theatlantic | Thus, as P2P meth spread nationwide, an unprecedented event took place in American drug use: Opioid addicts began to shift, en masse, to meth. Meth overdoses have risen rapidly in recent years, but they are much less common than opioid ODs—you don’t typically overdose and die on meth; you decay. By 2019, in the course of my reporting, I was routinely coming into contact with people in Kentucky, Ohio, Indiana, Tennessee, and West Virginia who were using Suboxone to control their opiate cravings from long-standing addiction to pain pills and heroin, while using methamphetamine to get high. Massive supplies of cheap P2P meth had created demand for a stimulant out of a market for a depressant. In the process, traffickers forged a new population of mentally ill Americans.
Over the past year and a half, I’ve talked with meth addicts, counselors, and cops around the country. The people I spoke with told me stories nearly identical to Eric Barrera’s: P2P-meth use was quickly causing steep deterioration in mental health. The symptoms were always similar: violent paranoia, hallucinations, conspiracy theories, isolation, massive memory loss, jumbled speech. Methamphetamine is a neurotoxin—it damages the brain no matter how it is derived. But P2P meth seems to create a higher order of cerebral catastrophe. “I don’t know that I would even call it meth anymore,” Ken Vick, the director of a drug-treatment center in Kansas City, Missouri, told me. Schizophrenia and bipolar disorder are afflictions that begin in the young. Now people in their 30s and 40s with no prior history of mental illness seemed to be going mad.
Portland, Oregon, began seeing the flood of meth around 2013. By January 2020, the city had to close its downtown sobering station. The station had opened in 1985 as a place for alcoholics to sober up for six to eight hours, but it was unequipped to handle people addicted to P2P meth. “The degree of mental-health disturbance; the wave of psychosis; the profound, profound disorganization [is something] I’ve never seen before,” Rachel Solotaroff, the CEO of Central City Concern, the social-service nonprofit that ran the station, told me. Solotaroff was among the first people I spoke with. She sounded overwhelmed. “If they’re not raging and agitated, they can be completely noncommunicative. Treating addiction [relies] on your ability to have a connection with someone. But I’ve never experienced something like this—where there’s no way in to that person.”
On Skid Row in Los Angeles, crack had been the drug of choice for decades. Dislodging it took some time. But by 2014 the new meth was everywhere. When that happened, “it seemed that people were losing their minds faster,” a Los Angeles Police Department beat officer named Deon Joseph told me. Joseph had worked Skid Row for 22 years. “They’d be okay when they were just using crack,” Joseph said. “Then in 2014, with meth, all of a sudden they became mentally ill. They deteriorated into mental illness faster than I ever saw with crack cocaine.”
Susan Partovi has been a physician for homeless people in Los Angeles since 2003. She noticed increasing mental illness—schizophrenia, bipolar disorder—at her clinics around the city starting in about 2012. She was soon astonished by “how many severely mentally ill people were out there,” Partovi told me. “Now almost everyone we see when we do homeless outreach on the streets is on meth. Meth may now be causing long-term psychosis, similar to schizophrenia, that lasts even after they’re not using anymore.”
I called James Mahoney, a neuropsychologist at West Virginia University who had studied the effects of ephedrine meth on the brain in the early 2000s at UCLA. The psychosis he saw then was bad, he said, but it frequently appeared to be the result of extended sleep deprivation. In 2016, Mahoney took a job as a drug researcher and specialist in WVU’s addiction clinic. Less than a year later, the P2P crystal meth from Mexico started showing up. Mahoney was inundated with meth patients who came in ranting, conversing with phantoms. “I can’t even compare it to what I was seeing at UCLA,” he told me. “Now we’re seeing it instantaneously, within hours, in people who just used: psychotic symptoms, hallucinations, delusions.”
In community after community, I heard stories like this. Southwest Virginia hadn’t seen much meth for almost a decade when suddenly, in about 2017, “we started to see people go into the state mental-hospital system who were just grossly psychotic,” Eric Greene, then a drug counselor in the area, told me. “Since then, it’s caused a crisis in our state mental-health hospitals. It’s difficult for the truly mentally ill to get care because the facilities are full of people who are on meth.”
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