A discussion of emerging patterns around illegal and prescription stimulant use, which we have sought to facilitate over the past year, reached a peak this week at our first-ever National Cocaine, Meth & Stimulant Summit in Broward County, Fla. The conference presentations left attendees with a sense that even if the field has begun capturing trends more rapidly than was the case historically, that won't necessarily lessen the challenge around curbing increases in stimulant use and its harms.
Take these two comments about methamphetamine that were heard at the meeting, one from the epidemiological world and the other from clinical practice:
“The market is inundated with so much pure, low-cost meth that dealers have more of it than they know what to do with,” said Jim Hall, PhD, a leading applied researcher based at Nova Southeastern University in South Florida.
“I've never seen a drug that can deteriorate someone so rapidly,” said famed clinical trainer and author Cardwell C. Nuckols, PhD.
That should strike any observer as a bad combination.
The tenor of the conversation at the three-day summit suggests that a rise nationally in stimulant use and stimulant-related deaths is both statistically indisputable and highly predictable. Hall's talk used compelling visuals to illustrate how the emergence of various drug epidemics in the nation's history has closely followed the waning of others. A progression from cocaine to pharmaceutical stimulants to methamphetamine generally occurred in this fashion across a span from the late 1800s to the mid-1990s.
Today, however, “The highest levels for each of these categories is at the present day, and still climbing,” Hall said.
The argument that policy leaders can't take their eyes off the opioid problem for one moment seems to lose force in the face of widespread polysubstance use, as well as strong evidence that deadly imports of fentanyl are now inflitrating the stimulant supply in some parts of the country. In a comment that also was echoed at the conference by President Trump's nominee to be the next national drug czar, Hall said, “The national opioid epidemic has progressed to the national addiction epidemic. This is a paradigm shift.”
How will professionals, policy-makers and the public respond? Clearly, many treatment professionals in the summit audience want to see developments such as greater access to naloxone in communities, more flexibility in federal funding, and less delay in communicating intelligence about emerging drug trends to the local level.
Other challenges may be even more daunting. This was expressed by University of Kentucky medication researcher Craig Rush, PhD, who, while offering hope that novel drug combinations or new medications could someday become the methadone or buprenorphine for stimulant dependence, summarized the current state of medication development with a simple “We got nothin'.”
What we learned most from the 300 dedicated clinicians, researchers, law enforcement officials and government leaders who gathered in the Fort Lauderdale area is they are committing to remain part of a cooperative effort to identify strategies to combat an addiction crisis.