CINCINNATI – The floor seemed filthy, and she could not get rid of the grime.
Amie Detzel frantically scrubbed that nursing home floor with cleaning supplies she’d found. On hands and knees, dragging her IV pole with her, the gravely sick woman incessantly scrubbed.
The psychotic episode happened after Detzel spent days (and nights) pushing the drug into the intravenous catheter her caregivers used to infuse antibiotics into her heart, which had become infected by a contaminated needle.
Methamphetamine, the primary drug flooding the streets of Cincinnati and other communities across the country, is a psychostimulant. It can induce psychosis.
That explains the scrubbing.
A new wave of meth is causing government officials, police and parents of users to shift their focus from opioids to the stimulant, which is resurging in a much purer form, coming directly from Mexico, not backyard cookeries or houses or sheds.
The 23 drug task forces funded through the Ohio High-Intensity Drug Trafficking Area agency saw a 1,600% jump in meth seized from 2015 to 2019 (and the 2019 numbers are incomplete).
“We just simply move like a herd of locusts from one drug to another,” said Mina “Mike” Kalfas, a certified addiction expert in northern Kentucky. “Meth is the replacement for the crack of old. We go from opioid (pain pills) to opioid (heroin) to opioid (fentanyl) to stimulant (meth).
“We try to get them off of the drug they’re on,” Kalfas said. “What we need to do is treat the addiction. They’re using (a) drug as a coping mechanism.”
The American Society of Addiction Medicine clamors for more doctors to attend to the problem as a disease.
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Historically, the medical community largely allowed the criminal justice establishment and treatment programs outside the health care system to deal with addiction, said Lindsey Vuolo, director of Health Law and Policy and public affairs for the nonprofit Center on Addiction in New York City.
As overdose death tolls from the opioid epidemic soared, the strategy became: Treat addiction. Save lives. Keep people safe if they use drugs. Carry the opioid-overdose antidote naloxone. Provide more needle exchanges to prevent the spread of diseases such as hepatitis and HIV. Continue treatment for this chronic disease.
“If we don’t start to effectively and efficiently address addiction like the public health issue that it is, we will continue to see drug epidemic after drug epidemic,” said Courtney Hunter, director of advocacy at the Center on Addiction.
Why meth? Why now?
People addicted to opiates hear others talk about a new high, cheap and easy to get and safer than fentanyl.
Meth is that alternative.
Kalfas calls the meth problem a new tentacle of the opioid epidemic, noting that most patients he sees who switch from heroin to meth don’t give up opioids for long.
“They perceive (meth) as different, sometimes even lesser somehow, which is how they underestimate it,” he said. “But when their batteries are dry, they need to ‘come down,’ what will they turn to? The opiate-addicted turns to opiates.”
Brittany Christian, 32, who’s in recovery, said she learned about meth while she was in treatment for heroin addiction in Louisville, Kentucky.
“Everybody had done it, and I hadn’t done it, and I really wanted to try it,” she said. “I did not want to go through the heroin withdrawal again.”
Six months after she left rehab, in May 2017, she decided to find meth.
“It’s just as easy as getting cigarettes at the gas station,” Christian said.
Detzel, 35, who’s been in recovery for a year, said drugs were a way to cope. She was 13 when she was led into a sex-for-drugs trafficking situation orchestrated by someone close to her family.
“I never knew the proper way, you know, to get help,” she said. “All I knew was to use because that’s what I’d seen … at a young age.”
She was vulnerable to anything that took her away from her real life.
“I just wanted to try anything,” she said, “anything that I thought would take me to another level.”
Detzel was able to maintain sobriety after her stint in the nursing home. She was prescribed Suboxone for her opioid addiction and had to steer clear of drug use for six months before she could have heart surgery. She learned coping mechanisms, learned she’d been trafficked through no fault of her own and turned to God for help. She celebrated one year in recovery in January.
No such help with meth
Detzel and Christian had medical help for their initial addictions. There is no medication-assisted treatment available for meth addiction, as there is for opioid addiction.
Some addiction experts recommend psycho-social therapy as the best treatment for meth addiction. The method can include talk therapy, learning about the illness and a rehabilitation regimen that helps people develop social and emotional skills they can employ to live a healthy life. Some sufferers are prescribed anti-anxiety or sleep-help drugs or other medications while they detox from meth.
In common with other addictions, “you have to look at the underlying issues and really make a treatment plan that’s individualized for the person,” said Kat Engel, vice president of nursing services for the Center of Addiction Treatment in the West End. “Are they self-medicating?”
Not enough people are getting treatment. Meth-related deaths are rising. The latest figures from the U.S. Centers for Disease Control and Prevention show that from 2012 to 2018, the rate of drug overdose deaths involving methamphetamine and other “psychostimulants with abuse potential” was up almost fivefold.
Christian, who has been in recovery for a year-and-a-half, said treating drug use “absolutely” has to include treating the individual’s trauma.
“What’s causing someone to use? What issues are they going through?” she said. “You know, I think a lot of it is underneath that needs to be brought up.”
In her case, it was sexual abuse she’d endured as a child.
On meth, she was paralyzed, hyper-focused on a single task. Sometimes, she felt empty. She scratched and picked sores on her body and face. She drove to a hospital, expecting to be locked in a psych ward, but she was discharged.
The confines and rules of the Center for Addiction Treatment saved her, she said. She found sobriety by following the rules.
“If they told me I could not have a pair of leggings, oh well, I can’t have a pair of leggings,” she said. “If they told me to go to group therapy three times a day, I did that. My counselor, when she told me to journal, I journaled.”
She and Detzel said their success has at least something to do with their work.
Christian is an admissions specialist for the Center for Addiction Treatment. She loves her job, saying, “Somebody did it for me.”
Detzel works at the YWCA downtown in Cincinnati, helping domestic violence and rape victims, as well as people with developmental disabilities who struggle with addiction.
They see the avalanche of meth on the streets. They know the attraction among opioid users to the drug is real.
In Hamilton County, Lakshmi Sammarco, the county coroner, said the crime lab’s meth caseload leaped from a little more than 600 in 2016 to 3,600-plus cases in 2019.
The amount of meth seized and tested at the Kentucky State Police Crime Laboratories rose by 77% from 2016 to 2018.
Adam Bisaga, an addiction research scientist and professor of psychiatry at Columbia University Medical Center, said, “The mixed stimulant-opioid addiction is a different one. We do not have a strategy to treat it, and many programs will be taken by surprise.
“The number of overdoses and adverse medical outcomes in people using both will increase, and this will be a fourth wave of the opioid epidemic.”
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