Meth Took Everything From JJ Keller. A Hospital That Refused to Write Him Off Got Some of It Back.

JJ Keller does not remember the exact hour he decided he was dying. He remembers the fear. “It was scary. I thought I was dying,” he says of the night his last stretch of methamphetamine use tipped into a psychotic episode. He was homeless. He had, in his words, “literally lost everything.” He tried to end his life, and he woke up in a hospital in Brooklyn where the staff did something he had not expected from anyone: they treated the psychosis, and then they kept treating him.

Five years later Keller is a peer recovery specialist in Colorado, working with young people at Denver Health who are where he was. His story was told by CU Anschutz in June 2025, and it is worth reading beside today’s data, because the two say the same thing.

A system that has already decided you can’t be helped is not treating you. It is discharging you.

That sentence is the whole argument of this piece. The rest is evidence, and a few things you can use.

Nothing is approved, and that is the wrong thing to fixate on

Here is the fact that makes clinics shrug. In October 2023, FDA’s Marta Sokolowska, deputy center director for substance use and behavioral health at the Center for Drug Evaluation and Research, put it in plain language when the agency released its first-ever draft guidance on developing stimulant treatments: “Currently there is no FDA-approved medication for stimulant use disorder.” That is still true today. Opioid use disorder has buprenorphine, methadone and naltrexone. Meth and cocaine have nothing you can swallow or inject that a regulator has stamped.

It matters, because the CDC’s numbers are not small. In 2023, nearly 60,000 overdose deaths involved cocaine or psychostimulants like methamphetamine, about 57 percent of the 105,007 total that year. Cocaine accounted for roughly 30,000 of them and psychostimulants for nearly 35,000, with some deaths counted in both. The same CDC page reports that 2.6 million people twelve and older used methamphetamine in the past year, and 5 million used cocaine.

Read that as a medical problem with no pill and a lot of people. The instinct, inside a lot of hospitals and clinics, is to conclude that nothing can be done. Scott Simpson, a psychiatrist at CU Anschutz who co-leads a program called BEAT Meth, has heard the exact sentence come out of his own colleagues: “There’s nothing I can do as a provider. There’s no treatment this patient can find.”

He says it is wrong. It is wrong in a way you can measure.

What actually moved the needle in Denver was staying put

BEAT Meth started in 2020 as a pilot in an emergency department. It did three unglamorous things. It let people stay in the ED longer, so a person coming down from a psychotic episode was not discharged into the street while still frightened. It treated the symptoms with medications, including antipsychotics and benzodiazepines, so the terror eased. And it worked on the staff, changing what the people in scrubs believed a meth patient deserved. According to CU Anschutz, the pilot tripled the likelihood that patients showed up to outpatient care afterward, and the CDC is now funding a randomized trial, which is the step that will tell us whether the pilot result holds when someone else runs it.

That last caveat matters, and you should hold onto it. A pilot that tripled follow-up is encouraging and it is one program in one Denver hospital. It has not been proven to work in a rural clinic or in a jail. But notice what it is not: a miracle drug. It is a hospital deciding a person was worth a longer stay and a kinder answer.

It has not been proven to work in a rural clinic or in a jail.

If you have ever been the patient in that ED, you already know the difference between being managed and being met. Psychologists call the first thing being a “problem to move along” and the second thing a working alliance. You do not need the term. You know it the second someone’s face changes.

Thirty years of proof that paying people to stay works

There is one treatment for stimulant use disorder with a serious evidence base, and it sounds like a scam until you see the results: you get rewarded, with cash-equivalent prizes, for testing negative or showing up. It is called contingency management. The idea is close to what a good sponsor does, only concrete. Your brain learned that the drug delivers a reward within minutes. Contingency management puts a small reward on the other side of the ledger, and it arrives fast enough for your brain to register it.

The evidence goes back decades. A 2006 meta-analysis of voucher-based reinforcement in Addiction, led by Jennifer Lussier, pooled voucher trials and found the approach improved outcomes across substance use disorders. The limit is worth naming: that review covers many substances, not only stimulants, so read it as strong support for the approach and not as a meth-specific effect size. Pair the rewards with therapy and peers, because a prize is a bridge and the person still has to cross it.

In Denver, the version CU Anschutz describes lets patients spin a wheel with a fifty percent chance of a cash prize up to twelve times over ninety days for attending therapy. That is the modern descendant of the old voucher studies, and it is stripped of any shame.

We have been here before, and we know how it ends

In 1986 Congress decided a cheap, fast drug had made a kind of person beyond help. The Anti-Drug Abuse Act set a 100-to-1 sentencing gap between crack and powder cocaine: five grams of crack carried the same five-year mandatory minimum as five hundred grams of powder. The chemistry was the same. What differed was who the country pictured holding it. Prisons filled while treatment stayed thin, and it took until the Fair Sentencing Act of 2010 to narrow the gap to 18-to-1, and until the First Step Act in 2018 to let people serving the old sentences ask for relief. The pattern is plain: when a stimulant panics us, we decide the person has stopped being able to change, and we build policy on the assumption. The policy outlasts the panic by a generation. We are at the start of that arc again with methamphetamine, and the people it lands on are in ED hallways tonight.

What is open right now, and what to do this week

Start with the door that is still real. If you are using stimulants right now, the risk you might not know about is that the supply can carry fentanyl you did not choose, and reporting on the stimulant crisis notes that stimulant deaths frequently involve fentanyl contamination the person didn’t know about. Naloxone reverses the opioid part of an overdose, and it is still yours to carry, whatever you are taking. SAMHSA’s National Helpline, 1-800-662-HELP (4357), is free and open every day.

If you work in a clinic, the move for this week is small. Ask whether anyone on your team has said “we have nothing for meth” in the last month, and replace it with something true: extended observation for the psychosis, a symptom-relief plan, and a referral to a contingency management program. California became the first state to get federal approval to cover contingency management through Medicaid under its Recovery Incentives Program. Other states are following, and our earlier reporting on contingency management’s spread through Medicaid covers who is next. The gate is real: coverage is state by state, and providers generally must be certified to bill it. Call your state Medicaid office and ask what the path is. If you want the wider picture, our stimulants pillar and the lived-experience desk keep the running file.

Other states are following, and our earlier reporting on contingency management’s spread through Medicaid covers who is next.

Keller could have been one more chart in that CDC number. What stopped it, by his telling, was a stranger’s decision at a bedside in Brooklyn to keep going. You may be the stranger for someone this week, or you may need one. Either way the treatment is not a drug yet. It is a person who does not give up first.