It's time to rethink our national drug policy

In America’s ongoing war on drugs, the methamphetamine crisis of the 1990s and 2000s fell from the national consciousness when the opioid epidemic first arrived. Yet, like most drug crises that cycle in and out of public view, abuse of methamphetamines — more commonly known as crystal meth — receded but never went away.

Now meth use is resurgent again. Hospitalizations and overdose deaths due to psycho-stimulants such as meth have risen dramatically, with annual fatalities more than tripling from 1,887 in 2011 to 6,762 in 2016, according to the Centers for Disease Control. Meth-related hospitalizations increased nearly 272 percent between 2008 and 2015, according to a study in the Journal of the American Medical Association.

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One reason for the high death toll now is that the meth coming into the U.S. today is not only purer and deadlier than ever before but it is also cheaper. Produced by Mexican cartels, the drug is streaming across the southern border, the federal Drug Enforcement Administration’s Drug Threat Assessment has concluded.

As a clinician with more than 50 years of experience treating substance abuse, I view meth’s re-emergence as tragic, but also foreseeable. Even as we have fought one drug epidemic after another in the past half-century we have failed to stem the national tide of addiction and substance abuse.

It is time to reassess the country’s anti-drug strategy. We must shift our efforts away from the current focus on particular substances to the individuals who are taking the drugs. While these substances can vary from decade to decade, the underlying psychology of substance abuse remains similar and consistent. 

Certainly, there are some targeted responses that are unique to certain drugs. For example, in the opioid epidemic we can reverse overdoses using the medication Naloxone. Drugs such as Methadone and Buprenorphine relieve cravings during opioid withdrawal.

But all too often what every substance abuser has in common is a shattered life. Their addictions have destroyed family ties, careers, finances and whatever plans these people may once have nurtured for a better future. Such severely disordered people require longer-term, intensive behavioral treatment, frequently on a residential basis, to treat the whole person. 

Through this process, we can reorient troubled people to live without drugs by dealing with the underlying anxieties and emotions that led them to these substances in the first place. Eventually, we can alter the way a substance abuser wants to lead the rest of his or her life.

Meth addiction provides a striking example of why we need more long-term, behavioral treatment programs. A highly addictive stimulant, meth produces powerful feelings of euphoria and energy, as well as anxiety, paranoia, depression and loss of appetite. The user is injured physically and mentally.

Currently, there are no new pharmaceutical interventions for those who are addicted to meth. We can only administer sedatives in a clinical setting to reduce agitation on a short-term basis. Beyond that, we fortunately have long-term behavioral and residential therapy through 12-step programs such Narcotics Anonymous.

Once in treatment, sobriety is possible: just ask the nearly 24 million Americans who are now in recovery from drug addiction or alcoholism and are leading stable and productive lives. It is a difficult path and relapses followed by fresh starts are commonplace. Also, we cannot forget the external forces such as poverty and economic hardship that create a greater vulnerability to addiction.

Sadly, there are not enough treatment options of this kind available for the growing number of substance abusers, due to the failure of national leadership and planning.

If the resurgent meth crisis teaches us anything, it is that fighting every new wave of drug addiction requires the availability of treatment programs that engage and treat individuals --no matter what their drug of choice may be. Implementing a national policy with the resources needed to help every addict can reduce the number of those dying from substance abuse today – as well as reduce the severity of the next, inevitable drug crisis.

Mitchell S. Rosenthal is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization and is now president of The Rosenthal Center for Addiction Studies in New York City.