Jay walked into the emergency room at Swedish on First Hill in April and said he was trying to quit meth. The 45-year-old Seattle resident and returning student had been off the drug only a few days. His esophagus, chest and stomach were a river of pain, and he didn’t know why.

“I just wanted somebody to tell me what was wrong with me. I didn’t know and I was so sick,” said Jay, who asked that his last not be used. “I sat in the emergency room for hours, and I got nothing.”

Jay left, and went back to the drug.

The era of the American meth lab is over a decade gone, yet pure, cheap meth is back and bigger than ever in Western Washington. When Seattle residents point to needles proliferating on sidewalks, they usually say heroin’s to blame; however, a bigger proportion of those needles in recent years is actually from people injecting meth, according to King County syringe exchange surveys.

Now, more people are dying in Washington from methamphetamine than during the height of the last meth wave in the early 2000s. Rates of death from meth were four times higher in 2017 than in 2005, right before Congress passed regulations to stop its production. The increase has almost entirely taken place in the last seven years.

In recent years, more meth has been smuggled into Washington in secret compartments, such as the one hidden in this tire, seized in the Tacoma area. (DEA)
In recent years, more meth has been smuggled into Washington in secret compartments, such as the one hidden in this tire, seized in the Tacoma area. (DEA)

“A lot of people have thought of methamphetamine as something that just went away and had been overtaken by the opioid problem,” said Sterling McPherson, head of the Analytics and Psychopharmacology Laboratory at Washington State University. “I didn’t really hear people talking about methamphetamine until relatively recently.”

But while heroin has dominated the drug conversation in King County, meth has crept up and quietly surpassed it. Last year, for the first time, more people in King County died with meth in their systems than heroin — 164 versus 156. (That doesn’t include illicit fentanyl, a synthetic opioid, which was found in another 65 dead people last year.)

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“There’s a lot more meth, it’s incredibly pure, and it’s cheap,” said Caleb Banta-Green, interim director of the Alcohol and Drug Abuse Institute at the University of Washington. “In our interviews, we’re hearing people say, ‘I don’t even really want to use meth, but when I go buy my heroin, they just give it to me.’ It’s that cheap and available.”

Opioid-related fatalities in King County have started to level off with the proliferation of the rescue drug NarCan and treatment medications, but unlike heroin, meth addiction can’t be treated with replacement drugs such as buprenorphine.

Even more distressing: As the meth epidemic has risen to stand alongside the heroin epidemic, more people shaking heroin addiction find themselves still hooked on meth. Meth use among people who were getting treatment — like methadone — for opioid use virtually doubled, from 19% in 2011 to 34% in 2017.

To many, meth will seem like a drug of the past. The state logged reports of nearly 9,500 clandestine meth labs from 1999 to 2005, the peak years of the home-cooked-meth epidemic. That year,  Congress passed laws limiting retail over-the-counter sales of drugs like pseudoephedrine, which “mom and pop” meth labs used to make meth. Since 2011, there have been just 212 meth-lab sites reported statewide, according to the state Department of Ecology.

But drug cartels south of the American border stepped in to fill demand, making more and more meth in “superlabs” in Mexico and shipping it, along with heroin and fentanyl, up Interstate 5 — hidden away in tires, paint cans and hidden compartments in semi-trucks — according to Keith Weis, special agent in charge of the Drug Enforcement Administration’s Pacific Northwest division.

In one four-week period this spring, the DEA seized 400 pounds of meth in the Pacific Northwest.

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“In the last 6 months or less, we have seized so much meth, it’s unbelievable,” said Jodie Underwood, a spokesperson for the DEA.

What used to be primarily a drug used by white people in the Western United States is moving eastward and into American cities, seeing more use by people of color — and people living on the streets.

Drug use and homelessness have risen together in King County, though research isn’t clear on how often drug use causes homelessness, or homelessness pushes people to drug use.

Meth found secreted in a tire in the Tacoma area. (DEA)
Meth found secreted in a tire in the Tacoma area. (DEA)

Last year, for the first time, more overdose deaths among people presumed to be homeless when they died involved methamphetamine (46) than heroin (37), according to a preliminary report from the King County Medical Examiner. In 2010, only 6% of deaths among people presumed to be homeless involved methamphetamine. Last year, almost a quarter involved meth.

The Seattle Times’ Project Homeless is funded by BECU, The Bernier McCaw Foundation, The Bill & Melinda Gates Foundation, Campion Foundation, the Paul G. Allen Family Foundation, Raikes Foundation, Schultz Family Foundation, Seattle Foundation, Seattle Mariners, Starbucks and the University of Washington. The Seattle Times maintains editorial control over Project Homeless content.

While many people who use meth are not homeless, homeless drug users are using more meth because it’s cheap and easy, and because the stimulant helps them survive, according to Banta-Green. Meth users can stay vigilant at night when they’re scared of being robbed.

“It’s an appetite suppressant. It’s a mood enhancer. If you’re homeless and poor and at risk for attack when you’re sleeping, methamphetamine is a great drug,” Banta-Green said. “Human beings who use methamphetamine are, first and foremost, human beings … they’re using them for practical reasons.”

As meth use has risen in past years, some activists and advocates have tried to sound the alarm. In 2016, when King County was putting together its Opiate and Prescription Opiate Addiction Task Force to recommend immediate actions on the opioid epidemic, Shilo Jama, an activist and director of the People’s Harm Reduction Alliance, pushed to convene one for stimulants as well. He argues that the count of drug deaths doesn’t fully capture how many people are using meth.

“We serve more stimulant users than opiate users in King County,” said Jama. “And we’ve seen that for several years going.” His organization hands out free meth pipes in an effort to encourage smoking rather than injecting, because smoking has fewer short-term effects.

It’s not that there is no treatment for methamphetamine users — behavioral therapies and some prescription antidepressants have had limited success. But there is no treatment as effective as what’s available for heroin users. If Jay had walked into an ER experiencing withdrawal from heroin, WSU’s McPherson said, he could have been prescribed buprenorphine, a synthetic opiate that helps reduce or eliminate symptoms.

But McPherson believes that until meth has the same national profile as heroin, drug companies won’t see a profit in pushing a medical treatment, and the FDA won’t approve it.

“The public only has the stomach for one addiction at a time,” McPherson said. “A lot of people are saying, ‘I’m overwhelmed already trying to combat opioid addiction.’”