Methamphetamine is still a widely used drug in many parts of the United States, and across the country, overdose deaths involving meth have more than quadrupled over a six-year period.
In Oregon, health authorities report that meth is now the leading cause of drug-related deaths in the state. Dr. Andy Mendenhall, chief medical officer for Central City Concern in Portland, Oregon, says meth use has a long history in Oregon.
"But in the last couple of years in particular, we've seen methamphetamine-related deaths outpace opioid-related deaths for the last three years and running," Mendenhall tells Here & Now's Jeremy Hobson.
An uptick in the amount of meth users has contributed to the rise in deaths, Mendenhall says. According to local and regional law enforcement, the meth being sold in Oregon is coming up through California from many Latin American countries.
Mendenhall also says that many meth users in Oregon also have severe polysubstance-use disorder, which means they use more than one drug at once.
"There's a deeper supply chain for methamphetamines that are more pure and more potent," he says. "So therefore, patients are using more substance and suffering fatal consequences."
On the typical person who is addicted to meth
"The typical person who's using methamphetamines is a little bit difficult to characterize. We do see trends associated with poverty. We know that methamphetamines affect many people of lower socioeconomic class and disenfranchised communities with high unemployment. In the Portland metropolitan area and the population we're serving, we're seeing methamphetamine use concurrent with opioid use in many of our homeless patients that have polysubstance-use disorder. We see it ranging from young adults all the way to people in their 50s and 60s who are really treating the pain of their existence, the pain of their life experience — depressed, disenfranchised — with very poor opportunities or at least a belief that the opportunity to change is is of large reach for them."
"Human beings have taken substances to change their consciousness for millennia. And I think that methamphetamines, in a way, are no different."Dr. Andy Mendenhall
On why people start using meth in the first place
"I think that it's a really important question to understand: Why do people seek relief or seek reward through the use of any substance? I think that if we look at human history and look at how we've evolved as a species, human beings have taken substances to change their consciousness for millennia. And I think that methamphetamines, in a way, are no different. I think that there is a great body of science that says that many human beings will seek reward to pathological levels.
"If we think about the National Institute on Drug Abuse — and their director Dr. Nora Volkow, who talked about the disease state of addiction as a chronic, relapsing brain disease that's characterized by compulsive use, despite harm. We have to acknowledge that many of us use substances. We use substances without significant harm, and that represents the vast majority of people that do use substances. And that's really a ubiquitous part of the human condition whether we're talking about the social use of alcohol, the recreational use of cannabis, the use of nicotine are all examples where people may or may not suffer any negative consequences.
"When we're talking about substances like opioids, heroin, methamphetamines, in particular ... we see that most patients have started with the use of alcohol or nicotine or cannabis, and there's good evidence not to say that those are gateway substances that lead directly to the use of more potent substances, but rather that individuals that have a propensity or a proclivity to experiment with substances, to use substances, also are frequently at risk of using other substances. So when we consider the social demographics of who uses, if you will, methamphetamines, this is a community-based disease state where people are exposed to individuals using substances. They are exposed to people using stronger and stronger substances, and at some point, people will pick up methamphetamines."
On how patients in Oregon seek help for their addiction
"So we are proud to serve the homeless population and population of patients who are impoverished within the Portland metropolitan region. We have many ways in which patients seek care. One of the primary portals of entry is our substance-use disorders continuum. So we have people that present right off the street seeking treatment for their substance-use disorder, seeking recovery. Many of our patients are concurrently seeking housing services. We have a large medical detoxification facility that people will start their journey with us as well. Presently, we're serving about 6,000 patients in our substance-use disorders continuum on an annual basis."
"There are no FDA-indicated medications for the treatment of methamphetamine use at this time."Dr. Andy Mendenhall
On what treatments are effective for meth users
"So the primary treatment for stimulant-use disorder, in particular methamphetamine-use disorder, is really an evidence-based practice of outpatient longitudinal group-based treatment along with one-on-one psychotherapy. There are no FDA-indicated medications for the treatment of methamphetamine use at this time, and there's a behavioral intervention called contingency management, whereby people are essentially rewarded for having negative urine drug screens or provided with little incentives for compliance with treatment.
"This is really the basis of best practice for the treatment of stimulant-use disorder, methamphetamines in particular. And concurrent with that, it's important to note that the recovery community of mutual help groups, the recovery community of people in sober living housing, in supportive recovery housing type facilities, creates an environment of recovery for people where they can have and develop new relationships with people that are on the same pathway. That's a literature-based and also very important part of the work that we're doing at Central City Concern to help patients who are using methamphetamines."
On the opioid crisis is taking away from funding to address the meth crisis
"Most definitely not. I think that if we look at the history of addiction treatment in the United States, there's been a slow but successful evolution towards the medicalization of the treatment of addictive disease. And over time with the passage of the 2008 Mental Health Parity and Addiction Equity Act, which really went into full implementation in 2012, there has been an acknowledgement that addiction is in fact a disease, that patients and communities and populations who suffer from this disease deserve access to high quality treatment. I think the challenge right now is that in the face of the epidemic, both with respect to opioids and with respect to methamphetamines, there's still a gap — meaning there's a gap in access. We need more funding for these services in order to provide access and capacity to the population that's currently suffering right now."
On one of his patients who is in recovery from meth use
"I think it's important to remember that recovery is possible. I work with patients every day who never expected that they would would grow up or have an experience of developing a severe substance-use disorder. Millions of people are living in the United States today in long-term successful recovery from stimulants. I remember a patient that I saw about five or six months ago, who had been living on the streets for seven or eight months, 24-year-old gentleman. He was using almost exclusively methamphetamine. He was suffering really significant psychiatric consequences from that substance and had gotten involved in the criminal justice system, was living in our recovery housing, and starting to benefit from our employment services, and has been working and achieved 120 days of abstinence, which for him, was the first time since he started using methamphetamines at the age of 15, that he had achieved that that timeline of abstinence."
This segment aired on May 15, 2019.