Person burying hands in face

Overshadowed by Opioids, Meth is Back With a Vengeance

The number of people hospitalized because of amphetamine use is skyrocketing in the United States, but the resurgence of the drug has largely 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 study published last month 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.

Addiction Scrabble

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, Washington, said she was hospitalized twice after having mental breakdowns related to methamphetamine use, including a monthlong stay in a 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 a 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, California. 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.”

 

 

Original article here featured on:NBC News logo

By Anna Gorman, Kaiser Health News

 

Main Street McArthur

New Wave Of Meth Overloads Communities In SE Ohio Struggling With Opioids

Principal Mary Ann Hale dreads weekends. By the time Fridays roll around, 74-year-old Hale, a principal at West Elementary School in McArthur, Ohio, is overcome with worry, wondering whether her students will survive the couple of days away from school.

Too many children in this part of Ohio’s Appalachian country live in unstable homes with a parent facing addiction. For years, the community has struggled with opioids. Ohio had the second-highest number of drug overdose deaths per capita in 2016, according to the Centers for Disease Control and Prevention.

But in McArthur, a close-knit village of about 2,000 in rural Vinton County, there has been a significant shift in recent months.

“They’ve moved on from the oxycodone and OxyContin,” says Hale. “Right now, the biggest problem is meth.”

Mary Ann Hale Principal

At the local ER dispatch, paramedics are observing the change firsthand. “We used to do a lot of pills, but now the problem is meth,” says Mike, a paramedic who asked to be identified only by his first name so he could speak freely. “And it’s worse because there’s no Narcan for meth,” he says, referring to the antidote that reverses an opioid overdose.

Though the opioid crisis endures in Ohio, the problem is now compounded by the resurgence of methamphetamine use, an addiction that’s even harder to treat, and can lead to troubling, violent behavior. Local officials and law enforcement are neither staffed nor funded to tackle the growing problem. For McArthur’s residents, the impact has been devastating for families across generations.

In the 2000s, the last time meth use surged across the country, people would often “cook” meth in toxic and explosive labs typically set up in bathrooms, kitchens or abandoned buildings. In response, Congress enacted the Combat Methamphetamine Epidemic Act in 2006, which regulated the sale of certain over-the-counter drugs, like pseudoephedrine, used in cooking meth. Meth use declined, seizures by law enforcement fell, and meth labs started to disappear.

Now, meth is back, and not just in Ohio. Communities around the country are raising the alarm.

In 2012, 17,846 pounds of the stimulant drug were seized by law enforcement agents in the U.S. or at the border, according to U.S. Customs and Border Control. By 2017, that number had more than tripled, and much of it now comes from Mexico.

Meth Graph SE Ohio

 

“What everybody is doing now is buying the cheap Mexican meth, and not cooking anymore,” says Vinton County prosecutor Trecia Kimes-Brown.

Meth overdoses have been climbing too, though it’s harder to overdose on meth than on opioids. Overdoses involving psychostimulants, which include meth, increased from 5 percent of total overdoses in 2010 to 11 percent in 2015.

The Drug Enforcement Administration confirms that Mexican drug dealers have taken over the market for meth in the U.S. “Trafficking and usage trends in places like Ohio are on the rise,” says Cheryl Davis, a special agent and a spokesperson for the DEA.

Trying to keep up with the need

There’s only one stoplight in McArthur. A sprinkling of locally-owned shops line main street. The talk of the town in recent months has been the opening of a new grocery store, the first in many years. What they still don’t have, anywhere in the county, is a hospital or an in-patient treatment center.

Vinton County prosecutor Kimes-Brown says that it’s hard to find mental health professionals for users who end up in custody. It’s the criminal justice system, she says, that has absorbed the brunt of the drug crisis.

Vinton Cty Prosecutor

People arrested on meth charges are often transported to neighboring counties, and when there are no spaces available at a nearby jail, Kimes-Brown has to triage. She’ll call a judge and negotiate a swap: Let out someone with a misdemeanor, a lower risk to society, and let in one of her violent meth arrestees.

“I literally have to put them on the street to put this other, more violent offender in jail,” says Kimes-Brown. “That happens at least once a week.”

That has left Vinton County with an enormous bill. In 2017, a sixth of the county’s budget went toward the jail bill — about $578,000, according to county records.

The surge of meth cases has also been overwhelming for local police. It can be riskier for officers to respond to meth-related calls.

“They are more violent,” says Ryan Cain, the lead detective on counternarcotics for the county. He says in a rural county with a culture of hunting, it’s not uncommon to encounter meth users who are hallucinating — and carrying a gun.

“We actually had one guy say that a helicopter was in the backyard and people were repelling down the helicopter,” he says. “How strong their hallucinations are is wild.”

Meth can make people agitated and prone to risk-taking, says Andy Chambers, an addiction psychiatrist and researcher at the Indiana University School of Medicine in Indianapolis.

“You can develop dangerous psychotic episodes that can look like schizophrenia,” says Chambers. “The psychosis can get dangerously paranoid — hearing stuff, feeling like they’re being pursued.”

And it can make people neglectful of their lives, their families — anything but the next high. Cain says he’s seen people sell food stamps for 25 or 50 cents on the dollar and steal from family members. “They spend every dollar they got trying to get the next hit,” he says.

Layers of addiction

Counselor Amanda Lee of Health Recovery Services rehab center on McArthur’s Main Street, regularly treats patients struggling with opioid addiction — and using meth. Sometimes, she says, people turn to meth when they’re detoxing from opioids.

“People are going to meth to get off of opiates,” says Lee, whose patients tell her opioids are less available on the street these days, while meth is everywhere. “They go through withdrawal from opiates and sickness and they’re using meth to get through it.”

Amanda Lee Counselor

Lee also says when staff give patients Vivitrol treatments, one of a handful of FDA-approved medications for opioid addiction, it still leaves users craving other highs. Vivitrol is a monthly injection which blocks opioid receptors.  “The Vivitrol injection does not cover receptors in the brain for methamphetamines, so, they can still get high on meth” says Lee. She thinks Vivitrol might be driving some patients to meth.

The connection is not so clear-cut for Chambers.

“There’s a lot of urban legend that Vivitrol is causing meth addiction, but it’s not true,” says Chambers. “You’re getting people who were using meth with opiates beforehand and now the meth is prevalent. But it’s not that Vivitrol is causing meth.”

The real problem, Chambers says, is that patients’ meth addiction may be going untreated. While some patients can benefit from Vivitrol or other medication-assisted treatment for opioid use disorder, there’s not a drug that helps with meth.

“The reality is meth has been with us for many years,” Chambers says. In fact, he says, it might be better to stop talking about an “opioid crisis” or a “meth crisis” and admit we have a “polysubstance epidemic.”

What’s underlying it he says, especially in rural areas, is a broken mental health care system.

In fact, 56 out of 88 Ohio counties have mental health care provider shortages, mostly in rural areas. This leaves about 70 percent of the population with unmet mental health care needs in Ohio, and rates are similar throughout much of the Midwest, South and Western U.S., according to data from the department of Health and Human Services.

“I’m concerned about the ongoing shortages,” says Chambers. “If you want decent mental healthcare in the U.S. you better live in the big cities.”

When home is no longer safe

Few have paid a steeper price than the children of Vinton County.

“These kids are living in these environments where they’re not being fed, they’re not being clothed properly, they’re not being sent to school, they’re being mistreated,” says county prosecutor Kimes-Brown. “They have a front row seat to all of this.”

Teachers and staff at West Elementary are often the first to notice that a child is no longer safe at home.

“They’ll just walk into the office and start crying,” says Hale, principal at West Elementary School. “They hug you and you sit down and talk with them and find out what’s going on in their secret little world.”

The staff at West Elementary School is aware of about 60 students directly affected by the drug crisis — about one sixth of their student body.

“I’ve had kids describe to me drug use they’ve seen,” says Rebecca Smallwood, the school counselor. “We had one student who performed CPR on her mom when she overdosed. We’ve had lots of kids see their parents get arrested.”

Hale says teachers must know how to read the signs in the classroom. Sometimes the clues are small but revealing. Shoes that are many sizes too small, or students who come to school without socks or underwear. Just outside the principal’s office, staff keep a storage room they refer to as “Little Walmart” stocked with underwear, shoes, T-shirts, and pants for their students.

For other kids at the school, the signs are much less ambiguous.

“[There’s] a slide in their academic behaviors, then aggression, crying, or kids talk about suicide,” says Hale. “We’ve been dealing with one of those [cases] this year. Mom’s an addict, dad went sideways when mom left, and grandma’s raising the little girl.”

This is not uncommon in Vinton County — parents, too consumed with addiction, rely on family members to step in and care for their kids. Usually, it’s the child’s grandparents.

Angela is one of those grandparents.

Her grandson, Billy, was exposed to his mother’s meth addiction early on.

(The grandmother asked NPR to refer to them as Angela and Billy to protect the family’s privacy.)

“One day, she brought him to the house. He was in diapers, he was about a year old and he had a smell to him,” Angela says. “He was beet red, like he’s been out in the sun. She had him in a meth house and the chemicals is what burned his skin, made him red.”

That part of Billy’s story is harrowing enough, but it takes an even darker turn.

While visiting his grandmother, Billy complained about pain. Angela saw signs on his body that suggested her daughter’s boyfriend sexually abused Billy.

“He did things he shouldn’t have to [Billy],” Angela says, through tears. “It did a heck of a number on him.”

Angela and her husband gained full custody of their grandson in April.

It was a difficult transition for Billy. When he started living with his grandparents, Angela says he wouldn’t talk to strangers — he wouldn’t go near men. “Even his grandpa,” Angela says, “he shied away from.”

Angela And Billy

Angela says he still won’t sleep alone.

“He sleeps on the couch and I’m there because I never know when he’s going to have his nightmares,” she says. “It’s harder on the kids than it is on anyone else.”

Smallwood says that the school is starting to see the effects of kids that have been shuffled from home to relatives or foster care. “That kind of disruption, what it does to a student forever, it’s huge. You just can’t, you can’t use enough adjectives to describe what that does.”

For kids like Billy, school is often the only place they are safe. It is where there is structure and regular meals and people who keep track of their lives from the moment they get off the school bus through the last bell of the day.

But it’s summer time now, a season most kids and teachers look forward to and relish.

At West Elementary it’s different.

“We worry,” says Principal Hale.

Original article here posted on NPR.org.

Person burying hands in face

Brain Recovery After Stopping Methamphetamine

Abstinence may restore some functions but not others and there is no doubt that methamphetamine(“meth”) can cause progressive and sometimes profound damage to the brain. The question is whether the damage is reversible once a person stops.

Unfortunately, the answer is rarely simple. While it is possible that some of the damage will begin to reverse when a user stops, there are other types of damage that may be harder to turn back.

Types of Brain Damage

Heavy or long-term methamphetamine use damages the brain both biochemically and physiologically.

Because the brain becomes accustomed to the drug during the addiction, the altered biochemical activity may take time to normalize once the drug is stopped. But, in most cases, it will, and any dysfunction in the biochemistry will eventually right itself.

From a physiological standpoint, reversal may not be so easy. Ultimately, meth causes damage to brain cells, and the ability to reverse this damage is largely dependant on where the injury occurred.

If it is in an area where other brain cells can compensate, then an improvement in symptoms is likely. If, on the other, it occurs where cells are more specialized and have fewer redundancies, then repair can be difficult, if not impossible.

Ultimately, there are three ways in which long-term meth use can damage the brain:

  • Causing acute neurotransmitter changes
  • Rewiring the brain’s reward system
  • Causing brain cell death

Acute Neurotransmitter Changes

Long-term meth exposure directly alters the brain’s cellular transporters and receptors (the systems responsible for delivering messages throughout the brain).

With that being said, the methamphetamine itself does not hurt the nerve cells (neurons) which receive the chemical messages. They remain intact.

As such, the cessation of meth can lead to the normalization of transporter and receptor activity. In some people, this can take a few weeks. In others, it may require up to 18 months to fully reverse the dysfunction.

Rewiring the Brain’s Reward System

Methamphetamine addiction also damages the brain’s so-called pleasure (or reward) center. These are regions of the brain that include the ventral tegmental area, nucleus accumbens, and frontal lobe.

Chronic methamphetamine use causes the increase in the level of cytokines in the brain. This is a class of chemicals that that, among other things, trigger the development of new synapses (connections) between brain cells. The more often that meth is used, the more that the cytokines will produce extra pathways between neurons to accommodate the increased brain activity.

Once these changes have occurred, they are usually permanent.

Brain Cell Death

Heavy meth use is known to cause cell death in parts of the brain associated with self-control, including the frontal lobe, caudate nucleus, and hippocampus. Damage in this area can manifest with psychiatric symptoms seen in later-stage addiction, including dementia, psychosis, and schizophrenia.

Unfortunately, these are the types of cells are not considered redundant. Their function cannot be compensated by other brain cells, and any damage caused to them can be considered permanent.

Likelihood of Reversal

In recent years, scientific studies have aimed to evaluate the effect of long-term abstinence on brain activity in former methamphetamine users.

A 2010 review of studies conducted by the Department of Psychology and Center for Substance Abuse Research at Temple University looked at the restoration of brain function after cessation of different recreational drugs, including cannabis, MDMA, and methamphetamine.

With methamphetamine, former users who had been abstinent for six months scored lower on motor skills, verbal skills, and psychological tasks compared to a matched set of people who had never used. After 12 and 17 months, however, their ability to perform many of the tasks improved with motor and verbal skills equal to that of the non-users.

The one area where they lagged behind was with psychological tasks, where former users were more likely to exhibit depression, apathy, or aggression.

What to Expect After Quitting

The ability to restore normal brain function after quitting meth can vary from person to person. It is largely related to how long you used the drug, how regularly you used it, and how much you used.

With that being said, a former user can expect an improvement in the following functions and/or symptoms within six to 12 months of stopping:

  • Restoration of neurotransmitter activity in parts of the brain regulating personality
  • Normalization of brain receptors and transporters
  • Improvement in depression and anxiety
  • Stabilization of mood swings
  • Improvement in focus and attention
  • Fewer nightmares
  • Reduction in jitteriness and emotional rages

The one thing that may not readily improve is the drug cravings a person can experience even after years of abstinence. It is a problem commonly caused by damage to the brain’s self-control tract (namely, the fasciculus retroflexus and ventral tegmental area).

To deal with these cravings, a former user should commit to an extensive rehabilitation program and the process of neurogenesis wherein a person learns to exercise self-control in order to stimulate activity in the fasciculus retroflexus and ventral tegmental area.

Original article here on verywellmind.com.

Sources:

Gould, T. “AddictionandCognition.” Addict Sci Clin Pract. 2010; 5(2):4-14. PMCID: PMC3120118.

National Institute on Drug Abuse. “What are the long-term effects of methamphetamine abuse?” Bethesda, Maryland; updated September 2013.