VIAGRA ADDS TO RISKS OF THE CLUB SCENE

Party drugs loosen users' inhibitions

SAN FRANCISCO - Dr. Jeffrey D. Klausner realized he had to do something
when he walked through one of the city's sex clubs and felt pill wrappers
crunching beneath his feet. "I picked one up, and it was a Viagra sample,"
said Klausner, who heads the city health department's sexually transmitted
disease unit. "I thought, 'What's happening if people are using Viagra in
sex clubs?"' He found that nearly a third of gay men surveyed at clinics
specializing in sexually transmitted diseases said they were using the
anti-impotence drug Viagra, often in combination with illegal drugs.

Health experts say Viagra alone seems to pose no real danger to men who use
it recreationally, though they don't need it to get erections.

But Klausner found that people who use it to offset the impotence effect of
"party drugs" such as Ecstasy and crystal methamphetamine also acknowledged
having unprotected sex with more partners.

And Viagra can be deadly if used with amyl nitrite ampoules, or "poppers."
Klausner's study, published June 10 in the London-based journal AIDS,
focused on a group of men in San Francisco who use Viagra and other drugs.

But public health experts say other cities have similar issues with gay and
straight men. "It's not just something going on at an STD clinic in San
Francisco - this is actually pretty common," said Patricia Case, who
directs the Program on Urban Health at Harvard University and is studying
"club drug" users in Boston and New York City for the National Institute on
Drug Abuse. At the Centers for Disease Control, AIDS specialists were
already concerned about rising rates of STDs among gays and young people
who have become complacent about condom use, because effective AIDS drugs
allow infected people to appear healthy and live longer.

Viagra needs to be studied more closely as another possible factor in
sexually reckless behavior, said Dr. Ronald Valdiserri, the CDC's deputy
chief of sexually transmitted diseases. "I see the Viagra story as sort of
a subplot in all of this," he said. "We take all of this very seriously."
Sipping a drink with friends at a popular gay bar at the edge of San
Francisco's Castro District, Lim, a 22-year-old gay man, said Viagra is
simply another part of the drug scene at the city's five regulated sex
clubs, and at nightclubs and raves. Lim, who gave only his last name, said
he began mixing Viagra with crystal meth or Ecstasy about two years ago to
improve his sexual stamina. Viagra is supposed to be available only by
prescription, after a doctor's consultation, at a cost of $8 to $10 a pill.
However, Internet companies sell the drug to anyone who completes an online
survey.

Viagra then gets traded among friends or resold for $20 to $30 a pill.
Pfizer Inc., which introduced Viagra in 1998 and now makes about $1.2
billion a year on the drug, said it's not responsible for drugs obtained
without a prescription, or Viagra knockoffs made by someone else. "We were
opposed to the recreational use of Viagra from Day One," said a company
spokesman, Geoff Cook. Pfizer has marketed Viagra mostly to men 40 and
older who suffer from erectile dysfunction, but the little blue diamonds
quickly became known for boosting the sexual stamina of younger, healthy
men. "Those of us really close to the street see what's going on," said
Alan Brown, who runs the Electric Dreams Foundation, which promotes health
at gay nightclubs nationwide. In the complicated mix of legal and illegal,
Viagra is considered a natural companion to drugs that remove inhibitions,
Brown said. The drug is also showing up among heterosexuals. "I thought,
'Hey, what a good idea,"' said a 33-year-old man from San Francisco,
recalling the time he first combined Viagra with Ecstasy. "If I had not
been on Ecstasy at the time I would have never thought of it," he said,
speaking on condition of anonymity.

He now uses Viagra regularly, and has combined it with Ecstasy twice in the
past two years, although he considers it an "unsafe decision." The most
worrisome combination, experts say, is Viagra with amyl nitrite.

Called "poppers" because the liquid drug was first available in a capsule
that was cracked or popped open to release vapors, amyl nitrite can cause a
deadly drop in blood pressure. Dr. Eric Christoff, a Chicago physician who
was medical volunteer at gay dance parties, said he warns patients not to
take Viagra with amyl nitrite, and he documents the warning in their
medical records.

Still, Christoff said he prescribes Viagra men in all age ranges. "If the
person is using Ecstasy and can't get an erection, then takes this to
obtain one, is that a problem?

I'm not sure that it is," he said.