards will be distributed to bars and treatment agencies in the city.

Eastlund is also the force behind the city's first crystal meth awareness
event, "Tina's a Drag," a play on a common nickname for meth. The show, set
for Oct. 1, will include music, workshops, a drag show and information on
recovery resources.

Gay-Specific Treatment

Also missing in the city is treatment specifically designed for gay men
struggling to get off of meth, said Alyce Belford, administrator at Redgate.

Patrick Piper, a behavioral interventions trainer who leads workshops on
crystal meth and its role in the gay community, agreed.

"A gay man is going to be a little reluctant to sit among a group of
heterosexual counterparts and talk about using meth for three days and
going onto the Internet and into bathhouses," Piper said.

Shoptaw and Cathy Reback, director of the prevention division of Van Ness
Recovery House in Los Angeles, have studied thousands of gay men undergoing
treatment for crystal meth addiction. They've found that gay men initially
respond best to treatment that tackles cultural issues specifically suited
to them.

"We use triggers that these guys can relate to: going to a circuit party,
going to a bathhouse ...," Reback said. "We don't talk about Super Bowl
Sunday, we talk about Halloween."

Jimmy Smith, a 39-year-old gay recovering crystal meth addict, undergoing
treatment at Long Beach's Redgate center, rejects the idea of gay-specific
treatment, echoing sentiments shared by some addicts.

"The world isn't gay," he said. "Being clean isn't about sexuality; it's
about living with yourself."

While Kathy Watt, executive director of Van Ness, doesn't believe that all
gay men need gay-specific treatment, she says it can be helpful for men
those who used crystal meth for sexual enhancement.

Developing a healthy sexual life without meth is one of the core elements
of the treatment program at Van Ness, which is targeted toward gay, lesbian
and transgender addicts.

"We all have the right to be sexual and if people don't have the tools to
do that in the right way, they're not going to succeed," Watt said.

Grueling Process

More than any other drug, recovery from crystal meth is a grueling,
slippery process, marked by anger, frustration and frequent relapse, said
Rebecca Kuhn, an internal medicine doctor and HIV and AIDS specialist at
CARE. She described it bluntly, as said by one of her patients:

"The addiction is like having sex with a gorilla. You're only done when the
gorilla's done."

Long-term studies show that the most important thing is that users get
themselves into some kind of treatment, regardless of the philosophy,
Shoptaw said.

"If somebody decides that they want to quit, they need to be able to access
support immediately," Piper said.

But sometimes treatment is hard to get. Facilities are expensive, and those
that aren't have waits as long as three months.

Costs vary widely. Some centers can cost several thousand dollars, others
provide free services. Certain patients, such as those with little income
or those who are HIV-positive, are sometimes eligible for certain grants.
But patients without insurance are often forced to wait for several months.

"The waiting list for in-house treatment is 9 miles long and people often
don't have insurance ...," Piper said. "There needs to be more treatment
available, and we need to advocate to our funders that this is a need."

Funding is a problem everywhere.

HIV and AIDS treatment programs are feeling the effects of sharp budget
cutbacks at state and federal levels.

The Center for Behavioral Research and Services at Cal State Long Beach
does HIV and STD testing, outreach and research with a focus on substance
abuse and health issues of the gay community. But with funding nearly
halved in the past five years, the number of full-time employees has
nosedived from 50 to 12.

With more funding, the center could expand programs it already has, said
Dennis Fisher, the center's director.

"We would have greatly expanded hours, we wouldn't have to close during
part of the day and we would have more people in the field," he said. "We
would have wireless communication with the field staff and a fully
operational Web site. And all of our computers wouldn't be completely
obsolete."

Even as funding has dwindled, the demand for the program has grown.

"The bottom line is we're doing the best we can, and we'd like to be doing
more," Fisher said.

The Health Department and the CARE program haven't faced funding cuts, but
officials there agree that funding is tight, especially with increasing demand.

"We're going to be seeing more and more people living with HIV, so how are
we going to continue to serve with flat funding?" Eastlund said.

Despair, But Hope

Having treated hundreds of HIV-positive crystal meth addicts, Kuhn has seen
firsthand the scope of the problem and knows how tricky it is to treat.

Kuhn is known for a blunt, candid approach with her patients. When they
look awful, she tells them. And in turn, they talk to her about bathhouses,
sex parties and their drug-fueled lifestyles. She urges them to stop taking
actions that would risk spreading HIV. And she tells them she won't judge them.

She thinks there are problems deeper than just drugs and sex in the HIV
community that lead to alienation and propel people toward drug use.

"We're dealing with a multi-layered epidemic," Kuhn said. "There's a lack
of something real to believe in, and a lack of hope. There's a lot of
despair. We need to look at why someone would go out and have unprotected
sex knowing they could be infecting other people.

"I said to one of my crystal meth sex addicts, ^iJust answer one more
question for me. Is this all there is?"' Kuhn said. "^iDo you ever walk
down the street, do you ever lie in your bed at night and think, is this
all there is? All this sex and disease, is this all there is?"'

Kuhn also thinks the answer lies in a mobilized community response.

"It's a war," she said. "It's about shame. It's about the Internet. It's
about HIV. It's about condoms. ..." she said. "I truly do believe that
there are dots that haven't been connected yet ... psycho-social,
spiritual, medical, recovery. ... We haven't figured out how to string them
all together."

At a recent workshop in Long Beach, Piper warned service providers against
creating hysteria and stigma about crystal meth in the gay community.

He showed a recent series of national headlines: "Health Officials Warn,"
said one. "Gay Men Feared," said another.

I want to caution us from using these terms," he said. "I happen to be one
of those people who believe that not all drug users are pathological
freak-out people," he said.

Piper's main suggestion is to focus on solutions, not dwell on the problem.

There has to be a shift in collective thinking away from stigma, Kuhn
concurred: "I'd like to see more compassion and willingness for people to
consider the possibility that this epidemic is more than just a bunch of
guys in a corner, having sex. These guys sitting in the corner, these are
the most precious guys I've ever met."