Meth’s Resurgence Spotlights Lack of Meds to Combat the Addiction

crystal meth

[By Carmen Heredia Rodriguez of Kaiser Health News, republished by permission.]

In 2016, news reports warned the public of an opioid epidemic gripping the nation.

But Madeline Vaughn, then a lead clinical intake coordinator at the Houston-based addiction treatment organization Council on Recovery, sensed something different was going on with the patients she checked in from the street.

Their behavior, marked by twitchy suspicion, a poor memory and the feeling that someone was following them, signaled that the people coming through the center’s doors were increasingly hooked on a different drug: methamphetamine.

“When you’re in the boots on the ground,” Vaughn said, “what you see may surprise you, because it’s not in the headlines.”

In the time since, it’s become increasingly clear that, even as the opioid epidemic continues, the toll of methamphetamine use, also known as meth or crystal meth, is on the rise, too.

The rate of overdose deaths involving the stimulant more than tripled from 2011 to 2016, the Centers for Disease Control and Prevention reported.

But unlike the opioid epidemic — for which medications exist to help combat addiction — medical providers have few such tools to help methamphetamine users survive and recover. A drug such as naloxone, which can reverse an opioid overdose, does not exist for meth. And there are no drugs approved by the Food and Drug Administration that can treat a meth addiction.

“We’re realizing that we don’t have everything we might wish we had to address these different kinds of drugs,” said Dr. Margaret Jarvis, a psychiatrist and distinguished fellow for the American Society of Addiction Medicine.

Meth revs up the human body, causing euphoria, elevated blood pressure and energy that enables users to go for days without sleeping or eating. In some cases, long-term use alters the user’s brain and causes psychotic symptoms that can take up to one year after the person has stopped using it to dissipate.

Overdosing can trigger heart attacks, strokes and seizures, which can make pinpointing the drug’s involvement difficult.

Meth users also tend to abuse other substances, which complicates first responders’ efforts to treat a patient in the event of an overdose, said Dr. David Persse, EMS physician director for Houston. With multiple drugs in a patient’s system, overdose symptoms may not neatly fit under the description for one substance.

“If we had five or six miracle drugs,” Persse said, to use immediately on the scene of the overdose, “it’s still gonna be difficult to know which one that patient needs.”

Research is underway to develop a medication that helps those with methamphetamine addiction overcome their condition. The National Institute on Drug Abuse Clinical Trials Network is testing a combination of naltrexone, a medication typically used to treat opioid and alcohol use disorders, and an antidepressant called bupropion.

And a team from the Universities of Kentucky and Arkansas created a molecule called lobeline that shows promise in blocking meth’s effects in the brain.

For now, though, existing treatments, such as the Matrix Model, a drug counseling technique, and contingency management, which offers patients incentives to stay away from drugs, are key options for what appears to be a meth resurgence, said Jarvis.

Illegal drugs never disappear from the street, she said. Their popularity waxes and wanes with demand. And as the demand for methamphetamine use increases, the gaps in treatment become more apparent.

Persse said he hasn’t seen a rise in the number of calls related to methamphetamine overdoses in his area. However, the death toll in Texas from meth now exceeds that of heroin.

Provisional death counts for 2017 showed methamphetamine claimed 813 lives in the Lone Star State. By comparison, 591 people died due to heroin.

The Drug Enforcement Administration reported that the price of meth is the lowest the agency has seen in years. It is increasingly available in the eastern region of the United States. Primary suppliers are Mexican drug cartels. And the meth on the streets is now more than 90 percent pure.

“The new methods [of making methamphetamine] have really altered the potency,” said Jane Maxwell, research professor at the University of Texas at Austin’s social work school. “So, the meth we’re looking at today is much more potent than it was 10 years ago.”

For Vaughn, who works as an outpatient therapist and treatment coordinator, these variables are a regular part of her daily challenge. So until the research arms her with something new, her go-to strategy is to use the available tools to tackle her patients’ methamphetamine addiction in layers.

She starts with writing assignments, then coping skills until they are capable of unpacking their trauma. Addiction is rarely the sole demon patients wrestle with, Vaughn said.

“Substance use is often a symptom for what’s really going on with someone,” she said.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 50

Guest Blogger and long-time Council friend, Bob W. presents Part 50 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

Star is born

The 2018 film, A Star is Born, is the fourth remake of an original 1937 film about an aging star and a young new prodigy.  This one stars Bradley Cooper as Jackson Maine, a famous C& W singer, and Lady Gaga, as Ally, a struggling lounge singer whom Jackson takes to stardom.  The story is impeccably done by Cooper and Gaga; its power is in the truly profound impact it seems to have on many of us in recovery.  This recent version also tracks almost precisely with two prior ones, a 1954 version with Judy Garland and James Mason, and a 1976 version with Barbra Streisand and Kris Kristofferson.

In this version, Jackson is a serious alcoholic and addict who stumbles into a back-street drag bar, desperately needing a drink between gigs;  he  finds Ally as a waitress who also sings in the small club venue.  The connection, both in the acting and in the energy Cooper and Gaga bring to the roles, is mesmerizing.  Predictably, and in line with its predecessors, they form a bond and perform together.  The bond leads to an affair of the heart.  Soon Ally’s career begins to take off while Jackson’s is continuing a drunken downward spiral.   

While Ally remains fully committed to Jackson, he becomes a major liability to her career.  He vacillates between loving attention to her and mean-spirited comments and abuse. Her manager does everything he can to try to keep Jackson away from Ally in various phases of her development and touring.  But Jackson’s drinking and drugging just keeps getting worse.  At the Grammy’s, when Ally goes up to accept the Award of Best New Artist, a falling down drunk Jackson goes up with her and, on stage, he wets himself and passes out.

Jackson does rehab and seems to be recovering, but the damage he believes he has done to Ally’s career and the constant pull of the disease lead him to a deep state of remorse and regret.  While Ally is singing at a major concert at which Jackson was to be present, he hangs himself in their garage.

It is interesting that this story seems to have a basic fundamental power…it has been told and retold in the span of generations over the last 80 years…with the players having the same general presence in their generations as Gaga and Cooper do here.  While, to this alcoholic, the option of suicide is never a valid one, there are untold examples where the bottom reached in a drinking life seems to present no other recourse to the sufferer.  It is a sad, sad, tragic reality.

How wonderful it is that many of us have been able to move beyond that point of “pitiful and incomprehensible demoralization” and put the probability of such a tragedy well behind us.  

The Lifelong Quest for Sobriety…The Ultimate Hero’s Journey—Part 49

Guest Blogger and long-time Council friend, Bob W. presents Part 49 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In all these Notes, the fundamental core element is the idea of the Hero, the individual who journeys into the Underworld of her/his life to initiate a process of ongoing recovery from the ravages and horrors of addiction.  This is the same Hero that attends the core of thousands upon thousands of stories told in all the societies of the human experience all over the world. We have merely focused on it here in these Notes, seeing its parallel in the lives of all of us.

The recent DC Comics movie, Aquaman, is a tale of an undersea society of women and men living in many tribes, the center of which is the mythic world of Atlantis.  Atlantis was also a world of hubris that was created by Plato and other scholars and which, as a result of massive mythical conflicts, was eventually buried on the floor of the Atlantic Ocean. 

Aquaman
Aquaman

The hero of the modern movie, Aquaman, was a crossbreed of the queen of the undersea world and a surface human, a lighthouse keeper who rescued her from near death on the rocks at the foot of his lighthouse.  This hero, Aquaman, is blessed with significant powers and, upon reaching adulthood, he is drawn into a conflict between the tribes of the undersea world.  He is charged with the mandate to restore order to this world. To carry out this mandate, he must journey to a strange and dangerous realm and retrieve a golden trident, a weapon which grants him a set of powers that approach invincibility. This trident will enable him to prevail over all others and to restore peace and prosperity to the undersea realm.

The parallel to other mythic systems, particularly to that of King Arthur of early Celtic lore, is clear and very powerfully done in Aquaman. As in King Arthur, the golden trident is akin to the sword Excalibur which Arthur, a seemingly common man of royal blood, retrieves from a stone and is elevated to the mantle of King. As King, Arthur leads the Knights of the Round Table, each of whom set out episodically on quests of chivalry, conquest and spiritual enlightenment.

Does all of this strike you as profoundly as it strikes me…that all of us in recovery, those of us who have truly committed ourselves to lives of responsibility, accountability and service, are heroes of precisely equal stature and power…all of us?  Our journeys to achieve levels of sobriety have the same elements of these majestic stories, from the explorations into the frightening darkness of our pasts to the glory of the milestones that we celebrate with our Fellows and through the service that we are challenged to provide to others.

As we look at all the great heroic stories of the human experience, all those stories that mirror the lives of so many of us, there is this heroic mantle that seems to have been laid upon all of us.  It is the grace of a Higher Power, a mantle which we all are mandated to wear, to work, to be of service, in small and large ways, to make the world in which we live a better, safer place.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 48

Guest Blogger and long-time Council friend, Bob W. presents Part 48 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the Hindu traditions, there is a long Sanskrit epic called the Mahabharata, about a multi-generational feud between two ruling families, the Kauravas and the Pandavas, ruling in the ancient land that is today Northern India. The story culminates in a giant battle involving all the young men of the time, all aligned with one of the two families.

As the battle is about to begin, the head of the Pandavas, Arjuna, asks his charioteer, who is also the god Krishna, to drive him into the ‘no man’s land’ between the two armies. Seeing the size of the armies aligned against each other and imagining what is about to begin, Arjuna is overcome with grief. He asks Krishna for some relief, some way to avoid the coming armageddon. Krishna answers with a long poetic text that has become highly celebrated in spiritual circles; it is the Bhagavad Gita, aka the “Gita,” a spectacular, deeply articulated, relatively long prescription for an enlightened way of being.

Krishna begins the Gita with a direct response to Arjuna’s question.  He says that, as a warrior, Arjuna’s dharma, his cosmic reason for being, is to fight; he cannot avoid the call to arms.  Krishna says, “For a warrior, nothing is higher than a war against evil […] for it comes as an open gate to heaven.”

This is a wonderfully inspirational message for me, and, I believe, for all of us on the lifelong journey in sobriety. Active alcoholic behavior, living in the active disease, is an intrinsic evil, a place where we are active agents of devastation and abuse, abuse of people and the cosmos.  Our efforts to cross the threshold to abstinence, to a life of deeply imbedded behavior modification, and to a committed life of service are truly those of the warrior, that of the nobility of a warrior in a glorious quest for conquest over evil. Reading the Gita, from its beginning in the exchange with Arjuna, is a wonderful spiritual experience…and seeing it from the perspective of our own personal journeys is a great gift of grace from our own Higher Power.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 45

Guest Blogger and long-time Council friend, Bob W. presents Part 45 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the aftermath of the fall of Rome in the 5th century and the loss of its literary and cultural majesty, the European continent became widely diverse and generally devoid of scholarship. The Church was the only institution of wide-spread power. In this environment, which lasted almost 600 years, there were a number of mythic systems which emerge. One was the great Celtic legend of King Arthur and the Knights of the Round Table. A host of stories emerged out of this system, about kings, queens, knights and ladies, who pursue glorious quests in search of physical, psychical and spiritual treasures.

Holy Grail Illustration

The most prominent of these quests is the search for the “Holy Grail,” which is the cup that Christ drank from at the Last Supper and which Joseph of Arimathea used to capture some of Christ’s blood as he was lowered from the Cross. Joseph was portrayed as part of a group that then fled Palestine, traveling West with the Cup to found an order in the Celtic lands charged with keeping the Cup. The Arthurian Knights that sought the Grail were on quests for spiritual enlightenment and ascension, which they achieve by coming into the presence of the Grail.

Those of us on the journeys into lives of sobriety are on similar quests…quests to achieve a sense of freedom, peace and serenity. Having made the decision to commit ourselves to the journey, we must do the work to recover with a sense of determination and rigor. We must explore the dark and frightening elements of our past in all its dimensions and find a conscious contact with our Higher Power so we can repair the harm we may have done in our disease and develop a saner mode of life.

Finally, we fully commit ourselves to a life of service, to mankind and to the cosmos. In relatively short order, we find ourselves in a place just as glorious as those the Arthurian Knights achieved in the presence of the Grail.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 44

Guest Blogger and long-time Council friend, Bob W. presents Part 44 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the Charles Dickens’ story, A Christmas Carol, the protagonist, Ebenezer Scrooge, a miserly banker whom no one likes and who has nothing good to say about life, sees an apparition late on Christmas Eve.  It is of his long dead partner, Jacob Marley, who warns him of the errors of his miserly ways and foretells the coming of three spirits in dreams Scrooge is to have that same night.  Scrooge 1

In the first such dream, the Ghost of Christmas Past takes Scrooge to the place of his boyhood and has him witness an adolescent Ebenezer struggling with his long abandonment by his father to a difficult boarding school. The young Ebenezer is rescued and brought home by his dear sister, but, as he grows into manhood in the dream, he becomes obsessed with the idea of working tirelessly to be financially successful, perhaps as a counterweight to the feelings of loneliness and deprivation he had as a boy.

The Ghost takes Scrooge through the various times of his later life…early adulthood, middle age, and full maturity, observing his increasing focus on financial success and on a gradual withdrawal from society.

The second dream has the Ghost of Christmas Present taking Scrooge around to those people of Scrooge’s current life, showing their happiness with simple things despite a very meager set of living circumstances.

The third dream, with the Ghost of Christmas Yet to Come, focuses on a series of dire future happenings that seem fully ordained, but for which Scrooge becomes obsessed with a desire to change.

Upon waking up on Christmas morning, Scrooge is entirely transformed.  He immediately attends to the serious circumstances of those people in his current life and commits himself to living a happy, joyous life with all those around him.

It occurs to me that, while the circumstances and nature of Scrooge’s addiction is radically different, the process of his deterioration over time and the depth of the societal chasm he creates for himself provide a stark parallel to our lives in the diseases of alcoholism and drug abuse.   Looking at the process of his change over Christmas Eve into Day, there appears a wonderful, if highly compressed, parallel to our getting sober and working the steps.

The confrontation with Marley is the beginning of the great awakening.  The journeys on which he is taken by the three Spirits seem akin to the working of Steps, traversing the long-gone and recent pasts to get a sense of the depth of his disease, and then the embrace of a new way to be present in the world.  They all seem a very sharp and poignant parallel to our own journeys.

The people Scrooge attends to on Christmas Day and beyond – his housekeeper, his clerk and family, and his own nephew, the son of his dear sister – all convey to Scrooge an infectious joy and wonder at life, one that seems to echo our own joyous lives in sobriety today.