ARI SHAPIRO, HOST:
Methamphetamine use is reaching crisis levels in some parts of the U.S., especially the West. Deaths are up. Hospitalizations are up. Some experts say this resurgence of meth got a kick-start from the opioid epidemic. April Dembosky of member station KQED in San Francisco introduces us to two women who used both drugs.
APRIL DEMBOSKY, BYLINE: At first, drugs were just a fun thing she would do on the weekend - ecstasy and cocaine with her friends. Then on Monday, Amelia went about her workweek.
AMELIA: I'm a horse trainer, and so I worked really hard, but I also partied really hard.
DEMBOSKY: Then one weekend when she was feeling kind of hungover from the night before, Amelia's friend passed her a pipe. She said it was opium.
AMELIA: I thought it was like smoking weed or hash, you know? That's kind of how I - I don't know. I just thought it was like that.
DEMBOSKY: Amelia grew to like this opium stuff. She took her friend's phone to get the dealer's number.
AMELIA: The woman said, how long have you been doing heroin for? And my jaw nearly hit the ground. I was just really honestly shocked that - I was like, what? I've been doing heroin this whole time. I felt really naive, really stupid for not even putting the two together.
DEMBOSKY: Pretty soon her weekend smoke became her daily morning smoke, then her lunch break routine, too.
AMELIA: So I just kind of, like, surrendered to that and decided, screw it; I'm just going to deal with it. Like, I'll just keep doing it. I'm obviously still working. I'm fine.
DEMBOSKY: Heroin is expensive. Amelia was working six days a week to pay for it. One day, a girl at the horse barn offered her some methamphetamine.
AMELIA: So that was introduced to me as, like, a pick-me-up.
DEMBOSKY: Meth is cheap. It became the thing that kept her going so she could earn enough money to buy heroin.
AMELIA: That was, like - I was spending, I think, $200 a day at one point. And the meth was, like, $150 a week.
DEMBOSKY: This lasted for three years until Amelia found out she was pregnant. She found a residential treatment program that would accept her and her baby.
AMELIA: I wasn't OK with having kids and letting that be part of my life.
DEMBOSKY: In recent years, more and more heroin addicts have been saying meth is also a problem for them. In San Francisco, it went from 14% of heroin users also getting treatment for meth to 22%. Nationally, 34% of opioid users now say they use meth as well.
DAN CICCARONE: That's alarming and new and intriguing - needs to be explored.
DEMBOSKY: UCSF professor Dan Ciccarone has been studying heroin for almost 20 years. He says heroin and cocaine is a classic combination, the speedball.
CICCARONE: It's like peanut butter cups - right? - the chocolate and peanut butter together, you know? But methamphetamine and heroin are an unusual combination.
DEMBOSKY: One recent study suggests that efforts to get doctors to cut down on opioid prescriptions may have driven some users to meth. They buy it on the street as an opioid substitute. Others like meth because it balances out the effects of heroin, kind of like having a cup of coffee in the morning to wake up and a glass of wine in the evening to wind down.
That's how it was for Kim. We're using just first names for the women in this story because of their past illegal drug use. Kim was in treatment for meth addiction when a friend offered her heroin.
KIM: I thought, oh, heroin's great; I don't do speed anymore. And then I ended up doing both at the same time every day, both of them.
DEMBOSKY: It was all about finding the recipe to what felt normal. Start with meth.
KIM: I felt normal.
DEMBOSKY: Add some heroin.
KIM: That could be normal on heroin.
DEMBOSKY: Touch up the speed.
KIM: Oh, finally, I'm normal.
DEMBOSKY: Up and down, back and forth.
KIM: You're like a chemist with your own body. It's like you're doing a balance of trying to figure out your own prescription.
DEMBOSKY: Now Kim is trying to find that balance without drugs. She's been sober for a year and so has Amelia, the horse trainer. Her sober anniversary is the same as her daughter's birthday. For NPR News, I'm April Dembosky in San Francisco.
SHAPIRO: And this story comes to us from a reporting partnership between NPR, KQED and Kaiser Health News.
(SOUNDBITE OF AQUILO AND LAMBERT'S "THIN (LAMBERT REWORK)")
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