Methamphetamine and the Overdose Crisis

We are now in the fourth wave of the overdose crisis. Fentanyl is the still the most common drug involved in these deaths, but stimulants, primarily methamphetamine, is increasingly prevalent. In fact, the vast majority of all overdose deaths now involve multiple drugs. Meth, cocaine, heroin; worse still, newer contaminants like the animal tranquilizer xylazine are showing up alongside fentanyl and its analogues. Even more concerning are the novel synthetic opioids that are now being found in toxicology reports. Some of these are even stronger than fentanyl - nitazine, for example. Opioid prescription rates have steadily declined in recent years, which is excellent news considering that overprescribing got us down this path in the first place. But clearly there is something else going. In particular, it’s evident that there is an incredibly high demand for stimulants, even stimulants known to be contaminated with extremely powerful sedatives like fentanyl. My guest this month is special agent Tommy Farmer of the Tennessee Bureau of Investigation’s Dangerous Drugs Task Force. He also serves on the state’s Opioid Abatement Council. In this conversation, we dive into the history of methamphetamine in Tennessee, and how law enforcement has responded over the past thirty years. Drug trends have changed a lot during that time, and the federal and state legal landscape along with it. Most importantly, how and where drugs are being produced has changed dramatically, resulting in profound consequences. Produced and edited by Jeremy Kourvelas. Original music by Blind House.

Transcript

SPEAKER_01 0:05

You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. We are now in the fourth wave of the overdose crisis. Fentanyl is still the most common drug involved in these deaths, but stimulants, primarily methamphetamine, is increasingly prevalent. In fact, the vast majority of all overdose deaths now involve multiple drugs. Meth, cocaine, heroin, or still newer contaminants like the animal tranquilizer xylazine are showing up alongside fentanyl in its analogs. Even more concerning are the novel synthetic opioids that are being found in toxicology reports. Some of these are even stronger than fentanyl. Opioid prescription rates have steadily declined in recent years, which is excellent news considering that over-prescribing got us down this path in the first place. But clearly there is something else going on. In particular, it's evident that there is an incredibly high demand for stimulants, even stimulants known to be contaminated with extremely powerful sedatives like phenomenal.

SPEAKER_00 1:15

This guy's funning up. Everybody wanted his job. Even knowing that it resulted in a bunch of overdoses, people wanted his bill. What we have is an addiction problem in the United States.

SPEAKER_01 1:32

My guest this month is Special Agent Tommy Farman of the Tennessee Bureau of Investigation's Dangerous Drugs Task Force. He also serves on the state's opioid period. In this conversation, we dive into the history of methamphetamine in Tennessee and how law enforcement has responded over the past 30 years. Drug trains have changed a lot, and the federal and state legal landscape along with it. Most importantly, how and where drugs are being produced has changed dramatically, resulting in profitable consequences.

SPEAKER_00 2:11

Hi, my name is Tommy Farmer, and I'm a special agent in charge with the TISE Bureau of Investigation. My responsibilities are the Statewide Dangerous Drugs Task Force, which has a couple of different units or groups within it, from supporting law enforcement with presumptive testing capabilities, technology to uh information sharing, technology, or intelligence. And then response, we provide safety, protective equipment, and training for state and local law enforcement across the state. So we started off as the meth task force years ago, where Tennessee was uh unfortunately had the dubious distinction of being the meth lab capital of the United States with uh 2,860 meth lab seizures or about 7.8 meth lab seizures a day across our state. Uh, we found ourselves in a very precarious situation about 23, 24 years ago. And that was local law enforcement. Law enforcement, we didn't have the resources, we didn't have the knowledge or the training or the equipment or specialized gear to be able to respond and handle uh these uh hazardous drug labs. And then, of course, dealing with the potential contamination of not only the environment, the the homes, the children. Um, it was just a mess, and then at the same time trying to protect law enforcement. So where that evolved, and I and it's a long way to get around. I would say how that big thing has changed. We were already in place. Meth labs themselves, uh, they're down, seizures are down about 90, about 89, 90 percent. That is fantastic. That's a success uh of those efforts.

SPEAKER_01 3:52

Yeah, that's amazing.

SPEAKER_00 3:53

However, the drug trends changed, and we went from meth, then meth and pharmaceuticals being an issue, and now the illicit side of those pharmaceuticals or the illicit side of the uh of the opioids is a significant problem. To me, I was familiar with probably a little bit more so about pharmaceutical diversion from my previous life in law enforcement. I mean, I was at Chattanooga Hamilton County. We had a we had one of the first diversion programs in the state. And in 1995, we were working 500 cases a year on pharmacy fraud diversion in Chattanooga. So I knew that wasn't a new concept for me to say that hey, there's a uh uh prescription drug problem out there, but to that level, what's the magnitude of it? And it wasn't until this years later um where we're going back up and we're meeting and so okay, how big is this problem? We start pulling the numbers on the state level. How many prescriptions? What's the drug of choice, hydrocodone? Okay, well, what are the numbers? And and we were absolutely blown away.

SPEAKER_01 5:03

I can imagine because in 95 you probably would have been focused on crack.

SPEAKER_00 5:07

There's no doubt about it. 95 crack, and you had diversion a little bit. Okay, it was a honestly, it was a soccer mom uh that had codeine or hydrocodone liquid or pill. But I mean, we knew there's a problem. We just didn't know how big is this issue. So we looked at what consumption rates are in 2014. The top 10 countries in the world for consumption of hydrocodone was, and I'm I'm shooting from the hip here. I know China was like number nine on the list with 10 kilograms, India was seventh on the list with about 20 kilograms, and then all the way down to the list, uh, down to uh number three was Canada at 150 kilos, Great Britain was number two on the list at 225 kilograms. Okay, I think you know where I'm going with this. Who is number one? Well, the United States. All right. So I asked this even to this day when I'm doing presentations, tell me how much? What do you think? The most common response that I get is 500 kilograms. I said, okay, 500. Anybody else? A thousand or two thousand, and then you'll always get somebody that comes in there that's gonna guess high, and they'll say, hey, it's gotta be at least 15,000 kilograms. And of course, then the rest of the crowd says, huh? 15,000 compared to Great Britain at 200 and Canada at 150, blah, blah, blah. And then when you put that number up there, that the United States come in at 79,000 kilograms. So 99.3, it's staggering. Everybody looks at that and says, There's no way. The United States consumes 89.4% of all of the world's opioids are being consumed. And the United States only making up one-fifth of the world's population at that time. And then you say, well, wait a minute, how does that work in Tennessee or the United States? Well, Tennessee per capita at that point was number two, number three in the United States with a 6.6 million population. And you start doing the math when it gets too big for math in my head, and I say, Wow, do you mean Tennessee at 6.6 million, we're prescribing more opioids than most countries in the world, even in the top 10? Yeah. You mean we're doling out 153 hydrocodon on average for every citizen in the United States or every citizen in the state above the age of 12? Yeah. That's when it was really um that's when you even hear um very knowledgeable, educated, much smarter than I am. People in a room sit back and you hear that gasp. This is holy cow.

SPEAKER_01 7:55

I was wondering if you could give us a uh a sort of sense of what these lab cleanups look like. I understand, as you've you've said as well, that they can be quite expensive, they require specialized equipment. I imagine hazmat suit. Wonder if you could explain a bit of that.

SPEAKER_00 8:09

The type of equipment, the type of response, the type of disposal has been and also been a big evolution of that. You know, we saw even the changing in manufacturing type, uh, where it went from a red phosphorus type manufacturing lab where there was iodines and red phosphorus and various chemicals, common household ingredients converted or manipulated in a house or a home or in a clandestine setting. It doesn't take a whole lot to change the molecular form or find commercial products that can do the same that you would use in an industrial setting. And so that's what we started seeing and dealing with. And it was, it was uh, it was an incredible challenge even in the beginning when you were coming into the courts and introducing or talking to a judge or a prosecutor about somebody setting up a drug lab and they were manufacturing drugs, methamphetamine. And the judge says, Okay, what is your evidence? And you say, Well, he had Coleman fuel, he had Red Devil Lie, he had uh uh 40 boxes of Pseudafed, uh, called it an allergy medication, or he had iodine, and we would generally lose them about that point. They say, Wait a minute, you've arrested this guy because of uh that illegal purchases. Exactly. I've got these things in my house. We we had to do a lot of education and show, you know, you do realize pseudoephedrine is an immediate precursor. Well, what does that mean? Well, that simply means that uh if this was the chemical structure of it, and this my thumb is the oxygen, that would be uh pseudoephedrine. If the other is the same, but it's a mirrored image, that would be ephedrin. And to change pseudoephedrine or ephedrin using Coleman fuel, all I got to do is go through a reduction method using the chemicals I just mentioned to knock off one oxygen off of either or, and then that's methamphetamine. So once we got past all that, then it became a little a little bit better. So we'll then say, Well, what's the hazards of that? Everybody deals with Coleman fuel or many do or no. Again, it's the combination when you mix the iodine with the Coleman fuel and you add this, then all of a sudden we create these things called phosphine gas or iodine prune, and I how dangerous iodine in itself really is. Absolutely. So those things um you don't think about it until even even now that you're you're you're you're asking me these questions. Uh, I haven't thought about that and how it changed and the way we view what potential hazards are or how we protect ourselves or how we move forward. Um, it really has. It changed. Um, this is and it being a law enforcement game, we had no choice. Um I can remember my first labs being out there, and I'm saying, wait a minute, what is this? And and we're literally picking these things up and we're holding them in our hands, and we don't know what it is. And but then we we figure up enough that it can't be good, it can't be good for us, and we start making phone calls. We try to give it to the fire department or to the hazmat, or what do we do with this? And everybody says, It's yours. And then we looked at it and said, you know what? Um, law enforcement didn't have a choice. And I guess probably one of the best analogies, other agencies, and I don't think that folks realize sometimes law enforcement has a different set of responsibilities. We have a duty, we have no choice but to deal with that. Intrinsically, because it's a drug crime and it's a crime that occurred, then law enforcement has to investigate it and potentially prosecute it and bring those individuals to justice. Okay, it doesn't matter what type of crime it is, then you have to develop the tools that you need to prosecute or to handle whatever that type of crime. Well, it's a drug crime that creates hazardous waste and chemicals. Okay. Well, then that application, if it's uh your responsibility, then you have a duty. If law enforcement passed that up uh and did not act, then it's a failure. So anyway, uh that's where we were at and how the evolution of these normal chemicals, Coleman fuel, uh diesel fuel, gasoline. There anyway, there's many ways to try to cancel or control all of those. The methamphetamines that we deal with today, um uh methamphetamine.

SPEAKER_01 12:48

I'm no, if I may, uh you you've mentioned um a lot of really volatile chemicals. I mean, gasoline. I mean, no wonder they talk about the dangers of meth labs exploding. And this is of course for that moral imperative to protect children and and and surrounding environs from the risks of these these labs. Uh, you said have meth has changed, and that's something I'm really glad you brought up because uh I understand writer Sam Canonis has talked about how the formula of contemporary meth is almost completely different, or at least different enough in really crucial ways from meth of 20 years ago. Uh and of course there's some symptoms with that, some psychotic presentations and things. But uh I I don't really know anything about how law enforcement is what the new hazards that law enforcement has to deal with are like. Uh could you explain a little bit about that?

SPEAKER_00 13:36

Well, you know, we should jokingly say when we were in the throes of working and responding to so many meth labs, we were saying, well, it would be just because you change the law, uh and the change in the law or change in a procedure or process uh causes um uh a ripple effect and has an impact. Okay, in this situation, there can be intended consequences and unintended consequences. All right. Well, the changes that we went through to deal with the meth labs to reduce the$6.9 billion a year in expenses, or the on average 1,300 children being removed from these contaminated or the five, five to two thousand homes a year contaminated that had to be remediated. To change that, we put restrictions the way somebody could sell pseudo-ephedrin, where it could be sold, the amounts or the levels that a person could. We went to the one thing and we took a strategic strike. What do they have to have? Because we couldn't control all those chemicals or all the so we went at pseudo-ephedrin and we saw an immediate reaction, and the number of clandestine drug labs dropped exponentially overnight. But the thing we had, the reality to it is we still have a meth problem. And even to this day, the meth problem, arguably, we have more methamphetamine, uh, more submissions coming into the crime lab, more people utilizing or using methamphetamine than uh arguably ever before. Well, wait a minute, I thought we dealt with that meth problem. No, we dealt with some of the precursor issues. We dealt with meth labs. Okay. So just because you reduced the availability by 50% overnight doesn't mean that you reduced the the demand by 50% overnight. Or it doesn't mean that you you you reduced that a person's no longer addicted. Okay, you have someone that's addicted to methamphetamine and they can't get it. Well, they passed a law, I can't get it anymore. So I guess I'll just be okay. No, they're still addicted. Methamphetamine didn't go away. It was a reaction over here with the drug cartels. There's still a huge profit margin, there's still a huge demand, and they've simply found ways to exploit that through other areas or other means. Now that methetamine at greater levels is being mass produced in Mexico or in other parts of the world, predominantly Mexico, in these huge, huge labs, huge pharmaceutical-looking labs, many times. Uh, and then it's being shipped into the United States or being brought into the United States in different forms. And so now they know uh that that methamphetamine can be suspended in solution or it can be manufactured or molded into various products, and so it has the appearance of a block, a brick, or packaged like a commercial product. But yet, once it gets in, either in that liquid suspended in a gas tank or a fuel cell or a big ship tank, uh, then it can be reconstituted out and the meth is precipitated out of the liquid or out of the uh product that it was molded into, either through uh a wash, an acid wash or acetone wash, or it's something as simple as evaporation. It just evaporates out the other liquids, or they heat it up, and then it turns right back in, reconstituted into a finished product. While we are not dealing with contamination issues necessarily, or environmental issues, what we do have is we have methamphetamine now that is that is in the largest volumes that I've ever seen coming into our country. We're also seeing the same at our crime labs. It's the number one drug that's being submitted and seized by law enforcement across the state. And then the potency levels of that methamphetamine have never been stronger than what it is right now. And that has also an intended or unintended consequence in terms of developing those psychosis or the after effects or the side effects of the drug on the individual, but also uh the addiction much faster, much quicker, uh stronger.

SPEAKER_01 18:00

This is a really sophisticated operation you're describing. Uh, you mentioned these these facilities that look like pharmaceutical companies.

SPEAKER_00 18:08

Oh, it can be as crude, it doesn't, I mean, it can be as sophisticated as a pharmaceutical-looking company. There's a lot of money, it's very sophisticated. Um and then, you know, with a saturated market, uh, the human side of this and how it impacts crime. Again, that just that ripple effect. We are seeing individuals now um that uh have access to large quantities. And I say individuals that are younger adults, that generally speaking, a younger person wouldn't have access historically when I started, um, they wouldn't have access to those types of volumes. But now you got young people, teenagers that are going down to Atlanta and being fronted with kilo amounts of methamphetamine, high quality, pure, potent kilo amounts of methamphetamine, um, and then they're on the hook for that. Or you've got individuals, family members that are from Mexico, that the the way for them to gain access into the United States, they have to transport the drugs into the United States. And if they don't, or if they get caught, then they're on the hook and they owe, they have to repay that, or that the family is threatened back in Mexico. It it is a it's um, and then the acts of violence back in the day was tracking the correlations with precursor chemical cells. If that went up, then there was a direct correlation, the number of meth labs would also go up, uh, or the number of children removed for a meth lab or the number of contaminations or seized properties or quarantines. There's just a direct correlation. Um, but also what we started witnessing there, and that correlation that continues, that we continue to see that despite the children going down or the precursor going down, it's contaminations going down, the others that we continue to see climb higher are those drug crimes or crimes of violence or uh where a weapon is used. Those were increasing from 2012 all the way through even uh the last to 2021 at a rate of about 26 to 32 percent increase in violent crime where a drug by type was mentioned, methamphetamine was that drug. And so we've also seen those drug crimes and the violent crimes and the weapons crimes going over the same correlation.

SPEAKER_01 20:45

Interestingly enough, this is about the exact, you said 2012, that's about the exact same time that prescription habits began to change. It's a little bit before the 2016 CDC guidelines, which we covered in our last episode, but regardless, that's about when the prescription misuse phase began to end. And that's when we started seeing heroin. And it sounds like what you're saying is uh, and this makes sense because we're seeing that even though fentanyl is involved in the vast majority of deaths, again, the vast majority of deaths are polysubstance. So it sounds like meth is actually driving the demand more than anything.

SPEAKER_00 21:18

Uh there's no question, it is a significant part of the demand. Um, and and again, I would say irrational people don't make rational decisions. It's very difficult for rational people to predict what an irrational person is going to do. It doesn't always fit into the model. One of the first models that I had was talking about fentanyl. Was the gentleman said, wait a minute, Tommy, if if the individual knows that they're selling a product, that their drug that they have, they're cutting it with fentanyl, then they know there's a high potential for them to overdose or kill their customer. That's not a good business model. And I said, Well, you're I understand, but you're looking at it from a rational business perspective. Standpoint, and this is not what this is. That individual is it's actually the contrary. When we see, um, and we've directly witnessed this myself, we will seize or we have a rash of overdoses. Um, and let's say that for one one example, a case, we had a rash of overdoses, we start the investigation six months, seven months into it, we identify who the target is. We suspect that the individual has a pill press for fentanyl. So right before, uh there's actually a buy that's set up and ready to go from one of the divisions. Uh right before that happens, that Friday before, uh, one community has about nine overdoses that's related to these uh fake pills. And over the as by Saturday, another metropolitan area had another 17 overdoses related to this individual. And then so the calls go out and say, wait a minute, we got to do something, we gotta put out an alert. So here's your scenario. It took you almost a year to work to the point where you've identified the source and you you you've got it. I mean, if you get this one more purchase with this individual, you can shut them down, bring them to justice, prevent God knows how many more potential overdoses into the future, but also clean up that contamination. Uh, you've got this one off the streets. What do you do? Do you put out a public notice or what? Okay, if you do put out a public notice, what happens? Does that impact your investigation? Does that drive that person underground? Does it just simply pack up shop and move to another community? And the next time you find out or you catch up to him again, uh, he's already another hundred people, 200 people have overdosed, resulting in 30 deaths.

SPEAKER_01 24:00

You you see what I'm saying? It's it's it's it's almost as if you're almost announcing this market is about to have one less competitor.

SPEAKER_00 24:07

Yeah, but I would tell you the what happened out of that. Uh out of that scenario, what did happen? Luckily, the individual did uh go through with the transaction and the sale with law enforcement. It worked. Um, he did, and then he even went as far as to cautioning uh the the individuals, the undercovers, and said, be careful with this. Uh, you if you saw the news, I don't want to lose another customer or I don't want to lose you. Be careful with this, it's hot. But this guy's in this guy's phone was blowing up. Everybody wanted his dope, even knowing that it resulted in a bunch of overdoses. People wanted his dope. Irrational people not making rational decisions. The way they viewed that is he's got the best dope. He's got the drugs, those others over there. They're chumps, they can't handle their stuff. I can handle it. They don't know what they're doing, they're inexperienced, they're naive. I can handle it. He's got the best. So that's the best bang for my buck or the best quality.

SPEAKER_01 25:06

This is a very interesting problem. Uh, because so so just to make sure I understand, you're saying when fentanyl comes in, when fentanyl contamination comes into an area, you want to warn the public. You uh and and we're trying to set the public health apparatus of the state of Tennessee is trying to set up alerts like this. But at the same time, what this might do is inhibit law enforcement's ability to target the person selling it, the person might stop selling, as you said, or might go underground or potentially stipul stimulate the sales. Absolutely.

SPEAKER_00 25:34

You have to reverse and increase the sales uh or the the intended. But but here's this you can't not do it. You still have to do it. Those are just the parameters you know, and you these are learned consequences or learned, intended or unintended, that you still have to go down this road. It's it's it's human, it's addiction, it's greed, it's money. How are we going to do this? And this wise gentleman named Johnny Birch looked at me and he said, just one at a time. We'll just do it one at a time.

SPEAKER_01 26:07

What would you like to see in terms of guiding the ship in the right direction? Uh, what kind of uh state or federal policies do you think might be beneficial?

SPEAKER_00 26:15

Uh I would say this. Um, be careful. We we we can be our own worst enemy. Little did we know that we had laws on the books that required physicians to offer patients an opioid, and I thought that was the biggest bunk that I'd ever heard when I heard a physician tell me that. We don't understand, agent. I have to offer them an opioid. I said, you're using that as an excuse. Guess what? He was right. I had to go back and look at the law. So wait a minute. And we did. So it required legislative change. Were we something as simple as let's make that, let's let the doctor and the patient make the decision based upon uh science or based upon medical uh opinions or medical practices and the best, and not necessarily something that's um uh legislating medicine. What scares the bejeebers out of me now is I see all of these we're regulating by medicine. The day we start regulating medicine uh by by popular vote or referendum uh or and doing that state by state by state, we're asking for double-double trouble. The states lack the fundamental infrastructure, uh, and right or wrong, I'm not saying that there's not the FDA approval process for medications, it may not be soundproof or 100%. We see mistakes, it makes mistakes, but I tell you what, it's probably one of the best doggone systems in the world. And it's developed into us having the best medical system in the world. Why in the world would we want to vacate an established process of to evaluate medications? We don't even consider allowing a drug to come to market for the treatment of cancer or diabetes or anything else that hasn't gone through that FDA approval. But yet we're willing to do all of this with other drugs, with the marijuana being one of the most uh prevalent of now being regulated. And there's that technology, there's nothing natural about it. It's either genetically manipulated or chemically manipulated.

SPEAKER_01 28:28

It's the the C BD derivatives you're talking about.

SPEAKER_00 28:31

These delta products, these eights and tens and p's and vs, we are off the charts. If any broke, it don't don't try to replace it. Um anyway, that's just that's just my personal opinion there. I I I see some uh I see some dangerous things, and we're already starting. You may have the best intentions in the world, it's just like with some of the states opening up and passing marijuana by re a referendum. So you've opened up this pathway that that diverts completely around the very well-established medical approval process, and I think that that can be incredibly dangerous.

SPEAKER_01 29:11

So it sounds like if you were to, if I were to summarize what you think the best path forward from a broad policy scope, from a broad policy framework, it would be allow the medical community, which has been doing its own work for a long time, to continue regulating itself. And that uh when you open up too much uh uh referendum voting or too much uh let's say state or federal uh top-down control, that that can impede the process.

SPEAKER_00 29:39

Well, yes and no. Uh there's no question, let the established process with the medical community do its job, but it does have to have that oversight. You do have to have the FDA approval, you do have to have the DDA, you do have to have, you know, uh, I think Theodore Roosevelt said it best is private industry needs just enough government to keep it honest. We all do to that degree. We all need um we need to be a little bit more transparent or or just just the just the thought somebody else is taking a look at this. It just keeps us all a little bit better. Um, and I think that that's what should should be here is we have these processes in place. There is oversight, there is a process, and if it needs to be fixed, then fix that process, but don't throw it out.

SPEAKER_01 30:25

Checks and balances then.

SPEAKER_00 30:27

Checks and balances.

SPEAKER_01 30:28

The American dream.

SPEAKER_00 30:30

That is the fundamental foundation. I think you just if you could summarize, in my opinion, what you just said right there, that summarizes exactly best what I'm trying to say. We are a country and a nation that's establishing checks and balances, and checks and balances work best.

SPEAKER_01 30:49

For more episodes on in-depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tennessee.edu. I'm Jeremy Corvinois. Thank you for listening and see you next month.