Finding a solution to the number of increasing Meth-related overdose deaths and related public health costs has been an important focus for California legislation over the past few months. A bill proposed by state Senator Scott Weiner, Senate Bill 110, suggested that an incentivized treatment program called contingency management be made more widely available. This bill hoped to make it so Medi-Cal, California’s medical assistance program, would cover this type of treatment.

Weiner’s Recovery Incentives Act was passed in both the Assembly and the Senate with bipartisan, unanimous support earlier this month. Despite voicing his support for contingency management programs, California Governor Gavin Newsom vetoed the bill this week. Newsom stated that he is hesitant to pass the bill without knowing the results of the state’s previously approved contingency management pilot program. This pilot program will begin in January, 2022 and will last until March, 2024.

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What Is Contingency Management?

Contingency management incorporates incentivized payments into addiction treatment. Those attempting to recover from a Meth or Cocaine addiction are rewarded with money or gift cards when they remain abstinent from these substances. Routine drug tests are used to determine if these payments will be awarded or not.

San Francisco resident, Billy Lemon, told his experience with contingency management to NPR. Lemon participated in a contingency management program with the San Francisco AIDS Foundation while trying to recover from an addiction to Meth. Each week, Lemon was tested 3 times. When the tests yielded a negative result, Lemon was given $7. By the end of 12 weeks, Lemon had earned $330 which he used to purchase a cell phone. Lemon said the program was more than just a way to get money for him, saying that it felt like he was being told “good job” for not using Meth. This gave him a sense of self-worth which has motivated him to still be sober today, 9 years later.

How Effective Is Paying Drug Users?

Many people who are addicted to Meth or other substances begin using drugs to cope with other aspects of their life. The highs that come from drug use provide a temporary relief. This fleeting relief rewires the reward system in the brain which causes an addiction. Drug use becomes an immediate reinforcement. Initially, recovering from substance abuse is typically the opposite of a reward as positive results are not immediate. Those going into recovery for substance abuse experience the most unpleasant and difficult effects early on during the detox process. The payments involved in contingency management programs are designed to provide immediate rewards into treatment.

For Meth and Cocaine addictions, contingency management is the most effective treatment according to some studies. This is particularly true when combined with behavioral therapy. At the San Francisco AIDS Foundation, 63% of those who participated in a 2019 contingency management program completely stopped using Meth. Since 2011, the federal government has been utilizing a contingency management program for veterans who struggle with drug use. A study of this veteran program examined 73,000 drug tests and showed that 92% were negative.

It is thought that in allowing more insurance coverage for contingency management programs, more drug treatment centers will be encouraged to offer it. This would be a huge improvement as there are currently no effective available treatment medications for Meth or Cocaine addictions. Whereas for Opioids there are 3 FDA approved medications. Those opposed to making contingency management programs more accessible are unsure about paying those who use Meth to stop using drugs. Some view this type of reward as an unethical bribe.

The Current State Of Meth Use

Drug overdose deaths are on the rise all over the US with a reported 93,000 occurring in the year 2020. Between the years of 2015 and 2019 the number of Meth related overdose deaths has almost tripled. In California, more individuals died of Meth and Cocaine overdose than from Fentanyl last year. Higher-risk use patterns and the popularity of injecting Meth may have contributed to this increase. Injecting Meth has also been linked to HIV transmission through needle sharing and lowered inhibitions that can lead to unprotected sexual activity.

According to US News, there has been a 585% increase in Meth related heart failures in California. When heart failure occurs the heart becomes too weak to properly pump blood causing symptoms of fatigue, breathlessness, and heart palpitations. Because chronic Meth use persistently activates sympathetic nervous systems, heart failure can lead to high blood pressure, increased heart rate, and heart arteries being narrowed and hardened.

People hospitalized for Meth related heart failure tend to stay in the hospital longer and have more procedures performed. This results in higher hospitalization costs. Meth related heart failure hospitalization costs rose from $41.5 million in 2008 to $390.2 million in 2018. Those in favor of contingency management programs believe making them more available could save California money, despite the payments included in the program. With Meth use leading to more crime, it currently costs $81,000 to put a person in a California jail for one year. In comparison, most contingency programs cost $6,000 per person each year.

The Future Of Contingency Management

Although Newsom has rejected making contingency management programs more accessible, the state will be moving forward with the approved pilot program. Newsom’s support of the treatment approach is promising for what’s to come after the pilot program concludes. The Biden Administration has also shown support for contingency management programs when the topic was addressed in the 2021 Drug Control Policy. “Identify and address policy barriers related to contingency management,” was listed as one of Biden’s 2021 drug policy goals. Washington, West Virginia, and Montana are also looking to make contingency management more accessible.

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On March 23, 2021, viewers got a deep and personal look into Grammy nominated pop-star Demi Lovato’s experience with addiction, overdose, and recovery. The signer held nothing back in the first 2 episodes of their YouTube documentary series Demi Lovato: Dancing with the Devil. Lovato and their friends, family, employees, and even the doctor who worked on Lovato after their 2018 overdose spoke in the documentary, leaving no details out and nothing to the imagination. The series’ first 2 episodes previse a story that tells the real and ugly truth about addiction.

Family History Of Substance Abuse

When you realize someone is battling addiction, you often see them at the end of the line, after addiction has inflicted its consequences on the individual and those around them. However, typically a lot happens before things come crashing down. Everyone has a story and Lovato’s starts from a very young age. Lovato opened up about their father who they described as an alcoholic and addict. He was abusive to Lovato’s mother, and according to Lovato’s mother, Demi witnessed some of the abuse as a child. Lovato’s father was also reportedly diagnosed with bipolar disorder and schizophrenia.

Those with mental health disorders are much more likely to develop a substance use disorder than the general population. One study found that among those with bipolar disorder, 61% had history of a drug or alcohol use disorder. Among those with schizophrenia, 47% have a serious problem with drugs or alcohol. Using substances to attempt to self-medicate is common for those with mental illness, especially if they do not seek out professional treatment. Due to Lovato’s fathers toxicity in Demi and Demi’s mother’s life, Demi had to create distance from him. This made his death a heartbreaking revelation, when Lovato’s father died alone and his body was not found for a week and a half.

Children of parents who struggle with addiction are at a higher risk of developing an addiction themselves. Lovato’s mother also opened up about her Xanax misuse. When childhood trauma involving abuse and drug misuse is left without professional intervention, it oftentimes presents itself as a repeated cycle when the children grow up. Lovato has spoken openly about their own substance abuse and the effects it has had on their life. Lovato started using alcohol as a student and tried Cocaine for the first time at age 17. During this time, Lovato was working for the Disney Channel. In Lovato’s new documentary, they explained that they used Cocaine and Xanax together. That combination would eventually escalate to even more dangerous drug use.

The Overdose

Since 2010, Lovato has a history of substance abuse, receiving treatment in rehabs, relapsing, and regaining sobriety. The popstar had a long stint of sobriety, stating that they were celebrating 6 years sober in March 2018. However, in July 2018 the media was flooded with reports that Demi Lovato had suffered an overdose.

When Lovato relapsed in 2018, they said in their documentary series, “I picked up a bottle of red wine that night and it wasn’t even 30 minutes before I called someone that I knew had drugs on them.” Lovato proceeded to use drugs that they hadn’t tried before like Methamphetamine. At a party one night Lovato explains using Meth with Molly, Cocaine, Marijuana, alcohol, and OxyContin. Lovato reflects back realizing that that alone should have led to their death. At one point Lovato asked their dealer if he had Xanax and Cocaine and he said no, but he did have Heroin and Crack Cocaine.

Lovato says at that point they began using Heroin recreationally and became physically dependent on it. Heroin is a powerful Opioid drug made from Morphine that comes with severe withdrawal symptoms, such as muscle and bone pain, diarrhea and vomiting, cold flashes, and uncontrollable leg movements.

The night of the overdose, Lovato shares that they told their friends they were going up to bed, but actually went upstairs to call a dealer. Lovato used Heroin that they now assume was actually Fentanyl. After providing the drugs and taking advantage of Lovato, the dealer left Lovato alone. When Lovato’s assistant found Lovato in the morning, Lovato was naked and blue. At 11:22am on July 24, 2018, a 911 call was made and paramedics rushed to the house, administering Narcan trying to save Lovato’s life.

The overdose caused Lovato to suffer 3 strokes and a heart attack. They suffered brain damage from the strokes, has blind spots in their vision, and is now unable to drive. They received dialysis at the hospital as doctors tried to save Lovato, and they did even after Lovato suffered multiple organ failure. The documentary shares that if it had been another 5 to 10 minutes without treatment, Lovato would have died.

Demi Lovato’s Recovery

Since the overdose in 2018, Lovato focused on their physical and mental recovery. Lovato shared in the documentary series that the quarantine brought on by COVID-19 helped with working through past traumas and brought a period of rediscovery. Despite their struggles with substance abuse, Lovato was able to produce 5 award winning albums from 2009 to 2017, and will be releasing a new album April 2^nd, with a similar name to the documentary series: Dancing with the Devil … the Art of Starting Over.

Demi Lovato: Dancing with the Devil is a reminder that addiction can reach anyone. It doesn’t matter how successful and wealthy a person is, addiction does not discriminate. Lovato’s vulnerability in this series demonstrates that fact. As the series progresses, Lovato will open up more about their history with addiction, sexual assault, an eating disorder, sexuality, and self-growth.

This article was updated on 9/6/2021 based on new information.

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The year 2020 has not only been deemed the deadliest year in American history but also a dangerous and deadly year for substance abuse. America has been fighting the impact of the Opioid Crisis prior to 2020. While many states lost Americans to drugs like Heroin, Fentanyl, and prescription medications, states like Virginia, Ohio, and Oregon have the highest rates of overdose deaths.

In 2020, numbers of drug overdoses hit an all-time high, with the aforementioned states. Oregon witnessed a 40% “death spike” with 580 fatalities because of illicit chemicals. Use of drugs like Meth increased 37% in a year in Oregon, Cocaine deaths climbed to 57%, Fentanyl deaths contributed to a shocking 92% of deaths, and Heroin reached 9%. Virginia also suffered record highs for drug abuse and fatalities, with 2,035 drug overdoses in 2020, exceeding its record of 1,626 overdoses within a year’s time. Ohio lost 548 individuals to drug abuse in the spring of 2020, increasing in 14 years. Furthermore, the summer months of June and July lost 481 and 442 people in the state.

Staggering Numbers Of 2020 Deaths Continue To Concern Many

2020 death tolls have alarmed many and have gained the year the reputation of being the “deadliest year in American history.” Interestingly, the Centers of Disease Control predicted higher numbers of deaths to occur throughout the year. The COVID-19 pandemic, which has ended the lives of over 318,000 Americans in 9 months, is a major influence on high death tolls. While much research is being done to understand the connection between 2020-related substance abuse and the effects of COVID-19, both the pandemic and drug overdoses have greatly contributed to many lost lives in 2020.

In addition to such effects of the pandemic, declining mental health due to COVID-19 infections and adjustments has encouraged more substance abuse to occur. As a result, drug abuse and suicide have contributed to the high number of deaths. Sadly, numbers are expected to rise to 3.2 million by the end of 2020. Lastly, deaths from conditions like dementia, diabetes, and cardiac problems have been also connected to 2020 increases in death.

2020 Death Rates: COVID-19 Considerations, Drug Abuse And Diseases Of Despair

Diseases of despair have also been connected to rises in drug abuse, due to the impact of COVID-19. Diseases of despair, which have resulted in suicide, declining mental health (anxiety, depression, loneliness, poor coping mechanisms), financial insecurity, and stress from isolation have caused many to experience new mental health challenges and worsen pre-existing ones. Because of this, some of those affected have turned to self-harm, substance abuse, or have increased their tolerance to or dependence on harmful substances.

Drug statistics have drastically shifted when compared to previous years. The Centers for Disease Control and Prevention (CDC) notes, “After declining 4.1% from 2017 and 2018, overdoses have increased 18.2% from the 12 months ending in June 2019.” Another source echoes a similar finding. According to United Press International (UPI), drug abuse and suicide rates increased 170% between 2009 and 2018; however the spread of COVID-19 has caused sharp increases in such findings. As a result, studies noticed a 59% increase in alcohol use, increases in Opioid overdoses and rises in suicidal thoughts. Additional statistics include 81,000 reported drug overdoses in a 12-month period during 2020, becoming the highest ever recorded in a year. The awareness is causing media outlets to spread the word in order to educate people. Essential workers in the medical field use Naloxone to try and revive those who overdosed on Opioids.

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Tse Chi Lop A.K.A. Asian “El Chapo”

For over a decade, the AFP has tentatively tracked Tse Chi Lop for his suspected involvement with the Sam Gor syndicate. Nicknamed “Operation Kungur,” the AFP and about 20 other foreign agencies led the international investigation. The multinational pursuit followed the drug conglomerate’s money trails. They eventually arrested 27 suspects and cut off a few global distribution networks. Based on the sheer size and billions generated by “the company,” people have dubbed Tse Chi Lop as the Asian “El Chapo.” Experts even believe the ex-convict to be among the leagues of Joaquín “El Chapo” Guzman and Pablo Escobar. Tse’s organization is, perhaps, the largest illicit narcotics trading ring in Asian history. But what is most concerning is the short amount of time it took him to build his empire.

The Rise of Sam Gor Syndicate

From 2015 to 2019, the syndicate rapidly expanded. It quadrupled the rate of crystal-methamphetamine trafficking in Asia. Tse’s Asia-Pacific drug trade supplied methamphetamine and other synthetic drugs globally. They also produced heroin, MDMA, and meth. The illicit operation became successful almost overnight. By partnering up with smaller groups of criminals, the conglomerate gained territory quickly. They traveled from nation to nation, creating deals with local gangs.

Before 2019, the accused drug kingpin, Tse Chi Lop, lived in the shadows. Police sources claim the wealthy man even traveled with a guard of Thai kickboxers. It wasn’t until Reuters published an investigative article that everything came to light. The piece revealed Tse’s identity. Only then were authorities able to close in on him. According to the report, Tse ran his operation from Hong Kong, Macao, and Southeast Asia. It also connected Tse’s syndicate to 13 drug trafficking cases.

Reuter’s Grand Reveal

Shortly after Reuter’s grand reveal, AFP issued a warrant for Tse Chi Lop’s arrest in 2019. Yet, after learning about the multinational investigation into him, he hid in Taiwan. Finally, last Friday, authorities caught the supposed “Asian El Chapo” in the Netherlands. The Dutch now detains Tse, and the Australian government has requested his extradition. Tse Chi Lop’s arrest is a win against the global war on drugs. But the was is not over. The demand for synthetic drugs remains strong. If efficient change is not made soon, it is only a matter of time before someone new steps up and replaces Tse.

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On January 3, the Journal of the American Medical Association (JAMA) published a study of about 1,050,000 urine samples that healthcare providers collected at clinics in the United States from January 2013 to October 2019. Over the course of those six years, the prevalence of samples which tested positive for methamphetamine rose from 1.4% of samples in 2013 to over 8% of samples in 2019. The urine samples also indicated an increase in fentanyl use, with about 1% of samples testing positive for fentanyl in 2013 and almost 5% of samples testing positive for the synthetic opioid last year. The results of the study suggest a concerning, long-term trend: more Americans are using meth and fentanyl, both of which are dangerous and highly addictive controlled substances.

The study predicts that meth overdoses may become more common in the future as the signs of widespread meth abuse only appear to become worse. In 2019, the Centers for Disease Control and Prevention reported that meth has already overtaken fentanyl as the deadliest drug in nineteen states, all in the Midwestern and Western regions of the country. Fentanyl continues to cause the most fatal overdoses east of the Mississippi River.

Meth-Fentanyl Combinations On the Rise

The JAMA study also found a growing prevalence of urine samples which tested positive for both meth and fentanyl. More specifically, from 2013 to 2019, there was an increase of over 1,000% in samples which indicated co-occurring abuse of both drugs. Furthermore, samples which tested positive for both fentanyl and cocaine increased by 530%, and samples which tested positive for fentanyl and heroin increased by 556%. All of these drugs alone have the potential to cause an overdose. A person amplifies the risk of overdose by using two or more of them at once.

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Meth Addiction Makes Overcoming Opioid Disorders More Difficult

Another recent study has shown that co-occurring meth and opioid abuse adversely affects opioid addiction treatment. Dr. Judith Tsui, an addiction specialist at the University of Washington, designed a study to assess the impact of meth on patients with an opioid use disorder. She just published her findings in the Journal of Substance Abuse Treatment. 

For her study, Dr. Tsui and her fellow researchers examined 799 adult patients who participated in the Washington State Medication Assisted Treatment-Prescription Drug and Opioid Addiction Program from 2015 to 2018.  The researchers asked each subject whether they had used meth in the past thirty days, and 30% of them reported that they had. The researchers then examined which subjects failed a course of treatment with buprenorphine, an anti-addiction medication.

According to the study, “patients who concurrently used methamphetamine were less likely to be retained in buprenorphine treatment compared to non-users.” The study concluded that meth abuse correlates to a greater risk of failing treatment for opioid addiction. Dr. Tsui theorized that many people who are addicted to both drugs are homeless and have easy access to meth. As a result, they fail to take buprenorphine and use meth instead, sometimes to stay awake and alert at night.

“The next step is to build into treatment models how we can help those patients who struggle both with opioids and methamphetamines to be successful,” she said in reference to the study. As meth abuse becomes an even larger problem in many states, the progress which the United States has achieved against the Opioid Epidemic might face a new obstacle.

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On November 17, 2019, agents on the United States/Mexico International Border witnessed a person ducking in and out of view along the secondary boarder wall. More agents responded to the site and found a 16-year-old boy hiding in thick brush. In his possession were two large duffle bags and a remote-controlled car. The agents discovered that the 16-year-old was a US citizen, and in the bags were 50 packages of methamphetamine weighing 55.84 pounds. The estimated street value of the drugs was $106,096. Q13 Fox TV stated that the remote-controlled car was most likely controlled by someone on the southern side and used to drive the drugs from Mexico into the US.

A press release from US Customs and Border Protection says that San Diego Sector Chief Patrol Agent Douglas Harrison commented, “I am extremely proud of the agents’ heightened vigilance and hard work in stopping this unusual smuggling scheme.”

After the search, the teen was arrested and taken to Otay Mesa, a California city near San Diego, to face drug smuggling charges. The US Drug Enforcement Administration (DEA) says that most of the methamphetamine available in the US is produced in Mexico and smuggled across the Southwest Border. Although restrictions have been placed on precursor chemicals in Mexico, Mexican Transnational Criminal Organizations (TCO) find alternative ways to manufacture the addictive drug.

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Making Meth

The number of American methamphetamine laboratories have been decreasing since their peak in 2004 and are currently at their lowest point since 2000. Most of the labs seized now are small and only produce about one or two ounces of meth per production cycle. Ingredients used to produce these small batches include household items such as lithium batteries, camp fuel, cold packs, and starting fluid. Mexican produced meth is a low cost, high purity, and high potency alternative and is now the main source for meth in America.

Smuggling Drugs Across The Border

The ways TCOs smuggle drugs into America is constantly evolving with more creative ideas. Methamphetamine is often dissolved into another substance, such as a paste or liquid, and disguised as items like soap or aloe Vera. Conversion laboratories are increasing around America, converting and recrystallizing meth so it can be sold.

The use of drones was previously not favored by traffickers because of their noise, short battery life, and limited payload, but advanced technology is making this option more convenient. The DEA says that the largest advantage is that drones can be operated from far away or set on a programmed route, decreasing the likelihood of being caught. There have been cases of drones dropping loads of heroin, marijuana, and methamphetamine.

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On November 18, the South Dakota Department of Social Services launched a multimedia advertising campaign against methamphetamine, a dangerous and illegal drug which has destroyed the lives of thousands of South Dakota residents. The South Dakota Meth Prevention and Awareness Campaign presents the state’s methamphetamine crisis as a community problem and calls for everyone to work together to solve it. The slogan for the campaign is “Meth. We’re on it.” Perhaps unsurprisingly, these four words instantly prompted a torrent of mockery on social media.

Some commentators on Twitter wondered if South Dakota was trying to advertise meth. Others called the slogan a joke. Even a famous marketing professor, Bill Pearce of UC Berkeley, weighed into the fray, describing the slogan as an example of “poor strategy and poor execution.” The promotional materials for the campaign feature ordinary South Dakotans – an elderly farmer, some high school football players, a man in a coffee shop – alongside the tagline “Meth. I’m on it.” Some interpreted the advertisements to mean that the individuals actually use meth. The domain name of the campaign’s website, onmeth.com, certainly doesn’t clear up any confusion.

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The Meth Crisis In South Dakota

According to the most recent data from the CDC, methamphetamine claims more lives in South Dakota than any other illegal drug. At least thirteen people in South Dakota died as a result of methamphetamine last year. Methamphetamine has burdened many more South Dakotans with debilitating substance use disorders. As in all other states, most of South Dakota’s meth supply originates in Mexico. In 2018, police in South Dakota arrested 3,684 people for possessing, transporting, or distributing methamphetamine, and confiscated about 100 lb. of the drug. Cities tend to be the main targets for drug traffickers. Last year, South Dakota police seized a total of 24 lb. of meth in the Rapid City area, over 20 lb. in Sioux Falls, and almost 1 lb. in Pierre, the state capital. For reference, only 150 milligrams of meth (or 0.0003 lb.) can cause a fatal overdose.

South Dakota’s Governor Defends The Slogan

After “Meth. We’re on it” appeared on billboards and televisions in South Dakota and ignited a national conversation about harebrained marketing, Governor Kristi Noem expressed her support for the campaign. “Hey Twitter, the whole point of this ad campaign is to raise awareness. So I think that’s working…” she tweeted on the 18th. The Governor later described the campaign as “a bold, innovative effort like the nation has never before seen.”

Earlier this year, Noem vowed to reduce the prevalence of meth in her state. She has since requested over $1 million from the federal government to fund addiction prevention programs and supplement federal assistance her state already receives to combat meth trafficking. The domain name notwithstanding, onmeth.com could be a helpful resource for South Dakotans living with a meth use disorder. The website features a directory of treatment centers and support groups for drug addiction.

The Campaign Could Be A Success

The South Dakota Department of Social Services hired Broadhead Co., a Minneapolis-based media firm, to design the anti-meth campaign. The state agreed to pay the company $1.4 million, a price tag which generated substantial criticism on social media. Nevertheless, Social Services Secretary Laurie Gill has insisted the cost is worthwhile for a campaign which stands out from prior anti-drug initiatives.

In defense of its work, Broadhead explained that its vision was to change the culture, not simply to tell meth addicts to get sober. Several professionals in addiction treatment agreed that engaging the whole community is the best way to raise awareness and fight the addiction crisis, so the campaign might have a positive impact. Meth addiction is “a dangerous disease,” said Carol Regier, the director of Keystone Treatment Center in Canton, South Dakota. “I think it’s very good that the state is going to take some action about it.”

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On October 25, the Centers for Disease Control and Prevention released a groundbreaking report on fatal drug overdoses in different regions of the United States. CDC researchers examined death certificates from 2017, the most recent year for which comprehensive data on drug fatalities is available, to compile the report. In 2017, over 70,000 Americans lost their lives to an overdose on at least one narcotic, with 68% of cases involving opioids. However, the report reveals that methamphetamine caused more fatal overdoses than fentanyl and other opioids in nineteen states west of the Mississippi River.

According to the CDC report, fentanyl caused 38.9% of all fatal overdoses nationwide, an increase from 29% of fatal overdoses in 2016. The synthetic opioid was the deadliest drug in America. After fentanyl, heroin was the second deadliest drug, cocaine was the third deadliest, and methamphetamine was the fourth deadliest. Heroin, cocaine, and meth respectively caused 22.8%, 21.3%, and 13.3% of all lethal overdoses in 2017. While methamphetamine was the fourth most lethal drug nationwide that year, it caused more fatalities than any other substance in Arkansas, Louisiana, Texas, Oklahoma, North Dakota, South Dakota, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, California, Oregon, Washington, Alaska, and Hawaii. In many of these states, methamphetamine surpassed black tar heroin as the most dangerous illegal substance and caused as many as 38% of drug-related deaths.

In some cases, the regional disparity is striking. While fentanyl far exceeded methamphetamine as the deadliest drug in New England, a region where methamphetamine was only the tenth most lethal controlled substance, fentanyl caused fewer deaths than methamphetamine and five other drugs in North and South Dakota.

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Fentanyl And Meth Present Different Challenges

According to the DEA, the vast majority of the methamphetamine supply in the American West originates in Mexico. By contrast, most of the country’s fentanyl supply comes from China. While the Chinese government has agreed to punish fentanyl exporters, authorities in Western states are working to devote greater resources to stopping the flow of methamphetamine across the Mexico-U.S. border. Officials from the health department in one target state, New Mexico, believe that the proliferation of methamphetamine throughout the country will become more severe, since the drug is easy to obtain at a low cost.

Furthermore, as methamphetamine continues to take lives, law enforcement and the medical system are struggling to save them. It is generally easier to save a life from an opioid overdose than from a meth overdose. A person who suffers an overdose on fentanyl could survive if they quickly receive a dose of naloxone, a medication which reverses the effects of opioids on the central nervous system. Unfortunately, there is no medication which counteracts the effects of methamphetamine. Instead, methamphetamine overdoses require treatment with a combination of sedatives.

What About 2018 And 2019?

Although researchers are still developing the data on drug overdoses this year and last year, they are beginning to understand how drug overdoses have most recently affected Americans. The CDC projects that the number of fatal overdoses in the United States declined in 2018. This may be the result of the increasingly widespread availability of naloxone. However, the country may be experiencing a shift in the regions where the deadliest illegal drugs take the greatest toll. Experts believe that America’s fentanyl supply has possibly started moving to Western states, a possible explanation for the fact that the number of fatal drug overdoses is growing in that region of the country. Meanwhile, experts and authorities in states east of the Mississippi River are beginning to find more methamphetamine and encounter more cases of methamphetamine addiction in their neighborhoods and hospitals.

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The unheard-of death rate within New Bilibid Prison (NBP) outside Manila developed as a confluence of recent political history, drug use, and culture in the Philippines. Like many other countries, illegal drug use has been popular and varied, and the most popular drugs in the Philippines are methamphetamines and marijuana. An anti-drug sentiment has grown since the 1970s, but recent years have seen a spike in the hostility with which drug offenders are treated. After his 2016 election, Rodrigo Duterte vowed to escalate the war on drugs in his country asking the public, “If you know of any addicts, go ahead, and kill them yourself…” in his inauguration speech.

The extremely hostile sentiment expressed by the president has encouraged police throughout the country to take lethal measures in the “management” of Philippine drug use. The rampant, and essentially state sanctioned violence has even begun to include public participation. Referred to as “riding in tandem” these civilians patrol on motorcycles in pairs and carry out drive by killings. The killers are almost always hired by the police, and targets are selected from lists of suspected, but unverified drug sellers or users. The definition of drug user specifies use within the last month, but reports describe many innocent lives lost in the seemingly indiscriminate raids and killings. People found in violation of the strict drug laws who haven’t been killed, are now flooding the country’s prisons.

Prison Crowding

Between the early 2000s and 2019, the Philippines saw a drastic increase in prison population and incarceration rate. In 2005, jails held about 90,500 people, and by 2010 that increased by 5,000, up to 95,400. The next jumps are much more dramatic, escalating to 120,000 by 2014 and 188,300 by 2018. Before Duterte took office, there was a trend of increasing incarceration, but after he took office, the country saw its biggest leap in prison population yet. An increasing proportion of the incoming inmates are classified as pre-trial detainees.

These prisoners have yet to be convicted or acquitted of a crime and spend extremely long periods of time in prison regardless of outcome. The average amount of time spent pre-trial has risen to 528 days, which is one of the longest pre-trial averages in the world. In some extreme cases, people have spent 10 years in prison pre-trial only to be acquitted once they’ve finally gotten their time in court. The combination of exploding prison populations and unbelievably lengthy pre-trial periods have compounded to push the Philippines to the top of the world in prison overpopulation.

The Philippines has roughly 933 penal facilities, a range including small provincial jails through to national prisons. The variance in size and population distribution lead to a handful of the large national and city prisons bearing the brunt of rising incarceration rates. Pictures and videos from prisons like NBP display a dystopian lack of space or standards. Rooms designed to fit 30 inmates holding 130 instead, and 500 people trying to sleep on a single basketball court, shoulder to shoulder in sweltering heat. Some prisons are handling well over six times their capacity with no additional staff to compensate.

The Philippine prison system has been known for decades for its relative lack of standards or standard enforcement. Analyses of the Philippine legal system blame congested and stagnant courts incapable of handling their previous number of cases, let alone the flood of drug related charges since Duterte’s election. Similar critiques note a distinct shortage of judges and other legal professionals to ease the process.

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Overcrowding Consequences

The extreme prison conditions provide the perfect environment for disease and violence to thrive. Currently, pulmonary tuberculosis is spreading quickly throughout NBP. The bacterial infection can spread through inhalation of an infected person’s coughs, sneezes, or breath, and in a prison where inmates have less than three square feet to themselves, it’s unavoidable. Wealthier prisoners can buy themselves a private cell and bribe guards into smuggling amenities into the prison, but the vast majority of prisoners are too poor to receive similar treatment.

When space is such a limited resource, many gang disputes can escalate and erupt quickly. Arguments between rival gang members become physical fights, which can often spark riots. The Manila City Jail experienced a large riot recently, resulting in two deaths and over 30 injuries. This specific prison currently holds 6,300 inmates even though it’s designed to hold 1,000. The prison staff aren’t properly equipped or numerous enough to manage a skyrocketing prison population, which means that episodes of violence are as unstoppable as they are unavoidable. Layer these conditions on top of the rampant spread of tuberculosis, sepsis, and other diseases, and it becomes clear how so many people could have died within a single year. Duterte vows that the violence and aggressive prosecution will continue as long as he’s in office. His promise suggests Philippine prison standards will continue to plummet, while their death rates continue to rise.

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