A person in a sports cap holding a needle box to be packed away and delivered to needle exchange participants. Dunlap says they meth use never went away in Haywood County.
Jesse-Lee Dunlap organizes supplies for needle drop-offs to participants across Haywood County. Dunlap, 38, delivers needles and other harm reduction supplies to participants once a week and also holds pickups at the Haywood County Health Department. Photo Credit: Liora Engel-Smith

Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org

By Liora Engel-Smith

Jesse-Lee Dunlap goes where not even the mail carrier does. The Haywood County resident, who works with the N.C. Harm Reduction Coalition, routinely navigates into dirt pathways so narrow they hardly count as roads.

On a recent afternoon, Dunlap maneuvered a white rental van up one such trail, squeezing up a steep hill past a row of faded mailboxes. The 38-year-old parked the vehicle near a mobile home surrounded by shaggy bushes — the first supply drop of the afternoon.

Dunlap hopped out of the van, greeting the people who clustered on the driveway, then popped the trunk to pull out care kits that volunteers put together earlier that day. The brown bags and boxes had band aids and other wound care items, vitamin C packets and tiny cotton balls through which to filter drugs. There were also dozens of 30-gauge syringes, the type a diabetic person might use.

But the people in the quiet neighborhood in Clyde, a town of almost 1,300 roughly 25 miles west of Asheville, aren’t getting needles because they’re diabetic.

There’s been much talk about drugs in Appalachia, particularly as opioids — first prescription pills, then heroin and its much deadlier cousin, fentanyl — tore through already distressed mountain communities. But even as state and federal agencies set their sights and budgets on ways to combat the opioid epidemic, another drug is wreaking havoc in Western North Carolina: methamphetamine. A stimulant that rose to national infamy in the 1990s and early 2000s, meth has been part of life here for years.

Residents say that even as opioid misuse blossomed, meth never went away.

‘THE drug’

Out of the shaded porch came Carrie Brayson, who grew up in the nearby community of Waynesville. Her eyes light up as she spots Dunlap. Having been part of the needle exchange since 2017, Brayson has come to trust the program. Dunlap comes around roughly once a week to collect used syringes and replace them with fresh ones.

The two chat amicably as Dunlap gathers the packages.

Drug overdose deaths in Appalachian Counties from 2013-17. Source: Appalachian Regional Commission

To explore the map further, visit the Appalachian Regional Commission.

Brayson shifts her gaze from Dunlap to the mountains that tower over her neighborhood. It’s a view that draws countless tourists to Haywood County and the mountain region. In 2013, domestic tourists generated $155.38 million for the county’s economy, up almost 5 percent over the previous year.

But not everyone in Haywood benefits from those tourist dollars. Many employment options in the county are low-wage service or retail jobs. And while the county’s older population is generally wealthier, families with children experience significant poverty,  the county’s 2018 community health assessment shows. The 2017 Census figures quoted in the report show that Haywood’s overall poverty rate is roughly 17 percent, but close to half of children under five live in poverty here.

The mountains may be pretty, Brayson said, but life here has significant disadvantages. Social services can be hard to come by. With limited transportation options, those who don’t have cars either have to walk or hitch rides from friends and family members.

Carrie Brayson’s home in Clyde is atop of a hill that overlooks the mountains. Photo credit: Liora Engel-Smith

Brayson, who says she used to be a nurse, came to drugs by a way of opioid pills at age 18. Later, she sought recovery and managed to stay clean for seven years. After her dad died, Brayson started using meth. The 37 year old said it was the lesser of two evils. Coming off of opioids was a horrible experience, she said, and she vowed to never take an opioid pill again.

“A lot of people think it is definitely heroin that is a problem, but meth, you can’t OD on it,” Brayson said. “It’s cheaper and lasts longer and gives you energy to where you can still maintain. You can still go to work.”

Dunlap, who knows many other people who use drugs in the county, said that a significant proportion prefer meth. Out of roughly a hundred clients who participate in the exchange, roughly three-quarters use meth, according to Dunlap.

And though some meth is now tainted with fentanyl, a synthetic painkiller 50 times more potent than morphine, the stimulant remains popular. So does the belief that it is safer.

“Meth is THE drug here,” Dunlap said.

‘You get some stuff done’

Overdosing on meth is not impossible, said Cynthia Kuhn, professor of pharmacology at Duke University School of Medicine. Methamphetamine gives its users energy, she said, keeping them awake for prolonged periods and sometimes causing hallucinations and paranoia.

“You can absolutely overdose and die with a methamphetamine,” she said.“I think what helps people titrate, to dose a little bit better, is the behavioral excitement that you feel can allow you to sort of track the dose that you’re getting.”

The Haywood County Health Department serves as a needle distribution site, but volunteers also travel to participants across the county. Photo credit: Liora Engel-Smith

Over time, methamphetamine can damage the cardiovascular system and in large quantities, it can cause a heart attack or a stroke. Unlike the high that opioids create for a user — a sleepy, dreamlike state that can also depress breathing — meth supplies a frantic, hyper-focused high.

It’s those stimulating qualities that can allow meth use fly under the radar, Dunlap said.

“[People who use meth are] more productive,” Dunlap said. “You’re not seeing this person that’s injecting something and nodding out and going to sleep, you see someone that’s working two jobs because that’s what you do when you’re on meth — you get some stuff done.”

A numbers problem

It’s hard to quantify exactly how common meth use is in Haywood County. National studies have noted a rise in meth use, either alone or in combination with opioids, but state data on indicators of meth use such as overdoses and hospitalizations aren’t reported as frequently as opioid data. North Carolina updates its opioid dashboard monthly, but methamphetamine-related deaths are clustered with other psychostimulant drugs — methamphetamines, Ritalin, Adderall and ecstasy — and these are updated once a year. The most recent year for which data is available is 2018.

Haywood County had seven fatal overdoses from psychostimulants in 2018, and a total of seven such deaths from 2009-2017, the data show. In that same timeframe, psychostimulant use caused at least 69 hospitalizations in the county, 12 of which occurred in 2018.

A representative from the state Department of Health and Human Services said in an email that the data focuses on the harm of opioids because these drugs make up the bulk of the deaths in North Carolina. But the data show there has been a rise statewide in deaths from psychostimulants, from nine in 2009 to 267 in 2018. Because of that surge, the spokeswoman wrote, the department plans to release a monthly medication and drug emergency department visit report for psychostimulants and cocaine — another drug with increasing impact in the state — beginning next year.

Whether the data capture it or not, there are telltale signs that meth is available on demand in Western North Carolina. Though law enforcement agencies in Clyde and Haywood County did not respond to interview requests for this story, there are news reports of recent meth busts and arrests across the region. Last year, the Haywood County Sheriff’s Office also told local media that methamphetamine use is a persistent problem.

“You don’t have many people overdose on meth,” one law enforcement officer told the Mountaineer. “You don’t have that dramatic incident in their life like you do with an overdose of opioids.”

Those who use it have largely moved away from producing small quantities of meth in local labs, according to the article. Instead, most of the county’s meth supply comes from Atlanta.

Up until a few weeks ago, Brayson was among the group that’s driving local demand for meth. She had said she wasn’t ready to give up meth.

“If you’re not ready, you’re wasting their time, you’re wasting your time,” she said. “I will know when I’m ready.”

But that’s changed, according to Dunlap who said Brayson has been sober for weeks. Further, she’s been helping Dunlap distribute needle exchange supplies.

Nestled in every needle exchange kit are pamphlets with local recovery resources. Those who receive the kits may not be ready for recovery yet, but they may change their minds. And when they do, Dunlap wants to be sure the information they need is at their fingertips.

Republish our articles for free, online or in print, under a Creative Commons license.

Liora Engel-Smith

Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...

One reply on “Even as opioids ravage WNC, mountain folks say meth never went away”

  1. I understand the thought behind all of this, but why exactly are you spending this time and effort on those who have voluntarily selected themselves for extinction, instead of celebrating and supporting those who have come from difficult backgrounds and have chosen not to engage in such activity?

    Why not assist the children of single parents who have outstanding grades? Why not help those single parents with Christmas or school supplies or groceries? Why not help upgrade an elderly veteran’s home? Why not do something that will do some good, instead of prolonging the lifespan of people who live only to feed an addiction that coerces them into victimizing everyone around them, including the families who try to help them?

    This is an utterly wasted pursuit, a waste of money, and frankly, all you guys are doing is making it far more likely that the responsible citizens of communities like these will be victimized because you are helping to keep these people alive. Are you trying to harm the communities in which these zombie-like creatures exist? Ever had a meth addict show up at your home and stick a gun in your face and threaten to kill your family over what little cash you may be keeping in your home? Try it sometime; I can guarantee it’ll change your thinking on this issue. These people are a danger not only to themselves but to their communities. With a national cure rate of 3%, you’re wasting your time and neglecting those who could use your service and put it to good use, instead of flushing down the toilet with their next fix.

    Everyone knows what comes of methamphetamine use. Everyone.

Comments are closed.