Joshua used to take Percocet to get through the day on construction sites.

“Getting up and going to work every day beats you up after a while,” says the 32-year-old Hamiltonian. “I was never prescribed them, but I was taking them illegally.”

He wasn’t the only one. It was a part of the work culture, says Joshua, who didn’t want his last name used because he’s concerned about future job prospects.

Taking that pain reliever led to a full-blown opioid and crystal meth addiction that lasted five years.

He has been sober for nearly 11 months after a stint in jail and three-month treatment program.

Opioids — fentanyl and its more powerful cousin, carfentanil — are driving the city’s overdose crisis. In 2018, 124 people died after taking them in Hamilton, up from 88 in 2017.

But the impact of crystal meth — a dirt cheap drug that Joshua says is “just as bad” — can get lost in the shadows.

The evidence points to a dramatic spike in crystal meth use in recent years, and health-care providers are feeling it.

Last week, the city’s public health department reported a 1,110 per cent rise in methamphetamine-related visits to local hospital emergency rooms since 2012.

Crystal meth is a form of methamphetamine, a stimulant made from chemicals “cooked” in illegal labs. It can be smoked, injected or snorted.

The high can last for hours, leaving users with little desire to sleep or eat. It causes irritation, aggression and psychosis.

The drug is proving a game-changer for St. Joseph’s Healthcare Hamilton.

St. Joseph’s plans to double the size of its Charlton Avenue emergency psychiatric ward, in part, to better handle the complex needs of patients who have taken the drug.

The ward is too cramped to handle the influx of such patients in proximity to others who may be in hospital with depression or suicidal ideations, says Holly Raymond, clinical director of general psychiatry.

“You have someone in the next room to you banging and screaming. Obviously, that person’s in a lot of pain, but it’s not going to be conducive to your healing. It’s also frightening,” Raymond said.

“This is really why we need to have a flexible level of support that addresses a whole continuum of patient needs,” she said.

The goal of the $6-million project is to expand the department to 20 beds from 10. St. Joseph’s has raised about one-third of the funds and hopes to complete the project by the winter of 2021.

“The hospital is one stop, but we really do need a city-wide response,” said Raymond, noting the hospital and partner agencies are working on a plan.

Withdrawal from methamphetamine “boomerangs,” she said. A patient may seem settled, but the psychosis can re-emerge hours later.

“Maybe that person has been discharged to a shelter by then and then they’re not in the (emergency department).”

There’s no effective medicine to treat crystal meth cravings like suboxone does for opioids, notes Dr. Kerry Beal, lead physician with the Shelter Health Network.

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A couple of patients in Hamilton receive daily doses of another amphetamine, however, to help them, Beal said.

“The whole idea is making them be a productive member of society because they’re getting it every day. They’re not having to out and buy it. It’s the same as giving heroin to heroin addicts on daily dispense.”

While it doesn’t lead to deadly overdoses like opioids, crystal meth’s affect on health is highly corrosive for users, with impacts such as rotting teeth, skin infections and endocarditis, which is a bacterial infection, Beal noted.

“They gradually fade away.”

Joshua says he took to mixing crystal meth with opioids — which are downers — as an ad hoc safeguard to prevent him from dying after taking opioids.

“If you put just a little bit of crystal into your fentanyl, it will kick your heart up. It’s dangerous, but some people are concerned about dying from the fentanyl.”

Other users, especially those who are homeless, say they take crystal meth to stay awake in an effort to avoid robbery and survive on the street.

For $10, a tenth of a gram of crystal meth was cheaper than cocaine and offered Joshua a 10-day supply.

“If you buy it in bulk, it’s a lot cheaper than that,” he said.

Joshua says he overdosed numerous times on fentanyl and heroin but was never in the emergency ward because of meth-induced psychosis. He knows many who were.

In that state, users believe people are out to manipulate or even kill them.

Eventually, Joshua would like to be an outreach worker to help others struggling with addiction. His three young children are a motivating factor to lead a healthy life.

For those who cast a judging eye, Joshua says the fall can happen to anyone. “Once you’re in it, if you don’t have somewhere to go, you’re stuck.”