The sun had begun to rise, and Matt could see the first flickers of light creeping around the curtains hanging on the motel room's windows. He'd been awake for days.
It must have been a Monday, because the paranoia and hallucinations had set in – blurry shadow people moving in the corners of his eyes, tricks of a tired mind. Friday evenings that lasted until Tuesday morning were routine. Matt had set his work schedule as a waiter that way, four days off in a row.
Enough time to get high.
By then, 2017, he'd been injecting methamphetamine intravenously – "slamming" – for about a year. It didn't matter where or with whom. He'd drift from motel to motel, at times lingering on the streets. He'd get high with doctors who'd shoot up before shifts, or with lawyers. He'd use dating apps to advertise as a prostitute, to bridge the gap between one high and the next. His customers always had what he needed.
By Monday, he'd feel depleted – physically, mentally, sexually. Tuesday would come, as would a small hit to get through the day, and Matt would find himself crying in the bathroom at work. He hated himself. He loved the high.
"Growing up gay, you already feel outcast by society, and this drug makes you feel like you're the most important person, that you're the hottest thing," Matt says. (He asked that his last name be withheld out of concern that his addiction could make employers wary of hiring him.) "There's an illusion behind it, that you just use it for sex. So it doesn't seem harmful. But the effects it had on my life – I lost everything."
Although the nation fixates on the opioid crisis that claimed nearly 49,000 American lives in 2017, meth is making a comeback.
In 2011, meth was the eighth-most common cause of overdose death in the U.S., according to the Centers for Disease Control and Prevention, claiming 1,887 lives, 4.6 percent of all overdose fatalities. By 2016, meth was the fourth-most common cause of overdose deaths, causing 10 percent of overdose death – 6,762 fatalities.
In Florida, according to the Florida Department of Law Enforcement, the drug killed 327 people in 2016. That's a 109 percent increase from the number of people meth killed in 2015, 156 – itself a 77 percent increase from the number of meth-related fatalities in 2014, 88.
From January to June 2017, according to the FDLE's most recent data, meth caused 213 more deaths in the state. That's on pace for a 30 percent increase from the previous year's tally, and a nearly 400 percent increase since the 2014 report.
It gets worse.
Amphetamine is a metabolite of methamphetamine, meaning meth breaks down to an amphetamine once inside the body. It's also meth's narcotic parent. So if you add all amphetamine deaths to the toll, it rises significantly: 526 deaths in 2016, up from 243 in 2015, up from 67 in 2014.
The Florida Department of Health in Orange County doesn't track meth abuse, but the Sheriff's Office says it has seen a sharp rise in meth-related arrests in recent years, from just 43 in 2012 to 87 in 2016 to 212 last year.
It's no secret who's most at risk. In 2015, the National Survey on Drug Use and Health found that adults defined as "sexual minority" – i.e., LGBTQ individuals – were more than twice as likely as heterosexual adults to have used an illicit drug in the past year. More specifically, gay men use meth at roughly twice the rate of the general population, according to data from the U.S. Department of Health and Human Services.
David Fawcett, a Fort Lauderdale-based sex therapist and the author of Lust, Men, and Meth: A Gay Man's Guide to Sex and Recovery, says the problem goes beyond just gay men. Trans and bisexual men across all ethnic groups are also at risk.
"What I started to recognize is that it's men who have sex with men," Fawcett says. "It's most certainly a problem – and I would say if it's not a crisis, it's bordering on a crisis. The reason that resonates with some people and doesn't with others, I think, is because it's a small portion of the [LGBTQ] community."
Meth – often referred to as "ice," "speed," "crank," "crystal" or "Tina" – isn't a new high for Floridians. The drug saw its heyday in the 2000s, when most supplies were "cooked" in fly-by-night labs set up in homes and abandoned buildings.
At the time, a common ingredient was pseudoephedrine, the decongestant found in cold medicines like Sudafed. To combat the problem, Congress passed the Combat Methamphetamine Epidemic Act in 2005, which regulated over-the-counter sales of pseudoephedrine-containing products, limited sales to 7.5 grams per customer every 30 days and required pharmacies to track sales.
Mexico cracked down, too, but the cartels there stayed ahead of the game. They used the chemical phenyl-2-propanone, or P2P – a method popularized among 1970s American biker gangs (and on the TV show Breaking Bad). Today, most American meth comes from Mexico, cooked up in the cartels' "superlabs," says a spokesperson for the Orange County Sheriff's Department.
According to Customs and Border Protection, over the past five years, the amount of meth seized at the border – almost always in trucks at legal ports of entry – has tripled, even as other drug seizures have declined or risen more modestly.
After the meth makes it into the U.S., it's trafficked to Florida by dealers driving from the West Coast along Interstate 10 or shipped across the country using the United States Postal Service. This supply chain, coupled with increasing demand, has led to an almost factory-like assembly line.
What's more, the meth is more potent than ever, and it's cheap, too.
"The cartels have refined it so that it's incredibly pure and addictive," Fawcett says. "It's cheaper, it's stronger, and it's everywhere. It comes in liquid form from Mexico, as tequila and windshield wiper fluid and all kinds of fluids, and then it's re-crystallized and basically distributed by FedEx once it gets into the country."
From there, the drug finds its way to people like Matt.
"If you were to take a hit right now, you wouldn't be able to sleep for 12 hours, and your body doesn't feel like it needs that," he says. "Literally, the days turn into nights, and it'll be day two, and oh, I haven't had anything to drink, I haven't had anything to eat. You just feel like you can keep going."
At the peak of his addiction, Matt says, he once stayed awake for 12 days.
After all, that was the point of the drug's design – an extreme hyper-energized sensation.
According to the Journal of Pharmacology and Experimental Therapeutics, the earliest form of meth was amphetamine, first synthesized by the Romanian chemist Lazar Edeleanu at the University of Berlin in 1887. What resembles today's methamphetamine wouldn't come about until several years later, when the Japanese pharmacologist Nagai Nagayoshi chemically altered the drug to be more potent.
During the Second World War, to manage so-called "battle fatigue," the U.S., Japan and Germany began distributing meth to their armies. (Japanese kamikaze pilots were pumped full of the drug prior to their suicide missions.)
In the '60s, meth spread across the country, from rural areas to urban. It wasn't until 1971 that Congress classified meth as a Schedule II drug under the Comprehensive Drug Abuse and Control Act because of its high potential for abuse.
"Meth works with the system of the brain called the reward circuitry, or the dopamine system," Fawcett says. "If we have a good meal, if we feel loved and belonging, and most of all, if we have an orgasm, we get shots of dopamine that reward the behavior and make us want to do it again."
But meth hijacks that system. It's neurotoxic, which means it gradually destroys the brain's ability to distribute dopamine. In other words, it rewires your system so that you'll feel depressed, impulsive or manic without it.
It's not like that at first, says Sam Graper, a recovering addict who's been clean for 10 years and is the community relations manager at the Orlando Immunology Center. At first, he says, you feel invincible.
"You can be as confident as you want to be. You can be outgoing. You can have sex for hours. All those things are the way it is in the beginning," Graper says. "And then, once you continue going with it, I think it always ends the same for people – in this horrible place of isolation, degradation, dereliction, lost jobs, all those things."
That's where Matt found himself during his days-long benders.
"I'd see the shadow people, things on the floor that weren't there – it was mental," Matt says. "Looking out the windows, thinking someone's out to get you, just extreme paranoia to the point where I would sit in the corner and not talk for hours and hours and hours."
Matt is 29 years old, white. His eyes are deep blue, his hair dirty-blonde. He wears it neatly cropped, high and tight. His beard is trimmed. He's slim but not gaunt, handsome. He's also very insecure, and he knows it.
Like many addicts, Matt says he's always searched for happiness. Growing up, his single mom worked two jobs to make ends meet; he and his sister had to raise themselves. At 13, he found Xanax and booze. By 21, he used cocaine regularly and he became involved with gay party culture.
Though he'd been offered it countless times before, he was 26 the first time he tried meth.
"How I got into it was one night I was using cocaine and I was on Grindr, and I said I wanted to party," Matt says. "Which, for me, that meant cocaine. For them, that meant [meth]. I was out of my stuff, so I was kind of just like, OK."
Matt's genesis story isn't uncommon in the community of men who have sex with men, or MSM. LGBTQ-focused dating apps have tried to suppress drug abuse in recent years, even banning certain terms such as "PNP" ("party and play") and the capitalization of certain letters in members' bios, such as the capital letter T ("Tina.")
In Fawcett's telling, Grindr and Scruff have become essential accessories for the MSM community as a whole.
"Those really facilitate the distribution and connection with sex and drugs, because it's so easy to find somebody who wants to PNP, or party," Fawcett says. "There's an overload of this chronic, low-grade dopamine simulation by looking at the app, much like pornography. ... Dating, which is so much slower and ultimately much more rewarding, and really getting a relationship with somebody over time, is a whole different experience. But it doesn't have the kick that a bump of meth does, and so it pales by comparison."
Scruff, a dating app for gay and bisexual men that claims more than 12 million members, declined to comment for this story. So did Grindr, which claims more than 10 million members.
"People [on dating apps] would have things like 'parTy boy' in their bio," Matt says, which means they're either selling meth or want to use it.
There's an entire community of meth-using MSMs, he adds. On his phone, he logs into the video conference app Zoom, where there are chat rooms with names like "HIV + Bareback PnP," and finds a video of a young man sitting upright naked on a bed, holding his penis. The room is dimly lit aside from a neon light in the background.
Matt says that's an indication he's using.
"Because everything's so sensitive when you're using, you turn the lights down and those colored lights just help everything blend together," Matt says. "So now you can isolate yourself in your room and still feel connected."
And this escalation of meth use in the local MSM community is more pronounced than people think. "That's the thing," he says. "Nobody knows about it."
Matt has never had sex sober. Not while he was using, and not since his most recent attempt to get clean more than a year ago.
"I'm just nervous that I'm going to have sex and it's not going to be good, or I'm just going to be like, 'Well, I'm never going to do that again, I'm just going to go use,'" he says. "For three years, I did nothing but have sex and use meth for sex. Having sex on meth, it's nothing compared to any kind of sex on [MDMA] or anything like that. So when I would think of fucking, which happened daily because I'm a human being, meth would be right there with it."
His drug use, he says, intensified his sexual fantasies, sometimes to a dangerous extent.
"It's fast, you can't really focus on everything, all your inhibitions are lower," Matt says. "You're just this thing that wants everything. It got crazier to where I had to keep one-upping whatever it was. My mind just went to different places."
Sometimes he'd add to his meth frenzy GHB, the anti-sleep date-rape drug that affects the central nervous system. "I'd turn blue for hours," he says. "People would leave me. I'd wake up by myself. I was used plenty of times."
When he woke up, Matt would get back on Grindr to find his next high.
"That's how I did everything," Matt says.
He rarely used condoms and didn't know if his partners were taking PrEP, a pre-exposure drug that lowers the chances of HIV transmission. Matt certainly wasn't. He thought he had the virus. He specified on Grindr that he'd only hook up with HIV-positive men for that reason. But he hadn't been tested. He just assumed.
Matt got lucky – he escaped with just a curable case of syphilis.
"I have absolutely no idea how," he says.
Not everyone in the MSM community is as fortunate. A 2016 study published in the Journal of Acquired Immune Deficiency Syndromes that followed the same group of MSM individuals over several years found that individuals who start using meth tend to engage in riskier sexual behavior than they had previously, providing "the strongest evidence that initiation of methamphetamine use increases sexual risk behavior among HIV-uninfected MSM."
"Part of the reason why I am HIV-positive is because of drugs," says Graper, who sits on the Central Florida HIV Planning Council. "If you're using drugs, that's risky. Let's be honest. It doesn't matter which drug it is. And then you add on to that a layer of multiple sex partners ...."
Graper describes it as a "wheelhouse of risky behavior." The combination of using drugs with multiple sex partners is infrequent at first – once a year becomes every six months, which then narrows down to every three months, every month, every week, every day. At first you're regularly using condoms, then you're not.
"Then all of a sudden whatever goes is whatever goes," Graper says. "It is a perfect storm, if you will, of different circumstances. I think it's one of the reasons that allows our HIV rates to remain high."
In February 2016, CDC researchers estimated that if current HIV rates continue as is, roughly one in two MSM African Americans and one in four MSM Latinos in the U.S. will be infected with the virus.
In 2015, Florida had the second-highest rate of new HIV diagnoses among adults and adolescents, with 27.9 new cases per 100,000 people, nearly double the national rate, according to the CDC. The Orlando metro area ranked sixth among U.S. cities for the highest rate of new HIV diagnoses.
In Central Florida that year, new diagnoses peaked at 25.7 cases per 100,000 people – adding 614 new diagnoses to the state total of 4,849 cases.
According to data from the Florida Department of Health, Orange County had the state's third-highest rate of MSM-specific HIV transmissions in 2017, with 345 out of more than 3,000 measured statewide, behind Broward (444) and Miami-Dade (798.)
Matt says the Health Department is aware of the risk, too. He says he's been asked by health managers how best to approach the situation, and if they can drop by and test people for HIV during sex parties. Officials are sometimes seen outside of local bathhouses and clubs, like Club Orlando and Parliament House.
"Our statement is that we have no knowledge of this," says a Parliament House manager when asked for comment on possible drug abuse at the club.
Club Orlando and Southern Nights did not respond to requests for comment.
Meth users describe the high as akin to Adderall, the prescription amphetamine used to treat attention deficit disorders, except it's stronger and looks like tiny shards of broken glass. You can crush it and snort it and feel a sudden burst of pain. You can smoke it in a glass pipe – it smells like vinegar and ammonia. Or you can shoot up, like Matt did.
Use enough and you're almost guaranteed to get hooked – you'll compulsively look at your phone, you'll compulsively clean your house, you'll compulsively seek out casual sex. You'll fixate. You'll crave. You'll lose your mind.
"Gay men fixate on sex," Matt says. "The whole entire time there's a preoccupation with sex until you get that. Some people take apart dishwashers and put them back together. I've met people who take apart a TV when they're in a hotel and put it back together – they'll do that for hours. So I guess it's wherever your mind is."
Sometimes Matt's mind would be stuck on his appearances. Because meth use can lead to extensive tooth decay, he would brush his teeth 20 times a day. He'd also wash his face at an almost fanatical level, to keep it from getting oily when he'd sweat and not shower. He'd wear charcoal masks, as if he were at a day spa and not a seedy motel.
In part, Matt says, it's this sense of vanity that led him to using in the first place.
"[Meth] gives people who feel insecure confidence, especially people who grew up not feeling a part of the gay community, including myself," Matt says. "So all of a sudden you have this drug and now you're part of the gay community, but you're a part of this part of the community. Because in your mind, when you think of the gay community you think of sex, parties – that's what comes to mind. If you're an average guy and you don't categorize yourself as really, really fit or just really skinny or a bear, then you're kind of just like – I don't know – in limbo. You have all these ideas off what you think it's supposed to be like to be a gay man. You just can't be yourself."
Meth helped Matt feel strong and confident, like he thought the other men in the room felt when he'd walk into a club. It helped him feel uninhibited during sex. It helped him feel not like Matt.
But his life was unmanageable, unraveling – from the nights he spent getting high with a random man who induced himself into psychosis and started throwing things at Matt to the cyst he developed on his arm after missing his vein with a needle.
He won't talk about the exact moment that convinced him to try to get clean.
"It was just something that scared me," he says. "It's something I don't want to talk about. It just scared me because I knew that if I continued with what I was doing, knowing the way my mind was going, I believed that I could do something ..."
His voice trails off.
For meth, there is no generally accepted detox or treatments. That's why most insurance carriers require meth addiction to be treated at the outpatient level, says Orlando Recovery Center executive director Katie Reeley.
"That is something that's contested in the industry," Reeley says. "There's no generally accepted medical-assisted treatment to use for them. So if someone comes in on methamphetamine primarily, usually we're not going to accept them as a patient because we know that there isn't a medically assisted treatment. It's like going to a hospital and not having something that they're actually going to be able to treat you with."
In late 2017, Matt began attending Narcotics Anonymous meetings and working the 12 steps. It was hit and miss. He relapsed a couple of times but found his way back, most recently a couple of months ago. He rejoined dating apps but edited his preferences to weed out drug dealers. It worked until it didn't.
"Hey," he texted last week. "I've relapsed and am still active."