State Your Case: Should Law Enforcement Endorse Safe Injection Sites?

From Police1.com

In late 2021, the nation’s first safe injection sites, also called overdose prevention centers (OPC), opened in New York City. Drug users can bring their drugs to the sites where trained staff provide clean needles, monitor them during use and can provide naloxone if necessary. 

The NYC Health Department reports that, in the first three weeks of operation, staff at the two OPCs averted at least 59 overdoses to prevent injury and death. In the first three weeks of operation, the centers have been used more than 2,000 times.

“These data are promising and show how Overdose Prevention Centers will reduce needless suffering and avoidable death,” said Health Commissioner Dr. Dave A. Chokshi. “The simple truth is that Overdose Prevention Centers save lives – the lives of our neighbors, family and loved ones.”

In December 2021, the Fund for Public Health, a non-profit organization in New York, opened a request for proposals to install public health vending machines that will dispense naloxone and clean needles in an effort to help those who are “disproportionately burdened” by overdoses.

In a recent poll, Police1 asked readers if safe injection sites can help reduce drug overdoses. Here’s how you responded. Click here to vote:

A total of 506 Police1 readers answered this Police1 poll as of 1/9/2022.
A total of 506 Police1 readers answered this Police1 poll as of 1/9/2022.

Read our columnists’ take on this issue and share your opinion.

The ground rules: As in an actual debate, the pro and con sides are assigned randomly as an exercise in critical thinking and analyzing problems from different perspectives.

Our debaters: Jim Dudley, a 32-year veteran of the San Francisco Police Department where he retired as deputy chief of the Patrol Bureau, and Chief Joel Shults, EdD, who retired as chief of police in Colorado.

Jim Dudley: I am steadfastly against the idea of legal supervised drug injection sites anywhere in America.  This is the latest example of a social experiment with deadly consequences and a major threat to the rest of those who are not active intravenous drug users. 

Harm reduction policies are often created with the knowledge that a harmful or illegal behavior may be adjusted to reduce harm. Safe injection sites seem to be encouraging rather than discouraging the illegal use of intravenous drugs. In this case, it creates a “normalization” of illegal and harmful drug use. 

The message of a state-sanctioned “legal supervised drug injection site” is preposterous. We are talking about illegal drugs that are harmful and addictive at the federal level and in most states in America today.  We are at a record-breaking pace over the past few years of overdose deaths across the country, with over 700 recorded in San Francisco alone in 2020.

The research so far is inconclusive at best as to whether drug injection sites create positive or negative results. We have seen catastrophic events over the past few years of other social experiments regarding de-funding the police, bail reform and decriminalization of crime statutes.

In the vein of drug use (pun somewhat intended), free needle programs that give out free syringes for drug injections have reduced the widespread diseases associated with the use of shared “dirty needles” among users. But when the details are examined, with so many needles given out (approximately 4.5 million per year) not nearly the same amount are returned, with dirty needles showing up on our nation’s streets, in doorways, at parks and other public spaces. As a result, another $1 million in San Francisco’s budget for example is reserved for needle pick-ups from public areas. I’m not sure where any sort of “prevention” aspects come from the free supplies given at needle exchanges, where verbiage states:

We provide safer injection supplies like cookers, cotton (small and large), alcohol wipes, sani hands, sterile water, saline, tourniquets (both latex and non-latex), and vitamin C. You can also get safer smoking supplies like aluminum foil, pipe covers and brillo, wound care and medical supplies like gauze, medical tape, hot hands (instant hot compress), Band-Aids, saline and triple antibiotic ointment.”

Joel Shults: Jim, you use the phrase “social experiment” to describe safe injection sites. We’ve been experimenting with a lot of things for over 100 years.

The federal government enacted its first drug regulation with the 1914 Harrison Act, which means we’ve been trying to control drug use for 108 years. In 1875, San Francisco attempted to regulate opium dens. The 1920s saw a brief experiment with banning alcohol. The successes of prohibition are overshadowed by its failure. During the 1950s, federal sentences were increased, including the death penalty for selling heroin to minors. The social upheavals of the 1960s saw debates favoring legalization vs. harsher penalties. The 1970s saw Nixon’s war on drugs declaring drugs “public enemy number one.” His recommended legislation included prevention and treatment, but that part got little attention. The 1980s saw the crack cocaine epidemic associated with the rise in violent crime that had spilled into suburbia from the inner city. The 1990s saw a ramping up of law enforcement and a building boom in prisons. Mandatory minimum sentences and racial disparity in sentencing attracted attention in the new century. In recent years the decriminalization of drugs, particularly marijuana, defied federal law and the Obama administration chose not to fight it.

The point of this little history lesson is to ask what have we accomplished in the 100+ years of trying to keep people drug-free? Can we rely on law enforcement and the courts to accomplish this goal? Maybe a strategy to keep people alive long enough to maintain the hope of recovery isn’t so wild after all.

Jim Dudley: Joel, I agree with the idea of keeping America “drug-free” is an impossibility. However, with respect to the 100 years of social experimenting – except for the horrendous alcohol prohibition policy from 1919-1933 – we have made some policy moves to keep drug abuse issues from going off the rails, as we have seen since the end of the “drug war” where we turned the keys to the car over to public health. 

Advocates and proponents of drugs have moved from “compassionate use” to de-criminalization to recreational and now, as we have seen in Oregon, to full on legalization. The normalization of drug use, from marijuana to federal schedule 1 hallucinogens and opiates, has created an explosion of overdose deaths as never seen before. Property crimes may be attributable to the trend to decriminalize as well.

Whenever people talk about legalization, I always ask if we will be giving drugs away for free as well. An unknown number of auto and home burglaries are certainly perpetrated by those with serious drug abuse and addiction issues. 

One aspect of the injection sites is that drug testing will be done. An individual walks in with their street drug and has it tested before use. It is unclear what will happen when the drug tests for high amounts of fentanyl or other dangerous substances. Will the sample be destroyed? Be given back with additional naloxone on hand? Will “clean” drugs then be substituted? 

There’s also the matter of the target audience who will be using injection sites. They are often homeless, drug-addicted and many suffering from mental illness. Does this cater to their addiction, in hopes of saving their lives, only to continue down their self-destructive path?

I also wonder what effect the city and state-sponsored injection sites (illegal by federal standards) will have on the public and impressionable youth, in particular. The message is a muddy one, to be sure, and a mixed one that says “drugs are bad and harmful, but not to worry, we will make it safe for your consumption.”

In reading studies on the viability and possible consequences of a “legal injection” site in America, the ones I have read are speculative, since there is only one currently in America today. We do not compare with other nations that may have different laws, cultures, resources and attitudes. We have seen the toll on lives and families with the harm reduction attitudes, policies and programs in cities where misery and blight are often accompanying consequences. Let’s not add to the problems.

Joel Shults: I think a good argument for harm reduction is harm reduction for the population at large. A decade of experience in 120 locations across 10 countries can’t be ignored. Their reports show less drug paraphernalia litter in neighborhoods, fewer overdose fatalities, and reduced disturbances related to drug use and sales. The centers provide access to intervention programs, as well as reduce HIV and drug-related sexual encounters.

There’s no question that the concept makes us a little queasy, kind of like hearing a parent give up and let their teenagers drink and party in the basement because “at least we know where they are.” I’m not much more enthusiastic about that than I am about safe injection sites. It smells of giving up. However, it will be the numbers that prove any results.

I hope that data on more than just overdose deaths are measured, such as the use of treatment programs, neighborhood safety and eventual reduction in demand. Might work, might not, but on balance, it’s probably worth trying.

POLICE1 READERS RESPOND

  • An addict who wants an immediate “fix” will pay little to no attention to a specific location where they can use. San Francisco already has a safe injection site, called the Tenderloin. An addict here will not look for a location to use “safely” when they can use on the street without penalty or consequence. There are droves of individuals, including officers, armed with naloxone (Narcan) who have administered it countless times.  Until the rules of engagement change and addicts may be mandated into treatment before they get to the irrevocable state of “gravely” disabled (from which it is extremely difficult if not impossible to recover), there will be no solution to the problem.
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US Overdose Deaths Topped 100,000 in One Year, Officials Say

This is what a lethal dose of fentanyl looks like. Drug overdoses now surpass deaths from car crashes, guns and flu and pneumonia.

By Mike Stobbe Medical Writer | Police1.com

An estimated 100,000 Americans died of drug overdoses in one year, a never-before-seen milestone that health officials say is tied to the COVID-19 pandemic and a more dangerous drug supply.

Overdose deaths have been rising for more than two decades, accelerated in the past two years and, according to new data posted Wednesday, jumped nearly 30% in the latest year.

Experts believe the top drivers are the growing prevalence of deadly fentanyl in the illicit drug supply and the COVID-19 pandemic, which left many drug users socially isolated and unable to get treatment or other support.

The number is “devastating,” said Katherine Keyes, a Columbia University expert on drug abuse issues. “It’s a magnitude of overdose death that we haven’t seen in this country.”

Drug overdoses now surpass deaths from car crashes, guns and even flu and pneumonia. The total is close to that for diabetes, the nation’s No. 7 cause of death.

Drawing from the latest available death certificate data, the Centers for Disease Control and Prevention estimated that 100,300 Americans died of drug overdoses from May 2020 to April 2021. It’s not an official count. It can take many months for death investigations involving drug fatalities to become final, so the agency made the estimate based on 98,000 reports it has received so far.

The CDC previously reported there were about 93,000 overdose deaths in 2020, the highest number recorded in a calendar year. Robert Anderson, the CDC’s chief of mortality statistics, said the 2021 tally is likely to surpass 100,000.

“2021 is going to be terrible,” agreed Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco.

The new data shows many of the deaths involve illicit fentanyl, a highly lethal opioid that five years ago surpassed heroin as the type of drug involved in the most overdose deaths. Dealers have mixed fentanyl with other drugs — one reason that deaths from methamphetamines and cocaine also are rising.

The CDC has not yet calculated racial and ethnic breakdowns of the overdose victims.

It found the estimated death toll rose in all but four states — Delaware, New Hampshire, New Jersey and South Dakota — compared with the same period a year earlier. The states with largest increases were Vermont (70%), West Virginia (62%) and Kentucky (55%).

Minnesota saw an increase of about 39%, with estimated overdose deaths rising to 1,188 in May 2020 through April 2021 from 858 in the previous 12-month period.

The area around the city of Mankato has seen its count of overdose deaths rise from two in 2019, to six last year to 16 so far this year, said police Lt. Jeff Wersal, who leads a regional drug task force.

“I honestly don’t see it getting better, not soon,” he said.

Among the year’s victims was Travis Gustavson, who died in February at the age of 21 in Mankato. His blood was found to show signs of fentanyl, heroin, marijuana and the sedative Xanax, Wersal said.

Gustavson was close to his mother, two brothers and the rest of his family, said his grandmother, Nancy Sack.

He was known for his easy smile, she said. “He could be crying when he was a little guy, but if someone smiled at him, he immediately stopped crying and smiled back,” she recalled.

Gustavson first tried drugs as kid and had been to drug treatment as a teenager, Sack said. He struggled with anxiety and depression, but mainly used marijuana and different kinds of pills, she said.

The morning of the day he died, Travis had a tooth pulled, but he wasn’t prescribed strong painkillers because of his drug history, Sack said. He told his mother he would just stay home and ride out the pain with ibuprofen. He was expecting a visit from his girlfriend that night to watch a movie, she said.

But Gustavson contacted Max Leo Miller, also 21, who provided him a bag containing heroin and fentanyl, according to police.

Some details of what happened are in dispute, but all accounts suggest Gustavson was new to heroin and fentanyl.

Police say Gustavson and Miller exchanged messages on social media. At one point, Gustavson sent a photo of a line of a white substance on a brown table and asked if he was taking the right amount and then wrote “Or bigger?”

According to a police report, Miller responded: “Smaller bro” and “Be careful plz!”

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Evolving Strategies to Win the War on Opioids

In this eBook, we explore the scope of the epidemic by looking at the evolving tactics of law enforcement response to the opioid crisis.

Sponsored by Thermo Fisher Scientific

While COVID-19 became public health enemy number one in 2020, a familiar foe continued to claim thousands of lives. Over 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period according to CDC data. This places law enforcement in the middle of a double public health crisis: a pandemic combined with the opioid epidemic.

In a recent poll, we asked Police1 readers if opioid overdose calls had increased in their jurisdictions since January 2020 and a staggering 60% answered yes.

Law enforcement plays a pivotal role in America winning the war on opioid trafficking and abuse. The key to success is collaboration among law enforcement, EMS, public health and policy makers. These partnerships enable the information sharing that will deliver actionable intelligence to target interdiction efforts to disrupt the opioids supply chain, enhance investigations into online drug distribution, drive outreach initiatives and define pathways of care to treatment and recovery services.

In this eBook, sponsored by Thermo Fisher Scientific, we explore the scope of the epidemic by looking at the evolving tactics of law enforcement response to the opioid crisis.

For a PDF of the complete eBook, fill out the form.

Some highlights from this issue include:

  • The keys to successful collaboration between law enforcement, public health, policymakers and congress to end the opioid scourge
  • How data can be used to drive initiatives between public safety partners, and
  • The steps all chiefs and sheriffs need to take on the front lines of the opioid crisis

To download your free copy of the “Evolving strategies to win the war on opioids” eBook from Police1, fill out the form

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A New Cheaper Form of Meth is Wreaking Havoc on America

Different chemically than it was a decade ago, the drug is creating a wave of severe mental illness and worsening America’s homelessness problem.

In the fall of 2006, law enforcement on the southwest border of the United States seized some crystal methamphetamine. In due course, a five-gram sample of that seizure landed on the desk of a 31-year-old chemist named Joe Bozenko, at the Drug Enforcement Administration lab outside Washington, D.C.

Organic chemistry can be endlessly manipulated, with compounds that, like Lego bricks, can be used to build almost anything. The field seems to breed folks whose every waking minute is spent puzzling over chemical reactions. Bozenko, a garrulous man with a wide smile, worked in the DEA lab during the day and taught chemistry at a local university in the evenings. “Chemist by day, chemist by night,” his Twitter bio once read.

Bozenko had joined the DEA seven years earlier, just as the global underworld was veering toward synthetic drugs and away from their plant-based cousins. Bozenko’s job was to understand the thinking of black-market chemists, samples of whose work were regularly plopped on his desk. He analyzed what they produced and worked out how they did it. In time, Bozenko began traveling abroad to clandestine labs after they’d been seized. His first foreign assignment was at a lab that had made the stimulant MDMA in Jakarta, Indonesia. He saw the world through the protective goggles of a hazmat suit, sifting through the remains of illegal labs in three dozen countries.

Meth was the drug that Bozenko analyzed most in the early years of his job. Large quantities of it were coming up out of Mexico, where traffickers had industrialized production, and into the American Southwest. All of the stuff Bozenko analyzed was made from ephedrine, a natural substance commonly found in decongestants and derived from the ephedra plant, which was used for millennia as a stimulant and an anti-asthmatic. A Japanese researcher had first altered the ephedrine molecule to synthesize crystal methamphetamine in 1919. During World War II, it was marketed in Japan as hiropon, a word that combines the Japanese terms for “fatigue” and “fly away.” Hiropon was given to Japanese soldiers to increase alertness.

In the early 1980s, the ephedrine method for making meth was rediscovered by the American criminal world. Ephedrine was the active ingredient in the over-the-counter decongestant Sudafed, and a long boom in meth supply followed. But the sample that arrived on Bozenko’s desk that day in 2006 was not made from ephedrine, which was growing harder to come by as both the U.S. and Mexico clamped down on it.

There was another way to make methamphetamine. Before the ephedrine method had been rediscovered, this other method had been used by the Hell’s Angels and other biker gangs, which had dominated a much smaller meth trade into the ’80s. Its essential chemical was a clear liquid called phenyl-2-propanone—P2P. Many combinations of chemicals could be used to make P2P. Most of these chemicals were legal, cheap, and toxic: cyanide, lye, mercury, sulfuric acid, hydrochloric acid, nitrostyrene. The P2P process of making meth was complicated and volatile. The bikers’ cooking method gave off a smell so rank that it could only be done in rural or desert outposts, and the market for their product was limited.

 

Bozenko tinkered with his sample for two or three days. He realized it had been made with the P2P method, which he had not seen employed. Still, that was not the most startling aspect of the sample. There was something else about those few grams that, to Bozenko, heralded a changed world.

Among the drawbacks of the P2P method is that it produces two kinds of methamphetamine. One is known as d-methamphetamine, which is the stuff that makes you high. The other is l-methamphetamine, which makes the heart race but does little to the brain; it is waste product. Most cooks would likely want to get rid of the l-meth if they knew what it was. But separating the two is tricky, beyond the skills of most clandestine chemists. And without doing so, the resulting drug is inferior to ephedrine-based meth. It makes your heart hammer without offering as potent a high.

Bozenko’s sample contained mostly d-methamphetamine. Someone had removed most of the l-meth. “I’ve taken down labs in several continents,” Bozenko told me years later. No one in the criminal world, as far as he and his colleagues knew, had ever figured out how to separate d-meth from l-meth before.

Back in the late ’80s and ’90s, when the ephedrine method had taken over, the market for meth had grown because of ephedrine’s availability—and because the substance could be transformed into meth with ease and efficiency. All you had to do was tweak the ephedrine molecule, and doing that required little more than following a recipe. But you had to have ephedrine.

The P2P method offered traffickers one huge advantage: The chemicals that could be used to make it were also used in a wide array of industries—among them racing fuel, tanning, gold mining, perfume, and photography. Law enforcement couldn’t restrict all these chemicals the way it had with ephedrine, not without damaging legitimate sectors of the economy. And a trained organic chemist could make P2P, the essential ingredient, in many ways. It was impossible to say how many methods of making P2P a creative chemist might come up with. Bozenko counted a dozen or so at first. He put them up in a large diagram on his office wall, and kept adding Post-it Notes with new ones as they appeared.

As Bozenko dissected that sample in 2006, its implications hit him. Drugs made in a lab were not subject to weather or soil or season, only to chemical availability: With this new method and full access to the world’s chemical markets through Mexican shipping ports, traffickers could ramp up production of P2P meth in quantities that were, effectively, limitless.

Even so, Bozenko couldn’t have anticipated just how widely the meth epidemic would reach some 15 years later, or how it would come to interact with the opioid epidemic, which was then gaining force. And he couldn’t know how strongly it would contribute to related scourges now very much evident in America—epidemics of mental illness and homelessness that year by year are growing worse.

A man wearing glasses, pink tie, white collared shirt, blue jacket with DEA logo, and DEA lanyard
Joe Bozenko at the DEA Special Testing and Research Laboratory in Virginia (Gabriella Demczuk for The Atlantic)

Afew months after Bozenko’s discovery, on December 15, 2006, in a town named Tlajomulco de Zúñiga in the central-Mexican state of Jalisco, a methamphetamine lab exploded. Firefighters responded to the blaze, at a warehouse where plastic dinnerware had once been made. No one was hurt in the fire, nor was anyone arrested. But a fire chief called the local DEA office.

Abe Perez supervised the DEA’s Guadalajara office back then. The warehouse stood on a cul-de-sac at the end of a house-lined street, Perez, who is now retired, remembered years later. Residents “knew something was going on; the smells were giving them headaches,” Perez told me. But they were afraid to say anything. So they lived with it as best they could until the warehouse exploded, most likely because of a worker’s carelessness.

Perez and his agents urged Mexican police and prosecutors to obtain a search warrant for the building. The process was slow, and the day ended with no warrant. That night another fire erupted, at a warehouse across the street that, the agents learned, contained chemicals in blue plastic barrels and in bags neatly stacked on pallets. “The traffickers came in the middle of the night with gasoline and burned it, burned all the evidence,” Perez said. “But we were able to get photos of the place.”

Eduardo Chávez, another DEA agent, flew in from Mexico City the next afternoon. He and Perez stood outside the second smoldering warehouse. Each man had spent the early part of his career busting meth labs in rural California—Chávez in the area around Bakersfield, Perez in northeastern San Diego County.

That had been a different era, and each had gotten a rare view into it. Bakersfield was Chávez’s first assignment, in 2000, and to his surprise, it was a hotbed of meth production. Southern California was where the ephedrine-based method had been rediscovered, largely due to the efforts of an ingenious criminal named Donald Stenger. Stenger died in 1988, in custody in San Diego County, after a packet of meth he’d inserted in his rectum broke open. But the ephedrine method had by then become more widely known and adopted by Mexican traffickers moving up and down the coast between Mexico and California.

The Mexican meth industry had been pioneered in that earlier time by two brothers, Luis and Jesús Amezcua. They came to California illegally as kids, and eventually ran an auto shop near San Diego. The story goes that a local meth cook dropped by their shop in about 1988, asking Jesús if he could bring in ephedrine from Mexico. Jesús at the time was smuggling Colombian cocaine. But he brought ephedrine north and, with that, became attuned to the market that had been opened by Stenger’s innovation.

Ephedrine was then an unregulated chemical in Mexico. Within a few years, the Amezcuas were importing tons of it. Jesús traveled to India and Thailand, where he set up an office to handle his ephedrine exports. Later, his focus shifted to China and the Czech Republic.

The Amezcuas’ meth career lasted about a decade, until cases brought against them landed them in a Mexican prison, where they remain. But the brothers marked a new way of thinking among Mexican traffickers. They were more interested in business deals and alliances than in the vengeance and endless shoot-outs so common to the previous generation of smugglers, who had trafficked mostly in marijuana and cocaine. The Amezcuas were the first Mexican traffickers to understand the profit potential of a synthetic drug, and the first to tap the global economy for chemical connections.

At first, the brothers ran labs on both sides of the border. They set up many in California’s rural Central Valley—Eduardo Chávez’s territory—making use of an existing network of traffickers among the truckers and migrant farmworkers that stretched up from San Diego. At one bust, agents found a man in protective garments with an air tank on his back. He turned out to be a veterinarian from Michoacán who said he came up for four-month stints to teach the workers to cook.

Hell’s Angels cooks took three days to make five pounds of meth. Mexican crews soon learned to arrive at cook sites like NASCAR pit crews, with premeasured chemicals, large vats, and seasoned workers. They produced 10 to 15 pounds per cook in 24 hours in what came to be known as “super labs.” Soon the biker gangs were buying their meth from the Mexicans.

But toward the end of Chávez’s Bakersfield assignment, in 2004, the cooks and workers who’d been coming up from Mexico began to vanish. His informants told him that they were heading home. In California, law enforcement had made things hard; the job was getting too risky, the chemicals too hard to come by. The meth-cook migration would accelerate after Chávez left the state in 2004. Meth-lab seizures in the United States withered—from more than 10,000 that year to some 2,500 in 2008. Today in the United States, they are rare, and “super labs” are practically nonexistent. In Mexico, however, it was a different story.

The burned-down lab being surveyed by Chávez and Perez at the end of 2006 had been designed to produce industrial quantities of meth. Like many other labs that had been popping up in Mexico, it reflected the union of substantial capital and little concern for law enforcement. It used expensive equipment and stored large inventories of chemicals awaiting processing. Notes found on the scene suggested that the cooks typically got about 240 pounds per batch.

Like Joe Bozenko, the agents standing at the edge of the smoke and the stench that afternoon felt that they were glimpsing a new drug world. What struck them both was what they were not seeing. No ephedrine. The lab was set up exclusively to make P2P meth.

What’s more, this lab was not hidden up in the mountains or on a rural ranch. Tlajomulco de Zúñiga lies just 15 miles south of Guadalajara, one of Mexico’s largest cities, and serves as home to the city’s international airport. The area has everything needed to be a center of meth manufacturing: warehouses, transportation hubs, proximity to chemists. Trucks rumble through the area daily from the shipping ports in Lázaro Cárdenas, in the state of Michoacán, and Manzanillo, in the state of Colima.

The ephedrine method was still very much in use in 2006; Mexico, which had been reducing legal imports of ephedrine, wouldn’t ban them outright until 2008; even after that, some traffickers relied on illegal shipments for a time. And despite all the advances when it came to making P2P, in at least some respects the traffickers “didn’t know what they were doing yet,” Chávez told me. The explosion showed that. Nonetheless, years later he thought back on that moment and realized that it was almost as if they were witnessing a shift right then, that week.

About five years after the Tlajomulco lab exploded, in June 2011, Mexican authorities discovered a massive P2P meth lab in the city of Querétaro, just a few hours north of Mexico City. It was in a warehouse that could have fit a 737, in an industrial park with roads wide enough for 18-wheelers; it made the Tlajomulco lab look tiny. Joe Bozenko and his colleague Steve Toske were called down from Washington to inspect it, and they wandered through it in awe. Bags of chemicals were stacked 30 feet high.

Hundreds of those bags contained a substance neither Bozenko nor Toske had ever thought could be used to make P2P. Bozenko often consulted a book that outlined chemicals that might serve as precursors to making methamphetamine, but this particular substance wasn’t in it. Well-trained organic chemists were clearly improvising new ways to make the ingredients, expanding potential supply even further.

Working through all the chemicals in the plant, by Bozenko’s estimation, the lab could have produced 900 metric tons of methamphetamine. Against a wall stood three 1,000-liter reactors, two stories tall.

Nothing like this had been achieved with ephedrine, nor could it have been; no one could have imagined the accumulation of 900 metric tons of the chemical. Later, Mexican investigators would report that of the 16 workers arrested at the Querétaro lab, 14 died over the next six months from liver failure—presumably caused by exposure to chemicals at the lab.

2 photos: meth paraphernalia including glass pipe, hypodermic needles and caps, knife; city street with tents crowded along both sides
Meth and paraphernalia (above) inside a tent on Skid Row, in Los Angeles. The area encompasses about 50 square blocks of the city; tents (below) line many of its streets. (Rachel Bujalski for The Atlantic)

Methamphetamine was having a cultural moment in the U.S.—“meth mouth” had become an object of can’t-look-away fascination on the internet, and Breaking Bad was big. The switch from ephedrine-based labs to ones using the P2P method was even a plot point in the series. But few people outside the DEA really understood the consequences of this shift. Soon, tons of P2P meth were moving north, without any letup, and the price of meth collapsed. But there was more to the story than higher volume. Ephedrine meth tended to damage people gradually, over years. With the switchover to P2P meth, that damage seemed to accelerate, especially damage to the brain.

One night in 2009, in Temecula, California, partway between San Diego and L.A., a longtime user of crystal meth named Eric Barrera felt the dope change.

Barrera is a stocky ex-Marine who’d grown up in the L.A. area. The meth he had been using for several years by then made him talkative and euphoric, made his scalp tingle. But that night, he was gripped with paranoia. His girlfriend, he was sure, had a man in her apartment. No one was in the apartment, she insisted. Barrera took a kitchen knife and began stabbing a sofa, certain the man was hiding there. Then he stabbed a mattress to tatters, and finally he began stabbing the walls, looking for this man he imagined was hiding inside. “That had never happened before,” he told me when I met him years later. Barrera was hardly alone in noting a change. Gang-member friends from his old neighborhood took to calling the meth that had begun to circulate in the area around that time “weirdo dope.”

Barrera had graduated from high school in 1998 and joined the Marine Corps. He was sent to Camp Lejeune, in North Carolina, where he was among the few nonwhite Marines in the platoon. The racism, he felt, was threatening and brazen. He asked for a transfer to Camp Pendleton, in San Diego County, and was denied. Over the next year and a half, he said, it got worse. Two years into his service, he was honorably discharged.

After the September 11, 2001, terrorist attacks, Barrera was filled with remorse that he hadn’t stuck it out in the Corps. He was home now, without the heroic story he’d imagined for himself when he joined the Marines. The way he tells it, he drank and used meth to relieve his depression.

He’d sometimes stay up on meth for four or five days, and he had to make excuses for missing work. But until that point, he’d held his life together. He worked as a loan processor, then for an insurance company. He had an apartment, a souped-up Acura Integra, a lot of friends.

But as the meth changed around 2009, so did Barrera’s life. His cravings for meth continued, but paranoia and delusions began to fill his days. “Those feelings of being chatty and wanting to talk go away,” he told me. “All of a sudden you’re stuck and you’re in your head and you’re there for hours.” He said strange things to people. He couldn’t hold a job. No one tolerated him for long. His girlfriend, then his mother, then his father kicked him out, followed by a string of friends who had welcomed him because he always had drugs. When he described his hallucinations, “my friends were like, ‘I don’t care how much dope you got, you can’t stay here.’ ”

By 2012, massive quantities of meth were flowing into Southern California. That same year, 96 percent of the meth samples tested by DEA chemists were made using the P2P method. And, for the first time in more than a decade of meth use, Barrera was homeless. He slept in his car and, for a while, in abandoned houses in Bakersfield. He was hearing voices. A Veterans Affairs psychologist diagnosed him with depression and symptoms of schizophrenia.

Even many years later, when I spoke with him, Barrera didn’t know how the drug he was using had changed and spread, or why. But as a resident of Southern California, he was among the first to be affected by it. Over the next half-dozen years or so, the flood of P2P meth would spread east, immersing much of the rest of the country, too.

Mention drug-running, and many people will think of cartels. Yet over the past decade, meth’s rising availability did not result from the dictates of some underworld board of directors. Something far more powerful was at work, particularly in the Sinaloa area: a massive, unregulated free market.

By the time Eric Barrera’s life began to collapse, something like a Silicon Valley of meth innovation, knowledge, skill, and production had formed in the states along Mexico’s northern Pacific Coast. The deaths of kingpins who had controlled the trade, in the early 2010s, had only accelerated the process. “When the control vanishes, all these regional fiefdoms spring up,” said a DEA supervisor who pursued Mexican trafficking organizations during these years. (He, like some other DEA agents I spoke with, asked that his name not be used, because of the dangerous nature of his work.) “We just started seeing more and more labs springing up everywhere.” The new labs weren’t all as enormous as the Querétaro lab that Bozenko had seen in 2011. But they multiplied quickly.

Beginning in about 2013 and continuing for the next several years, meth production expanded geometrically; the labs “just escape all limits,” a member of the Sinaloan drug world told me. “In a five-square-kilometer area outside Culiacán [Sinaloa’s capital city], there were, like, 20 labs. No exaggeration. You go out to 15 kilometers, there’s more than a hundred.”

Listening to traffickers on wiretaps, one DEA agent told me, made it clear just how loose the confederations of meth suppliers were by then. The cartels had not vanished, and many of these suppliers were likely paying one or another of them off. But the wires nonetheless revealed a pulsing ecosystem of independent brokers, truckers, packagers, pilots, shrimp-boat captains, mechanics, and tire-shop owners. In the United States, the system included meat-plant workers, money-wiring services, restaurants, farm foremen, drivers, safe houses, and used-car lots. The ecosystem harnessed the self-interest of each of these actors, who got paid only when deals got done.

“We’d waste hours listening on the wire,” the agent told me, “to people wasting their time calling around doing the networking as brokers, trying to set up drug deals, because they wanted to make money. There’s a huge layer of brokers who are the driving force [in Mexican drug trafficking]. Maybe they own a business or restaurant in Mexico or in the U.S.—this is something they do to supplement income. A large percentage of drug deals at this level don’t happen. But it’s like salesmen—the more calls you make, the more people you know, the more sales you get. So four or five people will be involved in getting 50 kilos to some city in the United States. This guy knows a guy who knows a guy who has a cousin in Atlanta … And with the independent transporters operating at the border, there’s no cartel allegiance. They’re all just making money.”

From 2015 to 2019, the Mexican military raided some 330 meth labs in Sinaloa alone. But arrests were rare, according to a person involved in targeting the labs. Far from being a deterrent, the raids showed that no one would pay a personal price, and more people entered the trade as a result. At one point in 2019, DEA intelligence held that, despite all the raids, at least 70 meth labs were operating in Sinaloa, each with the capacity to make tons of meth with every cook.

With labs popping up everywhere, the price of a pound of meth fell to nearly $1,000 for the first time on U.S. streets by the late 2010s—a 90 percent drop from a decade earlier in many areas. Yet traffickers’ response to tumbling prices was to increase production, hoping to make up for lower prices with higher volume. Competition among producers also drove meth purity to record highs.

Pot was part of this story too. As some American states legalized marijuana, Mexican pot revenue faltered. Many producers switched to making meth and found it liberating. Marijuana took months to grow, was bulky, and could rot. “But with crystal meth,” the member of the Sinaloan drug world told me, “in 10 days you’ve made it. It’s not as bulky as pot, so in two weeks you’re crossing the border with it. Within two or three months, you’re big.”

In the Southwest, the drug quickly became more prevalent than ever. And supply kept flowing east, covering the country in meth all the way to New England, which had almost none before the mid-2010s. Since late 2016, the Midwest and South have seen an especially dramatic shift. Mexican traffickers had never been able to get their hands on enough ephedrine to cover those regions, but now that was no longer an issue. In place after place, they made alliances with local dealers to introduce their product.

2 photos: man in red shorts does a high kick with foot above head inside tent containing chair, dresser, bike; another man in gray shirt/shorts sits and rests his head on a dog
Left: A man inside his encampment on a Skid Row sidewalk, after taking a puff of meth. Right: Another resident of the same encampment, who attributes his homelessness to a cycle of meth use he cannot break. (Rachel Bujalski for The Atlantic)

The Louisville, Kentucky, area is one example. For years, Louisville had a paltry meth market. A pound of it sold for $14,000. Then Wiley Greenhill went to prison. Greenhill was a minor drug dealer in Detroit who had come to Louisville in 1999, attracted by Kentucky’s vibrant street market for pain pills, which were fetching five times what they sold for in Detroit.

He eventually landed at the Roederer Correctional Complex, north of Louisville, where he struck up a friendship with an inmate from California. The inmate’s father, a businessman from Southern California named Jose Prieto, had gotten into debt with the wrong people from Sinaloa. The Sinaloans told Prieto that to settle his debt, he had to sell their meth. Greenhill was given the opportunity to buy it.

By 2016 Greenhill was out of prison, and the meth began to flow. At first Prieto sent small quantities through the mail. Soon the loads reached 50 to 100 pounds a month, driven east by women Greenhill hired.

Prieto proved eager to get his product out. He fronted Greenhill hundreds of thousands of dollars’ worth of meth on the promise that he would be repaid. Tim Fritz, a DEA agent who investigated the Prieto-Greenhill ring, told me, “Jose Prieto would say, ‘Whatever you need, we got it. Whatever you buy, I’ll double it. You want 10 pounds, I’ll give you 20—pay me later.’ ”

As months passed, the Louisville meth market expanded beyond anything the region had seen before. The trade spread to southern Indiana and nearby counties in Kentucky as the number of customers grew. Other local traffickers began to import meth as well. The price of a pound of meth fell to about $1,200, less than a tenth of what it had been just a few years earlier.

At the MORE Center, a Louisville clinic set up to treat pain-pill and heroin addicts, patients started coming in on meth. Before the Prieto-Greenhill connection, only two of counselor Jennifer Grzesik’s patients were using meth. Within three years, almost 90 percent of new patients coming to the clinic had meth in their drug screen. “I don’t remember having any homeless people in my caseload before 2016,” she told me. But 20 percent of her clients now are homeless.

Greenhill and Prieto were arrested in 2018 and 2019, respectively, and are now serving lengthy federal-prison terms. They left behind a transformed market. Primed by the new supply, meth demand has exploded, in turn drawing more dealers who have found their own supply connections. The price of a pound of meth remains low. To compete, some Louisville meth dealers now offer free delivery; others offer syringes already loaded with liquid meth so users can immediately shoot up. Similar partnerships, arrangements, and retail innovations have transformed regional drug markets across the U.S.

Habits, once entrenched, are difficult to change. If they weren’t, more Americans would have quit smoking soon after 1964, when the U.S. surgeon general issued his first report on its risks. American nicotine addicts kept smoking because nicotine had changed their brain chemistry, and cigarettes were everywhere. We stopped people from smoking, argues Wendy Wood, a psychologist at the University of Southern California and the author of a book on habituation, by adding “friction” to the activity—making it harder to do or limiting access to supply. We removed cigarette vending machines, banned smoking in public spaces. By adding friction to smoking, we also removed cues that prompted people to smoke: bars where booze, friends, and cigarettes went together, for example.

Something like the opposite of that has happened with P2P methamphetamine. “Meth reminds me of what alcoholics go through,” Matt Scharf, the director of recovery programs at Midnight Mission, a Los Angeles treatment center, told me. “There’s alcohol everywhere. Meth is now so readily available. There’s an availability to it that is not the case with heroin or crack. It’s everywhere.”

All of that meth has been pushed into a market already softened up by the opioid epidemic. That should not have mattered: Historically, meth and opioid users had been separate groups with different cultures, and the drugs affect the brain’s reward pathways differently. But as large supplies of P2P meth began to arrive, many opioid addicts already feared for their life. Fentanyl, a dangerous synthetic opioid, was also spreading quickly. For many, Suboxone—which blocks opiate receptors and hence eliminates opioid cravings—was a lifesaver. They use it daily, the way a heart patient uses daily blood thinners to stay alive. Yet the counseling and continuum of care required to support the broader life changes necessary for addiction recovery are often absent.

Thus, as P2P meth spread nationwide, an unprecedented event took place in American drug use: Opioid addicts began to shift, en masse, to meth. Meth overdoses have risen rapidly in recent years, but they are much less common than opioid ODs—you don’t typically overdose and die on meth; you decay. By 2019, in the course of my reporting, I was routinely coming into contact with people in Kentucky, Ohio, Indiana, Tennessee, and West Virginia who were using Suboxone to control their opiate cravings from long-standing addiction to pain pills and heroin, while using methamphetamine to get high. Massive supplies of cheap P2P meth had created demand for a stimulant out of a market for a depressant. In the process, traffickers forged a new population of mentally ill Americans.

Over the past year and a half, I’ve talked with meth addicts, counselors, and cops around the country. The people I spoke with told me stories nearly identical to Eric Barrera’s: P2P-meth use was quickly causing steep deterioration in mental health. The symptoms were always similar: violent paranoia, hallucinations, conspiracy theories, isolation, massive memory loss, jumbled speech. Methamphetamine is a neurotoxin—it damages the brain no matter how it is derived. But P2P meth seems to create a higher order of cerebral catastrophe. “I don’t know that I would even call it meth anymore,” Ken Vick, the director of a drug-treatment center in Kansas City, Missouri, told me. Schizophrenia and bipolar disorder are afflictions that begin in the young. Now people in their 30s and 40s with no prior history of mental illness seemed to be going mad.

Man wearing "Moving Forward" t-shirt and jeans and holding leash of a dog wearing harness and booties in front of blue-tarp-covered tent with American flag
Eric Barrera, now an outreach worker to homeless military veterans on Skid Row, had used meth for years before the flood of P2P meth hit. His mental health took a sharp downward turn. (Rachel Bujalski for The Atlantic)

Portland, Oregon, began seeing the flood of meth around 2013. By January 2020, the city had to close its downtown sobering station. The station had opened in 1985 as a place for alcoholics to sober up for six to eight hours, but it was unequipped to handle people addicted to P2P meth. “The degree of mental-health disturbance; the wave of psychosis; the profound, profound disorganization [is something] I’ve never seen before,” Rachel Solotaroff, the CEO of Central City Concern, the social-service nonprofit that ran the station, told me. Solotaroff was among the first people I spoke with. She sounded overwhelmed. “If they’re not raging and agitated, they can be completely noncommunicative. Treating addiction [relies] on your ability to have a connection with someone. But I’ve never experienced something like this—where there’s no way in to that person.”

On Skid Row in Los Angeles, crack had been the drug of choice for decades. Dislodging it took some time. But by 2014 the new meth was everywhere. When that happened, “it seemed that people were losing their minds faster,” a Los Angeles Police Department beat officer named Deon Joseph told me. Joseph had worked Skid Row for 22 years. “They’d be okay when they were just using crack,” Joseph said. “Then in 2014, with meth, all of a sudden they became mentally ill. They deteriorated into mental illness faster than I ever saw with crack cocaine.”

Susan Partovi has been a physician for homeless people in Los Angeles since 2003. She noticed increasing mental illness—schizophrenia, bipolar disorder—at her clinics around the city starting in about 2012. She was soon astonished by “how many severely mentally ill people were out there,” Partovi told me. “Now almost everyone we see when we do homeless outreach on the streets is on meth. Meth may now be causing long-term psychosis, similar to schizophrenia, that lasts even after they’re not using anymore.”

I called James Mahoney, a neuropsychologist at West Virginia University who had studied the effects of ephedrine meth on the brain in the early 2000s at UCLA. The psychosis he saw then was bad, he said, but it frequently appeared to be the result of extended sleep deprivation. In 2016, Mahoney took a job as a drug researcher and specialist in WVU’s addiction clinic. Less than a year later, the P2P crystal meth from Mexico started showing up. Mahoney was inundated with meth patients who came in ranting, conversing with phantoms. “I can’t even compare it to what I was seeing at UCLA,” he told me. “Now we’re seeing it instantaneously, within hours, in people who just used: psychotic symptoms, hallucinations, delusions.”

In community after community, I heard stories like this. Southwest Virginia hadn’t seen much meth for almost a decade when suddenly, in about 2017, “we started to see people go into the state mental-hospital system who were just grossly psychotic,” Eric Greene, then a drug counselor in the area, told me. “Since then, it’s caused a crisis in our state mental-health hospitals. It’s difficult for the truly mentally ill to get care because the facilities are full of people who are on meth.”

Symptoms could fade once users purged the drug, if they did not relapse. But while they were on this new meth, they grew antisocial, all but mute. I spoke with two recovering meth addicts who said they had to relearn how to speak. “It took me a year and a half to recover from the brain damage it had done to me,” one of them said. “I couldn’t hardly form sentences. I couldn’t laugh, smile. I couldn’t think.”

I spoke with Jennie Jobe, from rural Morgan County, in eastern Tennessee. Jobe had spent 20 years working in state prisons when she started a drug court and associated residential treatment center in 2013.

For its first few years, Jobe’s court handled meth addicts who got their drugs from local “shake and bake” manufacturers— small-batch cooks using Sudafed, and usually producing just a few grams of the drug at a time. These meth users were gaunt, she remembers, and picked at their skin. But they were animated, lucid, with memories and personalities intact when they arrived at her facility, detoxed after months in jail.

By 2017, however, people were coming to her treatment center stripped of human energy, even after several months spent detoxing from the drug in jail. “Normal recreational activities where guys talk trash and have fun—there’s none of that. It’s like their brain cannot fire.”

Treating them was daunting. Despite years of research, science has found no equivalent of methadone or Suboxone to help subdue meth cravings and allow people addicted to the drug a chance to break from it and begin repairing their life. And, like many others I spoke with, Jobe found that the human connection essential to successful drug treatment was almost impossible to establish. “It takes longer for them to actually be here mentally,” Jobe said. “Before, we didn’t keep anybody more than nine months. Now we’re running up to 14 months, because it’s not until six or nine months that we finally find out who we got.” Some can’t remember their life before jail. “It’s not unusual for them to ask what they were found guilty of and sentenced to,” she said.

Why is P2P meth producing such pronounced symptoms of mental illness in so many people? No one I spoke with knew for sure. One theory is that much of the meth contains residue of toxic chemicals used in its production, or other contaminants. Even traces of certain chemicals, in a relatively pure drug, might be devastating. The sheer number of users is up, too, and the abundance and low price of P2P meth may enable more continual use among them. That, combined with the drug’s potency today, might accelerate the mental deterioration that ephedrine-based meth can also produce, though usually over a period of months or years, not weeks. Meth and opioids (or other drugs) might also interact in particularly toxic ways. I don’t know of any study comparing the behavior of users—or rats for that matter—on meth made with ephedrine versus meth made with P2P. This now seems a crucial national question.

Once your eyes are open to the scale and human consequences of the P2P-meth epidemic, it’s hard to miss its ramifications in many areas of American public life.

Perhaps the most significant is homelessness.

In 2012, a Los Angeles Superior Court judge, Craig Mitchell, founded L.A.’s Skid Row Running Club. Every Monday, Thursday, and Saturday, 20 to 50 people—recovering addicts, cops, public defenders, social workers—meet around dawn in front of a local shelter to run for an hour through the greatest concentration of homeless people in the United States. The club’s broader mission is to support the area’s homeless community through mentorship and a focus on wellness.

2 photos: Barrera in backward cap, backpack, and face mask hands package to man wearing vest and shorts on bike; group of people running past tents along street under a bridge in early morning light
Top: Barrera, distributing socks on Skid Row. Bottom: The Skid Row Running Club—recovering addicts, cops, social workers—seeks to support the area’s homeless through mentorship and a focus on wellness. (Rachel Bujalski for The Atlantic)

Los Angeles has long been the nation’s homelessness capital, but as in many cities—large and small—the problem has worsened greatly in recent years. In the L.A. area, homelessness more than doubled from 2012 to 2020. Mitchell told me that the most visible homelessness—people sleeping on sidewalks, or in the tents that now crowd many of the city’s neighborhoods—was clearly due to the new meth. “There was a sea change with respect to meth being the main drug of choice beginning in about 2008,” he said. Now “it’s the No. 1 drug.”

Remarkably, meth rarely comes up in city discussions on homelessness, or in newspaper articles about it. Mitchell called it “the elephant in the room”—nobody wants to talk about it, he said. “There’s a desire not to stigmatize the homeless as drug users.” Policy makers and advocates instead prefer to focus on L.A.’s cost of housing, which is very high but hardly relevant to people rendered psychotic and unemployable by methamphetamine.

Addiction and mental illness have always been contributors to homelessness. P2P meth seems to produce those conditions quickly. “It took me 12 years of using before I was homeless,” Talie Wenick, a counselor in Bend, Oregon, who began using ephedrine-based meth in 1993 and has been clean for 15 years, told me. “Now within a year they’re homeless. So many homeless camps have popped up around Central Oregon—huge camps on Bureau of Land Management land, with tents and campers and roads they’ve cleared themselves. And almost everyone’s using. You’re trying to help someone get clean, and they live in a camp where almost everyone is using.”

Eric Barrera is now a member of Judge Mitchell’s running club. Through the VA, he got treatment for his meth addiction and found housing; without meth, he was able to keep it. The voices in his head went away. He volunteered at a treatment center, which eventually hired him as an outreach worker, looking for vets in the encampments.

Barrera told me that every story he hears in the course of his work is complex; homelessness, of course, has many roots. Some people he has met were disabled and couldn’t work, or were just out of prison. Others had lost jobs or health insurance and couldn’t pay for both rent and the surgeries or medications they needed. They’d scraped by until a landlord had raised their rent. Some kept their cars to sleep in, or had welcoming families who offered a couch or a bed in a garage. Barrera thought of them as invisible, the hidden homeless, the shredded-safety-net homeless.

But Barrera also told me that for a lot of the residents of Skid Row’s tent encampments, meth was a major reason they were there and couldn’t leave. Such was the pull. Some were addicted to other things: crack or heroin, alcohol or gambling. Many of them used any drug available. But what Barrera encountered the most was meth.

Tents themselves seem to play a role in this phenomenon. Tents protect many homeless people from the elements. But tents and the new meth seem made for each other. With a tent, the user can retreat not just mentally from the world but physically. Encampments provide a community for users, creating the kinds of environmental cues that the USC psychologist Wendy Wood finds crucial in forming and maintaining habits. They are often places where addicts flee from treatment, where they can find approval for their meth use.

In Los Angeles, the city’s unwillingness, or inability under judicial rulings, to remove the tents has allowed encampments to persist for weeks or months, though a recent law allows for more proactive action. In this environment, given the realities of addiction, the worst sorts of exploitation have sometimes followed. In 2020, I spoke with Ariel, a transgender woman then in rehab, who had come to Los Angeles from a small suburb of a midsize American city four years before. She had arrived hoping for gender-confirmation surgery and saddled with a meth habit. She eventually ended up alone on Hollywood’s streets. “There’s these camps in Hollywood, on Vine and other streets—distinct tent camps,” she said, where women on meth are commonly pimped. “A lot of people who aren’t homeless have these tents. They come from out of the area to sell drugs, move guns, prostitute girls out of the tents. The last guy I was getting worked out by, he was charging people $25 a night to use his tents. He would give you girls, me and three other people. He’d take the money and we’d get paid in drugs.”

Megan Schabbing, a psychiatrist and the medical director of emergency psychiatric services at OhioHealth, in Columbus, Ohio, later described to me how meth use and this sort of suffering can reinforce each other. Schabbing spends much of her time on the job digging into the underlying causes of drug use among those who end up in the ER. Often there was trauma: beatings, molestation, rape, war deployment, childhood chaos, neglect. For many of these patients, she discovered, the delusions fueled by meth became the point—the drug’s attraction. “Many would tell me, ‘I can stay out of reality on the street’ ” by using meth, she said. “When they come to us, it takes them days to figure out who and where they are. But some patients have told me that’s not a bad thing if you’re on the street.”

If P2P meth pushed her patients toward homelessness, it also helped them bear it.

How could this crisis emerge so quietly and remain, in many ways, invisible to most Americans? One reason, perhaps, is the national focus on the opioid epidemic, which was itself ignored for a long time. In recent years, the headlines have been about pain-pill or heroin overdoses, then fentanyl overdoses, and the funding has followed. Besides, deaths, however tragic, allow for memorials, a chance to remember the deceased’s better days. Meth doesn’t kill people at nearly the same rate as opioids. It presents, instead, the rawest face of living addiction. That part of addiction, one counselor told me, “people don’t want to touch it.”

There is no central villain in the P2P-meth story—no Purdue Pharma, no dominant cartel. There’s no single entity to target, either. So the issue is often enveloped in a willful myopia. Advocates for homeless people seem reluctant to speak out about the drug, for fear that the downtrodden will be blamed for their troubles.

2 photos: person lying on ground resting head on wheel of shopping cart in front of two people sitting on curb; woman with long blonde hair holding large wooden heart and wearing angel wings in front of tall brick and metal fence.
Left: A couple sits on a Skid Row sidewalk while a man sleeps next to them. Right: A woman near her tent in L.A., holding a wooden heart she found while searching for recyclables. She wants to kick her meth habit, she says, but cannot stop using. (Rachel Bujalski for The Atlantic)

The spread of P2P meth is part of a larger narrative—a shift in drug supply from plant-based drugs such as marijuana, cocaine, and heroin to synthetic drugs, which can be made anywhere, quickly, cheaply, and year-round. Underground chemists are continually seeking to develop more potent and addictive varieties of them. The use of mind-altering substances by humans is age-old, but we have entered a new era.

Drug demand is important in this new era. People need to understand what these drugs will ultimately do to them, and those who are using will need substantial help getting off them.

But it must be said: The story of the meth epidemic (like the opioid epidemic before it) begins with supply. In a previous era, most Vietnam vets kicked heroin when they got home and were far from war and the potent supplies they were used to in Southeast Asia. Today, supplies of meth are vast and cheap throughout much of the country.

Crystal meth is in some ways a metaphor for our times—times of anomie and isolation, of paranoia and delusion, of communities coming apart. Meth is not responsible for these much wider social problems, of course. But the meth epidemic is symptomatic of them, and also contributes to them.

If you spend time among meth users, you’ll notice certain habits and tics: fixations on flashlights, for instance, and on bicycles, which are endlessly disassembled and assembled again. Hoodies are everywhere. The hoodie is versatile—cheap, warm, functional. But as opioids, then meth, spread across America, the hoodie also became, for many, a hiding place from a harsh world. “When we put up that hood,” one recovering addict told me, “we’re making the choice to separate ourselves from everyone else—instead of someone pushing us out. I think it’s our way to hide from the world that doesn’t accept us. The hood is the refuge. It’s our safe place.”

Perhaps the best defense against epidemics like this one lies in choosing to look more closely and more sympathetically at the people in those hoods—to put a higher priority on community than we’ve done in recent years. America has made itself more vulnerable to scourges, even as those scourges grow more potent. But scourges are also an opportunity: They call on us to reexamine how we live. Until we begin to look out for the most vulnerable among us, there’s no reason to expect them to abate.


This article is adapted from Sam Quinones’s new book, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. It appears in the November 2021 print edition with the headline “The New Meth.” When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

About the Author
Sam Quinones is a Los Angeles–based journalist and the author of four books of narrative nonfiction, including his latest, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth.
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DEA Issues Public Safety Alert on Sharp Increase in Fake Prescription Pills Containing Fentanyl and Meth

DEA Warns that International and Domestic Criminal Drug Networks are Flooding the United States with Lethal Counterfeit Pills

WASHINGTON, D.C. – The Drug Enforcement Administration has issued a Public Safety Alert warning Americans of the alarming increase in the lethality and availability of fake prescription pills containing fentanyl and methamphetamine. DEA’s Public Safety Alert, the first in six years, seeks to raise public awareness of a significant nationwide surge in counterfeit pills that are mass-produced by criminal drug networks in labs, deceptively marketed as legitimate prescription pills, and are killing unsuspecting Americans at an unprecedented rate.

These counterfeit pills have been seized by DEA in every U.S. state in unprecedented quantities. More than 9.5 million counterfeit pills were seized so far this year, which is more than the last two years combined. DEA laboratory testing reveals a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a lethal dose. A deadly dose of fentanyl is small enough to fit on the tip of a pencil.   

Counterfeit pills are illegally manufactured by criminal drug networks and are made to look like real prescription opioid medications such as oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®); or stimulants like amphetamines (Adderall®). Fake prescription pills are widely accessible and often sold on social media and e-commerce platforms – making them available to anyone with a smartphone, including minors.

“The United States is facing an unprecedented crisis of overdose deaths fueled by illegally manufactured fentanyl and methamphetamine,” said Anne Milgram, Administrator of the Drug Enforcement Administration. “Counterfeit pills that contain these dangerous and extremely addictive drugs are more lethal and more accessible than ever before. In fact, DEA lab analyses reveal that two out of every five fake pills with fentanyl contain a potentially lethal dose. DEA is focusing resources on taking down the violent drug traffickers causing the greatest harm and posing the greatest threat to the safety and health of Americans. Today, we are alerting the public to this danger so that people have the information they need to protect themselves and their children.”

The vast majority of counterfeit pills brought into the United States are produced in Mexico, and China is supplying chemicals for the manufacturing of fentanyl in Mexico.

The drug overdose crisis in the United States is a serious public safety threat with rates currently reaching the highest level in history. Drug traffickers are using fake pills to exploit the opioid crisis and prescription drug misuse in the United States, bringing overdose deaths and violence to American communities. According to the Centers for Disease Control and Prevention (CDC), more than 93,000 people died of a drug overdose in the United States last year. Fentanyl, the synthetic opioid most commonly found in counterfeit pills, is the primary driver of this alarming increase in overdose deaths. Drug poisonings involving methamphetamine, increasingly found to be pressed into counterfeit pills, also continue to rise as illegal pills containing methamphetamine become more widespread.  

Drug trafficking is also inextricably linked to violence. This year alone, DEA seized more than 2700 firearms in connection with drug trafficking investigations – a 30 percent increase since 2019. DEA remains steadfast in its mission to protect our communities, enforce U.S. drug laws, and bring to justice the foreign and domestic criminals sourcing, producing, and distributing illicit drugs, including counterfeit pills.

This alert does not apply to legitimate pharmaceutical medications prescribed by medical professionals and dispensed by licensed pharmacists. The legitimate prescription supply chain is not impacted. Anyone filling a prescription at a licensed pharmacy can be confident that the medications they receive are safe when taken as directed by a medical professional.

The issuance of today’s Public Safety Alert coincides with the launch of DEA’s One Pill Can Kill Public Awareness Campaign to educate the public of the dangers of counterfeit pills. DEA urges all Americans to be vigilant and aware of the dangers of counterfeit pills, and to take only medications prescribed by a medical professional and dispensed by a licensed pharmacist. DEA warns that pills purchased outside of a licensed pharmacy are illegal, dangerous, and potentially lethal. For more information, visit https://www.dea.gov/onepill or scan the QR code below.

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YOU CAN’T STOP WHAT YOU DON’T KNOW.

TALL COP JERMAINE GALLOWAY PROVIDES THE TOOLS, RESOURCES AND TRAINING TO COMBAT SUBSTANCE ABUSE.

Tall Cop Says Stop™ was created by Officer Jermaine Galloway, an Idaho law enforcement officer since 1997. Regarded as one of America’s top experts in various drug and alcohol trends, he has specialized in underage drinking and drug enforcement for more than 15 years.

Since 2009, Officer Galloway has won four national awards and one international award for his work. In addition to his numerous talks at conferences and other events, he has personally trained more than 105,000 people nationwide.

Officer Galloway’s many years of experience have taught him one thing above all else. In his words, “You can’t stop what you don’t know™.”

Perry County will be hosting the training in October.

The training is for law enforcement, probation officers, school administration, treatment providers, and counselors. This session is unique, in that it provides over 120 visual aids for attendees to hold and become familiar with. In today’s culture, everything is person-specific and has different meanings to different individuals. For each person to help prevent youth and adult substance abuse, you MUST know what is going on in your community. These new trends are very popular and it is important for all who are involved in prevention, education, treatment, or enforcement to understand these sweeping changes in the drug culture.

TOPICS COVERED IN THE TRAINING

This training covers alcohol and drug clothing, alcoholic energy drinks, alcopops, alcohol and drug concealment methods and containers, drug paraphernalia, drug related music and groups, logos, stickers, new technology, youth party tendencies, party games, non-traditional alcoholic beverages, social networking sites, synthetic drugs, OTC drugs, inhalants, concentrates, E-cigarettes, and popular party drugs.

 

Instructor/Trainer: Officer Jermaine Galloway “Tall Cop Says Stop”

Class Cost: $25.00 per person

Registration Required – Class Limited to 150 Attendees

Class Date / Times

9:00 am- 3:00 pm

Tuesday, October 12, 2021 

Location: Robinson Event Center Address: 2411 Walters Lane, Perryville, MO 63775

For more information on the program, visit www.tallcopsaysstop.com

For more information, contact Deputy Auston Turner at  aturner@perrycountymo.us

Missouri Would Get $500M Under Opioid Settlement

By Associated Press for Missouri Lawyers Media | molawyersmedia.com

 

The attorney general on Thursday, July 22 said Missouri could get as much as $500 million to help victims of the opioid epidemic as part of a tentative settlement with the three biggest U.S. drug distribution companies and the drug maker Johnson & Johnson.

Republican Attorney General Eric Schmitt said it would be the biggest “victim-centric” settlement ever in Missouri.

“While this proposed settlement won’t bring back any of these victims, today’s announcement brings the very real possibility of just over half a billion dollars that will go directly toward funding crucial addiction treatment, recovery, and intervention programs,” Schmitt said in a statement.

Lawyers for state and local governments in the U.S. on Tuesday announced they were close to reaching a $26 billion settlement after suing to force the pharmaceutical industry to help pay to fix a nationwide opioid addiction and overdose crisis.

Under the deal, Johnson & Johnson would not produce any opioids for at least a decade. And AmerisourceBergen, Cardinal Health and McKesson share prescribing information under a new system intended to stop the avalanches of pills that arrived in some regions about a decade ago.

Schmitt said Missouri counties need to sign on to the agreement for the state to get its full share.

DEA Finalizes Measures to Expand Medication-Assisted Treatment

Improved access will benefit rural and underserved areas with limited treatment options

The Drug Enforcement Administration today announced an important step to improve access to medications for opioid use disorder, especially in rural areas where those suffering with opioid use disorder may have limited treatment options.

Under the final rule published today, DEA registrants who are authorized to dispense methadone for opioid use disorder would be authorized to add a “mobile component” to their existing registration – eliminating the separate registration requirement for these mobile narcotic treatment programs (NTPs). This will streamline the registration process and make it easier for registrants to provide needed services in remote or underserved areas. The rule also outlines the reports and records that shall be maintained for NTPs that wish to expand the reach of their treatment programs by use of mobile components.

“In the United States, we have been facing an opioid epidemic for more than a decade,” said DEA Assistant Administrator for Diversion Control Tim McDermott. “We are losing tens of thousands of Americans per year to opioid-involved overdoses. The Administration, DOJ, DEA, HHS, among many others, are squarely focused on efforts to improve the use of medication-assisted treatment in order to reduce overdose deaths and help those with opioid-addictions recover. Today’s action sends a very important message that we support the use of medication-assisted treatment for opioid use disorder and are using all the tools at our disposal to make treatment options available to anyone in need of them, anywhere in the country.”

“Today’s action by the DEA will improve access to life-saving medication for opioid use disorder, especially for those in underserved communities who face barriers to treatment,” said Acting Director of National Drug Control Policy Regina LaBelle. “This new rule is a significant step forward that supports the Biden-Harris Administration’s drug policy priorities, including expanding access to evidence-based treatment and advancing racial equity in our approach to drug policy.”

According to the Centers for Disease Control, provisional data indicate that there were more than 67,500 reported overdose deaths attributed to opioids during the 12-month period ending in November 2020. This accounts for approximately three quarters of all drug overdose deaths in the United States.

The demand for evidence-based medication-assisted treatment for substance use disorders, including opioid use disorder, has increased over the years, especially for services provided by NTPs. In certain areas of the country – particularly rural, urban, and Tribal communities – this has resulted in long waiting lists and high services fees. In addition, the distance to the nearest NTP or the lack of consistent access to transportation in rural and underserved communities may prevent or substantially impede access to these critical services.

Methadone is one of three FDA-approved medications for opioid use disorder.  There are more than 1,900 narcotic treatment program locations across the country, including opioid treatment programs, withdrawal management services that utilize methadone, and compounders.

This final rule builds on existing experience and provides additional flexibility for NTPs in operating mobile components, subject to the regulatory restrictions put into place to prevent the diversion of controlled substances.

For more information, the final rule is available here.

Drug Identification – The Opioid Crisis in America

The Opioid Crisis in America is an interactive two-part course in a series of Drug Identification training modules. The other courses in this series are Depressants, Antidepressants, and Inhalants and Stimulants.

This course provides an overview of the chemical and legal classification of opioids and examines the nationa​​l epidemic of opioid abuse. It provides key information and safety measures law enforcement and criminal justice providers should know when responding to opioid related events. Community response and other evidence-based practices are also discussed.

COURSE RUN TIME: 2 HOURS

ENROLL NOW

About This Course

According to the U.S. Department of Health and Human Services, every day in America, 116 people die from an opioid overdose.[1]

As reported by the US Surgeon General in 2015, 1.5 million Americans aged 12 or older reported misusing sedatives in the past year. Furthermore, 6.1 million individuals reported misusing tranquilizers such as Xanax® in the past year[1] This is especially concerning as many of these individuals will mix sedatives and/or tranquilizers with alcohol, a depressant in its own right. This risky behavior increases the potential for overdose which can occur when critical areas in the brain that control breathing, heart rate, and body temperature stop functioning.[2] This course will identify the various types of commonly abused depressants, sedatives, anti-depressants and inhalants; discuss current trends relating to these substances; examine side effects and symptoms of abuse of these substances; discuss the synergistic effects of depressants mixed with alcohol; and review common and household items used for inhalant properties.  

Part one of this course, “The Opioid Crisis in America: Overview”, discusses the differences between opiates and opioids; identifies uses of opioids, examines the overall national opioid epidemic, describes the societal impacts of opioid abuse.

Part two, “The Opioid Crisis in America: Opioid Drugs and Responses” reviews the most commonly abused prescription opioid drugs; differentiates between physical manifestations of synthetic opioids in comparison to other opioids; examines common methods of opioid injection and common paraphernalia used for ingestion; and reviews medications to reduce opioid dependence.

[1] Public Affairs. “HHS.gov/Opioids: The Prescription Drug & Heroin Overdose Epidemic.“ HHS.gov. Accessed May 03, 2018. https://www.hhs.gov/opioids/

properties.  

[1] “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.” U.S. Department of Health and Human Services. 2016. 1-9. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.

Participants should expect to spend approximately 2 hours reviewing the content and resources in this course.

This tuition-free online training was developed by the National Criminal Justice Training Center of Fox Valley Technical College and was originally supported by cooperative agreement 2017-CK-WX-K007 by the U.S. Department of Justice, Office of Community Oriented Policing Services.

Primary Audience

This course is ideal for all law enforcement, criminal justice professionals and service providers as well as community-policing stakeholders, including corrections professionals, court system personnel, social workers, and behavioral health/treatment providers.

Policing on the Front Lines of the Opioid Crisis

Law enforcement officers play three important roles on the front lines of the opioid epidemic: They are responsible for emergency response and preserving public safety as well as law enforcement. This report from the Office of Community Oriented Policing Services (COPS) discusses the challenge of reconciling the conflicts that can arise among these roles and presents recommendations for alleviating these difficulties and improving law enforcement response to the opioid crisis.

The COPS Office is the component of the U.S. Department of Justice responsible for advancing the practice of community policing by the nation’s state, local, territorial, and tribal law enforcement agencies through information and grant resources.

The COPS Office publishes materials for law enforcement and community stakeholders to use in collaborativ​​ely addressing crime and disorder challenges. 

These free publications provide best practice approaches and give access to collective knowledge from the field. You can find their recent and featured publications, and search the Resource Center or their Community Policing Topics pages for specific issues ​by visiting ​​https://cops.usdoj.gov/recentreleases or by calling the COPS Office Response Center at 800-421-6770.

Photo by camilo jimenez | Unsplash.com