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Santa Clara County's biggest drug scourge isn't fentanyl — it's meth

More than half of all drug-related deaths involve the powerful stimulant

Methamphetamine caused 582 deaths in Santa Clara County between Jan. 1, 2018 and July 17, 2022. Courtesy Getty Images.

The potent opioid fentanyl might be getting the lion's share of notoriety in recent years, but Santa Clara County — and California — have a much bigger drug-related killer: methamphetamine.

Methamphetamine-related deaths account for more than 50% of all drug-related fatalities in the county, far surpassing deaths from opioids, according to Santa Clara County Medical Examiner-Coroner data.

The dangers of methamphetamines, a cheap, powerful stimulant commonly known as meth, aren't just related to overdose; the drug is responsible for a voluminous increase in heart-failure deaths among younger, middle-aged people due to years of abuse, researchers said.

Between Jan. 1, 2018, and July 17, 2022, the county saw 1,339 drug-related deaths. Of those, 582, or 43.47%, were caused by methamphetamine alone. An additional 204 deaths or 15.24% were caused by a combination of methamphetamine and opioids, mainly fentanyl.

By contrast, opioids alone caused 23.3% of fatalities during the same time period. All other drug-related deaths accounted for 18%, according to the coroner's data.

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Meth has consistently dominated, in large part because it is inexpensive and ubiquitous, according to the Executive Office of the President's Office of National Drug Control Policy High Intensity Drug Trafficking Areas Program 2021 Report to Congress.

Mira Parwiz, division director in the Santa Clara County Behavioral Health Services Department, said meth has been a problem for a number of years in the county.

"Among all the drug-substance use issues in Santa Clara County, meth seems to be the number one issue. And the problem with meth is that it's growing and that it is very, very addictive. And secondly, it's readily available. Third, it's that we don't have any specific treatment for it," she said.

Although news stories in recent years have implicated methamphetamine use among tech workers to cope with long hours, Parwiz said there's no single demographic being affected by methamphetamine. People of all ages, genders and economic backgrounds are dying due to methamphetamine. Even fetuses.

In 2021 the county recorded three deaths of fetuses in the womb who succumbed to methamphetamine toxicity as a result of their mothers' usage.

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Among racial and ethnic groups, deaths related to methamphetamine occurred among people who are white, Black, Polynesian or Hispanic at rates in greater proportion to their population in the county. Whites accounted for 46.52% of methamphetamine-related deaths — 1.6 times their percentage in the county's population, according to the 2021 U.S. Census estimates. Blacks accounted for 7.39% of the deaths, or 2.5 times their proportionate census population. Polynesians accounted for 1.73% of deaths — nearly 3.5 times their proportionate census population.

Hispanics accounted for 34.34% of deaths, representing nearly 1.4 times their proportionate population.

Only Asians and Native Americans had death rates below their proportionate populations: at 0.2 times and 0.3 times deaths, respectively, according to the coroner and census 2021 data.

Meth also kills more men: more than three quarters of the county's methamphetamine-related deaths, the coroner's data shows.

The largest age group dying from meth were the middle-aged: 31.30% of those who died were 51 to 60 years old; 23.04% were ages 41 to 50; and 16.96% were 61 years and older, according to the corner's data.

Persons ages 31-40 accounted for 17.83% of the deaths; those aged 21-30 accounted for 9.13%, and young people ages 11 to 20 represented the smallest group of fatalities at 0.43%. Some of those deaths were caused by a mix of methamphetamine and fentanyl or other opioids, which are sometimes accidentally ingested when meth has been cut with fentanyl, according to the Office of National Drug Control Policy report.

More than overdoses

While an overdose from methamphetamine may be commonly assumed to be killing people, chronic meth use actually leads to more insidious causes of death: gastric hemorrhage, cardiac disease, aneurysm, ruptured aorta, congestive heart failure, brain hemorrhage and heart attack, according to the coroner's data.

Methamphetamine causes cardiac issues by triggering blood vessel spasms and life-threatening spikes in blood pressure, the study noted. It can increase plaque in the arteries and rewire the heart's electrical system.

Prolonged methamphetamine use is also associated with a severe form of dilated cardiomyopathy, in which the weakened heart muscle becomes enlarged and can't pump adequate blood, according to a July 2021 study led by Dr. Susan X. Zhao, a cardiologist at Santa Clara Valley Medical Center, which researched the socioeconomic burden of methamphetamine-related heart failure hospitalizations in California over a decade through 2018.

Heart failure usually occurs in adults over the age of 60. Yet, methamphetamine is the leading cause of heart failure in people who are younger than 65 years old, the research, which was published in the American Heart Association journal "Circulation: Cardiovascular Quality and Outcomes," found.

Methamphetamine-related heart failure hospitalizations rose a staggering 585% between 2008 and 2018 in California, compared with a 6% decline of heart-failure hospitalizations unrelated to methamphetamine use, the study noted.

Of the methamphetamine-related heart-failure patients, 94% were under age 65, with more than half being between ages 35 and 54. That's not likely to change as younger meth users age. The average age of new methamphetamines users is 23, according to the 2017 U.S. National Survey on Drug Use and Health.

Methamphetamine-related heart conditions are taking a huge economic toll. Hospital stays are several days longer for meth patients, who also require more medical procedures, the researchers said.

The costs for methamphetamine-related heart failure in California ballooned from $41.5 million in 2008 to $390.2 million in 2018 — an 840% increase — the researchers found, compared to an 82% increase in costs for all heart failure-related hospitalizations.

Will a new treatment program be the answer?

Solving the meth problem is difficult. While there are many interventions for people who are addicted to opioids, there are no Food and Drug Administration-approved medications for stimulant-use disorders such as methamphetamine addiction, the researchers noted.

Parwiz, who runs a county substance-abuse-treatment program that treats about 600 to 700 patients annually, said there are no stand-alone treatment facilities for meth users. Many of the people who are in the opioid treatment programs report they also have methamphetamine addictions, she said.

"If you have a heroin addiction, we do have drugs like methadone for that treatment available, (and) suboxone, etc. But none of those are really effective on meth if you're just using meth by itself," Parwiz said.

There is hope for medication-related treatment.

"They're hoping in the next two, three years there might be some medication available," she said.

There are also promising non-medication interventions, which some researchers say can help control stimulant addiction. "Contingency management" has been proven to reduce substance-abuse, according to research.

Contingency management rewards people with incentives such as prizes or vouchers, which are exchangeable for goods and services each time the client achieves a desired behavior, such as a negative drug test. If the behavior is not achieved, the client starts at the beginning of the incentive program, according to a May 2022 brief by the California Health Care Foundation.

'If you have a heroin addiction, we do have drugs like methadone for that treatment available, (and) suboxone, etc. But none of those are really effective on meth if you're just using meth by itself.'

-Mira Parwiz,, division director, Santa Clara County Behavioral Health Services Department

A 2021 study published in the Journal of the American Medical Association found that in 18 of 22 studies, contingency management significantly reduced stimulant use. Of the programs' participants, 75.8% had a better outcome than the mean outcome in the control group, the California Health Care Foundation report noted.

A separate April 2018 study of contingency management among veterans at the Department of Veterans Affairs found the average abstinence rate, based on negative test results, exceeded 90%.

Now California is poised to become the first state in the nation to pilot a contingency management program. In December, California received authorization through a Medicaid waiver from the federal Centers for Medicare and Medicaid Services to include contingency management as a service.

The pilot program, which begins this fall, will be covered by Medi-Cal under the California Advancing and Innovating MediCal (CalAIM) initiative.

The California legislature also sought to make contingency management a permanent part of Medi-Cal payments. In June 2021, legislators approved Senate Bill 110, The Recovery Incentive Act, which would have assured that contingency management programs don't violate anti-kickback laws and would have required Medi-Cal to cover the cost of contingency management programs.

Gov. Gavin Newsom vetoed the bill on Oct. 8, 2021, however, saying the 2021-22 state budget includes funding to support the Medi-Cal benefit contingency management pilot program through March 2024. The program should be evaluated before permanently extending the Medi-Cal benefit, Newsom said, explaining his veto.

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Sue Dremann
 
Sue Dremann is a veteran journalist who joined the Palo Alto Weekly in 2001. She is a breaking news and general assignment reporter who also covers the regional environmental, health and crime beats. Read more >>

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Santa Clara County's biggest drug scourge isn't fentanyl — it's meth

More than half of all drug-related deaths involve the powerful stimulant

by / Palo Alto Weekly

Uploaded: Fri, Aug 12, 2022, 6:58 am

The potent opioid fentanyl might be getting the lion's share of notoriety in recent years, but Santa Clara County — and California — have a much bigger drug-related killer: methamphetamine.

Methamphetamine-related deaths account for more than 50% of all drug-related fatalities in the county, far surpassing deaths from opioids, according to Santa Clara County Medical Examiner-Coroner data.

The dangers of methamphetamines, a cheap, powerful stimulant commonly known as meth, aren't just related to overdose; the drug is responsible for a voluminous increase in heart-failure deaths among younger, middle-aged people due to years of abuse, researchers said.

Between Jan. 1, 2018, and July 17, 2022, the county saw 1,339 drug-related deaths. Of those, 582, or 43.47%, were caused by methamphetamine alone. An additional 204 deaths or 15.24% were caused by a combination of methamphetamine and opioids, mainly fentanyl.

By contrast, opioids alone caused 23.3% of fatalities during the same time period. All other drug-related deaths accounted for 18%, according to the coroner's data.

Meth has consistently dominated, in large part because it is inexpensive and ubiquitous, according to the Executive Office of the President's Office of National Drug Control Policy High Intensity Drug Trafficking Areas Program 2021 Report to Congress.

Mira Parwiz, division director in the Santa Clara County Behavioral Health Services Department, said meth has been a problem for a number of years in the county.

"Among all the drug-substance use issues in Santa Clara County, meth seems to be the number one issue. And the problem with meth is that it's growing and that it is very, very addictive. And secondly, it's readily available. Third, it's that we don't have any specific treatment for it," she said.

Although news stories in recent years have implicated methamphetamine use among tech workers to cope with long hours, Parwiz said there's no single demographic being affected by methamphetamine. People of all ages, genders and economic backgrounds are dying due to methamphetamine. Even fetuses.

In 2021 the county recorded three deaths of fetuses in the womb who succumbed to methamphetamine toxicity as a result of their mothers' usage.

Among racial and ethnic groups, deaths related to methamphetamine occurred among people who are white, Black, Polynesian or Hispanic at rates in greater proportion to their population in the county. Whites accounted for 46.52% of methamphetamine-related deaths — 1.6 times their percentage in the county's population, according to the 2021 U.S. Census estimates. Blacks accounted for 7.39% of the deaths, or 2.5 times their proportionate census population. Polynesians accounted for 1.73% of deaths — nearly 3.5 times their proportionate census population.

Hispanics accounted for 34.34% of deaths, representing nearly 1.4 times their proportionate population.

Only Asians and Native Americans had death rates below their proportionate populations: at 0.2 times and 0.3 times deaths, respectively, according to the coroner and census 2021 data.

Meth also kills more men: more than three quarters of the county's methamphetamine-related deaths, the coroner's data shows.

The largest age group dying from meth were the middle-aged: 31.30% of those who died were 51 to 60 years old; 23.04% were ages 41 to 50; and 16.96% were 61 years and older, according to the corner's data.

Persons ages 31-40 accounted for 17.83% of the deaths; those aged 21-30 accounted for 9.13%, and young people ages 11 to 20 represented the smallest group of fatalities at 0.43%. Some of those deaths were caused by a mix of methamphetamine and fentanyl or other opioids, which are sometimes accidentally ingested when meth has been cut with fentanyl, according to the Office of National Drug Control Policy report.

More than overdoses

While an overdose from methamphetamine may be commonly assumed to be killing people, chronic meth use actually leads to more insidious causes of death: gastric hemorrhage, cardiac disease, aneurysm, ruptured aorta, congestive heart failure, brain hemorrhage and heart attack, according to the coroner's data.

Methamphetamine causes cardiac issues by triggering blood vessel spasms and life-threatening spikes in blood pressure, the study noted. It can increase plaque in the arteries and rewire the heart's electrical system.

Prolonged methamphetamine use is also associated with a severe form of dilated cardiomyopathy, in which the weakened heart muscle becomes enlarged and can't pump adequate blood, according to a July 2021 study led by Dr. Susan X. Zhao, a cardiologist at Santa Clara Valley Medical Center, which researched the socioeconomic burden of methamphetamine-related heart failure hospitalizations in California over a decade through 2018.

Heart failure usually occurs in adults over the age of 60. Yet, methamphetamine is the leading cause of heart failure in people who are younger than 65 years old, the research, which was published in the American Heart Association journal "Circulation: Cardiovascular Quality and Outcomes," found.

Methamphetamine-related heart failure hospitalizations rose a staggering 585% between 2008 and 2018 in California, compared with a 6% decline of heart-failure hospitalizations unrelated to methamphetamine use, the study noted.

Of the methamphetamine-related heart-failure patients, 94% were under age 65, with more than half being between ages 35 and 54. That's not likely to change as younger meth users age. The average age of new methamphetamines users is 23, according to the 2017 U.S. National Survey on Drug Use and Health.

Methamphetamine-related heart conditions are taking a huge economic toll. Hospital stays are several days longer for meth patients, who also require more medical procedures, the researchers said.

The costs for methamphetamine-related heart failure in California ballooned from $41.5 million in 2008 to $390.2 million in 2018 — an 840% increase — the researchers found, compared to an 82% increase in costs for all heart failure-related hospitalizations.

Will a new treatment program be the answer?

Solving the meth problem is difficult. While there are many interventions for people who are addicted to opioids, there are no Food and Drug Administration-approved medications for stimulant-use disorders such as methamphetamine addiction, the researchers noted.

Parwiz, who runs a county substance-abuse-treatment program that treats about 600 to 700 patients annually, said there are no stand-alone treatment facilities for meth users. Many of the people who are in the opioid treatment programs report they also have methamphetamine addictions, she said.

"If you have a heroin addiction, we do have drugs like methadone for that treatment available, (and) suboxone, etc. But none of those are really effective on meth if you're just using meth by itself," Parwiz said.

There is hope for medication-related treatment.

"They're hoping in the next two, three years there might be some medication available," she said.

There are also promising non-medication interventions, which some researchers say can help control stimulant addiction. "Contingency management" has been proven to reduce substance-abuse, according to research.

Contingency management rewards people with incentives such as prizes or vouchers, which are exchangeable for goods and services each time the client achieves a desired behavior, such as a negative drug test. If the behavior is not achieved, the client starts at the beginning of the incentive program, according to a May 2022 brief by the California Health Care Foundation.

A 2021 study published in the Journal of the American Medical Association found that in 18 of 22 studies, contingency management significantly reduced stimulant use. Of the programs' participants, 75.8% had a better outcome than the mean outcome in the control group, the California Health Care Foundation report noted.

A separate April 2018 study of contingency management among veterans at the Department of Veterans Affairs found the average abstinence rate, based on negative test results, exceeded 90%.

Now California is poised to become the first state in the nation to pilot a contingency management program. In December, California received authorization through a Medicaid waiver from the federal Centers for Medicare and Medicaid Services to include contingency management as a service.

The pilot program, which begins this fall, will be covered by Medi-Cal under the California Advancing and Innovating MediCal (CalAIM) initiative.

The California legislature also sought to make contingency management a permanent part of Medi-Cal payments. In June 2021, legislators approved Senate Bill 110, The Recovery Incentive Act, which would have assured that contingency management programs don't violate anti-kickback laws and would have required Medi-Cal to cover the cost of contingency management programs.

Gov. Gavin Newsom vetoed the bill on Oct. 8, 2021, however, saying the 2021-22 state budget includes funding to support the Medi-Cal benefit contingency management pilot program through March 2024. The program should be evaluated before permanently extending the Medi-Cal benefit, Newsom said, explaining his veto.

Comments

Consider Your Options.
Registered user
Another Palo Alto neighborhood
on Aug 12, 2022 at 10:51 am
Consider Your Options. , Another Palo Alto neighborhood
Registered user
on Aug 12, 2022 at 10:51 am

The "friend" you buy illicit drugs from gets his drug supply from a long chain of criminals who make it and don't care a whit for anyone's health and safety. Maybe you think he's a nice guy, but his suppliers are not. Giving these people access to your health and life is a monumentally foolish risk. Please don't take the drugs. Don't try it. Don't be a victim.

Today's illicit drugs are laced with chemicals that are designed to addict you quickly (and destroy your life). Criminals don't care. They just want your money. Addicting you quickly is how they force you to abandon any possibility of a stable, happy life in pursuit of the drug. That is what addicts do. Just trying these drugs is dangerous. The risk is not worth it.

Take control of your life. Do not give your life away to people who will only abuse you once you are hooked. Do not support the chains of criminals who are responsible for the deaths of millions worldwide by giving them your money.

If you cannot find another way to enjoy your life, please find help. There are many pathways toward happiness, but criminals, by definition, are intent on taking something precious from you, not helping you.


Michael Chang
Registered user
Los Altos
on Aug 12, 2022 at 11:21 am
Michael Chang, Los Altos
Registered user
on Aug 12, 2022 at 11:21 am

Illicit fentanyl is being manufactured in the People's Republic of China and then transported to Mexico for distribution throughout America.

The 'Just Say No' concept being expounded by Consider Your Options is somewhat reminiscent of Nancy Reagan.

Successfully curtailing fentynal distribution and addictions will involve a lot more than that.


Jennifer
Registered user
another community
on Aug 13, 2022 at 8:25 am
Jennifer, another community
Registered user
on Aug 13, 2022 at 8:25 am

Bring back the fried egg commercial. "This is drugs. This is your brain on drugs. Any questions?"

It sent a message that hard drugs might fry your brain, with irreversible damage. Drug usage did go down - teenagers and young adults.


Missy Carter
Registered user
Midtown
on Aug 13, 2022 at 10:02 am
Missy Carter, Midtown
Registered user
on Aug 13, 2022 at 10:02 am

Meth is cheaply (and dangerously) manufactured and readily available at minimal costs to the consumer.

Methamphetamine is a potent stimulant often referred to as the poor man's coke.

It will be very difficult to eradicate this substance as it is highly addictive and relatively easy to procure.


Carol
Registered user
another community
on Aug 13, 2022 at 1:09 pm
Carol, another community
Registered user
on Aug 13, 2022 at 1:09 pm

I remember hearing a number of years ago now (back before hospitals had fancy machines to monitor drug usage closer) of a Anesthesiologist who lost their life after using drugs in the work restroom. If I remember correctly they lost their life to fentanyl. Even this most highly trained professional with such drugs, likely having used hospital grade fentanyl succumbed to usage. In-spite of medical professionals even having through their licensing boards programs in place to help them with addictions.

If an Anesthesiologist can't get the dosage right (self administering to themselves), please don't also risk throwing your life away. Thank you.


Justine Walters
Registered user
Old Palo Alto
on Aug 13, 2022 at 2:59 pm
Justine Walters, Old Palo Alto
Registered user
on Aug 13, 2022 at 2:59 pm

Most drug abusers are not happy or fulfilled people and they are seeking an escape from the everyday world.

And sadly, most are incapable of transporting their gloom into art or literature.

[Portion removed.]


John
Registered user
Adobe-Meadow
on Aug 14, 2022 at 10:26 am
John, Adobe-Meadow
Registered user
on Aug 14, 2022 at 10:26 am

Possession used to be a felony and we could leverage criminal penalties to get ppl treatment and rehab. Until a legion of old hippies and do gooders basically decriminalized drugs with predictable results. DAs have previously said behind closed doors that getting a drug sales conviction out of a Palo Alto jury was next to impossible as they had romanticized ideas about drug use and “sticking it to the man.”
Portugal has a pretty good carrot and stick model to get users clean.


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