At some point between their son’s stints at sober houses, jail and 14 rehab centers, Annie and Richard Becker gave up hope that he would ever stop using meth.
The Beckers, who live in Seattle, haven’t seen their son in more than a year. Before meth, their son was “really caring, very funny and likable,” the kind of guy who “didn’t like to see anybody else picked on or harmed,” Richard said.
After meth, he was scary and unpredictable ― the kind of guy who thought nothing of throwing a brick through his parents’ window or threatening his mom, Annie said.
“I think when he was most dangerous to us is when he was in withdrawal and couldn’t get drugs, and we became the target,” she said.
There are medications to help with opioid addiction, including methadone ― in use since the early 1970s ― and buprenorphine, which became widely available in the last decade. Both drugs are substitute opiates that can take away the destructive urge to use and give people a chance at housing, medical care and stable relationships. But there are currently no similar treatments for methamphetamine addiction.
“I’ve always felt like, is anybody paying attention to the fact that there’s all these meth users who don’t have any kind of treatment?” Richard said.
While there have been some studies that tried substitute stimulants to treat methamphetamine addiction, the results have been mixed, leading some to conclude that a medical treatment for meth addiction is unlikely.
But a team of researchers in Seattle wants to challenge that theory. Their plan is to give relatively high doses of methylphenidate ― better known as the ADHD drug Ritalin ― to patients who are already in treatment for opiate use disorders and also use meth. The proposed pilot, which still needs about $500,000 in funding, is not yet underway. It would be a joint effort between Evergreen Treatment Services (ETS), the University of Washington and the Seattle Public Defender Association. Although the Seattle City Council declined to provide public funding for the program in its last budget cycle, researchers are optimistic that grants or federal dollars will come through. If researchers see significant results, the pilot could be expanded to include more patients.
“What we really want to see is a very substantial reduction in use, so that you could say this is making an impact on people’s lives, in terms of improving physical health, psychological health, reducing criminal activity, and improving their ability to take care of the basic things in life,” said Dr. Paul Grekin, the medical director at ETS.
Seattle seems primed for this kind of experiment. Meth use has been growing quietly across the United States for years in the shadow of the opiate epidemic, but the increase has been particularly acute on the West Coast, where meth now causes more overdose deaths than any other drug. In Washington state, meth overdoses killed about one person every day in 2016. In King County, which includes Seattle, there were 164 meth overdose deaths last year, outpacing heroin as the leading cause of overdose deaths.
“Is anybody paying attention to the fact that there’s all these meth users who don’t have any kind of treatment?”
- Richard Becker
Meth has become cheaper, more contaminated and more potent in the last several years, according to front-line emergency service and case workers, leading to an increase in dangerous symptoms like cardiac arrest, strokes and hyperthermia, a condition where the body essentially burns itself alive. That’s on top of the more common symptoms of meth use, such as psychosis, dental problems, injuries, malnutrition and diseases transmitted through needles or risky sex.
Kali Sedgemore, a meth user who works as a peer support and outreach worker in Vancouver, has been trying to get doctors to prescribe prescription stimulants for years, but says doctors perceive these requests as “drug-seeking behavior” and refuse. “I’ve been fighting with the doctors for four or five years now just to get Adderall or Dexedrine,” Sedgemore, who uses they/them pronouns, said. “My doctor doesn’t want to have those conversations. She told me she thinks I’ll just end up selling it or something.”
Sedgemore says a legal source of stimulants would help them and meth users like them stop engaging in risky behavior, like street-based sex work, and lower their risk of overdose from meth of unknown origin and purity.
In addition to advocates for harm reduction, the pilot proposal has attracted a number of supporters from business groups and first responders ― groups that don’t typically advocate for experimental or incremental approaches to drug use. Last month, Seattle Fire Chief Harold Scoggins wrote a letter to Mayor Jenny Durkan asking her to fund the pilot project, using $500,000 in unspent funds that were originally budgeted for a safe drug consumption site. Scoggins said the pilot had the potential to “address public disorder issues by reducing challenging behaviors associated with illicit stimulant use.”
Durkan’s office and a health adviser for the city speaking on background said the mayor doesn’t support funding a pilot to test Ritalin for meth addiction because Ritalin hasn’t been tested and approved by the U.S. Food and Drug Administration for this purpose. The spokeswoman, Kamaria Hightower, said Durkan “shares the concerns of the community” about meth and supports therapy-based strategies “including contingency management and cognitive behavioral therapies.”
Dave Willard, the vice president of the downtown Seattle Metropolitan Improvement District, says the business group hasn’t taken a formal position on the pilot but supports “anything that can move the ball forward and reduce impacts on the community,” including verbal and physical attacks against his organization’s street cleanup and outreach workers, which Willard says have increased dramatically in the last three years.
Starting in the late 1990s, nationwide anti-drug campaigns and media reports portrayed meth as uniquely addictive and instantly destructive. “Not even once,” one nationwide campaign blared, and the messaging stuck even as it morphed into a meme. The claims from anti-drug activists had echoes in the crack era, when drug warriors used similar hyperboles to call for a crackdown on the “crack epidemic,” but researchers say there’s little science to back them up. Carl Hart, a researcher at Columbia University and author of “High Price: A Neuroscientist’s Journey of Self Discovery That Challenges Everything You Know About Drugs and Society,” argued in a 2014 paper that “many of the immediate and long-term harmful effects caused by methamphetamine use have been greatly exaggerated just as the dangers of crack cocaine were overstated nearly three decades ago.”
Drug reform advocates say this stereotyping creates a stigma around meth use that makes it harder to gain political support for solutions like stimulant replacement therapy.
“The people that are most pissed off about public safety and the chaos of spun-out people wandering around downtown” ― conservatives and proponents of tough-love approaches to drug addiction ― “are also the people that are most resistant to doing anything about it,” said Kris Nyrop, a longtime harm reduction advocate who founded Seattle’s first street-based drug resource center in the late 1980s.
And yet, meth really isn’t all that different from Ritalin or Adderall, and is identical to Desoxyn, the brand name for prescription meth. All three drugs ― yes, even meth ― are used in the United States to treat ADHD, and many doctors believe that some meth users are self-medicating to help themselves deal with undiagnosed or untreated disorders.
“I hear all the time from patients who will say, ‘I did really well on Ritalin in my youth. It helped me focus and I was doing great, and when I didn’t have it, it was hard to keep track of things and so I resorted to self-medicating,’” said Dr. Richard Waters, the medical director of homeless and housing programs for the Neighborcare Health clinic network in Seattle.
However, Waters said he’s “skeptical” that “there’s going to be some miraculous breakthrough” from the proposed Seattle pilot, and says he’s sympathetic to critics of stimulant replacement therapy who say “let’s focus on the underlying social fabric and why people are using. Let’s boost family and incomes and child care and just give them more support.”
Waters supports the pilot because he wants to learn more about how stimulant replacement can help at least a narrow sliver of patients. Currently, many doctors are reluctant to prescribe stimulants to meth users ― partly because of the risk for abuse, and partly because this “off-label” use hasn’t been studied enough. But politicians and the public tend to resist funding solutions that don’t lead to dramatic, easily perceptible changes. And with meth use on the rise, a modest improvement could look like stagnation, Waters says.
Nyrop, the harm reduction advocate, says the biggest challenge may not be scientific but political. “We still have major political hurdles when it comes to treating people who use heroin or other opiates,” he said. “Sixty years after the advent of methadone treatment, our state still allows counties to veto the siting of new methadone clinics. That reflects the severity of the political battle that we’re going to be facing with meth.”
The Beckers don’t care about politics; they just want their kid, and others like him, to have a chance at getting well.
“When your child’s a meth addict, especially for a long time, it can feel very hopeless,” said Richard. “I fear all the time that I’m going to get a call telling me that my son is gone.”