Clinician describes intensifying drug threat in MSM community

Amid an opioid epidemic that has gripped the Northeast for years, a partial hospitalization program in Massachusetts is now seeing the emergence of another possible drug crisis among men who have sex with men (MSM). A clinician with Brookline-based Arbour-HRI Hospital's Triangle Program tells Addiction Professional that the intensive outpatient program is seeing a significant jump in patients who are addicted to crystal meth, spanning every walk of life.

Clinical social worker Austin Seeley doesn't necessarily believe significantly more people in the area are using crystal meth than in the past. But he says the opportunities to use dating technology and transportation services to access opportunities for “chemsex” more easily has made it more difficult for some men to control their use. Drug-enhanced hookups or group sex encounters that once might have been engaged in rarely are now within easy reach all the time, Seeley says.

“Previously, someone could delete all of his phone numbers and avoid risky places,” says Seeley. “Now, with the apps that are out there, things can happen anywhere in the day, and anywhere in the city.”

Powerful lure

With dopamine release significantly more pronounced from methamphetamine exposure than with cocaine, relapse risk remains prominent for the dependent user. The likelihood that a patient will return to Arbour-HRI's intensive outpatient program within a matter of months is high, Seeley indicates.

And whether a man is using meth to enhance the sexual experience in a one-on-one hookup or for group sex, the commonality Seeley sees is that his patients “are not having safe sex when they're on this,” he says.

With the treatment models in the region currently tailored to responding to the opioid crisis, effective treatment options for stimulant addiction might be difficult to come by. Seeley says of the experience of one his patients who previously had been admitted to a hospital, “The staff did not know what crystal meth was.”

At Arbour-HRI, the Triangle Program now is seeing triple the number of patients with methamphetamine addiction compared with the two or three patients a month it saw six months ago. The Triangle Program is an IOP that addresses the behavioral health needs of lesbian, gay, bisexual, transgender and questioning individuals.

Seeley says that at this point, more than half of the gay men being seen in the program are involved with methamphetamine use. “The ages are all over the board,” he says. “I've seen a patient who is 18, and one in his late 60s. And they represent all socioeconomic statuses. There are some high-powered people—doctors, account executives—who feel out of place in treatment.”

Therapeutic approach

Arbour-HRI's program has a clinical foundation in Dialectical Behavior Therapy (DBT), and Seeley says it embraces a “dialectical abstinence” concept that acknowledges the threat of relapse and seeks to plan around it.

He describes the approach as a middle ground between a rigid abstinence model and harm reduction. “You're always working to get or stay sober,” he says of the mindset the program tries to have patients adopt. “It often is very challenging for people to think in terms of the benefits of both approaches.”

Seeley says the word needs to get out to more providers on the threat of meth addiction in this population, and he and his organization are seeking to do that as they also continue to examine and refine their treatment model.