*Editor's Note: James Johnson is a pseudonym.
January was a rough stretch for James Johnson*. In the span of a few cold, miserable weeks, the Sikeston resident turned 26, and lost his $9-an-hour roofing job. To cap it off, he got a new tattoo on his shoulder that he regretted almost immediately: the Monopoly man holding the components of a miniature meth lab — a lithium battery, a blowtorch and a Mason jar filled with Sudafed tablets and anhydrous ammonia.
February wasn't off to a great start, either. It was snowing in southeast Missouri, and he had on just a T-shirt and a baseball cap, worn backward and pulled down to his eyebrows, to warm his wiry, five-foot-eight-inch frame. In a rush to leave the house, he forgot his winter coat. "I'd been eating Xanax that night," he notes, "so I wasn't in the right state of mind anyway."
The Chevy Blazer's heater, at least, kept him warm in the backseat as it cruised the back roads just after 3 a.m. One of Johnson's buddies rode shotgun; a new acquaintance was behind the wheel. The plan was to make a small batch of meth, smoke a little himself and give the rest to his friends to sell. Johnson had spent nearly half of the previous nine years in prison for a variety of minor, meth-related offenses. Out on parole, he'd managed to stay clean for several months. Then he got laid off and, as he says, started "cookin' to survive, I guess, basically."
Emptying all but the last few sips from a liter of Aquafina, he peeled off the outer layers of a lithium battery and crushed two packets' worth of Sudafed. He sprayed starting fluid into the plastic bottle and added the final few ingredients, including a few tablets of ammonium nitrate fertilizer. Then he commenced to shake the container like a maraca.
As he shook, gases produced by the chemical reaction caused the plastic bottle to expand. Johnson loosened the cap to relieve the pressure. The last thing he recalls seeing that night was the sparks that flared up from the innards of the lithium battery as it bobbed in the murky slush of chemicals and water.
Then the bottle exploded in his face.
"The sparks shot up in the bottle three times — like a Roman candle: poof, poof, poof," Johnson recounts. "I was told if it catches on fire, you got to shake it out. Don't throw it. Shake it out. I tried to shake it out, and it blew up on me. I was engulfed in flames."
When he twisted the cap, enough oxygen evidently seeped in to initiate combustion: The sparks ignited the ether vapors from the starting fluid that were still floating around the cab of the Blazer, scalding his entire upper body, as well as the faces of his companions, who bailed out the front doors of the SUV as it skidded to a stop. With his clothes ablaze, Johnson jumped through the car's rear window and rolled on the snowy asphalt until he was extinguished.
After ditching the remains of the mini meth lab on the side of the road, his friends loaded Johnson back into the car and drove him to his cousin's house. A cocktail of toxic chemicals continued to slowly eat away at the exposed flesh where his coat should have been. His eyes were coated in a milky white film, his face and arms grotesquely swollen.
His cousin dialed 911. The operator asked how the accident happened. Johnson screamed in the background, "It was a fuckin' meth lab!" As a consequence, the paramedics who responded parked their ambulance a half mile down the road and refused to come any closer until the region's drug task force arrived. The police eventually showed up, burned what was left of Johnson's tainted clothing and told the firemen on the scene to rinse him off before admitting him to the local hospital.
"They squirted him with a fire hose," says his sister. "He was skinless. He didn't have no meat on him after that."
The silence in the burn unit at St. John's Mercy Medical Center in Creve Coeur is, for want of a better word, painful. Sounds — the hum of fluorescent lighting, the beeping of medical equipment, the typing and chitchat of the four on-duty nurses — echo off the linoleum floor in the main hallway, but from the nine patients' rooms comes only stillness. Glass walls form airtight seals that keep germs out and prevent the occupants' open wounds from becoming infected beneath their mummy-like layers of gauze.
Sixteen days after his meth-making misadventure, Johnson awoke from a medically induced coma in one of these silent, sterile vaults and found himself being taken off life support. He made a lot of noise.
"He was wild," his sister recalls. "He was incoherent, and he didn't understand anything that was going on around him. You could tell he was scared. He used the f-word a whole lot. He had tried to climb out of bed, so they had him in restraints. We took them off, and he started swinging his arms and screaming like he was still on fire."
Johnson had suffered severe burns on his arms, hands, face and left calf. Eighty percent of his lungs were damaged from inhaling chemical fumes. He had no eyelashes, no eyebrows and no vision in his left eye. Doctors had replaced the irreparably damaged tissue on his hands and forearms with skin grafts from his thighs.
Still, he was able to walk out of the hospital after twenty days. By April he regained his vision and almost full mobility in his hands. His arms, though, remain the color of cherry Kool-Aid, as though he fell asleep on the beach for days and woke up with the worst sunburn imaginable.
"It's a constant burn," he says of his limbs, which he must keep covered with elbow-length white fabric gloves for 22 hours each day in order to compress the skin grafts and keep them healing properly.
The other lingering damage was done to his bank account. The bill for Johnson's time in the burn unit totaled more than $67,000. The two-and-a-half-hour ambulance ride to St. John's cost an additional $2,000. He left the hospital uninsured, unemployed and, given his condition, unlikely to find a job in the near future.
According to doctors at burn units across the Midwest, patients like Johnson have become an alarmingly familiar sight in their wards.
"We're seeing, now, maybe 25 to 30 percent of our patients or higher have meth-related burns," says Dr. Michael Smock, director of the St. John's burn unit. The facility typically treats about 220 patients each year from a region that encompasses parts of eastern Missouri, southern Illinois and northern Arkansas.
"We had an impression that it seemed to go down, maybe in the 10 percent range, for a couple of years," Smock says. "But in the last six months to a year, it's picking up again."
Law-enforcement officials say measures to restrict pseudoephedrine purchases briefly curtailed the number of mom-and-pop meth labs and the violent explosions that inevitably accompany them. But in the wake of the new laws, a highly combustible method known as "shake and bake" has emerged as the technique of choice for small-time cooks. It's portable, and easy to conceal, making it possible to whip up a batch of meth while en route from one pharmacy to another. (To read more about the two main methods for making methamphetamine from pseudoephedrine, click here.)
"It's a lot more volatile of a process than the other methods they were using," says Kevin Glaser, coordinator of the Southeast Missouri Drug Task Force. "Before, we never had the labs exploding — I mean, they would occasionally, but with this new method we've seen and recorded what I'd regard as a significant increase in lab explosions."
The region's burn units are struggling to cope with the corresponding influx of patients. Each one racks up approximately $6,000 in treatment per day; stays of up to six months are common. Doctors say unpaid bills, coupled with the labor-intensive care needed to nurse meth-burn victims back to health, are sapping their resources.
"There's not a good workers'-comp plan with drug manufacturing," quips Dr. Jeffrey Guy, director of the Vanderbilt Regional Burn Center in Nashville. "They're never insured. The costs of their treatment just get passed on to society. People who live in affluent areas, when these people blow themselves up they tend to say, 'Oh well, it's one less drug addict.' That couldn't be further from the truth."
According to the American Burn Association, a coalition of more than 3,500 doctors, nurses, hospitals and firemen that promotes burn-related research, treatment, rehabilitation and prevention, the number of burn-care facilities nationwide declined from 132 to 125 over the past five years, in large part owing to the costs of treating uninsured patients.
In the case of meth-burn victims, the situation is compounded by limited social and economic resources and the severity of the injuries.
"Because these people have less money, they end up staying in acute-care facilities longer," explains Dr. David Greenhalgh, chief of burns at the University of California, Davis Medical Center. "They don't have funding to get nursing help or go to a rehabilitation center or get in-home care."
Two studies published by the burn unit at the University of Iowa in 2008 found that meth makers typically "have larger injuries with longer hospital stays and larger, non-reimbursed hospital bills" than others with similar injuries. The university also found that meth burns accounted for at least 10 percent of its own patient population.
"We have a certain amount of healthcare resources to use in the state," says Barbara Latenser, one of the burn surgeons who co-authored the papers. "As a taxpayer I don't want to be using that resource for somebody who blew their ass up cooking meth."
Smock worries about a disaster scenario in which many people are critically burned at a time when his ward is filled with recovering meth addicts.
"As a nation we're really walking a pretty fine line with our burn-care resources," Smock says. "Each burn unit has perhaps five to twenty beds as a common number. Most are running at 70 or 80 percent capacity on any given day. There's not a lot of space to put hundreds of burn patients in this country."
He remembers the phone call he received on September 11, 2001, following the attacks on the World Trade Center.
"I was contacted, as were most burn-center directors around the country, to get an idea of how many patients we could accept if there were hundreds or thousands of burn casualties," he says. "Unfortunately, there were very few survivors. But if something like that happened again — our extra capacity is a pretty narrow margin."
A few weeks after James Johnson was released from St. John's, he paid a visit to his parole officer. Given the circumstances, she was not happy to see him. In the months leading up to his accident, he'd persuaded her to sign paperwork that allowed him to leave the state. He'd had her — along with most of his family and friends — believing that he had kicked his meth habit.
"She told me, and I quote, 'You're the fuckin' poster child for shake and bake,'" Johnson recalls. "She said 'fuckin'' too. It kinda freaked me out how she said it like that."
Missouri law-enforcement officials say they first encountered shake and bake about two years ago. The most popular meth-cooking method (then and now) involves anhydrous ammonia. That mode of manufacture requires several hours, not to mention a heat source such as a stovetop or a blowtorch, an improvised home-chemistry set of glass jars and plastic tubing, and, most essentially, multiple packets of medicine containing pseudoephedrine.
Shake and bake yields smaller (though equally pure) quantities of meth with fewer pills and takes less than 40 minutes from start to finish. The formula is widely available online. Johnson says a friend taught him how to do it.
"All I heard was shake and bake this and shake and bake that," he remembers. "I didn't know what it was. I was used to anhydrous ammonia. I had a friend that knew how to do it. I begged and begged, and he didn't want to show me. But he finally showed me how to do it. It didn't look dangerous. [But] some of that stuff [ammonium nitrate] is what they used in the Oklahoma City bombing."
Between 2000 and 2007, police busted 16,189 meth labs in Missouri. According to the Missouri State Highway Patrol, 330 of those labs — about 2 percent — involved incidences of explosions or fire.
Jason Grellner, commander of the Franklin County Narcotics Enforcement Unit, says the low ratio of fires to meth labs seized is due to the high percentage of cooks working almost exclusively with anhydrous ammonia.
"Basically," Grellner explains, "if you've got a few brain cells left snappin' and know your own name, you can make meth from the anhydrous method pretty quickly."
Johnson seconds that opinion. "It's simple," he says. "If you can make cookies, you can do it."
Even so, the process involves a number of highly flammable liquids and gases that can be touched off by something as simple as a lit cigarette.
"The problem is that they get impatient," Grellner explains. "They start adding heat to the process in different areas. They boil off the Coleman fuel rather than let it evaporate. They use heat guns to dry out the meth quicker. Then things start to go haywire."
Grellner knows from personal experience that anhydrous ammonia's hazards aren't limited to explosions. He lost 22 percent of his lung capacity after accidentally inhaling fumes during a meth bust in 2002. There are also the cooks who attempt to manufacture their own ammonia and store it in crudely modified propane tanks. "That's where we're seeing the really violent explosions," he says. "Leveling houses, twisting houses off of their frames and that sort of thing."
Shake-and-bake explosions are tame by comparison, making them much more difficult for law enforcement to track. Police found 1,774 meth labs in Missouri last year (up from 1,487 in 2008) and counted 17 explosions.
This year, for the first time, police in Missouri are able to differentiate between shake-and-bake and anhydrous labs when they fill out incident reports. Because the former often takes place in cars and the evidence can be discarded easily, Grellner and other law-enforcement officials suspect the statistics — which have not yet been compiled by the Missouri State Highway Patrol — will not reflect how widespread shake and bake has become.
"Coolers, garbage bags, nylon sports bags — you name it," Grellner says. "We get a dozen calls a week for dumped meth labs along the roadway. We also had two people pass out on I-44 from the ether fumes and hit bridge abutments."
Whereas old-school meth cooks often perished when things went explosively wrong, shake-and-bake mishaps tend not to be fatal. That translates into more meth addicts staggering into emergency rooms.
"It causes a pattern of burns that is more focused on the upper body, the face and the hands — as if somebody was working on a device or some equipment," Smock says. "It generally causes an explosion plus significant alkali injuries to the face and eyes. It's both thermal and chemical burns."
Adds UC Davis' Greenhalgh: "We've had people who were wearing nothing but Speedo-style underwear. And unfortunately, everything that's not covered is burned."
At the St. John's affiliate in Springfield, a meth cook actually brought his set-up with him to the hospital.
"We have hospitality rooms to make it convenient for patients' families and patients being treated with chemotherapy," explains burn unit director Dr. Ken Larson. "Somebody thought it would be a good place to set up their meth lab."
That oddity aside, Larson suspects a substantial percentage of the patients he treats are injured in meth explosions, but he can only guess at the exact number. "No one walks in and says, 'Hey my meth lab blew up,'" he notes. "It's always, 'My propane tank exploded.' It's always a convoluted story."
Vanderbilt burn doctor Jeffrey Guy estimates that 20 percent of his patients are meth cooks. He says the problem with their cover stories, however flimsy, is that first responders and local emergency rooms often unknowingly risk exposure to toxic chemicals because a meth cook is worried he'll incriminate himself if he reveals the true cause of his injury.
"As a regional burn unit, we're geared up for chemical exposure," Guy says. "These small hospitals are just not expecting it, and they're not equipped."
At least in the short term, the fear of arrest is unfounded. If police book a person while he or she is receiving medical care, they are required by law to foot the medical bill.
"Unless it's egregious, unless they harmed a police officer, they won't get involved," Guy says. "Even if it's a serial killer, they won't do anything while they're hospitalized."
Johnson didn't hear from the Southeast Missouri Drug Task Force until three and a half months after he was released from the hospital. Earlier this month he was placed on house arrest pending felony charges of conspiracy to manufacture meth, a violation of his parole that carries a prison sentence of five to fifteen years. Fearing that his statements could be used against him in court, he asked that a pseudonym be used in this story.
Johnson says he has applied for Medicaid and Social Security disability benefits. "I don't want the help forever," he says. "Just long enough to get back on my feet so I can work, get my life back. I just want to work and provide for the kid I got comin'."
Johnson's girlfriend is due to give birth to the couple's first child, a girl, in June. It's this element of Johnson's life that worries many of the doctors and police officers who deal with meth-lab explosions on a routine basis.
"The alarming fact recently is the number of children inside the fires," Grellner says. "I don't have a ton of compassion for the guy who burns his dick off — which I've seen — but I feel for those kids who don't have a choice about waking up in a meth lab."
"There's this secondary collateral damage," adds Pam Howard, director of the burn unit at Arkansas Children's Hospital. "Because they're using a bottle that says Mountain Dew to do shake and bake, we've had two children try to drink the acid left in the bottle — the residue after they're done making the meth."
At St. John's, Smock says he has seen at least three patients rehospitalized with "multiple significant burns" from subsequent meth-lab explosions.
Johnson admits the temptation to relapse is strong.
"There is no real treatment for a meth addict," he says. "Even if you've been clean for twenty years, I bet you still think about it once a day. And if somebody breaks it out in front of somebody like me, there's a 99.9 percent chance I'm going to do it."
Still, he believes the car catastrophe has scared him straight.
"This wasn't no freak accident," he says. "It's something I never thought would happen to me. But sometimes, goddamn, in a weird way, I'm glad it did."
James Johnson's parents separated when he was four years old. He lived with his mother and her new boyfriend until one morning in 1988 when they packed up the car, drove to his father's house and left him and his older sister on the doorstep. Twenty-two years later, he still remembers the childhood moment "like it happened yesterday."
"They're pulling out the driving wavin', and I'm like, 'Man, where y'all going?'" he says in a thick Missourah drawl. "I'm thinking I'm going to stay with Dad for the weekend. It ended up that my mom and her old man moved to California and started manufacturing meth for the Hells Angels."
Thus began Johnson's long, tragic relationship with methamphetamine. Seated on the couch in the living room of his father's double-wide with the TV tuned to Judge Judy and the mobile home's shades drawn against the spring sun, he describes how he first smoked the drug when he was fourteen and started using a needle at fifteen.
"I just didn't like it, I loved it," he says. "I lived every day for it. I would steal, burglarize — whatever I had to do to get my high. It felt like Superman. It makes you feel unstoppable, just a bunch of energy running through you."
He dropped out of school when he was sixteen, moved in with a meth cook and went on marathon benders that kept him awake for more than three weeks at a time. He ended up in jail in 2003 for felony burglary.
"I did nine months, and I was out on probation," he says. "I was probably off the bus about 30 minutes before I had somebody at my house with a gram of dope, offerin' a good deal. There I go again."
In 2005 six boxes of Sudafed put him back in prison for eight months. The following year Congress passed the Combat Methamphetamine Epidemic Act, requiring pharmacies to keep medicine containing pseudoephedrine "behind the counter," to log each purchase and to sell to any individual no more than 3.6 grams in a single day or 9 grams in a month.
Then, in November 2007, the Mexican federal government banned the import of pseudoephedrine in an attempt to curb the meth "super labs" operated by that nation's drug cartels. According to data from the U.S. Department of Justice's annual National Drug Threat Assessment, the tactic worked — but it had the unintended consequence of drastically upping demand for the high-grade, homemade version of meth cooked in small "addiction" labs. Since 2008, domestic meth-lab seizures have increased by nearly 50 percent, from 3,096 to 4,571. Meanwhile, the average price of the drug decreased from about $280 to $130 per gram, and purity nearly doubled.
"You still have the same number of addicts out there who have to get meth," notes Nick Reding, the St. Louis-based author of Methland: The Death and Life of an American Small Town. "They've gone back to the dependable local smurfing paradigm. They've actually become larger-scale operations in the United States where people don't just smurf in their own state, they do it regionally."
Johnson's experience supports Reding's observation. In 2008 he and three others were caught in a Wal-Mart parking lot with a carload of supplies, including thirteen boxes of Sudafed. "They can't do nothin' about you going from one store to another in the same day," he says.
At the behest of the pharmaceutical industry, many states, including Missouri, have turned to electronic tracking systems in an attempt to curb meth cooks' smurfing tactics.
"The makers of these medicines are in the business of making people who feel bad feel better," says Elizabeth Funderburk, spokeswoman for the Consumer Healthcare Products Association. "They don't want their medicine turned into methamphetamine."
Testifying before Congress in April, Kent Shaw, the assistant chief of California's Bureau of Narcotic Enforcement, disagreed.
"The [pharmaceutical] industry has mastered appearing as if it is attempting to solve the problem," he said. "In reality, it is merely perpetuating the problem in order to continue reaping the financial gains generated by meth labs."
Shaw and other law-enforcement officials say the electronic databases are shortsighted and ultimately ineffective. They argue that requiring a doctor's prescription to obtain pseudoephedrine — a policy that was in place in the U.S. until 1976 — is the only surefire solution.
The results in Oregon seem to back them up. Before becoming the first state to adopt a pseudoephedrine prescription measure in 2006 (Mississippi joined Oregon earlier this year), Oregon seized more than 200 meth labs annually. Last year police found just ten.
The Northwest's regional burn unit witnessed an equally precipitous drop in the number of meth-burn victims.
"We used to see them quite a bit," says Curtis Ryun, an outreach educator at the Oregon Burn Center in Portland. "But after the law, I really can't remember the last time we had a patient from a meth-lab explosion."
When enacted locally, pseudoephedrine prescription laws have had similarly dramatic effects. Last July Washington became the first of ten Missouri communities (nine cities and one county) to ban over-the-counter sales of Sudafed and similar products.
"Ninety days after the law went into effect, we saw a 94 percent drop in sales of cold remedies containing pseudoephedrine," Grellner says, "and a corresponding 84 percent drop in crimes in the Washington, Missouri, zip code."
Owing to strong opposition from the pharmaceutical lobby, a pseudoephedrine prescription bill was defeated this year in the Missouri House of Representatives. A similar measure considered by the St. Louis Board of Aldermen also failed.
Critics of the proposals, including the American Civil Liberties Union and the Missouri State Medical Association, maintain that the laws would raise healthcare costs and set a dangerous precedent by tightening regulation of a substance that is only harmful when combined with other chemicals.
The burn doctors interviewed for this story were unanimous in their support for pseudoephedrine prescription laws.
"This is a huge problem that we deal with in our burn center and that our whole society deals with," Smock argues. "Is it worth the inconvenience to people who have a cold to not have a product that treats their symptoms but, honestly, doesn't cure the common cold? There are a number of other products that are available over the counter that can't be turned into methamphetamine."