'A whole other high': How bad data may be slowing the response to Boston's meth crisis

Observers clearly see a growing local meth crisis. But existing data infrastructure can't actually track the surge.

Advocates, city residents and addiction patients alike say a nationwide wave of meth use has crashed on Boston. Researchers say those anecdotal reports may be accurate. But they can’t find the data to prove it. 

That latter revelation comes via a new study by researchers at the Boston Medical Center. Published in JAMA Pediatrics, the work looks at increasing trends in “polysubstance overdoses,” where more than one drug contributes to a death, among young people. 

As it confirms an increase in stimulant use within this polysubstance trend, the study notes that federal data does not go far enough in singling out meth as an independent data point.

“Future studies should further delineate the age-related and geographic differences in polysubstance overdoses over time,” authors write. 

A nationwide meth surge has arrived in Massachusetts

Meth is more popular today than it was even a few years ago. 

Nationwide, a 2018 survey by the Substance Abuse and Mental Health Services Administration found a 600% increase in positive meth tests since 2013 alone.

Locally, CDC data shows fatal overdoses on psychostimulants, which include meth, doubling in Massachusetts over the five years between April 2015 and April 2020. 

Residents, meanwhile, see the crisis on the streets of Boston as they say they observe more and more people suddenly acting erratically after injecting unknown substances, particularly in the South End and Roxbury.

“It’s a whole other high,” city council candidate and South End community advocate Leon Rivera said in a recent interview, comparing meth to opiates like heroin. “…It gets you a little more aggressive.” 

He said he’s seen people attack passers by while presumably high. 

Recently, he added, he called 911 on a man he said was clearly intoxicated and intentionally bashing his head into a block of concrete.

“All of it...comes back to the social and political determinants of health, including poverty, homelessness, and a lack of access to mental health care, that places people at higher risk of drug use and addiction in the first place,” wrote Jamie Lim, a co-author of that BMC study, in a recent email to Substantive. “We need to address all of these factors to combat opioid, stimulant, or any other substance use disorder.” 

Imprecise data causes problems for those fighting meth

As use proliferates, meth remains less common than both cocaine and opioids. 

Harm reduction experts handling addiction in drug use hot spots like the Mass and Cass area of the South End and Roxbury say that much.

Police reports obtained by Substantive earlier this year then confirm the statistical distribution, with cocaine and opioids making up almost every drug seizure connected to a series of arrests, in October, dubbed Operation Mass and Cass. 

Still, this data vacuum on meth remains pressing. Advocates, researchers, and political leaders alike simply don’t have the same kind of quantification of meth use that they have for the still raging opioid and cocaine epidemics. 

Instead, they’re just working with the broad category of “psychostimulants” which includes everything from commonly prescribed ADHD medications, to meth. 

That has ripple effects. 

In Washington DC, advocates calling for more resources devoted to the meth crisis say they’re getting boxed out as limited federal money for drug treatment and research goes towards opioid addiction.

The opioid crisis, while sometimes ignored or deprioritized, has a solid body of empirical, data driven study dissecting it.

Without data tracking meth, it’s harder for advocates to convince politicians and agencies to fund proactive treatment, research and prevention efforts.

In hospitals, meanwhile, while meth overdoses don’t kill at the rate that opioid overdoses do, incomplete and stunted research has doctors struggling. Meth intoxication, one 2019 report by Kaiser Health News read, often gets misidentified as schizophrenia. The symptoms of prolonged addiction that do kill people with meth addictions can then further confuse even experienced clinicians as 20 and 30 year old patients suddenly die of things like unexplained internal hemorrhaging.   

Experts chart a path forward in absence of good data

Back in Boston, while Lim says her team’s study does not focus on local trends, she explains that there are local applications of its observations. 

Namely, she says outreach workers and front-line clinicians need to consider how chaotic substance use can involve more than just one drug. 

From there, doctors and public policy experts alike should work to patch gaps in proverbial medical toolboxes, when possible. 

“Unfortunately, there are few evidence-based treatment options for stimulant use disorder,” she says. “But we can and should still utilize general harm reduction approaches, including supportive therapy and treatment of co-occurring problems.”

Ultimately, though, this all comes back to knowledge. When existing data can’t provide that, Lim and her study co-authors explain, communities need to know how to ask the right questions.

“The first step to fighting stimulant use,” Lim said, “is to recognize and identify it.” 

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