A decade ago, methamphetamine was a major problem in Texas and across the nation because of the availability of ephedrine and other cold medicines to make the drug. After these cold medicines were regulated in 2005-2006, there was a decrease in meth production and indicators of use and misuse dropped.
But now, a new methamphetamine epidemic is quietly rising in the southern and western states, all while media headlines and lawmakers focus on the increasing number of deaths due to heroin and prescription pain pills. I should know, I’ve studied patterns of substance abuse for more than 40 years.
Specifically in Texas, this new methamphetamine epidemic appears intertwined with increases in yet another problem: sexually transmitted diseases, including HIV.
What has happened is that we have a new precursor, phenyl-2-propanone (P2P), which is used by Mexican drug cartels to make methamphetamine. When made with P2P, meth is much more potent and has more ability to produce greater intoxication and enhanced dependence.
And the problem is getting worse. In 2015, 91% of methamphetamine tested in forensic laboratories in the U.S. was made with P2P from Mexico. Because of the demand in the U.S., the kilogram amount seized at the Mexico border increased 37% between 2010 and 2015. Last year, the Dallas and Houston DEA divisions ranked methamphetamine among the top two drug threats in their areas, similar to Atlanta and Los Angeles.
More available methamphetamine means more misuse and overdoses. In Texas, the number of people being admitted to treatment programs has doubled, as has the number of calls to poison centers specifically due to meth overdose. Methamphetamine has become the major drug problem in areas of Texas that previously were dominated by heroin. Even more so than it was problem back in the mid-2000s.
The methamphetamine epidemic in the Lone Star state is also going hand in hand with another troubling trend: increasing rates of sexually transmitted diseases, including HIV, particularly among young men who have sex with men.
A Centers for Disease Control and Prevention study shows that the proportion of men who have sex with men and use meth has gone up in the last five years – in Dallas, for instance, it has increased from nine to 45%. And we know that men having sex with men are making an increasing proportion of reported HIV cases in Texas – 70%, which is as high as rates in 1987 after a low 47% in 1999.
Is there a link between these two trends? The problem seems to be that meth use in this population encourages risky or unprotected sex. Texas HIV outreach workers have reported that methamphetamine use, particularly crystal meth, is “spiking” among young men who meet male partners through global-positioning-system-based apps such as Grindr, Scruff, and Jack’d.
We need to confront these intertwined epidemics of methamphetamine and HIV immediately. Although behavioral treatments have proven useful in improving treatment adherence for individuals with meth dependence, there are no approved medications to treat methamphetamine craving and dependence.
There still is no cure for AIDS, but there is at least one drug, a pre-exposure prophylaxis, that, if taken exactly as prescribed, can prevent infection by the HIV virus. Studies have shown the risk of getting HIV infection is lower if the pill is taken daily, safe sex practices are used, and condoms are used during any kind of sex.
The solution is education and advocacy. Users of methamphetamine and those engaging in risky sex must understand the dangers in which they are placing themselves and their friends. We all need to remember the lessons that those who survived the AIDS epidemic in the 1980s learned the hard way. Through regular use of condoms and medication compliance – that is, taking the pre-exposure prophylaxis drug daily – we can prevent another potential AIDS epidemic.
Top image: Methamphetamine. Photo courtesy of the DEA.