Despite the narrative of a meth overdose crisis, on some level the public understands that people using fentanyl are at risk in a way that people using just meth are not, because it’s not quite okay to openly demonize the victims of a mass death situation. But if you want to openly demonize meth users, that’s okay. And yet, if we take a closer look at meth in the context of the larger unregulated drug supply, we can see that public opinion has gone a little off course.

Most meth overdose isn’t physically harmful; occasionally someone might have a seizure, but it won’t hurt them. The supply is consistent. The supply is pure. The global supply chain is decentralized.

Meth has a withdrawal process, kind of, but nothing gastrointestinal. It’s shelf-stable dry or in liquid for months, probably years. It’s rural but also urban. It’s health care amid an Adderall shortage. It’s working class. It’s gay. It’s trans. It’s pretty. It’s invisible. It’s cheap.

Like it or not, meth is the people’s drug. It’s there for the people who need to stay awake when it’s not safe to sleep, or when their jobs won’t allow them to sleep. It’s there when people can’t afford food. It’s there for the people who can’t access antidepressants. It’s there to facilitate sex work. It’s there to give people the energy to carry their stuff around. It’s there to let people feel alive—or numb, depending—even in the most miserable of circumstances where they’re supposed to feel only bad things.

And the state hates that. You go and make all these laws to ban certain people from every place they could possibly try to get a job, get a home, go to sleep, go to the bathroom, you cut every social support out from under them and chase them out of anywhere they try to rest, but no matter what you do to get them to finally just lay down and die, meth picks them up and keeps them going.

I have some bias. I used meth for three or four years, every day, and while it made a lot of things in my life harder I’m not sure how else I could have managed the things it made easier. Plus when meth causes problems for people I don’t interpret that as the meth being, like, sinister, it’s just a function of whatever else people have going on in their lives at that time. I also never would have met my husband if meth hadn’t kept him alive for the decade or so when the rest of the world was trying to kill him, so even though it’s not part of my life anymore (or his) I default to a warm opinion of anyone who is using it. 

People look down on meth like it’s the drug you do when you’ve given up on life, which bugs me because I do not see that at all. I always saw it as something people use to participate. And in pretty much any context, but especially with anyone who doesn’t have housing, it always seems like meth is what people use when it’s hard to keep going, but they want to.

Opioid users hear all day long about how the supply is dangerous because it’s adulterated. Meth users are punished because the supply is pure. Even though consistent purity and potency are traditionally good qualities for a drug supply to have, from a public-health perspective.

“[M]ethamphetamine is less physically dangerous or addictive than heroin or cocaine, yet methamphetamine is now punished more severely than any other drug,” the National Association of Criminal Defense Lawyers wrote to the United States Sentencing Commission in 2025, referring to federal meth sentencing being determined by purity rather than by weight the way it is for other drugs. “Not only do the current methamphetamine guidelines lack a legislative basis, they also lack any empirical justification … sentences now receive massive arbitrary enhancement based entirely on whether the methamphetamine received laboratory testing [to establish purity], something that is obviously beyond the control, and unrelated to the culpability, of any defendant.” 

And then there’s police violence, which benefits from the same bias driving the narrative of a meth overdose crisis—once you say someone used meth, nobody questions why they died. They were unarmed and police shot them 10 times? Well, they were on meth. It’s so potent these days.

“We started to see a pattern of kind of irrational, aggressive behavior on the part of the people that were being shot or shot at,” a special prosecutor in a New Mexico told Colorado Public Radio of rising meth use in 2020, describing the case above. “It didn’t make any sense to us.”

Okay. 

In 2024, a Black man died after 40 minutes naked in a Wyoming county jail restraint chair, with two straps across his chest in addition to the restraints on his limbs, saying he couldn’t breathe. The forensic pathologist found no evidence of restraint-related death, but instead cited “methamphetamine overdose and the cardiac effects of excited delirium.” Remember excited delirium? The racist and unscientific diagnosis has been rejected by the medical establishment as a valid cause of death, because it was just how cops covered up excessive force. But this is “excited delirium due to methamphetamine overdose.” So it’s different.

Over the past decade the US harm reduction movement has been defined by the overdose crisis, and so services and policies have been designed for people who use opioids, then retrofitted for people who use stimulants.

Which is understandable; opioids are straightforward. We have methadone and buprenorphine, we have naloxone, we have the policy goal of overdose prevention centers and eventually safer supply. We have a clearly defined mechanism of overdose death, and we have a target demographic that—broadly speaking—uses fentanyl in similar settings and for similar reasons.

Stimulants are less straightforward. They interact with a wider range of systems in the brain and body, they produce a wider range of physical and psychological effects, and meth specifically appears in extremely different contexts in different people’s lives—chemsex, sex work, shift work, street homelessness, studying. Daily daytime use, monthly nighttime bingeing. And so on. It’s more difficult to categorize meth users and pin down what common services they need. If they need housing there’s only so much that harm reduction groups can do, and if they need a harm reduction resource other than sterile syringes and fentanyl test strips, whatever it is probably hasn’t been legalized yet anyway.

We’ve organized around access barriers to methadone and buprenorphine for opioid use disorder. But for stimulant use disorder this would require a policy leap more in the direction of safer supply, and so rather than organizing around stimulant agonist medications we just observe that we don’t have any. Instead we have contingency management, the practice of telling meth users that if they do a good job peeing in a cup they will be eligible for Walmart gift cards. And, now that they have something to look forward to, they don’t have to get their dopamine rush from stimulants anymore.

The movement hasn’t known what it’s supposed to offer meth users because it approaches the problem through a fentanyl lens, thinking in terms of meth’s physical effects and risks and harms. When it shouldn’t really be looking at meth, but at the people who use it. Queer communities, Indigenous communities, sex workers, people living with HIV, people living outside, people cycling through the criminal-legal system. The harms that the movement can reduce for meth users come primarily from being overpoliced. And from really bad public relations.

Artwork by Brooke Alexandria Paine. First inset image via County of Fresno. Second inset image (cropped) via Reentry Council of the City & County of San Francisco.

The post Big Shoutout to Meth appeared first on Filter.

The Nigerian mafia are not a single group. The term describes a vast network of different syndicates, but it is what everyone here calls them. Their presence in Cape Town is not new. In the late 1990s, a few years after apartheid ended, these syndicates first set up shop in Sea Point, an affluent suburb known for its safety and contributions to the economy. But they were pushed out of these communities and instead settled into Cape Town’s northern suburbs, where they could more easily operate under the radar.

Their modus operandi is to establish a foothold in an impoverished area where gang activity is not particularly strong. Once entrenched, they seek out local gangs they can collaborate with to distribute drugs more effectively. This allows them to expand, and results in a complex, decentralized web of different illicit activities.

From the northern suburbs the mafia began selling crack cocaine, and soon powder cocaine. Today, powder cocaine remains the biggest component of the trade, but the syndicates also supply other criminalized drugs like MDMA and tik, or methamphetamine.

“Our goal is to establish dominance by offering better drugs and protection,” BJ*, an upper-level supplier in his early 30s, told Filter. “It’s about building trust and ensuring that everyone benefits … We all need to support our families in Nigeria, and being involved in criminal activity is the easiest way to do it—to keep our families under a roof and food in their stomach. We are doing it to survive, without ill intentions.”

Local gangs often sell cheaper drugs that they manufacture themselves, but the Nigerian mafia’s cocaine and MDMA is imported from transnational drug-trafficking organizations in South America. It’s widely known that the quality is superior. The mafia is involved in manufacturing methamphetamine, but much of this is shipped to other countries where it can be sold at a higher price.

“Cocaine [is] the easiest and most lucrative trade which doesn’t require any legal [documentation], as the majority of us are in the country illegally.”

BJ is from Abuja, the capital city of Nigeria. He’s been in Cape Town for more than a decade now, and like many Nigerians living in South Africa he is undocumented. He is primarily involved in the importation and distribution of cocaine, but he also sells MDMA and tik. He’s a very resourceful individual.

“We didn’t come here to only be drug dealers, but we have to do what we must to survive and make a living,” he said. “Cocaine [is] the easiest and most lucrative trade which doesn’t require any legal [documentation], as the majority of us are in the country illegally.”

According to BJ, over the past few years the syndicates have had access to a steady supply of high-quality cocaine. Though they will sometimes cut the product, they will sell it pure to customers who purchase 5 grams or more. Everything is designed to maximize profit, but also to minimize conflict.

For example, because tik is cheaper than cocaine, cutting some of it into the cocaine supply would be an easy way to stretch profits further. But the mafia do not do this, nor do they hardly ever sell tik to customers from out of town. BJ said that this is a safety measure—they want to keep cocaine and tik separate so that users don’t get a drug they aren’t prepared for. Tik lasts much longer than cocaine.

Tik has become the most prominent drug in many neighborhoods, especially in the Western Cape province. It is inexpensive, and most of the people who use it live in poverty. Because of this, there has been little interest in establishing or expanding harm reduction services for them.

Many forms of harm reduction are legal in South Africa, including syringe service programs and medications for opioid use disorder, but the national government does not fund any of them. Much of the funding has come from PEPFAR (the United States President’s Emergency Plan for AIDS Relief) as part of that initiative’s global HIV/AIDS response. With President Donald Trump’s freeze on foreign aid, coverage for many services will run out at the end of March.

Cape Town’s youth—especially those raised in the townships—grow up seeing the drug trade as the best way to survive, and perhaps achieve some status.

Lieutenant Kris Pojie of the South African Police Service told Filter that law enforcement focuses on disrupting the Nigerian mafia’s supply chains and financial networks.

“Our strategy involves intelligence-driven operations targeting key individuals within these syndicates,” Pojie said. “Community tip-offs are invaluable.”

However, these syndicates are adaptable and crafty, and can swiftly relocate when necessary. Their networks have proved challenging for law enforcement to dismantle.

But the mafia do not have a strong presence in the townships, the impoverished neighborhoods that collected non-white people evicted or displaced under apartheid. Countless gangs emerged there as a result, which makes it much harder for Nigerian syndicates to establish a foothold. Today townships like those in Cape Flats see near-daily shootings as various groups fight for their position in the drug trade.

The two most powerful are the Hard Livings and the Americans, which hold substantial control in the markets for drugs like tik, heroin and marijuana. Children as young as 5 are recruited to transport drugs.

First responders will not go into some areas without police escorts, and police officers themselves are often hesitant to enter. Three provinces were recently selected for military deployment.

The mafia do not involve themselves in the day-to-day turf wars between gangs, and members of various syndicates usually reside in peaceful suburbs. They engage in other forms of violence, such as human trafficking.

But both the mafia and the local gangs rely heavily on the drug trade. So Cape Town’s youth—especially those raised in the townships—grow up seeing the drug trade as the best way to survive and perhaps achieve some status, similar to what BJ described. Economic opportunities are so limited that they are rarely able to envision a different future for themselves.

*Name has been changed to protect source

Image of Sea Point via Wikimedia/Hilton1949/Creative Commons 3.0

The post “We Are Doing It to Survive”—In Cape Town, the Drug Trade Feels Inevitable appeared first on Filter.

Unlike with other banned substances, meth convictions are punished according to substance purity. In 1988 the USSC decided that different mandatory minimums would be triggered depending on whether the meth in a given case was “actual” (sample weight represents pure meth) or “mixture” (sample weight includes fillers). Then in 1990 the commission added “ice,” a poorly defined category for crystal meth (as opposed to powder) with purity above 80 percent. Courts ended up treating it all as 100-percent pure “actual” meth.

There is no evidence base that supports any of this and no official explanation for why meth was singled out this way. Powder meth is just crystal meth that has been crushed up.

“Over the next 10 years, Congress considered changes to the statutory penalties for methamphetamine, frequently invoking comparisons between methamphetamine and crack cocaine in terms of the dangers and harms associated with the two drugs,” reads a draft of the proposed 2026 amendments. “With the Methamphetamine Trafficking Penalty Enhancement Act of 1998, Congress halved the quantities of methamphetamine set forth in the 1988 Act to the quantity threshold triggers that apply today. In doing so, it enacted mandatory minimum quantity thresholds for methamphetamine (actual) that matched those in place at the time for crack cocaine. Although the statutory penalties for crack cocaine have changed, the same statutory penalties for methamphetamine remain in place.”

Higher-purity meth was assumed to signify a higher level of the drug-distribution chain. But today, it’s the norm for meth to be over 90-percent pure—meaning there is no functional difference between “actual,” “mixture” and “ice,” yet they all meet the criteria for the highest penalties. Getting a forensics lab to determine the purity is expensive, and so the people sentenced to the higher penalties for “actual” meth are just the ones whose samples happened to get tested. Frequency of testing varies widely across the country, but it’s more common in border districts.

Almost half of all federal drug-trafficking cases are now related to meth, and those convictions come with the longest sentences—eight years on average, more than a year-and-a-half longer than the average sentence for fentanyl trafficking even though only about 1 percent of federal overdose cases involve meth.

Despite the substantial shifts in meth purity and the landscape of the drug war as a whole, for a quarter-century the USSC left the meth sentencing guidelines to rot until finally revisiting them for an analysis published in 2024. An amendment was proposed, but in 2025 the commission adopted the other amendments in the cycle without voting on that one.

The proposed 2026 amendment would remove references to “ice,” and proposes two options for reconciling the meth sentencing disparities. The first is to set one uniform quantity threshold for all meth sentencing, removing the distinction between “mixture” and “actual.” The new threshold could be the lower one currently used for “mixture,” the higher one currently used for “actual,” or the ones used for fentanyl or cocaine base, which are somewhere in the middle.

Using the “mixture” threshold would result in lighter overall sentencing for meth convictions, while using the “actual” threshold would result in harsher overall sentencing. Using the fentanyl or cocaine base thresholds would affect fewer people, but the net change would be toward lighter sentencing.

The second option is to retain the concept of two different meth thresholds, but begin all cases from a baseline threshold that’s in the middle, like the one currently used for cocaine base. From there, the courts would use one or more mitigating factors in each case to either raise the sentencing to “actual” or lower it to “mixture.”

Factors that could reduce someone’s sentence include lack of weapons involvement; having been coerced into participation; furnishing prosecutors with useful information for other cases; or being especially vulnerable due to age or a health condition including drug dependence. The factors that could increase someone’s sentence are essentially the opposite of those, along with others like use of a pill press or dark-web platforms. If both reducing and heightening factors were identified, the latter would be applied. 

The deadline to submit comment online or by mail is February 10.

Images (cropped) via United States Sentencing Commission

The post Feds Seek Public Comment on Meth Sentencing, Untouched for Decades appeared first on Filter.

In Oklahoma, legislators have proposed that when someone reports a child as “drug-endangered,” the Department of Human Services would request a drug screening from the parent, guardian or caregiver in question within 24 hours. If the request were refused, it would be replaced with a court order.

This screening would go beyond urinalysis, with the department looking for any sign of “methamphetamine production or use, opioid exposure, or any indication of fentanyl presence, including indication via report, observation or prior history.” Once opened, an investigation would include mandatory testing for fentanyl and other drugs throughout the process.

“Endangerment” would be defined to include exposing a child to fentanyl-related substances through “environmental contamination in the home.” For a conviction of fentanyl endangerment, the maximum penalty would be five years in prison and a $5,000 fine, plus $50 to the state’s Child Welfare Fentanyl Testing Revolving Fund.

Washington, which is seeing substantial increases in pediatric deaths including from fentanyl, has introduced a series of child endangerment bills. One would define placing a child in “imminent physical harm” to include the “presence or use of illicit substances in the child’s environment.” A separate bill reintroduced from 2025 would expand child “endangerment with a controlled substance” to include street fentanyl, rather than focusing just on meth; it would also add “absorb” to the list of potential means of exposure.

Another bill proposes to broaden the standards for removing a child from their home, so that it’s presumed necessary if there’s suspected exposure to any non-prescribed Schedule I or II controlled substance other than cannabis; currently the law directs the courts to essentially focus this on fentanyl. Anyone who loses custody of their child this way would need to submit to random drug-testing at least twice a month for six months before the child could be returned.

Another that’s calendared for a January 28 Senate committee hearing would focus on children for whom the Department of Children, Youth & Families has already opened dependency cases, meaning it’s monitoring their care. Dependency cases have typically been opened only when the department expects to remove the child from their home, but this bill calls for “the expansion of dependencies as an effective tool for engaging families and … to improve Washington’s response to the growing number of opioid and fentanyl-related child fatalities and near fatalities.”

These proposals always carve out exceptions for controlled substances with valid medical prescriptions, which belies how arbitrary they all are.

Kansas has proposed increasing existing penalties for allowing a child to be “in an environment” associated with manufacturing of fentanyl or meth, adding more severe felony penalties in cases involving children under age 6. Residential meth labs have been the focus of many endangerment laws over the years, particularly those that pertain to young children, infants and pre-natal exposure.

A New Mexico bill that encourages surveillance by medical providers would define use of Schedule I and II drugs during pregnancy as child abuse if a newborn tested positive for cocaine, fentanyl, heroin or meth.

A Virginia bill would make it Class 3 felony for anyone over 18 to knowingly allow anyone under 15 to be in the same building or vehicle as street fentanyl. This would mean a prison sentence of at least five years and potentially up to 20, a fine of up to $100,000 and a record that can’t be sealed.

These proposals always take care to carve out exceptions for controlled substances for which there’s a valid medical prescription, which belies how arbitrary they all are. Between 2020 and 2024, poison centers reported 189 deaths among children under age 6 due to “single-substance exposure.” The most common category of substance involved was pain medication. Then fumes like carbon monoxide; then batteries; then “stimulants and street drugs,” which were linked to 13 deaths. In 2022, emergency departments treated more children for accidental poisoning from prescription opioids than from all unregulated drugs.

Anything read out in court as a criminal charge can sound like an indefensible decision by an unfit parent, but mostly the things we’re criminalizing aren’t conscious decisions but just things that happen as people go about their lives in places where drug use is heavily surveilled. A lot of this is about criminalizing people’s surroundings, and then blaming those who have children for being there.

Image (cropped) via United States Drug Enforcement Administration. Inset graphic via United States Consumer Product Safety Commission.

The post Fentanyl Child Endangerment Bills Ramp Up Across the US appeared first on Filter.

“They are now putting methamphetamine in a pill form,” said United States Attorney General Pamela Bondi at a July 15 press conference. “First time we’ve seen that. A pill form. Now, a pill form of methamphetamine might not kill you instantly, but it can get you so addicted to meth that it can destroy your life. Instantly.”

This is definitely not the first time Bondi or any federal representative has seen that. The DEA has been announcing distribution and trafficking arrests related to these pills for years, going back to before the COVID-19 pandemic. In 2024 it declared meth pressed pills had become “an established and accepted form of the drug.” But historically the agency has referred to them as counterfeit Adderall pills.

While chaotic use may develop quickly with many things—not just drugs—the idea that certain drugs are so habit-forming that people become addicted the first time they try them is a myth.

In recent months there’s been an increase in meth seizures at the US-Mexico border, news which may not have had enough shock value on its own merits. So now we have meth pills.

“We are seeing a disturbing trend,” said DEA Acting Administrator Robert Murphy at the same press conference. “Cartels are now producing methamphetamine pills. Started seeing it in 2024 at a tremendous amount. We’ve already seized more methamphetamine pills this year than we did the entire year of 2024.”

The press conference was a joint event for the DOJ and DEA to share updates on the “Take Back America” initiative, covering drug seizures and other enforcement efforts in the first half of 2025.

“These are made to look like popular drugs that our youngest men and women want. Our college-age students,” Murphy said. “This is an effort by the cartels, a deliberate effort. Our young men and women are not seeking out methamphetamine pills. They are not seeking to get that. Unfortunately they’re being deceived into a life of potential addiction.”

The DEA has also been promoting a new interview in which Murphy told ABC News that “Methamphetamine is by far the most coveted drug” and it’s “what people want,” but maybe this is no longer the college demographic. At one point during the July 15 press conference Murphy said that “from a national security standpoint,” we could not allow so many young people to keep dying of overdose because they that’s who makes up our military forces.

The press conference also provided both agencies an opportunity to continue an ongoing schtick where they see how heavily they can imply that meth pressed pills contain fentanyl, but without actually saying it.

“Fentanyl remains the leading cause of death for Americans between the ages of 18 and 45. Fentanyl and methamphetamine together are toxic evidence the cartels have no value of life,” Murphy said. Bondi pointed to a posterboard showing a photo of a pill labeled “Fake Adderall” and said, “These are laced with drugs that could kill you.”

Meth is sometimes found in pills sold as MDMA, in addition to those sold as Adderall. But if the DEA had seized even one shipment of meth pressed pills that contained fentanyl, they’d have probably put up billboards about it.

Top image via Department of Justice. Inset image (cropped) via Drug Enforcement Administration/YouTube.

The post “First Time We’ve Seen That” Feds Say of Meth Pills They’ve Seen for Years appeared first on Filter.

This neatly encapsulates the abject failure of prohibition to impact drug supply or demand. 

It is right to be concerned about harms to people using methamphetamine. What most reporting ignores is that these harms are largely caused by prohibition. 

By driving meth underground, we clearly don’t eliminate it. But we do compel people who use it to buy it in risky environments; to ingest it with little idea of the dosage or purity; and often to avoid seeking help (if they want it) for fear of stigma, exclusion and arrest.

Like Pavlov’s dog, the programmed response of influential voices to news of the latest “drug crisis” will be a call for tougher, more invasive prohibition policies.

Like Pavlov’s dog, the programmed response of influential voices to news of the latest “drug crisis” will be a call for tougher, more invasive prohibition policies. Such calls for action are always loud and usually heeded, despite the evidence that this approach is ineffective and has devastating consequences for individuals, families and communities.

Endlessly repeating the same pattern for 50 years and imagining that—on this occasion, unlike all the other occasions—the results of prohibitionist policies will somehow be different is, to be frank, utterly deluded. Some would describe chronic, obsessive and harmful patterns of behavior despite adverse consequences as a sign of addiction. Are we addicted to prohibition?

That people use psychoactive drugs should not be a concern in itself. Virtually everyone uses drugs. Around 600,000 New Zealanders use cannabis, for instance, which is still largely banned here. And when it comes to state-approved substances, alcohol and caffeine are such central components of our daily routines that it is rare to see a gathering that doesn’t involve one or the other. 

People can and do develop difficulties with drugs of all kinds. But thankfully, as data even from the United Nations Office on Drugs and Crime show, the majority of people who use any drug do not experience substance use disorder (SUD). For them, our focus should simply be on making drug use as safe as possible.

The minority with SUD matter very much, of course, and we should seek to reduce levels of addiction. Yet it’s a complex issue to address, with many factors at play; the solutions are not straightforward, even if it is readily apparent that banning drugs is not one of them. 

In contrast, the solution to damaging drug policies is self-evident. A rational response would be legalization, regulation and drug laws rooted in evidence and experience, rather than ideology. 

As far back as 2011, the New Zealand Law Commission recommended that the 1975 Misuse of Drugs Act be rescinded and replaced with a new health-based law. 

Yet it seems we can’t stop ourselves from lurching back to default prohibition. 

As far back as 2011, following a three-year review of our drug laws, the New Zealand Law Commission recommended that the 1975 Misuse of Drugs Act (MoDA) be rescinded and replaced with a new health-based law. 

To this day, however, despite the review, the MoDA remains much the same. Tweaks include giving police discretion over personal possession arrests, and making medicinal cannabis legal—but only via a GP and at considerable expense. 

These small adjustments have had limited benefit to those most affected by 50 years of the MoDA: the poor, people with chronic unmet needs and Indigenous people. Māori arrests for cannabis possession have proportionately increased. Lots of people can’t afford to purchase medicinal cannabis via the pharmacy, while a “green fairy” who provided cheaper medicinal cannabis to people in need, without prescription, was recently busted.

The introduction of drug checking in New Zealand has been one remarkable, bottom-up achievement. The NZ Drug and Substance Checking Legislation Act 2021 was made possible because activists at festivals, where people use drugs to enhance their experience, delivered drug checking despite legal complications. 

That service, we should remember, is only necessary because our laws prevent quality controls on these drugs.

The drugs are already here to stay. Legalization is about moving them out of the shadows and into a responsible, accountable market.

Measures to alleviate some of the harms from prohibition seem to have reached the more privileged sections of society, leading to more leverage in parliament. But such measures, valuable as they are, don’t address the elephant in the room. 

Our addiction to prohibition continues. It is out of control, never satisfied, always wanting more. It leads to secretive use of drugs and increased risk of overdose and disease. It means incarceration, and criminal records denying people opportunities for work, housing, loans and travel. It causes a violent illicit trade, ecological damage from crop spraying, spiralling financial costs to the public and widespread human rights violations.

This cannot continue. We need to address the harms that prohibition perpetuates by ensuring a safe, regulated supply and the legal right of adults to possess, cultivate or produce any substance for personal use. 

The drugs are already here to stay. Legalization is about moving them out of the shadows and into a responsible, accountable market with consumer rights, proper labeling and reliable information and advice. 

We can learn to live with methamphetamine and any other drugs that people want to use, if only we recognize that our failed, harmful obsession with prohibition has always been the main problem.

Photograph by Vince via Flickr/Creative Commons 2.0

The post NZ “Meth Crisis” Highlights Failure of Prohibition. Can We Change? appeared first on Filter.

For the first time in nearly 25 years, the United States Sentencing Commission (USSC) published an analysis of federal meth trafficking cases and the impact of using purity to determine statutory penalties, particularly in the context of mandatory minimums. Though amphetamine, hydrocodone, oxycodone and PCP are also punished based on purity, none are punished nearly as harshly as meth.

According to the analysis released June 13, about half of all federal drug trafficking cases are related to meth. More mandatory minimum sentences are applied to meth convictions than for any other drug, partly because the thresholds are lower than for any other drug.

The first federal mandatory minimums for meth trafficking were set by the Anti-Drug Abuse Act of 1988. A minimum prison sentence of five years kicks in for “Serious” trafficking cases, and a 10-year minimum for “Major” ones.

Methamphetamine “mixture” refers to the weight of a powder sample including any filler that might have been cut into it. “Pure” or “actual” methamphetamine refers to the weight of just the meth and nothing else, i.e. however much is 100-percent pure.

In 1990, the USSC added “Ice” to the guidelines. This refers to crystal as opposed to powder, but more specifically it’s defined as having a purity of 80 percent or higher. Since the addition, USSC wrote in its new analysis, courts “have treated Ice as 100 percent pure methamphetamine and apply the mandatory minimum penalties for methamphetamine (actual) in those cases.”

Mandatory minimums for meth “mixture” versus “pure” meth are enforced 10:1. So the five-year mandatory minimum, for example, would be triggered by 50 grams of “mixture.” But if it’s considered “Ice,” it’d only take 5 grams.

A sample’s purity can be legally established through laboratory testing, but it doesn’t have to be. Eyewitness testimony is actually enough sometimes.

The USSC report reviewed samples that had been sentenced as “mixture” versus “pure” versus “Ice.” All three categories averaged over 90-percent pure.

Of course, the people sentenced to years extra prison time this way don’t have extra-pure meth. They just have the meth that happened to get tested. There’s no national standard for when prosecutors get these samples tested or why.

Though in the mid-’90s notorious sentencing disparities for crack cocaine were finally reduced, the meth sentencing guidelines have never been meaningfully amended. Meanwhile, the meth supply has averaged over 90-percent pure since around 2011. It takes 500 grams of powder cocaine to trigger a five-year mandatory minimum sentence. It takes 28 grams of crack cocaine. It takes 5 grams for meth, if the meth is deemed pure.

In recent years, a growing number of federal judges have noted that the unlike the sentencing guidelines for other banned drugs, the meth guidelines were not based on any empirical data. There is no evidence that supports harsher punishments based on purity, and no legislative precedent that explains why the USSC proceeded this way.

“The issue is fairly straightforward. The US Sentencing Guidelines use drug purity as a proxy for a defendant’s culpability,” US District Judge Carlton Reeves stated in December 2022. Notably, he’d been appointed the new chair of the USSC a few months earlier. The 2024 amendments left the purity enhancements alone, but efforts might have more traction next year.

Top image and inset graphics via United States Sentencing Commission

The post Decades After It Set Meth Sentencing by Purity, USSC Surveys the Damage appeared first on Filter.

The ONDCP plan had a “Harm Reduction” section alongside a handful of others like “Supply Reduction and Trafficking” and “Treatment.” When the first progress report was published in 2023, the harm reduction updates weren’t particularly interesting but did address the priorities in the original plan. In the 2024 update, harm reduction has been pared down to one paragraph each on fentanyl test strips, naloxone and a CDC page on polysubstance use that doesn’t discuss meth.

Chemsex Pilot

The first harm reduction priority outlined in the 2022 plan was developing a pilot program aimed at “the at-risk group men who have sex with men (MSM) who use methamphetamine or other psychostimulants, but do not yet meet criteria for stimulant use disorder.” It was supposed to “incorporate” people with lived experience—presumably not just as participants—and some form of HIV services.

By 2023, this had turned into one clinical trial which had already wrapped up several years earlier, and two about PrEP and contingency management. Both of those are still ongoing, but the June 2024 update doesn’t mention them. The original pilot program seems forgotten about.

Fentanyl Education

The next priority from 2022 was some sort of “fentanyl awareness effort” aimed at people who use meth. The 2023 update discussed the Centers for Disease Control and Prevention “Stop Overdose” website, and its separate Stimulant Guide.

That guide is probably one of the better government resources on stimulants to date, but none of the CDC’s stimulant-specific materials made the 2024 update. The only thing that remains is the polysubstance use page from CDC’s “Stop Overdose” site, which only mentions meth to state that it’s an example of a stimulant. 

Naloxone

The harm reduction priority that got the most space in the 2023 update was naloxone distribution in regions with higher rates of meth use. But this was essentially filler, cribbed from other federal-level naloxone access efforts, with no mention of how they’d be adapted to meth-use communities or even why they’d be a good fit in the first place. The exception was Indian Health Service “assessing methods of distributing naloxone to impacted regions, especially areas with high concentrations of methamphetamine use.”

In the 2024 update, this has all been condensed to a paragraph about Naloxone Safety Net Pilot Program for Indian/Tribal/Urban health centers.

Meth Antagonists

The 2022 plan directed various federal agencies to support research and development of “an antidote, reversal agent or better means of managing methamphetamine overdose or toxicity.” This translates to something like a meth version of naloxone. But by the 2023 update, this was mostly about the National Institute on Drug Abuse fund meth vaccines that were already under development.

That update did also describe one meth overdose reversal agent that was already in development, but overdose is not the aspect of meth use that could use medications in development—that would be stimulant agonist medications, for something a bit more like a meth equivalent of buprenorphine. Yet the 2024 update continues going in this direction, except it’s moved everything to the “Treatment” section.

Fentanyl Test Strips

The final harm reduction priority in 2022 was to build drug-checking capacity at syringe service programs, mostly through fentanyl test strip (FTS) distribution. 

“SAMHSA is tracking promising practices such as mass spectrometry testing,” the ONDCP stated that year, “which are more sophisticated and sensitive than fentanyl test strips and can also detect the presence of non-opioid threats, such as xylazine.”

Ideally federal agencies would be tracking these practices closely enough to know that “mass spectroscopy” technically does not encompass the drug-checking equipment they’re talking about (Fourier-transform infrared spectroscopy). FTS are actually more sensitive than the fancier forensic drug-checking equipment, not less. And they cannot detect all opioids—only fentanyl and its analogs, so they don’t detect e.g. heroin or nitazenes. But none of those are really the problem here.

What’s more likely to be a problem in real life is that FTS instructions aren’t written for meth, and the water dilution has to be properly adjusted otherwise they’re extremely likely to produce false-positives. The fentanyl awareness efforts could have at least included that.

Image via New York State

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This is partly because the Food and Drug Administration has not yet approved any medications for stimulant use disorder (SUD), so the binary of abstinence versus use is more intact compared to opioid use disorder. It’s also because stimulant withdrawal is so poorly understood by researchers and clinicians. And it’s because SUD treatment is mostly housed inside the criminal-legal system, where its success is determined with urinalysis results that are binary by design. No one in a position to strip bodily autonomy from stimulant users is going to factor in whether they’re using less than before, and it’s unheard of if the stimulant is meth.

An analysis of 13 studies on pharmacological interventions for SUD, at a “wide range of treatment facilities,” is one of very few where researchers looked at reduction in addition to abstinence. They found that while abstinence is associated with the greatest clinical improvements, reduction in use is associated with enough improvement to be considered a valid outcome. The new study, funded by National Institute on Drug Abuse, was published in Addiction on January 10.

“If somebody is working towards trying to be abstinent, but they’re struggling with that, this is a hopeful sign that we can see meaningful improvement along the way,” NIDA Deputy Director Dr. Wilson Compton told Filter. “Because the study also clearly shows that abstinence has more clear association with the positive outcomes than reduced use. But the real new information is that reduced use was so strongly associated with the improved outcomes as well.”

If you’ve been using meth or cocaine less than four days a month, it isn’t necessarily a big jump to go a month without it.

Abstinence has always been the treatment goal assigned to stimulant users whether they want it or not, but belief that it represents a bigger change than reduction in use isn’t necessarily true. The Addiction research, for example, quantified reduction as moving from high-frequency use (5-plus days per month) to low-frequency use (1-4 days per month) over a 30-day period, which makes the results a bit complicated.

If you’ve been using meth or cocaine less than four days a month, it isn’t necessarily a big jump to go a month without it. This means that the people who made it into the “abstinence” category were likelier to be people whose SUD complications weren’t as severe as those who landed in the “reduced use” category. Meanwhile, you could have gone from injecting an eight-ball of meth every day to just stirring a teensy bit into your coffee on the weekends and not even have made it into the reduced use category in the first place; the data would show you’d made no change.

“Abstinence is an easier thing to quantify,” Compton said. “Because when you say ‘reduced use,’ the question is always, ‘Well, how much does the reduction have to be before you see an improvement?’ And abstinence is pretty straightforward. So I understand the appeal of an abstinence measure.”

The researchers evaluated improvement according to clinical indicators drawn from the Addiction Severity Index. These include other illicit drug use; alcohol use; legal status; psychiatric status; and status of interpersonal relationships. The original ASI also has medical status and employment/financial support status, but the authors didn’t include those on the grounds that they “tend to stay stable over a short period of time.”

Short data-collection periods are the universal downfall of research on SUD treatment outcomes. A 30-day window probably isn’t representative no matter which part of your life you’re looking at, but employment status is something drug users do tend to find subject to sudden changes. The study authors did not respond to Filter’s request for comment.

If people wanted something even easier to measure than abstinence, and also more relevant to stimulant users specifically, there is an obvious one.

A recurring argument against using reduction as a research metric is that it’s is a difficult thing to measure. People lean on this argument both because it’s true and because it tends to preempt questions about how difficult, exactly, but nothing’s easier to measure than abstinence and so none of the rest really matters. Urine drug screens will always be quick and easy to read.

“If you cut back from smoking two packs a day to smoking one-and-three-quarters packs a day, obviously that’s a reduction,” Compton said. “But is that enough to see your risk of lung cancer or your risk of heart disease or your asthma problems or all the other issues related to tobacco use to be reduced?”

If people wanted an objective metric that was even easier to measure, and also more relevant to stimulant users specifically, the obvious one would be criminal-legal system involvement—especially if measured on the scale of years rather than weeks. Instead we keep saying the harms of stimulant use are medical, and cite the death data that’s deeply mischaracterized or cardiac strain that wouldn’t be statistically significant if we weren’t looking for ways to present cocaine and meth use as bad.

The publication years of the 13 studies selected average out to around 2010, and don’t include anything more recent than 2017. The “wide range of treatment facilities” doesn’t refer to the environments most drug users probably call to mind, but to clinical trials treating SUD with various psychiatric medications or muscle relaxants. But none of this is unusual, nor will it prevent the research from hopefully having a positive impact.

It’s worth pointing out the places where SUD research could be a bit more representative, because almost no one ever does it, but this doesn’t mean the Addiction research isn’t very good news for stimulant users. It is. So is the fact that NIDA is actively supportive. The utility of research like this is that it’ll be a supporting citation for eventual change at the policy level, rather than something that impacts present-day stimulant users one way or the other.

Photograph courtesy of Kastalia Medrano

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Due to numerous factors which they could only control for to some extent, the researchers warn that their work mustn’t be read as a definitive measure of stimulant purity in the United States. What they can say is that their findings run counter to the narrative that “fentanyl is in everything,” Colin Miller, community liaison with the University of North Carolina’s Street Drug Analysis Lab and a coauthor of the paper, told Filter.

Fentanyl appeared in 8.9 percent of meth samples, and 21.5 percent of cocaine samples. However, there were many caveats.

The researchers tested 718 samples of cocaine and methamphetamine from 77 harm reduction organizations and clinics in 25 states between May 2021 and June 2023. The samples were initially sent to the UNC Street Drug Analysis Lab, where gas chromatography-mass spectrometry was used to check for the presence of fentanyl.

Fentanyl appeared in 8.9 percent of meth samples, and 21.5 percent of cocaine samples. However, there were many caveats to these numbers. Deploying statistical adjustments to account for them, the team then arrived at 6.2 percent for meth and 12.6 percent for cocaine—or roughly one in 10 overall.

Karla Wagner, a professor at the University of Nevada, Reno’s School of Public Health and a coauthor of the paper, explained to Filter that the team adjusted the numbers to account for various confounding issues that could have made fentanyl appear more frequently. (Again, she cautioned, even after these adjustments, the numbers are not meant to be representative.)

Some of these confounding issues are fairly simple. For instance, people would probably be more likely to send in samples for testing if they suspect they contain fentanyl. This might be because they used a fentanyl test strip—which has a chance of producing a false positive—or, in some cases, because after using some of a batch of a stimulant, they felt tired or passed out.

However, the nature of different meth batches, in the absence of fentanyl, might sometimes explain this, described Phillip Fiuty, another coauthor of the paper and technical advisor for adulterant checking programs in New Mexico for the global public health organization Vital Strategies.

“I think there’s a whole confluence of things kind of feeding the situation.”

Other confounding factors the researchers tried to account for include, for instance, the fact that samples only came from around half of all US states.

“I think there’s a whole confluence of things kind of feeding the situation,” Fiuty, who has lived experience of drug use, told Filter.

Miller, who also has living experience with drug use, noted that the number of organizations sending drugs in for checking has grown to more than 160 across more than 30 states since the team performed the research, which should bolster future understanding. He added that there are, of course, cases in which fentanyl appears in batches of stimulants, but that the belief it’s extremely common isn’t necessarily justified.

Parts of the country are seeing more deaths where both stimulants and opioids were present. But Miller pointed out that this doesn’t demonstrate the opioids are appearing as adulterants in meth and coke, when polydrug use is the norm.

“You always have your sort of opiate purists, and sometimes your methamphetamine purists,” he said. “But for the most part, people are going to be using different substances simultaneously.”

At the same time, observers have argued, while accidental cross-contamination from sources selling more than one substance can happen, there’s no incentive for trafficking organizations to deliberately add fentanyl to stimulants. That won’t give the stimulant effects that some buyers solely want, wrote Jonathan Kirkpatrick for Filter, and most polydrug users prefer to measure their own combinations.

The narrative of deliberate contamination is “distorting the actual facts and our ability to respond sensibly with data-driven policies.”

Wagner said that the narrative of deliberate contamination is driving some parts of the US to implement harsher drug laws, such as increased penalties for fentanyl possession and drug-induced homicide laws.

This narrative is “distorting the actual facts and our ability to respond sensibly with data-driven policies,” she told Filter. She added that incarceration, and a drop in tolerance, can lead to more fatal and non-fatal overdoses—and that when drug markets can shift extremely quickly, regulations and policies that target specific drugs will end up obsolete.

Wagner acknowledged that a figure of roughly one in 10 stimulant samples containing fentanyl—while not representative—is concerning.

But taking a harm reduction approach which prioritizes safer supply programs, real-time drug checking services and overdose prevention centers is far better than crackdowns, she said. She recommended that people who use drugs test their batches as much as possible, and that they, their friends and family, and other members of the public get trained to recognize opioid-involved overdoses and to use naloxone.

Correction, December 20: This article has been edited to correct the description of Phillip Fiuty’s role with Vital Strategies.

Photograph of cocaine by Marco Verch Professional Photographer via Flickr/Creative Commons 2.0

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