The number of overdoses each year continues to rise — and gay men are particularly at risk.

Gay men are four times more likely to use meth than straight men, and over 12 times more likely to consume amphetamines compared to men who do not have same-sex relationships. As drug overdoses throughout the country — and particularly in New York City — continue to rise, the factors driving these disparities are overdue for examination.

Factors That Drive Meth Usage

Meth is commonly used in Party and Play (PnP) culture, not just for its effects, but also because of its reasonable price and considerable longevity — depending on one’s tolerance, a meth high can last over nine hours. It is also highly addictive, and can rapidly shift from a once-in-a-while party drug to a life-altering habit.

A study entitled “Crystal Methamphetamine and Sexual Sociality in an Urban Gay Subculture: an Elective Affinity,” found that, “because methamphetamine is associated with increased self-esteem, increased libido, greater sexual endurance, diminished sexual inhibition, and a higher threshold for pain, the drug is used strategically by gay and bisexual men to negotiate sexual sociality and increase sexual pleasure.” Because gay men have been historically marginalized, gay sex acts can elicit feelings of internalized homophobia — which makes a drug that decreases inhibitions understandably appealing.

Read More: Why Is Depression Higher in the LGBTQ Community?

What Makes Meth So Addictive

Even for those who may not be psychologically susceptible to the effects of crystal meth, the physical effects can be highly addictive. The drug is known for taking sex to the next level (which is why it’s largely the drug of choice in PnP settings), to the extent that once someone has had sex while on crystal meth, sober sex may have lost its appeal entirely.

What makes meth so addictive are its effects on the brain’s “feel good” chemical: dopamine. Dopamine is responsible for feelings of pleasure, reward, and motivation, meaning crystal meth gives users a euphoric rush. When someone becomes addicted to meth, the natural production of dopamine becomes dependent on the drug’s presence in the system. Meth also impacts the brain’s levels of serotonin, which regulates mood, appetite, and memory. When the drug’s effects wear off, the brain is depleted of both dopamine and serotonin, which creates feelings of depression and anxiety.

Crystal meth creates an intense high that fades quickly, leading people to take repeat doses in order to stay high and avoid a painful and disorienting comedown. Repeated usage also leads to increased tolerance, which means that users need higher doses to receive the same effect — a pattern that can quickly lead to a fatal overdose.

Increased HIV Risk

Meth usage has also been consistently linked to increased risk for HIV. Not only does sharing needles drive a high risk of HIV contraction, but meth usage has also been linked to unsafe sex, which can increase the spread of HIV and other STDs. This is of particular concern in a community where HIV risk is already disproportionately high. While researchers have yet to establish an indisputable link between meth usage and increased risk of HIV, the Los Angeles LGBT Center reports that gay men who had used meth within the previous 12 months were five times more likely to test positive for HIV than those who did not use meth.

For gay men who are already HIV positive, research has shown that crystal meth can potentially help promote a virulent strain of HIV that may severely reduce the effects of HIV medications. After a one-year evaluation, one study found that meth users had a lower ratio of CD4/CD8 cells than did counterparts who were not using meth — indicating a less resilient immune system.

What’s more, meth can increase an HIV-positive individual’s viral load, in turn increasing the likelihood of HIV transmission: researchers have found that among patients consistently taking highly active antiretroviral therapy (HAART), those who were also using methamphetamine had significantly higher viral loads (median 5,000 copies/mL) than individuals who were past users of the drug or had never taken it (median viral loads 1,000 copies/mL). Of the patients treated with HAART who had never taken methamphetamine, 62 percent had an undetectable viral load, compared to 59 percent of past users of the drug and 39 percent of current users.

Read More: How Minority Stress Drives Drug Use in the Gay Community

Withdrawal, Relapse, and the Road to Recovery

Chronic, long-term methamphetamine use can chemically alter the structure and function of the brain, impairing motor skills, learning abilities, and emotional regulation. Many of these symptoms may continue for several months or even years after users have stopped taking the drug.

But the road to recovery is far from easy, and withdrawal symptoms can be traumatic and painful. The severity of withdrawal symptoms will vary depending on the frequency and volume of an individual’s usage, but often include fatigue, increased appetite, agitation, insomnia, paranoia, hallucinations, suicidal thoughts, depression, and loss of motivation.

With its dramatic comedown and severe withdrawal symptoms, it’s easy to see why crystal meth has earned a reputation for being more difficult to quit than other drugs. In fact, for all drug addiction, relapse rates are estimated at 40 to 60 percent, while a 2012 study showed relapse rates for methamphetamine to be as high as 88 percent.

Seeking Help: Resources for Those Struggling With Meth Abuse

For those who are struggling with meth addiction — or know someone who is — there are a number of resources that can help. Sites like Tweaker provide volumes of information about how to end meth addiction, as well as educational resources that illustrate exactly what meth usage is doing to your body. “We’re here because we know that gay guys use crystal meth,” reads Tweaker’s homepage. “We’re not here to promote meth or glorify meth use. We’re not here to condemn or criticize meth use.”

Nonprofit organizations like The Center in New York City offer holistic recovery services, and programs like Crystal Meth Anonymous and Narcotics Anonymous guide those who wish to stop using through a 12-step recovery program for spiritual development. Mt. Sinai’s Addiction Institute hosts a network of support groups that comprise The Crystal Clear Project, offering a safe place for queer men to discuss issues of sexual orientation, sex, and identity as it relates to drug and alcohol use. The Substance Treatment and Research Service of Columbia University (STARS) even provides free and confidential treatment of substance abuse in the context of clinical trials and treatment research. Another — albeit more expensive — option is to check yourself into a medically supervised detox program where professionals will help you flush the drug from your system.

If you or a loved one are struggling with substance abuse of any kind, having a doctor and therapist who you trust is crucial. Visit to find an LGBTQ affirming provider in your area.


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