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 when no one was looking. On hands and knees, dragging her IV pole with her, the gravely sick woman incessantly scrubbed.
Meth had found its way into the nursing home. She was suffering from addiction. So she used it.
The psychotic episode happened after Detzel had spent days (and nights) of pushing the drug into the intravenous catheter that her caregivers were using to infuse antibiotics into her infected heart. The infection had come from a contaminated needle.
That catheter, the pathway for lifesaving antibiotics, became just another way to get a drug into Detzel’s body to alter her brain.
This was not heroin, which she’d been through. This was not fentanyl, the deadly synthetic opiate that had rushed into Cincinnati several years ago. This was methamphetamine, the primary drug now flooding the streets of Cincinnati and other communities across the country. It’s a psychostimulant. It can induce psychosis.
That explains the scrubbing.
This new wave of meth is causing police and parents of users and even government officials to shift their focus from opioids to this stimulant – a drug that used to be common, then faded, but is resurging. This time, with much more purity, coming directly from Mexico, not backyard cookeries or houses or sheds.
The rise in meth tested at law enforcement crime laboratories across Ohio and Kentucky is staggering.
Just one example: The 23 drug task forces (including Northern Kentucky’s) that are 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).
But as shocking as that number is, some addiction experts say that we are missing the point behind the new meth wave.
The point: Addiction. The United States has an addiction crisis.
“We just simply move like a herd of locusts from one drug to another,” said Dr. 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.”
Addiction, which has been with us forever, is what needs to be fixed. With evidence-based treatment. The American Society of Addiction Medicine is still clamoring for more doctors to learn about such treatment and to attend to the problem as a disease.
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Historically, the medical system largely ignored addiction, allowing the criminal justice system and treatment programs outside of the health care system to deal with it, said Lindsey Vuolo, director of Health Law and Policy and public affairs for the science-based nonprofit Center on Addiction in New York City.
The grudging change started with the opioid epidemic. As overdose death tolls soared, the mantra 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.
Those who ignore the advice put us at our own peril, experts say.
“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.
So why meth? Why now?
For starters, those who are addicted to opiates are hearing others talk about a new high, cheap and easy to get, and safer than fentanyl.
They are people with addiction, after all, and most people who suffer from addiction will reach for drugs other than the one they primarily use.
Meth is an alternative. But it’s sneaky.
Kalfas calls the current meth problem a new tentacle of the opioid epidemic, noting that most patients he’s seeing 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. 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, of Walnut Hills, who’s in recovery, said she learned about meth while she was in treatment for heroin addiction in Louisville.
“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 that rehab, in May 2017, she decided to find meth.
“It’s just as easy as getting cigarettes at the gas station,” Christian said.
For Detzel, the woman who fell into obsessive floor-scrubbing, drugs were a way to cope with living, she says. Now 35 and in recovery for a year, Detzel was 13 when she was led into a sex-for-drugs trafficking situation orchestrated by someone close to her family.
She did drugs, she said, because it seemed normal.
“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. Anything that I thought would take me to another level.”
And by the time she was 30, meth was simply there for her to try, she said. “Somebody was selling it.”
But Detzel rallied. She was able to maintain sobriety after her stint in the nursing home. She had been 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
Both Detzel and Christian had been introduced to medical help for their initial addictions. There is no medication-assisted treatment available for meth addiction, as there is for opioid addiction.
The best treatment right now for meth addiction is psycho-social therapy, addiction experts say. 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.
Like 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?”
As is usual with treatment, not enough are getting it. 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 that, “absolutely,” treating drug use has to include treating the individual’s trauma.
“What’s causing someone to use? What issues are they going through? 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.
With meth, she was paralyzed, hyper-focused on a single task. Sometimes, she felt empty. She scratched and picked sores onto her body and face. Once, she piloted her car to a hospital, expecting to be locked in a psych ward. But she was discharged.
For her, the confines and rules of the Center for Addiction Treatment saved her, she said. She found sobriety by following the rules, then looking into her own traumatic past.
“If they told me I could not have a pair of leggings, oh well, I can’t have a pair of leggings. 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.”
Both she and Detzel believe their continued 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. She’s been in recovery for just more than a year.
The lessons they learned about their own addictions and how to treat them are holding. But they see the avalanche of meth on the streets now. They know the attraction among opioid users to this drug is real.
In Hamilton County, Dr. 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 – “a sixfold increase.”
In Kentucky, the amount of meth seized and tested at the Kentucky State Police Crime Laboratories rose by 77% in just two years, from 2016 to 2018.
The outcomes of all this meth is yet to be seen.
Dr. Adam Bisaga, an addiction research scientist who is a professor of psychiatry at Columbia University Medical Center, has this prediction for those who use such stimulants along with opioids:
“The mixed stimulant-opioid addiction is a different one,” Bisaga said. “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.”