On any given day in Pikeville, Dwayne Kilburn knows where to find methamphetamine, and he hates that.
“There are so many people that’s on meth in this town right now. I have never seen something take over so quick in my life,” the 39-year-old said as he stood in front of Food City late on a Thursday night in early August. “You can find it anywhere, buddy. It’s like going in here and buying tampons, I swear to God it is. It really is that bad. It’s the new thing.”
As the death toll of the opioid crisis in Kentucky has ballooned to unprecedented heights in recent years, killing thousands and marking Appalachia as ground zero for the epidemic, a quieter crisis has emerged outside the limelight: meth. People here say meth, which is cheap and addictive, is more prevalent than opioids but gets far less attention.
Kilburn, who has a young face and a thick accent, has tried meth. Twice. It was always around, and he was curious.
“The times I’ve done it, it makes me crazier than hell. And as you can see, I’m high-strung anyway,” Kilburn said, lighting a cigarette. “I swear to God ... you start seeing [stuff], hallucinating and stuff, you freak out in your mind, like I thought I was in hell. I seen the floor open up, fire, flames come around me, and I was cussin’ at the devil. This been back years ago, and I had to go to the hospital over it.”
Kilburn, a formerly incarcerated veteran, has metal in his leg from an old break that needs replacing, and for the time being, he walks with a limp. He has lived in this Appalachian town of about 6,600 since 2009, after spending a stint in federal prison in Manchester. His criminal record is blotted with violent and non-violent offenses, several of which are drug and alcohol related. But he’s trying to stay clean these days — a feat made easier, he said, as he watches meth wreak havoc in his community.
“It’s ruining everybody we know,” he said. “I’m dead set against that [stuff].”
Someone broke into his apartment recently, high on meth, he said, and stole most of his possessions, including his groceries but not his television. He called the police to report it, and, while there, officers arrested his girlfriend because of an outstanding warrant.
On this night, without a car or groceries and despite his leg pain, Kilburn asked to borrow money from a friend and limped from his apartment to the grocery store. He made it most of the way before his friend, Angela Caines, picked him up.
“Me and her, both, everybody we know is on it. We were just talking about it,” he said, motioning to Caines, who hasn’t seen her husband lately because of his meth use, she said.
“I got people right now on my Facebook trying to sell it to me,” he said, taking out is cell phone and pulling up the app to prove it. “I could take you to 10 people right now and go buy it.”
He scrolled quickly, found a friend, and sent him a message.
Within seconds, his friend had responded.
“You got cash or what?”
“Yep,” Kilburn responded.
“How much you wanting?”
Later that night, Pikeville Sgt. Chad Branham, who has been with the department for 11 years and knows Kilburn personally, said his account is accurate.
“Every drug dealer that I’m aware of has it,” Branham said, turning up a darkened street in his unmarked police cruiser.
“I know everybody thinks Eastern Kentucky is the opioid capital of the world, but we don’t see a lot of opioids anymore. There’s been a lot of laws that have cracked down on opioid use, prescriptions and stuff, so it’s harder to get. Meth is readily available,” he said. “There’s just an abundance of it.”
Meth use has metastasized in the shadows
In Kentucky last year, the number of overdose deaths fell for the first time since 2013. All but two drugs contributing to those overdoses also dropped, including heroin, which led to 188 fatal overdoses, down from 270 in 2017. In total, Kentucky’s overdose deaths fell by 15 percent, outpacing the national reduction of 5 percent.
State and national leaders, including Gov. Matt Bevin and Vice President Mike Pence — both of whom visited Clay County last month to announce a $9 million federal grant earmarked for more opioid treatment and prevention services in Kentucky — have hailed the reduction as progress. They and others cite a number of state and federal initiatives aimed at stemming the flow of opioids, including a 2017 law increasing state penalties for trafficking of heroin and fentanyl and setting a three-day waiting period on opioid prescriptions for acute pain.
Fueling the state’s response was a years long shift in the public perception of opioid addiction as a medically treatable disease and a public health crisis. These have become common turns of phrase for lawmakers and leaders, including Pence, who in Manchester thanked Kentucky leaders for supporting Republican President Donald Trump’s “vision to combat opioid abuse and addiction,” and state and federal efforts for allocating “unprecedented resources to combat this crisis.”
This tack has informed a number of policy changes and research endeavors by state institutions like the University of Kentucky, and has helped the state secure hundreds of millions of dollars in grant money to stop the epidemic from blooming further. While some of these initiatives target drug use broadly, opioid mitigation is at the forefront.
Yet while the spotlight has burned brightly on opioids, methamphetamine use has metastasized in the shadows. Aside from fentanyl and its analogues, which played the biggest part in last year’s overdose deaths — 786 of the total, 1,333 — meth is the only other drug that grew in prominence across Kentucky. Though the overall overdose rate dropped 15 percent, use of meth in overdose cases rose by nearly 20 percent.
Nationwide, the U.S. Dept. for Health and Human Services reported that meth now outnumbers fatal fentanyl overdoses in at least a dozen states.
In 2018, meth arrests outpaced all other drug arrests except fentanyl, according to the annual crime report from the Kentucky State Police. Of the more than 107,300 drug arrests statewide, the 2018 report shows law enforcement made 25,766 meth arrests, compared with 21,130 arrests for opiates, and 32,276 for fentanyl.
As part of an ongoing federal crackdown on meth trafficking in Kentucky, Tennessee and West Virginia, Drug Enforcement Administration officials late last month announced they had seized more than 800 pounds of meth, the largest portion of which — 360 pounds — came from Kentucky.
“While America’s opioid crisis may dominate headlines, [the raid] should serve as a reminder that methamphetamine is a problem that has never gone away,” Louisville DEA Special Agent D. Christopher Evans said after the raid.
Pikeville police say most arrests involve meth
In Pikeville, at least eight out of every 10 arrests involve meth, Branham said.
It’s just after 10 p.m. and he is driving to Lancelot Court, a row of apartment buildings on the outskirts of town. He has a hunch that the apartment’s tenants and some of their friends —known meth users and traffickers with a history of police run-ins — might be there. That’s regularly the case these days, Branham said: Pikeville police don’t wait for drug-related calls, they go find them. And more often than not, they do.
“With any job, you come out some days and you’re just going through the motions. For us, that would just be answering all our complaints and dealing with what’s right in front of us,” he said. But even if a call or complaint isn’t made, finding meth is easy: “you just go to the known drug areas and make a drug bust,” he said. “We know where to look.”
At this apartment building, which Branham said has upwards of 40 drug trafficking complaints, the front door is open. Inside, two women and a man are bent over in front of a couch, looking at something. Branham walks through the door, and one of the women drops a small plastic bag to the ground. On the ottoman, there’s a weighted scale, a spoon and an empty Altoid container. In the small plastic bag, police believe, is crystal meth.
“Why do you have a scale laying right there?” Branham asked.
“I was trying to fix it,” said the woman, 45, who’d been holding the bag.
Branham, who was joined by several other officers, asked the trio more questions, including whether there were other drugs in the apartment and what happened to the back door window, which had been partially shattered.
“There ain’t nothing here, y’all, I swear there ain’t,” the man, 40, told Branham.
“Listen, y’all was either buying or selling dope when we got here. That’s why the scale’s out,” Branham said.
Officers asked to search the apartment, rifling through drawers and cabinets and under the mattresses upstairs. The third woman, 47, who had been sitting in a chair smoking a cigarette in the living room, was asked to wait outside with Branham.
In the driveway, he asked if the meth was hers, or if she took meth. No, she said, showing her arms and their lack of track marks. Meth used to be smoked, Branham said later, but most people in Pikeville now inject it.
In searching the apartment, officers found 15 empty bags, several syringes, some cash, a meth pipe fashioned out of a light bulb, and two small bags of Suboxone, a pill that’s prescribed to treat opioid use disorder, though it’s regularly sold on the streets. All three were arrested for trafficking and possession of scheduled drugs and paraphernalia.
After they were put in police cruisers, officers mentioned to Branham that he might want to check in on another man. A known meth user, he’d sprinted away from police earlier that morning and the night before, even though police weren’t trying to arrest him.
“Why was he running?” asked Branham, who knew the man personally.
“He said he wanted to be free,” Sgt. Russell Blankenship said.
“He must’ve been on meth,” Branham said, calling the phenomenon, which happens often enough to elicit its own phrase, “unprovoked flight.”
A ‘silent epidemic’
Pikeville police have been bearing witness to the shift away from opioids and toward meth for at least a year. It even claimed one of their own last March. While responding to a drug-related call, Patrolman Scotty Hamilton, 35 at the time, was shot and killed by John Russell Hall, who officers later said was high on meth. Hall was sentenced to life in prison.
How Kentuckians obtain meth also has shifted dramatically from years past. Before 2012, it was largely a homemade drug.
A state law went into effect that year limiting how much Pseudophedrine — a key ingredient in homemade meth — can be bought at a time from the pharmacy. Since then, the number of meth labs has waned significantly. Police busted fewer than 100 meth labs statewide last year, down from 1,233 in 2011, state data show.
Now, as officials have worked to tamp down access to prescription opioids, meth is being manufactured en masse outside the country and smuggled into the states.
At the Louisa-based Appalachian Recovery Center, which serves roughly 1,100 patients from across Kentucky, meth is the drug most patients are now abusing. It’s been that way since the spring, said chief of staff Matt Brown.
In the last 90 days, more than 41 percent of the center’s patients were treated for meth, 28 percent for prescription opiates, and 19 percent for heroin, he said. Two years ago, prescription opiates were the leading substance among more than 33 percent of patients, followed by 27 percent for meth and 25 percent for heroin.
“Just like any other time in the history of the war on drugs, it’s almost a game of wack a mole: you stop one and another pops up, you stop that one and a third pops up,” Brown said.
Though meth has been the “drug of choice” for awhile, Pikeville Police Chief Chris Edmonds said, it’s not the drug at the forefront of most Kentuckians’ minds. He called the surge a “silent epidemic” that “we’re behind on again in Kentucky when it comes to education.”
Silent in part because not many people in leadership positions are talking about it, and because its effects on the body are less acute than opioids. Opioids, which are a depressant, block the brain’s sensors that regulate the respiratory system, which makes death from overdosing an immediate risk. More potent fully synthetic opioids like fentanyl greatly increase this risk, and drugs like naloxone or Narcan, carried now by first responders across the state, can instantly reverse its effects.
There’s a much lower chance of fatal overdose from meth, unless its used with opioids. A cocktail of poisonous substances, meth is a stimulant that attacks the central nervous system and corrodes one’s body over time, making it much less visible when compared with a drug as lethal as fentanyl, which can kill someone in very small doses.
Meth abuse can also be harder to treat than other substance use disorders. Unlike opioids, meth induces a state of mind similar to psychosis. Hallucinations, paranoia and erratic behaviors are common side effects. To outsiders, these symptoms can be interpreted as mental illness, said several health and law enforcement officials interviewed for this story, making it difficult for medical providers to discern what the best course of treatment might be.
What’s more, while it’s widely believed that medication-assisted treatment is the best way to treat opioid use disorder, there’s no Federal Drug Administration-approved drug to treat meth addiction.
“Right now we have more tools in our toolbox for treating opioid use disorder,” said April Young, an associate professor of epidemiology at the University of Kentucky. In addition to behavioral therapy, opioid use disorder is regularly treated with medications, primarily Suboxone, methadone or Vivitrol. These opioids don’t cause the normal high that other illicit opioids do, but work instead to block cravings. Because there’s no medication to help with meth addiction, treatment programs instead rely largely on a combination of substance abuse therapies, Young said.
It often feels like a never ending battle, said Branham, the Pikeville policeman.
“We’re at such a disadvantage because the volume of meth is so high, and there’s not enough housing in the jails for them. We arrest them, the judge sentences them, and then they get out and we end up dealing with the same repeat offenders over and over. It really is a never ending battle.”
Short of stopping meth from crossing into Kentucky in the first place, which is “almost impossible,” he said, “I don’t know that there is a solution.”