PROVINCETOWN — Though crystal meth has long been a fixture in Provincetown’s drug scene, the rest of the Cape is experiencing its first big brush with the extremely addictive stimulant.
“For a really long time, I would say all over Massachusetts that Provincetown was the location where crystal meth was the most prevalent,” said Kate Lena, director of prevention and screening at the AIDS Support Group of Cape Cod (ASGCC).
But that picture has changed. “All around the eastern part of the state,” Lena said, “crystal meth use has increased dramatically in the past three to five years. That’s definitely happening in the mid-Cape area.”
After the federal Combat Methamphetamine Epidemic Act of 2005 restricted access to key ingredients used to produce the drug, domestic meth production dropped off. But in recent years, large-scale “super labs” operated by Mexican cartels have stepped in to meet demand. The current version of the drug is very pure, potent, and relatively cheap.
Increasingly, Cape fentanyl users are supplementing their opioid habits with methamphetamine. While meth-related overdoses soar, viable addiction treatment options and available public health data lag.
‘Do You Party?’
“I used crystal meth to get over insecurities and fears around sex. Smoking allowed me to relate to people,” said Provincetown resident and recovering meth user Shane Landry. But the progression of Landry’s addiction — from snorting to smoking and, finally, injecting the drug —took a toll. “Several times, I got the drug thinking I would go somewhere and do something, and then I would do it and get so paranoid that I couldn’t even leave the house. And that was it. I would spend an entire weekend alone in my house, using.”
Landry, who has been in recovery for six years, is the former owner of Connie’s Bakery and coordinator of Winter Wednesdays, a community program of free classes.
State Sen. Julian Cyr said that “in the context of Provincetown, meth use among MSM [men who have sex with men] is primarily for ‘chemsex,’ and this is something that’s been prevalent in our community for quite some time.” Chemsex, or “party and play,” is sex that’s enhanced and prolonged by stimulants such as meth.
According to Dan Gates, president and CEO of ASGCC, meth use in Provincetown has “been a little quiet the last couple months, but the belief is there’s probably been a lot going on at private homes.” Local addiction experts repeatedly claim, however, that they have no reliable way to quantify the problem.
An Insidious Spiral
David Pantalone, professor of psychology at UMass Boston, said that among MSM in the early 2000s, “meth had a meteoric rise. Then people realized exactly how deadly it was, due to the spread of HIV.” This was before the advent of PrEP (pre-exposure prophylaxis) medications, which drastically reduce the risk of HIV infection.
“If you posed a question to gay or bisexual men about whether they had used crystal meth during sex, those who answered yes were nine times more likely to have recently become infected with HIV,” Pantalone said.
Long-term methamphetamine use can lead to a host of serious health problems, such as extreme weight loss, severe dental problems, paranoia, and hallucinations. Meth’s euphoric effects make it increasingly difficult for users to experience pleasure without it. Sustained meth use builds tolerance, compelling users to take more and switch to more direct methods of consumption.
“Anecdotally, I’ve been surprised over the years at the number of people who inject it,” said Pantalone. “Also, in this current iteration of the meth use epidemic, it seems as if there are a lot more guys who use daily.”
Usage patterns vary. “There are folks who use it every day, a little in the morning, the way that I use caffeine,” said Lena. “There are some folks who use it more in a social setting, to party, for intimacy. At the other end of the spectrum, there are people who are dependent, whose lives are really negatively impacted by their drug use.”
The documentation is scarce, Lena added. “There’s a lot more research on the books about the experience of being addicted to heroin,” she said. “With crystal meth, because there are very few treatment programs designed specifically for its use, there’s not as much information out there.”
Pantalone, who studies stimulant addiction treatment, said that, in the early 2010s, when his team was running its first study, meth was around but expensive. When they began round two in 2017, meth had crossed demographic barriers. “I think it’s everyone now,” he said.
When it comes to treatment, “there is no gold standard,” Pantalone said. Unlike for opioids, there are no FDA-approved drugs to stem meth cravings. “The public health folks are mostly worried about getting everyone on PrEP, and the substance abuse folks are mostly worried about opioids,” he said.
In 2015, Provincetown created a seven-step action plan that began with the creation of a weekly “Crystal Free” group, run in conjunction with ASGCC.
Unlike Crystal Meth Anonymous (CMA), Crystal Free focuses on harm-reduction instead of abstinence, and targets men of marginalized sexual and gender identities. Year-round, Crystal Free has about a half dozen weekly attendees. In the summer, there are more, and since moving to Zoom during Covid-19, a few newcomers have joined from out of state, Gates said.
The rest of the action plan is an information-gathering mission, aiming to “quantify the issue and track it over time” and to “provide up-to-date information on existing resources for crystal meth users.”
Provincetown Health Dept. Director Morgan Clark is frustrated with the lack of outpatient services for meth users, as well as the dearth of data. Despite the goals of the action plan, which, she said, “hasn’t been looked at in a long time,” the health dept. did not provide numbers on the scope of the problem in Provincetown.
Meth is a relatively new problem on the rest of the Cape, where communities are even less prepared than Provincetown to deal with its influx.
“It seems like meth has been increasing for two years, and I’ve noticed a significant spike in the past six months,” said Daniel Rodrigues, associate director of substance use disorder services at Duffy Health Center in Hyannis.
Though alcohol and fentanyl are the most common sources of substance abuse disorders among Duffy’s patients, many report using both opioids and meth, Rodrigues said.
According to Cyr, “Across Massachusetts, overdose deaths involving meth and other stimulants rose by almost 21 percent in 2018. You’re now seeing a greater prevalence of methamphetamine and other stimulants involved in opioid overdoses.”
Though overdoses from stimulants alone in the forms of heart attack, stroke, and psychosis are possible, meth-only overdose deaths are less common than those caused by opioids. Even so, the New York Times reports that drug overdose deaths hit a record high in 2019, partly because deaths involving meth, “once concentrated in the Western states, have been moving eastward, even to regions like New England that meth once barely touched.”
Special Agent Tim Desmond at the New England office of the Drug Enforcement Administration said fentanyl is still the primary focus of his agency. But there has been a statewide uptick in methamphetamine seizures in the past two years, which is consistent on the Cape.
In the past, “one-pot” meth labs were able to produce individual doses of the drug. “Now we’ve seen a shift,” said Desmond. “There’s a lot more Mexican meth coming through the mail from the Southwest border areas. It’s a lot easier for people to receive a package through the Postal Service than it is to run a meth lab. For the user, there’s less danger of getting caught when you’re not making it yourself.
“Thank God, we do not have the demand that other parts of this country have for meth,” Desmond added. “But that’s not to say that the cartels won’t be trying to send as much as they can this way to gain new users.”
Where to Get Help
Despite the lack of medication-assisted treatment for meth addiction, area rehab centers such as Duffy and Gosnold offer outpatient programming for users, some of which has moved online due to Covid-19 risk. Inpatient meth treatment is possible but not likely to be covered by insurance.
Crystal Free meets on Wednesdays at 5:30 p.m. via Zoom. Email Dan Gates at [email protected] to join a meeting. Crystal Meth Anonymous offers virtual meetings every day of the week at CrystalMeth.org.
Olivia Weeks’s summer fellowship with the Independent is supported by the Harvard Alumni Association and the Harvard Club of Cape Cod.