At the park near Duboce Triangle in San Francisco, 5 p.m. is canine happy hour. About 40 dogs run around, chasing balls and wrestling, as their owners coo and ’90s hip-hop bumps out of a portable speaker.
One recent afternoon, a Chihuahua mix named Honey lounged on a bench wearing a blue tutu and a string of pearls. Her owner, Diana McAllister, fed her homemade treats from a zip-close bag, then popped one into her own mouth.
After spending two years at home through the pandemic, it’s clear that for a lot of these owners, their dogs are their children.
“I always say, dogs are people, so I love him,” said Yves Dudley, looking on as her 9-month-old collie-schnauzer mix played in the grass.
Across the country, about 23 million families adopted a pet in the first year of the pandemic. Other pet owners, working from home, started paying more attention to their animals’ daily routines, noticing symptoms like vomiting or coughing. The resulting spike in pet health concerns has been straining a corner of the medical world that doesn’t get as much attention as doctors and nurses: veterinarians.
The overwork and staffing shortages of the pandemic have affected veterinarians as much as other doctors and nurses, and dealing with the constant moral dilemmas and emotional output was driving many to burn out even before 2020. The mean salary for vets is about $110,000 per year, according to the Bureau of Labor Statistics, about half that of physicians catering to people.
At the Society for the Prevention of Cruelty to Animals’ veterinary hospital in San Francisco, so many vets and technicians have left that the clinic has had to cut back its hours, said veterinarian Kathy Gervais.
Dog owners say they’ve had to wait months for vet appointments or drive to vets far from home to get care.
“Getting your dog in to see the vet is as competitive as trying to buy Coachella tickets online,” said Laura Vittet, whose golden retriever, Gertrude, is 1½ years old. “You have to wait by the phone, you have to be ready to refresh your browser. It’s a very intense experience.”
Gervais said she works 12-hour days, constantly zigzagging from new puppies to dying cats. And the whole time, she takes care of their humans, too.
“To these people, and especially in these times, this is their love,” she said, thinking especially of the owners who dress and coif and cook for their dogs. “This is their being, this is what they live for. And for vets, it’s very hard for us to draw the line.”
Empathy overload and compassion fatigue affect veterinarians’ mental health. They carry the weight of having to euthanize animals that could be saved but whose owners can’t afford the care. Gervais said her practice euthanizes about five animals every day. Some upset owners become downright abusive when a pet is in distress, berating vets or later bullying them online.
“I dare you to try to talk to a veterinarian who’s been in practice more than five years who doesn’t know somebody who has committed suicide,” said Gervais. “I, unfortunately, can count on more than 10 fingers: classmates, colleagues, people I’ve dated.”
One in 6 veterinarians have considered suicide, according to studies from the Centers for Disease Control and Prevention. While male vets are 1.6 times as likely to die by suicide as the general population, female vets are 2.4 times as likely, and 80% of vets are women.
In the early months of the pandemic, Gervais could see things getting worse. She helped organize the Veterinary Mental Health Initiative, which offers free support groups and one-on-one help to vets across the country.
All the facilitators have doctorate-level training, said founder and director Katie Lawlor, also a psychologist, and they’re all familiar with the issues troubling vets.
“Burnout, compassion fatigue, managing panic attacks, how to communicate with both supervisors, colleagues, and clients when you’re under extreme deadlines or very intense stress,” she said. “And the loss of their own companion animals.”
The initiative helped Dr. Razyeeh Mazaheri work through the anxiety she was feeling every day caring for animals at a clinic outside Chicago last year. The clinic was regularly double- or triple-booked. As a new vet — Mazaheri graduated from veterinary school last spring — juggling so many cases was terrifying.
“I just feel like if I make a mistake, that is a problem. And if I make a mistake and kill something, that is my fault,” she said, tearing up. “I just knew that I was burned out.”
Through the support groups, Mazaheri was able to see that others shared her concerns and she learned coping tools. The initiative, housed under the nonprofit Shanti Project, has groups specifically for emergency vets, vet technicians, recent grads like Mazaheri, and longtime vets like Kathy Gervais who have more than 20 or 30 years of experience.
“I’ve had people look at me sometimes when they’ve seen me really tired, going, ‘Kathy, walk away,’” she said.
“I’m not ready to do it because, bottom line, I love my job. It is a vocation. It is a passion. And it’s hard to walk away from that,” she said. “But if it’s going to kill me on the flip side, I would hope I could just say, ‘OK, that’s it. I’m done.’”
This story is part of a partnership that includes KQED, NPR and KHN.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
For months, journalists, politicians and health officials — including New York Gov. Andrew Cuomo and Dr. Anthony Fauci — have invoked the infamous Tuskegee syphilis study to explain why Black Americans are more hesitant than white Americans to get the coronavirus vaccine.
“It’s ‘Oh, Tuskegee, Tuskegee, Tuskegee,’ and it’s mentioned every single time,” said Karen Lincoln, a professor of social work at the University of Southern California and founder of Advocates for African American Elders. “We make these assumptions that it’s Tuskegee. We don’t ask people.”
When she asks Black seniors in Los Angeles about the vaccine, Tuskegee rarely comes up. People in the community talk about contemporary racism and barriers to health care, she said, while it seems to be mainly academics and officials who are preoccupied with the history of Tuskegee.
“It’s a scapegoat,” Lincoln said. “It’s an excuse. If you continue to use it as a way of explaining why many African Americans are hesitant, it almost absolves you of having to learn more, do more, involve other people — admit that racism is actually a thing today.”
It’s the health inequities of today that Maxine Toler, 72, hears about when she asks her friends and neighbors in Los Angeles what they think about the vaccine. As president of her city’s senior advocacy council and her neighborhood block club, Toler said she and most of the other Black seniors she talks with want the vaccine but are having trouble getting it. And that alone sows mistrust, she said.
https://www.npr.org/player/embed/974059870/980308707Toler said the Black people she knows who don’t want the vaccine have very modern reasons for not wanting it. They talk about religious beliefs, safety concerns or a distrust of former U.S. President Donald Trump and his contentious relationship with science. Only a handful mention Tuskegee, she said, and when they do, they’re fuzzy on the details of what happened during the 40-year study.
“If you ask them ‘What was it about?’ and ‘Why do you feel like it would impact your receiving the vaccine?’ they can’t even tell you,” she said.
Toler knows the details, but she said that history is a distraction from today’s effort to get people vaccinated against the coronavirus.
“It’s almost the opposite of Tuskegee,” she said. “Because they were being denied treatment. And this is like, we’re pushing people forward: Go and get this vaccine. We want everybody to be protected from covid.”
Questioning the Modern Uses of the Tuskegee Legacy
The “Tuskegee Study of Untreated Syphilis in the Negro Male” was a government-sponsored, taxpayer-funded study that began in 1932. Some people believe that researchers injected the men with syphilis, but that’s not true. Rather, the scientists recruited 399 Black men from Alabama who already had the disease.
Researchers told the men they had come to Tuskegee to cure “bad blood,” but never told them they had syphilis. And, the government doctors never intended to cure the men. Even when an effective treatment for syphilis — penicillin — became widely available in the 1940s, the researchers withheld it from the infected men and continued the study for decades, determined to track the disease to its endpoint: autopsy.
By the time the study was exposed and shut down in 1972, 128 of the men involved had died from syphilis or related complications, and 40 of their wives and 19 children had become infected.Given this horrific history, many scientists assumed Black people would want nothing to do with the medical establishment again, particularly clinical research. Over the next three decades, various books, articles and films repeated this assumption until it became gospel.
“That was a false assumption,” said Dr. Rueben Warren, director of the National Center for Bioethics in Research and Health Care at Tuskegee University in Alabama, and former associate director of minority health at the Centers for Disease Control and Prevention from 1988 to 1997.
A few researchers began to question this assumption at a 1994 bioethics conference, where almost all the speakers seemed to accept it as a given. The doubters asked, what kind of scientific evidence is there to support the notion that Black people would refuse to participate in research because of Tuskegee?
When those researchers did a comprehensive search of the existing literature, they found nothing.
“It was apparently a ‘fact’ known more in the gut than in the head,” wrote lead doubter Dr. Ralph Katz, an epidemiologist at the New York University College of Dentistry.
So Katz formed a research team to look for this evidence. They completed a series of studies over the next 14 years, focused mainly on surveying thousands of people across seven cities, from Baltimore to San Antonio to Tuskegee.
The conclusions were definitive: While Black people were twice as “wary” of participating in research, compared with white people, they were equally willing to participate when asked. And there was no association between knowledge of Tuskegee and willingness to participate.
“The hesitancy is there, but the refusal is not. And that’s an important difference,” said Warren, who later joined Katz in editing a book about the research. “Hesitant, yes. But not refusal.”
Tuskegee was not the deal breaker everyone thought it was.
These results did not go over well within academic and government research circles, Warren said, as they “indicted and contradicted” the common belief that low minority enrollment in research was the result of Tuskegee.
“That was the excuse that they used,” Warren said. “If I don’t want to go to the extra energy, resources to include the population, I can simply say they were not interested. They refused.”
“If you say Tuskegee, then you don’t have to acknowledge things like pharmacy deserts, things like poverty and unemployment,” —Karen Lincoln
Now researchers had to confront the shortcomings of their own recruitment methods. Many of them never invited Black people to participate in their studies in the first place. When they did, they often did not try very hard. For example, two studies of cardiovascular disease offered enrollment to more than 2,000 white people, compared with no more than 30 people from minority groups.
“We have a tendency to use Tuskegee as a scapegoat, for us, as researchers, not doing what we need to do to ensure that people are well educated about the benefits of participating in a clinical trial,” said B. Lee Green, vice president of diversity at Moffitt Cancer Center in Florida, who worked on the early research debunking the assumptions about Tuskegee’s legacy.
“There may be individuals in the community who absolutely remember Tuskegee, and we should not discount that,” he said. But hesitancy “is more related to individuals’ lived experiences, what people live each and every day.”
“It’s What Happened to Me Yesterday“
Some of the same presumptions that were made about clinical research are resurfacing today around the coronavirus vaccine. A lot of hesitancy is being confused for refusal, Warren said. And so many of the entrenched structural barriers that limit access to the vaccine in Black communities are not sufficiently addressed.
Tuskegee is once again being used as a scapegoat, said Lincoln, the USC sociologist.
“If you say ‘Tuskegee,’ then you don’t have to acknowledge things like pharmacy deserts, things like poverty and unemployment,” she said. “You can just say, ‘That happened then … and there’s nothing we can do about it.’”
She said the contemporary failures of the health care system are more pressing and causing more mistrust than the events of the past.
“It’s what happened to me yesterday,” she said. “Not what happened in the ’50s or ’60s, when Tuskegee was actually active.”
The seniors she works with complain to her all the time about doctors dismissing their concerns or talking down to them, and nurses answering the hospital call buttons for their white roommates more often than for them.
As a prime example of the unequal treatment Black people receive, they point to the recent Facebook Live video of Dr. Susan Moore. When Moore, a geriatrician and family medicine physician from Indiana, got covid-19, she filmed herself from her hospital bed, an oxygen tube in her nose. She told the camera that she had to beg her physician to continue her course of remdesivir, the drug that speeds recovery from the disease.
“He said, ‘Ah, you don’t need it. You’re not even short of breath.’ I said ‘Yes, I am,’” Moore said into the camera. “I put forward and I maintain, if I was white, I wouldn’t have to go through that.”
Moore died two weeks later.
“She knew what kind of treatment she should be getting and she wasn’t getting it,” said Toler of L.A., contrasting Moore’s treatment with the care Trump received.
“We saw it up close and personal with the president, that he got the best of everything. They cured him in a couple of days, and our people are dying like flies.”
Toler and her neighbors said that the same inequity is playing out with the vaccine. Three months into the vaccine rollout, Black people made up about 3% of Californians who had received the vaccination, even though they account for 6.2% of the state’s covid deaths.
The first mass-vaccination sites set up in the Los Angeles area — at Dodger Stadium and at Disneyland — are difficult to get to from Black neighborhoods without a car. And you practically needed a computer science degree to get an early dose, as snagging an online appointment required navigating a confusing interface or constantly refreshing the portal.
It’s stories like these, of unequal treatment and barriers to care, that stoke mistrust, Lincoln said. “And the word travels fast when people have negative experiences. They share it.”
To address this mistrust will require a paradigm shift, said Warren of Tuskegee University. If you want Black people to trust doctors and trust the vaccine, don’t blame them for their distrust, he said. The obligation is on health institutions to first show they are trustworthy: to listen, take responsibility, show accountability and stop making excuses. That, he added, means providing information about the vaccine without being paternalistic and making the vaccine easy to access in Black communities.
“Prove yourself trustworthy and trust will follow,” he said.
Published in DailyNurse courtesy of KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Unconscious bias could be a matter of life or death.
“Doctors aren’t listening to us, just to be quite frank. We’re dying, three times more likely. And knowing that going in, some doctors not caring as much for us, it’s heartbreaking.”
—Serena Williams (2018 post-pregnancy interview with BBC)
In mid-March, Karla Monterroso flew home to Alameda, California, after a hiking trip in Utah’s Zion National Park. Four days later, she began to develop a bad, dry cough. Her lungs felt sticky.
The fevers that persisted for the next nine weeks grew so high — 100.4, 101.2, 101.7, 102.3 — that, on the worst night, she was in the shower on all fours, ice-cold water running down her back, willing her temperature to go down.
“That night I had written down in a journal, letters to everyone I’m close to, the things I wanted them to know in case I died,” she remembered.
Then, in the second month, came a new batch of symptoms: headaches and shooting pains in her legs and abdomen that made her worry she could be at risk for the blood clots and strokes that other COVID-19 patients in their 30s had reported.
Still, she wasn’t sure if she should go to the hospital.
“As women of color, you get questioned a lot about your emotions and the truth of your physical state. You get called an exaggerator a lot throughout the course of your life,” said Monterroso, who is Latina. “So there was this weird, ‘I don’t want to go and use resources for nothing’ feeling.”
It took four friends to convince her she needed to call 911.
But what happened in the emergency room at Alameda Hospital only confirmed her worst fears.
At nearly every turn during her emergency room visit, Monterroso said, providers dismissed her symptoms and concerns. Her low blood pressure? That’s a false reading. Her cycling oxygen levels? The machine’s wrong. The shooting pains in her leg? Probably just a cyst.
“The doctor came in and said, ‘I don’t think that much is happening here. I think we can send you home,’” Monterroso recalled.
Her experiences, she reasons, are part of why people of color are disproportionately affected by the coronavirus. It is not merely because they’re more likely to have front-line jobs that expose them to it and the underlying conditions that make COVID-19 worse.
“That is certainly part of it, but the other part is the lack of value people see in our lives,” Monterroso wrote in a Twitter thread detailing her experience.
I was hospitalized last week for a very accelerated heart rate, very low BP, and cycling oxygen levels. And my entire experience at Alameda hospital was of one of being punished for being “insubordinate”.
In the hospital that day in May, Monterroso was feeling woozy and having trouble communicating, so she had a friend and her friend’s cousin, a cardiac nurse, on the phone to help. They started asking questions: What about Karla’s accelerated heart rate? Her low oxygen levels? Why are her lips blue?
The doctor walked out of the room. He refused to care for Monterroso while her friends were on the phone, she said, and when he came back, the only thing he wanted to talk about was Monterroso’s tone and her friends’ tone.
“The implication was that we were insubordinate,” Monterroso said.
She told the doctor she didn’t want to talk about her tone. She wanted to talk about her health care. She was worried about possible blood clots in her leg and she asked for a CT scan.
“Well, you know, the CT scan is radiation right next to your breast tissue. Do you want to get breast cancer?” Monterroso recalled the doctor saying to her. “I only feel comfortable giving you that test if you say that you’re fine getting breast cancer.”
Monterroso thought to herself, “Swallow it up, Karla. You need to be well.” And so she said to the doctor: “I’m fine getting breast cancer.”
He never ordered the test.
Monterroso asked for a different doctor, for a hospital advocate. No and no, she was told. She began to worry about her safety. She wanted to get out of there. Her friends, all calling every medical professional they knew to confirm that this treatment was not right, came to pick her up and drove her to the University of California-San Francisco. The team there gave her an EKG, a chest X-ray and a CT scan.
“One of the nurses came in and she was like, ‘I heard about your ordeal. I just want you to know that I believe you. And we are not going to let you go until we know that you are safe to go,’” Monterroso said. “And I started bawling. Because that’s all you want is to be believed. You spend so much of the process not believing yourself, and then to not be believed when you go in? It’s really hard to be questioned in that way.”
Alameda Health System, which operates Alameda Hospital, declined to comment on the specifics of Monterroso’s case, but said in a statement that it is “deeply committed to equity in access to health care” and “providing culturally-sensitive care for all we serve.” After Monterroso filed a grievance with the hospital, management invited her to come talk to their staff and residents, but she declined.
She believes her experience is an example of why people of color are faring so badly in the pandemic.
“Because when we go and seek care, if we are advocating for ourselves, we can be treated as insubordinate,” she said. “And if we are not advocating for ourselves, we can be treated as invisible.”
Unconscious Bias in Health Care
Experts say this happens routinely, and regardless of a doctor’s intentions or race. Monterroso’s doctor was not white, for example.
Research shows that every doctor, every human being, has biases they’re not aware of, said Dr. René Salazar, assistant dean for diversity at the University of Texas-Austin medical school.
“Do I question a white man in a suit who’s coming in looking like he’s a professional when he asks for pain meds versus a Black man?” Salazar said, noting one of his own possible biases.
Unconscious bias most often surfaces in high-stress environments, like emergency rooms — where doctors are under tremendous pressure and have to make quick, high-stakes decisions. Add in a deadly pandemic, in which the science is changing by the day, and things can spiral.
“There’s just so much uncertainty,” he said. “When there is this uncertainty, there always is a level of opportunity for bias to make its way in and have an impact.”
Salazar used to teach at UCSF, where he helped develop unconscious-bias training for medical and pharmacy students. Although dozens of medical schools are picking up the training, he said, it’s not as commonly performed in hospitals. Even when a negative patient encounter like Monterroso’s is addressed, the intervention is usually weak.
“How do I tell my clinician, ‘Well, the patient thinks you’re racist?’” Salazar said. “It’s a hard conversation: ‘I gotta be careful, I don’t want to say the race word because I’m going to push some buttons here.’ So it just starts to become really complicated.”
A Data-Based Approach
Dr. Ronald Copeland said he remembers doctors also resisting these conversations in the early days of his training. Suggestions for workshops in cultural sensitivity or unconscious bias were met with a backlash.
“It was viewed almost from a punishment standpoint. ‘Doc, your patients of this persuasion don’t like you and you’ve got to do something about it.’ It’s like, ‘You’re a bad doctor, and so your punishment is you have to go get training,” said Copeland, who is chief of equity, inclusion and diversity at the Kaiser Permanente health system. (KHN is an editorially independent program of KFF, which is not affiliated with Kaiser Permanente.)
Now, KP’s approach is rooted in data from patient surveys that ask if a person felt respected, if the communication was good and if they were satisfied with the experience.
KP then breaks this data down by demographics, to see if a doctor may get good scores on respect and empathy from white patients, but not Black patients.
“If you see a pattern evolving around a certain group and it’s a persistent pattern, then that tells you there’s something that from a cultural, from an ethnicity, from a gender, something that group has in common, that you’re not addressing,” Copeland said. “Then the real work starts.”
When doctors are presented with the data from their patients and the science on unconscious bias, they’re less likely to resist it or deny it, Copeland said. At his health system, they’ve reframed the goal of training around delivering better quality care and getting better patient outcomes, so doctors want to do it.
“Folks don’t flinch about it,” he said. “They’re eager to learn more about it, particularly about how you mitigate it.”
Still Unwell
It’s been nearly six months since Monterroso first got sick, and she’s still not feeling well.
Her heart rate continues to spike and doctors told her she may need gallbladder surgery to address the gallstones she developed as a result of COVID-related dehydration. She decided recently to leave the Bay Area and move to Los Angeles so she could be closer to her family for the long recovery.
She declined Alameda Hospital’s invitation to speak to their staff about her experience, concluding it wasn’t her responsibility to fix the system. But she wants the broader health care system to take responsibility for the bias perpetuated in hospitals and clinics.
She acknowledges that Alameda Hospital is public, and it doesn’t have the kind of resources that KP and UCSF do. A recent audit warned that the Alameda Health System was on the brink of insolvency. But Monterroso is the CEO of Code2040, a racial equity nonprofit in the tech sector and even for her, she said, it took an army of support for her to be heard.
“Ninety percent of the people that are going to come through that hospital are not going to have what I have to fight that,” she said. “And if I don’t say what’s happening, then people with much less resources are going to come into this experience, and they’re going to die.”
This story is part of a partnership that includes KQED, NPR and KHN.
KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Kim had been wine tasting with a friend in Sonoma, Calif. They got into an
argument in the car that night and Kim thought someone was following them. She
was utterly convinced. And she had to get away.
“I jumped out of the car and started running, and I literally ran a mile. I
went through water, went up a tree,” she said. “I was literally running for my
life.”
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.
“But then I woke up and stole her car,” said Kim, who is 47 and now in
recovery. (KHN is using her first name only because she has used illicit
drugs.) Kim had been high on Xanax and methamphetamine. “I was crazy. Meth
causes people to act completely insane.”
While public health officials have focused on the opioid epidemic in recent
years, another epidemic has been brewing quietly, but vigorously, behind the
scenes. Methamphetamine use is surging
in parts of the U.S., particularly the West, leaving first responders and
addiction treatment providers struggling to handle a rising need.
Across the country, overdose deaths involving meth more
than quadrupled from 2011 to 2017. Admissions to treatment facilities for
meth are up 17%. Hospitalizations
related to meth jumped by about 245% from 2008 to 2015. And throughout the
West and Midwest, 70% of local law enforcement agencies say meth is their
biggest drug threat.
But policymakers in Washington, D.C., haven’t kept up, continuing to direct
the bulk of funding and attention to opioids, said Steve Shoptaw, an addiction
psychologist at UCLA in Los Angeles, where he hears one story after another
about meth destroying people’s lives.
“But when you’re in D.C., 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,” he said.
Even within drug treatment circles, there’s a divide. Opioid addiction
advocates are afraid their efforts to gain acceptance for measures like
needle-exchange programs and safe injection sites will be threatened if meth
advocates demand too much.
“The bottom line is, as Americans, we have just so much tolerance to deal
with addiction,” Shoptaw said. “And if the opioid users have taken that
tolerance, then there’s no more.”
So, lawmakers in San Francisco are trying to get a grip on the toll meth is
taking on their city’s public
health system on their own. The mayor recently established a task force to
combat the epidemic.
“It’s something we really have to interrupt,” said Rafael Mandelman, a San
Francisco district supervisor who will co-chair the task force. “Over time,
this does lasting damage to people’s brains. If they do not have an underlying
medical condition at the start, by the end, they will.”
Since 2011, emergency room visits related to meth in San Francisco have
jumped 600% to 1,965 visits in 2016, the last year for which ER data is
available. Admissions to the hospital are up 400% to 193, according to city
public health data. And at San Francisco General Hospital, of 7,000 annual
psychiatric emergency visits last year, 47% were people who were not
necessarily mentally ill — they were high on meth.
“They can look so similar to someone that’s experiencing chronic
schizophrenia,” said Dr. Anton Nigusse Bland, medical director of psychiatric
emergency services at San Francisco General. “It’s almost indistinguishable in
that moment.”
They have methamphetamine-induced psychosis.
“They’re often paranoid, they’re thinking someone might be trying to harm
them,” he said. “Their perceptions are all off.”
If the person is extremely agitated, doctors might administer a sedative or
even an antipsychotic medicine. Otherwise, the treatment is just waiting 12 to
16 hours for the meth to wear off. No more psychosis.
“Their thoughts are more organized, they’re able to maintain adequate
clothing. They’re eating, they’re communicating,” Nigusse Bland said. “The
improvement in the person is rather dramatic because it happens so quickly.”
Trends In Drug Use Come In Waves
The trend in rising stimulant use is nationwide: cocaine on the East Coast,
meth on the West Coast, said Dr. Daniel Ciccarone, a
professor of medicine and substance use researcher at the University of
California-San Francisco.
“It is an epidemic wave that’s coming, that’s already here,” he said. “But
it hasn’t fully reached our public consciousness.”
Drug preferences are generational, Ciccarone said. They change with the
hairstyles and clothing choices, like bell-bottoms or leg warmers. It was
heroin in the 1970s, cocaine and crack in the ’80s. Then opiate pills. Then
methamphetamine. Then heroin. And now meth again.
“The culture creates this notion of let’s go up, let’s not go down,”
Ciccarone said. “New people coming into drug use are saying, ‘Whoa, I don’t
really want to do that. I hear it’s deadly.’”
Kim has been with meth through two waves. When she got into speed in the 1990s, she was hanging out with bikers, going to clubs in San Francisco.
“Now what I see, in any neighborhood, you can find it. It’s not the same as it used to be where it was kind of taboo,” Kim said. “It’s more socially accepted now.”
Dying From Meth
A hint about who uses meth now comes from the data on deaths.
Meth is not as lethal as opioids: 47,600 people died of opioid-related
overdoses in 2017 compared with 10,333 deaths involving meth. But the death
rate for meth has been rising. Meth-related deaths in San Francisco doubled
since 2011, another indication that more people are using meth and that today’s
supply is very potent, said the UCSF’s Ciccarone.
Another hypothesis to explain the growth in meth-related overdoses is that
meth users are aging. Most meth deaths are from a brain hemorrhage or a heart
attack, which would be unusual for a 20-year-old.
“Because your tissue is so healthy at that age,” said Dr. Phillip
Coffin, a physician and the director of substance use research at the San
Francisco Department of Public Health. “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.”
Another explanation for the rising death rate is that meth has become
contaminated. And that affects everyone, old and young. Last year, three young
people in San Francisco died after smoking meth together. It turns out the meth
had fentanyl in it. The synthetic opioid has been causing waves of heroin
overdoses across the country, but now it’s showing up mixed into cocaine and
meth.
Most researchers believe the contamination happens accidentally, when a
dealer uses the same equipment to bag fentanyl and later meth, Ciccarone said.
In April, Kim completed a six-month residential treatment program for women
in San Francisco called the Epiphany Center. She came directly from jail, after
serving time for her housewarming-and-car-theft spree in Sonoma. She said that
in the first 30 days all she could do was try to clear the chaos from her mind.
“You have to get used to sitting with yourself, which is essential for life,
is to get along with your own self,” she said.
Kim, who has four children, is hopeful that this round of treatment will
stick. She is living in transitional housing now, has a job and has been
accepted to a program at the University of California-Berkeley to finish her
college degree.
“I’ve gone through 12 different programs and it’s been for my children, for
my mom, for the courts. I’ve never come to be there for myself,” Kim said. “So
it’s like I’ve come to a place where it has to be for me.”
This story is part of a partnership that includes KQED, NPR and Kaiser Health News.Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
for a lot of these owners, their dogs are their children.
