Meth use poses rising threat in Massachusetts
Report cites need for more harm reduction tactics for stimulant use
THE SCOURGE of opioid addiction has made headlines for years, as state policymakers aim to reduce the epidemic of overdose deaths. Less noticed – but still highly dangerous – is the growing use of stimulant drugs, like cocaine and methamphetamines.
“We’ve been seeing that stimulant use, especially stimulant involvement in overdose deaths, has increased dramatically in Massachusetts and across the country,” said Traci Green, director of the Opioid Policy Research Collaborative at Brandeis University and a member of the legislatively formed Commission on Methamphetamine Use.
The Boston Globe reported in 2019 that illegal meth use was becoming more prevalent in Massachusetts, long after it took hold in the West and Midwest. A report released this week by the Commission on Methamphetamine Use, a group of experts led by Health and Human Services Secretary Marylou Sudders, reported that in Massachusetts in 2020, there were 1,124 deaths from stimulants (including crack/cocaine, methamphetamines, and amphetamine drugs like Adderall), compared to around 2,100 opioid overdose deaths. Of those, 103 deaths were attributed to methamphetamines, a potent category of drugs that can be legally prescribed or obtained illegally, and come in pills, powder, or rocks.
Julie Burns, president and CEO of RIZE Massachusetts, a nonprofit working to address addiction, attributes the rise primarily to availability, as crystal meth and cocaine have become more prevalent on the East Coast.
The growth in stimulant-related deaths is not entirely independent from opioid deaths, since often drugs are combined, either intentionally or through contamination.
The report found that crack-cocaine has a higher prevalence in the African-American and Latino communities. Methamphetamine is used more in the eastern part of the state, particularly the Boston area, and among whites. Recreational meth use is particularly concentrated among gay men, which the report attributes to a “party and play” culture, where men use drugs to enhance sex.
One of the biggest problems highlighted is that Massachusetts “lacks an overall culture of harm reduction.” Typically, harm reduction refers to services like needle exchanges, access to an anti-overdose drug, or drug testing equipment to ensure drugs are pure. But Green said it goes beyond that. The commission heard testimony, for example, about the need for stimulant users to have a safe place to sleep or chill out. The report wrote that homeless people may use stimulants to stay vigilant on nights when they lack a safe place to sleep.
Burns said one important need is for doctors and first responders to better understand how to treat people on stimulants. For example, a loud emergency room with bright lights can exacerbate stimulant-related anxiety or aggression. Instead, a person needs a quiet place to cool down.
One challenge flagged by the report is there is no medication-assisted treatment for stimulant use, as there is for opioid use. One treatment method is “contingency management,” where people get rewards – financial or otherwise – for abstaining from use, a system meant to rewire the brain to associate rewards with abstinence. But insurance often doesn’t fully cover it.The commission recommends improving the treatment and harm reduction options available in Massachusetts. It says programs need to be culturally tailored to particular populations, like gay men, or people working in construction, an occupation with high rates of overdose deaths. In some places, for example, clubs distribute free fentanyl test strips, so patrons can make sure their drugs are uncontaminated. The report spotlights a couple of programs that treat stimulant use using a variety of methods, run by the Boston-based Bay Cove Human Services and Boston Medical Center, but notes that treatment is not easily accessible statewide.
The report said the state should explore the feasibility of establishing resource centers where people under the influence of stimulants could be diverted from emergency rooms to “cool down.” Policies should ensure insurers cover treatment, including resources like recovery coaches. There is also a need to run educational and anti-stigma campaigns around drug use beyond opioids; publish more data on all substances; and issue better guidance to first responders.