Can new experimental treatment stop meth addiction?
By Todd Ackerman
Before she’d meet up with her meth dealer first thing Monday mornings, Kim would impatiently count down the weekend.
The weekend was the time of the crash, the lethargy, depression and mood swings that set in when she laid off the highly addictive, illicit drug. It was miserable, but she wasn’t going to use around her husband, who’d surely leave her this time, she figured.
“It’d be like, ‘Lord, when is Monday coming?’” said Kim, who spoke on condition her last name not be published. “‘Is Monday not here yet?’”
Kim is one of more than twothirds of a million Americans battling an addiction to methamphetamine, the stimulant drug surging in popularity in the shadow of the opioid crisis. A decade after legislative action curtailed its use, meth has roared back, more potent, plentiful and affordable than ever. Researchers say the problem is greater now than the first decade of the century, its previous peak.
Nowhere is the problem greater than in Texas, where the U.S. Drug Enforcement Administration ranks meth the No. 1 threat in Houston and most of the rest of the state. The number of deaths, treatment facility admissions, poison center calls for help and law enforcement seizures are all higher for meth than for heroin, the No. 2 threat.
What’s more: Unlike opioid addiction, there is no approved medication to treat meth addiction. Those who want to kick meth can turn only to 12-step programs or behavioral therapies not specific to their addiction.
‘It makes you go’
But Kim and others are hoping to get help from an experimental drug treatment being tested in Houston and six other U.S. locations, a two-medication combination designed to block the euphoria that meth delivers and reduce the inevitable withdrawal symptoms. If the trial is successful, it could lead to the Food and Drug Administration approving the drugs for meth treatment.
“It’s a pivotal trial, the chance to confirm whether this addiction can be treated pharmacologically,” said Joy Schmitz, director of University of Texas Health Science Center at Houston’s Center for Neurobehavioral Research on Addictions and principal investigator of the study’s Houston site. “Without treatment, patients are nervous about even trying to stop because they so fear the crash.”
Methamphetamine, first synthesized in 1893 and later used during World War II to keep soldiers awake, became the drug of choice for many in the late 1990s and 2000s. Domestic labs such as those depicted in the popular television show “Breaking Bad” made the drug from pseudoephedrine, the decongestant used to treat colds and allergies, and it became a community scourge, particularly in rural America.
U.S. officials thought they’d fixed the problem about a decade ago after Congress passed the Combat Methamphetamine Act, which put products made with pseudoephedrine behind the counter, limited sales per customer and required pharmacies to track sales. As a result, meth cases plummeted.
But the taste for meth didn’t drop off. With the ingredients difficult to come by in the United States, Mexican drug cartels’ super labs stepped up to fill the vacuum. The labs produced a new version, more intoxicating and addicting, that by 2015 accounted for more than 90 percent of meth tested in forensic laboratories in the United States, according to the DEA.
It now sells for about $5 a hit, easy pickings for users like Kim, who would donate plasma and participate in research studies to buy meth.
The product of “a dysfunctional family,” Kim was a teenager in Virginia when she started using meth, one of many drugs she tried in her youth. She did cocaine first, before even marijuana, but didn’t like it all that much, particularly in comparison with meth, which she and friends would cook themselves.
“That juice, it makes you feel like you can take over the world,” said Kim, who moved to Texas in 2000. “You not only feel that way, you actually do more on it. It gives you additional energy; it makes you go.”
Jade, as another user enrolled in the UTHealth study calls herself, said meth makes you “feel 10 feet tall, full of energy, happy and, unlike alcohol, able to think quickly.”
Users on the rise
The numbers bear out meth’s growing appeal to people looking for a high. The Substance Abuse and Mental Health Services Administration estimated the number of Americans who used meth in the past month at 667,000 in 2016, the latest year for which statistics are available. That’s up from the 2008 low point of 314,000.
At the Mexico-U.S. border, agents are seizing 10 to 20 times the amount they did a decade ago. In 2016 in Texas, DEA officials seized more than 45,000 items of meth, compared to less than 6,000 items of heroin. The lab that identifies the drugs does not provide the item’s overall weight, but a Houston DEA official said that 7.5:1 ratio is consistent with the amount of the two drugs they seize.
Deaths, too, are on the rise. Nationally, nearly 6,000 people died from meth in 2015, a 255 percent increase from 2005, according to the Centers for Disease Control and Prevention.
Texas’ numbers are no less unsettling. In 2016, meth killed 715 people in the state, compared to heroin’s 539. Another 8,481 meth users were taken to Texas health department-funded substance abuse treatment centers, compared to 8,238 heroin users. Texas poison centers received 320 calls for help involving meth and 254 for heroin.
The Texas meth epidemic also appears intertwined with increases in sexually transmitted diseases, including HIV, according to Jane Maxwell, a University of Texas-Austin drug abuse researcher. She cites a 2015 CDC survey of HIV-positive homosexual men that found 86 percent of respondents in Houston and 91 percent in Dallas reported that they’d injected meth in the past 12 months. She said a recent state report on HIV trends shows such use by homosexual men is doubling HIV risk factors.
Maxwell said if the UTHealth trial finds the drug combination is beneficial, it will provide a needed boost in the fight against meth.
“I hope it has good outcomes — we really need it,” saidMaxwell, a professor in UT’s Steve Hicks School of Social Work. “Right now we can do therapy and that sort of thing, but we don’t have a magic pill.”
The combination being studied at UTHealth is actually two already-approved drugs — naltrexone, used to treat opioid and alcohol addiction; and bupropion, an antidepressant. The combination showed promise in two small pilot studies, and now researchers are hoping the trial provides definitive evidence of the drugs’ usefulness against meth addiction.
The Houston site is enrolling 55 of the study’s 370 total participants, aged 18 to 65, half of whom get the actual medication and half of whom get a placebo. The other sites in the study, sponsored by the National Institute on Drug Abuse, are New York City, Minneapolis, Los Angeles, San Francisco, Pickens, S.C., and Portland, Ore.
More than behaviorial therapy is needed for users, researchers say, because meth increases brain levels of dopamine, a chemical that conveys a powerful sense of pleasure and craving. It stays in the brain longer than, say, cocaine, a duration that Schmitz said can cause fundamental changes in brain structure and function in chronic users.
Jade said “taking it every day, it becomes like food or air — you don’t feel high, you feel normal.”
But the effects aren’t normal. Prolonged use can lead to cardiovascular problems such as high blood pressure and an irregular heartbeat, as well as hyperthermia, convulsions and death. It also wreaks havoc on addicts’ bodies, loosening teeth, thinning hair and causing acne and scars and muscle loss that results in a gaunt and skeletal look.
And then there are the psychiatric effects. Michael Weaver, a UTHealth psychiatrist and a coinvestigator in the trial, noted meth use can also cause everything from anxiety and confusion to mood disturbances, violent behavior and hallucinations.
Kim said she at times felt virtually all of those symptoms — including seeing “shadow people when no one is really there” — one reason she jumped at the study, resolved to “get out” of the destructive cycle. Now in her late 40s, she said she’s too old for the drama meth brings.
With less than a month to go in the study’s 12-week drug regimen, Kim reports significant progress. She said she still uses some, but she’s down to once a week or once every other week, usually just when friends with meth show up. She recently told her old dealer not to come around any more.
“I used to really chase it, but now I don’t have those cravings,” said Kim, who’s been in rehab four times and to prison twice because of meth.
“I’m not all the way there yet,” she said, “but I don’t need to stay in bed for days at a time, and I no longer count the minutes or hours until Monday morning.”