RACHEL MARTIN, HOST:
While health officials have been focused on the opioid crisis in this country, another drug epidemic has emerged. Overdose deaths from methamphetamine have more than doubled in recent years. Treatment admissions are up, and some law enforcement officials around the country say meth is their biggest drug problem. From member station KQED in San Francisco, April Dembosky reports.
APRIL DEMBOSKY, BYLINE: One of the main things police are responding to in the meth crisis are psychiatric emergencies.
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UNIDENTIFIED 911 OPERATOR #1: San Francisco, 911.
UNIDENTIFIED PERSON #1: Yeah, I got a white male acting crazy. He made threats to...
UNIDENTIFIED PERSON #2: An African American woman was just walking barefoot along Mission Street...
UNIDENTIFIED PERSON #3: There's a black guy outside. He's cursing.
UNIDENTIFIED PERSON #2: ...Going into traffic, stopping buses.
UNIDENTIFIED 911 OPERATOR #2: OK.
UNIDENTIFIED PERSON #3: He's mentally ill.
UNIDENTIFIED 911 OPERATOR #2: OK.
UNIDENTIFIED PERSON #3: He's manic, and he's banging on the window.
UNIDENTIFIED PERSON #2: She just punched somebody a minute ago.
DEMBOSKY: San Francisco received more than 19,000 calls like these last year reporting people on the streets who look mentally disturbed. Thousands of those people get picked up and taken to psychiatric emergency at San Francisco General Hospital. But a lot of them are not mentally ill. They're high on meth.
ANTON NIGUSSE BLAND: They're often paranoid. They're thinking that someone might be trying to harm them. Their perceptions are all off.
DEMBOSKY: Psychiatrist Anton Nigusse Bland says almost 50% of their psych emergencies are for meth-induced psychosis - 50%.
NIGUSSE BLAND: They can look so similar to someone that's experiencing chronic schizophrenia. It's almost indistinguishable.
DEMBOSKY: The main way to tell the difference is to wait 12 to 16 hours for the meth to wear off. No more psychosis.
NIGUSSE BLAND: Their thoughts are more organized. They're able to maintain adequate clothing. They're eating. They're communicating. They're able to advocate for themselves. The improvement in the person is rather dramatic because it happens so quickly.
KIM: Meth causes people to act, I mean, like, totally insane.
DEMBOSKY: This is Kim. She first started using meth 20 years ago.
KIM: I mean, it's crazy what people think and what people - you accept as normal.
DEMBOSKY: There was one day last year when Kim went wine tasting with a friend in Sonoma County.
KIM: I was on Xanax and speed.
DEMBOSKY: She and her friend got into an argument in the car. Kim thought someone was following them. She was utterly convinced she was being chased, and she had to get away.
KIM: He pulled over, and I jumped out the car and started running. And I literally ran a mile. I had poison oak from head to toe. I had bruises, cuts. I went through water. I went up a tree. And I was literally running for my life. In my head, I was running for my life.
DEMBOSKY: Kim was soaking wet when she walked into a woman's house, woke her from bed and asked for help. When the woman went to call the police, Kim left and found another woman's empty guesthouse to sleep in, Goldilocks-style. Kim says she just wanted to get warm.
KIM: But then I woke up and stole her car.
DEMBOSKY: That's how Kim ended up in jail, and that's why she asked us not to use her last name. She's out now and in a treatment program. She's part of the steady rise in people seeking help from meth addiction throughout the western U.S.
But policymakers along the East Coast haven't kept up. All they see in their backyard are opioids, and so that's where the funding and attention goes. That's according to Steve Shoptaw, an addiction psychologist in Los Angeles. He says, in his practice, he hears one story after another about meth destroying people's lives.
STEVE SHOPTAW: But when you're in D.C., or where people are making decisions about how to deploy resources, those stories are very much muffled by the much louder story about the opioid epidemic.
DEMBOSKY: Even within drug treatment circles, where you think everyone would be on the same side, advocates who focus on opioids are afraid their achievements will be threatened if meth advocates demand too much.
SHOPTAW: Bottom line is, as Americans, we have just so much tolerance to deal with addiction. And if the opioid users have taken that tolerance, then there's no more.
DEMBOSKY: One of the main problems is there are no medication treatments for meth the way there are for opioids. There is a behavioral therapy, something called contingency management. Basically, every time users pee in a cup and test negative for meth, they get paid. It works, but it's controversial. And most insurers, including California's Medicaid program, refuse to cover it.
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UNIDENTIFIED PERSON #4: Two.
DEMBOSKY: So San Francisco County uses its own money to pay for the 12-week program here at the San Francisco AIDS Foundation. It's focused on men in the gay community, where meth has long been a popular party drug. Program manager Rick Andrews says, these days, he's surprised by who's coming in.
RICK ANDREWS: Older gentleman who maybe they grew up in a time of HIV and AIDS initially, right? And maybe they led very safe lifestyles, and now they're older.
DEMBOSKY: And things are different with HIV. There's treatment. There's a prevention pill.
ANDREWS: They feel like they've missed out. And they want to have a little fun and make up for lost time, maybe.
DEMBOSKY: This idea of the aging meth user, it's one of the possible explanations for the steep rise in methamphetamine-related deaths. Dr. Phillip Coffin directs substance use research at the San Francisco Department of Public Health. He says most speed deaths are from brain hemorrhage or a heart attack. And that would be highly unusual for a 20-year-old.
PHILLIP COFFIN: Because your tissue's so healthy at that age. Whereas when you're 55 years old and using methamphetamine, you might be at higher risk for bursting a vessel and bleeding and dying from that.
DEMBOSKY: But other people are dying because their meth is contaminated with fentanyl, a synthetic opioid. Most researchers believe this is accidental. The same table or scale that was used to cut fentanyl was later used to package meth. Health officials are now distributing fentanyl test strips to meth users as well as naloxone, the nasal spray that can reverse an opioid overdose. They're telling meth users to carry it just in case. For NPR News, I'm April Dembosky in San Francisco.
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