The meth problem starting to show once again

While to many it is considered a seminal piece of television artistry, in reality Breaking Bad was just a TV series, a mere work of fiction highlighting meek high school science teacher Walter White and his transformation into a ruthless methamphetamine producer and dealer. Now, in another example of life imitating fiction, substance abusers are increasingly turning to methamphetamines as another drug in their arsenal, as the nation's attention has been focused on the skyrocketing opioid crisis, and more recently, the coronavirus pandemic and racial turmoil and unrest. Methamphetamines, or meth as it is commonly referred to, is a powerful, highly addictive stimulant that affects the central nervous system. It is associated with a wide range of harmful and dangerous consequences, including psychosis and other mental disorders, cardiovascular and renal dysfunction, infectious disease transmission and overdose. After being a popular drug among some users in the 1980s, 1990s and early 2000s, it generally faded from mass view until the last few years, when people who use and treat substance abusers and law enforcement have begun to see it rising up on their radar once again. Dr. Christopher Jones, lead researcher, associate director of the Office of Strategy and Innovation at Centers for Disease Control and Prevention (CDC) Injury Center, said their latest data for methamphetamine is for 2018, as research data from the National Survey of Drug Use and Health is released in September, and it showed a “statistically significant increase in usage, with 1.9 million people reported methamphetamine use compared to 2016, when 1.4 million reported past year use.” Jones said the epidemiological data is a “general source, asking those age 12 and up.” Statistics are from those who self-report usage. However, he does feel the data total is flawed and actually underreported because “it does not capture people who are institutionalized – whether incarcerated, homeless or in treatment. I think it largely underrepresented the numbers because those populations are likely to use methamphetamine.” Locally, Michigan, and Oakland County, have not been immune from methamphetamine's intangible tentacles. Oakland County Sheriff Michael Bouchard said, “We are seeing meth spiking, coming into the state – sometimes from out West, some from the South.” Year-over-year, Bouchard said so far in 2020, there has been a 134 percent increase in methamphetamine from 2019, as of June 2; in 2019 numbers from 2018, there was a 90 percent increase. “And with Covid, there are less traffic stops going on,” he said, noting there potentially could be much more in the county than has been caught in the last three months. “I've instructed my officers to do less stops for minor issues for their safety. Traffic stops result in a lot of criminality, so arrests are down, and a lot of dealers are moving product because the risks are down. “There are a lot of residual effects of Covid.” Bouchard said they have seen another stimulant, cocaine, increase, as well, with a 65 percent increase in cases from 2019, although crack is down 72 percent. “We had been making tremendous inroads on prescription pills. Last year, we were down 943 percent from 2018 to 2019. We really made a dent,” Bouchard said. “Just in the first few months of 2020, we're up 236 percent – especially Xanax, which is up 4,400 percent.” Perhaps another residual effect of Covid. Birmingham Chief of Police Mark Clemence said, “There is a statewide rise in presence of meth. Fortunately, we have seen very little here in the city, and no meth arrests have been made. Officers have not seen meth on the street, but specialized units have seen the uptick in use/users of meth.” Bloomfield Township and Bloomfield Hills police departments reported they have not made any meth arrests, either. Bloomfield Township Lieutenant Paul Schwab said the township has an officer assigned to the county Narcotics Enforcement Team (NET), which is run by Bouchard's office. Nearby Wayne County has not seen the same increase in methamphetamine use for a demographic reason – statistically, African Americans do not use methamphetamines to the same extent. “In Wayne County, methamphetamine is not big, but cocaine is,” of the stimulant preference, said Cynthia L. Arfken PhD., a professor in the department of psychiatry and behavioral neurosciences at Wayne State University who sits on the board of the Detroit Wayne Integrated Health Network. She said the areas in Wayne County where methamphetamine usage is seen is primarily among men who use it during sex with men – “it's part of the sex party culture that we've heard of,” she said, and by truck drivers, likely in order to stay awake over long hauls. She also said they are seeing people who are mixing use of heroin and meth. “We hear people using stimulants to stay awake after they take opioids. It underscores that the market is constantly changing and people are constantly using new drugs. Some people are willing to take anything to not feel what they're feeling, or just to feel different.” Jones, of the CDC, said they are also seeing heroin usage among people using methamphetamine increasing. “It seems it is very much intertwined with the opioid crisis – and not separate from the opioid crisis,” he said. “More people are coming in who are reporting using heroin and using meth. We're starting to see this emerging picture, with this amphetamine crisis, with this usage treatment crisis, and with the mortality data.” Jones said the CDC data points to a significant increase in overdose deaths where psychostimulants have been involved, from 1,632 deaths in 2009 to 12,676 deaths in 2018. “About 50 percent of those deaths (in 2018) also involved opioids, and a significant amount of those involve synthetic fentanyl,” Jones said. “It underscores the ongoing opioid crisis in combinations with the stimulant crisis. Rather than replacing it, it is clearly a combination. “We originally thought some of those deaths were from (drug) contaminations or from mixing of drugs, like fentanyl,” he further elaborated. “But the data shows an intentional mixing of substances. The majority of people say they like the high – or the synergy – because they produce an effect different than they can get from one or the other. Some use methamphetamine so they don't fall asleep from opioids. Some co-use, but some are clearly moving towards stimulants because they're scared of carfentanil, and they're scared of overdosing. There is also a clear availability between supply and demand. There is very pure, very available methamphetamine at very, very low prices. “It's clear there is not a single factor driving these trends,” Jones noted. “The thing with methamphetamine and cocaine, it's not as deadly, so it's harder to treat,” Arfken said. Statewide, in 2019, there were 3,150 methamphetamine-related incidents, according to detective sargeant Scott Josephs of Michigan State Police (MSP), which he said is a 21 percent increase from 2018. Josephs, who heads the MSP meth unit, said what has decreased significantly are homegrown meth labs, primarily due to the influx of Mexican cartels, which are now producing and trafficking a pure and very low-cost meth product, dominating the market. “According to the DEA (Drug Enforcement Agency), meth overtook marijuana as the most widely available drug – and it's not the crappy backyard meth of the '90s,” Jones said. “Mexico and the cartels have produced a very high quality stimulant for people who are looking for one.” While a report by the International Crisis Group stated that Myanmar is the world's largest producer of crystal methamphetamine, with Vietnam a second, for those on this side of the world, Mexico and Mexican cartels dominate the market for crystal methamphetamine. Product from Asia does not make it to this hemisphere due to transportation and other costs. Besides increasing the demand for methamphetamine in the U.S., the Mexican cartels have also driven most home cooks out of business. “The drug markets are like any other international markets – they're affected by price and affordability,” said Keith Humphreys, psychiatry professor, Esther Ting Memorial Professor, Stanford Health Policy associate, Stanford School of Medicine. “Drugs are like other commodities. When costs go down, you use them more. Mexico has perfected it – they make a meth that is much purer, of higher quality at much lower prices. They essentially have undercut, in quality and price, and they beat out the guys cooking it in their sink.” The Michigan State Police report stated, “The continued demand for methamphetamine in Michigan created a market for crystal methamphetamine. Manufactured in Mexico and trafficked into Michigan, crystal methamphetamine has become readily available and inexpensive. Crystal methamphetamine provides users with the same methamphetamine high without the risks associated with purchasing components and manufacturing methamphetamine in a clandestine laboratory.” Josephs of Michigan State Police concurs with that assessment. In 2018, there were 245 meth labs incidents in the state, primarily in the northern lower peninsula and upper peninsula. In 2019, there were only 45 incidents, “a significant drop,” he noted. So far for the first quarter of 2020, there were 28 lab incidents. Arrests and charges for manufacturing and producing dropped 56 percent from 2017 to 2018, and another 55 percent from 2018 to 2019. “It's a combination,” Josephs said of the drop in meth labs in the state. “I think the influx from Mexico convinced a lot of people not to risk making it in the labs as well as the ability of our law enforcement efforts because of our recognition of the dangers to people in the area, and the environmental hazards. “It provides the same high (of the Mexican drug),” he said. “It's the same drug, in a different form. It's been trafficked into Michigan in such great numbers, and the cost has been so low, it's become easy for it to be readily available. It's being trafficked more into Michigan now than being produced here in Michigan.” Methamphetamine cooked in home labs is typically produced into a powder form; from Mexico, it comes in crystals, or rock form. Additionally, home cooks run risks of labs blowing up, of trying to purchase the main ingredient, pseudoephedrine, which since 2012, Michigan pharmacies and drug retailers are required to track the sale of any medication it is included in. Michigan State Police reported “the purchase of medicine containing pseudoephedrine from a participating retailer requires gathering of identifying information at the point of sale and that information is submitted to the National Precursor Log Exchange (NPLEx),” which Josephs said is a real-time logging system providing law enforcement with the information to track individuals. “People who cook know we have it and it deters them,” he said. There also is tremendous environmental damage left behind from home labs due to the ingredients used. With directions provided by the Drug Enforcement Agency, when found, Michigan State Police are the only authorized agency to clean and contain lab sites. “The DEA provides us with safe storage containers. We train law enforcement officers to be careful and to be hazardous waste responders,” Josephs said. Michigan State Police reported Mexican cartels have discovered innovative methods to smuggle methamphetamine into the country. They stated the most common is it is hidden in a solution that is then dissolved into a solvent for ease of concealment to cross the border. “The most common solvents used for dissolving methamphetamine are acetone, water or methanol,” their report said. “Once dissolved, a common method of concealment is in fuel tanks of commercial vehicles. The commercial tanks have a large gallon capacity and diesel fuel is lighter than the methamphetamine in solution, meaning the solution will separate and rest below the diesel,” the Michigan State Police report stated. “Other concealment methods include laundry detergent containers, beverage bottles and in large drums. Once inside the United States, the methamphetamine is converted into crystal methamphetamine at locations known as conversion labs. The most common method involves adding acetone to the solution and adding heat until the solution boils. Crystals form as the solvent evaporates… To date, there have been no known conversion labs found in Michigan. Most of the conversion labs seized in the United States have been in California, Arizona and Georgia.” “It's really super pure. When a drug is more potent, you get a stronger high and you get it faster, from the moment of ingestion,” Humphreys explained. “You quickly get rewarded. Then we're more inclined to do it again. It's more addictive. Even though the long-term costs are horrific.” The Michigan State Police report noted that “potency … of the methamphetamine seized at the souther border of the United States being 90 percent-plus pure. Due to a high demand, Mexican Drug Trafficking Organizations continue to expand to virtually every region of the United States.” According to the Foundation of a Drug-Free World, amphetamine was first developed in Germany in 1887, and methamphetamine, an offshoot which was more potent and easier to make, was first made in Japan in 1919. It was a crystalline power which was soluble in water, making it a perfect candidate for injection. It then went into wide use during World War II, when both sides utilized it to keep their troops awake. “High doses were given to Japanese Kamikaze pilots before their suicide missions. And after the war, methamphetamine abuse by injection reached epidemic proportions when supplies stored for military use became available to the Japanese public,” stated Foundation of a Drug-Free World. However, German military command found that by 1941 methamphetamine pills, manufactured in Berlin under the name Pervitin, produced very harmful side effects, and its usage was best controlled by doctors' prescriptions, which the military tightly controlled. "A soldier going to battle on Pervitin usually found himself unable to perform effectively for the next day or two,” said historian Lukasz Kamienski. “Suffering from a drug hangover and looking more like a zombie than a great warrior, he had to recover from the side effects." Kamienski said some soldiers turned very violent, committing war crimes against civilians; it was reported that some others attacked their own officers. By the 1950s, methamphetamines, as a stimulant, had found a whole new use – they were being prescribed by doctors as a diet aid and and as an antidepressant. They became widely available, and were used as a medical stimulant by college students, truck drivers and athletes. Abuse began to become widespread in the 1960s as injectable versions became available, and in the early 1970s, the United States government classified methamphetamine as a Schedule II controlled substance under the Controlled Substance Act, meaning it has some medical uses with “severe restrictions,” and “abusing the drug can cause severe physical and mental addiction,” according to the act. “Under the Public Health Code (1978 PA 386, Part 72) methamphetamine is a Schedule II substance, which means the drug has a high potential for abuse, minimal medical use, and can lead to serious psychological and physical dependence. Methamphetamine is a synthetically produced central nervous system stimulant that produced long-lasting effects including heightened senses of alertness and euphoria as well as increases in heart rate, blood pressure, respiration and body temperature. Side effects from prolonged abuse can include agitation, tremors, hypertension, memory loss, hallucinations, psychotic episodes, paranoid delusions and violent behavior,” according to the Michigan State Police Methamphetamine Reporting Act. “Methamphetamines are highly addictive. It changes the way your brain works, and the chemicals in your brain,” said Stacey Henson, LCSW, ACSW, The Recovery Village. “It changes dopamine, specifically. It's the drug most known for criminal activity.” “Methamphetamine increases the amount of natural chemical dopamine in the brain. Dopamine is involved in body movement, motivation, and reinforcement of rewarding behaviors. The drug's ability to rapidly release high levels of dopamine in reward areas of the brain strongly reinforces drug-taking behavior, making the user want to repeat the experience,” explained Dr. Nora Volkow, director of the National Institute of Drug Abuse (NIDA). Taking even a small amount of methamphetamine can result in many of the same health effects as other stimulants, she said, such as cocaine and amphetamines, including increased wakefulness and physical activity; decreased appetite; faster breathing; rapid and/or an irregular heartbeat; and increased blood pressure and body temperature. “Because the 'high' from the drug both starts and fades quickly, people often take repeated doses in a 'binge and crash' pattern,” Volkow said. “In some cases, people take methamphetamine in a form known as a 'run,' giving up food and sleep while continuing to take the drug every few hours for up to several days.” Long term methamphetamine use has many extremely dangerous and negative consequences, Volkow said, including extreme weight loss; addiction; severe dental problems, which are often called “meth mouth;” intense itching, which can lead to sores around the body from scratching; anxiety; changes in brain structure and function; confusion; memory loss; sleep problems; violent behavior; paranoia; and hallucinations. “Of persons who used methamphetamine, an estimated 57.7 percent reported some mental illness, and 25 percent reported serious mental illness during the past year,” Jones of the CDC wrote in “Patterns and Characteristics of Methamphetamine Use Among Adults, United States, 2015-2018.” “In addition, continued methamphetamine use causes changes in the brain's dopamine system that are associated with reduced coordination and impaired verbal learning,” Volkow said. “In studies of people who used methamphetamine over the long term, severe changes also affected areas of the brain involved with emotion and memory. This may explain many of the emotional and cognitive problems seen in those who use methamphetamine.” She said that although some of the brain changes may reverse after being off the substance for a year or more, other physical and mental changes may not recover even after a very long period of time. On the street, methamphetamine has numerous slang names, and is also commonly known as meth, crank, chalk, ice, blue, crystal, glass, go fast and speed, both for its effects and because it looks like glass fragments or shiny bluish white rocks. Users smoke, swallow, snort and/or inject it. Increasingly, law enforcement and treatment officials are finding users are mixing it with opioids, such as heroin or fentanyl, and injecting it. According to Henson, “the combination of methamphetamine and fentanyl is 50 to 100 times more potent than morphine. A standard dose of Narcan is not going to work by itself on fentanyl, and it's specifically designed for opioids, so it's not going to work on meth.” “Meth users have typically have tried all the other drugs. Typically, people who use drugs, use many drugs. Some like the effect of multiple drugs. People who use meth have a high degree of using other drugs, as well as a high degree of mental illness,” said Jones of CDC. “Meth is cocaine-plus – and it lasts much longer. It has appeal for those who are experienced in substance use. It is a very potent stimulant, and it can be very toxic over time.” Demographically, Jones noted that “meth users tend to skew a little older.” On average, he said, males are more likely to report using methamphetamine than females, with the highest rates among 26 to 34 year olds; the next highest age range is 18 to 25 year olds; and next, 35 to 44 year olds. However, among those in drug rehabilitation, there are more females than males in treatment for methamphetamine, a statistic both Jones and Henson of The Recovery Village cited. Jones at the CDC said they had different theories as to why the rate of usage for males and females and those getting treatment for methamphetamines flip. “Women may progress from using methamphetamines to dependence to needing treatment,” while males do not as quickly, he said. “Or, pharmacological effects of methamphetamine may be different between the sexes.” It is something researchers are continuing to study. Racially, the highest use is among Native Americans Indians, 43 percent, followed by Hispanics, 30.6 percent, and white/Caucasians, 26.2 percent. Non-Hispanic blacks had the lowest percentage, at 6.5 percent. “From a stimulant point-of-view, African Americans tend to use cocaine,” Jones reported. “Hispanics use both. Native American Indians have a substantially higher use rate than whites.” Rural areas have much higher statistics of use compared to urban areas. “It's similar to the conventional wisdom, but it's interesting to see the data play out,” Jones said. Henson of The Recovery Village said their data points to a higher prevalence of use in Western and Midwestern states in the U.S., with the national average six percent for methamphetamine use. In Michigan, seven percent of respondents said methamphetamines are their substance of choice. Henson said there is a wide range across the country, from just four percent in California, to 22 percent in Alabama. Border state of Ohio is at six percent, while Wisconsin reported use at nine percent. Florida had a usage rate of five percent, while Kansas had 20 percent. Jones said that traditionally, methamphetamine has been smoked, “and smoking is still the most common, but increasingly users are injecting meth in combination with heroin among heroin users. We know people who inject a more severe usage level, and will have more difficulty with treatment, and greater mortality.” Simultaneously, he said, they are also seeing heroin usage increasing among people using methamphetamine. “Increasingly, we're seeing fentanyl in connection with methamphetamine. That's often where we get the overdoses,” said Henson. “In 2017, we saw 15 percent of overdoses from methamphetamine, and of those 50 percent were involved with opioids, and another 50 percent were involved with fentanyl.” Humphrey of Stanford Medical School said often street level dealers aren't aware that fentanyl is mixed in with methamphetamine. “They might not even know it's in it,” he said. “While a dead customer doesn’t buy more, the profit margin is so huge for fentanyl – it's one percent the price of heroin – dealers figure they can afford a few deaths. 'Our profit per sale is so huge we can stand it,'” he explained as to why larger dealers take the chance of lacing fentanyl, which is so toxic it can kill quickly, into other substances, such as methamphetamine. Henson said between 2014 and 2018, admissions to substance abuse facilities around the country just for methamphetamines went up 39 percent. “Between 2012 and 2018, methamphetamine deaths increased 430 percent,” she said. For those individuals who do seek out drug treatment for methamphetamine, it's not as straightforward, or as relatively manageable, as detox or treatment for opioids. So far, the Food and Drug Administration (FDA) has not approved any medicine or drug for detoxification. “There is detox, but it doesn't meet the criteria for hospitalization. It can be done at an in-patient residential facility,” said Henson, of The Recovery Village, with facilities across the country. She said there is no specific timeline for detox, or for recovery. “If there are any physical withdrawal symptoms, they would be managed medically. Then we would look at usage levels, as well as usually there is a mental health reason underlying the usage,” Henson explained. To treat the substance user, she said they first employ cognitive behavioral therapy (CBT). “It deals with the way we think and how we act derives our actions,” she said. Then they utilize dialectical behavior therapy (DBT), which she said is the core treatment. It is a treatment designed for high risk behaviors, such as self-harm and suicidal ideation. “It's looking at how personality characteristics drive our interactions with other people and their struggles,” Henson said. Twelve-step programming is another structure that is supportive, she noted, as an individual gets back into their own community. “Treatment is based on the amount of use and the person's own physical health and level of recovery,” she said. ` “Six months after leaving rehab, about half of users have relapsed,” Humphrey indicated. “But that doesn't mean you shouldn't try to help. It's much harder to treat meth and cocaine because there is no medication to treat it, while there are several medications that are successful for opioids.” “You've put in really toxic chemicals into your body,” Henson noted. “It can have a lot of long-term effects, from mood disruptions, insomnia, paranoia, psychosis, hallucinations, dental problems – which is a huge issue, because meth just eats away at the enamel of teeth. It can leave individuals with permanent brain chemistry damage.” Jones from the CDC noted that some people choose methamphetamines because they suffer from depression, and stimulants may improve their mood. “But chronic methamphetamine use causes deterioration of mental status,” Jones said. “It causes depression and other mental illness, and it exacerbates mental illness.” For those who continue to use, are not successful with substance abuse treatment, or have used for a long time, long-term use mortality is different than from opioids, Jones explained. “People using heroin or fentanyl die because their brain tells them to stop breathing. It's called respiratory depression,” he said. “Methamphetamines cause overstimulation, so users suffer cardiac arrhythmia, stroke. They cause a pretty significant toll on the body, significantly on the arteries. People will often have chronic kidney problems, heart problems, mental health problems, psychosis. “It is a very potent stimulant and it can be very toxic over time.”