There’s a street drug that barely registers on state graphs of drug overdose deaths. But some drug users, doctors and drug intelligence experts say methamphetamine, a longstanding problem in more rural states, is an emerging threat in Massachusetts that is already compounding the opioid epidemic.

For a little background — meth is a stimulant, like cocaine. It's similar, in structure, to legal drugs used to treat ADHD. There’s a form called crystal meth that looks like shiny, bluish chunks of glass. And there’s a white powder, which is how a man we’ll call just Michael because of his illegal drug use, was introduced to meth about three years ago.

As Michael tells it, he and his girlfriend had a heroin dealer who started mixing meth into his bags of dope.

"I was injecting meth without knowing it," Michael says. "Then I shot it, just straight meth, and I fell in love."

A few steps away, on a city block in Cambridge, a woman named Jade says people of all ages are falling into the same trap.

"Young kids, older people are doing meth because in your 60s and 70s it makes you feel 20, physically," says Jade. "It’s an amazing feeling but it’s an evil, evil, evil drug."

Evil because a user speeds through two, three or four days without sleep, crashes and then repeats the cycle, damaging their heart, brain, lungs, kidneys, teeth and skin.

Jade points to sores on her face, some open, some closing. She tugs a black cloth headband over one large scab.

"This is from meth," Jade says. "Like if you had a bullet inside your body and it's trying to come out, eventually it's going to come out."

Michael pulls up a pant leg to reveal a calf pocked with sores. But he’s hooked.

"You think the heroin epidemic is something. You have no clue. Everyone is switching to it, the meth," Michael says.

They switch because meth is cheaper and users don’t feel as sick when they come down. Women say they smoke, snort or inject meth to stay awake at night and avoid rape or theft. Other drug users say they tried meth because they were afraid of overdosing on fentanyl. But now there are reports of fentanyl added to meth, either intentionally or accidentally.

Michael says more meth is bad news for everybody. Think of it, he says, with opioids, a drug user nods off.

"A meth head is out, freaking out, running around the streets and when they don’t have what they want, they’re going to do whatever they have to do to get it," Michael says. "The heroin epidemic is like preschool hour compared to when this gets full tilt."

'Much Harder To Treat'

In the Boston area, meth may hit full tilt sooner rather than later.

"We’re on the verge of it really engulfing our drug using population out here," says Kristin Doneski, the outreach manager at Access, a drop-in center for drug users in Cambridge that offers support groups, a needle exchange, basic nursing and overdose education. Doneski says about a quarter of her clients are using meth — more than double the rate two years ago — and those numbers continue to rise.

"We’ve really had to research new resources for people because we don’t have a lot of them here," Doneski says.

Doneski is downloading brochures and articles about meth alerts from the West and Midwest where meth is already entrenched in the drug supply. Doctors are looking west as well for guidance. A patient who is bouncing around a room on meth is very different from one slumped on a couch, sedated by heroin or fentanyl.

"When people come in under the influence of methamphetamine they can often be paranoid, they can be very fearful, so it’s important for all staff, including front desk staff, to be trained in how to de-escalate," says Dr. Laura Kehoe, medical director of the Bridge Clinic at Massachusetts General Hospital (MGH). Patients with a substance use disorder can walk into the clinic for primary care, group meetings or just to hang out.