SOUTHERN INDIANA — As communities in Southern Indiana continue to tackle the opioid epidemic, local health officials and law enforcement say the rise in methamphetamine — a less talked about but just as dangerous drug — shouldn't be overlooked.
Nationwide, methamphetamine potency and purity has increased over the last decade, while price continues to drop. Laws curtailing opioid use and methamphetamine production in the states have led to larger operations south of the border, trafficking the drugs into the U.S.
Southern Indiana leaders say they've seen the shift — most notably within the last six months to two years.
CRYSTAL METH HITTING HARD
Clarksville Police Capt. Joel DeMoss said there is “no doubt” that meth use has been on the rise in Southern Indiana over the last two years. He sees this not only in his town, but surrounding agencies.
But different than the powdery version that was cooked in domestic labs in recent years, DeMoss said there's a resurgence of crystal methamphetamine, a more potent, crystalized version of the drug that's being mass-produced and trafficked into the states from the South.
The department reported that price has gone down to about $20 per gram from around $100 a few years ago. DeMoss said they're not only seeing more instances, but the people that have it just have much more.
“We see an ounce, several ounces at a time,” he said. “So It's more problematic than what people think it is. Crystal meth has hit our doorstep pretty hard the last one and a half to two years.”
METH AS DANGEROUS TO COMMUNITY AS HEROIN
DeMoss said he's seen an uptick in overall drug use in the past 10 years. And if methamphetamine has displaced some of the opioid use for now, it isn't any less destructive to the community.
“There's no way it gets better,” he said. “It gets worse. Any time you flood a community with drugs, the more people are going to use."
In both Clark and Floyd counties, law enforcement say that drug-related crimes — theft, robbery and some violent crimes — shake out the same whether the person is committing crimes to get heroin or methamphetamine.
“As far as the non-using community, it doesn't matter what the drug is people are using,” Floyd County Sheriff Frank Loop said, adding that the department stays vigilant to new trends in drugs, but tackles them similarly. The goal is to get them off the streets, he said.
VIEW FROM THE ER
Dr. Eric Yazel, Clark County Health officer, said his position as an emergency room doctor gives him the unique perspective of being able to detect new shifts in the health of the community. So while opioid overdoses have decreased by about half in the county over the past two years, he's been seeing more patients come in with methamphetamine issues over the last several months. That could mean running a drug screen and finding it in a patient's system, treating a related illness or a person coming in to say they need help with an addiction.
“There are all sorts of unusual health problems that 10 years ago, you could write up as a case report,” Yazel said. “Now we're seeing things about once a month that used to be extremely rare.”
While opioids can cause acute death from overdose more often than methamphetamine, the overall mortality rates are pretty similar, he said.
According to the U.S. Drug Enforcement Agency's 2017 Domestic Methamphetamine Threat Assessment, provisional data from the Centers for Disease Control and Prevention shows that 7,663 people died in 2016 from psychostimulant use — this includes amphetamines and methamphetamines.
Prolonged use can cause severe health issues — some of the most outwardly physical symptoms being rapid weight loss, tooth decay and sores. But there are other severe chronic complications that go hand in hand with any intravenous drug use, whether heroin or meth.
Users can develop endocarditis, which is an infection of the heart valves and bacteria can spread throughout the body, causing abscesses on the spine that lead to paralysis. Muscle tissue can break down over time from overstimulation and dehydration, the proteins clogging the kidneys and causing acute kidney failure. Intravenous drug use also contributes to the spread of HIV and Hepatitis A and C.
And the drug is getting stronger. According to the Drug Enforcement Agency Methamphetamine Profiling Program, purity and potency of the drug has increased since the start of the decade. In the first half of 2011, the purity of methamphetamine seized in the U.S. was 92.3 percent, with an average potency of 75.6 percent.
In the first half of 2016, that purity was several points higher at 95.9 percent, potency rising 15 percent to 90.2.
Yazel said while the opioid crisis is not over by any means, “I do think the public needs to be aware of [methamphetamines]," he said. "Because it has the potential to kind of sneak up on the public if we don't address it."
Floyd County Health Officer Dr. Tom Harris said he's seeing similar things in his county, and warns against both the chronic and acute toxicity levels of methamphetamine. Acutely, the big danger is with cardiac damage and irregular heartbeat.
Users have also died from ingesting large amounts of the drug at the time of an arrest, for instance, which can cause the body temperature to spike to upwards of 109 degrees, Yazel said.
The difference in how people first encounter methamphetamine versus opioids can be different. While opioid use can start in a physician's office and progress to street drugs, Harris said there are few therapeutic uses for methamphetamine, Adderall being one.
Other than that, “there's really no conventional drug that's an upper like that,” he said. “So in that context, there's really no 'gateway drug' that leads you to it.”
But opioid use itself can be a gateway drug — and as accessibility has become more limited, some people switch to methamphetamine or use them both.
“The people I've seen who have shifted tend to be people who don't have a drug of choice,” he said. “Their addictive personalities have led them to whatever it is to get high — and if they don't have one, they just shift to another.”
Harris said ER visits alone can't sufficiently track meth use in the communities — not all states have codes that discern types between drugs when it comes to overdoses, and not everyone who uses meth goes to the hospital.
"It is sort of the tip of the iceberg," he said. "There are a lot of people slowing ruining their health and their lives and you never see them in the hospital."
WHAT CAUSED THE SHIFT
According to the EPIC Methamphetamine Seizure System, domestic production of methamphetamine started a steady rise in the early 2000s, peaking in 2004 with around 23,800 methamphetamine lab incidents logged.
This led to federal regulations to counteract the practice.The Combat Methamphetamine Act of 2006 sought to curtail domestic activity by putting barriers on some ingredients used to make it, like over the counter pseudoephedrine purchases.
The laws seemed to be working. In 2016, the number of lab incidents had dropped to 5,000 nationwide, but with Indiana leading the charge with 945 incidents.
But at the same time, seizures of the drugs coming across the southwest border of the U.S. have risen. According to the U.S. Customs and Border Protection, there were around 5,000 kilograms of methamphetamine confiscated at the border; in 2016 that was up to more than 20,000.
"Meth is being made in Central America, just like opioids and marijuana are coming in," Loop said. "And people can get it a lot cheaper through the general channels than they can trying to make it [domestically]."
The health and safety officials say that while treating the opioid issues is definitely not a closed case, there needs to be collaboration to address the current and future shifts in drugs has on the people who use them and the community in general.
They say it's got to be a multi-pronged approach — no one agency can do this alone. And it may not be able to be done without collaboration at the state and federal level as well.
DeMoss said the biggest thing law enforcement can do is stay at it — trying to stop the supply when they can.
“We're fighting a losing battle,” he said. “But if we don't keep on doing what we're trying to do every day, it will be total anarchy.”
He said there also needs to be more available funding at the federal and state level to help — more resources to not only fight the crimes, but get people into treatment.
“You get a lot of people that want treatment, they desperately want it,” he said. “And you can't treat an addict who's been an addict for several years in 30 or 60 or 90 days. [It's] long-term support and care that they need.”
In Floyd County, Loop said he and his officers will continue to try to get drugs off the streets through dealer arrests, no matter what the drug. But he's been talking with legislators for the past year on getting laws drafted that are not just specific to opioids, but inclusive for what may come.
“Instead, we need to identify dangerous drugs and write legislation with a broader brush,” he said.
Yazel and Harris say that the framework and partnerships that have been forming through the opioid crisis can help with what is happening now.
“It's really important to be able to respond to emerging trends and start dealing with it before it explodes all around you,” Yazel said. “I think we saw the opioid crisis kind of perforate around us and I think we're just now starting to put together a pretty good framework on how to address it — but it's probably two to three years too late.
“Of all things, I want to make sure we learn from our previous mistakes to be proactive rather than reactive.”