Overshadowed by opioids, Meth is back and hospitalizations surge

The number of people hospitalized because of amphetamine use is
skyrocketing in the United States, but the resurgence of the drug largely
has been overshadowed by the nation’s intense focus on opioids.

Amphetamine-related hospitalizations jumped by about 245 percent from 2008
to 2015, according to a recent study in the Journal of the American Medical
Association. That dwarfs the rise in hospitalizations from other drugs,
such as opioids, which were up by about 46 percent. The most significant
increases were in Western states.

The surge in hospitalizations and deaths due to amphetamines “is just
totally off the radar,” said Jane Maxwell, an addiction researcher. “Nobody
is paying attention.”

Doctors see evidence of the drug’s comeback in emergency departments, where
patients arrive agitated, paranoid and aggressive. Paramedics and police
officers see it on the streets, where suspects’ heart rates are so high
that they need to be taken to the hospital for medical clearance before
being booked into jail. And medical examiners see it in the morgue, where
in a few states, such as Texas and Colorado, overdoses from meth have
surpassed those from the opioid heroin.

Amphetamines are stimulant drugs, which are both legally prescribed to
treat attention deficit hyperactivity disorder and produced illegally into
methamphetamine. Most of the hospitalizations in the study are believed to
be due to methamphetamine use.

Commonly known as crystal meth, methamphetamine was popular in the 1990s
before laws made it more difficult to access the pseudoephedrine, a common
cold medicine, needed to produce it. In recent years, law enforcement
officials said, there are fewer domestic meth labs and more meth is
smuggled in from south of the border.

As opioids become harder to get, police said, more people have turned to
meth, which is inexpensive and readily available.

Lupita Ruiz, 25, started using methamphetamine in her late teens but said
she has been clean for about two years. When she was using, she said, her
heart beat fast, she would stay up all night and she would forget to eat.

Ruiz, who lives in Spokane, Wash., said she was taken to the hospital twice
after having mental breakdowns related to methamphetamine use, including a
monthlong stay in the psychiatric ward in 2016. One time, Ruiz said, she
yelled at and kicked police officers after they responded to a call to her
apartment. Another time, she started walking on the freeway but doesn’t
remember why.

“It just made me go crazy,” she said. “I was all messed up in my head.”

The federal government estimates that more than 10,000 people died of
meth-related drug overdoses last year. Deaths from meth overdose generally
result from multiple organ failure or heart attacks and strokes, caused by
extraordinary pulse rates and skyrocketing blood pressure.

In California, the number of amphetamine-related overdose deaths rose by
127 percent from 456 in 2008 to 1,036 in 2013. At the same time, the number
of opioid-related overdose deaths rose by 8.4 percent from 1,784 to 1,934,
according to the most recent data from the state Department of Public
Health.

“It taxes your first responders, your emergency rooms, your coroners,” said
Robert Pennal, a retired supervisor with the California Department of
Justice. “It’s an incredible burden on the health system.”

Costs also are rising. The JAMA study, based on hospital discharge data,
found that the cost of amphetamine-related hospitalizations had jumped from
$436 million in 2003 to nearly $2.2 billion by 2015. Medicaid was the
primary payer.

“There is not a day that goes by that I don’t see someone acutely
intoxicated on methamphetamine,” said Dr. Tarak Trivedi, an emergency room
physician in Los Angeles and Santa Clara counties. “It’s a huge problem,
and it is 100 percent spilling over into the emergency room.”

Trivedi said many psychiatric patients are also meth users. Some act so
dangerously that they require sedation or restraints. He also sees people
who have been using the drug for a long time and are dealing with the
downstream consequences.

In the short term, the drug can cause a rapid heart rate and dangerously
high blood pressure. In the long term, it can cause anxiety, dental
problems and weight loss.

“You see people as young as their 30s with congestive heart failure as if
they were in their 70s,” he said

Jon Lopey, the sheriff-coroner of Siskiyou County in rural Northern
California, said his officers frequently encounter meth users who are prone
to violence and in the midst of what appear to be psychotic episodes. Many
are emaciated and have missing teeth, dilated pupils and a tendency to pick
at their skin because of a sensation of something beneath it.

“Meth is very, very destructive,” said Lopey, who also sits on the
executive board of the California Peace Officers Association. “It is just
so debilitating the way it ruins lives and health.”

Nationwide, amphetamine-related hospitalizations were primarily due to
mental health or cardiovascular complications of the drug use, the JAMA
study found. About half of the amphetamine hospitalizations also involved
at least one other drug.

Because there has been so much attention on opioids, “we have not been
properly keeping tabs on other substance use trends as robustly as we
should,” said study author Dr. Tyler Winkelman, a physician at Hennepin
Healthcare in Minneapolis.

Sometimes doctors have trouble distinguishing symptoms of methamphetamine
intoxication and underlying mental health conditions, said Dr. Erik
Anderson, an emergency room physician at Highland Hospital in Oakland,
Calif. Patients also may be homeless and using other drugs alongside the
methamphetamine.

Unlike opioid addiction, meth addiction cannot be treated with medication.
Rather, people addicted to the drug rely on counseling through outpatient
and residential treatment centers.

The opioid epidemic, which resulted in about 49,000 overdose deaths last
year, recently prompted bipartisan federal legislation to improve access to
recovery, expand coverage to treatment and combat drugs coming across the
border.

There hasn’t been a similar recent legislative focus on methamphetamine or
other drugs. And there simply aren’t enough resources devoted to
amphetamine addiction to reduce the hospitalizations and deaths, said
Maxwell, a researcher at the Addiction Research Institute at the University
of Texas at Austin. The number of residential treatment facilities, for
example, has continued to decline, she said.

“We have really undercut treatment for methamphetamine,” Maxwell said.
“Meth has been completely overshadowed by opioids.”

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