Opioids, heroin and fentanyl remain abundant, cheap and deadly in this part of Kentucky. In 2017, the rate of fatal opioid overdoses in the state was nearly twice the national average. But the sudden abundance of methamphetamine reflects a new reality in Louisa and elsewhere: A very public push to end opioid abuse has unwittingly ushered in the return of crystal meth.

In Concord, N.H., which was ravaged by opioids, the police say methamphetamine now accounts for 60 percent of all drug seizures. In Texas, Hawaii, Oklahoma and Colorado, overdoses from methamphetamine surpassed those from opioids in 2018. And in Mississippi late last year, the police discovered 140 pounds of methamphetamine in one of that state’s largest drug busts.

“Meth, that’s our drug now,” said Dennis Lowe, commander of a law enforcement task force in central and southeastern Ohio, which was also a center of the opioid epidemic. “In the past, it was easy for us to find opioids for sale on the street. Now we have to go look for it. With meth, users are walking around with ounces of it, where a few years ago, it might have been a gram or two.”

Doctors and hospitals have unwittingly accelerated the switch to methamphetamine by significantly reducing their patients’ access to pain medication; opioid users, increasingly fearful about overdosing on heroin and fentanyl, have been desperate for a substitute.

A powerful Mexican organized crime syndicate, the Sinaloa drug cartel, has sought to fill the vacuum by targeting Appalachia, federal drug officials say. The traffickers follow the same business model that allowed them to inundate the nation with heroin: make meth potent and sell it cheap to ensure a steady customer base, and ultimately, mass addiction.