“We are seeing more meth now than we have ever seen,” a local DEA agent says. Honeypower

Meth killed more people than heroin in King County last year. That might surprise you—we talk a lot more about the opioid crisis than meth abuse—but if you start looking around, it's not hard to see that Seattle has a meth problem.

You can see signs of it in the paranoid person twitching and pacing outside a bus stop. Meth shows up in criminal incidents—like the August attack outside Ballard's post office involving a pitchfork, or the unprovoked stabbing on the light rail in September. Surveys show meth use is concentrated in the homeless population. If it feels like there's a growing number of unstable people in Seattle using this extremely powerful stimulant, that's because there is.

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Meth use is increasing at a rapid pace by nearly every metric you can measure. And unlike alcoholism and opiate addiction, there's no medically accepted drug to combat meth abuse or to help addicts who try to stop using to cope with their withdrawal symptoms. That leaves doctors and public health officials few ways to fight the growing epidemic.

Seattle might be able to change that with a little help from Ritalin.

A proposed pilot research project is asking the city to pay for clinics to connect meth users with supportive services like housing and counseling while also giving them prescriptions for the pharmaceutical ADHD drug methylphenidate, commonly known as Ritalin. The program's proponents hope the drug can function like methadone, which has been shown to ease opiate addicts away from using heroin.

This proposed program would put Seattle in uncharted territory: No other program currently exists in the country that gives meth addicts Ritalin. But it would be an experiment worth taking, according to Lisa Daugaard, the executive director of Seattle's Public Defender Association (PDA), who last month won a MacArthur Foundation fellowship (or "genius grant") for her work on criminal justice reform.

"The current set of options available to engage with and support meth users is inadequate," Daugaard said. "And I think there's widespread agreement that this isn't going to work. We cannot just shrug our shoulders at a condition that is more highly correlated with problematic behavior than many other behavioral health conditions. Complacency is not viable."

The PDA asked Mayor Jenny Durkan to fund the pilot research project in this year's budget, but Durkan has so far declined. City council member Mike O'Brien is now pushing for the program as budget deliberations continue. If he gets his way, Seattle could still be a testing ground for this innovative therapy.


Meth Is Back and Bigger Than Before


Meth use is nothing new in the Seattle area. It surged in the 1990s, and by 2003, Rolling Stone was calling Granite Falls, Washington, a sleepy former logging town at the foot of the Cascade Mountains, "methville." That cover story warned that meth "is everywhere in the Pacific Northwest, and coming soon to a town near you."

The meth crisis back then was fueled by meth labs, where people would stockpile hundreds of pounds of cold medications like Sudafed (which contain a drug called pseudoephedrine) and turn those over-the-counter drugs into meth. This powerful stimulant is often called "crystal meth" because of its crystalline appearance, but it can also be made into pills.

Meth can be smoked, eaten, snorted, or injected. It creates feelings of energy and euphoria by increasing the release of pleasure- and alert-causing chemicals in the brain. Its high can last 8 to 12 hours and is usually followed by a period of exhaustion, depression, and paranoia.

Faced with this crisis, Congress passed the Combat Methamphetamine Epidemic Act in 2005, which stopped over-the-counter sales of medications that can be made into meth. Washington went further and mandated that pharmacies track who was buying these medications. The number of meth labs in the state dropped significantly.

But even though the meth labs are largely gone, the drug is now back more than ever before. That's driven in large part by Mexican criminal syndicates that smuggle meth supplies across the southern border and up Interstate 5 to Seattle, according to Keith Weis, a federal special agent in charge of Seattle's branch of the Drug Enforcement Administration (DEA). Weis said the DEA has more than doubled its seizures of meth shipments in the last year alone.

"We are seeing more meth now than we have ever seen," Weis said. "The shipments are increasingly larger and larger, everything from single pound shipments up to as much as 100 pounds per shipment."

Weis said that meth's "readily available supply" is dropping the price of the drug. Meanwhile, government data shows a strong increase in meth-related deaths. Meth-involved deaths in King County have increased from 4.2 deaths per 100,000 people in 2009 to 10.1 in 2018, according Public Health – Seattle & King County. And for the first time in two decades, meth was involved in more overdose deaths in 2018 than any other single drug. Heart attacks and strokes are common, and many users combine meth with other drugs, such as heroin, which can be a fatal mix.

Meth use, at least among users who use the state's syringe exchange program, appears to be heavily concentrated in the homeless or nearly homeless populations. A 2017 survey of meth users at the syringe exchanges statewide found that 32 percent of people said they were homeless, while another 40 percent were living in temporary housing, according to the UW's Alcohol and Drug Abuse Institute (ADAI).

Meth addiction is also concentrated among gay men, with meth injection being "consistently higher" among men who have sex with men compared to men who did not have sex with men, according to needle exchange surveys in King County.

The resurgence of meth is troubling to public health officials. Aside from death, there's a range of short- and long-term health impacts. Meth causes an elevated heart rate, teeth grinding, anxiety, damage to the nervous system, lesions and sores, insomnia, and hallucinations, and it is associated with tooth decay caused by "inadequate oral hygiene and preference for sugary foods and beverage," according to a 2018 report from ADAI.

Meth use also leads to a wide range of unhealthy associated behaviors, including riskier sexual activity and the danger of transmitting infectious diseases from sharing needles. And then there's the collateral danger of meth users buying possibly tainted meth on the black market or committing property crimes to get money to buy it. Those dangers could be entirely erased if a doctor just gave users a substitute stimulant.


Safer Stimulants


Prescription ADHD medications like Adderall and Ritalin are widely popular in the United States—an estimated 16 million Americans currently have prescriptions for these stimulants—but they aren't very well regarded by the general public. A recent editorial published by the Guardian was titled "ADHD drugs are as dangerous as street meth—and Americans are getting hooked."

But here's the thing about Ritalin: There's no way it's as dangerous as meth.

In addition to Ritalin being regulated for purity, which meth is not, there's a good amount of evidence that it does not cause long-term harm to your body. That's not true for meth. The high of meth is also significantly stronger, and the comedown is far sharper, which makes the drug harder on your nervous system and more difficult for users to manage, according to Dr. Paul Grekin, the medical director of Seattle's Evergreen Treatment Services.

That's why Grekin is part of a coalition that wants the city to embark on the pilot research project exploring whether prescribing Ritalin to meth users could reduce the harm associated with their drug use.

Grekin, along with Daugaard, the PDA, and Council Member Mike O'Brien, are asking the city to create a Ritalin clinic where meth users can get help, similar to how methadone clinics provide heroin users with a medically assisted way out of addiction. The city would set up an outpatient clinic somewhere in Seattle where meth users would go through a medical screening. If they qualified, a doctor would prescribe them extended-release Ritalin.

Daugaard said it was "fundamental" that this pilot research project include wraparound services for meth users, including help with housing. "Meth use is often driven by vulnerability and sense of threat. So security issues are very important in trying to get a handle on this," Daugaard said.

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Jesse Rawlins, a project manager with the PDA and a former staffer for O'Brien, said in an e-mail that running the pilot research program would cost the city between $250,000 and $500,000. "The higher end of the proposal would be sufficient for a five-year study with more ability to provide evidence regarding the efficacy of the program," Rawlins said.

The program's proponents repeatedly stressed that they still need to determine key details after funding is granted, including who exactly would qualify to participate and how supportive services like housing would be provided.

Proponents had hoped Durkan would fund the program in her 2019 budget, but the mayor declined to do so. Durkan said in an e-mailed statement to The Stranger that she "shares the concerns of the community that there is much more that needs to be done to address people who are using methamphetamine," but she declined to offer an opinion about the proposed program.

O'Brien is calling on the council to add funding for this project to the city's 2020 budget, which is currently being deliberated. But he said the complexities of the program might make it hard to fund during the hectic budget deliberations.

"A pilot program for treatment for folks using methamphetamines is probably a more complex question with the council," O'Brien said. "It wouldn't surprise me if the council needs more education to see if that's something they will prioritize."

Because no other program like it currently exists in the country, the council would be going into uncharted territory if it funded it. But there's some medical evidence to support the idea. A 20-week randomized study prescribing three drugs to meth addicts—Ritalin, an antipsychotic called aripiprazole, and a placebo—showed that Ritalin had "promising results" for reducing the meth dependence among people injecting the drug. A separate pilot study found that a different ADHD drug, called dextroamphetamine, showed increased treatment engagement in patients with meth dependence.

Dr. Judith Tsui, a physician at Harborview Medical Center and an associate professor at University of Washington, said the research shows evidence that meth users find prescription stimulants "useful in reducing or eliminating methamphetamine use. Furthermore, this is perhaps the most common strategy methamphetamine users themselves identify to reduce or eliminate their reliance on illicit drugs."

Grekin, who oversees a methadone clinic at Evergreen Treatment Services, said the proposed program would be trying to reduce the amount and risk of meth use, not force participants into totally quitting.

"I wouldn't measure success by abstinence, because it's not a realistic measure," Grekin said. "Just like if you are treating diabetes, you don't measure the success by the patient never having abnormal blood sugar, you are just trying to keep it normal and limit complications. Success [in this proposed research program] is reducing the quantity of use, reducing the ancillary uses like using needles, and reducing those kinds of high-risk behaviors."


Follow the Genius


This isn't the first time Lisa Daugaard has asked Seattle's officials to head into new territory. In 2011, she was part of a collaborative team of law enforcement and police-reform advocates who convinced the city to start a new program called Law Enforcement Assisted Diversion, or LEAD, that gave cops the discretion to refer people who commit low-level crimes to case management instead of jail.

Those services are often already offered to people who find their way into the criminal justice system, but LEAD did something revolutionary: It diverted those folks away from the system before they were ever booked in jail. The idea that police can catch someone committing a crime—like low-level drug dealing or prostitution—and they can give supportive services to that person without booking them is a transformational change in criminal justice.

And that program is clearly working. A UW study found that LEAD participants had 60 percent lower odds of arrest during the six months following their initial arrest and 39 percent lower odds of being charged with a felony over the following two years than people who weren't the program.

The program has since spread to jurisdictions across the country. New York Times columnist Nicholas Kristof featured LEAD in an August article this year that proclaimed: "Seattle Has Figured Out How to End the War on Drugs."

Last month, Daugaard's work on LEAD won her the prestigious MacArthur fellowship, an award that comes with $625,000, no strings attached. Daugaard said she wants to use it to write more about LEAD and criminal justice, and see if she can spread the program's ideas into more jurisdictions. She's also fighting for more LEAD funding in Seattle, where she says the program is underfunded and case workers are stretched too thin.

Daugaard said one of the more transformational aspects of LEAD is that rather than just calling for an end to over-criminalization, it's actually building something in the criminal justice system's place.

"So much energy has been poured into the critique of mass incarceration. And that's all right, but comparatively little energy has been put into building something that can take the place of that enormous dinosaur that is over-incarceration," Daugaard said.

Daugaard said LEAD was created only because there was a diverse group of interests supporting it, from cops to police reformers to business groups. She said that kind of diverse support is already forming around the idea of creating a medically assisted way to treat meth abuse. Social workers and drug users want a way to get people out of the miserable conditions of meth abuse, and neighborhood and business groups are pressuring the city to do something about the growing problem of meth-related property crime.

"When you put those two sets of interests together and they are united, we can often make a lot of progress," Daugaard said.

And Ritalin might help us get there.