Last year, methamphetamine was listed as the main contributing factor in 147 fatal drug poisonings in Hawaii — nearly quadruple the number a decade ago.

While opioid overdoses have claimed the national spotlight, deaths related to the use of psychostimulants in Hawaii — presumed to be methamphetamine — have quietly outpaced other drug overdose fatalities in just five years.

“It’s sad, but I’m not surprised, unfortunately,” said Heather Lusk, the executive director of the Hawaii Health and Harm Reduction Center. “We’ve been dealing with a methamphetamine epidemic for decades and generations of our ohana.”

The stark jump is perplexing, even to experts. But the uptick has occurred across all islands, signaling that it’s likely not a fluke. The trend has gathered little attention because methamphetamine has been overshadowed by news of opioid overdoses.

“In terms of data from death certificates, there is an alarming increase,” said Daniel Galanis, an epidemiologist at the Hawaii Department of Health’s Emergency Medical Services & Injury Prevention System Branch.

“Meth-related deaths have outnumbered opioid-related deaths since 2015, but opioids have gotten much more attention and funding over that same time period.”

Nearly 70% of people who lost their lives because of meth between 2012 and 2016 were men between the ages of 45 and 64.  

That has led to a theory offered by various experts in the health field: Hawaii could now be seeing the long-term effects of methamphetamine use among a certain cohort of people who started using meth in the 1980s and 1990s.

Decades later, the use of the drug is taking a toll on their hearts, marking a new, lethal chapter in Hawaii’s long-running methamphetamine crisis.

A ‘Death Kiss’

At Akamai Recovery Maui, a 63-year-old man in search of counseling said years of methamphetamine use unraveled his life and marriage. Civil Beat agreed not to use his name because we thought his story was necessary to help readers understand the life of a meth user and the toll it takes.

The residential group program he attended for three weeks on Oahu didn’t work out. The Kahului clinic was conveniently closer to his home in Wailuku and he wanted to try a new method to face his alcoholism.

Getting drunk often made him want to get high on methamphetamine, but he said he has managed to keep away from methamphetamine for a couple of months.

“I hate the stuff, unless I’m drinking,” he said.

The first time he smoked meth was with his wife in 1991.

“For a married couple, it did add some spice,” he recalled. “Then we were arguing and tearing the room apart. It does things to you.”

In 2008, she suffered a stroke and emerged alive but with severe brain damage, he said, unable to speak or understand anyone.

The doctors told him she had a preexisting heart murmur, and using methamphetamine probably didn’t help. When her daughter took guardianship of his wife, the man took a shot at rehab.

“If I wanted visitation, I had to clean up,” he said.

He’s still working on it, ridden with guilt and grief two years after her death.

“I didn’t mean to get her hooked,” he said. “It’s a death kiss.”

The Meth Effect

The vast majority of fatalities have been concentrated on populous Oahu, but methamphetamine-related deaths on the neighbor islands have also doubled over the past decade.

Glen Carner, who counsels many regular meth users on Oahu, called the addictive drug “insidious.”

“You feel like a million bucks initially, absolutely unstoppable, with bounds of energy,” said Carner, director and therapist at Family & Addiction Counseling. “It’s wonderful for performance up until the point it goes off the rails.”

Meth is relatively cheap and available, says Flynn Porter, the operations manager at Akamai Recovery Maui, who estimated that two-thirds of the clinic’s patients seek help in handling their methamphetamine use.

“For people under 21 years old here it’s more accessible than alcohol,” Porter said. “I hear from a lot of people coming in that started using meth at age 12, 13, 14 or 15 in their home. There’s a generational aspect if you’ve been seeing your parents, grandparents using it, so it’s kind of that natural cycle.”

Dr. Bill Haning agreed. He directs addiction training programs at the University of Hawaii John A. Burns School of Medicine and works as a physician at The Queen’s Health Systems. Haning has seen pre-teen and elderly patients who use methamphetamine.

“Drug use has a contagious quality,” he said. “You don’t have to go far to find two to three generations of local folks in a one or two-bedroom apartment. If any one of them in there is getting into meth, it’s only a matter of time until that becomes normalized behavior for other people there.”

Your Body On Meth

In the short term, methamphetamine use can cause high blood pressure, chest pain, irregular heartbeats and heart attacks.

After many years of use, meth can cause severe damage: heart complications, disease and even sudden cardiac death, according to the National Institutes of Health.

Few studies have focused on how the drug affects the body over the long term, but chronic use can enlarge the heart and make it difficult for it to pump blood. The American Heart Association recently reported that methamphetamine use is creating a unique form of heart failure among people who would typically be considered too young to have heart issues.

Haning, who recently became president-elect of the American Society of Addiction Medicine, has studied meth use in Hawaii and has counseled people with addictions for decades. He said it is usually rare for meth to be associated with acute overdose fatalities.

Heart complications may ultimately be listed as the cause of death, and meth use can even go undetected during regular appointments, since patients can visit the doctor with heart complications when they’re sober.

“Was it a quick rise in blood pressure causing a heart attack or stroke when they were susceptible to that? Or is it cardiovascular disease that’s just been brewing?” said Dr. Jeffrey Chester, the medical director at Akamai Recovery Maui.

“When they’re in their 20s and 30s, their blood pressure can go up high because their body can withstand it. For someone in their 60s, 70s or 80s, there’s less reserve.”

‘Drug Of Choice’ Since The 1980s

Meth reached Hawaii’s shores earlier than the rest of the United States and hasn’t let go of its grip, said John Callery, assistant special agent in charge of the U.S. Drug Enforcement Administration’s Honolulu district office.

“Hawaii never got a break from it,” he said. “It’s been the drug of choice since the 1980s.”

“Culturally in Hawaii it’s very acceptable. It’s a very easy drug to get pulled into.” — Glen Carner, director and therapist, Family & Addiction Counseling

Historically, crystal meth in its purest and most potent form came to the islands from markets in Asia and the Pacific as documented by the Hawaii’s Ice Age reporting series that Civil Beat and Hawaii Public Radio published five years ago.

Now, much of it is manufactured in Mexico and makes its way to Hawaii through states like California and Nevada, says Callery.

As a result, the methamphetamine-related death rate in Hawaii has crept up to the third-highest in the nation, behind Nevada and New Mexico.

“In general, the geographic western part of the U.S. has higher methamphetamine overdose rates,” said Galanis. “Hawaii is one of the more extreme western states in that regard.”

For decades, methamphetamine has had a strong presence in Hawaii’s court systems and hospitals.

“It’s a pretty democratic chemical that affects every socioeconomic stratum,” Haning said. “Most of the folks getting into it will be getting into it for the perceived therapeutic benefits. We’re talking about day laborers, blue collar workers having to hold down two to three jobs to provide for their family. It ends up having a huge prevalence in a service economy like ours.”

The high prevalence has almost normalized its use, some say.

“Culturally in Hawaii it’s very acceptable,” said Carner, whose counseling office is located in Waikiki. “It’s a very easy drug to get pulled into.”

Have Opioids Overshadowed Meth?

In comparison to methamphetamine poisonings, opioid overdose deaths in Hawaii have remained relatively static, at around 60 deaths per year for the past decade.

Compared to most states, Hawaii has one of the lowest mortality rates related to opioids, including synthetic ones like fentanyl and illicit ones like heroin.

In response to the harrowing number of deaths related to opioid overdoses on the continent, the Hawaii Opioid Initiative was launched in 2017 to proactively and “aggressively counteract the increased abuse and misuse of opioids” in the islands.

“Opioids make for some low hanging fruit because you can address it through the medical care delivery system and you can educate providers and patients, whereas when you’re trying to impact illicit street drug use, it’s an extremely hard area to treat,” said Galanis.

“There are very different prevention approaches for opioids that do not apply to someone addicted to methamphetamine.”

Heather Lusk, who sits on one of the seven task forces that make up the state’s Opioid Initiative, says the task force broadened its mission to include methamphetamine in its substance use disorder prevention and treatment programming. And some federal funding that has flowed to address opioid overdoses may be redirected to assist in the prevention of overdoses of all substances, including meth.

Her task force took note of the rapid rise in methamphetamine deaths and plans to investigate.

“We’ve actually prioritized within the Hawaii Opioid Initiative to collect data and do a deeper dive on what’s happening with methamphetamine overdoses,” Lusk said.

Hidden Killer

There are several factors that can alter mortality rates.

Limited toxicology reporting and testing or lack thereof may mean that some deaths go unnoticed. Galanis said testing rates are very low at hospitals, because sometimes doctors don’t need test results to know what’s going on.

On the other hand, even administrative changes in the medical examiner’s department can cause a shift in data because of autopsy case loads, some say.

Former Hawaii Medical Examiner Christopher Happy said when he took office five years ago, the department began to take on more cases and that could have contributed to the jump.

In the past decade, approximately 750 people on Oahu were identified with methamphetamine in their blood when they died, he said. The No. 1 cause of death was overdose, followed by suicide, traffic accidents, homicides and then natural causes.

“Especially on Oahu, that should be a high index of suspicion that someone is doing meth,” Happy said. “There’s plenty of people where the family has no idea and the doctors have no idea.”

Haning said because methamphetamine can cause cardiac irregularities that sometimes become suddenly fatal, many people may never know that the substance had an influence on that person’s death.

“I’m sure there are many physicians who wouldn’t be aware of it,” Haning said.

“It’s the equivalent of pouring water into the motherboard and it shorts out. We think that’s why a lot of folks have unattended death when they have meth in their system. People who use meth may die quietly and silently without people being aware of it because of the abrupt change in heart rhythm.”

A Beast To Treat

The Maui man’s visit to Akamai Recovery was his first and last because his insurance denied coverage for counseling.

“For the past 45 years I’ve been intoxicated,” he said. “I want to rediscover a sober me if I can find him.”

Unfortunately, there is no easy antidote for methamphetamine addiction.

“There’s no nicotine patch,” said Chester, who also works as a pain specialist and aids people with addictions to opioids. “There’s no Suboxone or methadone (opioid replacement drugs.) There’s no equivalent. If there were, this would be very different. Counseling is the only thing that’s been shown to be helpful.”

Carner says Hawaii needs more early interventions and treatment avenues beyond the residential group format.

“There’s a significant number of people who are out there using meth who are functional, and managing … yet the only placement that treatment addresses is ‘Are you ready to quit?’ and if you’re not ready, we shame you,” Carner said. “No one is talking about harm reduction around meth. We should be looking at replacement therapies.”

The Maui meth user is in an age range where heart complications can arise.

He recently visited a cardiologist in Kahului. They did an ultrasound of his arteries and the doctor told him he had an irregular heartbeat.

He was supposed to make a follow-up appointment, but hasn’t been able to bring himself to do it.

“If the doctor tells me I need a bypass, I’ll tell him… ah,” he said, trailing off into silence and shaking his head. “I have to find out but I’m scared to do it.”