THE UPCOUNTRY, S.C. — Erika Haas calls it “the pull.”
When Haas was 24, her doctor prescribed OxyContin for back pain. She quickly progressed to heroin — and then to methamphetamines. Now 30 and in recovery, she described the grip that meth had over her for more than five years.
“It’s like God tells you that if you take another breath, your children will die,” she said, shaking her head and trying to hold back tears. “You do everything you can not to take a breath. But eventually you do. That’s what it’s like. Your brain just screams at you.”
The opioid epidemic appears to be subsiding in the northwest corner of South Carolina, a region known as the Upcountry. Nationwide, the number of opioid-related overdose deaths is declining slightly. But a new variety of methamphetamine is taking its place as the No. 1 drug of abuse.
By most accounts, meth is much harder to quit. And the latest version of the illicit drug flooding the nation is cheaper than ever before.
Primarily imported from Mexico by major drug traffickers, “meth 2.0” is stronger, cheaper and far more plentiful than the old home-cooked variety. And with historic levels of funding from the federal government focused exclusively on fighting opioid addiction, states and counties are scrambling to find resources to combat this most recent drug plague.
In the small city of Greenville, Faces and Voices of Recovery staff work around the clock to provide a place people struggling with meth addiction can come to talk. CEO Rich Jones spends many evenings and weekends fundraising because little federal or state money exists to provide the kind of long-term support people in recovery from meth addiction need, he said.
Across town, Rebecca Maddox runs Phoenix Center’s Serenity Village, a women’s residential addiction treatment facility. The center receives substantial funding from Medicaid because patients are either pregnant or have custody of their children and therefore qualify for the federal-state health plan for low-income people.
She said federal funding for the center has remained flat for more than a decade, except for recent money targeted for treating opioid addiction. But data showed that opioid use was declining in Greenville, so “we didn’t get any of that money this year,” she said.
Sixty-three percent of the 81 women admitted to Serenity Village last year were treated for meth addiction. They include Haas, who is staying at the center with her three children.
When her heroin addiction caused her to lose everything, including her children, Haas said she decided to quit. Feeling sick and depressed as she came off the powerful drug, “some friends gave me meth and told me it would make me feel better,” she recalled. “It made my sickness go away, or maybe I just didn’t care about it anymore.”
For a time, Haas got her kids back. But within weeks, meth began to take an even bigger toll on Haas’ life. She lost custody of her oldest kids again, yet she said she still found it impossible to quit. After losing custody of her youngest, who just turned 1, she said she knew it was time to quit.
She checked into Serenity Village, and for the first few weeks, Haas said she struggled every minute of the day. But now, after nearly three months, “the pull” is starting to fade.
“When I get that pull,” she said, “I know I need to find someone who will tell me to play that tape again about what’s going to happen to me and my kids if I pick up,” she said, meaning if she started to use again. “I just need to find somebody to talk to.”
Harder to Stop
Pickens County, about 20 miles west of Greenville, has been hit hard by the meth surge.
Tucked into the foothills of the Blue Ridge Mountains and home to Clemson University, Pickens County is a destination for wealthy retirees who build multimillion-dollar homes on the shores of Lake Keowee and other scenic spots.
But jobs have been scarce and wages low ever since the cotton mills closed in the 1990s, creating stress and anxiety for many residents. That and its proximity to drug trafficking routes — it is less than 20 miles off Interstate 85, the main artery to Atlanta — have contributed to soaring meth use.
Between 2016 and 2017, the number of people seeking treatment for meth addiction nearly doubled in Pickens and the other nine counties in the Upcountry region, according to data from the state drug and alcohol agency.
In the midlands and coastal regions of the state, including Charleston, opioid addiction and overdose deaths remain the biggest threat, according to state data.
At Cafe Connections, a “coffeehouse ministry” in the town of Pickens, much of the talk is about families whose lives have been shattered by meth. The drug offers boundless energy to work extra shifts or clean the house — until it turns ugly.
“I can see on a personal basis what meth and other drugs are doing to our community. Homelessness wasn’t a problem in Pickens a few years ago. Now, it’s a big problem,” said Ann Corbin, who runs the cafe with her husband, Steve, and with support from the East Pickens Baptist Church and volunteers. Coffee, sweets and conversation are free at the cafe, a big airy former drugstore with cafe tables and cushy upholstered couches and chairs clustered along brightly painted walls.
Everyone here knows someone who uses meth or has lost a family member to its ravages, Corbin said. People have set aside long-held prejudices against drug users to focus on helping families who have been destroyed by meth.
The leap in deaths has been dramatic. The Pickens County coroner, Kandy Kelley, said 25 people died of a drug overdose in the county last year, topped by 39 as of September this year, mostly from a combination of meth, opioids and other substances.
At Behavioral Health Services of Pickens County, a state-funded drug treatment center a few doors down from the cafe, more people are seeking treatment for meth addiction than ever before, Executive Director Angela Farmer said. And those in treatment are having a much tougher time quitting.
Farmer, a licensed counselor and Pickens native, has seen a lot of changes in the habits of Pickens drug users over the 22 years she’s worked here.
More meth users are injecting the drug than smoking or snorting it as they did in the past, Farmer said, and people are starting to use it at a younger age.
“Our patients are struggling a lot more and they relapse more, and it takes them longer to engage in treatment,” Farmer said. “Most of our patients are compliant with their treatment for opioids, but they find it harder to stop using meth.”
With roughly 2,400 clients in a county of 120,000, Behavioral Health Services, which occupies nearly a full block of offices on Main Street, is bursting at its seams.
The county’s 50-year-old jail also is overflowing. In November, a new facility will open, providing more than triple the current jail’s capacity. And its staff will include an addiction treatment practitioner and a mental health counselor, thanks to a grant from the U.S. Justice Department.
“We haven’t been able to respond to as many of the drug-related crimes as we would like in the last couple of years, because we haven’t had anywhere to put them,” Pickens County Sheriff Rick Clark said. “It’s always a balancing act.”
Clark and other law enforcement officials say most of the meth supply in the region comes from Atlanta, where illicit labs convert liquid methamphetamine from Mexico into crystal powder for dealers to distribute across the South.
Not the ‘Pretty People’
Nationwide, the advancing meth scourge has yet to capture the kind of public response the opioid epidemic was, even though the nationwide spike in meth-related deaths in the past two years was steeper than the spike in opioid deaths two decades ago when that crisis began.
In the first decade of the opioid epidemic, the number of overdose deaths rose fourfold, from 3,400 in 1999 to 13,500 in 2009, based on a Stateline analysis of data from the U.S. Centers for Disease Control and Prevention. With the advent of cheap and powerful imported meth, the spike in deaths has been much sharper. Meth overdose deaths increased fourfold in half as much time, from 2,600 in 2012 to 10,300 in 2017.
Still, meth users are less likely to die of an overdose than users of painkillers and heroin. Instead, meth kills most of its victims slowly.
Opioids cause relatively little physical damage to chronic users, unless they take too high a dose. But meth takes a severe mental and physical toll on chronic users, destroying their appearance and substantially shortening their lives.
“If you want to know whether a town has a meth problem, just go to Walmart and take a look around,” Pickens Chief Deputy Chad Brooks said. Its symptoms are unmistakable: rotting teeth, skin lesions, extreme weight loss and premature aging.
The CDC only records meth-related overdose deaths — typically heart failure or stroke — resulting from using too much of the drug in a short period. It doesn’t include deaths from long-term use.
Despite the nation’s growing recognition because of the opioid crisis that addiction is a disease, Sheriff Clark said, society still tends to look down on meth users.
“I hate to say this,” Clark said, “but the reason we’re not hearing as much about the meth problem at the national level is that we don’t have as many pretty people dying of meth as we do with opioids.”
‘Rapid Downhill Course’
On average, patients addicted to meth require at least 90 days of intensive counseling and therapy to get started on recovery. And even then, nearly all of them can be expected to relapse multiple times before reaching sustained recovery, treatment experts say.
“Crystal meth accelerates the reward circuits in the brain more powerfully than any other drug we have,” said Dr. Paul Earley, an addiction physician in Georgia and the board president of the American Society of Addiction Medicine.
“There’s no doubt that it causes the most rapid downhill course of any drug.
“With heroin, people — Keith Richards [of the Rolling Stones], for example — can go on using the drug for 30 or 40 years without medical problems, as long as they dose it right,” the doctor said. “But with meth, 100% of people who use the drug experience severe and rapid physical deterioration.”
The Federal Drug Administration has approved three medications for the treatment of opioid addiction. Research is underway on meth addiction medications. Behavioral Health Services is one of seven sites funded by the National Institute on Drug Abuse in a study of the effectiveness of two drugs — extended-release bupropion sold as Wellbutrin and extended-release naltrexone sold as injectable Vivitrol — in easing detoxification and promoting recovery from meth addiction.
Farmer said Wellbutrin, a mild stimulant, seemed to alleviate the depression and exhaustion that typically occurs when people are coming off meth. She didn’t see as much evidence for Vivitrol warding off cravings.
But so far, no medications have been clinically proven to be effective in the treatment of meth addiction.
“If someone is addicted to opioids, they can get medication-assisted treatment pretty quickly,” said Charlie Stinson, executive director of GateWay Counseling Center, a state-funded treatment center in Clinton, another hard-hit Upcountry town.
“The problem is if they kick that addiction and start using meth, they can be out of luck when they decide it’s time for treatment.”