Recovery Mobile Clinic Reinvents Community Healthcare

Recovery Mobile Clinic Reinvents Community Healthcare

Jordana Latozas, RN, MSN, ACNP, went to nursing school intending to stay in the ICU forever, but her career trajectory took on a life of its own, and in February 2020, she founded the Recovery Mobile Clinic , Michigan’s first mobile addiction clinic.

The Clarkston, Michigan-based mobile clinic provides care and treatment to patients across seven Michigan counties who are recovering from substance use disorder and do not have access to the reliable transportation needed for regular care.

As National Recovery Month draws to a close, Daily Nurse spoke with Latozas about how she is changing lives as she helps patients battle substance use disorder. What follows is our interview, edited for length and clarity.

-Tell us about yourself and your role in nursing.

I’m an acute care nurse practitioner. My first nurse practitioner job was 2010 at an interventional pain management clinic. Much of the education at that time was different than now. Oxycontin and those kinds of medications were still being provided for you. At the beginning of my career, we started seeing the uptick in the opiate crisis, and we started identifying the addiction. Then, I left the pain clinic and started doing hospice and palliative care. I began because with my pain management background, even in the hospice and palliative side, where there’s pain management, there’s always the conversation of the addiction and the other side of the opiate. I come from a family who struggles with alcoholism. So, I’ve always been interested in that mindset of why I was different and could always put alcohol down and walk away. So that was always interesting to me.

But then, in the suboxone clinic, we started seeing the barriers that healthcare has. Not intentionally, but it’s just there. Even in a county like Oakland County, Michigan, which is relatively affluent, transportation was a huge barrier. We would lose around 30% of our patients to follow-ups due to transportation barriers. So, that would mean a relapse. It would mean running out of their medications and, worst case scenarios, death because they overdose. So I put my head together with my husband, who sells RV’s for a living. And it’s funny how these conversations come about sitting around the kitchen table playing a card game. And jokingly, he said, “Why don’t we just put a clinic in an RV ?” I was like, “Why don’t we put a clinic in an RV!” I started researching the medical models. In 2020, we got the unit and rolled it out with the focus of bringing Vivitrol, namely, the non-addictive naltrexone, into the community places where we’re now at SHAR House in Detroit, and other transitional houses, homeless shelters, trying to ease that transitional burden and inspire nurses like me to do exactly what we’re doing. I’m trying to teach other providers not only about ending the stigma and about Vivitrol and increasing access but also about taking community health into a different area and trying to train other providers about what the mobile model looks like and how they can improve themselves.

-Did you become a nurse to serve your community? Or did your role happen when you fulfilled a need you saw out there?

When I entered nursing school, I intended to stay in the ICU forever. It’s funny how the universe puts things in your path, and your career trajectory takes its own life. It may be different from what you expected it to be initially. Looking back and seeing where the right people came into your path at the right time and the right interactions, a clinic like the Recovery Mobile Clinic can blossom. It’s very empowering. And it’s empowering for other nurses looking at this, saying that they don’t have to do the cookie-cutter jobs of being in the nursing home, the hospital, or the bedside. Nurses do their best in a community setting or when we’re engaging with patients directly, educating, treating, preventing, and helping patients. In our case, we’re trying to transition patients back into a higher level, more traditional level of care and treating them as we’re bridging them over.

-You founded the Recovery Mobile Clinic, Michigan’s first mobile addiction clinic, in 2020. Talk about its impact on Michigan and how you’re helping patients battle substance abuse disorder.

When we started going into cities and municipalities and telling them we would be doing a mobile addiction clinic, the universal response was, oh, my gosh, that’s amazing. You’re so cool. Do it somewhere else. And that’s the stigma talking. I joke that they saw us like the pied piper like I was going to bring a problem with me, and they didn’t recognize the issue they already had. Then we entered COVID. So when we started doing COVID screens, it was to keep people in the shelters. We had to get people into the treatment centers and keep them in a shelter. So we started doing COVID tests to keep people in housing, but then it branched into the vaccines. The municipalities are seeing us as a solution now because the mobile clinic could bring those vaccinations into most areas that nobody wanted to go into. Nobody wanted to go into the homeless shelters and test everybody. So now we are a solution to their problem. They realized I wasn’t the pied piper. Then the barriers came down, and we went into seven counties within the first year and a half. It went fast. Since COVID has come down, we’re seeing more of this transition back to what we intended to do. The numbers of patients being seen are skewed slightly because of the COVID overlap, but for the first time, 95% of our cases are not COVID-related. I’ve tried to treat over 5,000 patients this year, so we’re growing quickly because we now have three full-time units. So we’ve got a full load of nurse practitioners and paramedics. A whole team of staff that are out there helping patients.

-What services, besides COVID screenings and vaccination, does the Recovery Mobile Clinic provide Michigan residents?

We offer a lot of primary care services and medication refills. You’d be surprised how many people come out of jail or an inpatient facility and can’t get into their primary care doctor or see a psychiatrist for a month, and they will only fill their meds. What are they supposed to do? They need meds for psych, diabetes, or hypertension, and nobody will fill them until they have an appointment in a month. There are other services we offer, but when we drive around, and it says Recovery Mobile Clinic in giant letters, sometimes it gives people a little bit of extra dignity or a little excuse that I’m just going in there for my COVID tests. I’m just going in there for my flu shot. There are so many other things that we’re doing. So it’s easy for people to save face. I hate to say the stigma is alive and well, but we must know that that is there.


Recovery Mobile Clinic

-How can we help end the stigma associated with substance abuse? 

I keep bringing up ending the stigma all the time. And it’s super important. And there are a lot of ways to end the stigma. One of the best ways to stop the stigma is to tell their story. Tell your story about your addiction, family experience, or someone you’ve worked with. People have to understand that an addiction isn’t rare. It’s not unique. It’s very common. And the more that we can bring it out of the closet and start talking about the realities of addiction in our community, families, and personal lives. The more people willing to talk about it, the more we will get help. Right now, there is a fear of asking for help. It’s mostly mental illness, where people are more scared of admitting the problem than actually the results of the illness, which could be death. We have to turn that around. And the best way to do that is to get people talking about it and opening up so those communications can happen. So, I would like everybody to focus on telling your story, especially in recovery. Be okay with talking about it with others because your story can and will save somebody else’s life, even if you don’t feel like it.

-September is National Recovery Month. Talk about how recovery is possible for everyone.

Recovery is possible for everyone who wants it. And that’s important to understand. You can’t force a behavioral change on somebody until they’re ready. We can educate and teach, we can provide tools, we can give them support, we can give them the ammunition so they’re prepared to make that real serious commitment. We can’t force someone to stay sober as much as we know that their life would improve if they could, but they have to recognize that it can be done and that they’re worth it. Then, acknowledging that the struggle will be worth the long-term goals. We see that a lot with our patients, unfortunately. Addiction is a symptom of the main problem, whether mental illness, depression, anxiety, abuse cases, or PTS. We’re always going to see that overlap. But we’re treating people who are lost, hopeless, lost sense of purpose that you’ve given up on. They’re searching for anything meaningful outside of the addiction. And when you bring them in, and they’ve been told they’re not worth it, shunted aside, or not taken seriously, you know their concerns aren’t recognized, so they don’t think anybody else cares. So why should they? I have one good example of this, and he’s essentially doing well and has been sober for over six months. So, we asked a patient to do a testimonial. Would you write something for us to put on our website? So this is a public website; he knows the world will see this and described himself as a throwaway person. That was his description of himself. We would never describe ourselves as a throwaway person. But that’s how he saw himself even six years sober. And he was having a hard time seeing value in the mirror. And that’s what we’re fighting. That’s the battle that we’re having.

-The use of fentanyl is a growing crisis. Can you talk about how NARCAN approval is a game-changer?

NARCAN saves lives. So anytime we have a medication that’s available that you can save a life, whether that’s your own, or your child’s, your husband, your wife, your parents, your grandma, your cousin, your best friend, anytime we have a way for people to prevent death for someone they love, that’s always a good thing. We think that with aspirin for heart attacks or EpiPens. Being able to have that awareness and that implementation is huge. So the other part of it, too, though, is it’s encouraging people to get educated. If it’s over the counter and I can get it, I need to know how and where to use it. And that’s a critical part of NARCAN’s stigma. So, getting people to be comfortable with having that medication around and utilizing it is an important step towards ending the stigma and getting people who need help willing to go and get the help. Having NARCAN over the counter, from the stigma standpoint, is a good thing. You don’t have to ask the provider for NARCAN or get a prescription. Then, you don’t have an uncomfortable conversation with the pharmacist behind the counter. So again, it’s just decreasing those barriers and increasing that accessibility that is extremely important because it will save lives. And we’re not just talking about fentanyl. We have to remember that children will get into pill bottles. Elderly parents or grandparents may forget how many pills they took that day, or they all look like little white pills, and you mix up the bottles. So, accidental overdoses happen not because of intention but can still be reversed in the same way. 

The other thing that we have to offer, and I know this is a little bit more controversial, but with the legalization of marijuana, we have started seeing an uptick in contaminated marijuana products. Fentanyl is finding its way into marijuana products. So, the young population may not intentionally try to take fentanyl or another type of opiate. They don’t know what’s in it. They don’t know what the potential for having an inadvertent opiate substance inside a marijuana product is, and it can still kill you whether you intend to take it or not. And so you have to have that population aware of how to use it, how to save their friend’s lives, you know, if that were to occur. The part that is super important that people need to know is that if you use NARCAN, you have to get that person into a higher level of care. NARCAN is designed to work extremely fast. We want it to absorb into that mucous membrane, which will be the effect so that person can start breathing, but it also wears off quickly. It doesn’t hang around for an extended period, but the medication they took will hang around for a while. We must get them into a hospital because a patient will return to the overdose. So if you leave them, they’ll overdose again. A lot of people don’t want to call 911. They’re scared that they’re going to get arrested or they’re going to get in trouble. They’re not going to arrest you for saving someone’s life. They may give you a pamphlet, lecture you, or ask if you want to talk to somebody. They’re just going to take the person that needs the attention and save their life. That’s it. That’s all they’re going to do.

-How can schools keep students safe, and what do parents need to know about fentanyl?

If your child is unresponsive or not breathing, you always want to use NARCAN first. Keeping it in your medicine cabinet, car, or purse is easy without going over the counter. Just keep it around everywhere you are because this can happen very fast. If we have an unresponsive person, even if we don’t know what it is. It could be a heart attack, someone choking, or anything else. It’s not going to hurt them. With opiates, they’ll get drowsy and stumble. They may not be breathing; if they’re breathing, it might be agonal breathing. It sounds like strong snoring, which means they’re not getting oxygen. So you want to ensure you’re giving the NARCAN, initiating CPR, and calling 911. 

Education with kids is super important. Teenagers and kids want to talk to their moms and dads about drugs. But you have to have difficult conversations about the fact that marijuana is legal, but people make stuff, and it’s not always what you think it might be, so we have to pay attention. Kids don’t want to hear that their friends will give them something bad or that their friends don’t have the best interest in heart for them. Sometimes, you have to have those kinds of conversations in schools. I firmly believe schools should have NARCAN available. And again, not in a way where kids must go into the office and talk with a teacher or somebody about what’s happening. Because you have to remember it might not be the kid having the problem. They’re living with parents or with older brothers and sisters or grandparents or aunts or uncles. If you have NARCAN available, it should be where the fire extinguisher and the first aid kit are so they see where those rescue things are. And if a NARCAN walks off, then replace it. It’s good to have around if they need that. I always say increase the accessibility; hopefully, it’ll save somebody’s life.

-Talk about other healthcare challenges and the growing role of nurse practitioners in delivering care to patients in underserved communities, which you’re doing with your mobile clinic.

There are always challenges in healthcare, and the unfortunate reality is that we need more primary care doctors. Medical schools are turning out different numbers than they used to, and nurse practitioners and PAs are one of the top-growing jobs out there right now. And we’re different. We’re not the same as doctors. And that’s good, especially in nursing, where nurses are more geared towards getting out into the community and engaging with patients. Starting with education, doing exactly what we’re doing, and pulling them back in so they interact. What we’re trying to do with The Recovery Mobile Clinic is reinvent the community care way of expecting people to come into a brick-and-mortar rather than taking the services out to the patient and meeting them where they’re at. Because when you have somebody who may be struggling with homelessness or mental illness, going into a big, sterile facility can be intimidating. Sometimes, when we’re in the facilities or out of the shelters, it takes some patients two or three times to start trusting us, building rapport, and understanding what we’re there for. And so they’re ready to open up. You have to have that accessibility for them and the right culture and communication to start breaking down those barriers. So, the Recovery Mobile Clinic focuses on education with therapeutic teaching, making people comfortable talking to others about their addiction problems and realizing that these people are no different from any other patient you’ve treated. It’s a disease stage, just like anything else is. And we must start teaching everybody the right questions to ask and how to engage. And it’s a very learnable skill and very rewarding because when it does work, it’s amazing.

NIH: Teen Marijuana, Alcohol Use Changed Little During Last Summer’s Lockdown

NIH: Teen Marijuana, Alcohol Use Changed Little During Last Summer’s Lockdown

Adolescent marijuana use and binge drinking did not significantly change during the COVID-19 pandemic, despite record decreases in the substances’ perceived availability, according to a survey of 12th graders in the United States. The study’s findings, which appeared online on June 24, 2021, in Drug and Alcohol Dependence, challenge the idea that reducing adolescent use of drugs can be achieved solely by limiting their supply. The work was led by researchers at the University of Michigan, Ann Arbor , and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH).

In contrast to consistent rates of marijuana and alcohol use, nicotine vaping in high school seniors declined during the pandemic, along with declines in perceived availability of vaping devices at this time. The legal purchase age is 21 for nicotine products and alcohol in all states, and for cannabis in states that have legalized nonmedical cannabis use.

“Last year brought dramatic changes to adolescents’ lives, as many teens remained home with parents and other family members full time,” said NIDA Director Nora D. Volkow, M.D. It is striking that despite this monumental shift and teens’ perceived decreases in availability of marijuana and alcohol, usage rates held steady for these substances. This indicates that teens were able to obtain them despite barriers caused by the pandemic and despite not being of age to legally purchase them.”

The data for the study came from the annual Monitoring the Future (MTF) survey of substance use behaviors and related attitudes among adolescents in the United States. In a typical year, MTF surveys thousands of middle and high school students at more than a hundred schools across the country in the spring. MTF has been watching substance use trends for 46 years.

To assess the impact of the pandemic, the investigators issued a survey between mid-July and mid-August 2020, which 12th graders could complete outside of school. This summer survey followed up on investigators’ standard MTF spring survey, which gathered responses between mid-February and mid-March 2020 before stopping prematurely due to school closures caused by COVID-19. Of the 3,770 12th graders who responded in the spring, 582 submitted a follow-up survey in the summer. All data and statistical analyses used in the study were weighted to be nationally representative.

Analysis of the responses revealed that students perceived a sharp decrease in availability of marijuana and alcohol in the months after the onset of the pandemic. For marijuana, the fraction of students who reported “fairly” or “very” easy access dropped by 17 percentage points, from 76% in the spring before the pandemic to 59% during the pandemic, and for alcohol it dropped by 24 percentage points, from 86% to 62%. These were the largest year-to-year decreases in perceived availability of marijuana and alcohol ever recorded since the survey began in 1975. Prior to 2020, the largest recorded decreases were only two percentage points for marijuana, and one percentage point for alcohol. Between the spring and summer of 2020, there was also a sharp decrease in respondents who said they could “fairly” or “very” easily obtain a vaping device, going from 73% before the pandemic to 63% during the pandemic.

Despite the reported declines in marijuana and alcohol availability, the levels of use of these substances did not change significantly. Before the pandemic, 23% of students said they had used marijuana in the past 30 days, compared to 20% during the pandemic. For alcohol, 17% reported binge drinking in the past two weeks pre-pandemic, compared to 13% during the pandemic. However, there was a moderate and significant decrease in nicotine vaping – before the pandemic, 24% of respondents said they had vaped nicotine in the past 30 days, compared to 17% during the pandemic.

The study authors cite the wide availability of alcohol and marijuana, even during the pandemic, as a factor in the continued use of these substances. While pandemic-related restrictions limited social interactions, and even with record-breaking decreases in perceived availability among participants, most students said they still had access to marijuana and alcohol. In addition, the authors suggest that when the substances became less available, the students may have intensified their efforts to obtain them.

While a dip in the perceived supply of vaping devices may have contributed to the decline in nicotine vaping that occurred during the pandemic, there may have been other factors as well. The federal minimum age for tobacco product purchases, including vaping devices and liquids, rose from 18 to 21 years and went into effect in early 2020. News reports on vaping-induced lung injuries may have also had a chilling effect on usage.

“These findings suggest that reducing adolescent substance use through attempts to restrict supply alone would be a difficult undertaking,” said Richard A. Miech, Ph.D., lead author of the paper and team lead of the Monitoring the Future study at the University of Michigan. “The best strategy is likely to be one that combines approaches to limit the supply of these substances with efforts to decrease demand, through educational and public health campaigns.”

Monitoring the Future continues to survey respondents as they progress through adulthood, providing the researchers with the opportunity to explore the impact of the pandemic and the social changes it brought about on future substance use trends.

Data from PA: Opioid Overdoses Escalated During Covid Lockdown

Data from PA: Opioid Overdoses Escalated During Covid Lockdown

Since the first diagnosed case of COVID-19 in the United States on Jan. 20, 2020, news about infection rates, deaths and pandemic-driven economic hardships has been part of our daily lives. 

But there is a knowledge gap in how COVID-19 has affected a public health crisis that existed before the pandemic: the opioid epidemic. Prior to 2020, an average of 128 Americans died every day from an opioid overdose. That trend accelerated during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.

Originally published in The Conversation - USE THIS LOGO

We are a team of health and environment geography researchers. When social distancing began in March 2020, addiction treatment experts were concerned that shutdowns might result in a spike in opioid overdose and deaths. In our latest research in the Journal of Drug Issues, we take a closer look at these trends by examining opioid overdoses in Pennsylvania prior to and following the statewide stay-at-home order.

Our findings suggest that this public health response to COVID-19 has had unintended consequences for opioid use and misuse.

History of the Opioid Epidemic

Opioid misuse has been a major U.S. health threat for over two decades, largely affecting rural areas and white populations. However, a recent shift in the drugs involved, from prescription opioids to illegally manufactured drugs such as fentanyl, has resulted in an expansion of the epidemic in urban areas and among other racial and ethnic groups

From 1999 to 2013, increasing death rates from drug abuse, primarily for those from 45 to 54 years of age, contributed to the first decline in life expectancy for white non-Hispanic Americans in decades.

There was a modest national decline in overdose mortality from prescription opioids from 2017 to 2019, but the COVID-19 pandemic has upended many of these advances. As one of our public health partners explained to us, “We were making progress until COVID-19 hit.” 

We believe this presents an urgent need for research on the relationships between COVID-19 policy responses and patterns of opioid use and misuse.

Opioid Use Increased During the Pandemic

Pennsylvania has been among the states hardest hit by the opioid epidemic. It had one of the highest rates of death due to drug overdose in 2018, with 65%, a total of 2,866 fatalities, involving opioids.

The state’s stay-at-home order, implemented on April 1, 2020, mandated that residents stay within their homes whenever possible, practice social distancing and wear masks when outside the home. All schools shifted to remote learning, and most businesses were required to operate remotely or close. Only essential services were allowed to continue operating in person.

In the following months, the public’s overall cooperation with these mandates contributed to measurable declines in coronavirus infection rates. To learn how these mandates also affected people’s use of opioids, we assessed data from the Pennsylvania Overdose Information Network for changes in monthly incidents of opioid-related overdose before and after April 1, 2020. We also examined the change by gender, age, race, drug class and doses of naloxone administered. (Naloxone is a drug widely used to reverse the effects of overdose.)

Our analysis of both fatal and nonfatal cases of opioid-related overdose from January 2019 through July 2020 revealed statistically significant increases in overdose incidents for both men and women, among whites and Blacks, and across several age groups, most notably the 30-39 and 40-49 groups, following April 1. This means there was an acceleration of overdoses within some of the populations most affected by opioids prior to the COVID-19 pandemic. But there were also uneven increases among other groups, such as Black people.

We found statistically significant increases in overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids and carfentanil. This is consistent with previous research on the main opioid classes contributing to increases in drug overdose and death. The results also affirm that heroin and synthetic opioids such as fentanyl are now the major threats in the epidemic. 

When a Pandemic and an Epidemic Collide

While we found significant change in opioid overdoses during the COVID-19 pandemic, the findings say less about some of the driving factors. To better understand these, we have been interviewing public health providers since December 2020. 

Among the important factors they highlight as contributing to increased opioid use are pandemic-driven economic hardship, social isolation and the disruption of in-person treatment and support services.

From March to April 2020, unemployment rates in Pennsylvania shot up from 5% to approximately 16%, resulting in a peak of more than 725,000 unemployment claims filed in April. As workplace shutdowns made it harder to pay for housing, food and other needs, and the opportunities for in-person support disappeared, some people turned to drugs, including opioids.

People in the early stages of treatment or recovery from opioid addiction may be particularly vulnerable to relapse, suggested one of our public health partners. “They might be working in industries that are closed down, so they have financial problems … [and] they have their addiction issues on top of that, and now they can’t like go to meetings, and they can’t make those connections.” (Under our clearance with Penn State for doing research with human subjects, our public health informants are kept anonymous.)

An addiction treatment counselor told us that especially for those with past or present opioid use problems, or histories of mental health issues, “It’s not a good thing to be alone in your own thoughts. And so, once everybody was kind of locked down … the depression and anxiety hit.”

Another counselor also pointed to depression, anxiety and isolation as driving increased opioid misuse. The pandemic “just spun everything out of control,” they said. “Overdoses up, everything up, everything.”

One question is whether states like Pennsylvania will continue to support telehealth in the future. While the transition from in-person to telehealth services has increased access to treatmentfor some, it has raised challenges for populations like the rural and elderly. As one provider explained, “it’s really hard for that [rural] population out there” to utilize telehealth services due to limited internet and broadband connection. In other words, flexible modes of addiction treatment might work for some but not others.

The goal of our research is not to criticize efforts to mitigate the spread of COVID-19. Without the mandatory stay-at-home order in Pennsylvania, both infection and death rates would have been worse. However, our research shows that such measures have had unintended consequences for those struggling with addiction and emphasizes the importance of taking a holistic approach to public health as policymakers work to confront both COVID-19 and the addiction crisis in America.

Meth Vs. Opioids: Can the US Focus on Two Drug Epidemics at Once?

Meth Vs. Opioids: Can the US Focus on Two Drug Epidemics at Once?

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.

Relapses Are Common

Over her two decades of meth use, Kim has been through drug treatment more than a dozen times. Relapse is part of recovery, and among meth users, 60% will start using again within a year of finishing treatment. Unlike opioids, there are no medication treatments for meth addiction, which makes it particularly hard to treat.

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.

HRSA Aims to Tackle Opioid Epidemic in New Mexico with $1.35M Grant to New Mexico State University School of Nursing

HRSA Aims to Tackle Opioid Epidemic in New Mexico with $1.35M Grant to New Mexico State University School of Nursing

The US Health Resources and Services Administration (HRSA) has announced a three-year, $1.35 million grant will be awarded to the New Mexico State University (NMSU) School of Nursing to fund a project to expand the number of professionals in New Mexico who are trained in interprofessional settings to prevent and treat opioid-use and substance abuse disorders in community-based practices.

This project is a collaboration between the NMSU College of Health and Social Services and the College of Education. It will support interprofessional faculty and community health provider training in the prevention, treatment, and recovery of opioid and substance abuse disorders, part of HRSA’s Opioid Workforce Education Program.

Shelly Noe, an assistant professor in the School of Nursing and director of the Psychiatric/Mental Health Nurse Practitioner program, will serve as the project director. She tells newscenter.nmsu.edu , “NMSU will leverage its current academic-practice partnerships to develop planned clinical training experiences in the delivery of OUD and SUD prevention, treatment and recovery services.”

NMSU faculty from three departments will participate in the project through 2021 – the Psychiatric/Mental Health Nurse Practitioner program, the PhD Counseling Psychology program, and the Master of Social Work program.

According to the New Mexico Department of Health, New Mexico reported a rate of 24.6 deaths per 100,000 people due to drug overdose in 2017, higher than the overall US rate of 21.7. The outcomes of this project will help achieve a long-term goal to transform integrated behavioral health teams to effectively prevent and treat opioid and substance abuse disorders in New Mexico’s medically underserved communities.

To learn more about the $1.35 million HRSA-funded grant awarded to the NMSU School of Nursing to help prevent and treat opioid and substance abuse disorders in New Mexico, visit here.