Something worrisome was happening at Spurwink, a mental health clinic in Portland, Maine. Many patients being treated for opioid addiction had gone missing for days, even weeks, skipping prescription refills and therapy appointments.
The counselors feared their patients were relapsing on fentanyl. But those who reappeared did not show the telltale signs — no slurred speech, pinpoint pupils or heavy eyelids. On the contrary, they were bouncy, frenetic, spraying rapid-fire chatter, their pupils dilated. They warned of spies lurking outside the building, listening devices in ceiling tiles, worms in their throats.
In Portland, where the fentanyl can be both diluted and even costly, another drug, cheap and plentiful, has been surging to meet demand: methamphetamine, a highly addictive stimulant that electrifies the brain and grips the central nervous system.
This pretty foodie mecca has become yet another American city to be overwhelmed by meth — not the home-cooked biker party drug from the ’90s, but a far more dangerous concoction, mass-produced in Mexican cartel labs. In recent years, it has been spreading across the country, increasingly becoming a drug of first choice in many locations.
Portland’s meth onslaught came on as the city’s drug treatment community was starting to taste hope: echoing a national trend, deaths from opioids have been declining, largely because of medications that reverse opioid overdoses and those that dull cravings.
But those remedies do not work for meth, a beast of another order.
There are no medications approved for treating addiction to meth, which works on the brain differently from opioids. Nor are there drugs that can quickly reverse meth overdoses in the field as Narcan does for fentanyl. And meth’s effects — including psychotic breaks and explosive violence — can be far more disruptive to communities than even fentanyl, a sedative.
Along the narrow streets of Bayside, a hilly neighborhood with worn homes, corner convenience shops and boarded-up storefronts, people writhe and twitch, compulsively clapping their hands behind their backs and scratching frantically at scabs to root out hallucinatory “meth bugs.” One longtime resident told of awakening at 2 a.m. to the yowling of a young man in the throes of meth, who was clinging slothlike to a tree branch overhanging her backyard.
On a recent afternoon, Bill Burns, an addiction and mental health responder with the Portland police, ran out of his Bayside office to a homeless shelter across the snowy street, where four people were frothing, gurgling, seizing with tremors and delirium. The synthetic marijuana they were smoking had been cut with meth. Ambulances rushed two to the hospital.
“The meth problems blossomed so fast, beyond anything anyone could grasp, and our tools are so inept and so few,” said Courtney Pladsen, a nurse practitioner who runs a Bayside health clinic for homeless people, as she picked up discarded syringes on the street in the dark dawn. “We’re right in the middle of a war and we don’t know our way out yet.”
‘Everyone is spinning’
One bright blue morning in September, a young man with dark tangled curls rushed over to a woman pushing a stroller along a Bayside street. He leaned in, cursing and yelling, “Your baby is not real!”
He was 26, a persistent meth user, his handsome face marked with raw, bleeding patches. This was the 84th call about him that the police had logged so far that year. The complaints varied: lying down in traffic, trying to get hit; masturbating on the back steps of a home. He was often bare-chested, with orange-capped syringes poking out of a hip pocket.
By the time the police got to the mother, he had disappeared.
Years ago, local people said, he was just another Bayside kid hanging out at the teen center, playing video games and flirting with girls. But the neighborhood has long been a magnet for people wrestling with addiction and mental illness, drawn to its remarkable repertoire of social services. Fentanyl and then meth readily found him. Abruptly, he began pinballing from the Bayside streets to the hospital to a local psychiatric facility to jail. The ricocheting was about to start again.
The next day, the 85th call came in: shirtless, shoeless man flinging toys around the sandbox at a nursery school playground. The police arrived in time, tucked him in their cruiser and took him to the hospital.
But the officers did not have a “blue paper” — an order signed by a judge that allows a hospital emergency department to hold a patient for psychiatric commitment. Without it, the hospital could not keep him involuntarily. Although he was high on meth, the staff decided he did not need further treatment. He left.
Three hours later, the 86th call: He was exposing himself in a Portland park. A judge authorized the blue paper. Officers returned him to the hospital.
By midafternoon, Mr. Burns sat in his police van in the hospital parking lot, juggling phone calls from social workers, hospital staff, beat cops and members of his behavioral unit. In the rush to get the young man committed, no one remembered to grab the blue paper, which was still sitting on a desk at the police department.
Mr. Burns, who has worked with homeless people around the country for three decades, massaged his aching temples. “Everyone is spinning,” he said. “The person on meth has no idea what’s going on, and neither do we. At the end of the day, nothing really gets better. It’s one big cyclone of misery and confusion.”
A slow killer
People who use meth claim it gives them “superpowers”— great sex, lots of energy, supreme confidence. That is because meth stimulates the brain to release unparalleled amounts of reinforcing, feel-good neurotransmitters such as dopamine.
In rural Maine, workers cobbling together a livelihood with repetitive shift work use meth to stay awake. In Portland, people living in shelters or encampments say meth keeps them alert against theft and sexual assault.
“Often meth use is a story of trying to survive,” said Dr. Kevin Sullivan, who lugs a cart of emergency medical supplies for Bayside patients living on the streets.
When meth euphoria wanes, many people keep using to reignite the high. Then they can’t sleep or eat for days. They forget to drink water. During the final stage of a binge, known as tweaking, they may become erratic, ranting, vicious. Paranoia and hallucinations seize them.
When people get pounded by meth withdrawal — sweating, depression, agitation — they may self-soothe with fentanyl to help them, in street talk, “land.” Conversely, when fentanyl users go into withdrawal, they may grab meth.
Monica, an occasional short-order cook, goes to a Portland outpatient clinic for daily medication to curb her cravings for opioids. But over a long holiday weekend, she missed three days of doses. To ease the dope sickness, she filled a syringe with meth and gave herself a shot in the neck. She stayed awake for the rest of the week.
“I’ll play with Tina anytime she comes around,” Monica said, using a street name for meth, as she headed to an opioid treatment clinic.
People who want to quit fentanyl have options, including medicines such as methadone to quell cravings. But researchers have yet to develop a medical treatment that quiets urges for meth.
Some seasoned drug users say that meth is safer than fentanyl. Yet meth is anything but safe. Many addiction experts believe that meth made by Mexican cartels, often mixed with hazardous chemicals, is far more destructive than the original party drug, which relied on pseudoephedrine, an ingredient found in pharmacy decongestant tablets.
Now, as meth travels north and east through the United States, snaking from Portland, Ore., to Portland, Maine, its impact becomes toxic and unpredictable as, en route, it gets cut with fentanyl and xylazine, an animal tranquilizer that causes necrotic flesh. “Dirty Tina,” it’s called in Bayside.
“Fentanyl is still a big deal, although from what we’re seeing in the market, there is a lessening of demand and the cartels are switching products to methamphetamine, counterfeit pills and crack,” said Rick Desjardins, director of the Maine Drug Enforcement Agency.
Fatal overdoses attributed to meth are often associated with the presence of fentanyl or to underlying causes aggravated by meth. But even as opioid fatalities drop, federal data shows a steady increase in the overdose deaths where meth or crack cocaine, whose popularity has also soared, has been detected.
In 2023, nearly 35,000 overdose deaths nationwide involved stimulants, primarily methamphetamine, with or without fentanyl also contributing. That number represents a rise of about 870 percent since 2013, when there were about 3,600 such deaths, according to researchers at the Centers for Disease Control and Prevention.
And in Maine, methamphetamine-involved overdose deaths rose to 194 in 2023 from 12 in 2013, according to Dr. Joseph R. Friedman, a psychiatrist and addiction researcher at the University of California, San Diego.
Compared with fentanyl, meth is a slow killer. Sustained use can lead to infected heart valves and higher risk of meth-induced cerebral or cardiac strokes.
The drug has other residual effects. Because meth dries up saliva, it can cause the tooth-decay and disfiguring-gum disease known as “meth mouth.” Long-term meth users can experience memory loss and anhedonia, the flat, gray affect that results when a person who has become accustomed to meth-pumped dopamine is deprived of it.
Meth-related psychiatric hospitalizations have been rising, studies show. When a thrashing, raving patient arrives at the emergency department, doctors often struggle to tease apart whether the patient is schizophrenic or experiencing methamphetamine-induced psychosis. Or both.
‘My best friend’
For the first six months of 2024, Portland emergency services revived Kailan from eight fentanyl overdoses, the most of any woman in the city.
Now Kailan, 38, has a bed in a Bayside shelter, a caseworker and a therapist. Among the Bayside folks whom Mr. Burns shuttles daily to opioid addiction treatment clinics, her attendance is among the most consistent.
On a biting cold day, she settled into his van alongside sleepy passengers. But Kailan was perky. “Dope is my worst enemy,” she declared, using the street word for opioids, “but meth is my best friend.” Meth, she said, gets her up and moving every day.
On the drive back to Bayside from the clinic, she asked Mr. Burns if he would stop so she could have a cigarette. He parked along a promenade overlooking Casco Bay and waited, as Kailan, in slippers, a thin T-shirt and a hooded jacket, trudged across the packed snow. At a picnic table behind a stand of trees, she crouched down and lifted her jacket over her head.
Shielded from bitter winds and curious passers-by, she dropped a grayish pebble of crystal meth into a glass pipe, lit it, and swirled till vapor steamed from the bowl. She took a hit.
Years ago, Kailan, whose schooling ended in 10th grade after she had a baby fathered by a man 20 years her senior, would cop illegal Adderall, a stimulant prescribed to treat people with A.D.H.D. Because the drug improved her alertness and focus, Kailan believes she does, in fact, have the disability, not uncommon among people who use meth. Adderall, an amphetamine, is chemically related to meth.
Kailan sometimes wonders how her life might have turned out if she had been given a proper psychiatric evaluation and a diagnosis of A.D.H.D. Without it, doctors refused her requests for Adderall. To them, she was just a drug seeker.
“I told them their decision was wrong and that an undiagnosed, unmedicated person isn’t safe, really, to themselves,” she said. “But now it’s too late. I’m fully addicted to another substance.”
She lost much of her teens and 20s to alcohol. But a few years ago, newly sober after a jail stint, she found steady work at a Portland banquet hall and was even being trained for an expanded role.
Then Covid came. Her shifts ended. Bored and lonely, she ventured out one day to score Adderall. Instead, a friend gave her a $20 shard of a drug she had never seen before in Portland: crystal meth.
Meth began writing its signature across Bayside. The walls of a vacant parking garage, where homeless people slept at night, became covered with meth-fueled murals. People did herky-jerky dancing in the middle of traffic, pausing only to scratch their imagined meth bugs. Recounting this, Kailan buried her head on the picnic table and wept.
“At no point did any of us ever say: ‘Yay, these drugs are here! Let’s have fun!’ None of us wanted these drugs on the streets. Like, if we had a vote, I don’t think any of us would vote for them.”
As Kailan’s meth dependence grew, her housing became unstable. A boyfriend introduced her to fentanyl, which they both injected. Days bled into nights as the couple toggled between meth and opioids. He beat her up, knocking out three teeth with one punch, and locked her in his basement. When he was hospitalized for drug-related infections, she fantasized about leaving him and drugs.
About two years ago, Kailan served another short jail sentence. As she sat at the promenade picnic table, she recalled her surprise in jail when she realized, “ ‘The whole time I haven’t wanted drugs at all!’ And I was thinking, ‘This has been you, locked up and lost inside of you, in chains, and now you’re released.’ And I said to myself: ‘Don’t forget. Don’t forget.’”
A year or so ago, she scored a coveted spot at Elena’s Way, a 40-bed shelter in Bayside. She said Mr. Burns and shelter social workers would tell her: “Kailan, obviously you’re having a hard time. Wish we could get you some help.”
“And finally I was like, ‘OK, it’s got to be better than being dope sick,” she said.
Now, methadone, the medicine she gets at the clinic, helps keep the lid on her opioid urges, as does the steady contact with Mr. Burns, who closely monitors his van filled with a chosen family of treatment regulars.
Stamping his feet against the cold, Mr. Burns walked over to tell Kailan it was time to head back to Bayside.
Kailan said she would be there in a minute. When his back was turned, she hurriedly walked over to a portable toilet, to hit her meth pipe again.
Fighting with limited weapons
“Meth depletes your nutrients and vitamins!” says the message printed in colored markers on the whiteboard at Commonspace, a Portland drop-in center that offers sterile drug use supplies and other services. “EAT foods high in magnesium! DRINK water!!!”
Portland’s service ecosystem, continually updated over decades to combat each siege of a new opioid — OxyContin, heroin and now fentanyl — has tried mightily to adapt to meth.
Preble Street, a large medical and social services nonprofit in Bayside, lets people strung out from meth sleep on cots in the hallways of its MaineHealth clinic. “They need a low-stimulation environment,” said Malia Haddock, a psychiatric nurse practitioner, who takes people to the clinic’s calming psych consultation room.
“We tell them they can put their bedding on the couch,” she said. “Then we turn the lights down, close the door most of the way and let people try to metabolize and get grounded.”
Last summer, Ms. Haddock began driving a mobile clinic van every day to encampments of homeless people. She ushers her patients into the van’s calm, ordered interior.
Spurwink, the behavioral health clinic in the heart of Bayside, offers 24-hour respite for people in crisis. Counselors sit quietly with clients on its couches, lights low. The clinic is testing a behavioral program known as “contingency management,” which rewards participants who test negative for meth with modest gift cards.
Portland has spent millions of dollars on new shelters and complexes for homeless people, with many structures built specifically for those with mental health and substance use disorders. But often when meth users secure a shelter bed or even a small apartment, they risk eviction — for ripping out faucets in search of listening devices, for menacing residents.
Even Spurwink draws a line. When the young man who threatened the mother and her baby is out and about, neither in jail nor at a psychiatric facility, he sees a counselor at the clinic. But in February, police said, he slugged a staffer. Spurwink did not press charges but barred him from the premises for a year.
Produced by Matt McCann and Elijah Walker.
Jan Hoffman is a health reporter for The Times covering drug addiction and health law.
The post As Fentanyl Deaths Slow, Meth Comes for Maine appeared first on New York Times.
