Tag: methamphetamine

Addiction, Featured

Seeking a Medical Approach to Meth Addiction, Seattle Researchers Look to Other Stimulants

As meth use and overdoses spike, particularly on the West Coast, researchers in Seattle are proposing a taking a medical approach to addiction‚ replacing with other stimulants in much the same way as methadone and suboxone replace heroin with alternative opiates. But propaganda painting the drug as uniquely addictive makes funding a challenge.

Here’s an excerpt from my latest piece at HuffPost; check out the whole story As meth use and overdoses spike, researchers in Seattle are proposing a medical solution that replaces meth with other stimulants. But propaganda painting the drug as uniquely addictive makes funding a challenge. Check out my latest at HuffPost.

At some point between their son’s stints at sober houses, jail and 14 rehab centers, Annie and Richard Becker gave up hope that he would ever stop using meth.

The Beckers, who live in Seattle, haven’t seen their son in more than a year. Before meth, their son was “really caring, very funny and likable,” the kind of guy who “didn’t like to see anybody else picked on or harmed,” Richard said.

After meth, he was scary and unpredictable ― the kind of guy who thought nothing of throwing a brick through his parents’ window or threatening his mom, Annie said.

“I think when he was most dangerous to us is when he was in withdrawal and couldn’t get drugs, and we became the target,” she said.

There are medications to help with opioid addiction, including methadone ― in use since the early 1970s ― and buprenorphine, which became widely available in the last decade. Both drugs are substitute opiates that can take away the destructive urge to use and give people a chance at housing, medical care and stable relationships. But there are currently no similar treatments for methamphetamine addiction.

“I’ve always felt like, is anybody paying attention to the fact that there’s all these meth users who don’t have any kind of treatment?” Richard said.

While there have been some studies that tried substitute stimulants to treat methamphetamine addiction, the results have been mixed, leading some to conclude that a medical treatment for meth addiction is unlikely.

But a team of researchers in Seattle wants to challenge that theory. Their plan is to give relatively high doses of methylphenidate ― better known as the ADHD drug Ritalin ― to patients who are already in treatment for opiate use disorders and also use meth. The proposed pilot, which still needs about $500,000 in funding, is not yet underway. It would be a joint effort between Evergreen Treatment Services (ETS), the University of Washington and the Seattle Public Defender Association. Although the Seattle City Council declined to provide public funding for the program in its last budget cycle, researchers are optimistic that grants or federal dollars will come through. If researchers see significant results, the pilot could be expanded to include more patients.

“What we really want to see is a very substantial reduction in use, so that you could say this is making an impact on people’s lives, in terms of improving physical health, psychological health, reducing criminal activity, and improving their ability to take care of the basic things in life,” said Dr. Paul Grekin, the medical director at ETS.

Seattle seems primed for this kind of experiment. Meth use has been growing quietly across the United States for years in the shadow of the opiate epidemic, but the increase has been particularly acute on the West Coast, where meth now causes more overdose deaths than any other drug. In Washington state, meth overdoses killed about one person every day in 2016. In King County, which includes Seattle, there were 164 meth overdose deaths last year, outpacing heroin as the leading cause of overdose deaths.

Meth has become cheaper, more contaminated and more potent in the last several years, according to front-line emergency service and case workers, leading to an increase in dangerous symptoms like cardiac arrest, strokes and hyperthermia, a condition where the body essentially burns itself alive. That’s on top of the more common symptoms of meth use, such as psychosis, dental problems, injuries, malnutrition and diseases transmitted through needles or risky sex.

Continue reading at HuffPost.
Addiction, Drugs, Health, King County

As King County Grapples With Heroin, Another Lethal Drug is on the Rise
Image Credit: SBSArtDept

This story originally appeared at Seattle Magazine.

As political leaders focus their attention on the ongoing epidemic of heroin and prescription opiate addiction—an epidemic that claimed 132 lives in King County in 2015, the last year for which statistics are available—another drug crisis may be developing right under their noses.

Since 2010, according to data just released by the University of Washington, the number of deaths related to methamphetamine has risen steadily throughout Washington State—from 1.8 deaths per 100,000 state residents in 2010 to 4.9 per 100,000 in 2015. In King County, the number of meth-related overdoses increased by 257 percent between 2003 and 2015. Dr. Michael Sayre, the medical director for the Seattle Fire Department and a Harborview-affiliated emergency medicine doctor, calls the uptick in meth ODs “the most significant trend in drug-related mortality” in the region.

Caleb Banta-Green, a researcher with the University of Washington’s Alcohol and Drug Abuse Institute and a member of the King County Heroin and Prescription Opiate Addiction Task Force, says one reason for the uptick in meth use is the fact that “cocaine availability has tanked in the last five years.” Meanwhile, meth has become more potent and readily available than ever before. People appear to be using meth as a cocaine substitute, even though, according to Banta-Green, the two drugs are quite different—cocaine is shorter-lived and less intense than meth, which can provide 20 times the dopamine hit and last many hours longer.

“You don’t hear a lot of people saying, ‘I use cocaine because it helps me stay at my job longer.’ You do hear people say that about methamphetamine,” Banta-Green says.

So why haven’t you read about this emerging epidemic? One of the reasons may be simply that, unlike for opiates, there aren’t any particularly effective medical interventions for meth overdoses or addiction. When someone overdoses on heroin, for example, emergency responders, or even a lay person with the right equipment, can quickly reverse the overdose by giving the victim a shot of Narcan, a drug that restores heart function and breathing. There is no similar drug for meth ODs, which overload the cardiovascular system with adrenalin and can lead to heart failure, stroke, seizures and hyperthermia (overheating). A stimulant overdose “definitely requires medical attention,” Sayre says. “It’s not something that a layperson or even a medically trained person without the proper resources can appropriately manage.”

 

So why haven’t you read about this emerging epidemic? One of the reasons may be simply that, unlike for opiates, there aren’t any particularly effective medical interventions for meth overdoses or addiction.

 

Methamphetamine addicts seeking treatment face a similar dearth of medical (as opposed to behavioral) treatment options as those with other addictions. While heroin addicts have the option of medication-assisted treatment with methadone or buprenorphine (Suboxone), two prescription opiates that serve as replacements for more harmful drugs like heroin, there is still no medication-assisted treatment for stimulants like meth. Drug replacement therapy with other stimulants like Adderal (a drug that’s very closely related to meth) doesn’t appear to work and can be dangerous to users who already have high blood pressure and enlarged hearts; and although two antidepressants, buproprion (Wellbutrin) and mirtazapine (Remeron) have shown some promise in reducing meth use in chronic users, neither has been widely tested or shown impressive results.

“I’m not very optimistic that we’re going to get a good medication any time soon,” says Dr. Andy Saxon, who directs the Center of Excellence in Substance Abuse Treatment and Education at the Veterans Administration in Seattle.

Instead, Saxon says that the best treatment he’s found for meth addiction is a behavioral approach called contingency management, where users are given rewards with some monetary value if they stop or reduce their use. The VA, for example, uses what Saxon calls the “fishbowl technique.” Veterans who pass a drug test get to pull a card from a fishbowl (or more than one card if they’ve passed several tests in a row); the reward on the card could be anything from verbal reinforcement (“Nice work”) to a $100 gift card for the VA store. The idea is to replace the hit of dopamine produced when a user takes a drink or a hit with a monetary reward, since both rewards act on the same pleasure center in the brain. Other moderately effective treatments include cognitive behavioral therapy, relapse prevention, and motivational interviewing, all mainstays of traditional treatment programs.

None of those treatments is particularly effective (according to Saxon, about half the people who are in the VA’s behavioral treatment programs manage to reduce their use), and all are significantly more expensive than medication-assisted treatment for opiates, which may consist of nothing more than a prescription for a replacement drug. Nor is it easy to reach meth addicts, particularly those who are homeless or living in marginal housing; unless they are injection users or use other injection drugs like heroin, meth users aren’t coming in to needle exchanges, and they typically leave emergency rooms with little more than a recommendation to seek further treatment and a “good luck.”

Sayre suggests a few solutions that could help meth users in the immediate and long term. First, he says, the state needs to do everything it can to ensure that users in crisis feel safe seeking help. Existing “Good Samaritan” laws, which shield people seeking medical help for an overdose from prosecution, should be expanded to cover people who are on parole, on probation, or who have outstanding warrants. Second, existing outreach programs, such as needle exchanges, should provide incentives for meth users to come in and access their services, such as providing new, unbroken meth pipes. (The People’s Harm Reduction Alliance, which runs a needle exchange in the University District, already does this.) And third, “maybe we need to think more seriously about offering safe spaces and more help for people who are tweaking”— overstimulated on meth—where they can get access to treatment and other services.

As it happens, the county has already proposed creating such a space. It’s called a community health engagement location (colloquially known as a safe consumption site). But it’s generated significant controversy, and is currently the subject of an initiative designed to ban all such facilities across the county.