While Louisville frantically tries to rescue residents from heroin, fentanyl and pain pills, another drug is creeping back to prominence.
Crystal meth.
From the periphery of the heroin and opioid crisis, it has quietly helped drive up the death toll in the city and across the nation.
The drug became popular decades ago because it offered a quick rush and a jolt of energy. And it could be made through a simple but dangerous process of mixing easy-to-get ingredients, including items on drug store shelves.
At its height a decade ago, Louisville police were discovering local meth labs multiple times a week — sometimes after someone was burned or killed from a fire or explosion.
Those hazards have lessened in the past few years, with fewer local labs. Today's meth is cheaper, easier to get — and more lethal.
"It's deadlier than the public perceives," said Russell Coleman, the U.S. attorney for the Western District of Kentucky and a former FBI agent who has worked drug cases.
Most of it is being made in Mexico by cartels. And sometimes its secretly mixed with fentanyl, which is even deadlier than heroin.
"Methamphetamines are the next phase of the drug epidemic in this commonwealth," Coleman said.
Meth on the streets today, dubbed "ice," has a purity often close to 100 percent, much more lethal than the 50 percent purity of local one-pot labs — a disconcerting national trend, said Steven Bell, a spokesman for the U.S. Drug Enforcement Administration.
Some health officials and police in major cities recently have warned about its return. But meth never went away. It has resurged.
Meth-related deaths in Kentucky more than tripled from 2013 to 2016, when 252 people died, according to the Kentucky Injury Prevention and Research Center. More than a third of those deaths were in Jefferson County.
And last year, there were more than 100 overdose deaths in the county involving meth or a mix of it and other drugs, according to preliminary data from the coroner's office.
That's triple the meth-related death toll from 2015.
Meth-related deaths also have skyrocketed across the country. In a federal study of 31 states and Washington, D.C., deaths related to stimulants — mostly meth — rose by a third in one year, with more than 7,500 deaths in 2016.
Coleman, the region's top federal prosecutor, said large drug trafficking cases involve meth more often than any other drug. His office has about 150 meth cases pending.
Police across Kentucky intercepted more than triple the amount of meth last year than they did in 2013, according to a recent state police report. Nearly 11,000 drug seizures submitted to the state crime lab last year were meth — more than heroin, cocaine and fentanyl combined.
But unlike those drugs, which can quickly kill by slowing and stopping breathing, meth often does its damage over time.
High doses can elevate body temperature to dangerous levels, causing convulsions and overheating major organs, according to the National Institute on Drug Abuse.
Meth use also contributes to strokes and heart attacks, even in otherwise healthy young adults, said Dr. Yngvild Olsen, who is medical director for the Institutes for Behavior Resources, an independent nonprofit based in Baltimore.
But meth-related stroke and heart attack deaths aren't always attributed to drug use. So, Coleman said, meth doesn't get its share of the blame for the havoc it wreaks.
Mexican cartels step in
Explosions and fires in cars, apartment buildings and subdivisions became a threat in the 1980s and '90s as meth labs began saturating the U.S.
In those days, abandoned chemicals frequently put children, neighbors and police in danger, requiring expensive cleanups by specially trained hazardous waste disposal teams wearing what looked like white and puffy marshmallow suits.
In response, Congress passed the Combat Methampetamine Epidemic Act of 2005 to regulate and limit the sale of cold and allergy medicines that contain pseudoephedrine, ephedrine or phenylpropanolamine, traditionally used to make meth.
But rogue chemists in Mexico figured out how to make meth in "superlabs" without pseudoephedrine, Bell said. Unlike cocaine or heroin, meth is a synthetic made with chemicals instead of plants, so it can be made in large quantities.
That allowed cartels to saturate American streets with a purer and more dangerous product. And a larger supply means cheaper prices.
The television hit "Breaking Bad," depicting a high school chemistry teacher who cooks up a fortune's worth of meth, may be entertaining — and largely scientifically spot-on — but it's an anomaly, Bell said.
"Cartels have chemists on staff," Bell said. "Huge production labs in the U.S. declined significantly."
Today's meth looks like chunks of clear glass with a slightly blue tint. Meth also comes in white pills and can be crushed into a powder.
"There’s just no incentive to make the meth yourself," said Melvin Patterson, a DEA spokesman based in Washington, D.C., who remembers the clutter and danger of local meth raids. "It’s safer and cheaper to just go and purchase it from a cartel."
Charles Wilson, 32, a self-described "meth head" who is in recovery, said he used to pay about $700 for an ounce of meth in Albany, Kentucky.
In Louisville, where there's more meth on the streets, the price today is as low as $300 per ounce, said Louisville Metro Police Sgt. Paul Neal, a veteran narcotics detective.
As meth began saturating local streets a few years ago, Neal noticed a shift in drugs found on suspects, which previously had been predominantly heroin, marijuana or cocaine.
"It seems like meth has really come back big and in really large amounts," Neal said.
During traffic stops on interstates and local roadways, police now are finding as much meth as marijuana, Coleman said.
Detectives recently intercepted 400 ounces near Churchill Downs and 560 ounces near Pikes Point.
An ounce of meth might last a new drug user a month. Wilson, a user since age 15, said he would shoot up that much in about a week.
And with addicts chasing meth, dealers are chasing cash.
"I know heroin dealers who stopped selling heroin and started selling meth," said recovering addict Natasha Turpin, 34, of Danville.
She said she vaguely remembers mornings waking up at 11:30 after a meth-induced deep sleep to find her three young kids hungry and hovering.
"I could see the pain in their eyes," she said.
With cartels making today's meth abroad, there's no telling what might be lurking within a stash. Bell said cartels are now mixing the powerful and deadly opioid fentanyl with meth and cocaine — often leaving longtime users like Wilson and Turpin unaware.
That greatly heightens the danger for people who are still using or anyone who relapses.
'The drug of violence'
Meth users can become paranoid and agitated, a dangerous combination.
“The paranoia may make them believe people, particularly police officers, are there to harm them," said Olsen, the Baltimore doctor, who is also a board member of the American Society of Addiction Medicine.
And while heroin users can become so lethargic that they nod off at the dinner table or in the middle of a conversation, meth amps people up.
Police across Kentucky are being cautioned about the dangers of coming across someone high on meth, state police Commissioner Rick Sanders said.
"Meth is the drug of violence," he said.
Last year, his agency's Critical Incident Response Team investigated 25 incidents in which police officers in the state shot suspects. Sanders said 21 of the suspects had used drugs — and at least a dozen tested positive for meth.
Fights, domestic assaults and incidents of resisting or running from police are also increasing, Sanders said.
In February, a Louisville Metro Police detective was shot in the head during a traffic stop that involved suspected meth traffickers. The officer survived, and two of the four suspects were killed by police.
In another Louisville case, police charged a 61-year-old with stabbing another man with a hunting knife in the back during a fight over a gram of meth.
"You can almost think of it a little like cocaine on steroids," Olsen said. "It’s a stimulant, like cocaine, but much longer acting. It can really rev all of the body’s systems up."
Bell, the DEA spokesman, said he's seen users sweaty and hyper after they snort, smoke, swallow or inject meth.
"Think of someone drinking a hundred cups of coffee," the Bell said. "They stay up for days. Then they crash for four or five days. You can't wake them up."
Shutting down Mexican superlabs
When someone overdoses on an opioid like heroin, CPR and squirts of Narcan — nasal naloxone — can quickly restore breathing.
But there is no similar antidote for meth.
And there are no medication-assisted treatments like the methadone and buprenorphine doctors can prescribe to ween people off opioids.
Olsen said she and other addiction specialists are optimistic that scientists eventually will develop intervention and treatment options for meth that can earn the U.S. Food and Drug Administration's approval.
On the law enforcement front, Coleman and other top prosecutors are pushing to send traffickers to federal prison, where there is no parole.
And Washington officials are trying to reduce the amount of meth that cartels sneak across the border.
James Walsh, deputy assistant secretary of state in the Bureau of International Narcotics and Law Enforcement Affairs, said the first line of attack is diplomacy – getting help from the Mexican government.
There are five or six predominantly Mexican cartels, Walsh told a Courier Journal reporter in April at the annual National Rx Drug Abuse and Heroin Summit in Atlanta.
He said cartels in Mexico have established such strong U.S. networks that "they’ve cornered the market" and are "working it down to the local level."
Mexican leaders want to help curb the flow of drugs because of the violent acts committed by cartels, Walsh said.
About 300 superlabs — both meth and heroin — have been shut down in the past two years, he said. Meanwhile, Mexican officials have extradited about 100 major traffickers since 2008.
“We have a good partnership at the law enforcement level,” Walsh said. “They realize these cartels are responsible for many deaths in Mexico.”
Coleman said enforcement is key to reducing the supply and addiction treatment helps put a dent in the demand.
"We want to make it harder to find the meth and drive the price up," he said.
"And we have to do a better job getting out there and telling what the risks are with the use of methamphetamines."