Communities fight methamphetamine outside the spotlight of the opioid crisis


The increase in methamphetamine use in western North Carolina affects the “misery index,” even though the death rate is lower than that of opioids.

through Christian Green for Carolina Public Press, July 13, 2021

As the opioid crisis hit many rural areas in the state, the proliferation of methamphetamine struggling communities in western North Carolina.

“The greatest thing here at Graham County is methamphetamine, ”Graham County Health Director Beth booth mentionned.

“Unlike opioids, with methamphetamine there is nowhere to blame and no one is taking the staff to fight it,” Booth said.

“There might not be that many directly associated deaths, but methamphetamine is readily available, it’s really cheap, it ruins lives, and there really isn’t a good cure.”

Insufficient data

The impact of methamphetamine on a specific community is difficult to assess from the data, in part because a key data point used to illustrate the severity of a substance is overdose death.

While the high rate of opioid deaths indicated the severity of the opioid epidemic, the results of methamphetamine use were more difficult to decipher because it is less likely to result in direct death from overdose.

In 2018, the state medical examiner told Carolina Public Press 160 people had died in the previous year from methamphetamine-related overdoses. This represented less than 10% of the 1,974 opioid-related deaths reported by the state medical examiner in the same year.

But the death rate is only one factor in understanding the effect of methamphetamine use on communities.

“I certainly wouldn’t want to give the impression that just because there are fewer deaths, methamphetamine is somehow less devastating to communities and individuals,” said William T. Stetzer, Acting U.S. Attorney for the Western District of North Carolina.

“Methamphetamine may not have the same number of overdose deaths, but I think the misery rate it causes is still very high for the communities, tribes and families who are suffering. “

Stetzer, who oversees criminal prosecutions against drug trafficking organizations, described a “significant” increase in the amount of methamphetamine arriving in North Carolina from cartels in Mexico via a supply line that runs through Atlanta to Charlotte, before continuing to Tennessee, then North.

In 2012, US Customs and Border Protection listed that he seized approximately 18,000 pounds of methamphetamine crossing the country. Through 2018, that number had grown to 85,000 pounds, and by 2020 that number has skyrocketed to 177,000 pounds of methamphetamine and crystal meth.

Local methamphetamine producers within communities still exist, Stetzer said, but the influx of high-purity crystalline methamphetamine has cut prices by more than half.

“More drugs are coming in, more are being distributed to local dealers who, in turn, are selling even more crystal meth in our communities,” Stetzer said.

Part of the use of polysubstances

Statewide, 75% of drug-related deaths were caused by multiple drugs taken by a single user, or the use of multiple substances, according to a recent report from NC Health News.

The use of polysubstances compounds the challenge of determining the impact of methamphetamine in western North Carolina.

Although methamphetamine is the dominant substance in Graham County, Booth said, it is not uncommon for people to use multiple substances. Most often, they mix methamphetamine, a stimulant, with another substance that acts as a depressant, such as opiates.

“Right now, a lot of our participants are mixing methamphetamine with heroin or fentanyl,” said Tanasia Boyd, the Harm Reduction Coordinator of the Buncombe County Department of Health and Human Services.

In North Carolina, the majority of recent overdose deaths have occurred in people who use multiple substances, and nationally, the majority of overdose deaths involving stimulants such as methamphetamine also involve an opiate.

Over the past two decades, Rebecca Smith, director of the Buncombe County DHHS social work division, has seen different drugs come in and out of popularity. Today, however, she said that it appears that illicit substances are more available than ever. Boyd agreed.

In his experience, Boyd said, few people of color used methamphetamine. “Now I’m starting to see more and more people,” she said. “It’s everyone. Everyone uses everything.

Processing challenges

Even for those who only use methamphetamine, receiving care or resources can be more difficult than for those who use opiates, Boyd said.

In a situation Boyd encountered, a woman was using methamphetamine and wanted treatment, but she was not yet using it long enough to qualify for drug addiction protocols.

“She ended up waiting a few weeks before finally entering and receiving treatment,” she said.

“She’s doing great now, which is good. But if she had had opiates in her body, it would have been automatic. She would have come in that day.

Even when those who use methamphetamine can seek treatment, they face a difficult road because, unlike many other substances, including opiates, there is currently no approved drug to treat methamphetamine overdose or provide relief. withdrawal symptoms.

“This is the biggest difference in the treatment of methamphetamine and opioid addiction – there are no treatment options for methamphetamine.” mentionned Michel Nader, professor of physiology and pharmacology in the faculty of medicine at Wake Forest University, specializing in stimulants.

Nader’s colleague Thomas martin, a professor of anesthesiology at Wake Forest who studies pain and opioid abuse, said that when it comes to treating opioid addiction, three approved drugs offer options.

Naloxone, also known by its brand name Narcan, is a fast-acting drug that blocks the effects of opioids. It is often used in an emergency to save someone suffering from an opioid overdose.

The other two drugs, methadone and buprenorphine, are long-term treatments used to counter opioid addiction. They are able to prevent or lessen withdrawal symptoms while decreasing the body’s response to opioids so that an individual is less likely to abuse them in the future.

These drugs are used in combination with other treatments such as therapy and counseling in a process known as “drug therapy” to help opioid addicts.

“Honestly, it’s usually a lot easier to wean someone off opioids than it is to get rid of methamphetamine,” Graham County Booth said.

“There is no drug treatment for methamphetamine, so they just have to quit on their own, and it’s really hard. So, it’s a bit counterintuitive, but honestly, opioid addiction probably seems like the easiest to fight. “

Joel chisholm, an addiction psychiatrist and medical director of behavioral health for the Cherokee Indian Health Authority in Swain County, said he saw a similar dynamic in his clinics.

“We are seeing a lot more people who use opiates going into treatment because we can provide them with drugs,” Chisholm said. “Carrots are just a lot bigger for them to get into treatment compared to someone using methamphetamine; we still offer them therapy and recovery classes, but it’s much more difficult.

Current research aims to create drugs that can serve a similar purpose for people who use stimulants, such as cocaine or methamphetamine, Nader said.

Creating treatment drugs in today’s climate may be more difficult than in the past, Nader said. Methadone, which was approved for use in the treatment of opioid dependence in the 1960s, would likely not be approved today because it has some potential for abuse, he said.

“The way the FDA has approached potential treatments for stimulant abuse,” Martin said, “… they want something that makes people sober, but that has virtually no responsibility for abuse and “Methadone certainly doesn’t meet those criteria for opioid treatment, so it’s true. There’s a chance it hasn’t been approved today.”

Nader said he hoped the U.S. Food and Drug Administration would establish specific guidelines on what she would like to see in treatment with methamphetamine, possibly a drug like methadone, which still has similar effects. , but to a much lesser degree so that they are less likely to be abused.

In the meantime, although there are no medications available to treat methamphetamine and opioid use continuing to receive a higher priority in many clinics when beds are scarce, it can be difficult for methamphetamine users. to find help.

“If we have someone who comes … on methamphetamine (who) wants to be treated and the beds are limited, there is a chance that they will not accept it,” said Samantha brawley, a peer support specialist from the Sunrise Community for Recovery and Wellness in Asheville and a user of medication-assisted treatment.

“When that happens, we suggest they sleep, eat and rest. But sometimes they don’t have a place to sleep, eat or rest, so it becomes a battle. It’s always a battle of trying to get someone to the right place at the right time.


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