Is Our Homelessness Crisis Really a Drug Problem?

Over the course of writing this newsletter,I’ve received quite a bit of feedback from you, the readers. I want to thank you for your thoughtful and informative emails, and wanted to take the time today to answer a question I’ve seen pop up quite a bit in my inbox: How much of America’s homelessness crisis can be attributed to a deepening nationwide addiction problem and new forms of meth and fentanyl that destroy or just straight-up end people’s lives? And can we even begin to talk about permanent housing solutions before we address the drug problem?

Many of these queries have been informed by the book, “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth,” by the former Los Angeles Times reporter Sam Quinones. The book details how methamphetamine and fentanyl have emptied out entire cities in the Midwest, destroyed families across the country and pushed thousands of formerly functional human beings into homeless encampments around the country. Several of you have suggested that I read the book or the excerpt that appeared last month in The Atlantic.

What follows isn’t so much a review of Quinones’s book, which I suggest everyone go out and read, but more of a response to the assertion that battling homelessness requires us first to confront rampant drug addiction, and in particular, a supposed spike in severe mental illness among meth addicts.

Quinones’s thesis, roughly speaking, is that a cheap and abundant supply of fentanyl and meth from China and Mexico, respectively, has replaced much of the heroin, cocaine and crack trade in America. This new drug market now feeds a country that has been primed for self-destruction and addiction by processed sugars, social media and the high-volume, high-dosage marketing mentality of Big Pharma companies like Purdue, the now-infamous sellers of OxyContin.

The book’s most alarming claim is that Mexican phenyl–2-propanone meth (P2P), which was once mostly cooked and distributed by biker gangs, causes users to experience psychotic breaks in a way that other forms of meth do not. For decades, meth was made with ephedrine, a stimulant that could be extracted from the decongestant Sudafed. After the Mexican government banned the ingredient in an effort to stop meth production, entrepreneurial drug producers began to manufacture P2P meth with the help of local organic chemists.

“The Least of Us” tracks how P2P meth now floods into the United States in a seemingly endless and cheap supply, leaving a brutal trail of addiction in its wake. What was once an extended process of deterioration now happens almost instantly. This change, Quinones writes, “rarely comes up in city discussions on homelessness, or in newspaper articles about it.” It is, in the words of a judge Quinones interviews, the “elephant in the room” — something that everyone who works with the homeless knows about, but doesn’t want to discuss because it stigmatizes unhoused people as drug users.

Jim Mahoney, a neuropsychologist who has studied the effects of ephedrine meth on the brain, tells Quinones that once P2P started showing up at the West Virginia University addiction clinic he worked at, he began to see a rapid, almost instantaneous breakdown of patients’ mental health. “Now we’re seeing it instantaneously, within hours, in people who just used,” Mahoney told Quinones. “Psychotic symptoms, hallucinations, delusions.”

This is all scary stuff. But I think it’s important to separate the undeniable claim that fentanyl and meth have caused an incredible amount of damage to the country from Quinones’s more speculative take that P2P meth, in particular, has accelerated the homelessness crisis by making people more prone to hoarding, delusions and psychotic behavior than ephedrine meth does.

This distinction is important because stories of “superdrugs” that turn seemingly normal addicts into depraved, violent lunatics have been around for decades. They helped justify the racist crack and cocaine sentencing guidelines that fueled the mass incarceration of Black people. More recently, there have been panics over so-called designer drugs like “Flakka” and “bath salts,” both of which have faded from the public’s consciousness.

These stories spread fear among the public and stigmatize people on the street. It’s one thing to believe, for example, that the people who live in the encampments in your town are heroin or fentanyl addicts on the fast path toward overdose; it’s quite another to believe their minds have been poisoned by a new superdrug that turns them into violent lunatics.

Quinones concedes that the specific effects of P2P meth have not yet been studied. The evidence he produces about its psychosis-inducing effects are anecdotal and make some assumptions about cause and effect. For example, Quinones writes, “As I talked with people across the country, it occurred to me that P2P meth that created delusional, paranoid, erratic people living on the street must have some effect on police shootings.” He talks to police officials and a special prosecutor in Albuquerque who tell him that a combination of cheap meth and bail reform have created a population of people who lose their minds, get arrested and then are released right back onto the street, where they induce themselves straight back into their P2P meth-induced psychosis.

As further proof, Quinones writes: “For years, fatal police shootings numbered about two or three annually in Albuquerque. That figure doubled as the P2P meth took over. Between 2011 and 2020, 60 percent of the people shot to death by Albuquerque police officers — 36 of 60 people — had meth in their bloodstream, up from zero in 2009.” It certainly is notable that more people had meth in their system when they were shot by the police, but what Quinones doesn’t say is whether the people shot by the police before the introduction of P2P meth had other drugs in their system. If meth, as Quinones credibly claims, took over the city’s drug trade, it makes sense that more users would have it in their system, whether they were shot by the police or not. But this is far from proof that the drug itself caused users to lose their minds in a way that made them more prone to getting shot by the cops. More important, a “doubling” of police shootings from “two or three annually” to presumably four to six could be explained by any number of factors, including the statistical randomness that plagues sample sizes this small.

Some of the power of Quinones’s book comes from how it has been positioned as almost illicit information — the hard truth that nobody wants to talk about. But is this actually true? As Ned Resnikoff, the policy manager at the Benioff Homelessness and Housing Initiative at the University of California, San Francisco, pointed out in a recent blog post titled, “How The Atlantic’s Big Piece on Meth and Homelessness Gets It Wrong,” there’s a wealth of studies out there about drug use and homelessness and a host of experts who have devoted their careers to the exact problems that Quinones outlines in his book.

My sense is that what Quinones is really saying is that there are progressive journalists who, out of some misguided fealty to political correctness, are afraid to tell the obvious truth about meth and homelessness. Toward the end of the book, he writes that any solution to the synthetic drug crisis requires people to come together and look out for the people at the bottom of society from whom the book derives its title. “The [drug] crisis is teaching us that we’d be wise to get our news by reading it, and demand more of ourselves as we develop opinions instead of swiping them from memes and ranters,” Quinones writes. “That we’d be equally wise to shed inquisitorial political correctness, cancel culture, and bizarre QAnon conspiracies, and instead fight hard for what brings us together.”

The fear of cancellation may very well be real for many journalists who write about homelessness, but I think others, including myself, would like to see more evidence about the psychosis-inducing effects of P2P meth than Quinones provides. There’s no question that meth, in general, can cause users to experience rapid declines in their mental health. Seeing those people suffering in the streets elicits powerful responses in others, whether compassion, revulsion and fear, or at the very least, a sense that something has gone very wrong. It also makes sense that a flood of cheap supply would allow addicts to use more, which, in turn, would lead to the rapid deterioration that Quinones documents. Perhaps the problem is just that there is more meth overall.

I listened to an audio version of“The Least of Us”on a series of drives along the Northern California coast, including a trip to Santa Cruz, a surf haven filled with towheaded kids biking through quiet streets with surfboards tucked under their arms. Meth has ripped through Santa Cruz over the past 20 years. Everyone from famous big wave surfers to local mothers have become addicted. Like so many other cities on the West Coast, more and more homeless encampments have begun to spring up throughout town

It’s tempting to look for one explanation that draws a straight line from a suitcase of meth entering the city to a deepening homelessness crisis. But it should also be noted that the cost of housing has skyrocketed in Santa Cruz over the past five years. In November 2017, the median sales price for a home was $920,000. Today, that number has increased by nearly 50%, to $1,375,000. The rental market has experienced a similarly steep increase.

I don’t believe that the price of housing or its short supply can explain all of California’s homelessness crisis, but I want to share something Resnikoff notes in his blog post. West Virginia has both the highest rate of drug overdose deaths in the country and one of the lowest rates of homelessness, in large part, because housing is cheap there.

So, my answer to the reader’s questions: Quinones’s concerns over mental health and meth should not be ignored: If you spend a lot of time in or even near a homeless encampment, you’ll find people who seem to be experiencing the psychosis Quinones describes, but you’ll also see families who have been priced out of their apartments or who have had their lives derailed by the pandemic. This doesn’t mean that we should create a hierarchy of the homeless, wherein the unlucky receive help and addicts are put in jail or moved out of town, but it also means that we can’t explain, or for that matter begin to solve, the homelessness crisis if we accept that one superdrug explains it all.

Have feedback? Send a note to [email protected].

Jay Caspian Kang (@jaycaspiankang), a writer for Opinion and The New York Times Magazine, is the author of “The Loneliest Americans.”