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  • Methamphetamine indicators are higher than before the pseudoephedrine ban in 2007–2008. The DEA El Paso Intelligence Center (EPIC) reported seizures of methamphetamine increased by 37% between 2013 and 2015 and it is ranked as the #1 drug threat in the DEA Dallas are and #2 in Houston. The methamphetamine made in Mexico using the P2P process is increasingly pure and more potent with more reports by Texas outreach workers of use by men who have sex with men and high-risk heterosexuals with increases in HIV and syphilis. The HIV mode of exposure among men who have sex with men is at the same level in 2015 (70% of all cases as it was in 1988 when data on mode of exposure were first collected.
  • The novel psychoactive substances/synthetics situation is mixed, marked by sporadic clusters of overdoses, which may be a result of amateur chemists mixing the drugs or bad batches of precursor chemicals. The number of poison calls for synthetic cannabinoids or cathinones peaked in 2014. The chemical ingredients of cannabinoids have changed from JWH varieties to AB-CHMINACA and XLR-11. The number of phenethylamines identified continues to increase. The primary synthetic cathinones in 2015 was ethylone. A growing problem is PCP-like reactions to the synthetic drugs; the analog producing these reactions is not yet identified.
  • Heroin users are younger and less likely to be people of color. Indicators of deaths and poison center calls continued to rise, but seizures along the Texas–Mexico border decreased 10%. Nevertheless, the DEA reported Mexican opium production is increasing to sustain the increasingly high levels of demand in the United States. “Other opiate” indicators are trending downward as a result of rescheduling of hydrocodone. Oxycodone is less of a problem than hydrocodone and it has remained stable, as have buprenorphine and methadone numbers. Oxycodone numbers are not as consistent in terms of trending, but its use is much lower than for hydrocodone. Fentanyl abuse and misuse in Texas traditionally involved the transdermal patches, but new rogue fentanyl powder began appearing in spring 2016. New synthetic opioids such as UR-47700 also began appearing.
  • The cannabis situation has been influenced by both supply and demand. Supply from Mexico has decreased, with increases instead occurring in the use of home-grown and hydroponic methods and the availability of high-quality cannabis from Colorado. The demand for the drug has been influenced by changes in patterns of use with blunts and now electronic cigarettes and the “vaping” of hash oil and “shatter.”
  • PCP remains as a problem. The number of PCP items identified by forensic labs peaked in 2014 at 1052 and dropped to 766 in 2015, which may reflect the characteristics exhibited by many individuals who needed hospital care had taken “K-2” OR “Spice” and they exhibited the classic PCP signs but the forensic tests did not indicate the presence of PCP. Some N-BOMe analogs that have not been identified may be mimicking the PCP behaviors.
  • Cocaine indicators continue to trend downward, but this may be changing. Availability is high, but the source has been unstable as a result of cartel wars, with the amounts seized at the Texas–Mexico border down 17% between 2013 and 2015. However, UNODC has reported an increase of almost 40 per cent in the Colombian coca crop acreage between 2014 2015. The Houston DEA Field Division reported that the flow of cocaine appeared to be rising at the end of 2015. Texas street outreach workers are reporting increased popularity of powder cocaine.
  • Benzodiazepine indicators have remained fairly stable over the last two years. Alprazolam is the most abused benzodiazepine.


A decade ago, methamphetamine was a major problem in Texas and across the nation because of the availability of ephedrine and other cold medicines to make the drug. After these cold medicines were regulated in 2005-2006, there was a decrease in meth production and indicators of use and misuse dropped.

But now a new methamphetamine epidemic is quietly rising in the southern and western states, all while media headlines and lawmakers focus on the increasing number of deaths due to heroin and prescription pain pills. I should know, I’ve studied patterns of substance abuse for more than 40 years. Specifically in Texas, this new methamphetamine epidemic appears intertwined with increases in yet another problem: sexually transmitted diseases, including HIV.

What has happened is that we have a new precursor, phenyl-2-propanone (P2P), which is used by Mexican drug cartels to make methamphetamine. When made with P2P, meth is much more potent and has more ability to produce greater intoxication and enhanced dependence.

And the problem is getting worse. In 2015, 91 percent of methamphetamine tested in forensic laboratories in the United States was made with P2P from Mexico. Because of the demand in the United States, the kilogram amount seized at the Mexico border increased 37 percent between 2010 and 2015. Last year, the Dallas and Houston DEA divisions ranked methamphetamine among the top two drug threats in their areas, similar to Atlanta and Los Angeles.

More available methamphetamine means more misuse and overdoses. In Texas, the number of people being admitted to treatment programs has doubled, as has the number of calls to poison centers specifically due to meth overdose. Methamphetamine has become the major drug problem in areas of Texas previously dominated by heroin..

The methamphetamine epidemic in the Lone Star state is also going hand in hand with another troubling trend: increasing rates of sexually transmitted diseases, including HIV, particularly among young men who have sex with men.

A Centers for Disease Control and Prevention study shows that the proportion of men who have sex with men and use meth has gone up in the last five years — in Dallas, for instance, it has increased from 9 to 45 percent. Is there a link between these two trends? The problem seems to be that meth use in this population encourages risky or unprotected sex.

We need to confront these intertwined epidemics of methamphetamine and HIV immediately. Although behavioral treatments have shown usefulness in improving treatment adherence for individuals with meth dependence, there are no medications approved to treat methamphetamine craving and dependence.

There still is no cure for AIDS, but there is at least one drug, a pre-exposure prophylaxis, that, if taken exactly as prescribed, can prevent infection by the HIV virus. Studies have shown the risk of getting HIV infection is lower if the pill is taken daily, safe sex practices are used and condoms are used during any kind of sex.

The solution is education and advocacy. Users of methamphetamine and those engaging in risky sex must understand the dangers in which they are placing themselves and their friends. We all need to remember the lessons that those who survived the AIDS epidemic in the 1980s learned the hard way. Through regular use of condoms and medication compliance — that is, taking the pre-exposure prophylaxis drug daily — we can prevent another potential AIDS epidemic.





  • “Molly” initially referred to ecstasy pills with high quality MDMA powder. After  the MDMA shortage several years ago, the capsules were more likely to contain caffeine, methamphetamine, & methylone with little MDMA.
  • The European Monitoring Centre for Drugs and Drug Addiction issued a warning in February 2014 that “dangerously high” levels of MDMA were appearing in Europe.
  • MDMA tablets in the Europe in 2012 contained 60 – 100 mg of MDMA, but tablets containing 150 and 200 mg of MDMA are were available in February 2014 and the warning stated they could contain even higher amounts, e.g. 240 mg.
  • Deaths due to potent levels of MDMA have been reported in New York City at a music festival last summer and a recent death in Austin involved MDMA.

“Will they turn you into a zombie? What clinicians need to know about synthetic drugs?” (2nd edition)

Updated Training Curriculum:  Download the training package as zip file or individually below.

  1. Synthetic Drugs Powerpoint (PPTX);
  2. Synthetic Drugs Trainer Guide (PDF);
  3. Synthetic Drugs Reference List (PDF)