The Drug in the Shadows
While opioids claim the headlines, methamphetamine abuse has made a significant comeback in Minnesota. U of M alumni are on the front lines.
In 1995, Lance Egley (B.A. ’81, Ph.D. ’90), moved to northern Minnesota to work as an assistant professor and coordinator of the chemical dependency minor program at Bemidji State University (BSU). As a longtime expert on substance abuse, Egley says one of his first surprises came when he discovered that in the area, many people considered Thursday, not Friday, as the first “drinking night” of the weekend.
Egley, who is the Region 1 Governor for the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH), an association of substance abuse treatment professionals, has seen addictions evolve in his area over the past 25 or so years. At first, he says, alcohol was primarily the abused substance. Since then, drugs have overtaken alcohol, including the well-documented opioid abuse that has swept the nation. Whatever the substance, Egley says Minnesota, like many other states, faces an addiction crisis.
But when it comes to this crisis, there may be worse news. While opioids grab most of the headlines, experts say methamphetamine, a highly addictive and more difficult drug to treat, is once again on the rise, particularly in parts of Greater Minnesota. That’s especially daunting because smaller towns and more rural areas of the state often lack the resources to effectively fight this deeply complex problem.
The Forgotten Drug
Although methamphetamine, commonly known as meth, was a higher-profile issue in Minnesota two decades ago, concern over it became somewhat muted after the government took steps to hamper production. Meth use plummeted as supplies dried up, and the opioid crisis began attracting the majority of the media’s attention.
However, recently meth has made a quiet comeback in Minnesota, particularly in certain rural areas of the state.
Consider these statistics:
• In 2016, 7,664 people in Greater Minnesota sought treatment for methamphetamine addiction, a 25 percent increase over the year before and almost twice as many as sought treatment for the drug in the Twin Cities—which accounts for more than half the state’s total population.
• In 2017, 74 percent of drug arrests across the state were for meth, up from 27 percent in 2001, according to the Minnesota Department of Public Safety. That dropped slightly—to 62 percent—in 2018.
• Minnesota law enforcement officers seized nearly 1,150 pounds of meth in 2018. That’s five times the amount seized in 2014, and more than twice the amount seized in 2016, according to the Department of Public Safety.
• In October alone, Minnesota authorities made arrests that netted significant amounts of meth throughout the state, including in Dassell, Sartell, St. Cloud, Granite Falls, North Mankato, Duluth-Superior, Wilmar, Stewartville and the small town of Buckman near Brainerd.
Meth and Foster Care
Last December, Jeffrey Lind asked his investigative staff at Beltrami County Health and Human Services to review the last 10 cases where a child had been placed in foster care by his department.
As the social service division’s director, Lind oversees the county’s child protection unit and is deeply aware that removing a child from the custody of his or her parents has far-reaching consequences. Beltrami County has the highest per capita number of children in foster care in the state, and Lind wanted to make sure the county was placing children for the right reasons.
While foster care placements often are triggered by abuse or neglect, Lind was surprised to learn that every single case in that random spot-check involved some kind of chemical use, whether it was alcohol or possessing and selling heroin.
What didn’t shock Lind was the drug most commonly used by mothers and fathers who lost their parental rights in the greater Bemidji area: methamphetamine. In fact, 50 percent of the cases in the random check involved methamphetamine. In one case, a father was arrested for driving under the influence with a child in the car and admitted to daily use of the drug; follow up tests showed he wasn’t able to stop using, even when he knew he could lose custody. In several other cases, infants had tested positive for methamphetamine at birth.
“[Meth’s] availability combined with the [low] price and the high associated with its use make methamphetamine a particularly hard drug to fight,” Lind says.
According to the Department of Human Services, in 2018 approximately 6,700 children and young adults were placed into foster care in Minnesota. Abuse of opioids and methamphetamine accounted for 32 percent of those cases—the leading cause for placements. In 2013, drug abuse accounted for only 17 percent.
Methamphetamine first emerged as a serious issue in Minnesota in the late ‘90s and early 2000s. The drug, which can be snorted, smoked, or injected intravenously, was mostly homemade, cooked or microwaved in motels, sheds, and even trenches dug into remote areas in national forests. At that time, these “labs” gained public attention because the chemicals used to make the drug were so toxic and flammable that they sometimes exploded, killing people and spewing toxic waste into the environment.
By 2005, Congress passed legislation to put cold medications containing pseudoephedrine—a key component in meth—behind pharmacy counters. The number of meth labs in Minnesota dropped precipitously from 410 in 2003 to just 13 in 2016. Methamphetamine use plunged.
That is until Mexican drug cartels started manufacturing the drug and smuggling it into the United States over the southern border. Authorities say the drug is often smuggled in vehicles, with most of it traveling up through the state on Highway 35.
This next-generation meth is cheaper and purer and can pack severe side effects, including psychosis, strokes, heart attacks, and dangerously high blood pressure, according to Tyler Winkelman (M.D. ’11), a clinician-investigator at Hennepin Healthcare in Minneapolis and an assistant professor of medicine at the University. Winkelman and other chemical use experts say they are also seeing an increase in people who combine meth with other drugs.
Rural Research Group Suggests a Path Forward
In June 2018, the Center for Rural Policy and Development, a nonpartisan, not-forprofit research organization based in Mankato, raised the alarm about growing addiction issues across Greater Minnesota. In particular, the group—which provides information to urban-based policymakers about rural issues—noted that methamphetamine abuse was a serious and often overlooked problem.
Marnie Werner (B.A. ’90, M.A. ’03), vice president of research and operations at the center, authored a white paper titled It’s an Addiction Crisis, describing the group’s research into the multifaceted problem. The report noted that while state and community leaders were aware of the opioid issue, “often only those directly involved at ground level were aware of the extent of meth use in Greater Minnesota.”
Werner says her center’s “core purpose is to provide policy information on economic and social issues from a rural perspective. Our goal is to get this out so that legislators, local governments, and the general public have better information that’s based on data.”
The report, while grim, offered a number of suggestions as to what policymakers and others can do to turn the tide of addiction, both for methamphetamine and other substances. It called for more actionable research into addiction, particularly to help hard-hit and underserved American Indian communities in rural areas. It asked lawmakers to “look to innovative programs in our colleges and universities that streamline the licensing process” for Licensed Alcohol and Drug Counselors (LADCs). It suggested finding ways to help existing county-based or local healthcare staff with some experience in treatment programs attain advanced credentials to enable them to better serve their nearby areas. It also recommended treatment programs be evaluated for “best practices” that can be replicated statewide, and that more diversionary programs be put into place to keep people who “need treatment more than jail, out of jail.”
“There’s this belief on the street that if you’re in withdrawal, you can use methamphetamine to sort of get through it,” says Winkelman. “I’ve heard some patients tell me, ‘Oh, I use meth when I use heroin because it protects me from overdose because it’s a stimulant.’ And that is definitely not true.”
Used by itself or with heroin, prescription opioids, or other drugs, methamphetamine addiction is a source of particular concern in more rural parts of the state both because of its prevalence and because these areas have fewer options for effective treatment. Methamphetamine addiction deeply strains hospitals, judicial and prison systems, and treatment facilities—and in smaller communities, the cost of dealing with the issue can be crushing.
According to the Centers for Disease Control and Prevention, deaths from psychostimulants—predominately methamphetamine—are higher in rural areas and small-to -medium-sized towns than in larger cities, where more deaths are caused by synthetic opioids, heroin, and cocaine.
In fact, overdose deaths stemming from methamphetamine tend to be highest in states west of the Mississippi, which have larger rural populations, according to Colin Planalp, a senior research fellow at the State Health Access Data Assistance Center at the University of Minnesota’s School of Public Health.
The situation throughout Minnesota has not gone unnoticed. This past September, the U.S. Drug Enforcement Administration announced it was opening an office in Duluth as part of an effort to expand drug busts and prosecute drug traffickers—including attacking the growth of methamphetamine use.
“The effects of methamphetamines aren’t limited to the users—it impacts the quality of life in a community,” says W. Anders Folk (B.A. ‘98, J.D. ‘01). Folk is First Assistant U.S. Attorney at the U.S. Department of Justice, and he notes that methamphetamine trafficking charges in Minnesota have surged 103 percent just this year.
“That the DEA is expanding its footprint into Duluth directly reflects the scope of the problem in terms of Greater Minnesota,” Folk says. He also adds that for the DOJ, “Our focus isn’t just enforcement, but doing what we can with prevention and treatment.”
Another law enforcement observer, Anoka County Sheriff James Stuart, whose region includes the semi-rural areas of Linwood Township, Nowthen, and East Bethel, agrees. “I think everyone needs to understand that this isn’t a medical problem or a law enforcement problem,” he says. “This truly is a community problem and a national problem.” Stuart, who studied public safety leadership at the U of M, adds that “Every day we’re seeing lives getting destroyed and families destroyed. As more and more people get addicted...it’s this hopelessness that really creates a scary future for our nation.”
A Troubling Drug to Treat
Like people who abuse alcohol, methamphetamine users aren’t easy to categorize. Students use it to focus when they’re studying. Moms take it to give them a boost to clean their homes after an exhausting day at work.
“Some people are using it to suppress weight,” says Dave Lee (B.S. ‘81), the director of Public Health and Human Services for Carlton County in northern Minnesota. “Some folks are self-medicating for all sorts of stressors or for a lack of good mental health services. People will sometimes turn to meth like they turn to alcohol or other drugs, to alleviate pain or anxiety. And recreational use will always be there. As long as there is the demand, which I don’t see going away, the supply’s going to be there. It’s just a matter of who, where, and why it’s going to get here.”
That’s concerning because unlike opioids, methamphetamine abuse doesn’t respond to medication-assisted treatment (MAT), where users can be “weaned” off their drug of choice with medicines such as methadone for heroin, for example.
A treatment option from California called the Matrix Model, which is an intensive outpatient program that takes a minimum of 16 weeks, has been shown to be effective in treating stimulant addiction for drugs such as methamphetamine or cocaine. But the program itself is so expensive that neither private insurers nor public agencies in Minnesota will pay for it.
In the midst of ordinary funding challenges, more rural areas of Minnesota also have to contend with the fact that their lower tax base translates to more roadblocks to getting people the help they need. This drug crisis is also impacted by a nationwide health care worker shortage caused, in part, by baby boomer retirements. That means there are fewer case workers, social workers, and addiction counselors available to provide help.
“We have all of the problems and all of the challenges that you would see in downtown Minneapolis,” says Jeffrey Lind, the social services division director for Beltrami County Health and Human Services. “We have all the drugs. We have the gangs ... And yet, we don’t have the tax base, and we don’t have the money to support it. All we have is each other.”
Facing the Challenge Head-on
By 2001, Bemidji-based substance abuse specialist Lance Egley had become staff development coordinator at Red Lake Nation Chemical Health Programs. The organization is a treatment program based in Anishinaabe culture designed to help Red Lake Tribal Band members. Beltrami County is home to portions of both the Leech Lake and Red Lake Indian reservations.
As Egley worked on addiction issues within his region, he wanted to find ways to overcome the bureaucratic roadblocks involved in trying to get individuals approved for paid treatment services. In response, he formed a group called Northern Access to bring a wide group of concerned individuals together to try and find better solutions to the challenges surrounding them.
Northern Access, which still meets every two months even though Egley himself just retired, brings together chemical health clinicians, mental health practitioners, hospital and clinic administrators, probation officers, and representatives from county social services and chemical health professionals from the Leech Lake Band of Ojibwe, White Earth Nation, and Red Lake Nation.
As a group, attendees share what they know in the hope of providing more comprehensive and effective chemical and mental health treatment and prevention services for the region.
In September, Northern Access gathered for its bimonthly meeting in a paneled conference room at the Sanford Health Behavioral Health Center in Bemidji. The 16 people who attended talked about everything from the nuts-and-bolts of using data to assess the effectiveness of their work to how to best inform the community about chemical abuse resources that are available to them. They also shared tips on how to fulfill new state-mandated paperwork requirements.
And sadly, they also described the pain of watching clients crash and burn while waiting for placements in treatment centers with long waitlists.
Egley and the members of Northern Access agree that the challenges of meth in their region have been overshadowed by the opioid epidemic. In addition to reviewing the role meth plays in foster care placements (see sidebar on page 30), the group also discussed the noticeable uptick in patients and clients who are addicted to the drug, including pregnant women.
“While heroin and prescription opioids caused an explosion in out-of-home [foster care] requests, the methamphetaminerelated cases turned out to be more problematic,” says Egley. “Most people who have their kids taken away stop using, go to treatment, and then get their kids back. But the methamphetamine people didn’t stop using and go to treatment.”
Egley agrees that treating methamphetamine addiction is often more complicated than opioids. “There is a waiting period [during treatment] where people’s brains just clear, which in most drugs is a few days,” he explains. “But with methamphetamine it can be a few weeks. So, who’s taking care of this person for two or three weeks while their brain clears?”
Across the state, groups are coming together to share strategies, including programs in jails that assess offenders for drug issues and set them up with treatment options and initiatives to support pregnant mothers in getting off drugs, including meth. But the key, observers say, is raising public awareness that a drug many assumed to be on the wane is back with a vengeance.
Elizabeth Foy Larsen is Minnesota Alumni’s senior editor and the author of 111 Places in the Twin Cities That You Must Not Miss.