Justin used to sell "Happy Meals" for $135: an ounce of G, an eighth of meth, and two to three Viagra. The meth pumps your brain with dopamine, the G makes you horny, and the Viagra allows you to stay erect.
"It's all the things that make you feel happy and loved and then also with the added boost so that you can perform," said Justin, who asked that his last name not be published.
For gay men in San Francisco, the "methamphetamine problem" is much more than a single drug. It's about Gamma hydroxybutyrate, GHB or G, which is often used concurrently with meth, and it's also about sexual and mental health. This trio — co-addiction, sex, and trauma — are fueling the demand for Happy Meals.
"The majority of gay men I've worked with have also used G at least some point with the crystal [meth]," said Kevin Shone, the supervising substance use counselor with the UCSF Alliance Health Project. He has been working with meth users for over 20 years in Los Angeles and San Francisco.
Because the high from meth is so extreme, he explained, many users experience a debilitating sense of depression that can last as long as a week. G then provides a brief respite during the comedown, distracting from the overwhelming side effects of meth. Sometimes, gay men will use both G and meth at the same time to heighten pleasure during sex.
But G has a number of knock-offs like Gamma-butyrolactone (GBL) and 1,4-Butanediol (BD/BDO), which can be more or less powerful and look the same. The science of dosing becomes especially precarious when the person using G is also high on meth. Shone recalled one patient who went home after a night of partying and started the water in his bathtub before taking a little more G. He passed out on the floor and woke up with an inch of water.
"We, as a community, don't recognize that this is almost a co-equal addiction," said Justin, 41, who identifies as gay. After he was evicted from his longtime apartment in 2014, he felt directionless and began more regularly using drugs. G and meth became habitual and inseparable for him. "It was never like, 'Oh I'm just going to have meth today,'" he recalled with a laugh. "It's like coffee with no cream."
He spent four years wired to G, meth, and whatever else he could find when G and meth were unavailable. "I lived probably 15 years in those four years," he said. Meth users often forget to sleep, and Justin didn't always have a bed either. He moved around, sleeping on couches at friends' homes in Washington, D.C., Indiana, Alabama, Florida, and California.
By the time he started dealing drugs in 2018, he wanted help getting sober, but he couldn't figure out how. He had flirted with 12-step programs like Crystal Meth Anonymous and had spent time in a rehabilitation center. One night in October 2018, he was high at Aunt Charlie's Lounge in San Francisco's Tenderloin neighborhood, carrying half a gallon of G and up to 200 grams of meth in his backpack when he had a nervous breakdown. He was paranoid that he would be arrested soon (another friend who dealt drugs had gotten caught earlier that year). Frantic, he left the bar and went over to a friend's house. He proceeded to flush everything — roughly $2,000 - $5,000 dollars worth of drugs — down his friend's drain and cried for two hours while his friend held him. He hoped it would be the end of his substance abuse.
It wasn't, but it was an inflection point: "That was the moment that I realized that this thing that I was using, all of these things that I was using, to make me feel okay — those were the ones that were causing me the most harm," he said.
G through sickness and health
For many gay men who use G and meth, the goal is to enhance their sexual experience. "I needed the meth to stay awake and kind of 'up,' but G was the physical, physiological experience I was looking for," said Justin.
Together, meth and G also lower inhibitions, making it easier to perform activities with a partner that might otherwise feel shameful. This formula of drugs and sex among gay men increases the risk of contracting HIV and other sexually-transmitted diseases. The phenomenon of chemically-induced sex is known as "chemsex" or in other circles, "party and play." Even without meth, users who drink G report that they were more likely to have unprotected sex simply because they were high.
Three out of four gay men interviewed by the Bay Area Reporter, for example, contracted HIV while using G in conjunction with other substances like meth. For Justin, the early symptoms of HIV triggered an immune response that worsened an underlying case of syphilis and led him to be hospitalized for three days.
Underneath these physical and sexual health complications are deeper mental health challenges. "A certain percentage of people who ended up having substance use issues have a history of trauma," said Shone.
His team at the UCSF Alliance Health Project includes therapists who help substance users manage that trauma, but he admits it's a "double-edged sword": in the short-term, G and meth can alleviate feelings like depression or anxiety, but over time, substance use will make those mental health conditions worse. For Justin, these drugs led to bouts of psychosis. Franz Lao, another former substance user who was featured in part one of this series, stopped taking anti-depression medication because he felt it interfered with the high he wanted from G and other party drugs like MDMA, also known as Ecstasy or Molly.
A recent study in Germany found that gay and bisexual men had higher rates for anxiety and depression than the general population, but that men who used drugs like G and meth during sex did not differ much from other gay and bisexual men.
G and meth are not only a coping mechanism for mental health challenges; they are also the basis of a tight-knit community for gay and bisexual men. While they might initially revolve around drugs, the relationships among fellow users often turn into genuine friendships. When someone takes too much G, i.e. they "fall out," other users watch after that person.
"One of the main reasons that I have used substances in my life is to find ways to connect with other people, especially gay men," reflected Justin.
For people who try to stop using G and meth, the recovery process is as much about the people in their lives as it is about the drugs. Some of those people are friends and family who have been harmed too, and seeking amends for them is a piece of the twelve-step program that users in Crystal Meth Anonymous follow.
Others struggle to navigate the relationships with friends who continue to use G and meth. Shone has even seen many patients develop close relationships with their meth dealers.
"There's real grief in letting go of these people," he said, "Just like there's real grief in letting go of the drug."
If you're seeking help, visit the San Francisco AIDS Foundation's Stonewall Project or the UCSF Alliance Health Project.
This is the second in a three-part series on GHB and the gay community. To read the first article, click here.
Help keep the Bay Area Reporter going in these tough times. To support local, independent, LGBTQ journalism, consider becoming a BAR member.