[Read Part 1 of this story here]
Larry Vessey Jr. is less than four months out from his release from Washington State Department of Corrections (WDOC) custody. He’ll be moving into his family’s home, the address WDOC previously rejected. He’ll have finally maxed out his sentence, so with nothing remaining to serve under community supervision—what’s elsewhere called “probation”—he doesn’t need WDOC approval to live there. Nor will he be subjected to urinalysis testing. But his housing is still contingent on abstinence from meth and any other illicit drugs; those are his family’s terms.
“[I’ll] have a place to go. And a job. I just don’t know if I can keep them,” Vessey told Filter. “I have people who understand, but I can’t slip up. At all.”
There are no Food and Drug Administration-approved medications for stimulant use disorder the way methadone and buprenorphine are approved for opioid use disorder. Though meth itself doesn’t introduce chaos into Vessey’s life when he uses it, he knows, unequivocally, that going back to meth would mean going back to the chaotic lifestyle that funded it. Which means going back to prison.
Obviously he doesn’t want that. But he’s not sure what he’s supposed to do instead. He’s done the 12-step, abstinence-based programs over and over, and only ever ended up back in prison. He’ll try the same thing again; what choice does he have?
“Treatment will be good, but it’s all the same,” Vessey said. “Everything in my life is abstinence or else.”
The lethargy and utter inability to concentrate is a state every chronic stimulant user knows well.
The closest thing to a state-sanctioned stimulant use disorder treatment is contingency management (CM)—financially incentivizing people to not use, like the program recently added under Medicaid coverage in California.
CM programs often pay only a few dollars per meth-free urinalysis test, or pay in gift cards rather than money. But the higher the financial incentives, the more effective CM becomes. CM is the best-evidenced approach to problematic meth use somewhat by default, because there isn’t much academic interest in meth harm reduction to begin with. It’s also because many people who use meth live in poverty.
“Lots of people think you do meth, then commit crimes,” Vessey said. “Which is sort of true; I would do crimes while high, but mostly because I needed to stay high.”
Everyone’s mileage varies, but a common pattern of use among people who come through Washington Corrections Center (WCC) is quarter-gram hits—by any method of consumption—three times a day. If you can afford to buy in bulk, you might pay $500 per ounce and sell it off by the gram, so that whatever you use pays for itself.
If you don’t have that kind of cash up front, as few of the people incarcerated here do, you could easily be looking at a $3,000-per-month habit. Vessey wants to stay away from all that and just focus on work, but that’s a Catch-22.
“I’m not able to focus. I don’t have any energy,” Vessey said. “A little prison job where I can slack isn’t the same thing as out there. I simply don’t have the energy to do a real job.”
The most harmful thing about meth is that it’s illegal.
Vessey, like most of the people incarcerated here, is from a rural part of the state. He’s a labor guy. A “real job” means logging, or something similar where you have to be aware of your surroundings and quick on your feet.
Meth helps people keep going through long shifts on little sleep, and especially in the early days of someone’s use it can boost their physical and mental performance. But Vessey’s concern isn’t about just going back to work at a regular pace, without the edge that once increased his productivity. Being able to keep a regular pace would be a blessing.
The lethargy and utter inability to concentrate that Vessey has been experiencing is a state every chronic stimulant user knows well. It’s like being underwater. But it doesn’t just resolve once the stimulants are out of your system; you stay underwater for a long time. The last time I went through it, it lasted about a year.
Vessey is staring down the prospect of going back to high-risk jobs where brain fog and slow reflexes mean you’re going to lose some fingers. Happens all the time.
More than anything, Vessey wants a couple of years in the free world without police.
Though he hadn’t thought of prescription stimulants as meth harm reduction, Vessey’s used Adderall in the past. He didn’t particularly like it because it didn’t get him high, but it did keep him on his feet enough to do whatever he needed to do. If there was a re-entry program for meth users like the one where WCC prisoners with OUD could get Suboxone in the six months leading up to release, that would change everything.
“I’d do that in a heartbeat,” Vessey said. “I could make do with just a little bit, if I could just get through my day … I won’t be going to trap houses.”
If the thing that got him through his day came from a pharmacy, dispensed once a month for a modest copay, Vessey believes he’d have a shot at finally breaking out of the cycle of surveillance and criminalization he’s been trapped in. All the 12-step programs never worked for him because they were about moral arguments and dealing with cravings, and never the thing he actually needed:
“I need the cops to leave me alone.”
The most harmful thing about meth is that it’s illegal. Some people struggle with problematic use and some people use while maintaining their day-to-day lives, but everyone is destabilized the moment law enforcement is involved. Stabilization for Vessey, and for the other meth users who comprise the majority of people WDOC assesses for any substance use disorder, means stabilizing from the chaos of the criminal-legal system.
Though when he walks out of WCC he’ll no longer be under community custody, once you have a felony on your record it never really leaves you. Every random traffic stop, every cop passed on the street, is now a road leading back to prison. More than anything, Vessey wants a couple of years in the free world, where he can just go to work and be with his family. A couple of years without police.
Photograph courtesy of Kastalia Medrano