Pubdate: Wed, 18 Dec 2019
Source: New York Times (NY)
Copyright: 2019 The New York Times Company
Author: Abby Goodnough


TULSA, Okla. - The teenager had pink cheeks from the cold and a
matter-of-fact tone as she explained why she had started using
methamphetamine after becoming homeless last year.

"Having nowhere to sleep, nothing to eat - that's where meth comes
into play," said the girl, 17, who asked to be identified by her
nickname, Rose. "Those things aren't a problem if you're using."

She stopped two months ago, she said, after smoking so much meth over
a 24-hour period that she hallucinated and nearly jumped off a bridge.
Deaths associated with meth use are climbing here in Oklahoma and in
many other states, an alarming trend for a nation battered by the
opioid epidemic, and one that public health officials are struggling
to fully explain.

The meth problem has sneaked up on state and national leaders. In
Oklahoma, meth and related drugs, including prescription stimulants,
now play a role in more deaths than all opioids combined, including
painkillers, heroin and fentanyl, according to the Centers for Disease
Control and Prevention.

The spending package that lawmakers agreed on this week includes
legislation from Senators Jeanne Shaheen, Democrat of New Hampshire,
and Rob Portman, Republican of Ohio, that would allow states to
address the resurgence of meth and cocaine by using some of the
billions of dollars that Congress had appropriated to combat opioid

Meth use first ballooned in the United States from the 1990s into the
early 2000s, when it was often made in small home labs with
pseudoephedrine, the main ingredient in many drugstore cold medicines.
But today's meth, largely imported from Mexico, is far more potent.

"It's way different from the meth people were using 20 years ago,"
said Dr. Jason Beaman, the chairman of psychiatry and behavioral
sciences at the Center for Health Sciences at Oklahoma State
University. "It's like they were drinking Mountain Dew and now they
are injecting Red Bull."

Nationally, since late last year, meth has turned up in more deaths
than opioid painkillers like oxycodone and hydrocodone. In 14 of the
35 states that report overdose deaths to the federal government on a
monthly basis, meth is also involved in more deaths than fentanyl, by
far the most potent opioid.

Provisional data from the C.D.C. shows there were about 13,000 deaths
involving meth nationwide in 2018, more than twice as many as in 2015.
That is still far fewer than opioid deaths over all, which passed
47,000, but the pace is accelerating while opioid fatalities have flattened.

The most recent federal data, for example, estimates that from May
2018 to May 2019 there were 24.6 percent more deaths involving meth
and other drugs in its class than in the previous year, compared with
9.4 percent more deaths involving fentanyl and other synthetic
opioids. Deaths involving meth have been concentrated in the western
United States but are moving eastward, even to regions that meth
barely touched in the past, like New England.

"This is the one thing that keeps me awake at night," said Dr. Brett
P. Giroir, assistant secretary for health at the Health and Human
Services Department, at a conference on stimulant abuse on Monday.
"Within a few short months, and you can model it any way you want,
methamphetamines will be secondary to fentanyl nationwide associated
with overdose deaths."

Unlike with opioids, there is no way to reverse the effects of a meth
overdose, just as there is no medication approved to treat meth
addiction and the cravings it creates. For now, treatment for meth
addiction consists largely of behavioral therapies with "a much more
moderate effect size compared with medication," said Dr. Nora Volkow,
the director of the National Institute on Drug Abuse.

For many here in Oklahoma, what treatments do exist are out of reach.
Most poor adults in the state do not qualify for Medicaid coverage
that would help those with meth addiction gain access to treatment,
because the state has chosen not to expand the program under the
Affordable Care Act. And while Oklahoma has won a windfall of money -
$355 million - from lawsuits against opioid manufacturers, much of it
is specifically for fighting opioid addiction.

"We know there is funding coming in for the opioid problem," said Mimi
Tarrasch, the chief officer of Women in Recovery, an alternative
sentencing program in Tulsa. "But what I see, and what our community
continues to see, is really a lot of addiction to methamphetamine."

Meth is still not considered nearly as deadly as heroin or synthetic
fentanyl, the latter of which has killed tens of thousands of
Americans over the past five years, often within minutes, by
depressing their breathing. Instead, meth stimulates the central
nervous system, causing agitation, sleeplessness, psychosis and
gradual damage to the heart, brain and other organs.

"Basically your blood pressure goes up so high that you can rupture
your aorta or have a stroke," said Dr. Andrew Herring, an emergency
medicine and addiction specialist in Oakland, Calif.

In many cases, opioids are contributing to meth deaths, as people use
both types of drugs together. Opioids were found to play a role in
about half of the deaths involving meth in 2017, the most recent year
for which detailed toxicology results are available.

Some experts think the number is probably larger. Dr. Daniel
Ciccarone, a professor at the University of California, San Francisco,
who studies patterns of drug use, said he suspected some coroners and
medical examiners were not checking the blood of overdose victims for
dozens of fentanyl analogues, which have chemical structures similar
to fentanyl but require specialized toxicology testing.

Meth-related deaths may also be rising simply because the number of
users is rising, Dr. Ciccarone said, including those with underlying
heart or other problems.

"It's embarrassing that we don't have the answer at our fingertips and
we should," Dr. Ciccarone said at the stimulant abuse conference.

Research suggests that in some cases, fear of dying from fentanyl is
compelling people to use meth instead. Others are using meth as an
upper to rouse themselves after using opioids, which have a sedative
effect, or to help with opioid withdrawal. Still others are turning to
meth for a high even as they take anti-craving medications to recover
from opioid addiction.

Dr. Giroir said combining meth and fentanyl could be the most
dangerous move of all, although researchers are still trying to figure
out how the drugs work together.

"We definitely want to dissuade people from the notion that somehow a
downer and an upper cancel each other out," he said. "Early data
suggests the combination is probably more deadly than the sum of its

Some deaths involving meth are due to the risky or violent behavior it
can cause, not the drug itself. Rose and her 19-year-old boyfriend,
stopping to talk to a reporter one morning on their way to a drop-in
center where they hoped to shower, said they knew of a man who had
hanged himself after a meth-fueled fight with his girlfriend.

Last year in Tulsa, a 25-year-old man with schizophrenia died after he
shattered the glass door of a downtown bank while on meth and two
police officers, who had been pursuing him, shot him with a Taser 27
times. His autopsy report said the likely cause of death was cardiac
arrest "due to methamphetamine toxicity in the setting of physical
exertion/restraint," with cardiovascular disease as a contributing
factor. The man's relatives say excessive force by the police was to
blame and are planning to sue, said Damario Solomon-Simmons, a lawyer
for the family.

Many autopsies of Oklahoma residents whose deaths involved meth also
found heart problems. In one typical case, a 48-year-old receptionist
was found dead in a hotel room in May, her body withered to 77 pounds,
her heart diseased. The cause of death was found to be acute
methamphetamine toxicity.

Dr. Beaman, who sees patients at a psychiatric crisis center here in
Tulsa, said psychosis and other mental conditions caused by meth use
were taking up more and more resources. In June alone, he said, more
than half of the admissions to the crisis center were related to meth.

"I can't treat people with schizophrenia," Dr. Beaman said, "because
I'm spending all my time treating people who are using meth."

Shayla Divelbiss, 29, of Glenpool, Okla., considers herself lucky to
be in good health now after using meth for six years, during which she
ignored a thyroid condition and went days at a time without sleep.
After waiting two harrowing months for a bed at 12 & 12, a treatment
center for the poor and uninsured, she was able to stop.

"All the responsibilities of being a human just went out the window,"
she said of her time on meth. "I quit cooking and eating. I had real
bad anxiety. I was skin and bones."

Daniel Raymond, the director of policy at the national Harm Reduction
Coalition, said it was imperative to figure out exactly how meth users
were dying so that cities and states could build public health
strategies based on that knowledge. For now, those strategies include
warning users about the risks of "overamping," a word used to describe
using too much meth, and the best ways to address it, like cooling
down, drinking water and sleeping. Syringe exchanges have an important
role for those who inject meth, he said, just as they do for opioid

At 12 & 12, a former hotel on the outskirts of Tulsa, 64 percent of
the clients are addicted to meth, said Bryan Day, the chief executive.
State lawmakers have agreed to give the center more money next year to
add beds for meth patients and increase their average stay, which is
about 30 days. He estimated that 4,000 people in the state need
treatment for meth addiction but are not receiving it.

"My belief is that their judgment for a period of time is very, very
skewed, leading to frightening choices and decisions and impulses,"
Mr. Day said. "The brain takes time to heal. We don't want to
shortchange this population."
- ---
MAP posted-by: Matt