A Pacific island jurisdiction of fewer than 50,000 people has just published the kind of methamphetamine data Fiji does not have: a year-by-year count of meth-related clinical cases, running from 71 in 2022 to 252 in 2025. The figures come from the Commonwealth Healthcare Corporation (CHCC), the public health provider for the Commonwealth of the Northern Mariana Islands (CNMI), a United States territory in the north-western Pacific — and they arrive alongside a frontline account from the territory’s drug recovery arm that withdrawal itself has become harder and more frightening to manage.
Charlotte Flores, manager of the CNMI’s Substance Abuse Addiction and Rehabilitation (SAAR) Program, told RNZ that symptoms at the Marpi-based HOPE Recovery Center are now “a lot scarier” than those staff saw five or six years ago, including hallucinations and psychotic episodes. RNZ published the report on 28 September 2026; it was republished by Scoop a day earlier, on 27 September. The two are the same report, not two separate investigations.
Key facts
CHCC methamphetamine-related cases, as cited by RNZ:
| Year | Meth-related cases |
|---|---|
| 2022 | 71 |
| 2023 | 78 |
| 2024 | 122 |
| 2025 | 252 |
| 2026 (to 31 August) | 179 |
- Across 2022 to 2026 the CHCC also logged 612 emergency department visits involving patients with identified methamphetamine use, 509 instances requiring urine drug screening and 57 psychiatric interventions. RNZ published these as combined totals, not annual splits.
- Flores said withdrawal at HOPE is now “a lot scarier”, with hallucinations and psychotic episodes among the symptoms staff encounter.
- Residential treatment at HOPE runs about four to five months.
- Neither report gives a figure for methamphetamine-related deaths, a supply route into the territory, or how many recorded cases reached treatment.
What the numbers actually measure
Read once, the case series looks like a straight line bending upward. Read closely, it says three more specific things.
First, the 2026 figure is not a slowdown. The 179 cases counted to 31 August work out to roughly 22 a month; the 252 cases recorded across the whole of 2025 average about 21 a month. On the CHCC’s own counting, this year is tracking at or slightly above last year’s pace rather than easing off — though partial-year counts can be revised upward as cases are coded, so the gap is too small to call a further rise.
Second, the five annual figures add to 702 recorded cases since 2022. Against that, the 612 emergency department visits across the same window suggest that acute care, not planned presentation, is where most of this caseload becomes visible to the health system. That inference carries a caveat RNZ’s figures do not resolve: the corporation does not state that the case count and the ED series cover the same individuals, and one patient can generate several visits. The 57 psychiatric interventions are equivalent to about 8 percent of the case total — a small share numerically, but the most staff-intensive end of the ledger for a territory with one public hospital system.
Third, scale matters in the other direction. If the 2020 US census count of roughly 47,000 CNMI residents broadly still holds, the 252 cases in 2025 amount to something in the order of 530 recorded meth-related cases per 100,000 people. That is not a prevalence estimate — it counts health-system contacts, not users — but it is a rate, and rates are what allow comparison.
Why this matters for Fiji
Fiji has the meth problem. What it does not appear to have, in public, is this kind of series.
Fiji’s methamphetamine story has largely been told through two other channels: seizures, and the HIV emergency. As reported earlier on this site, Fiji has linked methamphetamine use to its own HIV outbreak, with authorities putting the burden at about one in 60 adults living with HIV and pointing to meth-linked injecting drug use as a driver. Those are grave numbers. They are also epidemiological numbers about a consequence, not a running count of how many people are arriving at Fijian hospitals in meth-related crisis, how many need urine screening, or how many need psychiatric intervention. This site could not locate a published Fijian equivalent of the CHCC’s four measures; until one exists, any comparison between the two jurisdictions is an estimate rather than a finding.
The arithmetic is worth doing anyway, clearly labelled as arithmetic. Fiji’s most recent census counted roughly 900,000 people. A jurisdiction of that size recording meth-related cases at the CNMI’s 2025 rate would be logging in the region of 4,800 a year. That figure is an illustration of scale, not a measurement of Fiji, and nothing in the CHCC or SAAR material speaks to Fijian caseloads. Its only real use is to show what a number of that order would mean for services — and Fiji’s system is already carrying documented strain, including the pressure already building on Fiji’s health services from non-communicable disease in younger patients. Capacity absorbed by one demand is not available for another.
The second Fiji-relevant point is clinical, and it comes from Flores rather than from any data set: the treatment need may be changing shape faster than the case counts show. A patient who hallucinates during withdrawal needs closer supervision, and potentially psychiatric input, than one who mainly sleeps and eats. If that pattern travels — and the reports offer no evidence about whether it has reached Fiji — then rehabilitation capacity planned around the older presentation would be planned around the wrong patient.
What the recovery centre says has changed
Flores told RNZ she was shocked by the rise in the official numbers, and that HOPE had seen an increase in its own intake as well. She described a clear before-and-after: five or six years ago, participants going through withdrawal would typically sleep a lot and eat a lot while recuperating.
Those symptoms have not disappeared, she said, but in some cases they now come with more concerning ones — the hallucinations and psychotic episodes she gave as the reason withdrawal has become frightening to manage. She also set expectations on time: people trying to stop using meth can face exhaustion, depression and strong cravings, and the brain can take months rather than days to heal. RNZ reported that the shift the centre is seeing coincides with the CHCC’s data showing a sharp rise in meth-related illnesses and deaths in the territory, although no death figure is given.
CHCC public health medical director Dr Andrzej Szefler framed the increase as a growing public health concern affecting individuals, families and the wider community, according to RNZ. “Behind every statistic is a person whose life has been affected,” he said, urging those struggling with substance use, and their families, to seek help as early as possible.
How treatment is structured
RNZ reported that HOPE participants undergo roughly four to five months of residential treatment, delivered under SAAR, the territory’s substance abuse addiction and rehabilitation arm that Flores manages. The programme covers relapse prevention, early recovery and life skills, anger management, drug education and recovery support.
What the report does not supply is the denominator that would make the programme measurable: the centre’s bed capacity, its waiting list, its completion rate, and how many of the 702 recorded cases since 2022 reached residential treatment at all. Without those, the four-to-five-month figure describes a design, not a throughput.
One report, two mastheads — and the gaps in it
It is worth being explicit about sourcing. RNZ, New Zealand’s public broadcaster, produced this report; Scoop carried it. Both versions contain the same quotes and the same CHCC figures, so readers should treat this as a single line of reporting rather than corroboration, and the CHCC and SAAR statements in it are not independently verified here.
The unanswered questions are substantive. The combined 2022–2026 totals for ED visits, screenings and psychiatric interventions are not broken down by year, so it is not possible to say whether acute presentations climbed in step with the case count or spiked in a particular period. No death toll is published despite deaths being referenced. And nothing in the reporting identifies how methamphetamine is reaching the CNMI — the question that matters most to neighbouring jurisdictions, and the one that is hardest and most hazardous to report, as earlier coverage on this site of calls for protecting Pacific journalists who cover organised crime set out.
What the CNMI’s recovery agency has put on the record is narrower than a regional picture, and clinical: the people arriving for treatment are harder to bring through withdrawal than they were half a decade ago, and the caseload behind them is growing. The territory can say that with numbers attached. On the present public record, Fiji cannot.
Frequently Asked Questions
Why does a Northern Marianas meth story matter to Fiji?
Because the Commonwealth of the Northern Mariana Islands has done something Fiji has not, at least publicly: its health provider has released a year-by-year count of methamphetamine-related clinical cases, plus totals for emergency department visits, urine drug screenings and psychiatric interventions. Fiji’s public meth reporting has run largely through its HIV outbreak and drug seizures. This site could not locate an equivalent published Fijian clinical case series, so the two countries cannot be compared like for like.
What are the CNMI methamphetamine case numbers?
The Commonwealth Healthcare Corporation (CHCC) recorded 71 methamphetamine-related cases in 2022, 78 in 2023, 122 in 2024 and 252 in 2025, with a further 179 identified through 31 August 2026, according to figures cited by RNZ. Across 2022 to 2026 it also logged 612 emergency department visits involving patients with identified meth use, 509 instances requiring urine drug screening and 57 psychiatric interventions.
What has changed about meth withdrawal, according to the recovery programme?
SAAR programme manager Charlotte Flores told RNZ that withdrawal at the Marpi-based HOPE Recovery Center is now ‘a lot scarier’ than five or six years ago. She said participants used to mainly sleep and eat heavily while recuperating; those symptoms remain, but some cases now also involve hallucinations and psychotic episodes. She said the brain can take months rather than days to heal, alongside exhaustion, depression and strong cravings.
Are RNZ and Scoop two independent sources for this story?
No. Scoop’s 27 September item is a republication of the same RNZ report published on 28 September; the two carry the same account, quotes and figures. There is effectively one underlying line of reporting, and the CHCC and SAAR statements in it are not independently verified by this site.
What is the HOPE Recovery Center and what does its programme involve?
RNZ describes the HOPE Recovery Center as Marpi-based in the CNMI, run under the territory’s Substance Abuse Addiction and Rehabilitation (SAAR) Program, which Flores manages. Participants go through relapse prevention, early recovery and life skills programmes, anger management, drug education and recovery support, with a residential stay of about four to five months. Neither report gives the centre’s capacity or waiting list.
