A field of dreams was built and the people came. The precursor to the First National Conference on Methamphetamine, HIV, and Hepatitis was the perplexing problem of a drug that has been harrying the hinterland for the past decade or longer. Our initial goal was to draw maybe 300 people, but that was a gross underestimation of how this event was desperately needed. When we announced the conference, everyone wanted in, including the Federal government: Health and Human Services (HHS), the Centers for Disease Control (CDC), the Drug Enforcement Administration (DEA) and National Institute on Drug Abuse (NIDA). Utah Senator Orrin Hatch supplied a letter of support for the event that was instrumental in drawing in local health departments, many of which sent attendees and speakers and also lent their imprimatur to the conference. Then Rep. Mark Souder (R.-Ind.) sounded his warning that attending this hotbed of harm reduction would be stabbing the president in the back. As it turned out, when the rooster crowed a bunch of these folks turned and fled, but at the same time there was a surprisingly positive response from some health departments and even from HHS, which allowed attendees from the CDC to show up and present. The attacks from Congress and the Senate on HHS and the conference, as distressing and ignorant as they were, did help to draw attention to the event and put the issue firmly in the media: They're meeting about meth in Salt Lake City.

Our intent was never to produce a harm-reduction-oriented methamphetamine conference. Putting together a methamphetamine plenary for the last National Harm Reduction Conference in 2005 showed how difficult it was to draw a diverse group of people together who could present viable solutions to meth use. Certainly there has been a lot of good and useful prevention work done by and for gay men, but in the rest of the country law enforcement has been the answer. This conference was intended to be an introduction to the four-pillar approach of prevention, treatment, harm reduction, and law enforcement for those who had not seen it before. In looking at the spectrum of response to methamphetamine use, it was hoped that the different players could learn from each other, drawing upon what was effective or promising and applying it to their work.

The beauty of the conference was that it allowed the confluence of so many different tributaries of dealing with methamphetamine use. For some people this was their first drug-oriented meeting and for others it was the first time they had heard drugs discussed as a serious health issue. It brought together people from the urban, gay coastal regions, the Midwest, and the rural communities in between, as workers from large cities and small towns compared their issues. Treatment providers were listening to law enforcement and policy makers. Members of Crystal Meth Anonymous were arguing with harm reductionists from Australia over messages about personal responsibility. Over 150 Native Americans attended the conference making it one of the largest meetings outside of a Native gathering. Many members of the Church of the Latter Day Saints were in attendance and in many ways effectively represented Middle America. This was probably their first exposure to barebacking, tops, bottoms, and commercial sex venues. But maybe that is underestimating Utah's conservative roots. The exhibit hall brought together the Drug Policy Alliance, Hazelden, and Utah's Division of Substance Abuse Services.

In Washington, the day before the conference opened, U.S. attorney general Alberto Gonzales called for innovation in addressing the problems surrounding methamphetamine. In part his comments were a response to the existence of the Salt Lake City event, and the timing of the announcement of HHS's methamphetamine initiative appeared to have been rushed in response to Congressman Souder's attacks. Unfortunately, it only served to reveal that HHS has nothing new to say and that the drug enforcement empire has no new ideas.

Harm reductionists have demonstrated that we can stimulate new dialogues amongst diverse groups with differing perspectives, agendas, and mandates. Even as the federal government boasts about its "comprehensive, balanced approach to the methamphetamine challenge," the people who gathered in Salt Lake City are the ones who are practicing it. The absence of federal leadership and vision obliges us to forge ahead with a reality-based agenda, beginning with the recognition that crystal meth and meth users per se are not the problem and can't be prosecuted and stigmatized out of existence. We need honest, effective, and innovative tools for addressing the medical, psychological, and social threats of addiction and problematic patterns of meth use. And community by community, we'll keep developing and sharing these tools -- no matter how much the ideologues try to silence, defund, and discredit us.

In the end, over 900 people attended the Salt Lake City conference. Now the challenge is how to synthesize what occurred and how to keep all of the players engaged and productive until we meet again in 2006.

Allan Clear is the Executive Director of the Harm Reduction Coalition. Luciano Colonna is the Executive Director of the Harm Reduction Project. Their organizations co-sponsored the First National Conference on Methamphetamine, HIV, and Hepatitis.