8:50PM Dec 21, 2020
And welcome to pozcast, the show that puts the positive in podcasting. Our program is created by and for people living with HIV. And we're here to explore HIV research in ways that matter. We're accurate, but not clinical. We want to hear and tell stories about what new research means for us, for our health, our love lives, and our relationships. We're based in Toronto, but global and outlook, and were produced at the MAP Center for Urban Health Solutions of St. Michael's Hospital, like Universities Without Walls. We're pozcast, and we're bringing HIV research to life. Today, you'll hear the views and ideas of our podcast guests. And while we respect their expertise, they do not reflect the views of St. Michael's Hospital, or Universities Without Walls. I'm your host, James Watson, a person living with HIV and a community based research coordinator. I'll be your guide for today's journey into HIV research. It's not often you get to speak from the heart and say what's really on your mind at work. But here at pozcast, I get to do just that. I'm allowed to reflect on important issues and learn along with everyone else from some extraordinary people. And all the pozcasts mean a lot to me. But some strike a more personal chord. And this is one of those topics. The harmful use of crystal meth is taking a heck of a toll on our gay brothers, folks, especially our gay HIV positive brothers. Anyone who knows me knows I'm drug positive, I've had my own experiences with substances, and I'm close enough to this issue to be forever impacted. Meth can be like a rocketship to gay sex paradise, at least at first, I get that. But it's often a one way trip. And the landing is rough and the long term consequences can be devastating. But that's not everyone's experience, right? Some people seem to manage their meth use in ways that works for them. And that's okay. The meth is a tricky one to insidious and it creeps up on you. Meth distorts our sexual desire and plays off so many of our vulnerabilities as caveman. When a friend of mine heard I was doing research for the show, he asked me for some advice on how to approach a loved one he was concerned about. He wasn't sure what to do or say and I think there are lots of people who have been or are in similar situations, including myself. I've struggled not knowing how to reach out, or even if I should reach out. While most gay men don't use meth, there's an incredible amount of stigma cast on those that do, and from our own community, it's well, it's shameful. That makes it so much harder for those seeking recovery to come forward. We don't want people to isolate further. We want people to know that they're loved and supported, that there's a way out, if out is what they want. Addiction is a disease, friends. It's not a moral failing. It became clear to me quickly that I couldn't do this topic justice in a single twenty-minute episode, there's just too much to talk about. So we decided to do a three part series to get a bigger picture focused on solutions. In part one, we discussed the book Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery by David Fawcett. And in part two, we get up close and personal with Crystal Meth Anonymous: The Twelve Step Recovery Program. And in part three, we explore how methamphetamine fits within a harm reduction model.
In this third episode of the series gay men using meth, I wanted to focus on a harm reduction approach. So I reached out to two experts, Nick Boyce has been working in harm reduction for almost twenty years. He's a member of the Ontario Opioid Emergency Task Force, a board member with Addictions and Mental Health Ontario, and the director of the Ontario Harm Reduction Network. My other guest Colin Johnson immigrated to Canada from Jamaica in 1972 and is a gay rights activist committed to addressing HIV stigma and harm reduction by sharing his journey with others. He sits on the board of the Prisoners HIV/AIDS Support Action Network and is employed at the Black Coalition for AIDS Prevention as a men who have sex with men harm reduction peer educator, and co-facilitates trainings and workshops with the Ontario Harm Reduction Network. He is also an injection drug user whose drug of choice is crystal meth.
So guys, welcome to pozcast. And so I'd like to start right from the very beginning. So, Nick, maybe you could explain to us what is harm reduction?
That's an interesting question. To me harm reduction is a, it's not just something we do or practice. To me, it's a philosophical approach to understanding drug use, or working with drug use. So, within that philosophy or framework, there are things we can do and teach people programs and services we can offer, but fundamental to all of it is an approach to drug use that treats it as a health issue, as a social issue, and not as a criminal or moral issue.
Is there anything unique to crystal meth compared to other drugs, when it comes to harm reduction—for messaging and training, programming?
So every drug is unique. And they all have different pharmacologies, they all work differently in the body, they all have different effects. So I think that's one of the things when we're working from a harm reduction framework, and educating people about drugs, it's important to distinguish, you know, what makes one drug different than another. So undoubtedly, crystal meth has its own unique effects on the body, its own unique risks. And what I'm mindful of, though, is not trying to create a hierarchy, saying one is worse than another or one is more bad than another. Obviously, things are relative. But my concern is if we start saying one thing is worse than another, we lose the nuances there and you can create stigma around one versus another. And then the fact is, meth can be used by some people in some contexts in a safe way. Alcohol can be a very dangerous drug for some people in some contexts. So it's just trying to remove some of the fear around this and then and get to some of the science, which can then help explain some of the uniqueness around around every drug.
Okay, so what would be then some of the uniqueness around meth?
So from a pharmacological point of view, how it works in the brain in terms is that it works on sort of three major neurotransmitters, which are chemicals that create signals in the brain and the effects and it gets. So dopamine is one that's involved in pleasure and reward. Serotonin's involved in eat and sleep cycles. And Norepinephrine, which acts like adrenaline in the body. What makes crystal meth different than some of the other drugs that people might be familiar with, like cocaine, is the way it releases is the amount it releases those chemicals in the body. So when we have, when we feel good, when we have sex, when we eat and feel satisfied, we release some dopamine in the brain. And you'll see a little spike in if you measure this in people's brains. When we do a line of cocaine, you'll get what we think about a 400% release of those chemicals. When you do crystal meth, you get about a 1600% release, so it's releasing a lot more. The other thing that really distinguishes methamphetamine is what we call the half life. So the half life refers to how long it takes to metabolize and excrete a drug and get rid of it from your body. And methamphetamine has a particularly long half life, so it's about twelve hours. So if you do some methamphetamine, twevle hours later, half of that meth is still in your body, another 12 hours later, half of that amount is still in the body. Cocaine, as a another example, has a two hour half life. And that's why when people do lines of coke they're, typically, you know, going in every half hour doing a bump or doing another line.
So now you guys have done presentations together. Right? Colin, you've worked with the Ontario Harm Reduction Network?
I think I've been involved with them for about five years now, yeah, something about that.
So, and you co-facilitate on harm reduction presentation and things like that. So, why did you decide to talk about your meth use in such a public way?
I think it's important that people understand, as Nick alluded to, that people can use meth or actually any other substance and can go along with their life. It does not have to cause bankruptcy or disruption of family or disruption of life. You can actually use substances and be productive, you know, day to day. For me, particularly as a Black gay man, I think it's really important that people like myself, get out there and speak publicly to two facts: One, that we do use substances in the ACB (African, Caribbean and Black) community, which is something that we really don't talk about. It's either—it's either disavowed or, you know, just not acknowledged. Whether this comes from religious viewpoint or just personal beliefs, there is a very strong bias within my community about not discussing substance use openly and acknowledging that people do use it. Now, the second part of that is that, if we're not acknowledging that these things happen, then obviously we're not going to step forward and do something when people do have problems. And when people do lose their, their jobs, or do lose their families. So I think it's really important to acknowledge that A) we use substances and B) there people like me who use substances, and are productive.
So what is, what would you say your pattern of drug use is now?
Well, okay, so that has shifted quite a bit over the years. So just a quick comeback, because I think some histories...I started using substances from about 1972, when I came out in the gay community, and for me, substance use, and then was a part of the gay community, in so many circumstances still is. So I started with weed, smoking weed, that became doing a hit of acid. But for me, at that time, the whole idea was just enjoyment to go and dance until four or five in the morning, it was a social connectiveness that everybody used. When I became HIV, when I discovered that I was HIV positive, I sort of, I didn't stop, but I was more careful in my substance use. I changed over to cocaine at that point in time. And for me, then, it was it was an escape. It was an escape from the reality that I might die in three years. I just wanted to have life as glorious and as fulfilled as that, you know, get that Nirvana before I pass this mortal coil.
You're talking about because of the HIV?
Yes, beacause of the HIV. Not only that, but it also helped with medications in so many ways, because I mean, a lot of the medications where the side effects were just appalling. So it did help with that. Now, I use meth. So one reason that I use meth is that for me, the efficacy of cocaine has dropped. And in my opinion, I think the police really should stop interdicting cocaine runs, because they're just getting, you know, people are just getting just poor substances, you know, the efficacy and quality. So A), it's cheaper, and B) I get more, as Nick alluded to the that twelve hour high, I really don't have to do as much as I would have with cocaine. I'm on a fixed income, so again, that also helps. So for me, it's a better—it's more realistic, and more practical for me to use.
Did you always go into your crystal meth use—I mean you sound very logical and practical about this, right? Have you always approach drugs in that way?
So I'm going to go back and I'm going to say one of the things that I think helped was, I mean, from the 70s up until now, we were educated. You know, it was something that was passed on with your friends, about your substance use, nobody gave me a hit of acid and said, just take this, it was, here is a hit of acid, this is what it might do to you. So there was that sort of conscious community I found back then that I don't think quite exists as much now.
Can you speak a little bit about what—I mean, I've done other interviews with meth, and there's a lot of abstinence and on that approach, and, a lot of talk about what damage meth done to their lives. And so I wonder if somebody who is a current meth user, what good things meth brings to your life?
Okay, so for me now, meth is more something where I'll go home, I'll sit, I'll use a direct injection because I do use intravenously. And for me, it's to watch my soccer games, to, you know, to catch up on my television and my Netflix. It's not as much as a sexual drug as it used to be for me when I first started. When I first started, it was far more sexual. I mean, you know, it was all about sex. Times have changed for me. And, you know...
How did that switch up?
Okay, so to be honest with you, I really don't have an answer for that. I think, things have changed in the sense that sex is not as important for me as it was ten, fifteen years ago. I just turned 60, which I didn't expect to see, that was one other factor. So for me, it is not as much of a sexual drug as it was, as it is, for so many other people.
And this ties into another framework that we often use within harm reduction to talk about the risks and the experiences and how you can maintain safety, which is a concept known as Drug, Set and Setting. So drug, set and setting, these are the three factors that go into people's experiences with using drugs, and then the risks that may come along with it. So the first thing we think about is the drug and what are the pharmacological properties of that drug? What happens in the body? What do you need to know about the half life for example, and how it works, what to mix not mixed together, and how much the drug costs. Then the next thing we look at is what we call the "set" or the person that's using it and why are they using? What is their tolerance? What is their physical size and body weight? What's their situation right now in terms of income and housing? And then the third piece of it is the context in which the use is happening. So is it at home watching the soccer game? Or is it at the bath house getting fucked up? There's so those three things all interrelate. So when I first was introduced, or saw methamphetamine use, it was actually going to raves, and it was not a sexualized drug. People were using it to dance till eight o'clock in the morning. But they were also typically either smoking or doing a couple bumps of what was called jib at the time. But it was not a sexualized thing at all. It was for energy. But again, that comes back to—so they're using the same drug as some guys who were slamming at the bathhouse now, but the setting in the context, and what their motivation for using it was different. So these are all things that sort of fit into that concept of drug, set and setting.
Well, that's interesting. You know, as I was walking here today actually, by Yonge and College in the alley, there was three young guys, one with a shirt off. You know, I don't know if the right language is tweaking out, but just like, he looked like death. And, you know, rush hour, broad daylight, and it really broke my heart. You know, what do you...I don't know what you do in situations like this.
You know, the other issue, we have a serious housing crisis right now, right? So your ability to practice some harm reduction strategies can also depend again, on drug, set and setting. So if you have your own condo, and access to as consistent supply from a known dealer, and you're using with people you know or trust. That's a different context, and you're out on the street, and you've been up for three days and haven't eaten—that's very different. But you know, gentrification and the housing situation, I see—I live at Yonge and Wellesley, I see it more and more. Is that meth thats causing those issues? Or is it larger systemic issues?
Right. Yeah, absolutely. So for you, I mean, you say you don't know where that transition took place. But do you find, even though now that you're just, you know, you will do an injection of meth, and you're watching your shows. Do you find that—what are the negative issues that arise?
Okay, so for me, okay, so for me, one of the issues is eating. I do lose my appetite. So my solution to that, I buy comfort foods, or I buy soups or, even Ensure, stuff like that. So I do get that. The other major, major problem that has occurred for me, is taking my medications—adherence. Now, this is my thirty-seventh year of being HIV positive, so I have learned over the years that there's certain mechanisms I can use. So again, I will, instead of taking my medications all at once, I might take them over a two hour period, just to make it easier and smoother to go down. I also, that being the case, sometimes I do miss my medications. So instead of taking it like every twelve hours, it might be every twenty and that sort of thing. But as soon as I keep trying, just to ensure that I still try to get my medications. Soups work for me, soft foods, as I said, my comfort food, so it's stuff like patties, you know, stuff that are easy, that I'm used to, do help me in that case. But those are my biggest, are so far my biggest thing. Sleeping, I'm not worried about. If I know I'm doing something, I don't do drugs the day or the day before, because I know I have to be here, type of situation. So I'm always aware of what I have to do. And make sure that you know, I have my free time because I do know that it takes me at least a day and a half to recover. But that's that's because I know myself as well. And I think that's so important to get across: that you really have to know your body, how it deals with the substances, your metabolism rate, you know, when you can eat and you know, all of that. I think it is really critical that anybody who's using any substance actually know and understand what the substance is, their recovery time, you know, what they have to do. And also, prioritize, you know? The other thing is, I mean, canceling. I mean, if you've got, let's say, I've got a doctor's appointment or something, and you know, I overdid my thing. Cancel the appointment, you know? But just being proactive in so many ways can actually help. And it also brings a bit of order to what you're doing in your process.
I think what's coming up for me here is that you have a tremendous sort of nuanced and understanding and insights and knowledge here, and you also have a roof over your head, your ability to plan, you know, when we're educating people around meth, the whole piece around, you know, what goes up comes down. You're gonna need to know this. But you have had a wealth and years of insight and experience around that. When I think about, you know, some young kid that's being thrown into this and introduced to it, where are they getting that kind of messaging and support? Where I get concerned is, that's the kind of the level of support and education we need to be giving people. When you see those guys in the alleyway and when people see that, and the devastating impacts that meth can have on people, there can be this reaction that we just need to tell people not to do it. And it's this deadly scary drug. And I'm concerned that that also, the negative impacts of that kind of messaging are as bad as not educating people.
And that generally adds to the stigma.
So what is what would be your frequency of use?
Oh, at present, maybe once every three-four months. It's not an everyday thing for me. It really isn't. For me actually, it's almost like a celebration. So you know, if I've done something good for the week, or that sort of thing, and I know I have some free time. Definitely. So I definitely can't do the drug runs I used to do when I was thirty. You know what I mean? That's how they were, you know, those three-four days staying up.
There's a lot of talk about the correct terminology to use. And the right language is very important in harm reduction. And I'm wondering if you can tell me why and give me some examples?
Well, yeah, languages is important because it can convey, and it comes back to maybe the beginning of the conversation around the it's a philosophical way of understanding it, and language can impart your values and attitudes. It can be subtle, and we may not even realize what we're doing sometimes. So, when we refer to people as addicts, or meth heads, that's all they are. So in harm reduction, we often try to move away from labeling, and use people-first kind of language. Another really good example is, often in needle distribution or exchange programs, we'll hear people going to get clean needles. Well what's the opposite of clean?
Okay, but if I'm coming into those programs, and I'm, you know, does that now, do I internalize that? Am I now a dirty person? And what's that say about who I am as a person? And then does that feed into my feelings of guilt and shame, self worth, maybe I don't feel worthy of anything anymore. So language is very subtle, but can be also very powerful. So we're constantly mindful of that. If people want to call themselves a meth head, if they want to label themselves as an addict, that's okay. We'll use that language. But I think we just need to be more mindful of how stigmatizing language can be and the subtleties that language can impart.
To add to that, I mean, if you're talking to people, and the idea is to A) help them at whatever level, they want it to be helped. If you're using language like that, they're not going to open up to you about their substance use and be honest about. You know, if I'm a social worker, and I call you a junkie, well, that's the end of that conversation.
And not even just in their clinical settings, even just within friends, you know, the judgments and the look on people's faces when you admit to using certain drugs versus others. It's not even just language, it's just body language, too. It can shut down the conversation immediately. So if we're trying to, you know, have open honest conversations with people we need really need to reflect on the kind of language we're using and what subtleties we might be imparting there.
And to add to that, is how people do drugs. I mean, snorting is seen as "nice" and middle class and upper class. You get a pretty picture of people rolling up that nice $100 bill on television, or somebody using a needle anywhere for that matter. And, you know, this has always created stratas within the drug subculture. So you know, for some, it's good. And for others, it's bad. And I've seen it on many occasions when I tell people that I inject. And the first thing I get is people looking at my arm. I mean, well, seriously. You know, that's just not how it works.
Its another layer of stigma.
Yeah, and very and it's very crucial to how people are going to deal with you, if they're coming to you for, for anything, whether it's help, or whether trying to quit, or anything for that matter.
We're working primarily with service providers. But before we even start talking about harm reduction as a philosophy and an approach, we actually take a pause and say, what are your attitudes and values around people who use drugs? Why do you think the way you do? And a lot of this is rooted in our drug laws, and the fact that we prohibit drugs, and we criminalize people who use certain drugs. So we get people to reflect that. Now it can be based on media, as you mentioned, media portrayals. It can be based on personal experiences, maybe you grew up with an uncle, who, you know, you saw him beat his wife when he got drunk. That's going to really shape your attitudes and values around this. You may have lost friends to overdoses, or been at the bathhouse and seen people, as you said, tweaking out. All of that, you know, those filters, and those experiences, shape our attitudes and values. We try to get people to just pause and think about some of the bigger picture issues first. And then when you've done a bit of that self reflection, then we opened up the conversation around harm reduction.
It's challenging talking about the language and the terminology for me to ask any questions.
Well that's okay. And that's one of the things we say in our workshops is, you know, you'll get the language, right, it's ever evolving, it's evolving for me, you know, my language is always changing around this. And then I question, is this the right thing to be using or not? So it's not about a matter of right or wrong, it's about just learning and adapting and growing.
We are changing so much. For so many years, the only model we had was the abstinence model. It was either you quit cold turkey, or it's not gonna happen. And you know, and that meant for smokers, it meant for everybody.
Yeah, it's true. Now, it's still true in many ways, a lot of the—so people who are really struggling and looking for to change their use, perhaps, the model that they have is, or the only option that they've ever seen is they have to quit. I think in a harm reduction framework, your success is not based on whether you're using or not, it's about overall wellness and quality of life. And that can include using or not using. If your goal is abstinence, if you want to quit, we'll support you around that. But we'll also talk about there are other options out there, you know, you may not have to quit this or quit all drugs.
So if you're, you know, if there's a case where there's harmful use going on, often people won't know they're in that position, right? Or sometimes people won't know that they're in a position of problematic use, because the drug has taken over. How do you, how would you reach those people?
Well again, I think its around the language and the attitudes we use. So I think one way we're not going to reach those people is if we give signs and signals that what they're doing is bad thing, and they're bad for doing it. And that's where I get very cautious around these messages around meth is the devil's drug. And all hell's going to break loose if you ever touch it, because then if people are using it, they won't open up around that.
I also think that it's important that for the communities, it's important to have people who are substance users leading the way, or are sort of setting the policies. Because unless you have somebody who's been there and done it, it's really hard for somebody to actually, you know, be empathetic, or even to understand the varying reasons why people use substances. So you know, it's nice that somebody might have come up from, you know, educated with a degree or whatever the case may be, but unless you have actually understood where some people are coming from, or have input from them, I don't think any program is going to work.
So can you can you tell our listeners here then Colin, what your strategy is for successful management of your meth use?
I have good support team, I have good friends and I have a great sister. And that's what gets me through.
That's good to know. It's important to know.
For more, you know, for more sort of practical in the moment kind of strategies that can can keep people safer. People talk about "prep and accept" so you prepare ahead of time again, this comes back to, you know, your capacity in your place to do some of this stuff, right. But if you can prep ahead of time, source your drugs from someone, you know, can you test your drugs, you know? We haven't touched on this, but increasingly what we do hear of cross contamination with fentanyl. Can you test your drugs to make sure you've got a known supply of drugs? Measuring out your doses. Once you're using, stay hydrated, eat when you can, set a timer to take those meds when you need to. Longer and harder: the longer you stay high, the harder you're going to crash. So maybe, if you're if you're using it in a party context, maybe party for twenty-four hours, and then and then call it quits. Four days? You're you're pushing things. That's when the psychosis kicks in, that's when the crash is going to get harder. And then the other thing is, you know, take breaks. You can't be doing this all the time. Because that's going to—it takes time to rebuild those neurotransmitters for your body to repair itself. So if you can space it out and take those breaks.
So one last question for you guys. And I've asked this of all the people I've interviewed about meth. So because of the work you do, and the talks you give, I'm sure people must come up to you at some point and ask for advice. And, so if someone was to reach out to you, who is struggling with their meth use and doesn't know what to do, what would you advise?
As challenging as it can be, try to be present with them and have a lot of patience. You know, often people what they need is, again, not to be told what to do, but someone just to sit there and listen. And I know that can be, I know, I've seen it, it's very challenging when people have lied to you, steal from you, ripped you off. That can be very challenging. But you also need to make sure you're in the headspace to be able to work with that person. And you need to take care of yourself. Because if you're not taking care of your own self, you're not going to be able to be present for that person.
I'm just going to echo that. I think it's really important to listen, to try to find out where they are. I mean, you're not a psychologist. So you know, there's no way you can know what the issues are. But you might be able to direct them to places where they can get help, or assistance, if that's what they want. But again, it comes down to what do they want? You know, do they want to quit? You know, why are they struggling? What are some of those issues? Is it you know, a breakup, whatever the case may be. So just sitting down listening can give you a better idea of where and how to help somebody. And as I said, you know, in some cases, they might need directed care in the sense that they might need to go to a program. And other cases might just be that they want to sit down, have a conversation with somebody who's willing to listen.
And I think if you're if you're someone who has struggled with meth yourself made changes, maybe you've stopped or reduced your use, you can share your personal experiences and talk about what worked for you, but don't assume that that's going to work for the other person, or that's what they need to do. Because we're all unique and different. And just because that worked for you. It may work for someone else, it may not. It is also important to say that no matter how hard people are struggling, we got to keep that hope there because people can change. People do get better. I've seen it, it can take a long time, but there are so many success stories out there, as well. And it's important to be able to share those stories—give people that sense of hope, because too often that's lost.
Alright, thank you guys.
A big pozcast thank you to my guests, Nick Boyce and Colin Johnson. I'm glad I had the opportunity to learn more about crystal meth use through a harm reduction lens. As a social justice approach to understanding drug use, it frames the use of drugs as a health and social issue, rather than a criminal or moral issue. It seeks to meet people where they're at and offers practical strategies to reduce risk. Thanks to both of you for invigorating and an enlightening conversation. And thanks to you for listening.
Production services are provided by the Ontario HIV Treatment Network.