Adding stimulants like meth and cocaine to the mix creates another layer of challenges.

Those on the front lines say most stimulant users are unaware they are taking a mix of drugs. That was the case for Jessica Neal, who said she started using methamphetamine in her early 20s, got in trouble with the law, went on the run, became pregnant, and is now in recovery.

Neal, now 33, thought she was using only meth. But a toxicology report from a failed drug test revealed she had also taken heroin, fentanyl, barbiturates, and benzodiazepines.

While some opioid users prefer the contrasting effects of opioids and stimulants, others, particularly people who are homeless, take stimulants to stay awake and safe.

Larrecsa Barker, a paramedic with the Quick Response Team, said regardless of what people report using, she always asks them if they might test positive for heroin or fentanyl. “If so, that means you’re definitely one step closer to getting into treatment,” she said.

There is no equivalent to Suboxone to treat withdrawal from stimulants. “If you’re just using meth, the likelihood of getting into inpatient treatment is slim to none,” Barker said.

In 2020, local government agencies, health providers, and Marshall University assembled a resiliency plan. Short-term goals include expanding outpatient and inpatient care; reducing barriers to treatment and recovery services; and providing more substance use education. They’re also working to address the underlying social determinants of health, including housing and employment.

Rader, the drug control council director, sees incremental gains in caring for the most vulnerable. She said that Project Hope for Women & Children, a program operated by Marshall Health, has been a godsend. “So many success stories,” she said. Rader also lauded the city’s founding of the Crisis Intervention Team and the expansion of its shelter capacity. The low-barrier shelter admits people even if they have recently taken a drug.

Yet Pollini, the epidemiologist, said that too often lawmakers limit how local officials can respond. She cites restrictions, and prohibitions, on harm reduction initiatives at both the state and local levels.

She said that clamping down on syringe exchanges not only restricts the availability of syringes but reduces access to free naloxone, fentanyl test strips, and other lifesaving supplies.

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