- Rob Donnelly
Several years ago, Jess Kirby noticed that a number of her clients at Burlington's Safe Recovery were suddenly acting differently. They worried that they were being watched and that people were conspiring against them.
"People I've known for years, out of the blue, experiencing paranoia," Kirby said. "Saying things like, 'I don't know who to trust. Something is going on with me.'"
Some clients even grew wary of her, a former confidante. Others revealed what she was beginning to suspect. They had started using a new drug: meth.
Kirby was surprised. Vermont had largely managed to avoid the scourge of methamphetamine during the 1990s and early 2000s, even as it ravaged communities throughout the western U.S. In recovery herself, Kirby had rarely even seen meth. "I just thought we were somehow insulated from it," she said.
She doesn't believe that anymore.
While Vermont has been intent on its opioid crisis, meth use has been quietly increasing in the Burlington area; Kirby now knows dozens of people using the drug.
The toll can be felt in emergency rooms, where more people are arriving in the grip of meth-fueled psychosis; in the streets, where chronic users languish with few treatment options; and in the growing number of families who have lost someone to a meth-related overdose. The true scope of meth's reach is not fully understood, as opioids draw most of the state's attention and resources. But health care providers warn that the drug is devastating to users and fear that the problem will worsen if Vermont doesn't find a better way to treat it.
"People are falling through the cracks," said Kirby, who continues to work closely with substance users through her new job as director of client services at the nonprofit Vermonters for Criminal Justice Reform.
When meth use first spiked in the U.S. three decades ago, it was made in small home labs with pseudoephedrine, the main ingredient in many over-the-counter cold medicines. A federal crackdown on pseudoephedrine in 2006 helped curb these so-called "one-pot" operations, and meth seizures fell nationally. Then Mexican cartels figured out how to produce purer, cheaper and more lethal versions of the drug on an industrial scale.
As the western U.S. was flooded with potent meth in the early 2010s and street prices plummeted, the cartels began seeking untapped markets. They looked to the Northeast, where the opioid epidemic was already well under way.
In 2018, around the same time Kirby started hearing about meth in Burlington, drug treatment providers in other states were noticing similar changes. They had spent careers combating heroin and now needed to figure out how to address a very different drug. Many turned to national experts for advice — and their pleas ended up in the inbox of University of Vermont professor Rick Rawson.
"I started getting emails from West Virginia, Wisconsin, Florida, Kentucky: 'Hey, we've got this big meth problem,'" recalled Rawson, a renowned addiction expert who spent decades researching meth during a 40-year career at the University of California, Los Angeles.
Rawson moved to Vermont in 2015 and works as a research professor at UVM's Center on Behavior and Health. He held what he estimates were more than 600 virtual training sessions during the pandemic, including for providers in Maine and New Hampshire, where meth has become a growing problem. Requests for help in his own backyard have been far less frequent, though: Rawson has performed only a few trainings in Vermont and said he's had very little interaction with the Vermont Department of Health about meth.
The most logical explanation is that other states have been hit much harder, which Rawson himself believes. But it's also unclear whether Vermont grasps the extent of its own meth problem.
It's a tricky thing to track.
Unlike heroin and fentanyl, meth, on its own, doesn't usually lead to fatal overdoses. When it is detected in the blood of fatal overdose victims, it's almost always accompanied by an opioid — primarily fentanyl, a cheap synthetic opioid that dealers are adding to meth and other drugs in an attempt to increase their potency and addictiveness. At least 38 people have died in Vermont with meth in their systems since the start of 2020. While that represents a huge increase, it's unclear whether more people are using the drug or whether the deadlier fentanyl has become more common in Vermont's meth supply.
Hospital data is equally murky. The UVM Medical Center's emergency department says about 200 people have tested positive for amphetamines over the past year or so, a doubling in just a couple years' time. But that includes prescription drugs such as Adderall, and not every patient is tested upon arrival at the emergency department. Rawson usually looks to meth addiction treatment admissions for trends, but Vermont's lack of programs makes that impossible.
Health department officials acknowledge that meth is circulating in communities but say it remains nowhere near as prevalent as opioids or other stimulants, such as cocaine. A major meth surge would likely appear in hospital data and a rise in criminal behaviors linked back to the drug, said Tony Folland, clinical services manager at the department's Division of Alcohol and Drug Abuse Programs.
"We just haven't seen enough of that to suggest we're missing anything," he said.
Law enforcement officials suspect most of the meth making its way to Vermont originates in Mexico, though they say some is also shipped from China. Recent arrests suggest that people selling it locally often deal it along with opioids.
Anecdotal evidence indeed indicates a scattered meth presence statewide. Washington County prosecutors say they rarely encounter it, while Rutland addiction specialist Dr. Saeed Ahmed told Seven Days that he sees meth users frequently. One Lamoille County drug treatment provider said she's observed a noticeable increase; another in the same town has only encountered a few cases.
In Burlington, however, the trend seems clear.
Erin O'Keefe, one of Kirby's former colleagues at Safe Recovery, said meth appears "very frequently" in the routine drug screenings performed on people who access the nonprofit's low-barrier buprenorphine program. Those who pick up clean needles at the syringe exchange service regularly mention it.
One recovering meth user told Seven Days the drug is "prevalent" in Chittenden County. The man, who requested anonymity because his family did not know the extent of his recent drug use, came to Vermont in 2018 with a year of sobriety under his belt and hoped his meth days were behind him. But he ran into the drug almost immediately — his apartment building was "full of it," he said — and he eventually started smoking it again.
He didn't blame his neighbors for his relapse. "It was my decision to pick up a pipe again and smoke it," he said. Still, the drug's ready availability didn't help. He was buying from three dealers at any given time.
Research suggests that some people are turning to meth out of a fear of dying from fentanyl. Others take it to counteract the sedative effects of opioids, or for a high while they take medications such as Suboxone to block the effects of opioids. Still others turn to it as a cheaper alternative to cocaine or begin using it as a party drug.
Whatever the reason, people can quickly get hooked on meth because of the way it interacts with the brain, according to Kelly Klein, medical director at the Vermont Department of Mental Health.
"If somebody has chocolate cake or sex, their dopamine increases by around 150 percent. If they do coke, it's around 300 to 400 percent and only lasts about eight to 20 minutes," Klein said. "Meth? It's around 1,000 to 1,500 percent their baseline — and lasts around seven to eight hours."
This intense euphoria, coupled with an instant boost of energy, can make people feel confident, capable. "It's such a fucking cloud of, like, I don't care. It doesn't matter," said the man in recovery. "I can hide it. I can do this. I can function. I can go to work. I'm a rock star at work."
But over time, devastating side effects show up. The repeated dopamine blitz convinces the brain that it needs the drug to feel happy. Long-term users eventually feel anxious, paranoid and confused. They skip meals and go days without sleeping. Some become obsessed with meaningless tasks — tinkering with car engines or bicycles, for instance — a psychiatric phenomenon known as "punding" that has been linked to overstimulation of dopamine receptors.
As the recovering user put it: "You start using the drug, and you end with the drug using you."
Today's potent meth induces severe states of psychosis faster than ever, experts say. Some users develop symptoms that mimic schizophrenia, and while it can be hard to know whether the drug created a mental health issue or simply exacerbated an existing one, the effects can be long-lasting.
"In some instances, that psychosis does appear to be permanent or semipermanent," said O'Keefe.
Meth can cause risky or violent behavior. Just last week, it was implicated in a seemingly random shooting at a White River Junction motel involving a 25-year-old man who police say had shown signs of deteriorating mental health in days before he shot a stranger in the face, the Valley News reported.
Drug treatment providers often have little to offer people hooked on meth. There's no approved medication to curb meth cravings. Syringe exchange and other drop-in programs mostly just "make sure people have access to water," O'Keefe said. "It's really not the same as working with somebody using opioids."
With few treatment avenues, some people continue using until they reach a point of crisis, further limiting their options.
They often wind up at the emergency department desperate for a bed in an inpatient rehab or psychiatric facility. But the two inpatient rehab centers that take Medicaid — Valley Vista in Bradford and Serenity House in Wallingford — say they aren't equipped to handle people with severe psychosis. And some health care providers accuse Vermont's inadequate psychiatric system of overlooking people whose mental health issues are thought to be intertwined with drug use.
"When you've got 20 other people waiting for an inpatient psych bed and you're triaging cases, it's really easy to take situations with some element of uncertainty and push it in a different direction," said Dr. Adam Greenlee, the medical director of psychiatry and mental health at the Community Health Centers of Burlington. In other words, you don't admit the patient.
Kirby said she's seen at least 20 people get caught up in this not-our-job limbo. She's accompanied clients to the ER only to watch them get released hours later without any treatment. They use again; their mental health further deteriorates; the cycle continues.
People who do manage to land a spot at an inpatient rehab center, meanwhile, often find that the short-term programs designed for opioid and alcohol dependency don't help as much for their meth addiction. Research shows that it can take months for the brains of long-term meth users to fully heal.
Dr. Deb Richter, a Lamoille County drug treatment provider, recalled working with two patients addicted to meth: "We had tried the two-week detox, the 28-day rehab — nothing kept them away from meth," she said. What finally worked: a nine-month stay at an out-of-state rehab center.
"We need a bunch of nine- to 12-month facilities in order to get this problem under control," she said.
Drug treatment counselors have always called for better inpatient rehab options, but Vermont has also been slow to adopt even the outpatient behavioral therapies shown to have positive impacts on meth addiction.
State health officials argue that investing in treatments for one specific drug addiction over another could lead to a more rigid system that fails to address the many underlying reasons people turn to drugs in the first place.
But Rawson, the UVM professor, said Vermont's existing drug treatment system already focuses on opioids over stimulants, and until that changes, people who identify primarily as cocaine and meth users are unlikely to enter treatment at high rates. They will instead continue using, raising their risk of a fatal encounter with fentanyl.
The effects have already been felt: Nearly two-thirds of the 77 people who died from overdoses in the first five months of 2022 had either meth (six) or cocaine (41) in their system.
Rawson's now working in the Burlington area to help establish new treatment programs based on an idea pioneered by another UVM professor decades ago. It's called "contingency management," and it involves offering people rewards such as prepaid debit cards when they meet certain treatment goals. The strategy has become the gold standard for outpatient stimulant-addiction treatment, and Rawson said he's seen it work out west.
Safe Recovery plans to soon launch a program for stimulant users who frequent its syringe exchange service. Kirby and her colleagues, meanwhile, are starting their own program, and though it's open to all types of substance users, five of the first seven enrollees said they were struggling with meth, Kirby said. Rawson hopes success in these programs will convince Vermont to invest more in stimulant treatment programs statewide.
As they look ahead, service providers, treatment counselors and law enforcement officials all seem unsure whether Vermont's meth problem will worsen. Nikolas Kerest, the state's U.S. attorney, offered perhaps the clearest distillation of their dilemma.
On one hand, the extent of the meth problem in the rest of the country would suggest Vermont is in for more, he said. On the other, the sheer ubiquity of fentanyl makes it hard to imagine meth or any other drug overrunning the market anytime soon.
"It's hard, at least for me, to square both of those realities in [my] mind at once," Kerest said.