As the opioid crisis hit its peak in the last few years, methamphetamine slunk into the background — hidden, but still vicious.
Instead, the focus shifted onto doctors prescribing large amounts of pain medication, or drug dealers lacing their heroin, by then often being bought by people unable to feed their pill addiction, with deadly additions like fentanyl.
But in the background, it was there.
While the meth cooking labs that used to generate headlines — in Walmart bathrooms and suburban homes and RVs driven by Walter White on “Breaking Bad” — were rapidly disappearing, the market has always had a place for meth.
INCREASED USE
To put it simply, meth use is on the rise. And has been for a while.
Data released by the Howard County Jail in north central Indiana shows an increase in meth-related charges from 243 in 2016 to 407 in 2018, while information provided by Community Howard Regional Health in Kokomo also showed an increase in the substance frequency used by addicts seeking treatment.
In the 2018 state fiscal year (July 1, 2017, to June 30, 2018), just over 45% of people seeking treatment were diagnosed with opioid addictions, compared to 19% of people with an addiction to stimulants.
By the 2019 fiscal year (July 1, 2018, to June 30, 2019), there had been a shift: 32% of treatment-seekers were now being diagnosed with stimulant addictions, compared to 28% with opioid-based addictions, according to figures provided by Matt Oliver, executive director of operations for Community Howard’s outpatient Behavioral Health Services.
A recent study released by Michigan-based Forensic Fluids Laboratories, which was contracted in part by the Indiana Department of Child Services to conduct oral fluid drug testing, found that meth, cocaine, the pain reliever buprenorphine and fentanyl are on the rise across the Midwest.
In Indiana, the study noted, the number of counties showing a high positive meth rate increased from four in 2014 to 29 in 2018.
Additional data from the Substance Abuse and Mental Health Services Administration and its Treatment Episode Data Set shows that in 2014 there were 2,630 admissions in Indiana with a primary substance abuse of amphetamines.
By 2018, that number had grown to 5,593.
WHY THE SHIFT?
“I think you start to see that shift back in 2018, and you’re clearly seeing it through 2019. If I look at 2017, 2018 and 2019 data, I’m seeing a shift that was moving toward opiates that it’s now moving back away from opiates,” added Oliver about Community Howard’s findings.
“So by the beginning of 2019 I can say we’re definitely seeing an uptick in meth use and a decrease in opiate use by the people coming in the door seeking treatment.”
Oliver pointed to one potential reason for the shift: worries about safety.
Addicts, treatment specialists have been told, are concerned about overdosing on heroin, specifically heroin laced with fentanyl.
So, while a crackdown in recent years on illicit prescribing practices helped to push the opioid crisis toward heroin abuse and the enormous dangers posed by fentanyl, addicts are now telling medical professionals the record number of overdose deaths across Indiana and the nation has had an impact on their usage.
“Stimulants as a diagnostic group are being pushed up because of the move to methamphetamine vs. opioids. That doesn’t mean that opioids are less problematic, but I think it does reflect the general trend that dealers are moving away from heroin for various reasons,” said Oliver, who also acknowledged the skepticism that exists in some circles about the idea that drug addicts are taking into account their safety when choosing what to ingest.
“Individuals using would anecdotally say that meth is cheaper, safer, and more accessible. … That’s what the therapists are hearing: ‘I don’t want to die.’”
The presence of meth doesn’t come as a surprise to law enforcement.
Howard County officers, in 2018, arrested dozens of people as part of a major drug operation, netting nearly 1,000 grams of methamphetamine alongside other drugs, paraphernalia and weapons.
It was considered the second portion of the biggest drug bust in Howard County history, which started when warrants were executed in May 2018 at 13 locations across Kokomo and Macon, Georgia. Officers seized more than 17 pounds of meth, 2 pounds of cocaine, 2 ounces of heroin, 122 grams of fentanyl, 6 ounces of marijuana, two money counters, 12 vehicles, $37,000 in drug money and 24 firearms.
Then, earlier this month, federal officials announced indictments against 15 people alleged to have established a meth ring to distribute the drug in Terre Haute, Brazil, Gosport, Muncie and Anderson.
WHERE DOES IT COME FROM?
The formerly ubiquitous meth lab is, mostly, a thing of the past.
Now, the drug comes from Mexico following crackdowns on the sale of chemicals needed to produce meth.
“This case is a perfect example of the wingspan of drug trafficking and organizations even here in Indiana. We understand where the methamphetamine is coming; we know it is coming from Mexico,” J. Michael Gannon, Drug Enforcement Administration assistant special agent in charge, said at a press conference in Terre Haute announcing the 15 indictments.
Shipped by cartels across the border — specifically to Texas, California, Nevada or Arizona, said Byal — packages containing the highly-addictive drug are then often mailed or FedEx’ed to Indiana. Other times, they are driven across the country.
Detailing that shift is the number of meth labs — zero — reported to the Howard County Health Department in 2018, according to James Vest, the department’s director of environmental health.
In 2012, that number was 38. By 2017, it was down to one, found in a vehicle.
“Now the supply is coming directly from Mexico, higher quality methamphetamine [that’s] much cheaper,” Robert Glynn, a drug intelligence officer with Indiana’s High Intensity Drug Trafficking Area program, told WTHR-TV in Indianapolis this fall.
“Cartel members are even fronting it or handing it out free, as a business move to get people hooked so they’re going to have to come back and buy it.”
In conjunction, the Tribune-Star in Terre Haute reported on Dec. 21 that in 2018 Indiana State Police reported 192 clandestine meth lab seizures, a fraction of the 1,808 seizures in 2013 and the fewest since 1999.
On the surface, that may seem like a good thing. But meth in Indiana is now cheaper, more potent and helping to prop up hyper-violent drug cartels across America’s southern border.
“With so much of what people are using coming from Mexico, we’ve seen lab seizures dwindle in the last five years,” Indiana State Police narcotics detective Shilo Raulston told the Tribune-Star.
“Think about it. If it costs someone $100 to make a gram and face a higher felony for it, why would they do that? Especially when Mexican meth is cheaper, and generally, of a higher quality.”
IS IT SAFER?
While meth has the reputation of not being as deadly as opioids, there has been an increase in the amount of overdose deaths involving the drug.
Take, for example, Indiana’s most populous county, Marion County.
Data released by Indiana University Public Policy Institute shows that overdose deaths involving meth jumped from six in 2010 to 100 in 2018.
So, while the county’s opioid-related overdose deaths showed a decline from 329 in 2017 to 286 in 2018, meth has shown consistent increases over the last decade.
The Indiana State Department of Health, meanwhile, wrote in a 2019 report that the “drug overdose epidemic that has occurred both nationally and in Indiana has been primarily driven by opioids, but the involvement and co-use of other non-opioid substances cannot be ignored.”
It went on to note the number of overdose deaths “involving cocaine, benzodiazepines and psychostimulants [meth falls into this category] has increased simultaneously in the past few years.”
As a stimulant, meth is less likely to kill as heroin or fentanyl, which in the worst cases can leave people dead before any kind of help, like Narcan, can even arrive. The potency of opioids, and their quick-acting deadly components have been well documented.
Meth, on the other hand, often provides more gradual physical damage, leaving users hyperactive and often difficult to control in the immediate moments after using.
The drug, however, can lead to heatstroke and organ failure or quick rises in blood pressure and has become more potent in foreign batches.
But one thing that has happened — in conjunction with a higher presence of meth in overdose victims likely because the drug is simply being used more often — is the mixing of opioids like fentanyl and meth.
The Centers for Disease Control and Prevention wrote in a 2019 report that “recent data point to increasing synthetic opioid involvement in psychostimulant-involved deaths.” Approximately half of psychostimulant-involved deaths in the U.S. in 2017 also involved opioids, according to the most recent data.
A HOPE FOR TREATMENT
Oliver said the “bread-and-butter approach for methamphetamine dependence” is cognitive behavioral therapy, citing both individual or group therapy and look at stress management and coping tools.
But there has also been some attention given recently to whether naltrexone — a medication also used to treat alcohol addiction and opioids — could work for meth addicts.
The idea is that, similar to what it does for other addictions, naltrexone could bind to receptors that produce dopamine and also be helpful in reducing cravings.
Early studies, noted Oliver, have shown that when people have been given naltrexone versus a placebo, those who received the placebo have shown higher cravings and more reactions to meth than those using naltrexone.
But, without a well-established body of study, the idea is in its early stages, he noted.
“There’s been some early work done with naltrexone, and naltrexone is a medication that’s been somewhat effective for alcohol and opiates,” said Oliver.
“Because what it does is it tends to reduce the cravings. And so while there’s not like an FDA medication approved — medication for the treatment of methamphetamine — a number of medical providers are starting to look at naltrexone to see if that can help reduce the [meth[ cravings.”
He added: “And while I don’t know that we have a lot of literature on it, there seems to be some research articles that suggest it could be promising.”