When she admits a patient for detox treatment, one of the first things Katie Schneider does is administer a detailed drug test.
“We have a urine drug screen that we perform on intake for every person who comes in,” said Schneider, who runs Southcentral Foundation’s detox facility in Anchorage. “We share with them the results of that urine drug screen, and sometimes people are very surprised by what's in there.”
She said sometimes people think they’ve been taking prescription opioids, but it’s actually fentanyl. And she said sometimes urine tests will reveal ecstasy (MDMA) or something else the person never knowingly took.
Those detailed drug tests are essential to clinicians treating people, and, on a larger scale, results from drug tests nationwide paint a picture of the country’s changing patterns of drug use.
Eric Dawson, pharmacist and vice president for Millennium Health, which has a drug testing lab in San Diego, said their lab has tracked data from tests for about ten years. He said the US is cautiously celebrating a lower rate of overdose this year than last, but Alaska’s OD rate is still rising and drug testing data from Alaska reveals why.
“When I look at our data, I can see why they're climbing,” Dawson said. “Fentanyl use is still on the rise. The use of methamphetamine, cocaine, and now we're even seeing heroin, in the last couple months, rise within that population using fentanyl.”
He said it’s also insightful to look at how many fentanyl users in Alaska also test positive for methamphetamine.
“That number right now in Alaska is around 80%,” Dawson said. “So, eight out of 10 of the samples that are coming to our lab from Alaska that are positive for fentanyl are also positive for methamphetamine, and they're the two primary drivers of overdose.”
That rate in Alaska is much higher than the national rate, which is about 60%, Dawson said.
And both nationwide and in Alaska, that rate is rising. The rate of methamphetamine found in tests with fentanyl has increased seven fold in the Pacific region since 2015, according to data from Millenium. This increase of opioids combined with stimulants has experts in the field worried. It’s a dangerous combination that increases risk of overdose and death, and when people enter recovery, it’s more challenging for healthcare providers to help people detox from combinations of substances, and to treat them afterwards.
Dawson said there are a few reasons people combine opioids with a stimulant. He said a second drug magnifies the euphoria effect, but he thinks most people use a stimulant to reduce the likelihood of a fentanyl “nod” or sleepiness.
“All of that equates to risk for the user, and it also equates to treatment challenges for the treatment providers,” Dawson said. “It is a very difficult situation.”
Katie Schneider said adding methamphetamine or cocaine into the mix makes treatment hard because those stimulants can cause psychosis. And she said newer forms of methamphetamine seem to cause psychosis in more people and are more likely to cause lasting psychosis.
“It's making it really hard for people to get help because their brain is telling them that people are trying to hunt them down or that people are poisoning their medications, things like that,” Schneider said.
Treatment for stimulant addiction is also less straightforward than for opioid use disorder, according to Sarah Spencer, an addiction medicine specialist on the Kenai peninsula. She said the best treatment right now isn’t typically covered by insurance. It’s called “contingency management.” Patients set clear goals, like to stop using methamphetamine, which are then measured, often by drug tests.
“If they meet that goal, then they get a reward, which commonly might be something like a gift card, or it might be like drawing a random prize out of a ticket bowl,” Spencer said.
She said it’s the only thing shown to really help people who are trying to quit stimulants, especially methamphetamine, and she’d like to see Alaska start covering the costs of this kind of treatment through Medicaid, like a few other states do. But even without contingency management, Spencer said patients who stay in treatment for their opioid use disorder still tend to reduce their stimulant use over time.
Anyone facing a substance use disorder, or who is close to someone who is, can call 211 to be connected to resources.
