Fentanyl Gets a Test Strip. Meth Gets Called “Excited Delirium” and a Cell.

Kastalia Medrano used methamphetamine daily for three to four years, and in an essay published by Filter on August 12, she doesn’t ask for absolution for it. She and her husband were surviving something, and meth was, in her telling, one of the tools that got them through. “Like it or not,” she writes, “meth is the people’s drug.” That sentence is going to make some readers uncomfortable. It’s supposed to.

The harm reduction movement built an entire toolkit for opioids and largely forgot stimulant users exist.

Test strips, naloxone, syringe programs, overdose hotlines — every piece of harm reduction infrastructure built over the last decade assumes the person in front of you is at risk of a specific kind of death: one caused by an opioid depressing their breathing until it stops. Meth doesn’t work that way, and Medrano is blunt about it: “Most meth overdose isn’t physically harmful; occasionally someone might have a seizure, but it won’t hurt them.” She’s not wrong on the pharmacology. What kills stimulant users is usually cardiac stress, dehydration, psychosis-driven injury, or — increasingly — the fentanyl that’s been mixed into a supply they didn’t choose.

You don’t get a test strip for that. You get called a public safety problem instead of a patient.

Medrano’s essay connects that gap directly to a 2024 case in a Wyoming jail, where a forensic pathologist attributed a death partly to “methamphetamine overdose and the cardiac effects of excited delirium” — a term with no consistent clinical definition, used almost exclusively to explain deaths that happen in police or jail custody. The pattern isn’t new. The U.S. Sentencing Commission’s first comprehensive review of federal meth cases in nearly 25 years found methamphetamine is the only drug in the federal system still sentenced roughly ten times more harshly based on lab-tested purity — a distinction that made sense when most street meth was low-grade and now barely applies, since nearly all of it is high-purity. Meanwhile, CDC data show psychostimulant deaths rose from 2,266 in 2011 to 34,855 by 2023 — a fifteen-fold increase that got a fraction of the funding, research, and public sympathy fentanyl did.

If you use meth, or love someone who does, you already know which side of that gap you’re on. The infrastructure that exists to keep you alive was not built with you in mind. That’s not a reason to give up on it — it’s the argument for building the rest of it, starting with something as simple as a stimulant-specific harm reduction message that doesn’t route through a squad car.