Download Crystal Ball Full Crack.epub
Clint Callas
Crystal methamphetamine smoking is associated with many negative health consequences, including the potential for transmission of hepatitis. We examined whether or not a kit for crystal methamphetamine smoking might have some potential to reduce the negative health effects of crystal methamphetamine smoking.
Five focus groups were conducted with crystal methamphetamine smokers recruited by community health agencies and youth shelters in Toronto, Canada. Target groups included homeless/street-involved youth, sex workers, men who have sex with men, and youth in the party scene. Participants (n = 32) were asked questions about motivations for crystal methamphetamine use, the process of smoking, health problems experienced, sharing behaviour, risky sexual practices, and the ideal contents of a harm reduction kit.
Pipe sharing was widespread among participants and was deemed integral to the social experience of smoking crystal methamphetamine. Heated pipes were unlikely to cause direct injuries, but participants mentioned having dry, cracked lips, which may be a vector for disease transmission. Many reported having sex with multiple partners and being less likely to use condoms while on the drug. Demand for harm reduction kits was mixed.
Changing pipe sharing behaviours may be difficult because many participants considered sharing to be integral to the social experience of smoking crystal methamphetamine. Within the context of a broader health promotion and prevention program, pilot testing of safer smoking kits to initiate discussion and education on the risks associated with sharing pipes and unprotected sex for some communities (e.g., homeless/street-involved youth) is worth pursuing.
Crystal methamphetamine smoking is associated with many negative health consequences and is linked with transmission of Hepatitis C virus (HCV) [1]. Heated and damaged pipes may lead to injuries to the lips and mouth [1] and when shared these pipes may be a vector for Hepatitis C virus (HCV) transmission. A systematic review concluded an HCV prevalence ranging from 2.3 to 5.3% among never-injecting drug users represents a serious health concern among this population but the causal mechanism of transmission was unclear [2]. Populations most often associated with smoking crystal methamphetamine include homeless/street-involved youth, gay men, sex workers, and youth in the party scene [1].
Crystal methamphetamine smoking has also been linked with risky sexual behaviours. Studies show crystal methamphetamine increases sex drive and can enable longer sexual episodes; it also leads to drying of the mucosa, which can cause tears in the genital region and facilitate transmission of HIV or other sexually transmitted infections [3]. A study of sexually active adults in California found that non-injection methamphetamine use was inversely associated with condom use, regardless of the type of intercourse [4]. Low rates of condom use (one third of the time during vaginal sex and one quarter of the time during anal sex) in another study lend support to this finding [5]. Greater intensity of methamphetamine use was also positively associated with unprotected sex in a sample of 261 HIV-positive MSM in California [6].
The design of a harm reduction programs such as safer smoker kit, and other public health interventions, requires an understanding of the target population; underlying behavioural motivations; behavioural patterns; social context of behaviours; perceptions of harm and susceptibility; perceived benefits and barriers; kit preferences and perceived willingness and ability to modify behavior [17, 18]. Ultimately, our goal was to answer the question: is a crystal methamphetamine kit a desirable harm reduction tool, and if yes, what might a kit contain?
Between January and March, 2011, we conducted focus group discussions at community agencies in Toronto that served homeless/street-involved youth, gay men, sex workers, and youth who are not homeless/street involved but are involved in a party scene where drugs such as crystal methamphetamine are commonly used. Focus groups were selected because they are an efficient method of data collection and provide the opportunity to examine consistency and difference in opinions and experience within a group. Using poster advertisements and word of mouth, we asked each agency to recruit clients who had smoked crystal methamphetamine in the past month for the study. Focus groups were co-moderated by one of the lead researchers and another research team member. Participants were asked to provide verbal consent and received $25 and two transit tokens for participation. This project was approved by the Office of Research Ethics at the University of Toronto.
During the discussions, participants were asked about factors that lead individuals to smoke crystal methamphetamine; the process of smoking crystal methamphetamine; the types of equipment used for smoking; the frequency of equipment sharing; recommendations for the contents of an ideal 'safer crystal methamphetamine smoking' kit; and health consequences of smoking crystal methamphetamine. Each participant completed a short demographic questionnaire.
The focus groups were audio-recorded. The audio-recordings were reviewed and detailed notes compiled. The notes for each focus group were reviewed by both moderators and revised as necessary. These notes were managed using a word processing package. We followed an iterative analytic procedure [19]. Using the discussion guide questions as an initial structure, the notes were analysed for key themes and a coding structure created. Team members met to discuss and revise the coding structure. Thematic memos were written to describe, summarize, and analyse the content of each theme. Supporting illustrative quotes were identified in the audio-recordings and added to each memo. The recordings were reviewed periodically to ensure the accuracy of the memos. We compared thematic content across and within focus group discussion. All team members reviewed and revised the final analyses to ensure accuracy and completeness.
When describing their use of crystal methamphetamine, participants described varied reasons for using the drug: pharmacological, physical, psychological, emotional, cognitive and sexual. Commonly discussed was the big rush of adrenaline and feeling of euphoria that accompanies crystal methamphetamine smoking. Across all groups, participants talked about feeling a boost in energy after smoking it and the ability to use for extended periods of time without sleep. Delaying sleep helped those who worked at night. However, more often participants talked about how increases in energy helped them enjoy all night dance parties. Also, the boost in energy led many to feel more proactive and productive. Amongst the participants, only one mentioned smoking methamphetamine because of feeling addicted to it.
Right away you just feel amazing, and you feel like you can do anything. You have a lot of energy. Pretty much everything in your mind is going right... You're just in an amazing world, pretty much.
As well as providing a boost in energy, participants also discussed how smoking crystal methamphetamine improved their self-esteem, confidence and sociability. Crystal methamphetamine smoking was also linked with improvements in clarity of thought, concentration and ability to study 'especially in college or university, come exam time, when you have to do all that cramming.' For a small number, smoking crystal methamphetamine increased their creativity and artistic productivity. A participant remarked 'It helps me be more artistic. I find, like, I can draw and paint better.' It helped many to manage mood swings and reduce feelings of depression and other unwanted emotions.
With me, like, I have a lot of trauma in my past. Like, I used to be a cutter. I have suicide attempts under my belt, and so when I get into those moods, instead of harming myself or harming others I just smoke some crystal and it just goes away.
For some participants, the effects of crystal methamphetamine helped them to overcome self-stigma and negative feelings about being gay. For those involved in sex work, combined effects of increased awake time, energy and confidence with reduced negative emotions were desirable.
Across all discussion groups, participants strongly endorsed the positive effect of smoking crystal methamphetamine on sex. It made them feel sexier. While using methamphetamine, sex was described as better in terms of increasing its duration and physical intensity. Some participants described the increased sensitivity to physical touch. With few exceptions, participants described how they felt more sexually adventurous and less inhibited while on the drug. Gay men described feeling sexier, less worried about being rejected and less concerned that they could not perform as well as they might want.
I'm kind of sexually inhibited, so it allows me to access part of myself that I normally can't... It kind of allows me to get past those fears of rejection, or fears of not being good enough for somebody or not being sexy enough for somebody, because it makes you feel sexy.
During some discussions, participants described smoking crystal methamphetamine as a weight loss strategy. Amongst participants experiencing housing and food insecurity, smoking crystal methamphetamine reduced their appetites and feelings of hunger.
Basically, you put your crystal into [the pipe] and you should keep the lighter about an inch below the bottom of the pipe. You let it melt into a liquid form and you wait a second until it re-crystalizes over, and then you heat it up until it puddles again. You keep it constantly moving while inhaling not as hard as you would with crack, but not slow, just like a normal sized breath
When asking about the process of smoking, the most common ways described involved the use of a store-bought ball pipes (a glass stem with a bowl attached) or using tin foil and straws, a method known as "chasing the dragon". With the exception of participants who were homeless/street-involved, few discussed the use of improvised equipment such light bulbs, soft drink cans and/or ginseng vials. For the homeless participants, improvised pipes were only used when ball pipes were not available. Some participants had used crack stems to smoke crystal methamphetamine or had heard of others doing so. Smoking with a crack stem was generally considered an unsuitable method because it does not have a bowl to collect the liquefied crystal methamphetamine that prevents this liquid from being inhaled and/or swallowed. During several groups, a technique called "hot-railing" was described. Hot railing involves heating a crack stem and then inhaling a line of vaporized crystal methamphetamine through the nose. Although uncommon, a few participants mentioned converting crack stems into ball-type pipes. Some had seen friends or acquaintances heat a crack stem and then 'blow' out a ball that would be used to collect and smoke liquefied crystal methamphetamine. After hearing about this technique, we asked other participants but few were familiar with it.
b37509886e