Dean Foggin sits on the edge of his single bed, winter sunlight streaming through the window onto the white walls, his white robe, white slippers. It is his fifth time checking into this detox facility and, God willing, his last.
"I hope this time it sticks, or I don't know what's going to happen," says Mr. Foggin, 53. His shoulders are slight and he speaks at an accelerated pace. "I'm pretty much ready to give up. If I can't make it this time, I'm just not going to try any more."
It has been 13 years since he first took crystal methamphetamine, introduced to it, he says, by a friend who was a heavy user. Mr. Foggin dabbled in other drugs at the time – marijuana, cocaine – but nothing prepared him for what was to come.
"I said no, no, no for about three weeks, and then I tried crystal," he said. "It was earth-shattering. It was a drug that – I still really do like it, unfortunately. It was nothing I expected it to be and everything I wanted it to be."
Crystal meth has received little attention in recent years in the public actions to combat drug addiction compared to opioids such as oxycodone and fentanyl, the latter of which has made national headlines for its growing prevalence in the illicit drug market and its connection to an increase in fatal overdoses.
With attention focused elsewhere, crystal meth use has quietly climbed to alarming rates: In Vancouver's Downtown Eastside, by one account, the rate has increased seven-fold in the past decade. The stimulant is inexpensive, highly addictive and linked to psychosis – a troubling factor in a city whose mayor recently declared a mental-health crisis. And the increase is not limited to the Downtown Eastside.
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At the beginning, Mr. Foggin says, he used meth only on Friday nights. But then it became the whole weekend. And then Mondays, too.
"I used to take a bag, crush it up, put a straw in it, keep it in my shirt pocket and just go–" he mimes the act of snorting from his breast pocket. "It didn't matter what I got, just as long as I got lots. That's how I did it. I did that for a couple years. I called it 'nose-bagging.'"
Before long, Mr. Foggin was in the grip of a full-blown crystal meth addiction. His wife left him, and he says he was laid off from his job at a print shop, where he colour-corrected images for 18 years, after absent mindedly mentioning his drug use. ("But there were other things too," he admits.)
A couple of years ago, snorting turned to injecting, which is how he found his way to Insite, the supervised injection site in Vancouver's Downtown Eastside, and Onsite, the detox centre upstairs, where he was interviewed for this story. His goal, he says, is to be abstinent.
Insite opened in 2003, giving injection drug users a place – and sterile supplies – to inject illicit drugs under the supervision of medical staff. The next year, staff began developing a database, logging every substance that visitors said they were injecting.
The data were recently provided to The Globe and Mail.
From 2004 to 2010, heroin and cocaine were by far the most frequently injected drugs; heroin averaged 71,600 injections per year, while cocaine averaged 65,300. Methamphetamine, in comparison, averaged 6,500 per year.
After 2010, however, meth use climbed, reaching 39,400 injections in 2015 – a seven-fold increase from 10 years earlier. Meanwhile, cocaine dropped to 19,300 injections and heroin remained the most frequently injected drug, with 92,700 injections last year.
"It's quite apparent … there is a steady incline [in use], and there doesn't seem to be any sign of it levelling off or declining," said Ronald Joe, associate medical director of addiction services at Vancouver Coastal Health and medical director of Insite.
The data do not account for other methods of ingestion, such as smoking or snorting.
Dr. Joe said the increase in crystal meth use is particularly troubling because of its association with mental illness; the stimulant can cause psychosis on its own when used heavily or if used by someone with other risk factors for psychosis. The drug can also cause a user to become more impulsive and prone to risky behaviour. More immediate problems include the risk of seizures and heart attacks.
An international study published in February found that adolescents who chronically use the drug suffer greater and more widespread alterations to the brain than adults, which is especially problematic because adolescents are less able to control risky behaviour, researchers say.
A 2013 report by the Urban Health Research Initiative of the B.C. Centre for Excellence in HIV/AIDS also noted increases based on longitudinal cohort studies of Vancouver drug users: "While the prevalence of crystal methamphetamine use is much lower when compared with the use of other drugs … there is an identifiable increase in the prevalence of smoked and injected crystal methamphetamine use between 2001 and 2007." Between 2008 and 2011, non-injection crystal methamphetamine use plateaued, while injections remained high.
It is not just Vancouver. In a 2015 survey of street-involved adults in Victoria who regularly use substances, 62.5 per cent reported having used crystal meth in the previous 30 days, according to the Centre for Addictions Research of B.C. (CARBC). This is down slightly from 2014 (69.1 per cent) but up markedly from 2013 (42.5 per cent) and 2010 to 2012 (between 22 and 25 per cent). Last year, the stimulant surpassed heroin as the No. 1 substance injected among survey participants.
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Part of the challenge is that crystal meth addiction has no pharmacological treatments such as methadone or Suboxone for heroin addiction. Crystal meth addicts seeking help are steered toward detoxification and psychosocial interventions.
At Onsite, Mr. Foggin will receive physical detox support with the option of participating in other programs such as book club, creative writing and yoga. He will be provided with hot meals every day and have his own room and bathroom. After one or two weeks, he will be moved to transitional housing on the facility's third floor, where he will continue to receive recovery support.
As part of its Downtown Eastside Second Generation Strategy, rolling out now, VCH plans to open a low-barrier addiction service by the end of the year. This is expected to include fast access and same- or next-day starts for therapies, with no appointments necessary, in hopes of capturing users the moment they want help.
"People who want [help] only want to seek it at certain points in time," Dr. Joe said. "If you don't provide them with treatment when they want it, they will say, 'I will go back to using.'"
Rafal Gerszak/Rafal Gerszak
Christian Schuetz, research and education medical manager at the Burnaby Centre for Mental Health and Addiction, said about 80 per cent of clients there had reported some history of crystal meth use, making it the drug with the highest level of prevalence.
Some clients at the Burnaby Centre receive medication for mental disorders, such as mood stabilizers, that sometimes help curb the tendency to relapse into illicit drug use, Dr. Schuetz said. However, the most effective treatment currently offered in the inpatient program appears to be contingency management, a therapy that rewards good behaviour. Clients who actively participate, show up on time and produce clean drug tests, for example, receive vouchers that can be redeemed for small items such as food, cosmetics and clothing.
"It has been demonstrated that contingency management is one of the most effective ways of helping people in recovery," Dr. Schuetz said.
Dr. Schuetz is also studying the effectiveness of cognitive training techniques and transcranial magnetic stimulation – a noninvasive way of stimulating the brain – on reducing impulsiveness.
Bernadette Pauly, a scientist with CARBC and an associate professor in the School of Nursing at the University of Victoria, noted that the difficulty in getting harm reduction supplies on Vancouver Island presents a challenge for drug users there. A 2014 B.C. Centre for Disease Control report found that 20 per cent of drug users surveyed in the Vancouver Island Health Authority experienced difficulty finding clean needles, compared to 13 per cent under VCH.
Dr. Pauly also underscored the need to look at root causes of drug use.
"When we see an increase in use, we have to understand why," she said. "For example, in some cases, people might be using [crystal meth] to stay awake more, for longer periods of time. If that's the case, why are they staying awake? Is it because they're [staying] outside and they're worried about getting their stuff stolen?
"The majority of people that I work with, who are homeless, or living in poverty … often use drugs as a response to trauma, abuse, dislocation and other life events," she continued. "We can keep to a minimum the harms, but we also need to look upstream and say, 'What else is going on here that we need to address?'"