According to the Drug Abuse Warning Network survey conducted by the Substance Abuse and Mental Health Services Administration, methamphetamine-related emergency room visits between 1991 and 1994 increased by 258 percent, from 4,900 to 17,400. Meth-related deaths in several cities nearly tripled, from 151 to 433. Most of these deaths were in combination with at least one other drug, most often alcohol. (30 percent), heroin (23 percent), or cocaine (21 percent). Three cities- Los Angeles (134), San Diego (115), and Phoenix (76) accounted for 325 of the reported fatalities, and meth use remains most prevalent in the west. But the survey also documents an eastward movement. Atlanta, Minneapolis Paul, St Louis, and Washington DC, all had more then a 50 percent increase in emergency room cases. In New York city the increase was 31.3 percent, while Denver cases jumped by 160 percent.

Meth, or 'speed,' is swallowed in pill form, snorted as powder, or smoked ('ice,' 'crystal,' 'glass'), and is increasingly the drug-of-choice for all injecting drug users. The government reports growing popularity at raves (all night dance parties). In the Rocky Mountain Region, public health officials note that Meth is making a comeback among white, middle-class residents, with women's use on the rise, and the average user's age as 30.5 years. For lesbians/gays/bisexuals there's more to the story.

In the West, some lesbian/gay substance abuse program staff call methamphetamine the gay man's second drug of choice, and see it gaining popularity with lesbians. In his 1995 National Institute on Drug Abuse (NIDA) monograph article, Michael Gorman, Ph.D., of the Alcohol and Drug Abuse Institute at the University of Washington, cited a report from San Francisco's Operation Concern that 'speed' has replaced alcohol as the most common drug mentioned by treatment-seeking gay/bisexual men. And NIDA's Three Community Study of Methamphetamine Use (Morgan 1993,1994) found that injection is the primary mode for over half of gay/bisexual respondents, compared to 33 percent in the overall sample. Jay Paul, Ph.D., and Ron Stall, Ph.D., at the University of California, San Francisco, Center for AIDS Prevention Studies, assessed the effectiveness of San Francisco's lesbian/gay substance abuse treatment program, 18th Street Services, and found that among male clients who had injected meth, 65 percent were HIV-positive upon entering the program.

Much of meth's attraction to gays is its initial aphrodisiac effects. Gay men in both abstinence-model and harm-reduction programs who have injected the drug describe almost non-stop sex marathons lasting from 12-16 hours to as long as 3 to 4 days. But those seeking help to break free of meth also confirm that continued frequent use reverses the sexual effect physically, although the obsessive desire for sex remains. What is certain to increase even more than the meth user's sexual appetites is the risk and the opportunity for viral transmission. The powerful 'speed'-induced urge for sex frequently involves multiple partners, together or serially, often paid sex workers. (Besides the practice of addicts offering sex for drugs or money to buy them, some sex workers are said to push meth, since the drug creates a demand for their services.) Even more alarming: past users echo a 1993 report that gay methamphetamine users had difficulty recognizing risks of HIV from using drugs and having unprotected sex.

Last year, Dr. Gorman began alerting lesbian/gay activist and substance abuse agencies to the shocking results of his review of July 1994 Centers for Disease Control and Prevention (CDC) AIDS figures. That 59 percent of the cumulative AIDS caseload (then nearing 400,000) were men who had sex with other men (MSMs) wasn't news. But the discovery that about 11 percent of these men had a history of injected drug use struck Gorman as crucial information that he had never heard discussed. He went on to analyze the CDC total of IDU-AIDS cases and found that 20 percent were MSM's. Among male-only IDU-AIDS cases, MSM's accounted for 26 percent, just over one-fourth.

Last October, CDC, NIDA, and NIAAA, held a 2-day "Drug Use, Men Who Have Sex With Men, and HIV Infection" meeting. Other researchers confirmed and underscored Gormans concerns. Richard J. Wolitski, a visiting researcher at CDC reported a comparison study of HIV risks of nearly 1,800 MSM and non-MSM injecting drug users in Dallas, Denver and Long Beach. Among the MSM's who had male only anal sex with someone other then their main partners, 96 percent reported having sex within the last 30 days; only one-third used condoms on the last such occasion.

Apart from its role in unsafe sex, methamphetamine use can have other adverse effects. Some, such as hyperthermia, convulsions, and cardiovascular problems may lead to death. The drug can also cause irreversal damage to the blood vessels in the brain, resulting in strokes.

All this terrible news has some health professionals calling for a national meth campaign. Others are reluctant to call wider attention to a problem still confined to relatively small groups of fast-lane users. As one health professional said, "With the best intentions, the media and those of us trying to prevent drug abuse, may have helped promote new substance abuse trends to audiences who might not have been attracted to them without the attention we generated".

Meanwhile, workers in substance abuse services, lesbian/gay organizations and HIV/AIDS agencies are urged to be aware of the growing meth problem. Too many young lesbians/gays/bisexuals organizations don't understand the link between substance abuse and HIV/AIDS. They must learn that sex under the influence increases their risk of rape and sexual assault, unsafe sex and possibly the transmission of STD's, including HIV/AIDS, and negative impact of these drugs on the immune system. For bisexuals/heterosexuals, unwanted pregnancy is also a danger and continuing substance abuse can harm an unborn child. Everyone must avoid-needle sharing of any drug likely to interfere with their commitment to their own health or the health and safety of others.