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Experts See Dangerous Trend in Use of Viagra With 'Party Pills'
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By Kim Curtis and Margie Mason
Associated Press Writers
Sunday, June 23, 2002; 12:15 PM
SAN FRANCISCO �� Dr. Jeffrey Klausner realized he had to do something when
he walked through one of the city's sex clubs and heard pill wrappers crunching
beneath his feet.
"I picked one up, and it was a Viagra sample," said Klausner, who heads the city
health department's sexually transmitted disease unit. "I thought, 'What's happening
if people are using Viagra in sex clubs?'"
His research soon showed that nearly a third of gay men surveyed at sexually
transmitted disease clinics said they were using the anti-impotence drug Viagra,
often in combination with illegal drugs that tend to encourage risky behavior.
Health experts say Viagra alone seems to pose no real danger to men who use it
recreationally even though they don't need it to get erections.
But Klausner found that people who use it to offset the impotence effect of "party
drugs" such as Ecstasy and crystal methamphetamine also acknowledged having
unprotected sex with more partners � which can breed disease. And Viagra can be
deadly if used with amyl nitrite, commonly called "poppers," which some gay men
take to facilitate sex.
Klausner's study, published June 10 in the London-based journal AIDS, focused on
a particularly high-risk group of men in San Francisco. But public health experts say
other cities have similar subcultures where both gay and straight men combine
Viagra with other drugs.
"It's not just something going on at an STD clinic in San Francisco � this is actually
pretty common," said Patricia Case, who directs the Program on Urban Health at
Harvard University and is studying "club drug" users in Boston and New York City
for the National Institute on Drug Abuse.
At the Centers for Disease Control and Prevention, AIDS experts were already
concerned about rising rates of STDs among gays and other young people who
have become complacent about condom use because effective AIDS drugs allow
infected people to appear healthy and live longer.
Now, Viagra needs to be studied more closely as another possible factor in sexually
reckless behavior, said Dr. Ronald Valdiserri, the CDC's deputy chief of sexually
transmitted diseases.
"I see the Viagra story as sort of a subplot in all of this," he said. "We take all of
this
very seriously."
Sipping a drink with friends at a popular gay bar at the edge of San Francisco's
Castro District, Lim, a 22-year-old gay man, said Viagra is simply another part of the
drug scene at the city's five regulated sex clubs, and at nightclubs and raves.
Lim, who gave only his last name, says he began mixing Viagra with crystal meth or
Ecstasy about two years ago. It takes about 30 minutes to kick in, he says, and can
keep sex going strong for hours.
Lim says he's never had to buy party pills, because if you're "young and cute, it's
just there."
Viagra is supposed to be available only by prescription, after a doctor's consultation,
at a cost of $8 to $10 a pill. However, Internet companies sell the drug to anyone
who completes an online survey. Viagra then gets traded among friends or resold
for $20 to $30 a pill.
Pfizer Inc., which introduced Viagra in 1998 and now makes about $1.2 billion a
year on the drug, says it's not responsible for drugs obtained without a prescription,
or Viagra knockoffs made by someone else.
"We were opposed to the recreational use of Viagra from day one," said company
spokesman Geoff Cook.
Pfizer has marketed Viagra mostly to men 40 and older who suffer from erectile
dysfunction, but the little blue diamonds quickly became known for boosting the
sexual stamina of younger, healthy men.
"Those of us really close to the street see what's going on," said Alan Brown, who
runs the Electric Dreams Foundation, which promotes health at gay nightclubs
nationwide. In the complicated mix of legal and illegal drugs partyers use, Viagra is
considered a natural companion to drugs that remove inhibitions, Brown said.
The drug is also showing up among heterosexuals.
"I thought, 'Hey, what a good idea,'" said a 33-year-old heterosexual man from San
Francisco, recalling the time he first combined Viagra with Ecstasy.
"If I had not been on Ecstasy at the time I would have never thought of it," he said,
speaking on condition of anonymity.
He now uses Viagra regularly, and has combined it with Ecstasy twice in the past
two years, although he considers it an "unsafe decision."
The most worrisome combination, experts say, is Viagra with amyl nitrite. Called
"poppers" because the liquid drug was first available in a capsule that was cracked
or popped open to release vapors, amyl nitrite can cause a deadly drop in blood
pressure.
Dr. Eric Christoff, a Chicago physician who has served as a medical volunteer at
gay dance parties, says he warns his patients not to take Viagra with amyl nitrite,
and he documents the warning in their medical records.
"I will say, 'You cannot combine this with poppers. Don't do it. Don't even be in the
same room with it.'"
So far, there has been little research on what happens when Viagra is taken with
illegal drugs. "There have been fatalities � they just haven't been published," said
Case, who is conducting the study of club drug users.
Dr. Edward Boyer, a Boston area toxicologist, believes it was Viagra and poppers
that killed an otherwise healthy 48-year-old man he saw in an emergency room 1�
years ago. The man had suffered a heart attack while at a place where gay men
meet for sex.
Klausner is concerned about such fatalities, but he says a wider problem is the
possible link between Viagra use and an alarming increase in STDs. His survey
found that uninfected Viagra users were twice as likely to have unprotected sex with
someone who is or might be infected with the AIDS virus, compared to those not
taking Viagra.
In San Francisco, syphilis cases jumped to 183 in the first four months of this year,
up from just 41 by April 1998. Rectal gonorrhea is up nearly 50 percent, and the city
expects 750 to 900 new HIV infections this year, up from about 500 five years ago.
Klausner didn't conclude that Viagra leads to these diseases, but said his study did
show a significant correlation.
"It enables them to have more sexual partners and sex for a longer periods of time,"
he said. "Both of those are major factors for getting STDs."
His survey of men at STD clinics showed Viagra users reporting more sexual
partners than non-Viagra users.
The government has cracked down recently on abuse of Viagra and other
prescription drugs. Internet pharmacies in California, Texas, Florida, Louisiana,
Alabama and other states have been targeted, including a Los Angeles operation
that allegedly filled more than 3,500 prescriptions for Viagra and other drugs without
a "good-faith medical examination."
Klausner and other public health officials also want stronger warning labels,
including urging Viagra users to wear condoms.
Pfizer says Viagra labels and advertisements clearly indicate that the drug doesn't
protect against STDs. Cook, the Pfizer spokesman, said the drug maker also
supports the crackdown on Internet sales and knockoff pills.
The Food and Drug Administration is reviewing Klausner's complaints about Pfizer's
labels, said FDA spokeswoman Susan Cruzan.
But Viagra, which enables erections for up to 12 hours after taking it, may be just
the beginning. Eli Lilly and Co. is developing another anti-impotence drug, Cialis,
which promises to last 24 to 36 hours.
� 2002 The Associated Press
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