Although frequently overshadowed by the opioid epidemic, surging methamphetamine use nationally and around the world has fueled a chilling crisis of its own, according to a new report.
The result is a significant increase in meth-related deaths from unique cardiovascular consequences that researchers are trying to understand.
Methamphetamines can cause blood vessels to constrict and spasm, dangerous spikes in blood pressure, and the rewiring of the heart's electrical system, among other potentially fatal heart-related problems.
"Cardiovascular disease represents the second-leading cause of death among methamphetamine abusers following only accidental overdose," according to the report published Wednesday in the American Heart Association's journal Arteriosclerosis, Thrombosis, and Vascular Biology.
The report reviews current research on methamphetamine and the drug's effect on heart disease and stroke. "It discusses potential mechanisms behind those effects and highlights our deficiencies in understanding how to treat methamphetamine-associated cardiovascular dysfunction."
Methamphetamine, also known as crank, ice, crystal meth, speed and glass, is a highly addictive stimulant that can be smoked, snorted, swallowed or injected.
Meth users tend to show evidence of cardiovascular disease at greater intensity and at younger-than-typical ages, according to the report. The review also looked at how methamphetamine leads to a type of blood pressure that affects the heart and the arteries in the lungs, and how it can lead to an abnormal heart rhythm, called arrhythmia, and change in the structure of the heart muscle, or cardiomyopathy.
The drug's popularity has been reflected in emergency room visits. Amphetamine-related admissions to hospitals soared by more than 270 percent between 2008 and 2015, according to a study published last fall.
One reason for the drug's growth is that methamphetamine has been easier, and cheaper, to buy. Seizures at the U.S.-Mexico border increased tenfold from 2010 to 2018. A surplus of the drug has been documented in Southeast Asia.
But the rise in methamphetamine use has been overshadowed by an opioid epidemic full of headline-grabbing tragedies.
"When people look at overdose deaths from drugs, opioid is a much bigger problem. But what people are overlooking is the fact that meth users, while they're not overdosing, they're dying of other things. They're dying of heart attacks, they're dying of heart failure," said Wayne Orr, senior author of the report.
"A lot of the time, a meth user will come off of the methamphetamines, try to get clean, and the severe dysfunction in their cardiovascular system really limits their ability to function in society to work, and that can lead to enhanced relapses," said Orr, director of the Center for Cardiovascular Diseases and Sciences at Louisiana State University Health Shreveport.
The new report is a thorough review of what cardiologists are increasingly facing, said Dr. Isac Thomas, an assistant professor at the University of California, San Diego School of Medicine.
"It's a growing body of literature but frankly, there's an overall dearth of research. This problem is just rapidly accelerating," said Thomas, who was not involved in the report but has conducted several studies on the topic. Earlier this year, he released research that found widespread meth use has created a unique form of severe heart failure, often in younger patients.
"With production, trafficking and potency on the rise, methamphetamine is expanding to more and more parts of the country and the world," Thomas said, "and that's outpacing our knowledge of how to manage and treat it, and what kind of mechanisms are involved in terms of how it's causing cardiovascular disease."
For the medical community, the report discusses potential mechanics involved in the heart damage at a molecular level. It also stresses the need for more research and public awareness.
"I'm quite sure that people who use meth don't understand or appreciate the damage they're doing to their cardiovascular system. That even if they do get clean, the damage already there could be long-lasting," said lead author Chris Kevil, vice chancellor for research and professor of pathology at LSU Health Shreveport.
He said he and his colleagues can recite stories of people who have tried to bounce back from meth use.
"They've gotten clean after using meth for many years, and then all of a sudden they have a massive heart attack due to just getting excited at their son's football game," Kevil said. "They don't realize that it's like a ticking bomb in them. On top of that, neither do their primary care physicians, most likely. This is an education concept for both the public and health care professionals."
Nanette Castillo grieves next to the body of her dead son, Aldrin.
NYC meth deaths up sharply*
by Duncan Osborne | GCN | Sep 4 2019
While overdose deaths from meth use continue to be a small part of all drug overdose deaths in New York City, a significant increase in meth overdose deaths that was first seen in 2015 and 2016 continued into 2017 and 2018.
There were 66 meth overdose deaths in the city in 2018 and 64 such deaths in 2017 — compared to just 18 in 2013.
Last year, benzodiazepines were also present in 52 percent of the meth-involved deaths and fentanyl was present in 48 percent of the methamphetamine deaths, according to data from the city’s Department of Health and Mental Hygiene. Cocaine was found in 39 percent of overdose deaths involving meth in 2018.
Nationally, fentanyl, an opioid, has been blamed for a substantial increase in drug overdose deaths in recent years, with the drug being found mixed with heroin, cocaine, methamphetamine, and other substances.
Overall, there were 1,444 overdose deaths in New York City in 2018. Sixty percent of 2018 overdose deaths in the city involved the use of fentanyl, followed by heroin being present in 51 percent of such fatalities.
The city health department continues to recommend that people who are using drugs carry naloxone, a medication that can reverse the effects of an opioid drug overdose, and advises residents to not mix drugs. Users should also be accompanied by others who can administer naloxone if the medication is needed.
“The decrease in drug overdose deaths is promising, but far too many New Yorkers are still dying,” Dr. Oxiris Barbot, the city’s health commissioner, said in a statement regarding the downturn in total deaths. “We are closely monitoring the trends of the epidemic as they evolve and responding to upticks in emergency department visits and deaths with targeted strategies and community engagement. We remain firmly committed to expanding life-saving services and caring for New Yorkers who use drugs.”
The city health department reported that there were 55 methamphetamine overdose deaths in the city in 2016 and 61 such deaths in 2015. Those numbers represent an increase of more than 200 percent compared to the 18 overdose deaths attributable to meth in 2013. Compared to the 35 meth overdose deaths in 2014, the increases in 2015 and 2016 — 74 percent and 57 percent, respectively — are smaller, but altogether the data clearly indicate a trend of increases in deaths attributable to crystal.
While overdose deaths from meth use continue to be a small part of all drug overdose deaths in New York City, a significant increase in meth overdose deaths in the city first seen in 2015 and 2016 continued into 2017 and 2018.
Dr. Bruno Chaves has performed over 1200 treatments with ibogaine in hospital without a single adverse event. 62% of those treated remain abstinent long term. Dr. Chaves is currently accepting new patients for treatment in hospital in São Paulo, Brazil. For more information, contact Dr. Chaves directly at : [email protected] -pb
Cheap and powerful 'meth 2.0' ravaging communities and slowly killing its victims*
by Christine Vestal | Pew/Stateline | Nov 2 2019
The opioid epidemic appears to be subsiding in the northwest corner of South Carolina, a region known as Upstate. Some refer to this area as the Upcountry. Nationwide, the number of opioid-related overdose deaths is declining slightly. But a new variety of methamphetamine is taking its place as the No. 1 drug of abuse.
By most accounts, meth is much harder to quit. And the latest version of the illicit drug flooding the nation is cheaper than ever before.
Primarily imported from Mexico, “meth 2.0” is stronger, cheaper and far more plentiful than the old home-cooked variety. And with historic levels of funding from the federal government focused exclusively on fighting opioid addiction, states and counties are scrambling to find resources to combat this most recent drug plague.
In the small city of Greenville, Faces and Voices of Recovery staff work around the clock to provide a place people struggling with meth addiction can come to talk. CEO Rich Jones spends many evenings and weekends fundraising because little federal or state money exists to provide the kind of long-term support people in recovery from meth addiction need, he said.
Across town, Rebecca Maddox runs Phoenix Center’s Serenity Village, a women’s residential addiction treatment facility. The center receives substantial funding from Medicaid because patients are either pregnant or have custody of their children and therefore qualify for the federal-state health plan for low-income people.
She said federal funding for the center has remained flat for more than a decade, except for recent money targeted for treating opioid addiction. But data showed that opioid use was declining in Greenville, so “we didn’t get any of that money this year,” she said.
Sixty-three percent of the 81 women admitted to Serenity Village last year were treated for meth addiction. They include Haas, who is staying at the center with her three children.
When her heroin addiction caused her to lose everything, including her children, Haas said she decided to quit. Feeling sick and depressed as she came off the powerful drug, “some friends gave me meth and told me it would make me feel better,” she recalled. “It made my sickness go away, or maybe I just didn’t care about it anymore.”
For a time, Haas got her kids back. But within weeks, meth began to take an even bigger toll on Haas’ life. She lost custody of her oldest kids again, yet she said she still found it impossible to quit. After losing custody of her youngest, who just turned 1, she said she "knew it was time to quit."
She checked into Serenity Village, and for the first few weeks, Haas said she "struggled every minute of the day. But now, after nearly three months, “the pull” is starting to fade."
“When I get that pull,” she said, “I know I need to find someone who will tell me to play that tape again about what’s going to happen to me and my kids if I pick up,” she said, meaning if she started to use again. “I just need to find somebody to talk to.”
Harder to stop
Pickens County, about 20 miles west of Greenville, has been hit hard by the meth surge.
Tucked into the foothills of the Blue Ridge Mountains and home to Clemson University, Pickens County is a destination for wealthy retirees who build multimillion-dollar homes on the shores of Lake Keowee and other scenic spots.
But jobs have been scarce and wages low ever since the cotton mills closed in the 1990s, creating stress and anxiety for many residents. That and its proximity to drug trafficking routes – it is less than 20 miles off Interstate 85, the main artery to Atlanta – have contributed to soaring meth use.
Between 2016 and 2017, the number of people seeking treatment for meth addiction nearly doubled in Pickens and the other nine counties in the Upstate region, according to data from the state drug and alcohol agency.
In the midlands and coastal regions of the state, including Charleston, opioid addiction and overdose deaths remain the biggest threat, according to state data.
At Cafe Connections, a “coffeehouse ministry” in the town of Pickens, much of the talk is about families whose lives have been shattered by meth. The drug offers boundless energy to work extra shifts or clean the house – until it turns ugly.
“I can see on a personal basis what meth and other drugs are doing to our community. Homelessness wasn’t a problem in Pickens a few years ago. Now, it’s a big problem,” said Ann Corbin, who runs the cafe with her husband, Steve, and with support from the East Pickens Baptist Church and volunteers. Coffee, sweets and conversation are free at the cafe, a big airy former drugstore with cafe tables and cushy upholstered couches and chairs clustered along brightly painted walls.
"Everyone here knows someone who uses meth or has lost a family member to its ravages," Corbin said. "People have set aside long-held prejudices against drug users to focus on helping families who have been destroyed by meth."
The leap in deaths has been dramatic. The Pickens County coroner, Kandy Kelley, said 25 people died of a drug overdose in the county last year, topped by 39 as of September this year, mostly from a combination of meth, opioids and other substances.
At Behavioral Health Services of Pickens County, a state-funded drug treatment center a few doors down from the cafe, more people are seeking treatment for meth addiction than ever before, Executive Director Angela Farmer said. And those in treatment are having a much tougher time quitting.
Farmer, a licensed counselor and Pickens native, has seen a lot of changes in the habits of Pickens drug users over the 22 years she’s worked here.
"More meth users are injecting the drug than smoking or snorting it as they did in the past," Farmer said, "and people are starting to use it at a younger age."
“Our patients are struggling a lot more and they relapse more, and it takes them longer to engage in treatment,” Farmer said. “Most of our patients are compliant with their treatment for opioids, but they find it harder to stop using meth.”
With roughly 2,400 clients in a county of 120,000, Behavioral Health Services, which occupies nearly a full block of offices on Main Street, is bursting at its seams.
The county’s 50-year-old jail also is overflowing. In November, a new facility will open, providing more than triple the current jail’s capacity. And its staff will include an addiction treatment practitioner and a mental health counselor, thanks to a grant from the U.S. Justice Department.
“We haven’t been able to respond to as many of the drug-related crimes as we would like in the last couple of years, because we haven’t had anywhere to put them,” Pickens County Sheriff Rick Clark said. “It’s always a balancing act.”
Clark and other law enforcement officials say most of the meth supply in the region comes from Atlanta, where illicit labs convert liquid methamphetamine from Mexico into crystal powder for dealers to distribute across the South.
Not the ‘pretty people’
Nationwide, the advancing meth scourge has yet to capture the kind of public response the opioid epidemic was, even though the nationwide spike in meth-related deaths in the past two years was steeper than the spike in opioid deaths two decades ago when that crisis began.
In the first decade of the opioid epidemic, the number of overdose deaths rose fourfold, from 3,400 in 1999 to 13,500 in 2009, based on a Stateline analysis of data from the U.S. Centers for Disease Control and Prevention. With the advent of cheap and powerful imported meth, the spike in deaths has been much sharper. Meth overdose deaths increased fourfold in half as much time, from 2,600 in 2012 to 10,300 in 2017.
Still, meth users are less likely to die of an overdose than users of painkillers and heroin. Instead, meth kills most of its victims slowly.
Opioids cause relatively little physical damage to chronic users, unless they take too high a dose. But meth takes a severe mental and physical toll on chronic users, destroying their appearance and substantially shortening their lives.
“If you want to know whether a town has a meth problem, just go to Walmart and take a look around,” Pickens Chief Deputy Chad Brooks said. "Its symptoms are unmistakable: rotting teeth, skin lesions, extreme weight loss and premature aging."
The CDC only records meth-related overdose deaths – typically heart failure or stroke – resulting from using too much of the drug in a short period. It doesn’t include deaths from long-term use.
"Despite the nation’s growing recognition because of the opioid crisis that addiction is a disease," Sheriff Clark said, "society still tends to look down on meth users."
“I hate to say this,” Clark said, “but the reason we’re not hearing as much about the meth problem at the national level is that we don’t have as many pretty people dying of meth as we do with opioids.”
‘Rapid downhill course’
On average, patients addicted to meth require at least 90 days of intensive counseling and therapy to get started on recovery. And even then, nearly all of them can be expected to relapse multiple times before reaching sustained recovery, treatment experts say.
“Crystal meth accelerates the reward circuits in the brain more powerfully than any other drug we have,” said Dr. Paul Earley, an addiction physician in Georgia and the board president of the American Society of Addiction Medicine.
“There’s no doubt that it causes the most rapid downhill course of any drug."
“With heroin, some people can go on using the drug for 30 or 40 years without medical problems, as long as they dose it right,” the doctor said. “But with meth, 100% of people who use the drug experience severe and rapid physical deterioration.”
The Federal Drug Administration has approved three medications for the treatment of opioid addiction. Research is underway on meth addiction medications. Behavioral Health Services is one of seven sites funded by the National Institute on Drug Abuse in a study of the effectiveness of two drugs – extended-release bupropion sold as Wellbutrin and extended-release naltrexone sold as injectable Vivitrol – in easing detoxification and promoting recovery from meth addiction.
Farmer said Wellbutrin, a mild stimulant, seemed to alleviate the depression and exhaustion that typically occurs when people are coming off meth. She didn’t see as much evidence for Vivitrol warding off cravings.
But so far, no medications have been clinically proven to be effective in the treatment of meth addiction.
“If someone is addicted to opioids, they can get medication-assisted treatment pretty quickly,” said Charlie Stinson, executive director of GateWay Counseling Center, a state-funded treatment center in Clinton, another hard-hit Upstate town.
“The problem is if they kick that addiction and start using meth, they can be out of luck when they decide it’s time for treatment.”
Sharlene Kaye, Johan Duflou, Rebecca Mcketin, Shane Darke
There is sufficient clinical evidence to suggest that methamphetamine can have adverse and potentially fatal effects on the cardiovascular system. The existing literature suggests that: (1) meth users are at elevated risk of cardiac pathology; (2) risk is not likely to be limited to the duration of use, because of the chronic pathology associated with methamphetamine use; (3) the risk of cardiac pathology is greatest among chronic methamphetamine users; (4) pre‐existing cardiac pathology, due to methamphetamine use or other factors, increases the risk of an acute cardiac event; and (5) meth use is likely to exacerbate the risk of cardiac pathology from other causes, and may therefore lead to premature mortality.
Iboga accumulates in the body. It remains in the body for more than 4 weeks. This means that all the drops you take in a 5-week period will accumulate and remain in your body until they slowly wear off. If the dose you take exceeds 10 drops a day, physical and psychological effects can occur. Be aware of that some people respond very sensitively to a few drops only. It is important to listen to the signs of your body at all times, and adjust your dosage accordingly. Do not take the iboga tincture before going to sleep. The plant gives you energy and might cause insomnia.
Whilst treating yourself with iboga, it is advisable to keep stimulants—such as coffee—to a minimum, as well as tobacco or certain herbs. Your receptors will become very sensitive and you may have an unexpectedly strong reaction to them. It is strongly discouraged to combine iboga with other psychedelics. Iboga should never be combined with anti-depressant medication such as SSRI's. Such a combination would be very dangerous.
Doctors and treatment providers have found that daily low doses of iboga seem to work better for meth addiction than the mind-blowing "flood doses" used on opiate addicts.
"I’ve seen things you people wouldn’t believe. Attack ships on fire off the shoulder of Orion.
I watched C-beams glitter in the dark near the Tannhäuser Gate. All those moments... will
be lost in time, like… tears in rain... "
Meth the most common drug in overdose deaths in 19 states*
by Mike Stobbe | Associated Press | Oct 24 2019
Fentanyl is driving drug overdose deaths in the U.S. overall, but in nearly half of the country, it's a different story. Meth is the bigger killer, a new government report shows.
Nationwide, most deaths still involve opioid drugs like fentanyl and heroin. But in 2017, the stimulant meth was the drug most frequently involved in deaths in four regions that include 19 states west of the Mississippi.
The report released Friday by the Centers for Disease Control and Prevention is the agency's first geographic breakdown of deaths by drug. It's based on 2017 figures when there were more than 70,000 overdose deaths in the U.S., two-thirds of them involving opioids.
Fentanyl was involved in 39% of the deaths that year, followed by heroin, 23%, and cocaine, 21%. Those drugs top the list in the eastern part of the country.
Methamphetamine was No. 4 nationwide, cited in 13% of overdose deaths. But in the four western regions, it was No. 1, at 21% to 38%.
Previous CDC reports have charted meth's increasing toll, noting that it rose from eighth to fourth in just four years.
The new report found dramatic differences in the 10 regions. For example, In New England, fentanyl had the highest adjusted overdose death rate and meth was a distant 10th on the list. In the region that includes the mountain states and the Dakotas, meth was No. 1 and fentanyl was sixth.
Most of the meth in the U.S. is made in Mexico and smuggled across the border — U.S. production has actually been declining in recent years, according to the U.S. Drug Enforcement Agency. Its availability has held at high levels in recent years in areas of the Southwest, and has increased in some areas of the Midwest, the agency's field offices report.
Final 2018 data has not yet been released, but preliminary figures suggest that overdose deaths involving meth increased.
The CDC report is based on a search of overdose death certificates for the name of drugs. In many cases, a person was taking multiple drugs.
Since the report is the first of its kind, how meth factored into overdose deaths regionally in the past isn't known.
"New Mexico has seen a shift. For years, black tar heroin was the biggest problem, then prescription painkillers," said Dr. Michael Landen of the state's health department. State meth deaths went from 150 in 2017 to 194 last year, vaulting meth to the top.
"It's really been the first time we've seen that," said Landen.
He attributed the surge in meth to its wide availability and low cost, and said he worried it could get worse. "While there are programs to deal with fentanyl and heroin overdoses, there's not much in place to prevent meth deaths," he said.
"I think we're going to be caught off guard with methamphetamine deaths, and we have to get our act together," he said.
NEW YORK (AP) — Fentanyl is driving drug overdose deaths in the U.S. overall, but in nearly half of the country, it's a different story. Meth is the bigger killer, a new government report shows. Nationwide, most deaths still involve opioid drugs like fentanyl and heroin. But in 2017, the...
Meth, not fentanyl, driving overdose deaths in the western US
by Erin Schumaker | ABC | Oct 25 2019
Although fentanyl use remain a pressing concern in the United States, a government report that details regional differences in drug overdose deaths shows that in much of the country, methamphetamine is a bigger killer.
In the majority of states west of the Mississippi River, methamphetamine was the most common drug implicated in drug overdose deaths, according to the report, which utilized data from 2017, the latest available, and which was released Friday by the Centers for Disease Control and Prevention.
In states east of the Mississippi River that trend was reversed, with fentanyl the most common drug implicated in overdose deaths in 2017.
"What's interesting is that the patterns are different across the U.S.," said Dr. Holly Hedegaard, an epidemiologist at the CDC's National Center for Health Statistics and co-author of the report.
Hedegaard noted that since the report is a one-year snapshot of overdose deaths, it doesn't provide insight into whether fentanyl deaths are rising or falling in the western U.S.
"We have to recognize that the drug problem isn't the same across the entire U.S.," Hedegaard added.
While the report didn't examine potential underpinnings of those drug overdoses patterns, Dr. Zachary Dezman, an assistant professor of emergency medicine at University of Maryland School of Medicine, who was not associated with the report, pointed to regional variation in substance use throughout history.
"Like all culture, it varies from region to region and is a a result of history, demand, law enforcement," Dezman said.
In Baltimore, where Dezman is an emergency physician, heroin has been the most commonly misused substance among residents for decades, he explained, adding that since meth use in the U.S. started in California, that could explain the drug's stronger regional foothold.
"Meth can be made cheaply using materials found on most farms," Dezman said. "A large amount of toxic waste is produced in the process, so meth is more often produced in rural or isolated areas where it is easier to hide from the authorities."
For people who use methamphetamines, treatment and resources are slim. Opioid addiction can be treated with the medications buprenophine or methadone, and opioid overdoses can be reversed with the drug naloxone. "There's no FDA-approved medication for methamphetamine treatment, nor any overdose reversal drug to revive people," Dezman explained. "Developing such a treatment is a top research priority for the National Institute on Drug Abuse," he added.
Despite the regional implications of the report, fentanyl is still driving the nation's opioid crisis. The potent opioid, the most frequently cited substance in drug overdose deaths, was involved in 39% of those cases in 2017.
"Clearly, fentanyl continues to be a problem," Hedegaard said.
In comparison, nationwide, heroin was involved in 23% of overdose deaths, cocaine was involved in 21% and methamphetamines were involved in 13%.
The nation's drug overdose death rate has more than tripled since 1999, with 70,000 cases in 2017, according to the CDC.
Meth involved in one-third of all drug-related deaths in western states*
Filter | Nov 7 2019
In July 2019, the Center for Disease Control and Prevention (CDC) released preliminary data suggesting that national overdose deaths slightly declined in 2018 for the first time in 20 years. But on a state-by-state level, that’s not the case. While the parts of the United States with the highest rates of opioid-involved deaths, like Appalachia, are seeing overall drops in fatalities, the western part of the country is seeing an escalating crisis.
Researchers have suspected that methamphetamine has been involved in growing numbers of deaths in these regions, but because of the drug’s inclusion in broad data categories, like “psychostimulants with the potential for abuse,” they’ve had difficulty proving it.
A new report by the CDC was able to get around this issue. The researchers behind a study published on October 25, 2019 circumvented the usual roadblocks to identifying the exact drug, or drugs, determined to be involved in deaths by using a “literal text search” of death certificates for the specific mention of certain drugs.
Their research indicates that meth, specifically, was involved in around one-third of all drug-related deaths in western states in 2017. Using regions defined by the Department of Health and Human Services Regions to locate deaths, the researchers found that Region 9, a group of states including California, Nevada, Arizona, and Hawaii, saw 2,741 meth-involved deaths, involved in 37 percent of all drug fatalities across the four states.
In contrast, heroin was involved in 16 percent of drug-involved deaths in the area. The deaths across these states occurred occurred at a rate of a 5.2 per 100,000 people, with a higher meth-involved death rate than in any other HHS region—though the fentanyl-involved death rate was still far higher.
The findings are important but not necessarily groundbreaking. The report notes that the stark contrast between the western United States and the Northeast, for example, has been shown elsewhere. In 2017, methamphetamine was far more likely to be involved in seizures among folks in the West census region (46 percent) versus the Northeast census region (2 percent).
Media outlets are now beginning to ring the alarm bells about the role of meth use in driving fatalities. But public officials’ albeit-understandable preoccupation with opioid-involved deaths has long veiled this issue.
The CDC data, once more, underscores how myopically focusing on the harms of one drug can allow the harms associated with another to swell.
Ibogaine is an indole alkaloid isolated from the root bark of the African tree Tabernanthe Iboga, known to cause Long QT Syndrome (LQTS) — a dangerous condition that can lead to cardiac arrhythmia and death. But the risk is manageable. Dr. Bruno Chaves of Brazil has performed over 1200 treatments with ibogaine in hospital without a single adverse event. 62% of those treated by Bruno remain abstinent long term. Dr. Chaves is currently accepting new patients for treatment in hospital in São Paulo. For more information, contact Dr. Chaves directly : [email protected]
Stevon Williams (right), a homeless veteran, describes the effects of the “goofball,” a potent combo of meth and
fentanyl. With him on a plaza near the Embarcadero is David Valenzuela.
Bay Area death toll from drug overdoses passes 10,000*
by Erin Allday and Kevin Fagan | SF Chronicle | Nov 30 2019
More than 10,000 people have died across the Bay Area in the drug overdose epidemic, but the main killer hasn’t been prescription painkillers for several years — methamphetamine is now the biggest cause of deaths, and overdoses on the super-potent opioid fentanyl are spiking.
Nationally, millions of people have died in the opioid overdose crisis, using prescription painkillers and similar street drugs like heroin and fentanyl.
The Bay Area was never as hard hit as other parts of the country by prescription opioid overdoses. But it has endured an epidemic of deaths from a variety of other street drugs that is continuing to evolve and concern public health officials.
A Chronicle analysis of data from the California Department of Public Health found that 10,005 people have died in the nine Bay Area counties since the state began tracking overdose deaths in 2006, though that number is almost certainly an undercount of actual drug deaths.
The data also show that methamphetamine is now the leading cause of overdose deaths in the state. That statistic is reflected in the Bay Area, where meth overdose rates have tripled over the past decade while deaths from prescription opioids have dropped.
The methamphetamine crisis is a new-old problem, public health officials said. Meth was widespread in the 1990s and it never really went away, but the number of people now dying from it — and from dangerous combinations of methamphetamine and potent opioids like fentanyl — is new, and alarming.
“It’s the new speedball,” said 58-year-old Stevon Williams, a homeless Air Force veteran in San Francisco, describing the “goofball,” which is replacing the old combination of cocaine and heroin. “That combo of meth and fentanyl does the same thing. A lot of people like that.”
Though the public health data demonstrates shifting drug-use trends across the state, it is less precise at capturing overdose deaths caused by multiple drugs. Indeed, the state data as a whole is more subjective than most public health experts would like. It’s dependent upon how coroners and others label the cause of death, and some deaths are investigated much more thoroughly than others.
“It’s important when we’re thinking about overdose deaths that what we’re looking at isn’t necessarily the truth with a capital T,” said Dr. Matt Willis, public health officer for Marin County. “There’s a lot of bias built into the reporting.”
But the data backs up what health care providers, addiction experts and users themselves are experiencing firsthand: Drug overdoses, even in communities spared from the worst of the opioid epidemic, are a public health crisis.
Variations among counties: The data was obtained from the California Opioid Overdose Surveillance Dashboard, and the Chronicle analysis is a unique examination of the drug overdose epidemic in the Bay Area as a region.
The Bay Area consistently has had somewhat lower rates of prescription opioid overdose deaths than the rest of the state, especially compared with some rural counties in Northern California where rates were 10 or 20 times higher. But for all drug overdoses, the Bay Area as a whole comes in close to the state average, about 10 to 12 deaths per 100,000 people per year.
And that rate has been climbing — by about 21% since 2010.
Some local counties are notably higher than others. San Francisco has the highest rates of drug overdose deaths — about 23 per 100,000 in 2018. The North Bay counties of Sonoma and Solano also have higher death rates than the Bay Area average, about 15 per 100,000.
Santa Clara and San Mateo have the lowest rates, around eight deaths per 100,000 last year.
“There are marked differences in relatively small geographic areas. I couldn’t tell you why,” said Dr. Scott Morrow, public health officer for San Mateo County.
Drug overdose deaths have been up and down over the past decade in the Bay Area, but they reached a decade high 13 deaths per 100,000 residents in 2018, according to preliminary state data.
The overall death toll doesn’t tell the whole story, though.
Prescription overdose death rates have fallen slightly in the Bay Area, but deaths from heroin have been steadily increasing. And deaths from fentanyl — a synthetic opioid about 50 times more potent than heroin — have exploded in the past four years.
Opioids as a whole are still bigger killers than methamphetamine alone. But meth stands apart as the single largest killer. And that has public health officials concerned — and confused.
“Meth is not usually a very deadly drug,” said Dr. Daniel Ciccarone, a national drug use and policy expert at UCSF.
Opioids, and especially fentanyl, are so deadly because they can quickly shut down the respiratory system. Methamphetamine kills by essentially overstimulating the heart or the brain, leading to a heart attack or stroke. But in the past, only people who already had cardiovascular issues were at risk of overdoing it with meth — now, younger, otherwise healthy people are dying too.
"With meth overdose death rates climbing, it begs multiple questions," Ciccarone said. "Are more people using meth? Is the drug itself different and more potent? Does combining meth with fentanyl make it deadlier?"
Ciccarone said investigations of the drug supply have found that the meth sold in the United States is indeed stronger than what people were using a 10 or 20 years ago, when meth was primarily made in backyard labs. It’s now manufactured by global drug cartels.
“We have a drug coming in that’s at 90% purity and much higher potency. But we need more studies to say if the meth is more deadly,” Ciccarone said.
Deadly combinations: Combining drugs, especially meth with an opioid like fentanyl, is especially concerning to public health officials. It’s difficult to track those deaths, and dual addictions are more complicated to treat.
Purposely taking methamphetamine with fentanyl, one hit after the other, is like juggling dynamite - but hard-core addicts say they need it. The high of the methamphetamine sometimes needs counteracting with the chill-out effect of the fentanyl, they say. Or alternately, the deeply sedated state caused by fentanyl has to be offset by the rush of meth.
“Speed a lot of times gets you geeked out, with your heart racing and your head pounding, and then fentanyl evens you out,” said Shauna Arteago, 45, who has been homeless but currently lives in a San Francisco single-room apartment. “I smoke them one at a time, and you’ve got to be careful because fentanyl can kill you. I’ve overdosed three times, the last time a few months ago.”
Those who work daily with addicts in the street don’t need statistics to tell them the overdose problem is growing — particularly among the homeless.
Capt. Carl Fabbri, commander of the Tenderloin Police Station, said he often feels like he’s shoveling sand into tides when he and his officers try to intervene with addicts on the street, and it’s heartbreaking.
“We’ve made progress on the dealers, but the victims - the users? It’s almost out of our hands, there are so many,” he said. “It is terribly sad.”
A 39-year-old homeless longtime addict who goes by the street name of Country fired up a bubble — pipe load — of meth near the Ferry Building and said overdoses and addictions in the street “have gotten off the hook in the last year or so.”
“It’s so much more than ever, and I’ve seen it all,” he said.
“I makes me sad seeing so many people do so much drugs out here, but we’re stuck. We need help. You think we all want to be addicted to this crap? No way.”
San Francisco public health officials, who have been collecting data on overdose deaths involving more than one drug, say their analyses show that overdose rates with both meth and fentanyl have more than doubled in just the past two years.
A decade ago, meth was only causing a dozen or so deaths a year and fentanyl wasn’t even tracked. In 2018, roughly 50 people died with both drugs in their system — dozens more died from one or the other.
“The reality is that most drug use is poly drug use. It’s not unusual for people to be using more than one drug,” said Dr. Phillip Coffin, director of substance use research for the San Francisco Department of Public Health.
"Combining meth and fentanyl may be especially risky for a lot of reasons, among them that meth, in particular, leads to 'chaotic behavior' that may prevent people from practicing safer drug practices," he said.
For example, harm-reduction experts advise than anyone using fentanyl start with a small dose, and that they never get high alone, so that if they overdose someone can treat them with Narcan. But if they’re using meth too, people may not be thinking clearly enough to take those precautions.
The “goofball” is not just a San Francisco problem. What’s not clear from data and anecdotal information is how often people are choosing to combine meth with an opioid verus being “poisoned” by fentanyl that is sometimes added to other drugs without users knowing it, public health officials say.
Fentanyl isn’t necessarily pervasive in all Bay Area counties just yet — or at least, it’s not being identified as a cause of death. But not all counties have the laboratory resources to test for the specific opioid found in a person after death. When fentanyl is identified in an overdose, it’s often impossible to know whether the person chose to use it or took it by accident.
“The combination of opioids and stimulants is common,” said Dr. Ori Tzvieli, deputy health officer with Contra Costa County. “But did they die because they were a meth addict and they ended up buying some with fentanyl in it? Or did they die because they’re someone with an opioid overuse disorder who’s using fentanyl now?”
A Chronicle analysis of data from the California Department of Public Health found that more than 10,000 people have died in the nine Bay Area counties since the state began tracking overdose deaths in 2006.