EDITOR'S NOTE: This story is published in collaboration with The Lund Report.
The millions of dollars and countless hours that Oregon health officials have devoted to fighting the opioid epidemic in recent years have had an effect: Overdose deaths from prescription painkillers have fallen to a 14-year low.
At the same time, another drug threat is on the rise: methamphetamine. Oregon’s rate of meth use is 76 percent higher than the rest of the country, according to federal data, and that’s led to a spike in deaths. Methamphetamine now kills more people in Oregon every year than do prescription opioids, state data show.
“Methamphetamine is the epidemic that never went away,” said Brent Canode, executive director of The Alano Club, a nonprofit recovery center based in Portland for people with a drug or alcohol addiction. “But everything has been drowned out by the ‘opioid epidemic.’”
In 2016, with opioid overdose deaths spiraling out of control, the Centers for Disease Control and Prevention adopted prescription guidelines to curtail the availability of painkillers. Oregon followed suit, warning physicians and patients about the risk of addiction. For years, Oregon has had among the nation’s highest rates of opioid prescriptions per capita.
The public health focus on prescription painkillers stemmed the number of prescriptions written by providers, leading to fewer deaths and hospitalizations from painkillers. But little was done to address Oregon’s growing meth problem. In 2005, Oregon made it much harder to buy pseudoephedrine, which drug manufacturers used to make methamphetamine. The move dramatically cut the number of meth labs in the state but dealers just turned to Mexico for imports. So much meth has flooded the state that prices have plunged.
The federal government has poured money into fighting the opioid epidemic. Public health officials have adopted prescription monitoring programs, expanded access to overdose medication and conducted education and awareness campaigns. Lawmakers have passed laws to expand treatment, and the media has produced a stream of stories about the epidemic.
Little has been done or said about the ongoing meth epidemic. Oregon public health officials have no plans to focus on the drug. They say that drugs in general, and the social hardships that prompt their abuse, are the problem -- not one substance. Yet their focus has been singular.
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Racial and ethnic biases are partly to blame, Canode said.
“The opioid stories that have been told in the news are about kids next door, in the suburbs, who are dying in droves,” Canode said. “It’s a very different narrative (than the one for meth) and plays to the public in a very different way.”
Meth, he said, is “largely a drug that’s used by a class of individuals that we don’t mind marginalizing.”
To the middle class, the meth epidemic is largely invisible. But for the poor, the threat is pervasive, experts say, especially in rural areas.
“It tracks with poverty and joblessness and other social determinants of health that have been really hitting our rural communities quite hard since the decline of the lumber industry,” said Dr. Todd Korhuis, an addiction specialist at Oregon Health & Science University.
Police cite meth as top concern
Police are facing the problem on the front lines. The federally funded Oregon-Idaho High-Density Drug Trafficking area program, which develops law enforcement strategies, named methamphetamine the No. 1 threat in its just-released report for 2020.
That’s the second year in a row that meth has topped the threat list.
“It’s almost everybody’s primary threat,” said Chris Gibson, director of the program, which covers 11 counties in Oregon, three in Idaho and the Warm Springs Indian Reservation. “It’s impacting their caseloads the most.”
The report said police have stepped up drug seizures on the southwest border with Mexico as traffickers have expanded exports of meth into the United States along with heroin, cocaine, and fentanyl. Meth, especially, drives up crime rates, shatters families, fuels homelessness and taxes social services, experts say.
Unlike opioids, there is no approved medication for meth abuse. Patients who want to quit basically have to tough it out. Many relapse. It’s not uncommon for people like Racheal Hoskins to go into recovery more than once.
Hoskins, who grew up in the Gresham area, first tried meth at 18.
“I thought it was going to be a weekend party thing,” Hoskins said.
She met a man, got pregnant, ended up on the streets and suffered domestic violence. She entered a recovery program but then relapsed. Now 34, she’s getting help through Central City’s Concern program for mothers.
“When I’m away from the environment and the people it’s a lot easier,” Hoskins said, acknowledging that she’ll be in recovery the rest of her life.
“It’s going to be an ongoing process,” Hoskins said.
Oregon’s awash in Mexican meth
The widespread use of methamphetamine in Oregon has led to soaring deaths. The number of meth-related deaths in the state outpaced those from prescription opioids for the first time in 2016, according to Oregon Health Authority data. That trend continued in 2017, with 162 people dying from meth-related overdoses compared with 115 from prescription painkillers. In 2018, the number of meth-related deaths jumped to 272, according to the drug trafficking assessment report, which has more recent figures than those published by the health authority. Those deaths are more than double the number of individuals who died from prescription painkillers -- 129 -- and accounted for 45 percent of overall drug deaths in Oregon in 2018, the report showed.
Official warnings about the dangers of prescription opioids are almost a daily affair as news organizations roll out a drumbeat of stories of deaths. But there’s been no equivalent alarm about the toll of meth on Oregon society.
“We’ve really turned the corner on opioids here,” said Dr. Reginald Richardson Sr., executive director of the state’s Alcohol and Drug Policy Commission, which is working on a strategic state plan for the prevention and treatment of drug abuse. “We haven’t had a sustained focus on methamphetamines.”
The drug came up in public hearings this legislative session during discussions of a bill on pseudoephedrine, a decongestant in some cold medicines. Pseudoephedrine is also a key ingredient used to manufacture meth. When it was freely available in Oregon, drug traffickers obtained it through pharmacies and turned homes into meth labs. The lab properties became toxic from fumes emitted during manufacturing. Cleaning up the sites was difficult and expensive. In 2005, Oregon lawmakers enacted a bill that made pseudoephedrine available only with a provider’s prescription, a first in the nation. Only Mississippi has followed suit.
In Oregon, the number of incidents involving home meth labs plummeted from just over 190 in 2005 to two in 2018, according to Rob Bovett, who tracks these data as legal counsel for the Association of Oregon Counties.
A study by Oregon Health & Science University researchers published in 2010 found that between 2006 and 2007 emergency department visits related to meth fell, a trend that appears to have reversed in recent years. A study published last year showed that amphetamine-related ER visits tripled nationwide between 2009 and 2015.
“We’re seeing more methamphetamine-related ER visits,” said Dr. Rob Hendrickson, associate medical director of the Oregon Poison Center at OHSU.
Hendrickson, who participated in the 2010 study, said it’s difficult to nail down the ER data.
“Most ER doctors and primary care doctors don’t write in their discharge diagnoses ‘methamphetamine use,’” Hendrickson said.
Bovett and law enforcement agencies initially opposed this session’s bill because it would have lifted Oregon’s prescription requirement for pseudoephedrine. A compromise was worked out, requiring a pharmacist’s prescription to buy cold and sinus medication with pseudoephedrine, but the bill stalled in the House and died.
Nevertheless, there’s little reason for home meth labs now in Oregon. Methamphetamine is readily available from Mexico. The quality is pure and potent and it’s dirt cheap. According to the drug trafficking assessment report, the price of meth in Oregon between 2017 and 2018 fell by 18 percent, with a 25 percent drop in the Portland metro area.
In 2007, Mexico also moved cold medicines containing pseudoephedrine behind the counter. But that didn’t stop drug traffickers, Bovett said. They import precursor agents from China, manufacture the drug in illicit labs and then ship powder or liquid to the United States. It’s turned into crystal in California and sent up the Interstate 5 corridor where people buy it on the streets.
“It’s very easy to get,” Hoskins said.
The quality of the meth in Oregon could explain the rise in addiction, Bovett said.
“The higher the purity, the higher the potency, the higher the poundage, the cheaper the price, the more people use, the more people get hooked, the more people get addicted quicker and it has all those negative consequences on families, personal lives and death,” Bovett said.
‘I was a demon’
Hoskins’ battle with meth is familiar to specialists who help people in recovery. She got addicted and ended up living on the streets. She became pregnant, stopped using meth and had a son. But her mother, who assumed Hoskins was still on the drug, took her child.
Again, she ended up homeless and addicted.
“I didn’t know what I was going to do,” she said.
Determined to break her addiction, she went to the De Paul Treatment Center in Portland in 2009 and entered an intensive in-patient program. For four months, she got up around 6 a.m. and went to bed at 10 p.m., after a day packed with group meetings.
“It’s supposed to be one of the toughest programs,” Hoskins said. “I graduated.”
She learned to avoid the people, places and things associated with meth.
“Once I was away from the environment and the people I was with, it was fairly easy,” Hoskins said.
She won a financial aid package to attend Mount Hood Community College but then lost it and ended up back on the streets, sometimes living in a park under a tent, sometimes just with blankets. She hooked up with a man and they used meth together.
After he turned violent and broke her arm and pulled a gun on her, she left him. She was three months pregnant.
Hoskins’ daughter lived with her mother while she completed a residential program for mothers at Central City Concern.
This month she got her daughter back.
“I’m really happy about it,” Hoskins said. “She keeps me on my toes.”
A majority of the women in the residential program at Central City Concern are battling a meth addiction.
Hoskins said she’s learned to confront her anger and depression. She had a difficult childhood, punctuated by the death of her brother when she was 14. He was hit by a reckless driver. Hoskins later realized she turned to meth to escape.
“It was a rush -- I could stay awake and not missing anything,” Hoskins said. “And I didn’t have to feel.”
People usually turn to drugs to cope with problems in their life, said Karen Kern, senior director of substance use disorder services at Central City Concern.
“Substance use is a way for people to manage other things that are going on in their lives,” Kern said. “Oftentimes people have had long-term childhood trauma experiences or other negative experiences. And sometimes it’s losing a job or losing housing.”
In the program, Hoskins became close with another mother, Elesha Loftin, who got pregnant at 14, dropped out of high school and raised her son while living with her mother in east Multnomah County. Everything was fine, Loftin said. She even got a job at a fast food restaurant.
But one night at a friend’s house she tried meth.
“I did 13 lines that night,” Loftin said. “I got that rush feeling.”
Only 19, she quickly became addicted. She lost her job and ended up at her cousin’s house where she got clean. But the cycle began anew when her cousin’s husband brought out a meth pipe one night.
Loftin ended up back at her mother’s with her son, struggling with her addiction.
“I got argumentative and short-tempered,” Loftin said. “I wasn’t my loving self. I was a demon.”
Her mother kicked her out, she met a man and got pregnant. At the hospital about to give birth, she told staff that she had used meth. They alerted the Department of Human Services.
“That was the best thing that ever happened to me,” Loftin said. “Before I was doing anything I wanted and didn’t have consequences. But then they told me that we’re going to take your kids away. I couldn’t let my baby go into the system.”
She’s now 23 and has been clean for a year.
“They gave me the ultimatum of my kids or treatment,” Loftin said. “I accepted that I needed help.”
Like Hoskins, she knows her recovery will be a lifelong process.
‘You’re using the drug to feel normal’
Though not as addictive as nicotine or heroin, meth is still easy to get hooked on, experts say.
It releases dopamine and other neurotransmitters in the brain, giving users a sense of euphoria.
“You feel a rush,” said Hendrickson, the OHSU physician. “Then as the drug wears off, the opposite happens. You start to feel tired, sleepy and depressed.”
People use again, to rev up their energy level. Eventually, they need it to feel normal.
“Like most illicit drugs, you get to a point where you’re using the drug to feel normal rather than to feel high,” Hendrickson said.
The drug changes the brain -- and the personality. Unregulated, dopamine is associated with schizophrenia and psychosis. People can become violent. Desperate for money, they turn to crime.
“The most common thing that we see in ERs are people who come in with hallucinations and delusions and agitation,” Hendrickson said.
Unlike opioids, there are no drugs to counteract the effects. Patients who take too many opioids can be treated with naloxone, which reverses the life-threatening depression of the central nervous and respiratory system. There are also medications to treat the disorder. By contrast, when a person is coming off a meth high, physicians can only provide palliative care.
The lack of treatments approved by the Food and Drug Administration has made it difficult for providers to help patients with a meth addiction.
“We have excellent medications to treat opioid use disorder but we do not have any FDA approved medicines to treat methamphetamine use,” said Dr. Todd Korhuis, the addiction specialist at OHSU.
That could change.
Researchers at CODA, Inc., a drug treatment center in the Portland area, are involved in a clinical trial of 400 patients nationwide who use meth. The trial involves testing a potential treatment involving two FDA-approved drugs -- bupropion or Wellbutrin, an antidepressant, and extended-release naltrexone, sold as Vivitrol or ReVia, which is used to prevent alcohol or opioid use disorders.
“Wellbutrin helps with the lack of feeling you have when stop using meth,” said Katharina Wiest, director of research CODA. “We use naltrexone to help with the craving.”
A pilot study a few years ago indicated that this medication combination could be helpful in treating a meth addiction.
Wiest would not comment on the results. Those are sealed until the study is complete.
CODA has good reason to be involved with a search for a treatment for meth use disorder: It’s the most common reason people seek treatment at the nonprofit.
“We sure are eager to see the results for this trial of medicine for methamphetamine, said Tim Hartnett, who just stepped down as executive director of CODA and is an advisor to the board. “We need more tools to help with the abuse of that substance.”
Financial focus on opioids
Over the past three years, the federal government has authorized more than $10 billion to fight opioid use disorder, according to a study by The Pew Charitable Trusts. That includes $21 million allocated to Oregon. Federal block grants have enabled states to expand access to treatment, an area where Oregon needs to improve. It can take as long as three weeks for people to get into inpatient services at places serving the state’s Medicaid population like De Paul Treatment Centers, Central City Concern and the Native American Rehabilitation Association of the Northwest.
The proportion of people in Oregon who’ve been treated for opioid abuse jumped from 4.9 percent of everyone in treatment in 2010 to 36.5 percent last year.
“You have robust federal funding streams -- and full disclosure, I get some of them -- that are targeting opioid use disorder,” said Canode, of The Alano Club. “That’s something we’ve never had for methamphetamine use disorder.”
He said the money has skewed treatment, with recovery centers focused on helping people with opioid problems.
“There’s an emphasis on making sure that your pool of clients is disproportionately weighted to opioid use disorder even though we’re seeing far more people with methamphetamine use disorder coming through our door,” Canode said.
He calls the emphasis on one drug a “failed strategy.”
Public health officials said they’ve focused on prescription opioids in part because they’re easier to target. The opioid epidemic has been fueled by state-licensed medical care providers, not illegal drug traffickers.
“Health systems were prescribing high amounts of prescription opioids to chronic pain patients,” said Dr. Katrina Hedberg, who recently stepped down as Oregon’s state epidemiologist and health officer.
Users turn to multiple drugs
The state has no plans to target the meth epidemic, she said. Rather, it’s focused on a multi-drug approach, she said.
People with an addiction problem often use more than one drug. A study released in April by the Center for Substance Abuse Research at the University of Maryland showed that about a third of urine specimens collected at Lane County-based Serenity Lane between December 2017 and February 2018 tested positive for four or more drugs. The nonprofit offers residential and outpatients addiction services at eight locations in Oregon. The tests confirmed high rates of meth use: The drug was found in 61 percent of samples.
Richardson, who’s leading the Alcohol and Drug Policy Commission, said that his strategic plan aims to increase recovery rates by 25 percent over the next five years. The plan also includes reducing deaths and addiction.
He said Oregon needs an “on demand system of treatment and recovery.”
“When a person is ready to take on this disease, they have to have access to assessment and treatment immediately,” Richardson said. “So that’s a major issue.”
He said the state also needs to work on early intervention activities in schools and in the workplace to reduce the number of people addicted to drugs.
“We’ve got to have prevention, we’ve got to have immediate access to treatment,” Richardson said. “And once a person has gone through an episode of treatment, because it’s a chronic disease requiring a lifetime of interventions, we need comprehensive support services.”
You can reach Lynne Terry at email@example.com.