Crystal meth, a highly potent, dangerously addictive drug that swept the West Coast and spawned crime waves in the nation's heartland, is slowly establishing a foothold in New England, prompting campaigns by public health authorities and medical specialists to stop small outbreaks of use from raging into wildfires.
Doctors and social workers who specialize in treating gay men report seeing an increase in patients hooked on meth, fueling fears that a drug capable of lowering inhibitions will result in risky sexual behavior and a flood of HIV infections.
A survey of nearly 1,000 gay men conducted by Massachusetts health authorities in 2004 and obtained by the Globe indicated that one in 10 had tried crystal methamphetamine at least once in the preceding year and that 2 percent acknowledged smoking, snorting, or injecting the drug at least once a week.
The drug gained notoriety on the East Coast earlier this year, when New York doctors sounded a health alert after discovering that a man with dozens of sexual liaisons while high on meth had contracted an especially virulent strain of HIV.
Even before that case landed in the spotlight, local, state, and federal authorities had begun meeting with greater urgency to examine the potential link between meth and the spread of sexually transmitted illnesses.
In January, drug and disease specialists converged on the Atlanta headquarters of the Centers for Disease Control and Prevention to develop better methods for tracking and combating meth and the behaviors it causes.
In February, the CDC chief, Dr. Julie Gerberding, briefed President Bush's advisory council on AIDS regarding her concerns about a crisis in the making.
In March, representatives from local and state governments huddled in Washington to consider how public health agencies should respond. That same month, a CDC official visited a bathhouse in Providence to learn more about a campaign there to discourage use of the drug.
The growing use of meth in gay communities in New England, HIV specialists said, threatens the advances made in combating the AIDS epidemic. After enduring years of burying friends and viewing HIV as a death sentence, gay men now regard it as more of a chronic, treatable disease, with ads for powerful drug regimens portraying robust men celebrating newfound health.
''The intersection of this drug with HIV is obviously a major concern for controlling the epidemic," said Dr. Stephen Boswell, executive director of Fenway Community Health, a major Boston provider of AIDS treatment. ''I've had tons of patients telling me they've wound up doing things they never would have done if they weren't on the drug."
New England stands on a precipice, said Gordon Mansergh, senior behavioral scientist in the CDC's Division of HIV/AIDS Prevention. ''Your community," he said, ''is in a really good position to prevent something from happening with meth that you might not see happening really clearly now."
It is a drug wrecking the lives of men in their prime -- men like Jeff Epperly, who, starting at age 38, took one hit and then another and another, until he lost his partner, squandered his savings, and abandoned, as he put it, his moral compass.
Over four years, meth came to define his identity. ''By the end, I was high every single day," Epperly said. ''My entire life revolved around doing the drug, finding more of it."
His was a life in full descent when one day, out of cash, his downstairs dealer dead, Epperly took a vacuum cleaner to the carpet in the room of his Kendall Square apartment where he had most often smoked or snorted meth. He emptied the contents of the vacuum bag and tried to smoke them.
''At the time, it seemed perfectly logical there might be crystal in the carpet," Epperly recalled, his face turning weary at the memory. ''It's funny and it's horrifying."
Shortly after that episode, like a man waking from a deep slumber, Epperly freed himself from the manacles of meth, the rare example of an addict succeeding in shunning the drug without benefit of medical help or a support group.
He returned to his hometown, Omaha, in 2002 before finally returning to Boston, where he had been editor of Bay Windows, a newspaper reporting on the gay and lesbian community. ''I feel very lucky," Epperly said. ''I'm alive, and I have all my friends."
Crystal meth, like most narcotics, has ridden cycles of popularity. In the 1950s, amphetamine was renowned as the drug of choice among suburbanites desperate to shed pounds.
Meth induces a state of hyper- alertness. To understand the effect, said Dr. Stephen Traub, a toxicologist at Beth Israel Deaconess Medical Center, think of that first cup of morning coffee and the jolt it unleashes. Now, imagine that amplified many times over.
The drug works by increasing the availability of a chemical messenger in the brain called dopamine. And that substance is a prime mover in the cerebral pathways that engender pleasure and excitement.
Meth began making a resurgence in the late 1980s and early '90s on the West Coast. Carrie Blake recalls snorting the drug as a teenager in Southern California.
''When you're really taking a significant amount of meth, you can go without sleep for three, four days," said Blake, now coordinator of Rhode Island CARES, an advocacy organization for substance abusers. ''I'd be flying for days.
''But when you come off? It's really a major crash," she said.
From the West Coast, where the drug insinuated itself most prominently in gay communities, meth migrated to the Midwest. There, in Missouri, Iowa, Indiana, and other states, the drug took root in rural towns, disrupting the lives of heterosexuals and sometimes resulting in crime rampages.
By 2002, the telltale markings of meth's arrival had become evident in Boston and New York, where clinics began treating men whose losses were mounting: lost jobs, lost homes, and lost teeth, a consequence of taking a drug that is cut with toxic substances and that causes the mouth to turn dry, saliva replaced by tooth-rotting acids.
''So many of us know people whose lives have been destroyed by crystal meth, people whose lives have just crumbled in a short period of time," said Sophie Godley, prevention director at AIDS Action Committee of Massachusetts, New England's largest provider of HIV prevention and education services.
But quantifying the precise scope of the problem in New England is a tricky proposition, substance abuse and disease specialists acknowledge.
From February through December 2004, an acupuncture detox program at Fenway provided treatment to about 140 gay and bisexual men addicted to crystal meth.
And for the first three months of this year, state-run substance abuse programs recorded 268 admissions related to meth. If admissions continue at that pace for the remainder of the year, the number would substantially exceed the 680 admissions of 2004, although Michael Botticelli, director of substance abuse services for the state, cautioned against making assumptions about trends in use.
Kevin Cranston, chief of the state's HIV/AIDS Bureau, also warned that a slight increase in HIV cases among gay and bisexual men in 2003 and 2004 should not be interpreted as a trend, nor, he said, can it necessarily be linked to meth use.
''We have ample anecdotal data that crystal meth appears to be increasingly prevalent," Cranston said. ''But we need to be careful before we extrapolate from individual reports to a pattern of use and abuse in the community."
Representatives of the New England branch of the US Drug Enforcement Administration and the Boston Police Department said their narcotics agents have uncovered meth labs and seized the drug but in volumes lower than elsewhere in the country.
Nationally, concerns about meth and its potential for introducing a new generation of HIV infections led representatives from health departments, along with AIDS and substance abuse specialists, to gather last month in the Washington offices of the National Alliance of State and Territorial AIDS Directors. A Globe reporter was allowed to observe the private meeting.
Discussions focused on the course of meth use in different cities, the link between meth and risky sexual behavior, and prevention strategies that worked in one place but not another. For instance, a campaign built around the tagline ''Meth=Death" was a hit in Miami but a dud elsewhere.
The health officials also reviewed research associating meth with sexually transmitted diseases. One San Francisco study, for example, documented that gay meth users were twice as likely to be infected with HIV as men who had not used the drug. The same study discovered that the meth users were nearly five times more likely to have syphilis.
The CDC's Mansergh described the Washington conference and the Atlanta meeting two months earlier as evidence that meth and its role in HIV infections had become an issue of national importance. ''Certainly, there's been regional attention for many years on the West Coast," Mansergh said. ''Now, there's a critical mass that calls for national attention."
Which is why representatives of AIDS Action, clad in red T-shirts, found themselves one Friday night inside a pulsating gay nightspot called Machine. They were there to distribute condoms and to answer questions about meth or other drugs.
Machine's manager, Mike Fabiano, said his club aggressively discourages drug use and thus welcomes the AIDS Action squad. The motivation, he acknowledged, is equal parts altruism and self- interest: Crystal meth can lead to isolation, to men staying cloistered in their homes.
The past few years have been tough for gay clubs across the nation, and some club owners say meth is partly to blame.
''There used to be people who would come to the clubs, and then you wouldn't see them for months," Fabiano said. ''The next time you see them, they're emaciated figures."
Bob Braunewell saw himself eroding into one of those figures. He had his first meth six years ago, dabbling briefly. It was only after a relationship soured, three years later, that he and meth became reacquainted.
His use, he said, escalated but never stretched beyond weekend binges. For Braunewell, 38, the drug proved acutely isolating: He would smoke it alone while holed up in his Boston apartment.
It was one weekend morning less than two months ago when Braunewell, who works with social service agencies and sings and writes music, hit a physical and emotional trip line. Something, somewhere deep inside, told him to seek help. Now.
He drove himself to Faulkner Hospital's emergency room. He is recovering now, writing music to explain the pain. His eyes glisten with an intensity suggesting that, all at once, he is looking behind and looking ahead.
Late on a sunny afternoon, crouching at a baby grand piano at Boston University, Braunewell practices a song he penned during his recovery. He calls the song ''How Much."
Tell me tell me how/How much is enough?/Do you have to see the inside of heaven/To know you're done?
Stephen Smith can be reached at firstname.lastname@example.org.