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 by Liora Engel-Smith)

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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 by 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 by 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.