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Meth, once the drug scourge of Indiana, is back but in a new and deadlier way

By Shari Rudavsky,IndyStar on 9/9/2019

Methamphetamine use appears to be making a comeback as the country continues to grapple with the opioid epidemic.

But unlike the period  marked a decade ago by hodgepodge labs hidden in rural communities in Indiana and elsewhere, the reemergence appears fueled by two factors: The drug is being smuggled in from other countries, and users are using it along with the opioid fentanyl — a far riskier high.

Indiana University researchers who track accidental drug overdose deaths have noted a rapid rise in the number of deadly overdoses involving methamphetamine since 2013 in Marion County. The number of deaths involving cocaine also has been rising.

Less than a decade ago, in 2010, methamphetamine was detected in only six of the 132 overdose deaths in Marion County, according to data from Indiana University’s Public Policy Institute. In 2018, 100 of the 361 overdose deaths involved methamphetamine.

Nationally the number of overdose deaths in which methamphetamine played a role increased 7.5 times from 2007 to 2017, according to the National Institute on Drug Abuse. The number of people who reported having a methamphetamine use disorder soared in just one year. In 2016 an estimated 684,000 people reported having a methamphetamine use disorder. The following year that number rose to 964,000.

“There is a true shift in the market from opioids towards methamphetamine and cocaine," said Bradley Ray, a former research director at the Indiana University Public Policy Institute.

Locally, the Indiana Poison Center also has seen an increase in calls associated with methamphetamine exposure. In 2009, the hotline received 76 such calls. Last year that number rose to 274, said Dr. Blake Froberg, the center’s medical director. 

Fentanyl often involved in deaths

When it comes to deadly overdoses, only rarely does methamphetamine act alone. 

Last year fentanyl played a role in nearly 60 percent of overdose deaths that involved methamphetamine. 

"The increasing death is tied to fentanyl,” said Ray, now director of Wayne State University’s Center for Behavioral Health and Justice. “This is a new type of methamphetamine and cocaine use that is associated with death at rates that we have not previously seen."

The data sheds no light on whether so-called polysubstance drug users purchase the chemicals separately or in one concoction, such as a "speedball," which mixes an opioid such as fentanyl or heroin with a stimulant such as methamphetamine or cocaine.

Decline of the meth lab

One thing law enforcement officers do know: The source of methamphetamine on the streets today is not the same as that of a decade ago.

At that point, most of the methamphetamine was manufactured in Indiana. Law enforcement focused on finding and shutting down local labs, said Indiana State Police spokesman Sgt. John Perrine.

Even today the number of methamphetamine labs in the state continues to decline.

Now, though, dealers are importing the drug from outside the country.

“We’re trying to adjust our tactics to combat the current trends,” he said. “For so long, the trend was in making methamphetamine, and we specialized ourselves in stopping that. And now those numbers are down. Now we have to go looking for the drug itself, not just the manufacturers.”

Danger of drug cocktails

The trend in Indiana mirrors one addiction experts are seeing nationally: People increasingly are mixing stimulants with opioids.

A study last year found that in 2011, 19 percent of substance users surveyed said they used both drugs. In 2017 that had risen to 34 percent, said Jessica Hulsey, founder of the Addiction Policy Forum, a national non-profit based in Washington.

Many people who use substances never restrict themselves to just one type of drug, she said. Some might use a stimulant on Monday to start the week and an opioid on Friday to wind down for the weekend.

“We have a myth in this country that people struggle with just one substance,” she said. “While we have this idea that meth left the scene and we fixed that issue 15 years ago, that’s just not the case.

“It has been very prevalent in Western states in particular, and now we’re seeing it emerge again.”          

When law enforcement cracks down on one type of drug, she said, it’s not uncommon to see users switch to another substance easier to find.

In general drug epidemics tend to go in waves, experts say. Painkillers, such as opioids, may be the popular drug one generation and then stimulants replace them.      

Treating meth addiction

Still, these days many in the field of addiction medicine report it’s not uncommon to find patients who use both opioids and stimulants.

Because of the way addiction affects the brain, once a person develops an addiction to one substance, he or she is more likely to become addicted to another, said Dr. Claudie Jimenez, regional medical director of CleanSlate for Indiana and Kentucky, an outpatient addiction center.  

And once a person has an addiction to more than one substance, treatment can be more complicated.

Medication assisted therapy such as buprenorphine can assist with opioid addiction, but no such equivalent pharmaceutical exists to ease methamphetamine addiction. Instead, time-consuming behavioral health programs like cognitive behavioral therapy tend to be the best way to treat the addiction, Jimenez said.

Similarly, while naloxone can reverse an opioid overdose, no such antidote to methamphetamine exists.

When a person overdose on methamphetamine, health care providers focus on delivering supportive care, said Froberg, also a medical toxicologist with Indiana University Health and an associate professor of clinical pediatrics at the Indiana University School of Medicine.

A meth overdose can lead to an elevated heart rate, breathing problems or excessive agitation. One of the most worrisome symptoms, said Froberg, can be hyperthermia, very high temperatures. In that instance, doctors may use ice, fans or cooled intravenous fluid to restore the body to normal.

If the current trend continues, Froberg said, it could spur more exploring into what lies behind the situation and what can be done to reverse it.

“If we continue to see this increase, it will start to come up on more and more people’s radars,” he said. “It’s already a substance of concern, but if it keeps increasing, more and more people will become concerned about finding out why there’s an increase and what kind of interventions can be done.”