Overshadowed By Opioids, Meth Is Back And Hospitalizations Surge

Yves here. I don’t know about other routes into meth use and abuse, but in New York City, it has long been a gay club drugs. Like amphetamines generally, it also increases mental focus, so users would convince themselves that it increased their work productivity….when you get past the fact that several days of getting only 4 hours a night of sleep would lead to crashes of 12 hours of sleep. One person I know who became addicted and eventually got off meth said one of the scary parts was when he went off meth, he slept 15 days straight. This happened every time he quit.

By Anna Gorman, Senior Correspondent at Kaiser Health News. Previously, she worked for the Los Angeles Times, where she was part of a team that won a Pulitzer Prize, and taught journalism at Harvard University and at USC Annenberg School for Communication and Journalism. Anna earned her bachelor’s degree from UC Berkeley and her master’s from Columbia University Graduate School of Journalism. Originally published at Kaiser Health News

The number of people hospitalized because of amphetamine use is skyrocketing in the United States, but the resurgence of the drug largely has been overshadowed by the nation’s intense focus on opioids.

Amphetamine-related hospitalizations jumped by about 245 percent from 2008 to 2015, according to a recent study in the Journal of the American Medical Association. That dwarfs the rise in hospitalizations from other drugs, such as opioids, which were up by about 46 percent. The most significant increases were in Western states.

The surge in hospitalizations and deaths due to amphetamines “is just totally off the radar,” said Jane Maxwell, an addiction researcher. “Nobody is paying attention.”

Doctors see evidence of the drug’s comeback in emergency departments, where patients arrive agitated, paranoid and aggressive. Paramedics and police officers see it on the streets, where suspects’ heart rates are so high that they need to be taken to the hospital for medical clearance before being booked into jail. And medical examiners see it in the morgue, where in a few states, such as Texas and Colorado, overdoses from meth have surpassed those from the opioid heroin.

Amphetamines are stimulant drugs, which are both legally prescribed to treat attention deficit hyperactivity disorder and produced illegally into methamphetamine. Most of the hospitalizations in the study are believed to be due to methamphetamine use.

Commonly known as crystal meth, methamphetamine was popular in the 1990s before laws made it more difficult to access the pseudoephedrine, a common cold medicine, needed to produce it. In recent years, law enforcement officials said, there are fewer domestic meth labs and more meth is smuggled in from south of the border.

As opioids become harder to get, police said, more people have turned to meth, which is inexpensive and readily available.

Lupita Ruiz, 25, started using methamphetamine in her late teens but said she has been clean for about two years. When she was using, she said, her heart beat fast, she would stay up all night and she would forget to eat.

Ruiz, who lives in Spokane, Wash., said she was taken to the hospital twice after having mental breakdowns related to methamphetamine use, including a monthlong stay in the psychiatric ward in 2016. One time, Ruiz said, she yelled at and kicked police officers after they responded to a call to her apartment. Another time, she started walking on the freeway but doesn’t remember why.

“It just made me go crazy,” she said. “I was all messed up in my head.”

The federal government estimates that more than 10,000 people died of meth-related drug overdoses last year. Deaths from meth overdose generally result from multiple organ failure or heart attacks and strokes, caused by extraordinary pulse rates and skyrocketing blood pressure.

In California, the number of amphetamine-related overdose deaths rose by 127 percent from 456 in 2008 to 1,036 in 2013. At the same time, the number of opioid-related overdose deaths rose by 8.4 percent from 1,784 to 1,934, according to the most recent data from the state Department of Public Health.

“It taxes your first responders, your emergency rooms, your coroners,” said Robert Pennal, a retired supervisor with the California Department of Justice. “It’s an incredible burden on the health system.”

Costs also are rising. The JAMA study, based on hospital discharge data, found that the cost of amphetamine-related hospitalizations had jumped from $436 million in 2003 to nearly $2.2 billion by 2015. Medicaid was the primary payer.

“There is not a day that goes by that I don’t see someone acutely intoxicated on methamphetamine,” said Dr. Tarak Trivedi, an emergency room physician in Los Angeles and Santa Clara counties. “It’s a huge problem, and it is 100 percent spilling over into the emergency room.”

Trivedi said many psychiatric patients are also meth users. Some act so dangerously that they require sedation or restraints. He also sees people who have been using the drug for a long time and are dealing with the downstream consequences.

In the short term, the drug can cause a rapid heart rate and dangerously high blood pressure. In the long term, it can cause anxiety, dental problems and weight loss.

“You see people as young as their 30s with congestive heart failure as if they were in their 70s,” he said.

Jon Lopey, the sheriff-coroner of Siskiyou County in rural Northern California, said his officers frequently encounter meth users who are prone to violence and in the midst of what appear to be psychotic episodes. Many are emaciated and have missing teeth, dilated pupils and a tendency to pick at their skin because of a sensation of something beneath it.

“Meth is very, very destructive,” said Lopey, who also sits on the executive board of the California Peace Officers Association. “It is just so debilitating the way it ruins lives and health.”

Nationwide, amphetamine-related hospitalizations were primarily due to mental health or cardiovascular complications of the drug use, the JAMA study found. About half of the amphetamine hospitalizations also involved at least one other drug.

Because there has been so much attention on opioids, “we have not been properly keeping tabs on other substance use trends as robustly as we should,” said study author Dr. Tyler Winkelman, a physician at Hennepin Healthcare in Minneapolis.

Sometimes doctors have trouble distinguishing symptoms of methamphetamine intoxication and underlying mental health conditions, said Dr. Erik Anderson, an emergency room physician at Highland Hospital in Oakland, Calif. Patients also may be homeless and using other drugs alongside the methamphetamine.

Unlike opioid addiction, meth addiction cannot be treated with medication. Rather, people addicted to the drug rely on counseling through outpatient and residential treatment centers.

The opioid epidemic, which resulted in about 49,000 overdose deaths last year, recently prompted bipartisan federal legislation to improve access to recovery, expand coverage to treatment and combat drugs coming across the border.

There hasn’t been a similar recent legislative focus on methamphetamine or other drugs. And there simply aren’t enough resources devoted to amphetamine addiction to reduce the hospitalizations and deaths, said Maxwell, a researcher at the Addiction Research Institute at the University of Texas at Austin. The number of residential treatment facilities, for example, has continued to decline, she said.

“We have really undercut treatment for methamphetamine,” Maxwell said. “Meth has been completely overshadowed by opioids.”

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49 comments

  1. Aumua

    A 3AM post on methamphetamine use. I like it!

    A couple points.
    a) drug use does go through multi-year trends, where certain kinds of drugs are in for a while, then it’s something else.
    b) Opiates are still far and away the number one concern (and they should be) because an opiate overdose is way more likely to kill you.
    c)

    And medical examiners see it in the morgue, where in a few states, such as Texas and Colorado, overdoses from meth have surpassed those from the opioid heroin.

    A dubious statement which blurs the line between overdoses and overdose deaths. It certainly implies deaths with the word morgue, but I’d like to see the actual numbers on that. It doesn’t really jive with the chart given further down the article. It’s possible that heroin overdoses have decreased, simply because people are ODing on fentanyl which is in their “heroin”.
    d) addicts are dropping like flies, and it’s a direct result of the war on drugs. End prohibition!

    Reply
    1. skippy

      I think the war on drugs is only to increase its price and how that reflects on its value to some, see Hudson.

      Read some interesting sociology papers over a decade ago, where traditional drugs used in spiritual or shared communal aspect was abused when people moved to the nearest city for work.

      Reply
      1. vlade

        Well, there is a lot of drugs used in the shared communal aspect these days. It’s called clubbing, and often it seems to me that it’s more of an exception not to be stoned there on something than to be.

        The absolute problem with drugs – any drugs – is that we all react differently. And there’s no way to tell whether you’re the one who can go for quite a while and ignore it all, or whether one dose will hook you up – or what your “safe” dose is (and for some people the only safe dose is no dose) [IIRC, the current knowledge indicates that addiction is driven by over-expression of certain genes in brain. There are normal inhibitors for this, and your genetic makeup + activation means different people can have wastly different safe – as in non-addictive – dose]

        To me, both solutions – total criminalization and total de-criminalization (including of providers of drugs where there’s really no safe dose for majority of the population) are just extremes and equally bad.

        Reply
        1. Ignacio

          The absolute problem with drugs – any drugs – is that we all react differently. And there’s no way to tell whether you’re the one who can go for quite a while and ignore it all, or whether one dose will hook you up – or what your “safe” dose is (and for some people the only safe dose is no dose)

          This is so true! Talking about drugs everyone has her/his Achilles’ heel. Mine is tobacco although I am out of it currently. Alcohol is terrible for many, I can live with it without interferences. Some drugs are more socially accepted than others but all have their tolls to be paid by part of the population. Then we come to the medical use of drugs and its toll in the case of opioids. This is, apart from the criminalized drugs, kind of a third category, medically accepted socially rejected… aren’t we just a little bit crazy about our drug uses and prejudices?

          Reply
        2. skippy

          Largely agree aside the clubbing being the same vein, say doing something in a nature background vs a pulsating arena of people doing their own thing in a group setting.

          Reply
      2. wilroncanada

        Without drugs, the poor tax havens would have to fall back on ordinary elite robbery, gambling and prostitution for their churn. Think how many bankers would be out of jobs.

        Reply
    2. Clive

      The majority late-stage chemically dependent people are “poly-addicted” — using several substances simultaneously. Tranquillisers to steady themselves after coke, MDMA to lift mood after depression caused by excess alcohol — that kind of thing.

      So determination of specific cause of death is never going to be an exact science.

      Reply
    3. Lord Koos

      Unlike opioids which don’t actually harm human tissue much, meth can destroy the brain, nervous system, teeth, etc. With opioids the addiction itself is the main problem. If you can get off of opioids, you’ll be OK, but after a certain amount of time the damage from meth addiction is permanent.

      Reply
  2. Clive

    When I used to do voluntary work at a treatment centre, methamphetamine users faced by far the most difficult path to recovery. In addition to the psychological, emotional and physical dependency, most had turned to meth to sustain, at least so they thought, a lifestyle of near constant activity. Almost all had work patterns which required unstinting concentration over a long period with little opportunity for getting down time and proper rest.

    They had to rebuild their lives from scratch, from the ground up. Most were unable to return to the jobs and career paths they’d been on.

    The majority never made it. Most relapsed several times. A few died, mostly from cardiovascular ailments. The biggest group was simply lost track of (which was a bad sign because the treatment centre always wanted to do long-term follow-ups and patients who had recovered were almost universally keen to participate).

    To anyone who is reading this and is an active meth user, please get help to start your recovery *today*. If you are not sure where to start, I am sure Yves won’t mind if I suggested a few links.

    Reply
    1. skippy

      I remember an old public health advert in Calif during the mid 80s where a guy in a business suit walked in circles in a little white room. With it came a chorus – I do coke so I can work harder and make more money and with each chorus the tempo went up.

      The fade away was the same guy sans he suit sitting on the steps of a low socioeconomic flat and the information about losing the wife, kids, job, friends, et al.

      Reply
        1. skippy

          Exactamodo….

          Sorta like reading Less Than Zero at the time and then realizing your in the book.

          Actually a blend of Less Than Zero and the movie Blow w/ side of Cocaine Cowboys… abandoned new Merc at L.A. train station, international where is Waldo bar pub phone calls – found in a pub in Jamaica, national shopping mall shoe repair distribution hubs, why did you sell the BMW M1 when its the wife that’s going to kill you or send you to jail, two female psychiatrists Manhattan Bch neighbors asking if you want to make some money on the side, I regress…

          Reply
  3. PlutoniumKun

    I think its worth pointing out the link between amphetimines and haphazard work hours. Most casual amphetimine workers I know use it to get through long hours or late nights. Lots of casual bar and restaurant staff use it to keep going.

    Reply
  4. Superduperdave

    “Amphetamines are stimulant drugs, which are both legally prescribed to treat attention deficit hyperactivity disorder and produced illegally into methamphetamine.”

    Imagine, a country where 10 percent of kids in some states – link here – are prescribed Ritalin or other amphetamine-type drugs for so called ADHD, and there’s a problem with meth. Boggles the mind.

    Reply
    1. orange cats

      I’ve been ranting about this for 30 years. Many drug addicts get their start at age 4. When I was teaching I saw kids put on drugs when it was their parents who were nut jobs. Doctors went right along with it.

      The truth is, children are disciplined, beaten and drugged for somebody else’s failure.

      Reply
      1. Arizona Slim

        Nut job parents? Ummm, orange cats, did you teach in the same high school as my mother? Because that was one of her favorite rants.

        Reply
        1. JBird4049

          It is a complaint I have heard before. Kids can be a problem. But you look at their insane families.

          It is not just “those” people either. The Better Half would tell me of rich parents would treat their children almost like fashion accessories and not like children. It disturbed her to see that. If you got money and little Johnny is acting like a child… that’s what drugs are for.

          Reply
    2. Aaron Boyden

      Adults with untreated ADHD are more likely to be addicts to illegal stimulants than adults who had their ADHD treated with medication. A lot of addictions involve various forms of self-medication, and treating yourself with the random crap available on the streets is, shockingly, more likely to go badly than getting reliable quality medications available from pharmacists.

      Reply
      1. orange cats

        “Adults with untreated ADHD are more likely to be addicts to illegal stimulants than adults who had their ADHD treated with medication”

        The study I saw said their findings supported a ‘reduced’ (slightly) risk of later substance abuse in psychostimulant-treated boys with ADHA than the non-treated ADHA boys. Girls was the opposite. In any case it was not a good study as there was 1/3 the number of subjects in the untreated group and there was NO group that received a behavioral treatment.
        My issue is children being diagnosed and drugged after one glance by a doctor and before a less invasive treatment is tried. ADHA is a slippery diagnosis in the first place and the effects of powerful drugs on a developing brain is unknown. Drugs should be a last resort which is not what I saw happening.

        Reply
  5. russell1200

    Amphetamines are very similar to meth, but not exactly the same. I find it a bit confusing the way the two are being used synonymously. I would agree that amphetamine use had declined, I don’t see how you can say meth used declined other than as short term response to market availability. Limiting the over counter sales of pseudoephedrine put a crimp on your kitchen counter top production.

    Reply
    1. Kurt Sperry

      I’m not a pharmacist or chemist, but isn’t “meth” just short for “methampetamine”. a common amphetamine among many others?

      Reply
      1. Grebo

        Yes, in the same way that fentanyl is a common opioid among many others.

        I won’t be sending you to get my fix, and keep out of my stash!

        Reply
  6. divadab

    Amphetamines have medicinal use – the air force still gives go-pills to pilots on long missions to maintain alertness. And amphetamines fueled the blitzkrieg, right to the top – Hitler used amphetamines heavily and you can see the effects in his later public behavior – tweaking away, shouting and shaking and burning up.

    But what we call “meth” is made by criminals and is hardly pharmaceutically-pure, containing solvents and who-knows-what nasty residue from criminal manufacture.

    To me, the only solution is to make pharmaceutical grade amphetamines available and put the whole criminal enterprise down. I know people who will take adderol (which is an amphetamine) when they have a long job and have to work into the night. It’s an order of magnitude up from coffee or red bull.

    People will abuse whatever is available. At least make sure what they abuse is not toxic. That’s my admittedly libertarian view. That way people who need the bump, like commercial fishermen, or night shift warehouse workers, are not poisoning themselves with criminal meth.

    Reply
    1. Wukchumni

      But what we call “meth” is made by criminals and is hardly pharmaceutically-pure, containing solvents and who-knows-what nasty residue from criminal manufacture.

      My guess is more than likely a careless tweaker is in charge of ‘production’ of most meth out there, and it isn’t as if he or she doesn’t have important considerations to ponder, such as, is the battery acid from a 9 volt better than that from a AAA, from a getting you high standpoint?

      Reply
    2. The Rev Kev

      Not such a great idea giving go-pills to pilots, especially those armed with 500lb bombs and 20mm cannons. It seems that in the US Air Force you have to take these pills or you will lose your flying status. Trouble is that these pills can apparently encourage paranoia and aggressiveness. These pills were partly to blame back in 2002 when a USAF F-16 attacked a Canadian troop killing four and wounding eight others because the pilot was edgy and did not want to wait for clearance. More on this at-

      https://en.wikipedia.org/wiki/Tarnak_Farm_incident

      Reply
      1. Divadab

        Well yes the pilot was on go pills but he was also an air national reserve pilot who had not seen active duty for years and was totally keyed up by the prospect of action before he took the go pills. I’d say the speed was a contributing factor but not the main factor.

        A sad case of friendly fire also sadly not that uncommon.

        Would hitler still have been a monster without the amphétamines? Magic eight ball says yes.

        Reply
    3. LyonNightroad

      I fear a dystopian future where you have to take amphetamines to be competitive. We might already be halfway there.

      Reply
      1. John

        Go to any competitive American college during finals week and you’ll see that dystopia. They’re full of kids who think that “drugs are bad” (including marijuana) but they’re all hopped up on adderall.

        Reply
  7. Lori J

    Just before the Thanksgiving break, my teaching partner and I welcomed the supervising public defender for Sacramento County into our classroom of high school seniors. After a terrific discussion on the challenges and necessity of providing a vigorous defense for indigent clients, I asked him to name the most significant way his job has changed over the nearly two decades he’s practiced. His simple answer: meth. Shaking his head, he added, it devastates more lives than anything else he’s seen. It is the driving factor in far too many of his cases. He called it pure hell.

    Reply
  8. Wukchumni

    The visible tweaker domicile in town got nicknamed “Pirates of the Kaweahbe’in” eons ago, and they’d rearrange the debris field in front of their house in the wee hours a few times a week, not that it ever looked any better in light of the next day.

    The house got condemned by the county about 6 months ago, and is in dire need of the wrecking ball…

    We don’t have a bad meth problem-there’s a tweaker here a tweaker there, but it’s mostly older retired people not into destroying themselves.

    Porterville being the poster child locally, I hear it’s very prevalent.

    Reply
    1. ambrit

      That’s curious because, here abouts, especially the rural areas, if the meth heads, especially the cookers, piss off the locals too much, they get burned out. Then, there is the unfortunate tendency for a meth lab to spontaneously combust. Really, the cooking process is dangerous.

      Reply
  9. TimH

    “said Dr. Tarak Trivedi, an emergency room physician in Los Angeles and Santa Clara counties.”

    A man with a private jet? Or a clone, to be in two distant places at once?

    Reply
  10. Larry Coffield

    Drug prohibition creates the profit motives from which markets emanate and expand. The drug war is one of bureaucrats and banks prospering from waging a fake war against the purest form of free trade in history. The drug war is not merely a failure , it is the root cause of epidemics. The elective war on drugs has served neoliberalism well by being a feeder system to incarcerate and enslave surplus labor.

    Reply
  11. Roger

    Perhaps we should get a few things straight: The taking of mind altering drugs like dope, meth, crack, cocaine and heroin is shameful, self destructive, nihilistic behavior. Legalizing this behavior isn’t going to change that, all that will happen is that the cultural barriers to such behavior will be weakened thereby drawing in more victims.
    If we believe in personal liberty, which I certainly do, we must allow people to do bad things as well as good things. What is missing is the necessity of taking responsibility for the self destructive behavior. The consequences of the behavior are profound and appalling, allowing people to die from their habits may have the result of dissuading others from engaging in those habits. A junkie is essentially someone who has turned themselves into human garbage, very few make it back to the straight and narrow, most are irretrievably lost, better to face that fact.

    Reply
    1. Divadab

      Your assertions are extreme and not supported by science or most peoples’ personal experience. You casually damn all people who use amphétamines and opiates to outer darkness- pure self righteousness, based on disgust and fear and ignorance.

      Some people are addicts. Damaged goods. Do you actually know a heroin addict? I doubt knowingly- since who would identify themselves as such to you given your utter contempt for them?

      Rather addicts deserve understanding and tolerance, not punishment and the type of cruelty people like you inflict on them.

      In Switzerland where heroin addiction is treated as a public health issue and registered addicts receive daily heroin from a public health nurse, over eighty percent of the addicts in the heroin replacement program are gainfully employed. This is a humane approach that is respectful and kind, two attributes you seem to lack.

      Reply
    2. LyonNightroad

      When I have thoughts that are this self-aggrandizing, I’ve trained myself to immediately be critical of them. I’d recommend developing the same habit.

      Reply
  12. Larry Coffield

    You are confusing legalization with commercialization. Cultural barriers were eviscerated in the mid-Sixties, with mainstream embracement of illegal euphoriants. Are you making a distinction between the tragic life of a junkie and one of an alcohol addict? Do you have any idea of how much fear-aroused crime is fomented by addicts and suppliers? Watch the Untouchables and imagine the crime if addicts had to pay $20- for a shot of whisky.

    You might be a child so I will close by saying, yes Roger we allow people to do bad things, e.g.., mortgage fraudsters in 2008..

    Reply
  13. Hot Dog McKoy

    This is gonna be a long one. I’ll do my best to be brief. Meth and Heroin are as serious as a heart attack. 2 of the most positive and social people I have known in my life have fallen prey to meth. Having a 48 year old sister who is today in jail for Meth. And a daughter who got hooked on both gives me some very direct and awful experience with these insidious substances. Here is a little of what Ive learned.
    The only way to sobriety is 1st too want it badly and 2nd having a family willing to go through hell and sacrifice some time from there life for the addict.
    1.) My daughter has been clean for over 4 years and still experiences urges for Meth, but not Heroin.
    2.) She has explained Heroin users as a club of misery. They proudly wallow and display their misery, constantly debating who is the most depressed and who has the most reason to be. If you try and quit heroin, the group gets paranoid and comes after you. They want you to be as miserable as them and hate to people succeed out of it. They threatened her life and accused her of being a rat when someone had issues with the law when she 1st got clean..
    3.) When trying to get clean most meth users were at least verbally, very supportive. They all know its shitty way too live.
    4.) Female meth use has the attraction of being great for weight loss, socializing and house chores.
    5.) Both ladies were introduced to the meth and heroin by a boyfriend.
    6.) Both came from blue collar, middle class, decent schools and supportive families.
    7.) Meth gets exponentially physically more dangerous the further it gets from the manufacturer. My sister has done meth for 30 years. Still has all her teeth and is overweight(but developed ALS). Her meth is made in So-Cal where she lives. She has always been getting meth from close to the manufacturer. Up in Oregon where I live and in NC where I have family. If you do meth for 2 years your teeth will all fallout and you age 15 years.
    8.) People with manipulative personalities thrive in the meth world. You have to be a good liar to keep robbing your loved ones. And getting them too keep letting you back in.
    9.) When my daughter was on heroin it was like she disappeared, no job, no life, would not answer my calls. On meth she was there everyday(acting like a nut, but present)working and going out at night. Just lying it about everything.
    10.) My daughter was fighting to get off Zantax and colonopen(that she was perscribed by a doctor), when she started doing heroin.
    11.) We started her sobriety with a week long family trip, getting her out of town, taking her phone away and being with out access to drugs was very key to getting a head start.
    12.) I am so proud of my daughter for coming thru as she has. Everyday my thought and hopes are with her, as she searches for a happy place and keeps her sobriety going.

    Reply
    1. Democrita

      A moving summary, Hot Dog. Thanks for sharing with us. Wishing you and yours a growing share of peace and joy going forward.

      Reply
  14. blake a kelly

    You say that there are no drugs to treat it, but wouldn’t the Sinclair Method with Naltrexone probably work, or at least help? Opioid blockers wouldn’t cure overdoses like they do with opiods, but it to my understanding they would make amphetamines a lot less comfortable to use. Vivitrol might help too, although it is far less elegant than the Sinclair Protocol.

    Reply
  15. John

    I wasn’t surprised to see that Lupita Ruiz was from Spokane, Washington. When I went to school there 15 years ago, meth was an epidemic that was absolutely destroying eastern Washington and Idaho. I’m surprised that it never got the media coverage the way that opioids have the past year or so. I wonder if the trends have changed and if opioids are now more commonly used there, if these trends are regional.

    Reply

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