San Francisco Has A Meth Problem

Methamphetamine is far more prevalent than you think. A new report has some ideas on how to curb its impact.

For Alyssa, meth was a miracle drug that solved her biggest problem. “My depression feels like you’re carrying one of those weighted blankets around on your shoulders all the time,” Alyssa says. “Everything you do seems like a huge effort.” But on meth, Alyssa “had more energy than I’ve ever had in my life. It was frankly kind of like my depressive symptoms were cured.”

A pharmacist by trade, Alyssa — whose name has been changed to protect her identity, like the other meth users in this story — is highly aware of the irony of turning to meth to manage her illness. 

“Separating users into ‘these people are taking a prescribed drug’ and ‘these people are degenerate junkies’ … it’s terribly hypocritical,” she tells SF Weekly. “This is really just me trying so hard for so long to fight depression, and I just want something that works. So when something works, do I really care that it’s neurotoxic and cardiotoxic and schedule two? There’s a lot of risk versus benefit there, because it benefits me enough to the point where I’m more functional with it.”

A vicious drug

While the frenzy over opioids has dominated headlines and presidential debates, meth has steadily risen in popularity. Use of methamphetamine — a bitter crystalline powder with a variety of delivery vectors, including snorting, injection, smoking, or “booty bumping” (putting it up your butt)  — has risen sharply across the country. Nationwide, overdose deaths related to meth more than quadrupled from 2011 to 2017, and in San Francisco, more than 45 percent of all people who were taken to psychiatric emergency services in 2018 were high on meth. 

It’s a highly-addictive drug that, with long-term heavy use, can cause permanent damage to the brain in a variety of ways, including altering how the brain deals with habits, which can in turn make it even harder to quit doing meth. Unlike cocaine, meth stays in the body for up to 12 hours, and some studies have found the increased release of dopamine in the brain caused by meth can be toxic to nerve terminals. This can result in hallucinations, paranoia, memory loss, and unpredictable behavior. Long-term use also makes it harder for the brain to repair itself. Physical effects include weight loss, severe tooth decay, and skin sores. 

Local politicians have started to pay attention. Mayor London Breed and Supervisor Rafael Mandelman — both of whom have had close family members who were addicted to drugs —  created a Meth Task Force in February of this year to identify solutions for the crisis. 

Twenty-two people — from former users to police to healthcare workers — convened to identify some initial solutions to the visible crises on our streets. A report from the task force released late last month suggested a meth sobering center as an alternative to emergency rooms, and if it’s opened, it could be the first such facility in the country. 

But not everyone who uses meth is immediately addicted, or ends up in a locked psych ward, or experiences meth-induced psychosis. 

“Today meth addiction is still very much a queer issue in San Francisco,” Mandelman said at a press conference in October. “But it’s also a public health crisis for the safety and well-being of vulnerable residents across the city, in every community.” 

“This is really just me trying so hard for so long to fight depression, and I just want something that works. So when something works, do I really care that it’s neurotoxic and cardiotoxic and schedule two?”

Alyssa, meth user

While meth use is most obvious downtown, in the Tenderloin, and in SoMa where unhoused people use drugs out in the open, it’s not a drug that is used solely on the streets. As with Alyssa, Jenna found that it helped her get through her day — but in her case, she preferred to mix it with heroin. 

During her period of highest use — just a few years ago — she ran a high-profile political campaign, organized on behalf of a local union, and sat on the board of a democratic club. She got her master’s degree and wrote her thesis while high on meth.

“It both helped me function, and was really hard to stop in the middle of a work schedule like that,” she says. 

Jenna’s injection drug use largely remained a secret — she wore long sleeves to hide the marks on her veins, and adjusted the amounts of meth and heroin to meet the needs of each day. If it was a high-intensity work day, she’d use a little more meth; if it was a weekend, she could relax into more heroin.

“Meth allowed me to stay more alert and awake and balance out the effects of heroin, which are more sedating,” she says. 

But in the end the stigma — even among her radical queer community — began to wear on her. “People would support each other around all of this other substance use, but if it was injection use or certain drugs then all of a sudden no one wants anything to do with you, and they’re certainly not going to reach out to support, aside from saying things like, ‘you’re going to rehab or we’re cutting you off’,” she says. 

After 22 years of using off and on, Jenna finally reached the point where she wanted to become sober. “I was spending all my money, I felt physically terrible, I lost a lot of weight, my veins were not in good shape, and I’d isolated myself so much from people in my life.”

Finally, Jenna quit her job to spend 90 days in treatment. She’s been sober for four-and-a-half years.

Now, she gets a little reminder of what the drugs felt like after a yoga class. “Sometimes I feel that way at the end of a yoga class, just a little bit,” she says. “That’s what I go for now. Your whole body is buzzing, and warm and relaxed. It’s not really that different.”

On the rise

It’s difficult for public health departments and drug researchers to count meth users like Alyssa and Jenna, who partake in the drug in the privacy of their own homes, and function fairly well on it publicly. The rise in meth use in San Francisco was outlined in the Meth Task Force report only through the most extreme situations that can involve the drug. The Medical Examiner’s office noted an increase in meth-related overdose death — now, 47 percent of unhoused people who have died from an overdose in San Francisco are reported to have meth in their system.  There’s been an uptick in hospitalizations and emergency room visits related to meth use, according to the city’s Department of Public Health. And the San Francisco Police Department says they’re making more and more seizures of meth from dealers and users on the street. Last year, SFPD arrests for meth were the second-most common in the city, behind cocaine. In 2018 one in five arrests citywide were meth-related, compared with one in 20 in 2008. 

But all of that data aside, the report itself admits that “there are no reliable estimates of how many people use methamphetamine,” which makes providing services to that population a real challenge for service providers. 

 That said, some are successful. For years the San Francisco AIDS Foundation’s Positive Reinforcement Opportunity Project (PROP) group has provided a safe space for people to find support and resources to better-manage their meth use for nearly ten years. 

“We see a wide range of participants from wildly diverse cultural and economic backgrounds,” says Rick Andrews, the foundation’s associate director of contingency management. “Some are housed or recently housed, some are without housing, couch surfing, doing sex work or professionals coming in on their lunch hour. It’s because our program includes people of all backgrounds that participants feel comfortable bringing their substance use to light.”

Connecting to services was key to Connor’s path to recovery. He grew up in a “typical upper-middle-class family” in the Bay Area, and had a fairly typical upbringing; he partied in high school, and played sports in college. But his privileged adolescence didn’t alleviate the stress of coming out, and halfway through college, he found himself accepting an offer of meth from a friend. Connor, who describes himself as having “a genetic disposition for addiction,” immediately took to the drug.

“It erased a lot of worry, fear, and self-consciousness,” he says. “Meth revs you up in a way that is hard to describe. You have this energy. Your mind is not working properly, but you’re amped up. Soon I was using every day — and if not meth every day, it was weed or alcohol.”

Connor used for over a year, but keeping it secret was key. 

“In the collegiate world it’s totally okay to be a raging alcoholic, but crystal meth — any of the non-alcohol things are kind of looked down on,” Connor explains. 

Connor didn’t choose to leave college — he was kicked out at age 22. It was then that he turned to his parents and asked for help with his addiction. They sent him to an expensive rehabilitation center in Arizona, and with assistance from his community and the 12-step program, he managed to get sober. Sixteen years later, he still doesn’t use.

“The older I get I’m grateful for it happening so young,” Connor says. “I don’t have a base of friends that are drug users, I have a base of friends that are in recovery.” 

Solving the problem

The late October report included  17 recommendations, ranging from tangible ideas like creating a sobering center to vague platitudes like “strengthen collaboration among city agencies and service providers.” 

A common thread among solutions suggested by the report, however, is a greater need for space for meth users to come down safely, from a sobering center — emergency rooms are not adequately equipped to handle potentially psychotic meth users coming down, the report says — to more safe indoor spaces to more housing in general. The key challenge among many of these suggestions is location — where to put a sobering center, indoor spaces, and more housing. 

“This task force and report are not the beginning of the conversation, and it’s certainly not the end of the conversation, but I do believe we made important contributions,” says Mandelman. 

And, that conversation will need to include more than just those who are suffering publicly on our streets. 

“It is important that we tell stories and show different faces of meth use, because it isn’t just men who sleep with men, and it isn’t just unhoused people who are in psychosis, or people in a trailer park somewhere,” Jenna says. “Everyone is so focused on opiates. But there are all these people using meth who are just slipping through the cracks.” 

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