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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International Law Enforcement Operation Targeting Opioid Traffickers on the Darknet

Darknet Narcotics Vendors Selling to Tens of Thousands of U.S. Residents Charged

 

On Tuesday, October 26, the Department of Justice, through the Joint Criminal Opioid and Darknet Enforcement (JCODE) team joined Europol to announce the results of Operation Dark HunTor, a coordinated international effort on three continents to disrupt opioid trafficking on the Darknet. The operation, which was conducted across the United States, Australia, and Europe, was a result of the continued partnership between JCODE and foreign law enforcement against the illegal sale of drugs and other illicit goods and services. Operation Dark HunTor builds on the success of last year’s Operation DisrupTor and the coordinated law enforcement takedown earlier this year of DarkMarket, the world’s then-largest illegal marketplace on the Darknet. At the time, German authorities arrested the marketplace’s alleged operator and seized the site’s infrastructure, providing investigators across the world with a trove of evidence. Europol’s European Cybercrime Centre (EC3) and JCODE have since been compiling intelligence packages to identify key targets.

Following the DarkMarket takedown in January 2021, U.S. and international law enforcement agencies identified Darknet drug vendors and buyers, resulting in a series of complementary, but separate, law enforcement investigations. Operation Dark HunTor actions have resulted in the arrest of 150 alleged Darknet drug traffickers and other criminals who engaged in tens of thousands of sales of illicit goods and services across Australia, Bulgaria, France, Germany, Italy, the Netherlands, Switzerland, the United Kingdom, and the United States. Prior to, but in support of Operation Dark HunTor, Italian authorities also shut down the DeepSea and Berlusconi dark web marketplaces which boasted over 40,000 advertisements of illegal products. Four alleged administrators were arrested, and €3.6 million in cryptocurrencies were seized in coordinated U.S.-Italian operations.

Operation Dark HunTor resulted in the seizure of over $31.6 million in both cash and virtual currencies; approximately 234 kilograms (kg) of drugs worldwide including 152.1 kg of amphetamine, 21.6 kg of cocaine, 26.9 kg of opioids, 32.5 kg of MDMA, in addition to more than 200,000 ecstasy, fentanyl, oxycodone, hydrocodone, and methamphetamine pills, and counterfeit medicine ; and 45 firearms. Darknet vendor accounts were also identified and attributed to real individuals selling illicit goods on active marketplaces, as well as inactive Darknet marketplaces such as Dream, WallStreet, White House, DeepSea, and Dark Market.

Operation Dark HunTor led to 65 arrests in the United States, one in Bulgaria, three in France, 47 in Germany, four in the Netherlands, 24 in the United Kingdom, four in Italy, and two in Switzerland. A number of investigations are still ongoing.

“This 10-month massive international law enforcement operation spanned across three continents and involved dozens of U.S. and international law enforcement agencies to send one clear message to those hiding on the Darknet peddling illegal drugs: there is no dark internet. We can and we will shine a light,” said Deputy Attorney General Monaco. “Operation Dark HunTor prevented countless lives from being lost to this dangerous trade in illicit and counterfeit drugs, because one pill can kill. The Department of Justice with our international partners will continue to crack down on lethal counterfeit opioids purchased on the Darknet.”

“The men and women of the department’s Criminal Division, in close collaboration with our team of interagency and international partners, stand ready to leverage all our resources to protect our communities through the pursuit of those who profit from addiction, under the false belief that they are anonymous on the Darknet,” said Assistant Attorney General Kenneth A. Polite Jr of the Justice Department’s Criminal Division. “Only through a whole of government and, in this case, global approach to tackling cyber-enabled drug trafficking can we hope to achieve the significant results illustrated in Operation Dark HunTor.”

“The FBI continues to identify and bring to justice drug dealers who believe they can hide their illegal activity through the Darknet,” said FBI Director Christopher A. Wray. “Criminal darknet markets exist so drug dealers can profit at the expense of others’ safety. The FBI is committed to working with our JCODE and EUROPOL law enforcement partners to disrupt those markets and the borderless, worldwide trade in illicit drugs they enable.”

“Today, we face new and increasingly dangerous threats as drug traffickers expand into the digital world and use the Darknet to sell dangerous drugs like fentanyl and methamphetamine,” said Administrator Anne Milgram of the Drug Enforcement Administration (DEA). “These drug traffickers are flooding the United States with deadly, fake pills, driving the U.S. overdose crisis, spurring violence, and threatening the safety and health of American communities. DEA’s message today is clear: criminal drug networks operating on the Darknet, trying to hide from law enforcement, can no longer hide. DEA, the U.S. interagency, and our valued international partners, are committed to dismantling drug networks wherever they are, including on the Darknet.”

“Illicit darkweb marketplaces represent a significant threat to public health, economic, and national security,” said Acting Director Tae Johnson of U.S. Immigration and Customs Enforcement (ICE). “By working collaboratively and sharing intelligence across local, state, federal, and international law enforcement agencies, Homeland Security Investigations (HSI) and its partners are disrupting and dismantling transnational criminal organizations responsible for introducing dangerous narcotics and other contraband into our communities.”  

“The dark web has become an underground facilitator of illegal commerce,” said Chief Postal Inspector Gary Barksdale of the U.S. Postal Inspection Service (USPIS). “Criminals use the dark web to sell and ship narcotics and other dangerous goods around the world, often relying on the postal system and private carriers to deliver these illegal products. The U.S. Postal Inspection Service is committed to finding and stopping these drug traffickers.”

“The Darknet no longer provides a concealing cloak for criminals to operate,” said IRS Criminal Investigation (IRS-CI) Chief Jim Lee. “The expertise of our agents and law enforcement partners helped uncover significant quantities of narcotics and money — both cash and virtual currency — derived from illicit means.”

“The point of operations such as the one today is to put criminals operating on the dark web on notice: the law enforcement community has the means and global partnerships to unmask them and hold them accountable for their illegal activities, even in areas of the dark web,” said Europol’s Deputy Executive Director of Operations Jean-Philippe Lecouffe.

The extensive operation, which lasted 10 months, resulted in dozens of federal operations and prosecutions, including:

  • Four search warrants were executed in furtherance of a multiagency investigation resulting in the seizure of approximately $1 million in drug proceeds (including approximately $700,000 in cryptocurrency), eight firearms, one vehicle, and various controlled substances including MDMA, LSD, and cocaine. The FBI, DEA, Food and Drug Administration (FDA), and USPIS jointly conducted the investigation. According to court documents, the targets of the investigation were operating over multiple Darknet marketplaces to traffic methamphetamine, counterfeit pressed Adderall (containing methamphetamine), MDMA, cocaine, and ketamine to customers throughout the United States. The investigation revealed that the organization’s base of operations was in Houston, Texas, and the organization shipped to various cities throughout the United States. Six defendants are charged in a five-count indictment in the Southern District of Ohio with conspiracy to distribute controlled substances, distribution of controlled substances, sale of counterfeit drugs, and conspiracy to commit money laundering.
  • The FBI in conjunction with the USPIS, FDA, and DEA, had been investigating a criminal enterprise that operated two Darknet vendor accounts. One of the accounts was operated out of the Miami area and the other out of the Providence, Rhode Island, area. According to court documents, the vendors, Luis Spencer, 31, of Fort Lauderdale, Florida; Olatunji Dawodu, 36, of Fort Lauderdale, Florida; and Alex Ogando, 35, of Providence, Rhode Island, allegedly advertised and sold pressed fentanyl pills throughout the United States. Agents identified several other co-conspirators and obtained search and arrest warrants for each. During the execution of the warrants, agents seized approximately $770,000, one weapon and approximately 3.5 kilograms of pressed fentanyl. Spencer, Dawodu, and Ogando are charged in the District of Columbia with conspiracy to distribute 400 grams or more of a mixture and substance containing a detectable amount of fentanyl.
  • Kevin Olando Ombisi, 32, and Eric Bernard Russell Jr, 36, both of Katy, Texas, are alleged to have participated in Darknet controlled substances trafficking activities using the moniker Cardingmaster and are charged in a 10-count indictment in the Western District of Tennessee with conspiracy to distribute controlled substances, distribution of controlled substances, attempted unlawful distribution of controlled substances, sale of counterfeit drugs, money laundering conspiracy, and mail fraud. According to court documents, Ombisi and Russell are alleged to have used the moniker Cardingmaster and conspired and attempted to, and did unlawfully distribute the Schedule II controlled substance methamphetamine, which was falsely represented to be Adderall, through the mail in the Western District of Tennessee and elsewhere. In conjunction with their arrests, the government seized more than $5 million in assets alleged to be connected to the drug trafficking activity. The case was investigated by the DEA, HSI, USPIS, and the FDA, and is being prosecuted by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Western District of Tennessee.

An indictment and criminal complaint are merely allegations, and the defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Operation Dark HunTor was a collaborative initiative across JCODE members, including the Department of Justice; FBI; DEA; USPIS; ICE’s Homeland Security Investigations (HSI); IRS-Criminal Investigation; Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF); Naval Criminal Investigative Service (NCIS) and the FDA’s Office of Investigations. This operation was aided by non-operational supporting participation from the Financial Crimes Enforcement Network (FinCEN) and U.S. Customs and Border Protection (CBP). Local, state, and other federal agencies also contributed to Operation Dark HunTor investigations through task force participation and regional partnerships. The investigations leading to Operation Dark HunTor were significantly aided by support and coordination by the Department of Justice’s Organized Crime Drug Enforcement Task Forces (OCDETF), multi-agency Special Operations Division, the Criminal Division’s Computer Crime and Intellectual Property Section, Money Laundering and Asset Recovery Section’s Digital Currency Initiative, Narcotic and Dangerous Drug Section, the Fraud Section, the Justice Department’s Office of International Affairs, the National Cyber Joint Investigative Task Force (NCJITF), Europol and its Dark Web team and international partners Eurojust, Australian Federal Police (AFP), Bulgaria’s General Directorate Combating Organized Crime (Главна дирекция Борба с организираната престъпност), France’s National Police (Police National – OCLCTIC) and National Gendarmerie (Gendarmerie Nationale – C3N), Germany’s Federal Criminal Police Office (Bundeskriminalamt), Central Criminal Investigation Department in the German city of Oldenburg (Zentrale KriminaIinspektion Oldenburg), State Criminal Police Offices (Landeskriminalämter), State Criminal Police Office of Lower Saxony (LKA Niedersachsen), various police departments (Dienststellen der Länderpolizeien), German Investigation Customs ( Zollfahndungsämter), Italy’s Finance Corps (Guardia di Finanza) and Public Prosecutor’s Office Brescia, the Netherland’s National Police (Politie), Switzerland’s Zurich Canton Police (Kantonspolizei Zürich) and Public Prosecutor’s Office II of the Canton of Zurich (Staatsanwaltschaft II), and the United Kingdom’s National Crime Agency (NCA) and NPCC.

Federal prosecutions are being conducted in more than 15 federal districts, including the Central District of California, the Eastern District of California, the Northern District of California, the District of Columbia, the Southern District of Florida, the District of Massachusetts, the District of Nebraska, the District of Nevada, the Western District of New York, the Southern District of Ohio, the Northern District of Texas, the Eastern District of Virginia, the Western District of Virginia, the District of Rhode Island, the Western District of Tennessee, and the Western District of Washington.

JCODE is an FBI-led Department of Justice initiative, which supports, coordinates, and assists in de-confliction of investigations targeting for disruption and dismantlement of the online sale of illegal drugs, especially fentanyl and other opioids. JCODE also targets the trafficking of weapons and other illicit goods and services on the internet.

View documents and resources related to this announcement.

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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 Museum to Hold Lecture Series ‘Disrupt, Dismantle, and Destroy: Smuggling Stories’

The Drug Enforcement Administration Museum and Visitors Center will present the next installment of its Lecture Series, “Disrupt, Dismantle, and Destroy: Smuggling Stories,” at 1 p.m. EDT (2 p.m. CDT) on June 17.

Join host Josh Edmundson, the DEA Museum’s Curator of Education, for a live, virtual discussion with DEA experts about drug smuggling, a fundamental element of all major drug trafficking organizations’ business models and a critical component of DEA’s work.

Smuggling Stories investigates one of the pillars of DEA’s Kingpin Strategy: disrupting smuggling routes and discovering and seizing shipments of illicit narcotics, weapons, cash, and other goods. The Kingpin Strategy focuses on removing the delivery capabilities of drug trafficking organizations to prevent their products from further distribution in the United States.

The Lecture Series will feature retired Special Agent Tony Placido and Special Agent Nate Jones, who will speak about DEA’s work thwarting the efforts of international drug trafficking organizations and the unique enforcement challenge that is our Southern Border.

As part of the event, Mr. Edmundson will present additional information on smuggling artifacts using objects from the Museum’s collection.

The DEA Museum collects, preserves, and interprets the material culture and artifacts pertaining to DEA and its predecessor agencies, U.S. drug policy and enforcement of U.S. drug laws, and drug education programs. The Museum interprets its collection for the public benefit through permanent and temporary exhibits, programs, the Museum website, publications, social media, and other mediums.

This event is free and open to the public. Sign language interpretation will be provided. Reserve your free ticket at www.smuggling_stories.eventbrite.com.

WHEN: Thursday, June 17, 1 to 2:30 p.m. EDT (2 to 3:30 p.m. CDT)

WHERE: Live-streamed from DEA Headquarters

ACCESS: Streaming link will be emailed to all ticket holders

EMAIL QUESTIONS: During the event, email questions to Elizabeth.P.Thompson@usdoj.gov

CONTACT: DEA Museum (202) 307-3463, DEAMuseum@usdoj.gov or Elizabeth Thompson, Visitor Services Coordinator, Elizabeth.P.Thompson@usdoj.gov

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.

DEA Launches Project Wave Break to Stop Flood of Deadly Fentanyl

DEA illustration of 2 milligrams of Fentanyl, a lethal dose in most persons.

 

Today, Tuesday April 27, the Drug Enforcement Administration announced a new initiative, Project Wave Breaker, to disrupt the flow of deadly fentanyl into the United States.

Project Wave Breaker will direct interdiction, enforcement, and outreach efforts to high-impact areas to disrupt the flow of fentanyl in and around the United States. The initiative will also employ analytical intelligence assets to target the activities of Mexican transnational criminal organizations, which are the primary suppliers and distributors of illicit fentanyl and fentanyl substances throughout the United States.

“While a major entry point for fentanyl is the Southwest border, the cartels are spreading their poison into communities across the Nation,” said DEA Acting Administrator D. Christopher Evans. “Through this initiative, we’re tackling a very real public health, public safety, and national security threat, identifying the most egregious street-level networks in our communities and working our way up through the supply chain.”

The eleven divisions participating in Project Wave Breaker are credited with 85 percent of all synthetic opioids seized by the DEA in 2020. They include: Phoenix, New York, San Diego, New England, Los Angeles, Chicago, Detroit, St. Louis, San Francisco, Houston, and El Paso.

Mexican cartels, particularly the Sinaloa Cartel, have capitalized on the opioid epidemic and prescription drug misuse and abuse in the United States, flooding communities with illicit fentanyl and driving the record-setting rates of overdose deaths. According to the most recently published CDC provisional data, more than 87,200 people died from an overdose last year, marking the largest number of overdose deaths ever recorded in a 12-month period. Deaths involving synthetic opioids increased nearly 60 percent during the same 12-month period ending September 1, 2020.

Facts about fentanyl:

  • Fentanyl is a synthetic opioid that is approximately 50 times more potent than heroin and 100 times more potent that morphine.
  • Of counterfeit pills tested in DEA laboratories, one in four pills made with fentanyl contained a potentially lethal dose.
  • A kilogram of fentanyl can contain 500,000 potentially lethal doses. Last year, the eleven divisions participating in Project Wave Breaker seized a combined total of 2,316 kilograms of fentanyl (more than a billion potentially lethal doses).
  • The seizure of fentanyl-laced pills along the Southwest border increased more than 89 percent from January 2019 to December 2020.

Project Wave Breaker aims to reduce the amount of fentanyl coming across the Southwest border, reduce crime and violence associated with drug trafficking, and ultimately save lives by reducing the demand for illicit fentanyl.

For resources and additional information on fentanyl and other illicit drugs, visit www.dea.gov/divisions/facts-about-fentanyl.

Jefferson County Jailers Save Four Inmates in Two Days, Sheriff Says

​Female cells at the Jefferson County Jail in 2005 file photo by Wayne Crosslin St. Louis Post Dispatch.

Correctional officers in the Jefferson County jail recently stopped one suicide attempt and three opiate overdoses, the sheriff said Tuesday.

Sheriff Dave Marshak credited the work of jailers, both in a tweet and in an interview with the Post-Dispatch, saying he was prompted to recognize the employees publicly in part by the “general conversation about jail safety and jail security” that has been occurring since an inmate uprising at the St. Louis City Justice Center on Sunday night.

“I think sometimes these correctional officers do the most difficult job and they’re often underrecognized and underappreciated,” he said.

Marshak said the three overdoses Sunday night were stopped with the aid of naloxone, a drug that reverses the effects of opiates. The inmates were then taken to a hospital for evaluation and have since been returned to jail, he said. “Everyone’s recovered. Everyone’s fine.”

An investigation showed that another inmate smuggled a drug into jail in a body cavity, and offered to sell it to others, Marshak said. Drugs are sometimes sold in exchange for food or other items that inmates can purchase from the commissary.

It’s believed the drug was fentanyl. The smuggler may now face new charges, he said.

Although a body scanner is used to try and prevent the smuggling of contraband into jail, Marshak said the drugs may have been hard to detect. “It was difficult to see how it was packaged in the rectum area,” he said.

If the drugs were missed by jailers, that would spark an internal investigation, he said.

The scanner has been used at the jail for two years. “We had an overdose in the past so we thought it was important to purchase it,” he said.

Although expensive, Marshak said, “if you have an incident like that in your facility, you have to look at it from a risk-management standpoint.”

Meanwhile, the suicide attempt Monday involved a woman who tried to hang herself using her pants leg, sheriff’s spokesman Grant Bissell said. Another inmate alerted officers who found her in her cell blue in the face and unresponsive, he said. They called a nurse and an ambulance and she was taken to the hospital where she was being held for a psychiatric evaluation, he said.

“It happens once or twice a year where a correctional officer will see it or be made aware of it and intervene,” Marshak said.

“We have a responsibility to maintain their health,” the sheriff said of inmates.

Story By Robert Patrick | St. Louis Today | https://www.stltoday.com/

The Lone Holdout

After Anand and Kourtney Torres, ages 41 and 29, were found dead in their Lake Ozark condo in November 2019, the community mourned the loss of the couple for months. Kourtney had been a nurse at the local hospital, and both were dedicated to coaching kids sports. Adding to the tragedy, they also left behind three young children. Nearly half a year later, the Camden County sheriff’s office revealed the cause of death: fentanyl-related overdose.

The toxicology results shocked Kourtney’s mother, Kris Benecke.

“She was so much more than just her tragic … she was about life,” she says. “She brought passion to everything. She was a nurse. I did not know her to be a drug user at all.”

Kourtney’s is the second opioid-related death in the family; Benecke’s son Justin died from a heroin overdose over a decade ago.

“I never expected it to happen once, and definitely not twice.”

It is an all-too-familiar story. In 2018, 1,132 Missourians died of opioid-related overdoses. Opioids include heroin, synthetic opioids such as fentanyl, and legal prescription pain relievers such as OxyContin, Vicodin, codeine, morphine, and others.

According to the National Institute on Drug Abuse, Missouri ranks 14th in the country in opioid deaths, with approximately 19.6 per 100,000 people. It’s a public health crisis that everyone pays for. By the most recent estimates, the Hospital Industry Data Institute claimed that the opioid epidemic cost Missourians $12.6 billion a year, or $34.5 million every day. That breaks down even further to an astonishing $24,000 per minute. According to a report from the institute, the costs associated with the opioid epidemic include increased consumption of healthcare, law enforcement, and social services, as well as lost productivity. By the time you finish this sentence, the epidemic will have cost another $399 dollars. Most deaths are clustered around the state’s urban centers, but rural counties are not immune, either. Nearly everyone knows someone whose life has been touched by opioid addiction.

The statistics are staggering. What can be done? What should be done? These questions have plagued state lawmakers for nearly a decade.

One solution may be a statewide prescription drug monitoring program (PDMP). This digital medical record system tracks patients who fill opioid prescriptions and makes that information available to healthcare providers. Its uses are multiple—for example, when patients can’t report or remember their prescriptions, doctors can refer to a PDMP to prevent mixing medications that might result in accidental overdose. In relation to the opioid epidemic, it can be used to identify behaviors like doctor shopping and prescription history. PDMPs have been enacted in every state but Missouri, despite support by the Missouri Department of Health and Senior Services, Missouri Academy of Family Physicians, Missouri American College of Physicians, Missouri State Medical Association, Missouri Pharmacy Association, and the nation’s most trusted medical organizations, including the American Medical Association (AMA) and the National Institute on Drug Abuse. The Centers for Disease Control and Prevention calls these databases one of the most “promising state-level interventions” to improve opioid prescribing and patient care. But year after year, legislative PDMP efforts have been thwarted, making Missouri the lone national holdout.

“People ask me all the time, ‘You’re from Missouri. Why haven’t you all passed a PDMP?’ And the answer I give is that it has not made it through the Senate in a form that’s acceptable to the House,” says Dr. Randall Williams, the director of Missouri’s Department of Health and Senior Services. “I’m not pretending to be the expert on legislative intent, but my sense from my four years here is it’s not been one thing; it’s just been different things.”

Republican Representative Holly Rehder has sponsored a PDMP bill in the Missouri legislature for years.

“Over the years, PDMP has become a political football for both sides of the aisle. It doesn’t make sense. Missouri’s lack of a PDMP is a front row seat to politics at its worst,” she says. In 2018, Republican Governor Eric Greitens tried establishing a statewide PDMP via executive order, but the legislature refused to fund it.

A year earlier, the St. Louis County Health Department had launched a voluntary program available to any jurisdiction that wanted to participate. Today, more than 75 jurisdictions out of about 129 jurisdictions (counties plus several city jurisdictions) have opted in. Walmart, Walgreens, and Medicaid also track prescription history. Overall, around 85 percent of Missouri’s population is covered by some form of prescription drug monitoring, but it’s still a patchwork system.

So why not make an end run around the legislature and recruit the remaining counties that include the 15 percent of the population not covered yet? Many jurisdictions are afraid of being sued, Representative Rehder suspects. For example, Newton County officials voted to join the St. Louis County’s voluntary program, but then postponed implementation, planning to await the results of a lawsuit against St. Charles County by United for Missouri, a limited government advocacy group that claimed the program violated privacy. But Newton County officials changed their minds and decided to proceed.

The patchwork system is also far from ideal for healthcare providers like Dr. David Barbe, a family health practitioner with Mercy Clinic in Wright County.

“You can get certain pieces of info from one database and other pieces from PDMP, but that only applies to certain people. If that doesn’t scream at you, ‘we need a coordinated statewide PDMP,’ then nothing will,” says Barbe, who is also the former president of the American Medical Association. “Until we get all of the counties on, all of the pharmacies on, and all of the payers on, it won’t accomplish what we can accomplish for the patients. This is for patient safety, patient care, to identify those that are misusing so you can get them the help they need, and so you can potentially ID those getting prescriptions and diverting them.”

By diverting them, he’s referring to medications that get stolen or distributed to family and friends. A PDMP would help track unusual habits—people seeking multiple refills within a month or visiting multiple doctors to obtain prescriptions.

“The PDMP by itself doesn’t completely solve that but is best at identifying patients getting scripts from more than one provider, and you can use that to infer other things,” Barbe says.

His county, Wright County, has not opted into the St. Louis County PDMP, which means anyone can come there to fill prescriptions at a nonparticipating pharmacy without ever leaving a record of their opioid use patterns.

The current system’s weaknesses are a glaring problem to Jim Marshall, the founder of Cody’s Gift. “It’s not working if you’ve got a county next door that’s not using it,” he says. “It’s why Missouri has been one of the biggest states in prescription doctor shopping. The US Drug Enforcement Agency calls us the ‘pill mill’ of the United States.” Cody’s Gift is a nonprofit organization that primarily works in public schools to educate and prevent substance use disorders by raising awareness about mental health issues and alternative coping skills besides drug use. Marshall’s son, Cody, died in 2011 from an overdose.

Some emergency rooms see opioid-related problems during nearly every shift, from overdoses to drug-seekers. Dr. Howard Jarvis, the medical director of the emergency department of Cox Health in Springfield, says, “I can assure you that there are patients who are well aware of what pharmacies are participating and what pharmacies are not participating. We literally get patients from out of state coming here to get prescriptions filled. It’s an everyday problem. People sometimes tell me they’re getting prescription narcotics, and I look them up and can’t find evidence of it on the St. Louis County PDMP. It’s because they live in a municipality that doesn’t participate.” While Springfield and Greene County are currently enrolled in the St. Louis PDMP, five of its six adjacent counties are not.

PDMP opponents such as Republican Senator Denny Hoskins often question efficacy. “Just look at the data. Obviously, Missouri is the only state that does not have a statewide government prescription drug tracking system, and therefore you’d think that we would be number one in opioid-related deaths. However, we’re somewhere in the middle of the pack. Many of the supporters say the PDMPs will stop doctor shopping. Well, doctor shopping accounts for less than 5 percent of the people illegally obtaining opioids. The real reasons for the opioid crisis is we’ve seen an increase in deaths related to fentanyl. The PDMP has no effect on illicit fentanyl. PDMPs simply don’t work. At best, they focus on 5 percent of the problem and not the other 95 percent. I equate it to sticking a band-aid on a broken ankle and saying, ‘At least we did something.’ ”

Republican Senator Cindy O’Lauglin adds, “For those who despise PDMP, the main argument is the intrusion on personal decisions by outside interests and the state maintaining a database. On the other side, we do understand that doctors and pharmacies would like to know if a patient has been subscribed [sic] opioids before then issuing another prescription.”

While these medical databases are no magic bullet, there is evidence they can affect positive change. One year after New York required prescribers to check the state’s PDMP before issuing prescriptions, doctor shopping dropped by nearly 75 percent. In states like Connecticut and Rhode Island, doctors reported that PDMPs helped identify opioid drug abuse and intervene with patients who needed help. In Ohio, the National Institutes of Health credited the PDMP with reducing opioid-related deaths thanks to a 41 percent decrease in opioid prescriptions after implementation. Florida reduced oxycodone deaths by more than 50 percent after just two years with a PDMP. While encouraging, these numbers still don’t shift political opponents of PDMPs.

“When you get to a public policy discussion or debate, people use data to support whichever position they believe in,” says Dr. Williams, Missouri Department of Health and Senior Services. “Any time in medicine we try to prove something, the gold standard is a double-blinded, randomized controlled trial. That’s where you take a group of people and do something, take another group of people just like that group and don’t do it, and look down the road to see if there’s a difference in outcomes. With a PDMP, it’s very hard to find two populations that you can do that for. When you compare two states, you get into confounding variables, and different things might change other than just a PDMP.”

In short, correlation does not always equal causation. “Every year, people testify very much that PDMPs make a difference, and then other people get right up and produce data that says it doesn’t make a difference.” Dr. Williams explains that his department has chosen to support a PDMP based on the number of state medical associations and physicians asking for one. “We want to be responsive to our physicians’ opinions and give them every tool to help them individually with their patients, to help them prevent opioid abuse diversion and addiction and deaths.”

Of course, not every prescription leads to abuse, and plenty of patients responsibly manage pain with prescription opioids. The thought of additional policies and regulations sometimes sparks fears about access and harming the very people opioids are meant to help. Republican Senator Cindy O’Laughlin reports this “is a huge concern expressed by chronic pain patients” within her constituency.

“I don’t think it’s going to affect them at all,” says Jarvis, the Cox Health emergency department medical director. “Most people who require chronic opioids for cancer or other things like that, they’re usually getting those from a single prescriber. They’re not going to multiple places to obtain narcotics.”

Some argue that since PDMPs make prescription medications harder to access, people who abuse pills often turn to heroin or fentanyl, which is cheaper, easier to find, and far deadlier. In fact, Missouri’s recent surge in opioid deaths was largely due to the introduction of inexpensive, highly potent synthetic opioids like fentanyl. These numbers ​​grew from 192 deaths in 2015 to 448 in 2016. In November 2019, more than 20 arrests were made relating to a drug trafficking ring accused of distributing heroin and fentanyl in Springfield. Kris Benecke suspects it may have been this ring who sold the drugs that took her daughter’s life. Would a PDMP take fentanyl off today’s streets? Of course not. But it might deter a future generation’s drug-using habits.

“To stop the problem, you have to limit the number of people who get addicted in the first place,” says Jarvis. “The PDMP is helpful. There’s no question. It’s just a tool. It’s not a panacea.”

Drug monitoring legislation has long been caught in the cogs of the Missouri state government. When initial efforts by Republican Senator Kevin Engler failed in 2012, it was largely due to vehement opposition led by Republican Senator Rob Schaaf, a family doctor who cited privacy concerns and described the proposal as “the heavy hand of government taking away your liberty.”

Even though the US Supreme Court ruled PDMPs constitutional in Whalen vs. Roe (1977) and the US Court of Appeals for the Ninth Circuit held that PDMPs do not inherently violate Fourth Amendment rights as recently as 2019, many Missouri legislators still cited concerns over privacy and voted no.

The current sponsor of the latest series of PDMP bills, Republican Representative Holly Rehder, is still optimistic about the debate’s slow progress. “We’ve really gotten somewhere in the last seven or eight years in regards to the stigma of addiction, but we still have a small handful of people who are just vehemently opposed,” she says.

Further complicating the issue, opponents of PDMPs suggest a link between digital medical databases to the theoretical infringement of Second Amendment arms rights. The concerns aren’t entirely baseless—in 2013, Missouri Highway Patrol handed over a database of concealed weapons permit holders to a federal agent seeking links between disability claims and gun ownership. Even though the agent never actually used the files, according to the highway patrol, the story was used as evidence of database abuse in the hands of big government.

For frustrated doctors on the front lines, tying PDMPs to guns makes no sense. “It’s frightening,” says Jarvis. “There is no connection.”

While concerns over privacy, personal liberty, and even Second Amendment rights may be sincere, at its heart, opposition seems to stem from the long-held conservative penchant for personal responsibility. In the early days of PDMP legislation, Schaaf was widely criticized for saying about drug users, “If they overdose and kill themselves, it just removes them from the gene pool.”

In the medical community and for families of drug users, addiction is a medical crisis, not a moral failing. As Christa Harmon puts it, “I hate this term, ‘junkies.’ They are someone’s someone, and that matters.” For Harmon, founder and president of Mid-MO Addiction Awareness, desire for legislative action against the opioid epidemic is personal. Her daughter began abusing prescription opioids in high school. By her early 20s, she was seeking heroin in St. Louis. “It was pretty bad. I knew nothing. I knew nothing about it. I didn’t even know people did pills, snorted pills, I was clueless. It hit me like a brick wall.”

That feeling of cluelessness is why Harmon founded the organization. By breaking the stigma of silence around a family member’s drug abuse, she can at least encourage people to speak up and share information. Hers is just one organization out of many across the state that has stepped up to try to address the many layers of the opioid epidemic.

Jim Marshall, the father who lost his son and founded Cody’s gift, has spoken at hundreds of schools and conferences for the last nine years.

“You never know when a kid walks away from an assembly whether they’re going to make better choices or be more sympathetic to people in their families who have these issues,” he says. “I’ve been doing this for a long time and I have to think that one thing about kids that hasn’t changed is that they will listen to people like me who have a real story to tell.” All he can do is try.

“We have to start at the front end of the problem, where they get their drugs to start with,” he says. “Maybe if we shut the front door, we’ll prevent them from ending up as addicts or in jail when they walk out the back door,” he says.

But no one organization has the power or money that the legislature does to affect statewide change, and advocates say a PDMP shouldn’t be politicized. But again and again, it is.

“It’s an electronic medical record. It’s technology. At some point, it became a political banner, and a lot of lives have been harmed by that,” says Representative Rehder. She has been fighting for a PDMP since her first year in office in 2013. It’s an issue close to home. Her mother was addicted to prescription medications. Her stepfather was a dealer. Her sister used. Her cousin died of long-term drug abuse. And for over a decade, her own daughter struggled with drug abuse—an addiction that began with a legal prescription for Lorcet after an injury at age 17.

“I’ve been the bill’s sponsor for the last seven years and have really poured my heart and soul into it,” she says. “As a child growing up in it, as a mom trying to fight it, I’ve got a little more perspective than probably a lot of legislators.”

For years, Rehder’s bills passed the House only to be rejected by the Senate. This year, she collaborated with Republican Senator Tony Luetkemeyer to craft a compromise with the conservative caucus of their party. HB1693 expanded privacy protections by restricting law enforcement access to data, deleted patient data every three years, and most controversially, assigned oversight to a privatized task force instead of the Missouri Department of Health and Senior Services. Though imperfect to House Democrats, it was still a PDMP, and in February, it passed 98-56. But once in the Senate, additional provisions to increase fentanyl penalties were added, upsetting the already fragile support from key House Democrats. This dissatisfaction surprised Rehder.

“These increased penalties had already passed on several other bills, so I never thought that this would become a problem,” Rehder recalls.

It was. Many Democrats, including House Minority Leader Crystal Quade, felt that they had made significant compromises to pass a PDMP that Republicans could support, but that the fentanyl penalty provisions were just too much. In a May 11 Facebook post, Democratic Representative Peter Merideth told constituents he’d already been on the fence with the initial negotiations, but that he’d opposed the language of the proposed fentanyl laws all year. “It would take an addict that possesses a substance that has been laced with any traceable amount of fentanyl (whether they knew it or not) and make them subject to a trafficking felony with a penalty equivalent to that of first-degree murder. Amazing that even in a bill that’s supposed to be about trying to help prevent addiction early, they can’t help but add massive over-criminalization of drugs at the same time.”

Sensing an opportunity to advance other, unrelated legislation, Democrats sent the bill back to committee for review. At best, it was a political maneuver. The plan backfired. The Senate was furious with what they referred to as “House shenanigans” and filibustered, killing the bill on the floor. The harsher penalties were added to another bill that was passed and signed into law anyway, but still no PDMP.

“We just ran out of time,” Rehder says. Her term limits are up in the House, although she’s running for a Senate seat in the November election. “It’s awful. It’s politics. It was just one thing after another. It was being used as a political football, and they killed it. It was just sad. Sad for the people of Missouri and for the families that have struggled with trying to fight this awful epidemic.”

It would be nice if all it took was a big burst of will power to kick an opioid addiction. But that’s just not how it works. Thanks to the history of addiction in her own family, Rehder understands that intimately. “With my DNA, it takes me one to three days to become addicted to something. My husband has no drug addictions in his family line, and he can take an opioid for a week after an injury and stop it immediately without any problems.”

Her point is everyone is different. At the height of dependency, addicts can rarely advocate for themselves. Too often, it’s the parents left behind to pick up the pieces. Some become activists, like Jim Marshall and Christa Harmon. Many just steel themselves and go on, coping with their grief in private silence.

In Camden County, Kris Benecke, who lost her son and daughter to drug overdoses and is now raising her 9-year-old grandson, had never even heard of prescription drug monitoring programs until this year, but she supports the concept now. Her county is not enrolled, although its two Republican representatives both voted in favor of HB1693. Her son died from a heroin overdose at age 19, but his drug use started in high school, when a friend shared prescription opioids stolen from his father’s medicine cabinet.

“If something like a PDMP had been in place, maybe there would’ve been a totally different outcome,” Benecke says. Maybe a doctor would have noticed a prescription was being refilled too soon.

Maybe.

By Rose Hansen | Missouri Life Magazine | missourilife.com

DEA Announces the Largest Domestic Seizure of Methamphetamine in DEA History

At a press conference today, DEA Acting Administrator Timothy J. Shea and Los Angeles Field Division Special Agent in Charge Bill Bodner announced the seizure of 893 pounds of cocaine, 13 pounds of heroin, and 2,224 pounds of crystal methamphetamine, which is the largest domestic seizure of crystal methamphetamine in DEA history.

In June 2020, the Los Angeles Field Division, Southwest Border Group 2, began investigating a large-scale drug trafficking organization with ties to the Sinaloa Cartel involved in the transportation and delivery of large quantities of cocaine and crystal methamphetamine. During the course of the investigation, agents identified a Southern California-based narcotics courier/stash house manager along with multiple locations and vehicles associated with the courier and the DTO.

On October 2, 2020, through investigative means, agents and Fontana Police Department investigators established surveillance on the courier’s residence. During surveillance, Fontana Police Department investigators observed the target and a secondary associate load two duffle bags into a vehicle and leave the location. The courier target and the associate ultimately met with a third associate at a Sam’s Club parking lot in the city of Moreno Valley where they unloaded and delivered the two duffle bags to the third associate. During that time, investigators detained the courier target and the two other associates in the parking lot for questioning and they were later released.

Based upon the investigation and locations previously identified, agents authored state search warrants for multiple locations, including the courier target’s residence and a narcotics stash house within the city of Perris. During a search of the courier’s residence, agents located approximately 25 duffle bags within the garage of the residence containing approximately 406 kilograms of cocaine, six kilograms of heroin, and 650 pounds of crystal methamphetamine.

Additionally, during a search of the narcotics stash house in Perris, agents located approximately 1,600 pounds of crystal methamphetamine. This is an ongoing investigation.

“The largest DEA domestic seizure of methamphetamine in history is a significant blow to the cartels, but more importantly it is a gigantic victory for communities throughout Southern California and the United States who have had to deal with the torrent of methamphetamine coming into their neighborhoods,” said Acting Administrator Shea. “We continue to work with our state and local partners to attack drug trafficking at all levels and this seizure sends a clear message that we mean business.”

“Los Angeles is the major transshipment hub for Mexican cartels trafficking illicit drugs across our southwest border,” said Special Agent in Charge Bodner. “Successful seizures like these save lives and reduce the exploitation and victimization of our local communities.”

“The significant seizures announced today thwarted drug traffickers’ plans to profit from these dangerous drugs that cause incredible harm to our communities,” said Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division. “The Justice Department is committed to making our neighborhoods safer by aggressively disrupting drug cartel operations in the United States.”

Participating law enforcement partners include the Southwest Border Group 2 – including the South Gate Police Department, Simi Valley Police Department, Huntington Park Police Department, Glendora Police Department, Downey Police Department, El Monte Police Department, Irwindale Police Department, Los Angeles County District Attorney’s Office, and the Los Angeles County Sheriff’s Department – and the Criminal Division’s Narcotic and Dangerous Drug Section of the U.S. Department of Justice.