In a Town Where Meth Is Eclipsing Opioids, Everyone Feels the Pain

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Hilary Swift for The New York Times

LOUISA, Ky. — Home deliveries from the local food bank now require a police escort. A shop owner has started to carry her gun to work. And the local constable, who rarely had to pull his weapon in the past, has drawn it a dozen times over the past year.

All because people hooked on methamphetamine have threatened them.

For years, opioid addiction ravaged Louisa and its neighbors in Appalachia. But the sudden return of methamphetamine — in a powerful new form — has brought a sharply different set of problems to this small Kentucky town amid coal mines on the West Virginia border.

If pain pills left residents struggling to help many family members deal with the risk of overdose, methamphetamine has bred fear and division in the community of 2,500, especially as a growing number of users have begun living on the streets.

“Half the people want to take them to the river and tie something around their neck,” said the town’s mayor, Harold Slone, adding, “We hadn’t seen that level of anger before.”

Opioids, heroin and fentanyl remain abundant, cheap and deadly in this part of Kentucky. In 2017, the rate of fatal opioid overdoses in the state was nearly twice the national average. But the sudden abundance of methamphetamine reflects a new reality in Louisa and elsewhere: A very public push to end opioid abuse has unwittingly ushered in the return of crystal meth.

In Concord, N.H., which was ravaged by opioids, the police say methamphetamine now accounts for 60 percent of all drug seizures. In Texas, Hawaii, Oklahoma and Colorado, overdoses from methamphetamine surpassed those from opioids in 2018. And in Mississippi late last year, the police discovered 140 pounds of methamphetamine in one of that state’s largest drug busts.

“Meth, that’s our drug now,” said Dennis Lowe, commander of a law enforcement task force in central and southeastern Ohio, which was also a center of the opioid epidemic. “In the past, it was easy for us to find opioids for sale on the street. Now we have to go look for it. With meth, users are walking around with ounces of it, where a few years ago, it might have been a gram or two.”

Doctors and hospitals have unwittingly accelerated the switch to methamphetamine by significantly reducing their patients’ access to pain medication; opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute.

A powerful Mexican organized crime syndicate, the Sinaloa drug cartel, has sought to fill the vacuum by targeting Appalachia, federal drug officials say. The traffickers follow the same business model that allowed them to inundate the nation with heroin: make meth potent and sell it cheap to ensure a steady customer base, and ultimately, mass addiction.

The inexpensive, purer class of methamphetamine now available in many places is so powerful that some people who have used it say it caused extended hallucinations, leading them to commit serious crimes or to lose track of time altogether.

“There are no memories — it’s just ‘high time,’” said Dakota Scott, 32, a recovering drug user who lives near Louisa. She said much of her recall had been blotted out after she used methamphetamine. “It makes you feel like you can do anything. You’re invincible.”

But the drug exacts a devastating psychological toll on chronic users and substantially shortens their lives because of the strain it places on the heart and circulatory system. It can also lead to sleeplessness and intense paranoia. Users often scar their faces and arms because they feel itchy and scratch themselves.

In Louisa, where a drug rehabilitation center called Addiction Recovery Care has become one of the largest private employers in town, the number of opioid deaths has been on the decline, according to state data, as the use of pain pills and heroin has diminished.

But Tim Robinson, the center’s chief executive, feared that the drop might lead to a loss of federal and state treatment money, just as it is needed to combat the growing meth crisis. Kentucky’s expansion of Medicaid in 2014 helped fund Addiction Recovery Care’s growth; it operates outpatient and inpatient medical and counseling services and houses recovering drug users.

“We shouldn’t be taking a victory lap,” Mr. Robinson said. “We need to understand that some of our success is because we have just changed the crisis, and meth doesn’t kill people as quick. There’s a really strong fear that we’re going to say, ‘Rah rah rah,’ and declare victory and back off when we should be doubling down, because it’s about to be a whole lot worse.”

The region where Kentucky meets Ohio and West Virginia has served as a harbinger of national drug trends. Pain pills like OxyContin, stimulants known as bath salts, prescription anti-anxiety medications like Xanax and, more recently, heroin and fentanyl were all adopted by drug users here before gaining wider use nationally.

Pain pills have been popular in the region since at least the 1960s, when coal miners began to use them to help cope with their grueling work. In 2011, Kentucky doctors wrote 137 opioid prescriptions for every 100 residents, far higher than the national average.

Methamphetamine has also been available in Appalachia for decades, but until recently, it had been mostly made in backyards and basements and varied widely in strength.

But the new Mexican variant is often mixed with cocaine, and increasingly, with fentanyl. Law enforcement officials said cartels mix in those ingredients because fentanyl is inexpensive to produce, enhances the effects of meth and appears to cause faster addiction.

Meth users around Louisa sometimes add their own dangerous ingredients, including wasp repellent, which users say produces a more intense high.

Michael Murriell, a sergeant for the Kentucky State Police who lives in Louisa, said police officers have become more wary when making traffic stops or when approaching people — a conspicuous change from their interactions with pain pill abusers, who rarely argued or resisted arrest.

“Everything we do is different now,” he said. “We have to be more careful.”

The state police said that in some communities around Louisa, nearly eight in 10 arrests are related to methamphetamine use. The local court docket is full of methamphetamine-related crimes — mostly shoplifting, burglary or assault, but occasionally attempted murder.

The seat of Lawrence County, Louisa is similar to many small towns in the rolling hills of Eastern Kentucky. Some of the nearby coal mines still operate, though many have been abandoned for years, their massive belt conveyor equipment left to rust amid scarred brown hillsides. But the downtown is well-kept and quiet, with few visible signs that it has been at the heart of a series of drug plagues.

Residents, however, say people addicted to meth are altering the town in ways both obvious and imperceptible.

Chris Wilson, a local pastor, said a close childhood friend had recently appeared at his church. The man had lost nearly half of his body weight since they had last seen each other. When his friend asked for a ride to the next county over, Mr. Wilson agreed, even though he suspected the man was looking for methamphetamine.

“I said, ‘David, I can get you help.’ He said, ‘You don’t understand. There is no help,’” Mr. Wilson said.

Mr. Slone, the town’s mayor, said that although some residents of Louisa have acted with anger to the meth addicts in their midst, others have focused on trying to feed and clothe them and get them treatment.

But even charity comes with risks in the new environment. Rachel Wheeler, who operates a local food bank ministry, said volunteers now have to be far more cautious when making home deliveries, in case there’s a meth user in the house. Police officers have started escorting volunteers on some deliveries, or making the deliveries themselves.

Kimber Skaggs, who operates Kimber’s Country Market in nearby Blaine, Ky., said she had become adept at discerning the difference between customers who were high on pain pills and those on methamphetamine. Opioid users are often quiet and move and speak slowly, she said, while those on meth are often jumpy, scratch at their sores and behave erratically.

“We’ve had people come in and start talking over by the pop cooler — having a conversation, but then I look up, and there’s no one else there,” she said.

Daniel Castle, the town’s constable — an elected local law enforcement position in Kentucky — said his job became progressively more dangerous as the new form of meth took hold and opioid use waned.

“You’ve got an energized addict versus a lethargic addict,” Mr. Castle said. “I’ve had multiple foot chases in the past year, and it’s all related to methamphetamine. I’ve never had someone on opiates run from me.”

Mr. Castle said he does not know a single family in Louisa untouched by opiate or methamphetamine addiction.

“I know individuals, who are friends of mine, who are losing touch with reality,” he said. “And I fear we haven’t reached a tipping point. It’s going to get worse before it gets better, because we have not stopped the flow of meth coming in.”

Mitch Smith contributed reporting from Chicago.