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Journalist and author Sam Quinones has written a lot about the drug trade. His newest book, “The Least of Us,” focuses on fentanyl and meth. In a new article in The Atlantic magazine, Quinones argues that the way meth is being made currently has changed the chemical structure of the drug and made it much more dangerous to users’ mental health. Quinones explains what he learned.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: We start today with the reporter Sam Quinones. In 2015, he published an award-winning book called “Dreamland.” It traced the origins and the devastating consequences of the opioid epidemic in this country. Now he has a new book called, “The Least of Us.” It comes out tomorrow. It focuses on the latest drug scourges, the synthetic opioid Fentanyl and a new highly dangerous psychosis-inducing formulation of meth. Quinones connects the widespread availability of this meth to homelessness and to serious mental health crises playing out daily on American streets. Part of the new book was adapted into an article for the latest issue of The Atlantic magazine. Sam Quinones, welcome back to Think Out Loud.

Sam Quinones: Thanks for having me again, David, good to talk with you.

Miller: So humans are at the heart of your story. This is, after all, about people’s lives being devastated by drugs, but the story hinges on chemistry. What do we need to understand as lay people about two different ways to make meth?

Quinones: I think the important thing is to understand that there’s a before and then there’s an after. With the way that Mexican traffickers were making meth before, using a chemical called ephedrine which you find in the Sudafed pills, the methamphetamine that they were producing is not good for you. It decayed you over a number of years and there were famous posters out of Multnomah County or mugshots of people this happened to, but it was a kind of a euphoric drug, a party drug, a social drug, making you want to spend a lot of time around people and so on. And then the way of making meth changed down in Mexico because it had to. The Mexican government made ephedrine illegal and the trafficking world gradually shifted to a new way of making meth using the precursor known as p2p, phenyl-2-propanone. And with that you began to see a whole new experience–very sinister, very lonely people isolating horribly in their own minds. It’s not a social drug anymore. It’s not a party drug anymore. On the contrary, what it seems to breed is a very sinister kind of schizophrenia, horrible paranoia, great amounts of hallucinations and with that of course comes homelessness. And I think, also, you can chart the rise of the tent encampments so common in the West, but also now all across the country in many areas. I just spoke with a guy in Boston where this is the case as well. That the meth is really contributing to the formation of these encampments. This is all connected to the idea, too, that the trafficking world down in Mexico now has access to two very large ports that give them access to world chemical markets–China, India, Chile, a variety of areas where they can get all the chemicals that they need to make this stuff year round, add to that

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Miller: So let’s go piece by piece here because the supply, it seems, is directly related to the difference in these two ways of making methamphetamine.

Quinones: Correct.

Miller: Am I right that the older version with ephedrine was based on a natural substance, something that was grown and that was a kind of a natural limiter on how much meth you could make?

Quinones: Yes, but also it was that the Mexican trafficking world had a limitation on how much it could actually import.  It used to be legal for many years and that’s how the industry grew up. Just getting access to those amounts of ephedrine, they were able to make enough to cover significant parts of the Western United States. Never were they really able to take over the market east of the Mississippi River. And that was the whole other world that they never actually had access to, but now they do with this p2p meth because of the access to all the kinds of different chemicals that you can make p2p with.

Miller: Can you give us a sense for the scale of the industrial operations that we’re talking about? Because for the ephedrine-based meth there were basically on the West Coast, if I understand correctly, two ways people have, but one is home labs in the US and the other was Mexican drug makers who would make it there and bring it in. What’s the scale now for the production of the p2p meth?

Quinones: Yes, it just dwarfs anything we’ve ever seen. You’re right. For many years there was a whole kind of homemade way of making meth. You found this a lot in the Midwest, you found it in certain parts of the Western United States–making it in kind of an informal concoction, a little bit like moonshine almost. You can make it in a Mountain Dew bottle, but you were talking about grams or ounces at the very most that you were able to do. This p2p meth that is able to be made down in Mexico is like what happened with Main Street when Walmart came in. When Walmart came in, Main Street was just out competed and died off in so many towns. Well, the same is true of those homemade meth makers, those shake and bakers as they’re called, in many parts of the country.  They don’t really exist anymore. They’ve been out competed and really destroyed by the enormous amount of meth coming in from Mexico and the best way to show it is what’s happening to the price. The price has just collapsed. And this is a remarkable feat. It collapsed in LA, it collapsed on the East Coast. I’m in Nashville where it used to be that a pound of meth was $20,000. And now it’s $4,000. That kind of percentage drop in price is happening all over the country.  It is a remarkable achievement, if you want to call it that, in just pure supply of one drug.

Miller:  What did you hear from longtime meth users about the differences they’ve experienced between older versions of meth and what’s on the street now?

Quinones: It’s a great question. In fact, I was clued into this from a fellow by the name of Eric Barrera, in Los Angeles, a former Marine, a user for many years when it was ephedrine. He was the one who told me first and later confirmed by many others that there’s a kind of a euphoric drug, you wanted a party, you wanted to be hanging out with people and he was on his game; and, meanwhile he was able to maintain more or less a life. He had a series of jobs he didn’t really like, but they were jobs. He had a car and an apartment, and had a girlfriend. And then one night he said to me, the meth just changed and all of a sudden he was raging at his girlfriend, believing she had hidden a man in the walls, stabbing the walls with butcher knives. He never again felt that euphoria. Within a short period of time, he was homeless for the very first time after maybe 10 years using nothing methamphetamine. It was a dramatic transformation and it’s also very isolating. He didn’t want to be around people anymore. He didn’t want to be on his game and jabbering away and partying. He wanted to just be alone, watching his porno and kind of on his own. Alone in his own brain is the way he put it. He comes from a gang neighborhood, a lot of his friends began calling it weirdo dope because it just turned people very quickly psychotic, schizophrenic. And you began to feel this deep, deep derangement of people that you never saw on the old meth.

Miller: But it remained addictive. Everything you’re describing sounds terrible, but people wanted to keep doing this?

Quinones: It’s an interesting thing because this meth kind of creates a world unto its own and you want to be in that world. And that’s where the tents come in. Tents are almost tailor made for a meth addict. If you are in a world where all around you are sinister conspiracies and you’re taking pictures of every car license on the street because you’re sure they’re tailing you. And if you have monsters tailing you and cheetahs coming out of the walls the best place to be is inside a tent all alone, all by yourself, it allows you space from the world. It’s an intensely addictive thing. And speaking with an ER psychiatrist in Columbus, Ohio, she said something very astute to me. She said this meth not only makes you homeless, it divorces you from reality so you can bear it better. So, it doesn’t send you shrieking thinking I’ve got to get out of this, it kind of enures you to that and it makes you feel like, okay, I’m separated completely from reality, I don’t know where I am, I’m in a psychotic state. And that’s a good thing to be if you’re going to be on the street because you don’t feel the daily grind, the harrowing lack of hygiene and all the degrading things that go along with life on the street. The meth turns you homeless and allows you then later to bear it.THANKS TO OUR SPONSOR:Become a Sponsor

Miller: When you talked to public health experts or people who focus on homelessness in LA or anywhere else in the West Coast, anywhere else in the country, how much did you hear specifically about the connection between homelessness now and the rise in this super dangerous meth?

Quinones: Almost none. Well, it depends who you’re talking about. If you’re talking to treatment providers, people who are dealing with these folks in a serious way, then yes, they’re very clear about what’s been happening.  This meth moves across the country and over the last eight years. So in ‘13 and ‘14, it’s in LA and on the West Coast. By ‘16 and ‘17, it’s in Ohio, it’s in Kentucky, West Virginia, Indiana. And by ‘18 and ‘19, primarily it’s up in New England which never had any meth before. So you talk to people in those areas on the ground who are addicted and they’re very clear about it. On the other hand, there’s a whole cadre of homeless advocates who have willfully blinded themselves to this problem. They want to focus only on the high cost of housing as a reason for homelessness, not wanting to stigmatize homeless people as drug users. The problem is that they are turning away from one of the main causes, I suggest. Homelessness is a complicated thing and there’s various kinds of homelessness, but the tent encampment homeless, I would submit, has enormously to do with drug addiction and primarily nowadays with this new meth coming out. It is very well associated with this now. This has not been studied in neuroscience, no mice or rats studies, no journal reports. This is pure street reporting on my part, but the fact that I was able to report on this and see how clear it is and not really see anybody else talking about it means to me, frankly, that there’s this kind of willful blindness, kind of politically correct blindness that people want to put blank blinkers on and not view the issue with any kind of realism.

Miller:  What would follow taking the blinkers off? If you’re arguing that out of a sense of political correctness and not wanting to stigmatize people who are experiencing homeless, I guess maybe to extend it further to blame them for being homeless. Let’s say that societally we took the blinders off and paid more attention to meth. What would that lead us to do?

Quinones: I think at first it might lead to a number of many things, perhaps, it depends on the community, but certainly it might lead us to understand that there is no treatment, there is no housing of people until they are detoxed from this and until they have spent several weeks without this drug. Then this is what treatment providers always say, too: There’s no way we can treat folks who are speaking to you in numbers, every answer you give to your questions are in numbers. They’re talking about conspiracy theories that you have no idea about. There’s no way of going forward with drug treatment until you can have people connected with other humans in some kind of real sense. And so that means first we need to rethink housing for the mentally ill and detoxing. I think that’s the very first step. I would also suggest though that this gets probably far beyond your conversation, probably far beyond what I want to talk about today, but the truth is too, we have to do something about this supply. This is a supply story pure and simple. And that comes from Mexico. And there needs to be an engagement with Mexico right off the bat. Mexico is producing utter poison that is creating homelessness and mental illness all across our country. It has to do partly with our own unwillingness to stop any kind of the smuggling of weapons down into Mexico that are allowing the impunity, with which those traffickers operate very clearly. I lived in Mexico as you may know, for 10 years, and that’s a very clear thing that’s going on. I think it probably starts at the local level. First of all, I don’t think the tents are anything but vectors of negativity and addiction at this point. And so maybe something with regard to ways of finding housing that is kind of controlled housing, detoxed housing, that kind of thing. Not just an apartment. Folks on this kind of meth cannot function in the same way. They will destroy those houses. They’re not capable now in the current state of living in this house though. The idea of getting a house first before anything else, I think is kind of made obsolete by this new meth issue.

Miller:  You got a pretty chilling quote from Rachel Solotaroff, the CEO of Central City Concern in Portland, they closed down a sobering station a year and a half ago and you attribute that to an inability to deal with people who are addicted to this new version of meth. You quote her saying this, “The degree of mental health disturbance, the wave of psychosis, the profound, profound disorganization is something I’ve never seen before. If they’re not raging and agitated, they can be completely non communicative. 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 into that person.”  What does this mean in terms of treatment?  You just said that the idea of housing first may not work because people who are in the throes of this p2p meth addiction can’t even live in housing, that they’ll destroy their housing. So the argument, I suppose, would be treatment first, but from that quote from Rachel’s it seems that the treatment itself seems so difficult. So where do you start?

Quinones: I’m not a treatment professional and there’s a long conversation that can be had around this so long as we’re talking about this and not some idea that somehow this is just an affordable housing issue and a high cost of housing issue.  But I would say it’s a detox issue first. It really cannot do anything with people on this very deranging methamphetamine that’s so prevalent on the street, so cheap on the street. I think it’s an interesting concept too, because it now flies in the face of a lot of the decriminalization that we’re seeing.  It may be in fact extraordinarily damaging to people, not an act of benevolence, but an act of torment to actually keep someone on the street. Taking someone off the street using jail somehow to detox people–people are doing this across the country now– might be a more benevolent, more kind way of dealing with someone. Certainly just saying, well, you’re on the street and we’ve got you with these implements that are kind of misdemeanors or low level felonies or maybe you have some stolen property or whatever, but we’re going to leave you here and we’re going to wait till you’re ready for treatment. The idea that people need to be ready for treatment is an idea that’s made completely obsolete by this meth. I would suggest also by the Fentanyl that’s now also coast-to-coast created down in Mexico.

Miller: I’m glad you mentioned Fentanyl. And folks probably heard that that’s in the subtitle of your book, you focused on these two synthetic drugs in tandem. Why? What’s the connection between these two drugs?

Quinones: Well, I focused there because this is now the synthetic era of drug trafficking down in Mexico. It was the ephedrine world that taught certain visionaries down in the Mexican trafficking world, particularly a guy by the name of Nacho Coronel who was killed by the military in 2010. But, they began to see the trafficking world down in Mexico is farm-based. They’re ranchers, rancheros. Their grandparents grew up in this world and it was growing from the land. So marijuana, poppies, all that kind of stuff is what they focused on. Well, their grandchildren now see that actually making drugs in a lab is so much more profitable and easier. You don’t need land, you don’t need the seasons. You don’t need irrigation, don’t need legions of farmers to help you harvest the stuff. All you need is a warehouse of some kind, a chemist who may or may not be pretty good  but can teach you what you need to know. And above all everything depends on your access to shipping ports. If you have access to shipping ports and you can get access to the chemicals that you need to make those drugs then all of a sudden you can make drugs no matter what the season all year round. And as those chemicals really proliferate, this is what’s happening down in Mexico. There are more and more people getting into this world. We call these groups cartels, they’re not cartels, they’re just loose affiliations of producers. A cartel is an organization that works to limit supply to force up prices. The exact opposite is happening now, both with methamphetamine–I said the prices have collapsed–and also with Fentanyl. So methamphetamine taught them this lesson. The chemical drugs are better than plant-based drugs. And then along the way they got involved in the opioid epidemic providing heroin and that’s when they discovered Fentanyl and Fentanyl just fell right into their wheelhouse that meth had already created. They realized, oh my God, this is synthetic heroin and we can make huge amounts of money now that all those gringos up there are addicted to pills and then heroin, man, this is gonna be great. And I tell the story in the book of how the Sinaloa cartel first encountered Fentanyl. But it’s that idea that they are now fastened on and makes total business sense if you’re a drug trafficker.

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Miller: There’s now overlap between people who are addicted to opiates and people who are using this new meth, what does that mean?  And where does that fit in our longer history of drug abuse in this country?

Quinones: Well, it’s fascinating. That’s an excellent question, Dave, and there’s a lot to go on. But basically what you’re seeing now is an outgrowth of that massive supply. We are seeing supplies of both the meth and Fentanyl in just staggering unprecedented amounts from coast to coast.

Miller: What does that mean?

Quinones: Well with Fentanyl, it means almost anybody can be a kingpin now. You don’t have to work your way like Scarface in some nasty, dangerous organization.  Anybody can be selling quantities that for years would be considered kingpin quantities.  Also, with Fentanyl being an opioid, you can create new opioid addicts by selling them meth or cocaine laced with Fentanyl. And this is what’s happening all across the country as well. If you sell a customer who may buy your cocaine or your meth, only occasionally like two to three times a week that is fairly common for users of it. But you put Fentanyl into it and pretty soon you have an opioid addict and when you do that pretty soon that person has to be buying daily from you as that Fentanyl begins to addict more and more people as you’re seeing now, all across the country. People are addicted to quantities of Fentanyl that would have killed them a year or two ago. But the tolerance they have now is so, so high. But they are daily customers, because only with Fentanyl can they keep the withdrawals and the sickness away. Heroin is disappearing from the streets of the United States. It won’t be around for much longer because heroin doesn’t provide the kick and it doesn’t satiate you enough to keep that illness away. So there are a lot of reasons why you might introduce Fentanyl which is very dangerous and has killed many Americans into drugs thinking that it might kill them. The other thing that is very important to keep in mind is that to the addicted brain–certainly the opioid addicted brain and this has been common in the heroin world for a long time–an overdose, a death, it’s not a warning, it’s an advertisement. It’s a way of saying, hey guys that dealer over there is selling serious dope, it puts so and so on his butt. The dealer lets people know that and pretty soon people are flocking to it. This is not just common to Fentanyl, this has been a case of heroin, too. When someone dies of a heroin overdose, all the addicts run to it because that is the control by drugs of abuse, particularly opioids of the brain, and all that the brain has evolved to keep us alive and is completely controlled now.

Miller: I want to go back to something you said earlier that this is a supply issue. The real root of this right now is the US law enforcement has to somehow stop the supply of meth and Fentanyl from crossing the Mexico-US border. But you also noted that we’re not talking about a cartel here or a couple big deal kingpins. We’re talking about a hugely amorphous distributed network of smaller or mid level players that are flooding our country with this supply. So what does that mean in terms of law enforcement’s ability to crack down?

Quinones: Well, again, I get back to what we need to do in tandem with Mexico, which we have never done. No president in my lifetime has done what I think– after years of living in Mexico, writing two books about the country–that we need to do as a country with a level of engagement.

I understand that it’s extraordinarily difficult. There’s a lot of history to overcome. There’s a lot of suspicion, mistrust. But the truth is that we don’t get anywhere dealing with a bi-national problem in a uni-national way, if that’s even a word.  We need this engagement deeply.  And Mexico needs it. We need to understand how our guns play a role in all this. What is the price of an AK47 that we import from, say, Eastern Europe and then someone in the United States smuggles down to Mexico?  I submit to you that it’s methamphetamine sold on the streets of Portland for I suspect anywhere between $850-1500 a pound, an unprecedentedly low price. That is the price we are paying for our guns going south. At the same time, what is the price that Mexico pays for not addressing the horrible toxic effect that these cartels and these groups, trafficking world subculture, has on that country? The cost is being paid all over Mexico very sadly. I think at the local level there’s a lot we can do in providing some kind of detox areas for people on meth.  I think, though, in some larger scheme, it’s hard for me to understand how we get further along without addressing the problem with Mexico. It’s like we’re in a leaky boat and we’re bailing out the water and somebody else keeps on drilling holes in the boat.

Miller: The subtitle of your book is, “True tales of America and Hope in the Time of Fentanyl and Meth,” but the short version of this story as you’re telling it, is that there’s an essentially unlimited supply of a super dangerous drug or drugs that are ravaging people’s lives, where does hope come in?

Quinones: It’s not even just that. It’s that we are surrounded in a culture in which we are constantly being plied with legal stuff, social media, addictive stuff, gambling. You saw in the World Series last night how there was a gambling app that could allow you to bet on whether this batter got a hit. You get to sugar, you get this horrible fast food and junk food that is kind of creating obesity, which is its own form of addiction, I think. So my question to myself as I got into this book and was struggling with it was what is our defense then? How do we defend ourselves against these enormously powerful forces? And my feeling is that the best way to do that is a return to rebuilding the community that in many ways we have destroyed over the last 40 years. Basically it’s a reexamination of how we live. In my own case, I stopped drinking sodas and eating lots of refined foods just because I felt like this was my way of saying, I’m not going to be part of this problem, but it’s this idea of getting back towards working in small, unheralded ways. So much of what started the opioid epidemic had to do with our search for a magical answer. Right? What was the problem? This very mysterious problem of human pain? What was the magical answer? Opioid painkillers for everybody no matter the background, no matter the person. We need to get away from that and get back to the idea that it is small stuff, the local working, working daily, not worrying if you’re saving the world in some noble sense, but just working daily with it. We have seen the effects of that. That’s where you create true, really important political, cultural and societal change. We’re seeing it in the opioid epidemic.

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One of the great grassroots movements of our time, very unnoticed and very unheralded, has been all these people who have come out of the shadows who have had people in their family addicted or dying and were silent and were quiet and they came out of the shadows and they met their mayors and their clergy and they met their their state rep in the grocery store and began to be heard in a way that was not the case when I was writing “Dreamland.” It was only after the book came out and you’re seeing that one result of that are these amazing lawsuits that are now forcing major, very powerful corporations to cough up billions of dollars to help redress this thing. Is that enough? Probably not. But the idea is when people work in this small, unheralded, quiet way, there are daily steps forward.  And, that is why a good half the book, you’re right, talked about the very damaging part of the sinister story. The other half of this book is me going out trying to find the smallest, quietest, least sexy, most unnoticed stories of Americans involved in community repair that I could find. And that’s the other half.

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Health Effects of Meth Use

Meth is a powerful stimulant that can cause noticeable effects even at low doses. It works by increasing the activity of neurotransmitters throughout the brain—most notably dopamine, which regulates the brain’s responses to pleasure and reward.4

Short-term effects of meth may include:2

  • Increased energy or activity.
  • Decreased appetite.
  • Breathing more or faster.
  • Rapid or irregular heartbeat.
  • Overheating.

Meth use can become even more detrimental over long-term or chronic use. As a person begins to use more meth, the brain will need higher and higher doses to achieve the same high.3 This pattern of increased doses often leads to dependency and addiction, which come with many negative and dangerous consequences.

Long term effects of meth abuse can include:3

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In addition to these problems, meth abuse is known to cause damage to the actual brain cells, particularly in the areas that influence emotion and memory.6 Sustained abstinence can help reverse much of the damage caused by meth use.

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Mixing meth with other drugs is a risky endeavor. Combinations of meth and other stimulants such as cocaine or ecstasy may have compounding effects that greatly agitate the central nervous system and lead to a dangerous increase in heart rate and blood pressure.7,8

When meth is mixed with a depressant substance such as alcohol, opioids, or barbiturates, dangerous counteracting effects can occur.2 With alcohol, for example, meth can decrease the feeling of drunkenness, causing the person to drink more and more to achieve the desired effect, potentially leading to alcohol poisoning.

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  • Depression.
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  • Intense cravings.

The period of detox and withdrawal, while not life-threatening, can be extremely unpleasant. Recovering users may want to work through treatment in a more luxurious setting focused on comfort.

Luxury and executive rehab programs focus on providing the most comfortable rehab experience. The facilities tend to have many amenities such as:

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While traditional addiction rehab programs and luxury rehab programs may vary in offered amenities and services, both will offer quality treatment and support.

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A meth user may show obvious signs of intoxication. Some common indications that a person is abusing meth include:10

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When a person is addicted to meth, they may show signs of habitual drug-seeking behavior, such as:

  • Sacrificing other interests and activities in lieu of getting their next high.
  • Spending a large amount of their time thinking about meth.
  • Neglecting responsibilities in order to acquire and consume meth.

The combination of these meth effects and drug-seeking compulsions would indicate that your loved one is addicted to meth and should get help immediately before long-term damage can develop.

While the number of methamphetamine users did not increase as steeply, researchers said frequent use of methamphetamine, and using other drugs at the same time, may have contributed to the increase in overdose deaths. Meth users have also become more diverse, according to the report.

“We are in the midst of an overdose crisis in the United States, and this tragic trajectory goes far beyond an opioid epidemic. In addition to heroin, methamphetamine and cocaine are becoming more dangerous due to contamination with highly potent fentanyl, and increases in higher risk use patterns such as multiple substance use and regular use,” said researcher Dr. Nora Volkow, director of the U.S. National Institute on Drug Abuse.

In 2020, more than 93,000 Americans died from drug overdoses, the largest one-year increase on record. The increase was largely driven by overdoses involving synthetic opioids, primarily fentanyl, but overdoses involving methamphetamine were also significant.

To assess trends in methamphetamine use, researchers analyzed cause of death files from the National Vital Statistics System and 2015-2019 data on adults 18 to 64 from the National Survey on Drug Use and Health.

From that time period, the investigators found the number of overdose deaths involving drugs other than cocaine, mostly methamphetamine, rose from more than 5,500 to nearly 15,500, a 180% increase. The number of people who reported using methamphetamine, however, increased by 43%.

Also, people who said they often used methamphetamine rose 66% between 2015 and 2019, and the number of people who used methamphetamine and cocaine together increased 60%.

Since 2017, more methamphetamine users reported higher-risk use patterns, such as having methamphetamine use disorder and/or injecting methamphetamine, which may be contributing to the uptick in meth overdose deaths, the researchers said.

Historically, methamphetamine has mostly been used by middle-aged white people, but now American Indians/Alaska Natives are the biggest users of the drug, according to the report.

“Public health approaches must be tailored to address methamphetamine use across the diverse communities at risk, and particularly for American Indian and Alaska Native communities, who have the highest risk for methamphetamine misuse and are too often underserved,” Volkow said in an institute news release.

Also, the prevalence of methamphetamine use disorder among those who did not inject the drug increased 10 times among Black people from 2015 to 2019, a much steeper increase than among white or Hispanic people.

Methamphetamine use has been linked to HIV transmission through needle-sharing and engaging in unprotected sexual activity often associated with meth use. Researchers found the prevalence of methamphetamine injection was the highest among homosexual men. Methamphetamine use disorder without injection more than doubled among homosexual or bisexual men. And it more than tripled among heterosexual women and lesbian or bisexual women, and more than doubled among heterosexual men.

The analysis also found that methamphetamine use disorder without injection quadrupled in young adults ages 18 to 23.

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