Pubdate: Sat, 05 Mar 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Andrea Woo
Page: S1

THE QUIET RISE OF CRYSTAL METH

Fentanyl and Oxycodone May Be Getting the Headlines, but the Use of 
Cheap and Available Speed Is Soaring

Dean Foggin sits on the edge of his single bed, winter sunlight 
streaming through the window onto the white walls, his white robe, 
white slippers. It is his fifth time checking into this detox 
facility and, God willing, his last.

"I hope this time it sticks, or I don't know what's going to happen," 
says Mr. Foggin, 53. His shoulders are slight and he speaks at an 
accelerated pace. "I'm pretty much ready to give up. If I can't make 
it this time, I'm just not going to try any more."

It has been 13 years since he first took crystal methamphetamine, 
introduced to it, he says, by a friend who was a heavy user. Mr. 
Foggin dabbled in other drugs at the time - marijuana, cocaine - but 
nothing prepared him for what was to come.

"I said no, no, no for about three weeks, and then I tried crystal," 
he said. "It was earth-shattering. It was a drug that - I still 
really do like it, unfortunately. It was nothing I expected it to be 
and everything I wanted it to be."

Crystal meth has received little attention in recent years in the 
public actions to combat drug addiction when compared with opioids 
such as oxycodone and fentanyl, the latter of which has made national 
headlines for its growing prevalence in the illicit drug market and 
its connection to an increase in fatal overdoses.

With attention focused elsewhere, crystal meth use has quietly 
climbed to alarming rates: In Vancouver's Downtown Eastside, by one 
account, the rate has increased seven fold in the past decade. The 
stimulant is inexpensive, highly addictive and linked to psychosis - 
a troubling factor in a city whose mayor recently declared a mental 
health crisis. And the increase is not limited to the Downtown Eastside.

At the beginning, Mr. Foggin says, he used meth only on Friday 
nights. But then it became the whole weekend. And then Mondays, too.

"I used to take a bag, crush it up, put a straw in it, keep it in my 
shirt pocket and just go ..." as he mimes the act of snorting from 
his breast pocket. "It didn't matter what I got, just as long as I 
got lots. That's how I did it. I did that for a couple years. I 
called it 'nose-bagging.' "

Before long, Mr. Foggin was in the grip of a full-blown crystal meth 
addiction. His wife left him, and he says he was laid off from his 
job at a print shop, where he colour-corrected images for 18 years, 
after absentmindedly mentioning his drug use. ("But there were other 
things, too," he admits.)

A couple of years ago, snorting turned to injecting, which is how he 
found his way to Insite, the supervised injection site in Vancouver's 
Downtown Eastside, and Onsite, the detox centre upstairs, where he 
was interviewed for this story. His goal, he says, is to be abstinent.

Insite opened in 2003, giving injection drug users a place - and 
sterile supplies - to inject illicit drugs under the supervision of 
medical staff. The next year, staff began developing a database, 
logging every substance that visitors said they were injecting.

The data were recently provided to The Globe and Mail.

 From 2004 to 2010, heroin and cocaine were by far the most 
frequently injected drugs; heroin averaged 71,600 injections a year, 
while cocaine averaged 65,300. Methamphetamine, in comparison, 
averaged 6,500 a year.

After 2010, however, meth use climbed, reaching 39,400 injections in 
2015 - a seven-fold increase from 10 years earlier. Meanwhile, 
cocaine dropped to 19,300 injections and heroin remained the most 
frequently injected drug, with 92,700 injections last year.

"It's quite apparent ... there is a steady incline [in use], and 
there doesn't seem to be any sign of it levelling off or declining," 
said Ronald Joe, associate medical director of addiction services at 
Vancouver Coastal Health (VCH) and medical director of Insite.

The data do not account for other methods of ingestion, such as 
smoking or snorting.

Dr. Joe said the increase in crystal meth use is particularly 
troubling because of its association with mental illness; the 
stimulant can cause psychosis on its own when used heavily or if used 
by someone with other risk factors for psychosis. The drug can also 
cause a user to become more impulsive and prone to risky behaviour. 
More immediate problems include the risk of seizures and heart attacks.

An international study published in February found that adolescents 
who chronically use the drug suffer greater and more widespread 
alterations to the brain than adults, which is especially problematic 
because adolescents are less able to control risky behaviour, researchers say.

A 2013 report by the Urban Health Research Initiative of the B.C. 
Centre for Excellence in HIV/AIDS also noted increases based on 
longitudinal cohort studies of Vancouver drug users: "While the 
prevalence of crystal methamphetamine use is much lower when compared 
with the use of other drugs ... there is an identifiable increase in 
the prevalence of smoked and injected crystal methamphetamine use 
between 2001 and 2007." Between 2008 and 2011, non-injection crystal 
methamphetamine use plateaued, while injections remained high.

Detox centre patient He will be provided with hot meals every day and 
have his own room and bathroom. After one or two weeks, he will be 
moved to transitional housing on the facility's third floor, where he 
will continue to receive recovery support.

As part of its Downtown Eastside Second Generation Strategy, rolling 
out now, VCH plans to open a low-barrier addiction service by the end 
of the year. This is expected to include fast access and same-or 
next-day starts for therapies, with no appointments necessary, in 
hopes of capturing users the moment they want help.

"People who want [help] only want to seek it at certain points in 
time," Dr. Joe said. "If you don't provide them with treatment when 
they want it, they will say, 'I will go back to using.' "

Christian Schuetz, research and education medical manager at the 
Burnaby Centre for Mental Health and Addiction, said about 80 per 
cent of clients there had reported some history of crystal meth use, 
making it the drug with the highest level of prevalence.

Some clients at the Burnaby Centre receive medication for mental 
disorders, such as mood stabilizers, that sometimes help curb the 
tendency to relapse into illicit drug use, Dr. Schuetz said.

However, the most effective treatment currently offered in the 
inpatient program appears to be contingency management, a therapy 
that rewards good behaviour.

Clients who actively participate, show up on time and produce clean 
drug tests, for example, receive vouchers that can be redeemed for 
small items such as food, cosmetics and clothing.

"It has been demonstrated that contingency management is one of the 
most effective ways of helping people in recovery," Dr. Schuetz said.

Dr. Schuetz is also studying the effectiveness of cognitive training 
techniques and transcranial magnetic stimulation - a noninvasive way 
of stimulating the brain - on reducing impulsiveness.

Bernadette Pauly, a scientist with CARBC and an associate professor 
in the School of Nursing at the University of Victoria, noted that 
the difficulty in getting harm-reduction supplies on Vancouver Island 
presents a challenge for drug users there. A 2014 B.C. Centre for 
Disease Control report found that 20 per cent of drug users surveyed 
in the Vancouver Island Health Authority experienced difficulty 
finding clean needles, compared with 13 per cent under VCH.

Dr. Pauly also underscored the need to look at root causes of drug use.

"When we see an increase in use, we have to understand why," she 
said. "For example, in some cases, people might be using [crystal 
meth] to stay awake more, for longer periods of time.

"If that's the case, why are they staying awake? Is it because 
they're [staying] outside and they're worried about getting their stuff stolen?

"The majority of people that I work with, who are homeless, or living 
in poverty ... often use drugs as a response to trauma, abuse, 
dislocation and other life events," she continued. "We can keep to a 
minimum the harms, but we also need to look upstream and say, 'What 
else is going on here that we need to address?' "
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MAP posted-by: Jay Bergstrom