Methamphetamine, an illegal drug that sends the body into overdrive, is surging through the United States. Federal drug data provided exclusively to NPR show seizures of meth by authorities have spiked, rising 142% between 2017 and 2018.

“Seizures indicate increasing trafficking in these drugs,” says John Eadie, public health coordinator for the federal government’s National Emerging Threats Initiative, part of the High Intensity Drug Trafficking Areas program. “So if seizures have more than doubled, it probably means more than double trafficking in methamphetamines. And with that go additional deaths.”

Overdose deaths involving meth and other psychostimulants did rise last year — by 21% (to 12,987 from 10,749 in 2017) — according to provisional data from the Centers for Disease Control and Prevention. Deaths from cocaine and fentanyl were up too. But overdose deaths dropped overall because of a decline in the number of fatalities tied to pain pills.

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For decades, meth has been associated with working-class Americans trying to hold down two or more jobs and has been popular in some gay communities, but it hasn’t been widely available in every region of the country. Now that’s changing too. Seizures of meth are up, sometimes dramatically, in pockets of nearly every state in the U.S., based on data collected in 32 High Intensity Drug Trafficking Areas.

“It was all about the meth”

There are many paths to meth use. Some drug users say they take it to pick themselves up after taking downers: heroin or fentanyl. Those on the streets say they take it to stay awake at night and avoid rape or robbery. Meth offers a relatively cheap high that can last days. That means fewer injections and less worry about finding money for the next hit. And some drug users pick up meth because they are terrified of fentanyl, the opioid that can shut down breathing in seconds.

“I knew if I went back to using fentanyl, I would likely overdose and die,” says Mike Leslie, 37, who has overdosed on fentanyl twice.

Leslie found his way to meth after more than 20 years of drug use that started with marijuana and alcohol, progressed to cocaine and then led to opioids: pain pills, heroin and fentanyl. Leslie had been off fentanyl for about four years last fall when he ran into an old acquaintance on the streets of Boston and that urge to get high took over.

“He was selling meth. It was basically the one thing out there that I hadn’t tried,” Leslie says. “Now it was readily available. So I tried it.”

Leslie says meth wrecked his life so fast that he hardly knew what was happening. He’d kept working while on heroin, but four months after his first hit of meth, he had lost his job as a recovery outreach worker, had dropped out of graduate school and was sleeping on the floor of a train station.

“As soon as I tried it, I was no longer functioning,” Leslie says. “It was all about the meth.”

Leslie had tried a weaker drug in the same class as meth a few years ago — Adderall, the medication for attention deficit hyperactivity disorder. He persuaded a doctor that he needed the pills to concentrate but says he just used them for a mild high and rush of energy while he was recovering from heroin and fentanyl. But Leslie’s deception might be a window into an even bigger problem when it comes to stimulants.

An emerging stimulant epidemic?

Eadie, who tracks the country’s prescription drug monitoring programs, says the data from the High Intensity Drug Trafficking Areas show an increase in prescribed stimulants like ADHD meds. They show that seizures of cocaine are rising too, though not as fast as meth. Combine the legal and illegal stimulants, with meth leading the way, and Eadie says it looks like there’s an emerging stimulant epidemic, entwined with the opioid crisis.

“We’re seeing almost as many people starting up methamphetamines and cocaine and prescription stimulants as are abusing the opioids,” Eadie says. “So the problem is getting worse at the moment, and it’s getting more complicated to deal with.”

Half of the people who died after a meth overdose in 2017 also had an opioid in their system, according to an analysis that the Centers for Disease Control and Prevention released in May. That same report showed 73% of cocaine deaths included opioids. The CDC is stepping up prevention and surveillance efforts to get a better understanding of what’s happening with stimulants. In September, it expects to begin collecting more local information about meth, cocaine and other stimulants, as it does now with opioids.

“We know that the relationship between stimulants and cocaine is a growing problem, and it requires an increase in public health and data collection efforts so that we can implement effective and comprehensive drug overdose prevention,” says Mbabazi Kariisa, a health scientist at the National Center for Injury Prevention and Control at the CDC.

Meth means new problems and dangers for first responders

The complications are not news to Bradley Osgood, the chief of police in Concord, N.H., which has one of the highest opioid overdose death rates in the United States.

“Methamphetamine just presents a whole new issue for us,” says Osgood, “and our officers are getting hurt. We’ve had concussions. We’ve had broken hands.”

He says officers may need to run through traffic after someone who is high and leaping between cars. Sometimes most of the nine Concord officers on duty at any one time are needed to restrain one person thrashing about on meth. Concord police get crisis intervention training and know how to calm residents who have uncontrolled mental health issues, but Osgood says those same techniques don’t seem to work with people high on meth.

Osgood says calls to reverse an opioid overdose have started to drop in Concord because more people have the opioid-reversal drug naloxone, brand name Narcan, and use it themselves. But meth is more than filling that gap.

“It’s surpassed what we’re seeing from heroin and fentanyl,” Osgood says. “The rise in meth has just been unbelievable.”

There is no drug like naloxone that police officers or family members can use to reverse an overdose from meth or other stimulant — a racing heart, dangerously high blood pressure and extreme sweats. Deaths involve a heart attack or stroke.

Dr. Melisa Lai-Becker, who runs the emergency department at CHA Everett Hospital outside Boston, says she and her staff often get hurt, as Osgood’s officers do, before they can inject a sedative, typically a benzodiazepine, to calm someone down. Figuring out how much of which benzo to give is an art, Lai-Becker says, because she doesn’t know how much of what kind of stimulant the person took.

“You’re looking at the speedometer, and you’re trying to get them down from going 148 miles per hour down to 60 miles per hour,” she says. “You want to get them to right around the speed limit, but you don’t want to bring them all the way to a full stop.”

In that case, doctors have to restart breathing and maybe the patient’s heart. For the past 10 years, Lai-Becker says, she hardly saw any stimulant overdoses. These days, there are about four a week.

Meth’s path into the U.S.

If a person is on meth, the U.S. Drug Enforcement Administration says it more than likely came into the U.S. from Mexico. Jon DeLena, associate special agent in charge for the New England Field Division, recently toured a crystal meth lab in a Mexican jungle that the Mexican military said was producing 7 tons every three days.

“It was enormous. It was incredible,” DeLena says. “Those are the drugs that are coming into the United States and ultimately up into our region.”

DeLena says the Mexican cartels put almost all U.S. domestic meth producers out of business several years ago with a cheaper, more potent version of the drug that travels into the U.S. through the same channels as fentanyl and cocaine. He says cartel leaders realized that drug users would want an alternative to fentanyl.

“They study the trends just like people here study the stock market,” DeLena says. “They know what the next trend is going to be, and sometimes they force that trend upon people. And that’s exactly what they’re doing in this case.”

Some doctors, researchers and recovery program leaders worry that growing attention to meth might slow the expansion of medication-assisted treatment and other efforts to reduce opioid overdose deaths.

“That’s the real focus nationally,” says Traci Green, deputy director of the Injury Prevention Center at Boston Medical Center. But “we need to start paying a lot more attention to stimulants, quickly.”

Mike Leslie says he worries that other drug users aren’t taking meth seriously because they don’t think that it, like fentanyl, will kill them.

“Meth is extremely dangerous, but the chance of overdose is not as great as it is with opiates, so people, from my experience, have less of a desire to get clean from the meth,” he says.

Leslie says he’s no longer using any drugs. And with the help of 12-step meetings, he’s reconnecting with his family.

“I’ve put my family and my parents especially through hell and back,” he says. Now, “the way my parents put it, for me to give them their son back is the best thing I could do.”

But the rising drug-seizure numbers suggest there’s more hell ahead for communities across the country facing a new or renewed wave of meth.

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Altovise Ewing was a senior at Rhodes College in Memphis, Tenn., when she first learned what a genetic counselor was. Although she had a strong interest in research, she suspected working in a lab wasn’t for her — not enough social interaction.

Then, when a genetic counselor came to her class as a guest lecturer, Ewing had what she recalls as a “lightbulb moment.” Genetic counseling, she realized, would allow her to be immersed in the science but also interact with patients. And maybe, she thought, she’d be able to help address racial health disparities, too.

That was 15 years ago. Ewing, who went on to earn a doctorate in Genetics and Human Genetics/Genetic Counseling from Howard University, now works as a genetic counselor for 23andMe, one of the largest direct-to-consumer genetic testing companies. As a black woman, Ewing is also a rarity in her profession.

Genetic counselors work with patients to decide when genetic testing is appropriate, interpret any test results and counsel patients on the ways hereditary diseases might impact them or their families. According to data from the U.S. Department of Labor’s Bureau of Labor Statistics, the number of genetic counselors is expected to grow by 29% between 2016 and 2026, compared with 7% average growth rate for all occupations.

However, despite the field’s rapid growth, the number of African Americans, Hispanics and Native Americans working as genetic counselors has remained low.

As genetics’ role in medicine expands, diversity among providers is crucial, say people working in the field. “It is well documented that people want medical services from people who look like them, and genetic counseling is not an exception,” says Barbara Harrison, an assistant professor and genetic counselor at Howard University.

Ana Sarmiento, who wrote her master’s thesis on the importance of diversity among genetic counselors, has seen this firsthand.

“I can’t tell you how many times I’ve seen the look of relief on a Spanish-speaking patient’s face when they realize they can communicate with me,” says Sarmiento, a recent graduate of Brandeis University’s genetic counseling program. “It’s what keeps me passionate about being a genetic counselor.”

Ethnic and gender diversity among providers can also increase the depth and scope of information patients are willing to share in the clinical settings — information that’s important to their health.

“In my opinion,” says Erica Price, who just received her master’s in genetic counseling from Arcadia University, “no one fights for the black community the way other black people do. I encounter a lot of other African Americans who don’t know what genetic counseling is. But when they find out that I’m a genetic counselor, they will give me their entire family medical history.”

Bryana Rivers, who is African American, recently graduated from the University of Cincinnati’s genetic counseling program, and wrote last year about her experience with a black mother whose two children had undergone extensive genetic testing to try to determine the cause of their developmental delays.

Having a firm diagnosis, the mother explained to Rivers, could help the children get access to the resources they needed in school. The mom wanted to know if the genetic variant that had been identified in her children — one that geneticists had decided was a “variant of unknown significance” — had been observed in other black families.

That question, which she hadn’t brought up in earlier discussions with health providers who weren’t African American, led to a broader, candid discussion of what these unknown variants mean and don’t mean, and why they are more common among members of understudied minorities.

“I cannot stress enough how important it is for patients to feel comfortable, to feel heard, and to know that they will not be ignored or discriminated against by their providers based on the color of their skin,” Rivers wrote in her blog post.

“I don’t want to suggest that a genetic counselor who wasn’t black wouldn’t have listened to her, but there are factors outside of what we do and say that can have an impact on our patients. Just the fact that she was able to lower her guard a bit because we share the same racial background as her speaks volumes.”

In an interview Rivers also recounted a recent session conducted by a white female genetic counselor that Rivers was shadowing that day. The patient, who was a black woman, addressed all of her answers to Rivers, although Rivers’ official role was to merely observe the appointment.

“I do feel a responsibility as a black provider to look out for my black patients and make sure they are receiving the appropriate care,” Rivers says. “Not everyone is willing to go that extra mile, and they may be more dismissive of the concerns of black patients and may not actually hear them.”

Ewing, who also conducts research, adds that the lack of diversity among genetic counselors has had a negative impact on research.

“The lack of diversity has an effect on the willingness of minorities to pursue clinical trials, because they’re not able to connect with the counselor or the scientist involved in the research initiative,” she explains. “We are now in the era of precision and personalized medicine and we need people who are comfortable talking about genetic and genomic information with people from all walks of life, so that we’re reaching all demographics.”

Since 1992, the National Society of Genetic Counselors, the largest professional organization for genetic counselors in the United States, has conducted an annual survey on the demographics of its members. Between 1992 and 2006, non-Hispanic white genetic counselors made up 91 to 94.2% of the NSGC’s membership.

In 2019, 90% of survey respondents identified as Caucasian, while only 1% of respondents identified as Black or African-American. Just over 2% of respondents identified as Hispanic, 0.4% identified as American Indian or Alaskan Native.

Some genetic counselors cite a lack of awareness among underrepresented minorities of genetic counseling as a profession as a major barrier to diversity in the field. Rivers says she had little exposure to genetic counseling as a future career path while enrolled as a biology major at the University of Maryland.

“My university stressed medical school, nursing school, or a Ph.D. in the biological sciences,” Rivers recalls. “I only had one professor in four years bring up genetic counseling.”

Samiento concurs. “You don’t have 6-year-olds running around saying ‘I want to be a genetic counselor’ — because it’s not a high visibility profession,” she says. “There are also very few minority professionals in the training programs and it takes a brave minority to look at the sea of white female faces and say ‘yes I can fit in here.’ “

“Genetic counseling is still a relatively new profession and there hasn’t been enough time and exposure for people to view [the field] the way they view other medical professions,” says Price. “People have asked me why I would pursue genetic counseling when I could be a physician assistant or a nurse or go to medical school.”

After Price’s acceptance to graduate school, one of her undergraduate professors questioned her chosen career path. “She said to me, ‘You’re a black woman in the sciences. We could have gotten you into a Ph.D. program or something where you’re making more money.’ “

As a part of its strategic plan for the years 2019-2021, the NSGC has identified diversity and inclusion as one of its four areas of strategic focus. Specific plans include developing mechanisms to highlight genetic counseling as a career in hard-to-reach communities by the end of the year. Erica Ramos, who is the immediate past president of the NSGC and serves as the board liaison to the task force, says she is optimistic that the numbers of underrepresented minorities in the field will improve.

“People in the profession have realized that we have blinders on,” she says. “But as an organization, the NSGC has been asking questions about how we can improve on diversity and be supportive of existing minority genetic counselors. We had 100 people apply to serve on the task force.”

A number of genetic counselors from diverse backgrounds have also come together to form their own support and advocacy networks. In November 2018, the Minority Genetic Professionals Network was formed to provide a forum for genetic counselors from diverse backgrounds to connect with one another.

Erika Stallings is an attorney and freelance writer based in New York City. Her work focuses on health care disparities, with a focus on breast cancer and genetics. Find her on Twitter: @quidditch424.

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