As stimulant use and deaths increase, Mass. launches commission to find solutions

The long shadow of the opioid epidemic hides a twin problem: the rising use of — and deaths from — stimulants such as cocaine, crack and methamphetamine. In Massachusetts, a state commission is looking at who is most affected, why, and what can be done about it.

The commission was formed amid increasing concern about meth, including a 2020 report that showed stimulant overdose deaths up more than 400% since 2010. Data presented Wednesday at the commission’s first meeting offered more specifics: Most of the meth supply is in the Boston area. Meth users are predominantly white. About 25% of men who have sex with men report using a stimulant, usually crystal meth. And 10% of admissions to addiction treatment programs so far this year are for meth use, up from 1.4% in 2005.

The latest statewide numbers point to cocaine as the main concern when it comes to stimulants. Of all overdose deaths currently involving stimulants, 86% show the presence of cocaine. According to an analysis presented to the commission, Black and Latino patients enrolled in drug treatment programs report crack and cocaine use more often than whites. Drug users surveyed say cocaine is cheaper than meth.

The main reason deaths traced to cocaine are higher right now in Massachusetts than those involving meth may be the powerful opioid, fentanyl. Traci Green, with the Opioid Policy Research Collaborative at Brandeis University, has been testing residue from discarded drug supplies in Quincy, New Bedford, Lynn, Lowell, Boston and Berkshire County. She found fentanyl in 25% of powder cocaine samples; none in samples of meth.

“This, potentially, is unwitting exposure for someone who might be snorting cocaine,” said Green, who is also a member of the meth commission.

Green warned about a range of illicit drug issues beyond meth and stimulants. She also found fentanyl in 26% of counterfeit pills, typically pain medications, sold on the streets. A fake Adderall pill contained meth, and a fake benzo included an anti-anxiety medication not approved in the U.S.

Together, these findings suggest the state needs to do a lot more outreach to recreational drug users who may not know that fentanyl can cut off breathing within minutes. Green told the commission that people who use drugs can check what they buy with fentanyl test strips, they must not use alone, and they should carry naloxone, the drug that reverses an opioid overdose.

A very small fraction, only 7% of the 1,400 samples Green has tested to date, included meth. However, Green reported seeing a more deadly form of fentanyl, 4-Flurofentanyl, which can trigger a fatal overdose within seconds. And she’s finding something she calls strange: samples sold as dope or heroin are actually all meth or include meth.

“This is a twist on the story that I had not anticipated,” Green said, “but there may be multiple pathways that people are exposed to methamphetamine. This is important for treatment.”

“That’s actually a large part of what I’m seeing,” said fellow commission member Dr. Claudia Rodriquez. “People are in treatment for an opioid use disorder, and they inadvertently have methamphetamine [in their system].”

The commission on meth and other stimulants will look at all of these issues as it wrestles with ways to address drug use, overdoses and deaths. Most fatal overdoses in Massachusetts involve more than one type of drug.

The commission is scheduled to hold three more meetings and send a report to the Legislature by the end of March.