For more than a decade starting in the early 2000s, Missouri was at the top nationally in methamphetamine lab busts, and Jefferson County was tops in the state.
In 2004 and 2005, authorities in Jefferson County raided labs at a rate of two every three days. Some called it the meth capital of the world.
Last year, according to a Missouri Highway Patrol database, that number had dwindled to 51. Neighboring Franklin County, which had 139 busts in 2004, had just four in 2016.
“It’s back to being newsworthy if you find a meth lab,” said Jason Grellner, a former lieutenant with the Franklin County Sheriff’s Department who made a name for himself in the fight against meth labs in the St. Louis area.
But that doesn’t mean meth has gone away.
From Arizona, New Mexico and Oklahoma to Montana, Wisconsin and Minnesota and all across the South, and yes, in Missouri, inexpensive methamphetamine is flowing in from Mexico, fueling what police and epidemiologists say is an alarming increase in the number of people using the drug, and dying from it.
Nationwide, regular use of the inexpensive and widely available illicit stimulant increased from 3 to 4 percent of the population between 2010 and 2015, according to the Substance Abuse and Mental Health Services Administration, or SAMHSA. At the same time, heroin use shot from 1 to 2 percent of the population.
The number of people using methamphetamine, also known as meth, crystal meth, crystal, crank, ice and speed, has been among the highest of any illicit substance for decades. But despite the stimulant’s harmful long-term effects on the body — including rotting teeth, heart and kidney failure, and skin lesions — its overdose potential is much lower than prescription painkillers and other opioids. Those drugs have gained the spotlight in recent years.
Still, overdose deaths from methamphetamine have spiked recently.
In 2014, roughly 3,700 Americans died from drug overdoses involving methamphetamine, more than double the 2010 number, according to the Centers for Disease Control and Prevention. In 2015, the most recent year for which federal data are available, nearly 4,900 meth users died of an overdose, a 30 percent jump in one year.
In Oklahoma, methamphetamine was involved in 328 overdose deaths last year, a sharp climb from 271 in 2015, and more than the combined deaths from prescription painkillers hydrocodone and oxycodone, according to Mark Woodward, a spokesman for the Oklahoma Narcotics Bureau.
In contrast to the last epidemic, which began in the 1990s, rural meth labs are now a rarity and the fires and explosions that made headlines back then are practically nonexistent today, Woodward said. “So a lot of people thought if meth labs are down, meth use is down.”
But huge quantities of pure, affordable meth from Mexico have taken the place of local labs all over the country, including in Jefferson County.
“Now that the quantity is coming in, nobody is cooking,” said Sgt. Gerald Williams of the Jefferson County Sheriff’s Department. “People who used to cook just to get several grams of meth are now walking around with several pounds. It’s just so easy to get. And why make it when you can buy it?”
The majority of methamphetamine is now smuggled across the Southwest border, according to the Drug Enforcement Administration’s 2016 National Drug Threat Assessment Summary. Its purity is high and its street price is relatively low, much cheaper than heroin. “While the current opioid crisis has deservedly garnered significant attention, the methamphetamine threat has remained prevalent,” the report warns.
In Jefferson County, Williams said his unit has shifted its focus from busting meth labs to long-term investigations into major suppliers of Mexican meth with links to Kansas City, Chicago and Springfield, Mo.
Regulation cuts local production
In the Midwest and much of the rest of the country, 2005 was the peak year for methamphetamine use. After that, federal and state laws restricting the sale of an essential ingredient in methamphetamine, the over-the-counter cold medicine pseudoephedrine, led to a sharp decrease in U.S. meth labs.
In Missouri, one of the most outspoken proponents of regulation of the decongestant was Franklin County’s Grellner, now vice president of the National Narcotics Officers Associations Coalition. Grellner successfully lobbied dozens of counties to require the medication be sold only as a prescription.
Even as he did so, he cautioned that the elimination of mom-and-pop meth labs would not eradicate the drug.
“Limiting pseudoephedrine or making it a prescription doesn’t beat addiction,” Grellner said. “But you no longer are seeing the burns, the fires, the respiratory hazards to children and the elderly because of all of the things going on inside the home.
“Those things are now going on in large clandestine plants in Mexico and some Central American countries, and are no longer going on in every other house up and down the street here in the U.S.”
As more meth started coming in from Mexico, the number of people seeking treatment began creeping up again and began to surge in many places in 2015. Last year, nearly 11,600 meth users were admitted for treatment in Minnesota, according to state data — a significant increase over the 6,700 who sought treatment for methamphetamine addiction in 2005.
Methamphetamine is also showing up in places that never experienced an earlier epidemic.
“What we’re seeing is that the use of methamphetamines has recently moved out of trailer parks and rural areas and into inner cities,” said Ken Roy, medical director of a major treatment facility, Addiction Recovery Resources, in New Orleans. “We’re seeing a lot of heroin addicts that also use methamphetamines. It used to be the only way we got meth patients was when they came to the hospital from rural areas,” Roy said.
Opioid users experience a dreamlike state and typically nod off. But methamphetamine produces an entirely different high. Users experience a sense of elation and hypervigilance, and often become paranoid and aggressive. “They may binge on meth for days without eating or sleeping, and they often start seeing things that aren’t there,” said Carol Falkowski, an addiction expert in Minnesota.
Death from a methamphetamine overdose is also very different from an opioid death. With opioids, which affect the part of the brain that controls breathing, high enough doses can shut down respiratory functions, quickly causing death.
With methamphetamine, death is typically caused by a stroke or heart attack, and is characterized by extreme sweating as the body overheats prior to death. Because methamphetamine represents a lower risk of overdose, many use it for decades, which often results in gradual organ failure and death. The deaths are typically not counted in overdose statistics.
Likewise, treatment for addiction to methamphetamine is different than for opioids. No FDA-approved medications exist to stop cravings for methamphetamine, whereas three effective drugs are able to help people recover from opioid addiction.
As a result, methamphetamine treatment primarily consists of outpatient therapy, often after a brief stay in a residential facility.
Health officials in places like Minnesota and Oklahoma say the health care providers who helped legions of people overcome methamphetamine addiction during the last epidemic are prepared for a new onslaught. But some caution that the addiction treatment workforce has not grown in proportion to the growth in overall drug use since then.
Tackling a new meth addiction wave on top of an opioid epidemic could strain the nation’s health care system, said Kimberly Johnson, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration. “I don’t think what we’ve done to scale up access to treatment for opioid disorders is going to be that helpful for methamphetamines.”
Christine Byers of the Post-Dispatch contributed to this report.
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