Friday, June 9, 2023

Can brains bounce back? Recovering addicts turn to science to map the effects of meth

Every few months, Cohen “Coey” Irwin lies on his back and lets the walls close in. Lights move overhead, scanning over the tattoos covering his cheeks. He lies suspended, his head encased by a padded helmet, ears blocked, as his body is shunted into a tunnel. The noise begins: a rhythmic crashing, loud as a jackhammer. For the next hour, an enormous magnet will produce finely detailed images of Irwin’s brain.

Irwin has spent much of his adult life addicted to smoking methamphetamine – or P, as the drug is known in New Zealand. He knows its effects intimately: the euphoria, the paranoia, the explosive violence, the energy, the tics that run through his neck and lips. Stepping outside the MRI machine, however, he can get a fresh view for the first time – looking in from the outside at what the drug has done to his internal organs.

‘Meth is death’

New Zealanders are some of the world’s biggest meth takers: wastewater testing has placed it in the top four consumers worldwide. The country’s physical isolation – 4,000km from the nearest major ports – makes importing hard drugs challenging and costly, but meth can be manufactured relatively cheaply and easily, and is derived from available pharmaceuticals. Almost a third of middle-aged New Zealanders have tried the drug, a University of Otago study found in 2020.

In the backroom of Mātai research centre, Irwin thinks back to when it all started. He was a teenager when he tried P for the first time – trying to impress a girl on New Year’s Eve, in his home town of Porirua, Wellington. The girlfriend didn’t last, but the drug was love at first puff, he says, and would become one of the defining relationships of his life. “I remember it was the next day, the sun had risen, I was still awake with the people at the table I’d been smoking with. And I was instantly trying to find ways: how can we make money to get more?” Within a few years, he would be smoking every day.

Chatty and gregarious, Irwin is also a confronting figure: a curly beard only partially covers the tattoos mapped over his face, including large swastikas, which are common among the Mongrel Mob gang. The gang – which is majority Māori – adopted them as a symbol of extreme transgression, rather than an affinity with Nazism, he says. “We said to the crown, if you’re going to treat us like the enemy – which was Hitler at the time – we’re going to become the enemy,” he says. “But Hitler’s a cocksucker too. Fuck him too.”

Now, he has found himself as an unexpected but eager face of a new pilot study in New Zealand that works with meth users to map the effects of the drug on their brains – and to trace signs of healing and rehabilitation in the brains of those that stop smoking. He likes to post chatty, popular social media videos about his trips to the MRI. “If like me you’ve been smoking meth for years and years,” he says to camera, “this is the place to be.”

Irwin also hopes the research will help him stay abstinent. “Meth is death,” he says – but recovery is also excruciatingly difficult. He has dedicated most of a decade to selling and smoking it, with his longest break from use coming in the form of a seven-year prison stint for grievous bodily harm. The drug helped contribute to his part in that attack, on a man associated with a rival gang. Irwin hacked at the man with a machete, cleaving into his hand and severing his thumb. “I’d say if I wasn’t on P back then, I would’ve made slightly different decisions at that moment,” he says.

Seeing the effect on his family helped drive him to want to quit, Irwin says. He would sit in the closet to smoke – away from fire alarms, which he was convinced contained hidden cameras. “I’d be smoking and you know, it breaks my heart because my son would knock – he’s eight years old – and he’d go: ‘Dad? Are you coming out?’ And I’d say: “Twenty more minutes, my boy. Twenty more minutes.” He pauses for a moment. “That’s fucking ugly.”

New Zealanders are some of the world’s biggest meth takers. Photograph: The AGE/Fairfax Media/Getty Images

An opportunity to give back

As well as the usual damage wrought by addiction, meth has strong links with organised crime, and fuels violence among those who use it: a 2020 study found weekly users were between two and five times more likely to be involved in violence than non-users. New Zealand’s Ministry of Health estimates methamphetamine costs more than $820m annually in social harm. While methamphetamine use spans social class and race, wastewater testing indicates that its use is more common in areas with higher social deprivation – including some areas in Gisborne/Tairāwhiti.

“Meth arrived in Gisborne/Tairawhiti about 20 years ago, and its impact was immediately really noticeable,” says Tuta Ngarimu, a community worker and advocate. “It’s just destroyed so many of our people.

“It kind of crept up on everybody, and just smashed everybody really. We’re going into our second generation now.”

Ngarimu says the community has been crying out for better resourcing – including residential rehab facilities – for years and help for addicts is chronically underfunded. The Mātai meth recovery study, which has now been running for a year, is “a fresh approach”, he says, and offers something special to a community that typically gets little in the way of cutting-edge international health technology.

When he brings participants for scans, he says, “they could actually see something physically that was sitting in your brain or your heart – rather than hearsay,” he says. “To me that’s the power here.”

Tapping at the computer, Dr Samantha Holdsworth pulls up two images to the screen: the first, a scan of a healthy brain, the second from a participant who spent several decades using meth. The brain on meth is literally shrunken – the thick white swells of white and grey matter appear atrophied and diminished. More detailed scans show dark central areas foggy and spotted with white, like a spider has spun a web through it. “All that white haze, that’s not normal,” Holdsworth says. “That’s what we think is underlying neuro-inflammation.”

A comparison of two scans showing a healthy brain on the left and a methamphetamine damaged brain on the right
A comparison of two scans showing a healthy brain on the left and a methamphetamine damaged brain on the right Photograph: Mātai methamphetamine brain recovery study

Then she clicks through to another set of images – comparing a meth user’s brain after several months of abstinence. It is too limited a dataset to draw conclusions or publish yet, she cautions – but the image shows some of the white haze clearing. “This is the hope part of the project,” she says. “We’re trying to see – as people recover – whether the brain actually bounces back.”

The Mātai study has been set up to partner closely with the local community: to offer the images to participants as soon as they step out of the MRI.

Associate professor Miriam Scadeng, the principal investigator on the meth study, hopes that the process of simply seeing their brains onscreen – and seeing them potentially recover if they stay off the drug – could fuel recovery for addicts.

“If we can demonstrate that there is possibility for improvement, it will encourage people who are participating to stop this – it’s not ‘you’ve done your damage, and then you’ve got it for life’. If you stop using, you can potentially recover. And we’ve certainly seen that in our early results,” she says.

Around Tairāwhiti, the word has been spreading, Tuta says. He now gets near-daily calls from people asking about how they can be part of the study.

“Everyone feels when they’ve been in addiction, they’ve destroyed this community, they’re worth nothing,” he says. “Here’s an opportunity for them to actually give something back. To be a part of something.”

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