Methamphetamine, an illegal drug that has long plagued the West and Midwest, has finally taken hold in Massachusetts, posing a daunting new challenge to a state still grappling with the opioid crisis.
Meth caught the public eye last week when it was blamed for aggressive behavior by street drug users in the South End.
But the effects of methamphetamine, which has become increasingly popular in Massachusetts over the past year or two, go beyond the annoyances caused by users bathing in public fountains or congregating in front of restaurants.
Meth is a body-revving stimulant like cocaine, but its effects last longer and can be at least as addictive. Those who fall into its clutches suffer persistent physical and mental damage, and face huge hurdles if they want to break free of it.
“It’s really the last thing we need right now,” said Dr. Alexander Y. Walley, an addiction specialist and researcher at Boston Medical Center.
Meth has become more available and less expensive in New England, and it is often used in combination with other drugs. Experts aren’t sure why it arrived here later than other regions.
The state Department of Health reports that the number of people who say they use methamphetamine as their primary or secondary drug has increased — but remains a small percentage of people who use the treatment system or call for help.
In the fiscal year that ended in June 2014, 12 people called the Massachusetts Substance Use Helpline (800-327-5050) and said that methamphetamine was the primary substance they used. By fiscal year 2019, that had increased to 63 people — still less than 1 percent of total calls. Those reporting methamphetamine as their secondary substance went from just 1 in fiscal year 2017 to 25 this year.
Asa Morse, spokesman for the New England division of the Drug Enforcement Administration, said that despite “an uptick” in meth throughout New England, “It’s nowhere near approaching what they’re experiencing in the Midwest or on the West Coast.” Opioids remain the DEA’s top concern in this region, Morse said.
Still, addiction specialists are troubled by the way meth has become intertwined with the opioid crisis, especially because the treatment system is ill-prepared to deal with stimulant addiction. “Most providers don’t know where to start helping people with meth use disorders,” said Alex S. Keuroghlian, a psychiatrist at Fenway Health and Massachusetts General Hospital.
Meth doesn’t kill with the swift ferocity of fentanyl, but can be fatal over time, damaging the cardiovascular system in ways that can cause heart attacks and strokes.
Withdrawing from meth isn’t as painful as withdrawing from opioids, but afterward patients are often in no condition to engage in recovery; they can be deeply depressed or even psychotic, often with impaired decision-making and an inability to experience pleasure. At the same time they’re gripped by powerful urges to use again.
And unlike with opioids, which can be successfully treated by any of three drugs, there is no FDA-approved medication to ease the cravings for meth.
That forces providers to go “back to the basics” of specialized talk-therapy methods and social supports, said Keuroghlian, who has treated meth addiction in the gay community.
Dr. Timothy Wilens, director of Mass. General’s Center for Addiction Medicine, said people who have been taking meth often arrive at treatment in extremely poor health — skinny, dehydrated, sleepless, pock-marked, missing teeth.
“They get really sick really fast,” he said.
Once they stop taking meth, patients will often sleep nonstop for two or three days. When they wake up, they desperately crave meth and often can’t think clearly, Wilens said. “It’s hard for them to understand what you’re saying, hard to follow up with appointments,” he said.
If people can stay away from meth, their brains will gradually recover, although that can take six months to a year. Patients need to be in a safe place, away from other users, and undergoing psychotherapy, Wilens said.
But Wilens adds, “It’s not like we have a lot of evidence on what works. It’s a very hard addiction that has not had a simple solution.”
Walley, the Boston Medical Center doctor, said he rarely saw meth use until about year ago, and now sees it almost exclusively among people who are already injecting opioids such as fentanyl.
Meth lasts longer than other stimulants. Users, who sniff, smoke, or inject the drug, get a brief spurt of euphoria but continue to remain activated for hours, Walley said. Typically they’ll seek their next meth dose before coming down from the high. “You get this stacking of stimulation,” Walley said, leading to binges that can last days. When that happens, the risk of psychosis increases.
Walley described the daily pattern of many of the patients he sees who use both opioids and meth. Waking up in withdrawal from opioids, their first task is to obtain an opioid. That makes them feel sedated, so they seek a stimulant. But the stimulant “gives them the sense that they’re metabolizing the opioid faster,” he said, so they’re soon seeking another dose of opioid.
“It’s kind of like putting your foot on the gas and the brake sequentially throughout the day,” Walley said.
The result is a lot of injections of both drugs — and the more one injects, the greater the risk of contracting a serious illness such as HIV, hepatitis C, or heart infections.
Although newly visible, meth is not new to Boston. For decades it’s been a staple of the gay party scene. But meth got little attention, Keuroghlian said.
Richard, a 36-year-old North Shore man, became part of that scene. At first, he said, he could smoke meth daily and still hold down a job in health care administration.
“It makes you feel kind of invincible. You have a lot of self-confidence. Nothing bothers you,” said Richard, who asked to be identified only by his middle name. “It lowers your inhibitions. It gives you a lot of energy — you don’t need to sleep.”
Then he started injecting meth. “Injecting is like smoking it times 1,000,” he said. “That really makes you crazy. . . . I was paranoid, I thought people were following me all the time. I didn’t trust anybody. I was really skinny.” He lost his job and apartment, and ended up living with friends.
When that arrangement fell apart, Richard went to live with his mother, where it was difficult to keep using. Gradually, he used less and less. As he came down from the meth high, he slept a lot, cried “for no reason,” and rarely left the house.
In 2017, Richard was diagnosed with HIV and connected with a therapist who has helped him manage his addiction since. He said he’s working again and not using.
“It’s frustrating to me to see heroin get all this attention, and there’s almost nothing about crystal meth ever,” he said.
That is starting to change, said Wilens, of Mass. General. He’s seeing a new interest among detox centers in developing treatment protocols for people addicted to meth.
“I am hopeful because people are worried about it,” he said.