Fentanyl-meth combo ravages homeless in Denver, so why aren't there better treatments?

Photo byGreta Schölderle MölleronUnsplash

An opinion piece appearing in the Journal of the American Medical Association, or JAMA this week illustrates why the drug problem among people experiencing homelessness in Denver may be so severe. It's because many homeless people aren't addicted to just one drug, but two, according to the viewpoint's author, Benjamin A. Howell of Yale School of Medicine and colleagues.

"The modal individual who dies from overdose today is struggling with use of multiple substances, commonly both fentanyl and stimulants (eg, cocaine or methamphetamine)," according to the viewpoint. "Despite tremendous investment and strides in improving care for people who use opioids, we have yet to make a real dent in the overdose crisis. We are missing a piece of the puzzle—understanding and addressing the needs of people who co-use opioids and stimulants."

Tailor-made for homeless people

Fentanyl and meth have been described as tailor-made for people experiencing homeless, as Denver Mayor Mike Johnston once noted. Both substances go hand in hand, according to the JAMA study.

In March, Johnston said a professor from the University of California at San Francisco told him the drugs help keep homeless people warm, awake and suppresses their hunger. "That is quite literally what we know methamphetamine and fentanyl do to help survive the conditions of being unsheltered," Johnston said.

Meth overdose deaths up

"About 12% of opioid overdose deaths from January to June 2018 involved methamphetamine, an illicit drug," acccording to Pew Charitable Trusts. "In 2017, opioids were involved in 50% of methamphetamine-involved deaths, and recent data suggests synthetic opioids are driving increases in methamphetamine-involved deaths. One study found that 65% of those seeking opioid treatment had reported a history of methamphetamine use, with more than three-quarters of them indicating that they had used methamphetamines and opioids mostly at the same time or on the same day.^"

Last year at Fusion Studios, a Colorado Coalition for the Homeless property, residents reported buying crushed blues and meth mixed together.

Better treatments needed

Despite the pervasive use of these drugs in tandem, few models exist for treating addiction to meth and fentanyl as a co-occuring disorder. According to the U.S. Centers for Disease Control and Prevention, "Intentional polysubstance use occurs when a person takes a drug to increase or decrease the effects of a different drug or wants to experience the effects of the combination. Unintentional polysubstance use occurs when a person takes drugs that have been mixed or cut with other substances, like fentanyl, without their knowledge. Whether intentional or not, mixing drugs is never safe because the effects from combining drugs may be stronger and more unpredictable than one drug alone, and even deadly."

The CDC warns against mixing uppers and downers like meth and fentanyl. "Mixing stimulants and depressants doesn't balance or cancel them out," according to the CDC website. "In fact, the results of combining drugs are unpredictable, often modifying or even masking the effects of one or both drugs. This may trick you into thinking that the drugs are not affecting you, making it easier to overdose."

The role of drug decriminalization

Some people blame Denver's addiction and mental health crisis on the decriminalization of marijuana. Colorado was the first state in the U.S. to legalize cannabis. Another study published this week in JAMA concluded that evidence exists to show the prescription of antipsychotics and antidepressants are up in states that legalized weed. Prescriptions of dangerous benzodiazepines, often used for anxiety, are down, however.

Another JAMA study published this week looking at the imapct of drug decriminalization in Oregon found that while overdoses in that state increased after the change in law, other factors were present that kept the overdose rate high regardless.