The drug is no relic of the past—it’s a problem of the present that seems to be worsening by the day
By Jason Langendorf
With the opioid epidemic continuing to spread across the country and our most familiar cultural touchstone for methamphetamine being a decade-old television series (Breaking Bad), meth may feel like a problem from a different era. But an overdose rate in recent years that has tripled—to more than 15,000 deaths in 2019—says otherwise.
To be precise, the number of overdose deaths involving psychostimulant drugs other than cocaine (largely methamphetamine) from 2015 to 2019 increased from 5,526 to 15,489—a 180% spike. And this was before the COVID-19 pandemic fanned the flames of addiction in the U.S. Breaking Bad didn’t just describe the narrative arc of fictional schoolteacher Walter White—it articulates America’s relationship with methamphetamine at this very moment.
“We are in the midst of an overdose crisis in the United States, and this tragic trajectory goes far beyond an opioid epidemic,” said Nora Volkow, MD., director of the National Institute on Drug Abuse (NIDA). “In addition to heroin, methamphetamine and cocaine are becoming more dangerous due to contamination with extraordinarily lethal fentanyl, and increases in higher-risk use patterns, such as multiple substance use and regular use.”
In a study co-authored by Volkow and published in JAMA Psychiatry in September 2021, researchers found that methamphetamine use among survey respondents ages 18 to 64 increased by 43% between that same four-year period of 2015 to 2019—a concerning number, but not enough to explain the exponential rise in meth-related overdose deaths. The most troubling discoveries were surges in frequent methamphetamine use (66%) and combined meth and cocaine use (60%), as well as its spread across populations at higher risk for methamphetamine use disorder (MUD), such as those with socioeconomic risk factors and comorbidities.
Recent attention both from the public and from policymakers has been focused on the opioid epidemic—and with good reason: Lately, opioids have been the primary driver of exploding overdose rates in the U.S. But the trends around methamphetamine are still pointed in the wrong direction, and experts warn that the cyclical nature of substances—and the inability of our systems to consistently treat the root problems of addiction—could lead many back to meth.
“This is just part of the zeitgeist—the public perception of safety—and the one that’s touted the most as being dangerous is the one that people avoid,” said Paul Earley, MD, DFASAM, president of the American Society of Addiction Medicine. “So inevitably, for those who aren’t suffering from addiction to one of the drugs, they’ll start switching.”
A Short History of Meth
Methamphetamine is a stimulant categorized as a Schedule II drug by the Drug Enforcement Administration (DEA) and Department of Health and Human Services (HHS) under the Controlled Substances Act. Like most synthetic substances, its origins can be traced to the development of medical treatments.
Amphetamine, methamphetamine’s chemical progenitor, was first synthesized by Romanian chemist Lazar Edeleanu in 1887. By the 1930s, the drug was being widely distributed as a decongestant called Benzedrine, in the form of an inhaler. Soon after, it became a popular appetite suppressant used for weight-loss purposes and also was being prescribed to treat conditions such as depression and sleep disorders. By World War II, chemists had learned how to more easily synthesize methamphetamine—which arrives in the brain much faster than amphetamine—and the drug was distributed to soldiers on both sides to increase the energy and elevate the moods of the fighting forces. Over time, the stimulant effects of the drug became increasingly sought after for recreational use.
Methamphetamine is Food and Drug Administration (FDA)-approved and, in some cases, still prescribed as a second-line treatment for ADHD, obesity and narcolepsy. But its dependency risk to patients is high, and the cost of becoming addicted to it is staggering. Neurotoxicity can occur as a result of meth use, damaging the central and peripheral nervous systems and eventually even killing neurons and altering brain structure. Common side effects of prolonged meth use are psychosis, the breakdown of skeletal muscle, brain bleeds, skin sores, the rapid loss of teeth (also known as meth mouth) and a host of other problems ranging from hallucinations to intense itching (meth users often describe feeling as though insects are crawling under their skin).
The quick and powerful high delivered by methamphetamines is followed by a similarly swift and crashing low, often leading to binge use of the drug. Withdrawal from meth can cause depressive symptoms, paranoia, extreme cravings and suicidal thoughts, driving a user to seek more and perpetuating an insidious physiological and psychological whiplash effect.
Diversion and Treatment
While opioids have become the public’s primary subject of scrutiny and fear among substances, illicit methamphetamine producers have become savvier and better equipped.
Meth has become like marijuana once was—it is everywhere. Users report it is extremely cheap, even free.”—Police officers Jason Olson and Evan Raleigh, to the Santa Monica Daily Press
According to the Santa Monica Daily Press, “Innovation in the chemical production process has led to the creation of a more pure and therefore addictive meth. A flood of money from China has made it easier for individuals in Mexico to acquire the chemicals for production and brought down the price of the product. The addition of the synthetic opioid fentanyl into some batches increases the risk of overdose.”
“Meth has become like marijuana once was—it is everywhere,” Santa Monica Police Department officer Jason Olson and investigator Evan Raleigh told the newspaper in a joint statement. “Users report it is extremely cheap, even free.”
And because so many illicit substances are now being laced—sometimes deliberately, sometimes unintentionally—with fentanyl, methamphetamine is arguably more accessible, addictive and lethal than ever. Local, state and federal governments have struggled mightily to keep up with, let alone get ahead of, drug manufacturers and distributors—a problem that isn’t likely to be solved without more forward-thinking policy and a massive influx of funding.
In the meantime, the standard for treatment of methamphetamine use disorder is a combination of behavioral therapy (such as cognitive behavioral therapy and community reinforcement and family training, or CRAFT) and contingency management interventions. At present, there are no FDA-approved medication-assisted treatments for meth addiction.
Still, there are both methamphetamine treatment therapies and medications currently in development or being tested. And the increasing awareness of the severity of the opioid epidemic, along with the public’s evolving understanding of addiction, offers hope that more support—and less stigma—will empower lawmakers to begin appropriating the necessary level of resources toward more treatment and prevention programs that can stem the rising tide of meth.
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