By LUKE ENGAN
As methamphetamine moves from the rural Heartland into American cities, police, experts and health officials sort through their toolbox for ways to fight the epidemic.
It’s a challenge that can be seen from the darting eyes of recovering users to the wringing hands of concerned citizens.
But allowing use to spread unimpeded is costly to the public pocketbook.
More than 12 million people in the United States have used meth at least once, estimated a U.S. Department of Health and Human Services survey. More women now use meth than cocaine.
Despite its spread, methamphetamine remains a rural drug in much of the country.
Take Maryland, where meth use is most common in the state’s western hills, said Vern Conaway, commander of drug enforcement for Maryland State Police.
Clubgoers in the Baltimore area use crystal meth and ecstasy, two forms of methamphetamine. But Conaway said the most common profile of a meth user in Maryland is a middle-aged employed white male of low to moderate income who lives in the countryside.
Retailers faced meth-related costs after pseudoephedrine, a legal cold medicine ingredient, was targeted for its role in producing meth. Some retailers were concerned about convenient access to the products. A wave of state regulations restricted sale, but some companies did not wait for the laws before they made changes.
In February, Pfizer, the maker of Sudafed, launched Sudafed PE, a decongestant that uses phenylephrine instead of pseudoephedrine. The similar drug is not used in meth labs.
Erica Johnson, a Pfizer spokeswoman, said the company responded to the problem of its products being misused, not the tide of state laws. Pfizer continues to market both types of Sudafed.
Target stores took pseudoephedrine behind counters at pharmacies, though it means only locations with pharmacies can sell the medicine, said Brie Heath, spokeswoman in Minneapolis. By July, the policy was implemented in all stores.
Solutions are not easily found.
Meth is a sticky drug, not for its texture so much as its chemical and social effects. It sticks to the places and people that it contacts.
Its toxic residue seeps into the carpets, permeates the walls and remains in the vessels where it is synthesized. Gases get into building materials — even concrete, which has to be chipped away and replaced.
And recovering users have suffered permanent damage as brain cells are left with nerve endings that do not regrow, according to the National Institute on Drug Abuse. The brain also suffers irreversible blood vessel damage that puts users at higher risk of strokes, even years after quitting meth.
Merrill Norton, clinical associate professor at the University of Georgia’s college of pharmacy, said meth kills brain cells. It can damage users’ abilities for years after they quit.
A recent study found that, after 14 days on ecstasy, a methamphetamine, monkeys needed seven years to regain 40 percent of brain material killed by the drug, Norton said.
Meth can disrupt the brain’s dopamine levels for more than 18 hours. By contrast, crack cocaine blocks dopamine — a neurotransmitter in the brain — for 15 minutes.
Law enforcement agents who bust meth labs are exposed to dangerous chemicals that users combine to produce the drug.
Efforts to combat meth use have ranged from restricting the drug and its ingredients to educating the public and expanding treatment.
The greatest gains could be made between public education and potential users’ personal experiences, said David Rosenbloom, director of Join Together, a project of the Boston University School of Public Health.
“The biggest dent is going to get made in people figuring out just how bad this stuff is,” Rosenbloom said.
Nearly 2 million middle school and high school students and teachers will receive information on meth’s ill effects through the National Institute on Drug Abuse.
“Public education efforts are terribly important — but it also happens as people observe the consequences” of meth use in acquaintances and in the news, Rosenbloom said.
Judges in the western United States, where much of its early use occurred, told Rosenbloom it was an “economic drug,” he said. People who work extensive hours in two jobs often use the drug to stay awake. Rosenbloom reasoned that a higher minimum wage could be another weapon against abuse.
Economic pressures to use meth can be seen in Dalton, Ga., said Philippa Maister, spokeswoman in the Administrative Office of the Courts in Atlanta.
Many work long shifts in Dalton, known as the carpet capital of the world for its manufacturing specialty.
The community’s drug court has a higher proportion of meth users than its counterparts around Georgia, Maister said. But meth has not been around long enough for the state to have measured the users’ success rates in drug courts.
“Meth is a fairly new epidemic, although it’s very serious,” Maister said.
Robert Helfrich agreed.
“Meth is even more difficult to treat than a crack addict,” said Helfrich, state circuit judge in Hattiesburg, Miss.
Helfrich has overseen a budding drug court there for two years — not enough time to gauge the program’s success in treating meth dependency.
But the results elsewhere have been much better than what came before: Locking up drug addicts in jail, where many returned soon after their release.
Growing more common around the country, drug courts require treatment and jobs for non-violent offenders with drug histories.
Uncooperative users can be diverted for criminal sentencing. More successful participants graduate back into society.
Judges, elected officials and recovering users often emphasize the courts are not soft on crime, a get-out-of-jail-free card. And a year in drug court costs less than one-fourth the price of incarceration, according to Georgia’s Administrative Office of the Courts.
In North Carolina, the Sampson County Methamphetamine Task Force uses early intervention and treatment, educating children in schools, caring for children found living in meth houses and training emergency responders. The task force also instructs those whose work could bring them in contact with dangerous home environments.
Treatment programs for meth users will see the greatest success if they offer cash rewards for clean urine tests — prizes even as small as $1, according to a recent study. Results were published in the October issue of Archives of General Psychiatry.
There is room for such innovations. It is easy for meth addicts to fail recovery programs, said John Law, spokesman for the West Virginia Department of Health and Human Resources.
“People have to be absolutely ready before they receive treatment,” Law said.
After its strict pseudoephedrine law took effect — putting Sudafed and similar cold remedies behind pharmacy counters — Oklahoma saw a downturn in meth labs seized by authorities, presumably because fewer labs were springing up.
Drug agents along the state’s borders said in a recent survey that meth cooks were taking home most of their key-ingredient pseudoephedrine from other states, and most of it was locally bought before the law change.
A cascade of similar laws followed, sweeping through state legislatures and landing in Washington this year.
Some states passed tough restrictions like Oklahoma’s, but others have seen little effect from their efforts.
Oklahoma’s law made a greater dent in the number of discovered meth labs, dump sites and supply stashes than a new law in Illinois. The difference could be in the language.
Steve Guess, director of the Vermilion County Metropolitan Enforcement Group, a narcotics unit in Danville, Ill., sees no drop in meth production as a result of the law.
The Illinois law took effect this year, limiting customers to two boxes at a time of cold remedies that contain pseudoephedrine.
But with about 40,000 residents, Danville has about 10 locations that offer the products used by methamphetamine cooks.
“There’s nothing stopping them from going from store to store to store,” Guess said.
The failure of pseudoephedrine laws to reduce use of the drug points to alternative solutions to address the scourge. In Kansas, some coalitions between local governments and community groups draw training and funds from Prevention and Recovery Services, a Topeka-based nonprofit.
Coordinator Cristi Cain said a central role of the group is in working with drug-endangered children.
A grandmother called her on a recent Friday morning on behalf of her grandson, a 3-year-old whose mother cooks meth.
After they are identified, endangered children need to be decontaminated from chemical exposure and treated for disorders.
PARS also trains retail workers to spot meth cooks by their pseudoephedrine purchases and trains farmers to lock up their ammonia, another ingredient.
Solving the meth crisis takes more than one strategy. The program’s solutions are most effective in tandem, she said.
“It really has to be a comprehensive approach,” Cain said. “Just doing one thing probably wouldn’t have much effect.”
Luke Engan is CNHI Oklahoma reporter.