Do you have to leave Appalachia to find opportunity? One woman did and wants the region to receive more attention

Melissa Smith, center, left her Appalachian home behind
in search of a better life. (Melissa Smith photo via Fox News)

An upbringing surrounded by drug use, crime and poverty made one woman leave her Appalachian home in search of opportunity. She compares the region's problems to intercity issues, reports Teny Sahakian of Fox News. "Melissa Smith, 26, managed to leave her family and her hometown behind four years ago to build a better life, but she fears communities like hers will continue to rot without more attention. National media outlets report daily about the rampant crime and drug use afflicting major cities across the country. But Smith feels the Appalachia region as a whole doesn't get the same level of consideration, causing them to suffer in silence as they face similar issues."

Smith told Sahakian, "I just pray that something could be done, some opportunities could be created, rehabs could be made more readily available, and these people can get help and realize that there is a better life. But at the moment, it's just not talked about. Nobody talks about it." Sahakian reports, "Smith's grandmother raised her and her siblings in a trailer park in Corbin, Kentucky. Her mother, who struggled with drug addiction, was in and out of jail for most of her childhood. . . . Most of the kids she grew up with had at least one parent addicted to drugs. . . . Smith said she recently watched a YouTube video that featured interviews with Black Americans living in a poor area of California. She was shocked to hear how similar their stories were to her own."

The first wave of the opioid epidemic hit Appalachia during the 1990s and continued to gain steam through the 2000s when coal mine closures happened in quick succession. Smith said the pairing "ignited a cultural and economic downward spiral in rural areas across Kentucky, West Virginia, Tennessee and other states in the region," Sahakian writes. "Although the entire nation is facing a drug crisis, Appalachia is disproportionately impacted, according to the Appalachian Regional Commission. In 2020, overdose deaths of people ages 25 to 54 were 61% higher in the region compared to the rest of the country."

"Smith said many kids she grew up with are now either on drugs, in jail or dead from an overdose and that methamphetamines, rather than opioids, have become the drug of choice ravaging her community," Sahakian reports. "Most families rely on welfare checks or selling drugs to get by, she said, and with only one factory remaining in her town, the ability to work hard and improve one’s life seems impossible. . . Between 2001 and 2021, employment in Appalachia only grew 1.5% compared to 12% for the rest of the U.S., according to the Bureau of Labor Statistics." Smith told Sahakian: "They really don't have the opportunity to kind of improve or pull themselves up by their bootstraps."

Rural, under-served towns battle rising fentanyl addiction; N.M. town long troubled by drugs seeks new ways to cope

People in Española, N.M., wait to get inside Pathways homeless
shelter for the night. (Photo by Francine Orr, Los Angeles Times)

What does a town overwhelmed by fentanyl addiction look like? "In Española, New Mexico, shoppers and workers drive past addicts roaming Riverside Drive, the main drag in this town of 10,500. Kids played in trailer parks. . . . Cars came and went from a methadone clinic. . . . Men wearing hoodies and expectant gazes drifted toward a house with barred windows," reports Jeffrey Fleishman of the Los Angeles Times. "Rallying voices are trying to fix this community under siege. But it's unclear if the story of Española, where a quarter of the population is poor, will be a narrative about how to save a town from addiction — or lose it."

The data in Rio Arriba County, which has long been troubled by drugs, are startling. "Fifty residents died from drug overdoses during the one-year period ending in July 2022, among the highest totals ever recorded in the county, according to provisional data provided by the Centers for Disease Control," reports Kevin Deutsch of The Rio Grande Sun in Española. How did this happen? Fleishman writes, "Española is a troubling American tale. Its despair and suffering echo through cities large and small, from the pitched tents and open drug use in Los Angeles to the hamlets and hollows reeling from the opioid epidemic across Appalachia. The crisis is born from a decades-long misguided war on drugs, greed in the pharmaceutical industry, an ill-equipped prison system, failed treatment programs and a nation seemingly inured to the startling toll of addiction."

For Española, drug addiction came "after the Vietnam War as heroin, cocaine and other drugs flowed in from Mexico," Fleischman writes. "Heroin settled in hard for years. . . .But over the last two years, the market has been taken over by fentanyl. . . . The town has drawn addicts and the homeless from other states has too few detox and drug treatment centers. . . . . A 'baby box' has been built at the fire station to take in unwanted infants. . . . . Shoplifters haunt the aisles at Lowe's and Walmart. Syringes for heroin that once littered sidewalks and riverbanks have often been replaced by glints of tin foil used for smoking fentanyl."

Crime is addiction's partner. Cristian Madrid-Estrada, who runs the local homeless shelter Pathways with a gun on his hip, "spends much of his time at the shelter, giving addicts beds and warmth on frigid nights. But like others in this city, he contends with burglaries, robberies and thefts carried out by fentanyl addicts desperate to fuel their next high," Fleischman reports. "The state police and the county sheriff have been called in to help Española's understaffed police department, which reported 224 burglary calls last year, up from 155 in 2020."

Resident Nicko Zamora, who used drugs for over 40 years and now works to help addicts recover, told Fleischman, "A lot of us got sick on our secrets. Drugs were the Band-Aid. It goes with our heritage in a weird, crazy way. We've seen it happen to Great-grandpa, Grandpa, Dad and all the uncles. Drug use became normal." But fentanyl isn't a normal drug. Deutsch explains that the drug has a very short life. Addicts need it "all day, every day." Fentanyl's potency as addictive and short-lived is fueling the depth of this town's addiction crisis.

Some residents finding ways to create a future. "Madrid-Estrada and Pathways co-founders Ralph Martinez and former state Rep. Roger Montoya are working to change things. Martinez and Montoya helped get a $1.8 million grant for the property that houses the shelter, a Goodwill, a wellness center and a food pantry," Fleischman reports, "Martinez was once a man under a bridge, sleeping on the dirt, shooting heroin into a neck vein. . . . John Ramon Vigil, at 27, the youngest mayor in New Mexico, is proposing the state open a regional drug treatment center. And Jeramay Martinez, who sued OxyContin manufacturer Purdue Pharma, is raising the 4-year-old son of a fentanyl addict and plans to start an agency to help addicted mothers and children exposed to drugs in the womb."

Madrid-Estrada told Fleischman, "It does take a village. Everyone is just trying to figure out how to handle it all."

'Staggering increase' in opioid-fentanyl deaths, study finds

Graph from University of Illinois research paper; for a larger version, click on it.

The recent surge in deaths from opioid overdoses has been accompanied by a related increase in deaths caused by methamphetamine. "The U.S. methamphetamine mortality rate increased 50-fold between 1999 and 2021, with most of the added deaths also involving heroin or fentanyl, researchers report in the American Journal of Public Health," reports the University of Illinois, where the research was conducted. 

“We looked at trends from 1999 to 2021 and we saw this staggering increase in methamphetamine mortality accompanied by a proportional increase in those deaths that also involved heroin or fentanyl,” said Rachel Hoopsick, the UI professor who led the research.

The Centers for Disease Control and Prevention says 608 deaths were attributed to methamphetamine use in 1999; "that number increased to 52,397 in 2021," the UI news release says. "Hoopsick and R. Andrew Yockey at the University of Texas found that 61.2% of the methamphetamine overdose deaths in 2021 co-involved heroin or fentanyl."  Much of the increase in meth-related deaths occurred from 2010 to 2021 and shows no sign of abating, Hoopsick said.

"We knew from behavioral studies that the use of stimulants, in general, as well as the use of stimulants with opioids has been increasing over the past decade or two," Hoopsick said. "But we didn’t know how deadly it was becoming. I think what is different now versus 10 years ago is we have a much more toxic unregulated drug supply here in the U.S. . . . Methamphetamine by itself can be deadly, but its toxicity does not appear to have increased in recent years. The potency of illicitly manufactured fentanyl, however, has skyrocketed."

Hoopsick added, “I was really surprised to hear from the folks at the syringe service program that just as many of them were injecting methamphetamine as they were opioids, and many of them were co-using both types of substances. That got me thinking that the increase in methamphetamine mortality might be driven by the co-use of meth with illicitly manufactured fentanyl, in particular, which we’ve seen in the opioid overdose crisis is driving a lot of the deaths in the United States.”

Meth use dramatically increases odds of nonfatal overdose among rural drug users, whether used with opioids or alone

Nearly 80 percent of recreational drug users in rural areas have taken methamphetamines in the past month, according to a newly published study in the Journal of the American Medical Association. That's concerning, because meth use greatly increases the risk of non-fatal overdose—whether it's used alone or with opioids—and because rural drug users are more likely to suffer consequences from meth use but less likely to have access to treatment or prevention measures. Other studies have found that opioids were involved in about two-thirds of overdose deaths, and that fentanyl contamination increasingly drives opioid and meth-associated overdose deaths.

Overall, 22% of survey participants who co-used opioids and meth had survived an overdose in the past six months, compared to 14% of those who used opioids alone and 6% who used meth alone. Participants who co-used most often (44%) were also more likely to have tried and failed to access drug treatment measures than those who used opioids alone (36%) or meth alone (30%).

The researchers noted that meth use has been endemic in rural areas for decades, and that meth-related hospitalizations nationwide skyrocketed 270% from 2007 to 2015. Even so, not much research has focused on the characteristics of purely rural meth use, or meth use combined with opioid use.

Researchers gathered data for the study from January 2018 to March 2020, surveying drug users in rural communities in the 10 states participating in the Rural Opioid Initiative Research Consortium: Illinois, Kentucky, Massachusetts, New Hampshire, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin. The findings suggest that harm reduction and drug treatment programs must address meth use as well as opioids to decrease overdoses in rural communities, the researchers write.

DEA issues public warning about deadly black-market pain medications laced with fentanyl and methamphetamine

"The Drug Enforcement Administration issued a public warning Monday that a growing number of pain medications bought on the black market are laced with the synthetic opioid fentanyl or the stimulant methamphetamine, driving overdose deaths to record levels," Devlin Barrett reports for The Washington Post. "Officials said the DEA hasn’t issued such a public safety alert since 2015, when the agency warned that agents were seeing an alarming amount of heroin laced with fentanyl. Fentanyl, even in much smaller amounts, is deadlier than street heroin."

Drug overdose deaths in 2020 surpassed a record 93,000, up nearly 30 percent from 2019. "In recent years, the death toll has risen sharply, fueled in large part by fentanyl, a synthetic opioid that is relatively cheap to manufacture and distribute," Barrett reports. "Last year, drug overdoses killed more than twice as many Americans as car crashes."

Illegal drug trafficking is increasingly shifting from plant-based drugs such as cocaine and heroin to chemical-based drugs such as meth and fentanyl. "The DEA has seized 9.6 million counterfeit pills already this budget year, which is more than it seized in the previous two years combined, officials said. The number of seized counterfeit pills found to contain fentanyl has jumped 430 percent since 2019," Barrett reports.

The drug epidemic, mostly fueled by opioids, has been getting worse since 1999. "At first, that drug abuse centered around prescription pain pills, such as Oxycodone, Vicodin or Percocet," Barrett reports. "In recent years, the death toll has risen sharply, fueled in large part by fentanyl, a synthetic opioid that is relatively cheap to manufacture and distribute. Last year, drug overdoses killed more than twice as many Americans as car crashes."

Meth-overdose deaths tripled in 2015-19; still most prevalent by far among Native populations, but soared among Blacks

Deaths from methamphetamine overdoses increased 180 percent from 2015 to 2019, and "Researchers found Native Americans and Alaska Natives still have the highest rate of methamphetamine use disorder and have seen sharp increases in drug deaths in recent years," Brian Mann reports for NPR.

"The difference is gigantic" between those groups and the rest of the population, said Dr. Nora Volkow, director of the National Institute on Drug Abuse, who co-authored the study published Wednesday in the journal JAMA Psychiatry.

"Methamphetamines are increasingly deadly because much of the supply of the stimulant sold on the street is contaminated with the potent synthetic opioid fentanyl," Mann reports. "Volkov says use of the drug has also spread rapidly into communities where it was once considered rare. Black Americans saw a tenfold increase in methamphetamine use over the same five-year period. Dr. Stephen Taylor, a psychiatrist and fellow with the American Society of Addiction Medicine, says the nation's focus on the opioid crisis — with its devastating impact on white, rural communities — distracted attention and resources away from the deadly spread of methamphetamines in communities of color."

The data in the study precede the pandemic, but Volkov noted that information collected by the Centers for Disease Control and Prevention last year "points to another more recent spike in methamphetamine-related overdose deaths," Mann reports.

Meth OD deaths and opioids in pregnancy spiked in past decade; study points to possible meth-addiction treatment

Two new studies illustrate the impact of drug addiction in rural America over the past decade. 

The first study, published in the Journal of the American Medical Association, found that the incidence of pregnant people diagnosed with opioid-use disorder increased 131 percent nationwide from 2010 to 2017, and the nationwide incidence of babies born with withdrawal symptoms increased 82% in that same period. Though increases were seen in almost all demographic groups, the groups with the highest rates of both diagnoses were rural, white and relied on Medicaid. 

The second study, published in JAMA Psychiatry, found that methamphetamine overdose deaths surged nationwide from 2010 to 2018, especially among Native Americans and Alaskan Natives (many of whom suffer health disparities linked to poverty and rural disparities such as lack of access to health care).

Researchers say they may have found an effective treatment for meth addiction. In a study published in The New England Journal of Medicine, researchers outline how a combination of two relatively familiar medications (the antidepressant bupropion and the addiction treatment medication naltrexone) can safely and effectively treat adults with moderate or severe methamphetamine-use disorder. However, they caution, more research is needed.

Meth from Mexican drug cartels is on the rise in Appalachia, fueled partly by officials' efforts to cut off opioid access

Central Appalachia has been long known as a hotbed of opioid addiction, but, aided by Mexican drug cartels, methamphetamine abuse has been surging in the area for the past few years, presaging a nationwide increase in abuse of a more powerful form of the drug.

"The region where Kentucky meets Ohio and West Virginia has served as a harbinger of national drug trends," Timothy Williams reports for The New York Times. Pain pills like OxyContin, stimulants known as bath salts, prescription anti-anxiety medications like Xanax and, more recently, heroin and fentanyl were all adopted by drug users here before gaining wider use nationally."

Efforts to end opioid abuse, along with increasing awareness of the dangers of adulterated opioids, have led to the resurgence of crystal meth. "Doctors and hospitals have unwittingly accelerated the switch to methamphetamine by significantly reducing their patients’ access to pain medication; opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute," Williams reports. Mexican drug cartels such as Sinaloa or the Jalisco Nueva Generación have "sought to fill the vacuum by targeting Appalachia, federal drug officials say. The traffickers follow the same business model that allowed them to inundate the nation with heroin: make meth potent and sell it cheap to ensure a steady customer base, and ultimately, mass addiction."

Until recently, meth was mostly a locally made product that varied widely in strength, but the newer Mexican version is often mixed with cocaine and/or fentanyl. Because fentanyl is cheap and a little goes a long way, it and cocaine enhance the user's high and hasten addiction, Williams reports. But it also makes overdoses more likely.

South Dakota anti-meth ad campaign widely mocked, but governor says it's doing its job by getting people's attention

Part of the ad campaign

South Dakota is getting a lot of attention for a new ad campaign to raise awareness of the state's methamphetamine problem—likely not in the way state officials wanted. The campaign has been widely mocked for making it sound as if meth use is a good thing, Michael Brice-Saddler reports for The Washington Post.

Gov. Kristi L. Noem unveiled the "Meth. We're On It." awareness initiative on Monday, which includes a TV ad, billboards, posters, and a website; an accompanying news release highlighted the fact that meth use among South Dakota teens is double the national average, Liza Kaczke reports for the Argus Leader in Sioux Falls.

"But Bill Pearce, assistant dean at the University of California at Berkeley’s Haas School of Business, said any sincere messaging by the governor was lost by an ad campaign that embodies 'poor strategy and poor execution,'" Brice-Saddler reports. "I can’t imagine this is what they intended to do; any good marketer would look at this and say: 'Yeah, let’s not do that.' . . . I’m sure South Dakota residents don’t like being laughed at. That’s what’s happening right now."

The state's Department of Social Services has paid Minneapolis ad agency Broadhead Co. nearly $450,000 for the campaign. The contract allows for up to $1.4 million in payments. Social media immediately blew up with posts and tweets mocking the ads, but Noem declared the campaign a success because she believed it's fulfilling its mission of raising awareness, Kaczke reports.

Noem "might have added that the campaign only continues a tradition of weird South Dakota marketing," Nat Ives writes for The Wall Street Journal. "It follows a campaign seeking long-term residents that set a pretty low bar (“Why die on Mars when you can live in South Dakota?”) and a safe-driving push themed “Don’t Jerk and Drive.” The state canceled that one after complaints."

Love the campaign or hate it, but one thing's for sure: a lot more people are talking about South Dakota's meth problem this week than last week.

Tomorrow is deadline to register for Covering Substance Abuse and Recovery journalism workshop in Ashland, Ky.

Tomorrow, Nov. 8, is the deadline to register for Covering Substance Abuse and Recovery: A Workshop for Journalists, to be held in Ashland, Ky., on Nov. 15. Space is limited. Details and registration are here.

The workshop has been designed with rural journalists in mind, because research at Oak Ridge Associated Universities has found that the stigma still attached to drug abuse keeps people from seeking help. “The increasing news media reports of opioid-related overdoses and crimes has led many to overlook the fact that prevention programs are working and that many people are entering treatment and living in active recovery,” ORAU said in a report on its study.

It also said local news media could help by reporting more success stories from people in recovery. "We think stigma also discourages some news outlets from reporting on substance abuse and recovery, and that’s why we’re holding this workshop," said Al Cross, director of the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog.

"We have a national-quality lineup of reporters who have won Pulitzer Prizes for their coverage, a weekly newspaper editor-publisher who has tackled the subject head-on, a recovering addict who writes a newspaper column about his experiences, and several experts on the subject," Cross told editors in an email this week. "We don’t know of another such workshop having been held anywhere, and we want you to be part of it."

The workshop will be held at the Marriott Delta Downtown from 8:30 a.m. to 5 p.m. Nov. 15. Early arrivals have an informal gathering at the hotel the night before, and a special room rate of $109 is available through today. The registration fee is $60.

Cross wrote, "As we planned this workshop, I thought of one of the best-known lines from the play Death of a Salesman: 'He's not the finest character that ever lived. But he's a human being, and a terrible thing is happening to him. So attention must be paid. He's not to be allowed to fall into his grave like an old dog. Attention, attention must finally be paid to such a person.' Let's pay attention to these people and their problem, and help solve it."

Save the date: Covering Substance Abuse and Recovery, a workshop for journalists, will be held in Ashland, Ky., Nov. 15

UPDATE, Oct. 1: Registration for the workshop has opened; click here for information and registration.

Covering Substance Abuse and Recovery: A Workshop for Journalists is designed to help rural journalists cover a difficult subject, but one that needs covering to help their communities deal with it. It will be held by the Institute for Rural Journalism and Community Issues and Oak Ridge Associated Universities in Ashland, Kentucky, on Friday, Nov. 15.

More details and online registration will be available soon, but we have lined up several award-winning speakers who have been leaders in covering these topics in Appalachia and adjoining areas:

• Beth Macy, award-winning author of Dopesick: Dealers, Doctors, and the Drug Company That Addicted America, just released in paperback.
• Terry DeMio and Liz Dufour, Pulitzer Prize-winning journalists from The Cincinnati Enquirer; DeMio has been the newspaper’s opioid beat reporter for five years, and Dufour is the lead visuals person on the beat and the Pulitzer-winning series, "Seven Days of Heroin."
• Eric Eyre, Pulitzer Prize-winning reporter from the Charleston Gazette-Mail, who revealed opioid distribution patterns in West Virginia.
• Sharon Burton, editor publisher of the Adair County (Ky.) Community Voice, a national leader in substance-abuse coverage by small newspapers.

Research by Oak Ridge Associated Universities has shown that the stigma attached to drug use and addiction are major obstacles to news coverage of the problem, which makes it harder for communities to find solutions.

Attendees will learn about the issues from a variety of experts in the field including award-winning journalists, authors, researchers, officials and people in recovery. Our goals are to make sure you:

• Understand the depth and breadth of the problem and how it affects local communities
• Know how to get reliable data and other local information for your reporting
• Develop local, state, regional and national sources for stories and story ideas
• Hear reporters explain how they cover the problem and the people affected by it
• Appreciate the role of local news media in reducing the stigma that inhibit local action

The workshop will be held on Friday, Nov. 15 in Ashland, Kentucky, with a welcome reception on Thursday evening, Nov. 14. Online registration will be required, with an early-bird registration rate of $50 to cover meals, snacks, and materials. Please contact Al Cross at the University of Kentucky’s Institute for Rural Journalism and Community Issues with any questions: acros3@email.uky.edu

DEA, state and local agents seize over 800 pounds of meth in three states, arrest 375 in seven-month investigation

DEA map shows location of agents and amounts of methamphetamine and arrests in each state.

If you were looking for proof that methamphetamine has resurged in Central Appalachia and adjoining regions, here it is. The Drug Enforcement Administration announced this week that more than 800 pounds of meth were seized 375 arrests made in "Operation Crystal Mountain," a seven-month investigation in Kentucky, Tennessee and West Virginia.

DEA said 235 people had been arrested on federal drug-related charges since January, and another 140 on state-level charges. "The operation also included the seizure of more than $800,000, 52 firearms and significant quantities of heroin, fentanyl and other drugs," reports Hayes Hickman of the Knoxville News Sentinel.

"Several large swaths of the U.S. see meth as their primary drug threat," D. Christopher Evans, special agent in charge of the DEA Louisville office, said in a news release. "The majority of methamphetamine in the U.S. is produced in Mexico and trafficked by Mexican DTOs (drug trafficking organizations). However, the DEA continues to work to disrupt and dismantle all components of both foreign and domestic organizations which produce and traffic methamphetamine."

Fentanyl, an added ingredient, drives increases in deaths from cocaine and methamphetamine overdoses

The same drug that is driving opioid-overdose deaths is also causing a surge in deaths from cocaine and overdoses of psychostimulants such as methamphetamine and legal drugs like Adderall.

"That’s according to a new analysis of death certificate data from the U.S. Centers for Disease Control and Prevention, showing that fentanyl — a cheap synthetic opioid that is a hundred times more potent than morphine — and other opioids were involved in nearly three-fourths of all cocaine overdose deaths and an increasing number of methamphetamine deaths," Christine Vestal reports for Stateline, the nonprofit, nonpartisan reporting arm of the Pew Charitable Trusts. Dealers are adding fentanyl to cocaine and meth.

Death rates from cocaine and psychostimulants increased from 2016 to 2017 in both rural and urban areas, and the most rural counties showed the biggest relative rate increase, the CDC study says. Efforts to fight the overdose epidemic have mostly focused on opioids, which have killed more than 700,000 Americans since 1999, but CDC officials say states and localities need to be more aware of emerging threats like fentanyl, Vestal reports.

Christopher Jones, strategy director at the CDC’s National Center for Injury Prevention and Control, told Vestal: "Broader awareness of emerging drug threats and how they intersect with the opioid-overdose crisis will help public health officials and the health care community better tailor their prevention and response efforts for all the substances and combinations of substances people are using in their community."

Meth, cheap and available, makes a comeback in the U.S.

Though the opioid epidemic has garnered the lion's share of headlines, methamphetamine use is on the rise across the U.S. "Even in rural communities ravaged by decades of experience with the drug, meth is on the upswing thanks to its relatively low price, availability and a shortage of treatment options," Frank Morris reports for NPR.

Partly because the U.S. tightened access to common meth ingredients like pseudoephedrine, "Methamphetamine is now the domain of Mexican drug cartels that are mass-producing high-quality quantities of the drug and pushing it into markets where it was previously unknown," Morris reports.

Meth and opioid abuse trigger many of the same social problems. Beyond health risks, which include getting hepatitis A from risky behavior while high, drug abuse spurs theft and prostitution. Children of users suffer too, as their parents leave them unsupervised or sell food and use rent money to buy more drugs.

"The meth problem has basically exploded across every race and social-economic class that you can imagine" and is reaching people and places it never did before, Sgt. Mark McClendon of the Missouri Highway Patrol told Morris.

Sperling's Best Places map

Because the government has prioritized fighting the opioid epidemic, there aren't many intensive treatment resources for uninsured meth users, and there are no government-approved medications to treat meth addiction, Morris reports. Faith-based initiatives appear to be trying to fill in the gap, at least in southeastern Missouri.

Dustin Siebert, who used to use and manufacture meth, founded one of them — the Matthew 25 Project — in the Missouri Bootheel town of Qulin (pop. 450). He preaches to meth addicts and their loved ones that God meant for people with addictive personalities to be addicted to religion instead of drugs. "Because the problem is addiction," he told the group recently. "Until they figure out why people want to get high and use drugs, it's always going to be something else."

Fewer U.S. workers are using prescription opioids, but more are using cocaine, methamphetamine and marijuana

Fewer U.S. workers are using prescription opioids, but more are using methamphetamines, cocaine, and marijuana, according to data released by Quest Diagnostics, which conducts workplace drug testing, Katie Zezima reports for The Washington Post.

The overall percentage of workers who tested positive for drug use remains unchanged since 2016 at 4.2 percent, but it's higher than the 3.5 percent return in 2012. Positives for meth have increased 167 percent in the South and Midwest in the past five years, and cocaine positives have increased dramatically in some areas: there was a spike of 91 percent in Nebraska and 88 percent in Idaho from 2016 to 2017. Marijuana positives have increased in states where recreational use of the drug has been legalized, such as Nevada, Massachusetts, and California. Those states also saw a bump in positive marijuana tests among safety-sensitive workers such as pilots and truck drivers, Zezima reports.

"The increases come as the number of workers testing positive for prescription opioids and heroin have declined, even though the opioid crisis continues to ravage the United States," Zezima reports. "The rate of drug tests that were positive for a prescription painkiller declined by 17 percent from 2016 to 2017. Tests for a metabolite that is in heroin dropped by 11 percent from 2016 to 2017, a three-year low." Part of that may be because Quest doesn't test for synthetic opioids such as fentanyl, which is driving the increase in drug overdose deaths.

Barry Sample, senior director of science and technology at Quest, told Zezima: These changing patterns and geographical variations may challenge the ability of employers to anticipate the 'drug of choice' for their workforce or where to best focus their drug prevention efforts to ensure a safe and healthy work environment."

Click here for a handy guide for journalists on how to cover rising meth use, from Journalist's Resource at Harvard University.

Twice-weekly newspaper tackles homelessness in northwestern North Carolina with three-part series

Here's a worthy read: a three-part series by Kayla Lasure of the twice-weekly Watauga Democrat in the northwest corner of North Carolina, delving homelessness in a seven-county region that has the second-highest rate of homelessness in the state: Alleghany, Ashe, Avery, Mitchell, Watauga, Wilkes and Yancey counties. A 2017 count documented 466 homeless in the region, about 70 percent of them unsheltered. Another 69 who were placed in permanent and rapid rehousing weren't part of the homeless count, Lasure reports in her first story.

Several community members told Laysure they want to erase the stigma of being homeless; Todd Carter, the director of the area's homeless shelter, the Hospitality House, told her that many of the residents are judged for listing the shelter as their address. But many don't realize that 63 percent of shelter residents "recently went through some form of trauma. This wasn’t counting any trauma the person had experienced in the past or in childhood," Lasure reports.

Hospitality House Executive Director Tina Krause told her: "We're not just a homeless shelter; we're a trauma center providing critical care." Krause said that most weeks, at least one client acts on a suicidal thought, and that there were six suicide attempts on site in one week last winter, and one client died off site.

The McKinneys with their newborn son Liam.
(Watauga Democrat photo by Kayla Lasure)

In her second story, Lasure illustrates the lack of resources for the homeless by profiling Justin and
Amanda McKinney, who are rebuilding their lives after years of homelessness, jail and drug abuse. After Amanda  was released, she had a hard time affording a place to live because no one would hire her with her criminal history. After living at the Hospitality House for three months and sending out 42 job applications, she finally landed a job, but didn't tell her employer where she lived until she had proved her work ethic.

Justin's story began similarly: While deployed in the Air Force, he broke his back in an explosion and needed surgery. He became addicted to the opioids he was prescribed, and said the withdrawal was so painful that he began using methamphetamines to cope. He also had difficulty finding work or housing after his release, which led to Hospitality House.

The couple told Lasure they had little in the way of support from family or friends because of their addictions. "When you’re in an addiction, you push a lot of people away, and people distance themselves from you," Justin told Lasure. "You do a lot of things during an addiction you wouldn’t normally do. You crush your own support system."

In her third story of the series, Lasure profiles a Watauga County sheriff's sergeant's efforts to change the way other law-enforcement officials view the homeless community. "Sgt. Casey Miller is a member of the Sheriff’s Office Problem-Oriented Policing Squad . . . a call-based group that can concentrate on community issues that regular patrol deputies wouldn’t have the time to focus on. These issues consist of places with common reports of speeding or drug activity," Lasure reports.

Sheriff Len Hagaman told Miller that neighbors of Hospitality House were complaining that shelter residents were trespassing on their property, loitering, dealing drugs, and leaving trash. Miller met with area leaders and listened to their concerns, then investigated. It turned out that Hospitality House residents weren't the culprits: about 15 people who lived in the community were preying on the residents, trying to sell them drugs, get money from them or steal their belongings. The 15 were ordered to stay away; three were later caught and charged with trespassing.

Miller told Lasure that the issue caused him to think differently about the homeless, especially when he learned that 96 percent of Hospitality House's clients reported at least one instance of trauma in the past year. He says he now checks up on residents and tries to get to know them. "What people don’t understand they tend to try to avoid," Miller told Lasure. Officers "don’t think bad of homeless people; they can’t wrap their head around why they can’t just go out and get a job and a house. It’s not always that simple."

Study of Ky. meth-lab busts boosts case that drug use is less prevalent where alcohol sales are legal

Meth use is more prevalent in counties where the sale of alcohol is illegal, say researchers at the University of Louisville. They looked at meth-lab seizures (based on Drug Enforcement Administration records) and local-option ordinances in Kentucky counties from 2004 to 2010, and found that "the number of meth-lab seizures in Kentucky would decrease by 34.5 percent if all counties became wet." (UofL maps: Meth lab seizures by county, with green indicating more busts; alcohol status: red for wet, orange for moist or limited, and yellow for dry)

In 2010 Kentucky had 39 "dry" counties (where all alcohol sales are banned), 32 "wet" counties (sales are allowed), 20 "moist" counties (contain some wet jurisdictions) and 29 "limited" counties (sale by the drink in restaurants meeting certain criteria). All the dry counties were rural; several have since gone wet or moist.

For the study period the mean lab-seizure rate was 2.17 per 100,000 residents in wet counties, 2.26 in moist counties and 3.92 in dry counties. The highest rates of lab seizures were along the border of Tennessee, a state in which beer is generally available but stronger drink is less so.

Christopher Ingraham of The Washington Post reports, "After running some statistical tests, the researchers found that this is more than just a simple correlation." They said, "Our results add support to the idea that prohibiting the sale of alcohol flattens the punishment gradient, lowering the relative cost of participating in the market for illegal drugs."

"In other words: people who buy alcohol in places where it's illegal become accustomed to dealing with the black market," Ingraham writes. "If you're going to get punished whether you trade in booze or trade in meth, why not give meth a spin?" (Post graphic using data from UofL study)

The UofL research "fits in with other findings showing harmful effects of localized alcohol prohibitions," Ingraham writes. "A 2005 paper in the Journal of Law and Economics found that when Texas counties changed from dry to wet, their incidences of drug-related mortality decreased by 14 percent as people substituted alcohol for other drugs. Records from the Kentucky State Police show that dry counties tend to have higher rates of DUI-related car crashes than wet ones, presumably because when you live in a dry county, you have to drive farther to get your booze. A 2010 report from the Robert Wood Johnson Foundation found that binge drinking rates were often higher in Alabama's dry counties than its wet ones."

Drug-overdose deaths spike in rural Colorado

Drug overdose rates in Colorado have hit record levels, increasing 68 percent from 2002-2014, with numbers especially high in rural Southern agricultural counties, says a report by the Colorado Health Institute. In 2002, the state had 9.7 drug overdose deaths per 100,000 people. Deaths nearly doubled in 2014, up to 16.3 per every 100,000 residents, above the national average of 14.7 drug-related deaths per every 100,000 people. (Colorado Health Institute graphic: Drug overdose deaths in 2014)

Twelve counties had more than 20 overdose deaths per 100,000 people. Seven are located in rural areas, all in the southern half of the state. Baca County, near the Kansas border, had the biggest increase, going from 4.1 to more than 20 deaths per 100,000 in 2014. (Drug overdose deaths in 2002)

An influx of heroin to the state's poorest and least populated counties is one of the reasons for the increase, along with a rise in abuse of prescription drugs and methamphetamine. In 2012-13 Colorado ranked 12th nationally in non-medical use of opioid painkillers, with state statistics showing that 25 percent of state residents said they had used pain medications not prescribed by their doctor and 29 percent saying they had used pain medications prescribed for someone else.

Overall, 63 of Colorado's 64 counties experienced an increase in drug overdose deaths from 2002 to 2014, David Olinger reports for The Denver Post. Tamara Keeney, a policy analyst at the Colorado Health Institute, told Olinger, "We do know that heroin and prescription drugs are what's driving the increase across the board. Cocaine has actually decreased as a cause. It was surprising to us to see that it wasn't just the urban counties."

Bent County Coroner Dave Roberts, who said many of the deaths in his county are the result of prescription painkillers, said the average age of death is early 30s, Olinger writes. Roberts told him, "When I first started, there were hardly any overdoses. Now it's really prevalent... It's amazing the amount of meth that's in small counties."

Rural meth users in South Carolina more likely to be poor white women, says UCLA study

Rural meth users in South Carolina are more likely to be poor white women, said a study by researchers at UCLA presented last week at the American Academy of Addiction Psychiatry meeting in Huntington Beach, Calif., Parker Brown reports for MedPage Today. The study, which included 199 participants in Los Angeles and 66 participants in rural eastern South Carolina, found that 63 percent of rural meth users were women, compared to 28 percent in urban areas. In rural areas, 98 percent of meth users were white, compared to 22 percent in urban areas, and 77 percent of rural users make less than $15,000 per year, compared to 48 percent of urban users. (South Carolina Law Enforcement Division graphic)

"There was no significant difference in the level of education in the two groups, but rural users also had less use in the past 30 days, using methamphetamine six times on average during the last 30 days versus 20 days in the urban group," Brown writes. "'Understanding regional differences may improve treatment adherence and retention,' the authors wrote, noting that white women from rural areas with a lack of education and job opportunities may have different treatment needs than men living in urban areas."

Emily Hartwell, a fourth year clinical psychology graduate student at UCLA, who was the lead researcher, told Brown, "It's possible that because meth was introduced in the [western U.S.] and has slowly trickled its way across the country, rates are higher in the west. So in some ways, it's not surprising that people are using quite as much, just in that it's a new substance on the east coast. But for it to be this different was a little surprising." (Read more)

Bill introduced in Maine would make possession of meth-making ingredients a felony

Maine Sen. Kimberley Rosen (R-Bucksport) introduced legislation, backed by the attorney general's office, to help curb the state's meth problem by making the operation of a meth lab or possession of meth-making materials, a felony, Christopher Cousins reports for Bangor Daily News.

Assistant Attorney General Lisa Marchese told Cousins,“There are significant investigative and environmental costs associated with the response to and cleanup of a methamphetamine lab, yet people are operating these labs in cars, hotels, apartment buildings and their own dwellings, often putting their children at risk. This is a growing problem, and the Maine Legislature must act."

Critics say the proposed bill is too stern, Cousins writes. Walter McKee, an Augusta-based criminal defense attorney and member of the Maine Association of Criminal Defense Lawyers "said the bill would make possession of what is essentially a single dose of fentanyl a felony. He told Cousins, “The simple possession of a drug in and of itself should not be a felony. These people have a bad addiction. They have possession of a dangerous drug, but that should not make them convicted felons.” Critics says the key is prevention and treatment. (Read more)