One hundred people died on Oʻahu from methamphetamine over a span of 10 months across 2024 and 2025, and their autopsies tell a common story: hearts scarred and enlarged after years of smoking ice, bodies found in vans, drainage culverts, and hospital beds, lives unraveled by a drug that arrived in Hawaiʻi nearly four decades ago and never left. The first of the 100 deaths was identified on October 19, 2024, and the last on July 11, 2025.
The review, conducted by Honolulu Civil Beat, found dilated cardiomyopathy — a condition in which the heart muscle weakens and stretches from chronic drug toxicity — affected at least 30% of the subjects examined. Hawaiʻi meth overdoses have exceeded opioid overdoses by more than two times, and the state's meth overdose rate is double the national rate, according to the outlet's reporting. Hawaiʻi is the only U.S. state where methamphetamine kills far more people than opioids, and as of 2025 it had the highest rate of dilated cardiomyopathy in the nation, per the same investigation.
Decades of Damage Catch Up With Aging Users
Smokable crystal methamphetamine, known as ice, first arrived in Hawaiʻi from East Asia in the late 1980s, making the islands the nation's original epicenter for the drug years before it spread to the mainland, according to research published on PMC. That 40-year legacy shows up in the bodies of long-term users now reaching middle age with failing organs. Thomas Manijo learned he had meth-related congestive heart failure in 2017, later returned to smoking meth after quitting temporarily, per Civil Beat's account. Ronnie Jaralba, who moved to Oʻahu in 1990 and became homeless in 2014, was told in June 2024 that his heart function was down to 20%; he died from acute methamphetamine intoxication, the outlet reported.
Others named in the review died young relative to the disease's toll but still bore its physical signature. Isaiah Edayan suffered from dilated cardiomyopathy tied to chronic meth use and had received a one-year restraining order in 2023. Eddie Vergara, who suffered from meth-related dilated cardiomyopathy and had received a 20-year restraining order, died in the driver's seat of his van in Kalihi in January 2025. Kennies Rowe Jr., 64, who also suffered from dilated cardiomyopathy, checked into a hospital on February 1, 2025, before his death.
A Cross-Section of Ages, Neighborhoods, and Circumstances
The deaths Civil Beat traced spanned a wide range of ages and settings across the island. Emerson Butay, 47, died in Kalihi in May after failing to respond to CPR; he was found with a glass pipe containing burnt methamphetamine residue. John Nobriga, 55, died from methamphetamine in February 2025, while Lily Shoaf died at 54 and Chau Luong died at 68. Chanel Louie, 31, died from a lethal combination of methamphetamine and fentanyl, and Guy Yonamine, 65, had a very high level of methamphetamine in his blood at autopsy.
Some cases involved people already known to local institutions. Peter Wokoun, 56, died after methamphetamine and MDMA contributed to his death; the Honolulu City Council is set to rename his baseball field in his honor next month. State Sen. Kurt Favella said of Wokoun, “He led by example and showed our youth the importance of responsibility, respect, and how to care for our community,” according to Civil Beat's reporting. Terrill Scott, the 71st of the 100 deaths examined, had been convicted of conspiracy to distribute a controlled substance in 2014, sentenced to slightly more than seven years, and died on March 28, 2025. Anthony Lewis died in a drainage culvert in Kapolei after returning to Hawaiʻi following drug treatment he had sought in Maryland in 2023.
Homelessness, Instability, and Precarious Housing
Roughly one in four of the 100 people who died from meth were homeless, per the outlet's review, while only about two in ten had serious criminal records — a detail that complicates assumptions about who the crisis touches. Aemarie Bracks, who held a master's degree in mental health counseling, died at 39, just hours after violating a restraining order. Ellen Botelho, 65, received eight homelessness-related citations in less than two months before her death. Paul Poomaihealani, 52, died after an autopsy showed methamphetamine use, and meth-related deaths in the review also included a 50-year-old Waikīkī hotel pool attendant.
Financial ruin appeared alongside addiction in some cases. Christopher Woodard, who had previously earned $150,000 a year at the University of Hawaiʻi and later earned $139,860 annually as chief planner for the state's Department of Business, Economic Development and Tourism, declared bankruptcy in 2021 with $120,000 in liabilities, Civil Beat reported. Rhonda Valera, describing the isolation that comes with the disease, told the outlet, “It's very lonely.”
A System Still Built Around Opioids
Statewide numbers back up what the 100 case files suggest. Methamphetamine overdoses claimed 184 Hawaiʻi residents in 2021 and 275 residents within three years, according to Civil Beat's data. Separately, USAFacts reported that Hawaiʻi recorded 333 total overdose deaths in 2024, an age-adjusted rate of 23.0 per 100,000 that was the highest since state tracking began in 1999 — even as national overdose death rates fell 26.2% that year. A University of Hawaiʻi at Mānoa study of state records from July 2020 through December 2021 found residents aged 50 to 79 accounted for 58.2% of drug fatalities statewide, with methamphetamine poisoning causing 64.3% of deaths in that older age group compared to 16.4% from opioids, according to University of Hawaiʻi System News.
Yet the money meant to fight Hawaiʻi's drug crisis is largely earmarked for a different drug. Hawaiʻi received $150 million from a national opioid settlement, but under state law and settlement terms, funds must be spent specifically on addiction to opioids, per Civil Beat's reporting — leaving methamphetamine, the state's leading killer, without a comparable dedicated funding stream. Fewer than one in three drug treatment participants complete treatment without drug use, the outlet found, and a Honolulu emergency room doctor reported that as many as one in five patients are there because of meth use. Publicly funded drug treatment admissions list meth as the primary drug for six in ten patients, per the same review, while primary care offices conduct universal substance-use-disorder screening in only about a quarter of cases as of 2023.
Cardiac Toll and a Widening Regional Pattern
The heart damage documented in Hawaiʻi's autopsies mirrors a broader regional trend. Meth-related dilated cardiomyopathy hospitalizations increased fivefold across the Western U.S. over 13 years, according to Civil Beat, while hospital data published in JACC: Advances and reported by MedPage Today found methamphetamine-associated cardiomyopathy admissions surged 530% in the Western U.S. between 2008 and 2020, compared to a 12% rise in general heart failure hospitalizations nationwide. The American Heart Association has noted that chronic methamphetamine abuse raises the risk of heart failure and pulmonary hypertension by 32%, driven by oxidative stress, tissue inflammation, and myocardial scarring.
The crisis has also left a disproportionate mark on Native Hawaiian and Pacific Islander communities. A nationwide study analyzing CDC WONDER data from 2018 to 2022 found methamphetamine was the leading cause of drug overdose deaths among NHPI populations, with a meth mortality rate of 11.38 per 100,000, according to research indexed on PubMed. U.S. Rep. Ed Case has said Hawaiʻi would report to the country on how it handled its methamphetamine crisis, Civil Beat noted.
State Response and Where Policy Stands
State lawmakers' attention to meth has fluctuated sharply over the past two decades. The Hawaiʻi Legislature considered 19 bills mentioning methamphetamine and passed two in 2004, but considered no bills mentioning the drug at all from 2011 through 2014, per Civil Beat's legislative review. More recently, the Hawaiʻi State Department of Health launched the Hawaiʻi Overdose Initiative Action Plan in January 2025 to expand intervention strategies beyond opioids to explicitly include psychostimulants like methamphetamine and co-occurring mental health disorders.
Hoodline has previously reported on the scale of federal enforcement targeting Hawaiʻi's meth trade, including a federal indictment of an Oʻahu meth pipeline and a case where investigators seized 100% pure methamphetamine during a Kaimukī apartment raid. Hawaiʻi Department of Health data analyzed by the Hawaiʻi Island Fentanyl Task Force showed total drug overdose fatalities in the state nearly doubled from 160 in 2014 to 309 in 2023 — an average of one overdose death every 28 hours statewide, according to the Hawaiʻi Island Fentanyl Task Force.
For residents seeking help, Hawaiʻi CARES offers free 24/7 crisis, mental-health and substance-use support, reachable at (808) 832-3100 or (800) 753-6879.
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