I knew it was time to go to sleep when I started to see the insanity fleas. That's what I called the little black dots that jumped across my arms and burrowed into my flesh, tickling the underside of my skin. They usually started to appear after staying awake for three nights, which I was doing because I was spun out on methamphetamine. I was 16, and taking way too much of it with an addicted boyfriend.
Methamphetamine psychosis is a severe reaction estimated to occur in about 40 percent of users—which far surpasses rates of substance-induced psychosis associated with other commonly misused drugs. It's caused by the overproduction of dopamine in the brain that is induced by methamphetamine, says Larissa Mooney, director of the UCLA Addiction Medicine Clinic. In combination with other factors, like lack of sleep or a genetic predisposition to mental illness, this neurochemical surge can trigger a complete break from reality.
I experienced methamphetamine psychosis numerous times, and each break was different after the insanity fleas showed up. The first time, I hallucinated miniature people, about the size of my thumb, dancing and playing on the furniture in the house where I was getting high. The worst time, I believed that I had written the world into existence, and had to wage an epic war against evil shape-shifting wizards who morphed out of strangers everywhere I went. On other occasions I thought I was an alien, or had the ability to translate secret messages from dog barks, or had foreknowledge of an imminent nuclear attack on Seattle, where I lived. Each time was short—once I got some sleep, the psychosis waned. But those handful of hours were terrifying.
I managed to kick meth for good when I was 17. That was 2005, when the drug was being recognized nationally and internationally as a major problem. After that, the United States began tightening regulations around pseudoephedrine, an ingredient found in cold medicine that was being used to home-manufacture meth across the country. This led to a decline in meth use for several years. And in those years, rates of opioid addiction and opioid-related complications surged. The result? A hyper focus on what is now being termed the "opioid crisis," to the exclusion of other commonly misused drugs. But it appears that meth use is back on the rise, and with it a host of health and social problems that are going to become really hard to ignore if this upward trend continues.
This resurgence may be compounded, in part, by the fact that polydrug use is common among people with substance use disorders in general. "It's common for people to use substances together," Mooney says. "For example, someone might take a stimulant [like methamphetamine] and a central nervous system depressant [such as heroin] to help alleviate the symptoms of the other substance. It's almost like using drugs for the opposite effect—if you're agitated you might take something more sedating to calm the anxiety."
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But the rise in meth use is not just a side-effect of the opioid crisis. Manufacturers have found new ways to create meth and get it into the hands of drug users, including using phenylacetone (P2P) instead of pseudoephedrine to cook bulk batches, kind of like fictional school-teacher-turned-kingpin Walter White on Breaking Bad. Because methamphetamine doesn't share the same prescription distribution as opioids—pharmaceutical methamphetamine (Desoxyn) is only prescribed in cases of severe narcolepsy, ADD, and morbid obesity—its usage rate will likely never rival that of opioids. But SAMSHA found that in 2014 there were 569,000 people over the age of 12 using methamphetamine within the month prior to the survey. That's almost double the low point of meth use, which was 314,000 in 2008, and statistically similar to the "meth crisis" of the early 2000s. It also surpassed heroin use in the same year.
Methamphetamine misuse comes with health complications worse than hallucinations. For example, states and counties across the country are reporting an increase in methamphetamine-related deaths. In 2016, methamphetamine accounted for 7,663 overdose deaths in the United States, a significant jump from 4,900 the year before.
Mooney, who has published a number of studies focused on methamphetamine, says it has the potential to affect "all major organs, but especially the brain." She warns of potential long-term neurotoxicity, seizures, worsening of depression or anxiety, paranoia, violent behavior and, like I experienced, psychosis. It also accounts for more drug-related convictions than any other illegal drug, which means its impact hits hard at both the health and societal levels.
Paranoia or transient psychoses are among the most common serious side-effects of meth use. In fact, paranoia and psychotic behaviors are so strongly linked with meth in our social consciousness they've essentially become a joke. It's true that—as disturbing as the experience was in the moment—I'm not really affected by my meth-induced psychosis anymore. I've certainly told the story of babbling to a stranger about my liaisons with his other body as a dark-comedy bit. But what about those people who have a genetic vulnerability that predisposes them to long-term psychosis? People like my husband, Ricardo.
Last November, my husband took a hit of meth as a study aid. He has a maternal family history of schizoid personality disorders, and a previous history of marijuana-induced psychosis. He's absolutely the last person who should have ever taken methamphetamine, but he did—and he paid the price. Since late November 2017 until early May 2018, he's been in and out of psych wards in both Washington State and Florida, unable to differentiate his perceptions from reality.
"I thought I saw people lingering outside of the apartment and I heard people talking about me," he tells me, describing his version of the events that I witnessed firsthand. I remember him waking me throughout the night for weeks on end, convinced someone was outside the window with a gun aimed at him. I remember him begging me to call the police on the man only he could hear, who he insisted was screaming non-stop homicidal threats. I remember him hiding knives around our apartment, readying for a fight that would never come. I remember him giving up; standing in front of the window for hours, waiting for that bullet to tear through his chest.
My husband chose to take meth, but I know he never expected to spend six months in fear for his life. The next person who experiences that probably won't expect it either. Nor do the more than 7,000 people expect to die from a drug we aren't focusing on enough. We can't stop fighting on the opioid front, but we need to start recognizing that there are other factors when it comes to substance misuse in this country—and methamphetamine could be gearing up to be a major player once again.
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