The first time James Savage used meth it was to avoid shooting heroin. Back when he was 19, working as a baker in the remote town of Beluga, Alaska, Savage fell off a ladder, shattering the bones in his right foot. A camp medic gave him painkillers to cope with the discomfort as they waited for the weather to clear to get him to proper medical care. It was his introduction to opioids, and kicked off years spent rotating through pain clinics, growing more and more dependent on legal pills.
“Realistically, they’re all trying to help,” he says of the clinicians who dispensed greater and greater quantities of meds. By the time he was 24, Savage was walking out of pharmacies with a shopping bag’s worth of pills, trading them in parking lots with other users.
When it became apparent to the clinics that he was doctor shopping, they cut him off, leaving Savage with a choice: turn to heroin to stave off crippling withdrawal symptoms, or grit his teeth through DIY detox.
Instead, he found a middle-ground: methamphetamine. A drug buddy told him that if he stayed awake in a meth-induced mania for a few days, he could crash into two or three days of torpid sleep, bypassing the worst parts of withdrawal.
It worked — at least for a while. After the meth bender came seven months of what Savage called “white-knuckle sobriety,” muddling through a shattered life without a support structure, or even a stable place to stay from one night to the next. An ex-wrestler, he maintained an addict’s reckless disregard for precaution, entering cage fights in small towns outside Anchorage for a few hundred dollars a win.
“Engaging in a professional fight was just another thing I did,” Savage says. “I was pretty indifferent to the fact that I was putting myself in grave danger.”
He was underweight and ignored anything like a training regimine. Still, Savage fought with a feral tenacity that left him with a seven-two record.
Sitting in his office recently, Savage, now 30, shows off a Facebook picture from one of those fights: a baby-faced young man with a desperate gaze affecting a fighter’s stance, his tattooed torso flesh soft and unorganized.
In the years since, he’s gained back his mass. A bear of a man who looks comfortable in his 280 pounds, Savage slumps concavely into his chair as we talk in his office at Fiend2Clean, the Wasilla nonprofit where he works helping others kick addictions. The sleeves of his collared shirt are rolled all the way down to his wrists, but etchings of ink still peek out each time he reaches an empty RedBull can to his lips, shooting tobacco spittle from the wad of dip packed in his lip.
“I’m better, I’m not well,” he laughs, setting down the makeshift spittoon.
Savage recounts an ogre’s tolerance for mind-altering substances, going all the way back to high-school parties with his older brother’s friends, when he’d step over passed-out bodies hunting for half-empty beers at the end of the night. It took a lot to get him messed up. And likewise, when he was addicted to Oxycontin, his daily doses were far higher than even regular users would typically consume.
Though he’s been clean for almost three years now, Savage stumbled through another relapse before he reassembled a life for himself. Even after he detoxed from opioids, Savage didn’t go through rehab or a structured recovery process. After seven months without using, he failed a drug test (he blames a common testing error), setting off a tailspin that led him back to meth. Pretty soon he was using it “all day, every day.”
Versions of this story are playing out all over the United States. Alongside epidemic abuse of the grim opioid-heroin-Fentanyl triad, meth use is surging. One crude measure of its prevalence is the number of overdose deaths reported to the Centers for Disease Control: between 2005 and 2015 fatal overdoses involving stimulants shot up almost 300 percent, the vast majority of which were attributable to meth. Its price has never been lower, its purity never higher. More people are injecting it with needles, opening up new frontiers in disease transmission and overdose. And in an effort to eke out a profit amid a glut in supply, transnational criminal organizations are cultivating customers in areas that were spared the last meth scourge — many of them places where there is already an infrastructure for heroin.
In the last 12 years, meth has changed, but not disappeared. Since the Combat Methamphetamine Epidemic Act took effect in 2006, over-the-counter sales of the essential cold-medicine ingredients small-time meth cooks relied on dried up, and with them the small-time cooks. But the market abhors a vacuum, and according to the Drug Enforcement Administration, soon afterwards criminal networks in Mexico stepped in.
The cheap, potent meth arriving in the U.S. is manufactured at an industrial scale by cartels, according the Justice Department and DEA’s most recent Drug Threat Assessment. In fact, domestic meth lab seizures are the lowest they’ve been in 16 years. “Most of the methamphetamine available in the United States is produced clandestinely in Mexico and smuggled across the Southwest Border,” the report states. Professional chemists working in “super labs” have abandoned pseudoephedrine as a key ingredient and gone back to the precursor chemicals. Though a 2015 federal action controlling access to those precursor ingredients in Mexico caused their prices to triple, cartel operators have imported them from China or tried to “self-synthesize.”
The effect of all this for users is that the purity of meth in the United States is now consistently above 90 percent. And according to DEA figures, “domestic methamphetamine purchases analyzed from January 2011 through September 2016 indicate the price per pure gram of methamphetamine decreased 41 percent from $98 to $58.”
Nowadays, potent methamphetamine makes it all the way from Sinaloa and Guadalajara to Alaska, arriving almost totally pure.
Meth is not nearly as front-and-center as it was in American culture even a decade ago. Around the time Breaking Bad premiered, ghoulish mug shots were circulated as drug deterrents, and residential lab explosions were a staple of local TV news. Since then, the opioid epidemic has eclipsed meth as the nation’s most prominent drug threat. But according to health and law enforcement officials in places like Alaska, that does not mean meth has gone away. It not only stuck around, they say, but is getting worse.
“It’s out of control,” says Ron Greene, with a calm but exasperated tone. An Air Force brat, Greene has lived most of his life in Anchorage, and spent 30 years working in the treatment field. He is in charge of the Narcotic Drug Treatment Center, one of the only methadone clinics in Alaska. The job affords him proximity to the front lines of severe drug abuse.
It has been a frustrating position to be in when policy-makers have been slow to listen to his concerns. In 2017, Alaska was the third state to declare a public health emergency from opioids. The problems started way before, though. As early as 2012 the state’s rate of overdose deaths from prescription pills was double the national average. By 2015, heroin-related deaths had quadrupled from just a few years earlier.
Greene forecasted Alaska’s opioid disaster as early as 2003, when he began to see heroin eclipse Oxycontin as the drug of choice among people seeking methadone treatment.
“Heroin was just running rampant from the people that we were admitting,” Greene says of folks seeking drug treatment back then. “We saw this problem coming, and we saw people on waitlists that needed help. And we kinda felt like we were shunned, that nobody gave us the assistance or helped the people that needed help at the time.”
As a result, “People died, and people suffered.”
Greene’s staff begins work around 5 a.m., giving out doses of methadone in a spartan waiting room full of plastic chairs that resembles a DMV. The clinic is in a grimey patch of downtown Anchorage flecked with alcoholic bars and seedy hotels. Greene’s window looks out over an alley, and as we talk a motley group in oversized, dirty sweatshirts and jackets gathers in a semi-circle, passing something back and forth.
“I see a lot,” Greene says of the view, unfazed. “I see things back here that people probably don’t want to see.”
Meth has a longer half-life than heroin, so it appears in the drug screenings at Greene’s clinics after people have begun to abstain. For heavy users it shows up in urine tests up to a week after it was consumed, compared to under three days for heroin (the exception is hair follicle testing). Greene estimates 60 to 70 percent of the people coming off heroin have meth in their system.
“It’s the new speed ball,” he explains, referring to a drug cocktail where, traditionally, an upper like cocaine is mixed with a downer like heroin, then injected.
Speed-balling can bring the best part of each drug to the fore while minimizing the downsides: the energy of an amphetamine without the anxiety, the euphoria of an opioid without the drowsiness. People combine extreme uppers and downers recreationally for the pure pleasure, or as a functional means to balance out.
“It’s the best of both worlds, from what our people report to us,” Greene says. But it’s playing with fire, he adds. The stimulant can temporarily mask lethal doses of an opioid. But once it wears off the respiratory depression from too-high a dose of heroin can be fatal.
“It can overwhelm your system.”
Meth’s casualties in Alaska are rising, in part because of how it is being used in combination with other drugs. The rate of meth-related overdoses quadrupled in less than a decade. Between 2008 and 2016, the fatality rate went from 1.4 to 5.8 per every 100,000 residents, according to a report by the state’s Division of Public Health. Of the 193 lethal overdoses caused by meth in that period, 54 percent also involved an opioid like heroin.
Police in Alaska find meth and heroin in many of the same places. They’re both shipped in through the mail system. Tucked into hidden compartments of cars barged up from the Lower 48. Carried in body cavities on commercial flights. Mid-level dealers frequently have both when they are busted. At the street level the two drugs are sold side by side.
“The problem with cocaine is its got a very short high. Meth’s got a much, much longer high that pairs up with heroin a lot more equally,” explains Lieutenant Jack Carson, who oversees much of the drug crime for the Anchorage Police Department.
Alaska is a small but lucrative market for drugs. Though prices for heroin and meth have come down in recent years, the real change in value has occurred primarily at the bulk level.
On the streets of Anchorage, meth sells for around $100 a gram, according to Carson. Though the clear crystalline shards sold today are consistently stronger than the grainy, red-tinged powder that was churned out by local mom-and-pop meth labs a decade ago, the street prices paid are relatively similar.
But ten years ago, a pound of meth that would have cost $26,000 in Alaska now sells for between $11,000 and $8,000. Those savings have not trickled down to low-level sales, in part because there’s relatively little competition on the supply side in this remote market. It is hard getting illegal drugs into Alaska, and this keeps out newcomers who might undersell established distributors.
But for those who can get drugs into Alaska, particularly rural areas, the profits can be enormous.
Though the state’s population of 740,000 is tiny, Alaska has a large appetite for booze and drugs. By the state health department’s own calculations, the rate of alcohol-induced deaths in 2015 was 140 percent above than the national average. Binge drinking is more frequent, too. Illegal drug use is 35 percent higher. The suicide rate is double the national average.
Explanations abound for why all this is.
The oil-dependent state has been in an economic recession the last few years from low global fuel prices, with an unemployment rate above the national average. Indigenous Alaska Natives are still dealing with decades of historical trauma inflicted by disease, discriminatory government policies, forced removal of children to boarding schools, and systematic sexual abuse by the Catholic church. Many of the seasonal industries like commercial fishing and gold dredging demand long stretches of intense labor, the kind made easier when supplemented by amphetamines.
Nationally, the meth market is in a glut, and the price declines are prompting cartels and domestic dealers to cultivate new markets, not unlike the way cheap black-tar heroin began quietly showing up in small regional hubs west of the Mississippi in the 2000s, as documented in journalist Sam Quinones’s book Dreamland. Though concentrations of meth are still higher in the Midwest and western states, cartels are expanding their efforts along places that were spared the last big meth scourge, like New England and along the East Coast.
“Gangs are also traveling to areas of the United States where drug prices are at a premium, such as Alaska,” the DEA found.
The Administration’s office in Anchorage is tucked discreetly behind a high gate on a wooded block where the neighbors include a Samoan Seventh-Day Adventist church and a bingo parlor. I’m told the fence is to keep moose off the property.
In a second-floor office, Assistant Special Agent Michael J. Root explains the distribution of drugs coming into Alaska.
“90 percent comes here,” Root says of Anchorage, before shipments are broken down, sold on the street or moved to smaller communities.
Of the drug packages interdicted by the DEA entering Alaska, the split between heroin and meth is about half and half — but both are arriving more frequently and in higher volumes. Federal drug cases in Alaska used to be built on one-pound shipments. Now, interdicting five-pound lots is routine. Root mentioned a recent case exemplifying distribution trends: a couple traveled to California and shipped heroin and meth through FedEx. When police busted them in a hotel room they found more than 13 pounds of methamphetamines, according to the criminal complaint.
Even with the increase in volume arriving in Alaska, Root seems somewhat unmoved. He explains this is because he worked on the Southwest border in the past, where the volume of drugs intercepted are eye-popping compared to what makes it into the distant northern hinterlands.
Conversely, though, in a state with just a few hundred thousand residents, removing shipments that size can have a substantial impact in the drug supply. “When you do a five-pound case in Anchorage it has more of an effect than Atlanta or Chicago,” Root says.
As with most commodities in Alaska, it is a seller’s market for hard drugs, especially the further away from population hubs and infrastructure you go. Though there are interdiction methods at the port and international airports, once inside the state there are few opportunities to spot contraband. Passengers travelling on small airplanes are exempt from TSA screenings, meaning you can walk onto the regional flights that serve most rural communities without ever opening a backpack or passing through a metal detector. For decades, bootleggers smuggling booze into small dry villages have used rivers and snowmachine trails where the presence of law enforcement is a rarity.
According to the DEA’s Root, a gram of meth that may cost $100 on the streets of Anchorage (already about double the average price in many lower-48 cities), once it reaches a remote indigenous community or small commercial fishing town could sell for $300 to $500.
Because Alaskans are such valuable customers, “If the cartels have connections in Alaska they’re looking to exploit those,” says Assistant U.S. Attorney Frank Russo, criminal chief of the Justice Department in Anchorage. “Prices of drugs are so much higher here.”
In the 1990s and early 2000s, when most of the state’s meth came from labs in Anchorage and the more sparsely populated towns to the north, federal officials would intercept and build cases on the order of ounces.
“Now we’re seeing much larger quantities,” Russo says. They arrive principally in the mail or hidden ingeniously in freighted items like cars.
Law enforcement is candid that they miss a lot of drugs coming into the state. The resources for sniffing out drugs are nowhere near as robust as along the southern border, where a veritable arms race of drug smuggling and interdiction technologies is progressing at an almost farcical pace. New methods include dissolving high-grade meth in seemingly innocuous liquids like of iced tea, transporting it over the border, then reconstituting it in labs. In 2017, at the Hidalgo Port of Entry, 62 pounds of meth were allegedly found concealed in horse shampoo.
“Gangs are traveling to areas of the United States where drug prices are at a premium, such as Alaska,” according to the DEA.
Alaska’s increase in deadly meth-related overdoses is mirrored nationally, if not quite as drastically.
According to Center for Disease Control figures, 2015 saw a 255 percent increase in poisoning deaths from what death certificates code as “psychostimulants” — uppers, basically — compared to a decade earlier. In the overwhelming majority of those incidents the drug in question was meth.
While meth is still predominantly smoked or snorted, police and public health workers in Anchorage also say that the ubiquity of intravenous opioid use has opened the door to more people shooting meth with needles, though nobody can provide firm data. The theory goes that prescription opioids and heroin may have helped people get acquainted with intravenous use, making it more palatable for those hunting for more intense highs. “Slamming,” as injecting speed is called, is the most dangerous ingestion method. Not only does this raise the risk of overdose, but also transmission of HIV and Hepatitis C.
One focus of the Alaska AIDS Assistance Association (Four A’s) is reducing the amount of physical damage and psychic distress that come along with injecting drugs. The needle exchange they run is booming, one of just four such programs in the state — although one “program” consists of a coin-operated vending machine with clean syringes inside. Demand has pushed the group’s resources to its limits over the last year.
The syringe exchange gets about 100 people a day who come in to trade used needles for clean ones, along with other supplies for shooting up: Cotton balls, tourniquets, tiny metal cookers and alcohol wipes to sterilize a patch of skin before a needle slips beneath it.
The busiest times tend to be afternoons before and after the weekend, as people are either stocking up or replenishing their works. On a recent Monday afternoon, the organization’s chipper 20-something Jesuit volunteer, Rachel, tried to keep up with a line of clients that steadily grew as it got closer to closing time. Though the exchange is anonymous, the staff collects basic demographic data from each person who comes into the closet-sized supply room next to the front desk.
As people wait they stare at phones, the floor, make idle chit-chat with one another. A 27-year-old white woman with maniacal eyes and a shambling gait plops down in a leather armchair, pulling loose syringes out of a cavernous green backpack, complaining about losing part of her tax refund because of her preparer’s mistake.
A tall blond man with a tattoo under his left eye and a dagger-sized knife tucked in a thigh holster discreetly soothes a female companion with long black hair and sunken eyes. “I’m tired of using dirty fucking needles,” she says in a raspy voice.
Two middle-aged women that came separately spotted each other in line.
“Where you been?” asks one as they hug. The other murmurs something vague, keeping the brown paper bag with her fresh supplies pressed close as she excuses herself and walks out the door.
The crowd spans ethnicity, age and race, something that is consistent with the data collected by the Four A’s about who is utilizing the exchange. And because Anchorage is a hub for travel and social services, the organization sees people from all over the state, including small rural communities hundreds of miles from the nearest road. A young Alaska Native waiting in line wears a blue hoodie that reads “I [heart] Husky Boys,” the sports mascot for a high school in Kotzebue, a town of about 3,200 at the edge of the Chukchi Sea, north of the Arctic Circle.
People can also get Narcan at the syringe exchange, the opioid overdose-reversing spray that’s being carried by civilians and emergency responders with greater frequency. But the demand is huge. No sooner does Four A’s get a new shipment in than they run out.
“Hopefully we’ll have some in next week,” Rachel the volunteer tells a client apologetically.
Narcan works well on opioid overdoses, but it does nothing for many of the hazards that go along with shooting meth or using the two drugs in combination.
“With mixing, that’s a huge danger,” says Matt Allen, the HIV prevention and education director at Four A’s. His office has piles of prophylactic supplies sprouting like mushrooms: heaps of condoms on the desk, drawers full of dental dams, little towers of rectangular red boxes for collecting used needles. It’s tricky carrying used needles around, you can get pricked if they pierce through pockets or purses. The plastic in soda bottles is puncture proof, and it’s normal to see people come into the exchange with Pepsi, Gatorade or Big Gulp containers crammed with spent syringes. The red plastic boxes are small portable depositories, which Allen gives out for this very problem.
Four A’s doesn’t yet collect data on which specific drugs people are using, but they’re about to start. Allen declined to even estimate what percentage of the clientele is using which drug, but what’s clear to him is that meth never went away — it was just eclipsed. He shies away from labeling what’s happening in Alaska an “opioid epidemic” or a “meth crisis.”
“It’s a drug issue,” he says. The accelerant for an addiction might shift, but from his vantage point the underlying isolation, shame, and despair are consistent.
“It’s something that’s hurting and killing people, doesn’t matter what substance it is.”