Methamphetamine returns to Appalachian Kentucky, in a more deadly form, and it's causing fear and division in communities

Dakota Scott, with her two-week-old daughter, fights meth addiction at Karen’s Place Maternity Center in Ashland, a facility for women in addiction recovery (Photo by Hilary Swift for The New York Times)

Timothy Williams of The New York Times reports from Louisa: "Home deliveries from the local food bank now require a police escort. A shop owner has started to carry her gun to work. And the local constable, who rarely had to pull his weapon in the past, has drawn it a dozen times over the past year. All because people hooked on methamphetamine have threatened them. . . . A very public push to end opioid abuse has unwittingly ushered in the return of crystal meth."

Officials have warned for a year or more that meth was making a comeback even as the opioid epidemic continued in Appalachia. It returned in "a powerful new form," Williams notes, and that "has brought a sharply different set of problems . . . If pain pills left residents struggling to help many family members deal with the risk of overdose, methamphetamine has bred fear and division."

Referring to homeless meth users, Louisa Mayor Harold Slone told the Times, “Half the people want to take them to the river and tie something around their neck. We hadn’t seen that level of anger before.” State police told Williams that in some places, about three-fourths of arrests are related to meth crimes — "mostly shoplifting, burglary or assault, but occasionally attempted murder."

Much as a crackdown early in the last decade on prescription opioids led to a surge in heroin, the latest crackdown and increased awareness of the epidemic has "unwittingly accelerated the switch to methamphetamine," Williams writes.

"Opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute. A powerful Mexican organized crime syndicate, the Sinaloa drug cartel, has sought to fill the vacuum by targeting Appalachia, federal drug officials say. . . . The new Mexican variant is often mixed with cocaine, and increasingly, with fentanyl. Law-enforcement officials said cartels mix in those ingredients because fentanyl is inexpensive to produce, enhances the effects of meth and appears to cause faster addiction. Meth users around Louisa sometimes add their own dangerous ingredients, including wasp repellent, which users say produces a more intense high."