Speed Bump

But do these tawdry details apply everywhere? With a large city already in the clutches of cocaine and heroin and plenty of wide-open rural spaces, Maryland would seem to be a perfect spot for the methamphetamine crisis to make a stop on its eastward crawl across the United States. Sparsely populated counties provide cover for putrid-smelling, treacherous meth labs. Baltimore City offers up a strong gay community, plus a concentrated group of urban drug users, many of whom may no longer be getting the high they need from crack or are looking for an upper after shooting up with heroin.

But statistics and experts paint a very different picture than is being seen elsewhere in the country. Fewer than 5 percent of Baltimore drug addicts reported using meth in 2004, according to University of Maryland’s Center for Substance Abuse Research, as opposed to the more than 40 percent who reported using cocaine and the 36 percent who reported using heroin. Last year the Maryland State Police identified only nine meth-lab incidents, including one dump site, where meth production-related chemicals and waste products are tossed. That’s compared with 52 meth-lab incidents in Virginia, 79 in Pennsylvania, 213 in West Virginia, and 331 in Ohio during 2005, according to the federal Drug Enforcement Agency.

Why has meth seemingly skipped Maryland? The answer to that question has law-enforcement officials and drug-rehab counselors stumped, but they’re not idle. While meth hasn’t hit the state in a big way, many who are on the front lines of drug enforcement and addiction agree on one thing: It’s only a matter of time.

"We’re excited that it’s not here yet," says Adam Brickner, president of Baltimore Substance Abuse Systems Inc., a Baltimore-based nonprofit with a contract as the state’s substance-abuse authority. "We don’t want it to be here, but we’re ready if it does get here."

"There’s no question that within the near future that methamphetamine will be our biggest problem," says State Police Trooper First Class Dave Keller, who’s based in Westminster. "I have no crystal ball," he adds. "I hope I’m wrong."

At Baltimore Pride this past June, Dr. Liz Disney withstood scorching temperatures to sit at a booth and distribute information about meth. "Are you ready to stop using crystal and need help? Do you want to talk about using more safely? Or are you just interested in learning more about crystal meth?" read the fliers. Business cards read, "Using? Being Used?" and advertised a club-drug discussion group forming at Chase Brexton Health Services, the city’s gay, lesbian, bisexual, and transgender health center.

But even Disney, a clinical psychologist who sees patients addicted to crystal meth, says that Maryland does not currently have a meth problem.

"Maryland is kind of unique in that we’re not seeing it much," she says in a later interview. "That’s confusing."

It’s confusing because cocaine is such a powerful force in the city. Both cocaine and meth are in the same class of drugs: stimulants. And as with most addictions, when cocaine addicts use for a long enough time, the high becomes weaker. That’s when some of them might go looking for a quicker, stronger high--exactly what meth can offer.

"The hard-core [cocaine] users, their goal is to get the best high they can get," says the Center for Substance Abuse Research’s Erin Artigiani. "They don’t care if it will kill them."

Disney stuck out the heat at Pride because, historically, gay men are at particular risk of meth addiction. Meth has been a part of the club scene on the West Coast and in New York for many years. "This was a drug more than any other that is associated with sexuality," Disney says.

That sexual component complicates the drug’s impact. One of meth’s big draws for users is that it relieves apprehension and self-doubt, making users less sexually inhibited, but that means it also squashes useful anxiety that encourages condom use. This has contributed to a higher incidence of HIV infection. But it doesn’t stop there. Researchers have found that meth can also suppress the immune system, making users more receptive to HIV transmission. In addition, those with HIV may find themselves more susceptible to dementia as a result of using the drug.

But so far it has made little impact on the young gay men that Disney sees at Chase Brexton. "We’re seeing a low level of use," she says. "We’re certainly not overwhelmed." In the last year, Disney has seen 25 clients addicted to crystal meth.

Nonetheless, Chase Brexton has a meth prevention and treatment program, funded by a five-year $290,000 per year federal HIV/AIDS Bureau grant that began in September 2004. Originally, the grant was to focus on club drugs in general, including Ecstasy and ketamine, or Special K. Those drugs are not much of an issue anymore, Disney says, so "the decision was made to redirect funding to methamphetamine."

"We keep being told that [meth is] inevitable and it’s coming, but we don’t have any patients right now," agrees Lillian Donnard, executive director of Glenwood Life Counseling, a methadone clinic in Baltimore.

Each year, Donnard’s center sees as many as 800 heroin addicts, a third of whom use cocaine as well as heroin. "Baltimore does have a longstanding culture of heroin use," she says. "It’s part of our fabric, and to a smaller extent cocaine [is too]." If meth were to become more of a presence in Baltimore, "certainly it would have the crossover to cocaine." She explains that speedballing--when heroin and cocaine are used together--might eventually lure heroin users to replace cocaine or crack with meth.

If all this worry over something that doesn’t appear to be a problem here seems paranoid or excessive, it’s only because drug rehab professionals agree: Meth is one scary drug. A high from one hit of meth can last eight to 24 hours; compare that with a 20- to 30-minute high from cocaine. It can be swallowed in pill form, snorted, injected, smoked, or even inserted into the rectum to be absorbed. The high begins with a rush that then melts into euphoria. "It’s as if you are eating chocolate cake, while flirting, while having an orgasm," Disney says.

But tolerance levels can build up within minutes, leading to "tweaking"--using over and over again in an attempt to avoid the inevitable crash. Since meth completely hypes up the user, addicts may forget to eat, sleep, or drink water.

Meth also screws with the brain in stunning ways. The drug damages the brain cells that make dopamine--a naturally occurring pleasure chemical--which in turn leads to harder and harder crashes. When dopamine production is altered by meth use, it can take 12 to 17 days to recover from a crash. Evidence has shown that with long-term use these systems can be altered permanently.

Like many drugs, some people can try it and walk away, Disney says. Others are hooked automatically. "You don’t know which one you’ll be," she notes. "So it’s like playing Russian roulette."

 

THE FIRST TIME MATTHEW DID METH, he came to five days later, starving, dehydrated, convulsing, and scared out of his mind. He had been at a party in Washington one Sunday in January 2003, where he snorted meth powder into his nostrils. When he came to, the last thing he remembered was getting online after taking a train back to Baltimore the previous Wednesday. It was now Friday. He had lost almost an entire week.

That week eventually stretched into a nearly two-year active addiction to snorting and injecting meth, or crystal as he calls it.

He tells his story in a downtown coffee shop, impeccably dressed in a starched button-down shirt and Dockers. Matthew is not his real name; he says that being identified would put friends and family members through too much pain all over again. Plus he doesn’t want to jeopardize his own recovery. "What if I relapsed?" he asks.

He’s not fooling himself any longer; he knows that recidivism rates for meth addicts are big--from 60 to 90 percent, depending on what researcher you talk to. Only a fraction of the patients Disney has seen have managed to stay with the recovery program, a rate she says is similar to crack cocaine.

Pouring tea from a lime-green teapot, Matthew’s movements are slow and deliberate, a far cry from his days of tweaking on meth.

"It was about continuing on," he says of his meth benders. "When your odometer says you haven’t eaten, you’re hungry, you’re lonely, you’re irritable because you haven’t slept, and you really shouldn’t be around other people right now, you do [meth] and it cleans your odometer. Now it doesn’t undo the fact that you’re starving, dehydrating, and you really shouldn’t be around other people. But you don’t know that anymore. And it just kicks you right up."

Growing up, Matthew was acutely aware of the alcohol addiction in his family. He knew enough to steer clear of booze. But in 2000 when he was 36 years old--out of the closet for 10 years and partying with friends in Baltimore gay bars--he tried Ecstasy for the first time.

"It was amazing," he says. "It was just, Oh my god, this is what everybody was talking about." Matthew thought that since he had no problem with alcohol, drugs would be OK. He went on to other club drugs, like Special K, and did them for three years.

"I felt like I fit in for the first time in my life," he says. "Even as a kid in high school, I was always not fitting into what I had seen everybody else do."

He got the drugs from friends and never asked where they got it. "Nobody wanted to know where you got it," he says. "If you scratched the surface too far, you’d have to admit it was coming from the same place that anyone else got it. You know, the ugliness of drive-by shootings and things like that were actually connected somehow, and you didn’t want to think about it." These were pretty people, doing pretty drugs.

"I was at a [D.C.] party with friends," he says. "And people were using meth--a large part of them. And I said, Oh my god, you can’t do that. And then I said, Oh yeah, you can." And he did. Five days later, he was so terrified of what had happened that he vowed never to try crystal again.

"I cleaned myself up," he says. "It took a good two weeks before I was feeling human again. I didn’t really tell anybody. I couldn’t believe it had happened."

Back then, he and his friends considered meth something that other people did. It was an extreme that they were convinced they wouldn’t get to. Suddenly Matthew was at that extreme, and it scared the hell out of him. But a month later, he was ready to try it again. "I thought, You know, that wasn’t really so bad. In fact, it was kind of fun," he says. "So I went and did it again. I got lost for a week again. This time, I knew where to go, knew where to find it, and what to do."

Where he went was online chat rooms for gay men, like ManHunt.com and AOL chat rooms. He scoured the profiles and messages of the guys in the rooms, looking for two things--Baltimore and "pnp," or party and play, a sure sign that a guy is looking for sex while high on crystal. "Any time I’ve gone out and used, [being online has] been the beginning of the story," he says.

Sex and crystal meth go together like peanut butter and jelly. Combine that with a 24-hour high and you’ve got a recipe for hours-long orgies. It’s no wonder meth has become a part of sex-charged gay chat rooms.

"People recognize that if it feels like an orgasm, how much better would it feel if I was having an orgasm?" Disney says. "Apparently pretty damn good."

Matthew says he snorted crystal on and off during the summer of 2003. But that all changed when he met a regular playing partner online. Over time they fell for each other and tried to build a relationship. Matthew fell harder and harder for the drug, too.

By December--almost a year after he first tried crystal--he was injecting. "In relation to how quickly and how intense it takes you, the coming down from [injecting] is that much more horrific," he says. "Absolutely horrific. Because you don’t ever want to go to that, you just keep doing it. You don’t ever want to hit that emotional, spiritual, physical disaster of coming down."

So, basically, Matthew didn’t come down for a long time: "In a month to a month and a half, I was on my knees begging for my life to end. I couldn’t see straight. I couldn’t think straight. I couldn’t even speak clearly to say, ‘I don’t want these things happening anymore.’ And I don’t know if I didn’t want them to happen anymore."

He lost his job and almost 30 pounds. At one point he hadn’t left his apartment for three weeks except to get drugs. He lost contact with all of his former friends, who were worried sick about him. Finally he’d had enough.

"I called my closest friend in the world, and all I could say was ‘help,’" Matthew says. "And he was at my door in 45 minutes. He lives in D.C. At my door in 45 minutes." They walked over to Chase Brexton together. Matthew started in the intensive outpatient program and stopped using for 37 days.

"I decided I needed to do some more research," he says sarcastically about his relapse. "When they say you go right back to where you left off--absolutely. And that was frightening. I guess I thought I had it kicked. I don’t [now], in any way, shape, or form." He went back into the program and celebrated his first year of sobriety in August with the help of 12-step programs like Narcotics Anonymous and a Crystal Meth Anonymous group he helped start in January 2006 at the Gay, Lesbian, Bisexual, and Transgender Community Center of Baltimore.

"On good days it’s like, My god, I’ve been given this gift of a [12-step] program and even the gift of my addiction coming out and going to the extreme that it did," he says. "And then other days it’s like, I just want to go use. Screw it--I don’t want to think about this stuff. I don’t want to go there. I don’t want to worry about it. I don’t want to think about the consequences. I just want to go use. That blows my mind."

 

IN RURAL PARTS OF THE COUNTRY, the issue is not gay men hooking up with pnp partners online. Rural users are usually young, heterosexual, and white--blue-collar workers and high-school students. Unlike with heroin and cocaine, meth users are as likely to be female as male. And the drugs they do are not smuggled in from foreign countries, but cooked up nearby.

For years, news reports on the impact of meth have focused on surprising areas of the country--North Dakota, Colorado, Arkansas. These rural states host meth-manufacturing labs set up on farms, in rental homes, in trailers, and even out of the trunks of cars. Aside from so-called superlabs--where meth is made for large-scale distribution--most of these labs are created to support the cooks’ personal habit and provide the drug for friends and family members. It takes a lot of work and ingredients to make meth, so for most rural cooks there’s no real money to be made.

Outside of Baltimore, Maryland law enforcement is less worried about meth users and more worried about meth labs. These smelly, noxious spots are less noticeable in sparsely populated areas. They are also incredibly dangerous and not too difficult to set up. The internet offers methamphetamine recipes, and the ingredients can be purchased at drug and hardware stores.

So far the impact of meth labs in Maryland has been relatively minor. For years, the state saw on average two or three meth lab discoveries a year. In 2005, that number tripled to nine, but all indicators point to this year’s total being back to normal. Caroline, Cecil, Harford, Charles, and Anne Arundel counties all reported meth labs or dump sites last year. So far this year, two meth labs have been discovered--a mobile lab in Garrett County along I-68 and an abandoned lab found in a rented townhouse in Montgomery County.

Cooking meth is dirty, dangerous business. The ingredients include caustic drain cleaners, acetone, matchbook strike pads (for the red phosphorous), iodine tincture, and lithium batteries. One in five meth labs will explode thanks to the volatile chemicals involved, Maryland State Police’s Dave Keller says. In some situations, "putting on a light switch can blow up a room," says Eddie Marcinko, special agent and spokesman with the DEA’s Baltimore district office.

Not only are users and innocent bystanders in danger of explosions and chemical burns, but meth and the chemicals involved in producing the drug have also been detected in the systems of children of meth users and police officers who discover a lab, Disney says. They hang in the air and reside in walls and carpets, even after the lab has been abandoned.

Keller has spent much of the last year giving a meth presentation to more than 1,000 landlords, first responders, and plain old concerned citizens around the state. His more than 100 PowerPoint slides detail the basics of meth use--how it is used and what it does to the body, including graphic before-and-after photos--as well as the ABCs of meth labs--how to detect one, where they’re likely to be, and the horrors of meth-lab accidents and cleanup. Keller is motivated by his view that rural Carroll County was completely unprepared for the heroin epidemic that hit the area in the mid-’90s and equates his presentation with a weather report--helping prepare people for the potential storm of meth. "Why do we have to wait for people to die to talk about it?" he wonders. Not that anyone is asking him to shut up.

Keller started giving his meth talks at the request of a Carroll County landlord association, whose members were concerned about the liabilities of finding meth labs on their property. "From there it just skyrocketed," he says, and these days he gives as many as three presentations a month.

When Keller first started touring the state with his presentation, there were no laws protecting landlords from financial responsibility if a meth lab was found on their property. And those liabilities can be extreme.

When a meth lab is discovered, first an entry team secures the scene, wearing self-contained breathing apparatus and chemical gear suits, says Capt. Vernon Conaway of the State Police’s Drug Enforcement Division. These investigators determine if the lab is active or inactive and make sure that further investigation won’t trigger an explosion or lead troopers into a toxic spill. Then they contact the DEA, which sends a cleanup team. It’s estimated that for every one pound of meth that is manufactured, six pounds of toxic waste are created.

But often toxins permeate the building structures, and the DEA doesn’t clean these up. It’s up to the landlords to remediate in full, and that costs a pretty penny.

Last spring, the Maryland General Assembly passed a law, sponsored by Del. Pauline Menes (D-Anne Arundel and Prince George’s counties), putting the responsibilities of these costs onto the cookers, or meth-lab operators. That’s not necessarily going to ease anyone’s mind, Keller says. "Law enforcement finds a lab, the cook--if they’re aware that law enforcement is coming--they’re going to leave," he says. Besides, even if the cook is caught, he or she is not likely to have the kind of cash needed to pay for cleanup. Usually cooks are making meth to support their own habits.

"I don’t think it’s a bad law. Any legislation is going to help," Keller says. But "the best thing that can be done is to restrict the sale and movement of pseudoephedrine."

Pseudoephedrine, one of the less toxic but more vital ingredients in home-cooked meth, is found in common cold and allergy medications found in almost any medicine chest, including Sudafed, Claritin-D, and Actifed. But to make meth, cookers need huge amounts of the over-the-counter meds. As of April 8, federal law restricted the sale of pseudoephedrine: Customers may purchase only 3.6 grams per day or 9 grams every 30 days. As of Sept. 30, all pseudoephedrine products must be placed behind the pharmacy counter, and retailers must maintain a logbook of sales, including the buyers’ signatures. Many large retailers, such as Wal-Mart and Target, moved pseudoephedrine products behind the counter in 2005, and others followed suit.

The federal law protects states such as Maryland, which have not enacted their own restrictions on pseudoephedrine products, says Keller. "For a while, Maryland had a big target on its back," he adds. And meth cooks from other states were aiming for it.

In April, the Maryland State Police received a tip from a sales clerk in Anne Arundel County: Three people had purchased large amounts of cold medications containing pseudoephedrine. When troopers searched the trio’s vehicle during a traffic stop, they found 103 boxes of pseudoephedrine, $4,880 in cash, and a GPS system programmed to help the passengers locate retail stores in the area. The buyers were from Indiana, traveling through Maryland to purchase pseudoephedrine.

Conaway of the State Police’s Drug Enforcement Division says that there’s reason to believe that strict laws on the sale of pseudoephedrine in surrounding states have in the past simply pushed cooks into Maryland to buy the stuff, adding that many of the meth-lab busts over the past few years have pointed to that conclusion. "Our suspects were actually meth cooks from other states that fled to this area," he notes, some working in mobile labs.

State Sen. Lisa Gladden (D-Baltimore City) sponsored a bill that made an attempt to tighten the state laws that focus on meth production. "I represent heroin and cocaine addicts," she says of her job as assistant public defender in Baltimore City. "If we had been vigilant about heroin in the 1920s, we would not have a [heroin] problem in 2006. If we had been vigilant about cocaine in the mid-’80s, we would not have a [cocaine] problem in 2006." She says that drug dealers are bright, so it’s best for the state to stay ahead of the learning curve.

Gladden’s bill (SB 474) would have restricted pseudoephedrine sales but died in committee. It was cut to shreds by the time it was voted on, leaving only the sections pertaining to landlord liabilities. "I wanted a real-time log so you could put a person’s name on a log and see how much they’ve bought," Gladden says. While she contends that her idea was sound, she acknowledges that such a process was "burdensome and impractical for pharmacists."

"I knew we’d keep working on it," she says.

 

RIGHT NOW, GOOD OLD SUPPLY AND DEMAND seems to be doing most of the work in keeping meth out of Maryland. "There’s not a lot of supply in this area," Chase Brexton’s Disney says. And "the price is high compared to other places [around the country] by, like, a factor of two or three."

In Baltimore, meth is selling for about $60 per tablet and up, says Adam Brickner of Baltimore Substance Abuse Systems. Brickner recently relocated here from Denver, where he ran that city’s Office of Drug Strategy. On the West Coast, he says, a buyer can plunk down a $5 bill for the same amount of meth.

Low supply means higher prices; higher prices means low demand, especially in a state where cheap heroin and cocaine rule. "While meth can appeal to lots of different people for lots of different reasons, it needs to be available and cheap to get for people to start trying it," says the Center for Substance Abuse Research’s Erin Artigiani.

Gladden points to "mature drug delivery systems" as a possible reason that meth has not taken hold in Baltimore City. The street trade in heroin and cocaine is working for drug dealers, and "they don’t want to be interrupted" to introduce another drug to their buyers. "There’s uncertainty in meth," she says.

Economics also plays a role in who the customers are, Gladden adds, considering there appears to be little street-level meth dealing in the state. "The person who trolls for drugs on the internet is a different person [than the person] who looks for heroin on the streets of Baltimore," she says.

But Matthew says that he often didn’t pay for his meth--it was available in large quantities at parties in D.C., and his online hookups frequently provided the drug. "It’s not in the clubs," he says emphatically. He says he didn’t know and doesn’t want to know where his partners got it.

But cheap meth may not be a rarity for long. With nationwide crackdowns on the sale of meth ingredients, "the tide has turned again," Artigiani says. "It’s being manufactured over the border" in Mexico.

"The Mexican drug cartel is filling a void," Conaway concurs. Mexican meth is often delivered as "ice"--the crystallized form of meth, which is smokable. "Ice is to meth as crack is to cocaine," Conaway adds. "The supply in Baltimore City is going to grow unless we have effective prevention and effective law enforcement."

If meth is not being made here on a large scale, it is entering the state. The Washington/Baltimore High Intensity Drug Trafficking Area, an office of the National Drug Control Program that identified this region as a high drug-trafficking area, reported 10 parcel interdictions--the discovery of illicit drugs sent through the mail or delivery companies like Federal Express--involving meth in 2005: three in Baltimore City and seven in the counties.

But tracking statistics doesn’t necessarily give an accurate picture of an emerging drug. Matthew, for one, was never arrested and never visited an emergency room. He was invisible, statistically, until he entered treatment. How long does a drug stay underground before use shows up in the numbers?

"That’s a good question," says Dr. Joshua Sharfstein, Baltimore City’s health commissioner. Right now, the city relies on passive surveillance of drug use: If emergency rooms, drug rehab centers, or the police department notice a potential problem, they alert the Health Department, but there are no formal reports to help track drug-use trends in the city. "We have not heard about [meth] from drug rehab centers, police, emergency rooms, or the medical examiner," Sharfstein says. But in December, the city Health Department will implement an Office of Epidemiology and Planning to track the progress of diseases, including drug use and addiction.

"We’re not seeing major warning signs of meth in Baltimore," Sharfstein says. "But we should be looking harder."

Heroin and cocaine have plagued Baltimore and other parts of the state for decades, but Maryland has dodged other drug crises. Artigiani accredits the reduction of Ecstasy use in the state to prevention measures. "It fell back and stayed back," she says.

"It would be great if this were like PCP," Disney says, remembering past warnings that the hallucinogenic was about to storm the state--warnings that proved unwarranted. "It would be lovely if this were true about meth."

In addition to Keller’s meth presentations, the Baltimore office of the DEA is sponsoring its first educational seminar in the state at Johns Hopkins University on Oct. 5. The four-hour training will focus on identifying potential meth labs and is offered to local police, emergency medical services (EMS), firefighters, and other first responders.

"We’re being very proactive," the DEA’s Marcinko says. "We feel it’s basically all around us--West Virginia, Kentucky, Ohio, Virginia. I hope that through education we can prevent the problem from getting large." Still, he acknowledges, "we’re lucky."

Keller is a bit more cynical about the current status of meth production in Maryland. "To be completely honest, I think there are more [labs] out there than we know about," he says. In mid-September, he learned of a meth lab bust in Jefferson County, W.Va., just over the state line from Hagerstown.

"I guess it definitely is underground," Matthew says of use among gay men in the region. "If you look across the country, this hits the gay community strongly--and we do have a strong gay community here in Baltimore."

Still, he continues, "I don’t think people see it as a problem. In my own life, the folks that I used with looked at me, like, Well, we haven’t gone that far."

While law-enforcement officials are convinced that education is the best form of prevention, Brickner says that, in the rehab field, it’s a fine line to walk. "It’s a double-edged sword," he says. "We don’t want to tell people not to use it, if they’re not aware of it."

There are pitfalls in reporting about meth at all, given recent calls of exaggeration by media watchdogs. Last spring,Willamette Week, an alternative weekly newspaper in Portland, Ore., took daily newspaper The Oregonian to task for its extensive--and, Willamette Week argued, misleading--reporting on the state’s meth problem. And alt-weeklyWashington City Paper dissected a Washington Post meth story in March, concluding that the paper "got it all wrong": "There is no big meth problem in the region."

Sources for this story were careful to emphasize that they are not seeing much meth use in Maryland, and there are other concerns to consider as well. "Sometimes when I see meth [coverage] in the popular press, there is a way that it’s excessively demonized--that it’s the worst thing to hit America," Disney says. "There’s also a negative message out there that people can’t recover [from meth addiction]. Recovery from any addiction is not a cakewalk."

Regardless, like others, Disney has her fingers crossed that somehow Maryland will remain relatively untouched, and she’s committed to continuing her prevention efforts. "We’d love to see this just miss us," she says. "California certainly wishes it had laid some groundwork." H