Answers elusive as meth toll rises
Deaths and emergency room visits connected to methamphetamine use have climbed sharply over the past decade in San Francisco, where the drug is almost as significant a public health threat as heroin and opioids like fentanyl, according to city reports.
Methamphetamine overdose deaths doubled over the past decade, even as opioid fatalities stabilized; more people die from methamphetamine use than heroin in San Francisco. Meth-related emergency room visits skyrocketed more than 1,200 percent from about 150 in 2008 to nearly 2,000 in 2016.
Treating people who are having bad reactions to the drug — suffering extreme paranoia or hallucinations, for example, or exhibiting aggressive behavior — at times strains police and psychiatric services.
In response to what’s being perceived as a growing threat with few clear solutions, San Francisco is putting together a methamphetamine task force, which will begin meeting this spring and intends to put out a report this fall. The task force will be co-chaired by Mayor London Breed and Supervisor Rafael Mandelman and include representatives from public health, addiction research and the community of methamphetamine users.
“The data is showing us that as opioid use is tapering off — even though it’s still a real challenge — methamphetamine is on the rise, and we need to address that,” Breed said in an interview Thursday. “This is why we decided to put together a task force for the purposes of bringing all parties to the table to come up with solutions.”
Methamphetamine is a syn-
thetic stimulant that is typically smoked, snorted or injected. Long-term use can cause brain damage. People who overdose can become combative and unpredictable, and they may feel urges to harm themselves or others.
Overdose deaths happen when methamphetamine causes sudden heart failure or bleeding of the brain’s main blood vessels. Also, methamphetamine can be spiked with the synthetic opioid fentanyl, which can cause fatal respiratory failure in even small doses.
About 100 people died from methamphetamine overdoses in 2017, compared with about 150 from all types of opioids, according to a San Francisco sentinel center that is part of the National Drug Early Warning System. Numbers for 2018 are expected this year, but public health officials don’t expect the statistics to change dramatically, said Dr. Phillip Coffin, director of substance use research with the San Francisco Department of Public Health.
Currently, roughly half of all visits to the psychiatric emergency department at San Francisco General Hospital are because of methamphetamine intoxication, said Dr. Anton Nigusse Bland, medical director of psychiatric emergency services.
“When a person is using methamphetamine, they can look essentially like a person who’s suffering with a severe mental illness like schizophrenia,” Bland said. “They’re running around, they’re anxious, they may be taking their clothes off, they may be yelling at the top of their lungs. They often are not caring for themselves adequately, and they may look malnourished and disheveled.”
The treatments for methamphetamine intoxication and psychotic episodes are often similar, too, he said. Patients generally are given antianxiety drugs such as Valium and a calm, quiet place to recover.
Sometimes it becomes clear that they’re suffering from methamphetamine use — not mental illness — only after 12 hours or so, when they’ve sobered up. That’s important because the city has limited services for people with serious mental health issues. The emergency psychiatric unit at San Francisco General has 18 beds and is almost always at capacity.
Many of the patients treated in the psychiatric emergency department are homeless, which can make them more vulnerable to drug use and also complicate both their shortand long-term treatment, public health experts said.
“Our public health challenges are made worse because of the easy access to meth,” Mandelman said. “It’s a very cheap drug. And if you’re homeless and on the street and you’re having to stay awake or just get through a really hard time, increasingly people are turning to meth. That exacerbates all the other problems we have around homelessness.”
Unlike with opioids, there are almost no evidence-based treatment programs to help people stop using methamphetamine, and no emergency drugs like naloxone to reverse lifethreatening overdoses.
The task force will prioritize creative solutions to reducing death and injury caused by methamphetamine use, Mandelman and Breed said. That could mean developing programs similar to safe-injection sites, where people could smoke or inject methamphetamine in an environment where they have immediate access to care if something goes wrong.
Solutions also could include more programs like San Francisco General’s Hummingbird Place — a respite center for people who are recovering from drug or mental health crises — and addiction treatment programs that focus more on harm reduction than abstinence.
Researchers also are looking into medications that could help people quit methamphetamine — an option that so far has proved elusive.
“For the opioid issue we have treatments that have stood the test of time,” Bland said. “With methamphetamine use, we still are collecting data. We don’t have a plethora of really well studied, highly effective treatments.”
One other priority for the task force should be addressing stigma around drug use, which can block people’s access to care, whether they’re in the midst of an overdose or want help quitting or cutting back their use, Bland said.
Among the few treatment programs that have consistently shown results in helping people scale back their use involve paying participants to reinforce positive behaviors. The San Francisco AIDS Foundation has such a program, called the Positive Reinforcement Opportunity Project, specifically targeting methamphetamine use. It also has the Stonewall Project, a harm reduction program for all types of drug and alcohol use.
The programs are effective, said leaders with the San Francisco AIDS Foundation. But they depend on community support.
“Stigma can be a barrier to a lot of these interventions,” said Mike Discepola, director of the Stonewall Project. “We need partnerships. We can do better.”