Drugs, Homelessness & a Growing Public Health Disaster
by PAULA D. GORDON
By many criteria, 21st-century California is both the poorest and the richest state in the union. Almost a quarter of the population lives below the poverty line. Another fifth is categorized as near the poverty level – facts not true during the latter 20th century. A third of the nation’s welfare recipients now live in California. The state has the highest homeless population in the nation (135,000). About 22 percent of the nation’s total homeless population reside in the state – whose economy is the largest in the U.S., fueling the greatest numbers of American billionaires and high-income zip codes…..
If someone predicted half a century ago that a Los Angeles police station or indeed L.A. City Hall would be in danger of periodic, flea-borne infectious typhus outbreaks, he would have been considered unhinged. After all, the city that gave us the modern freeway system is not supposed to resemble Justinian’s sixth-century Constantinople. Yet typhus, along with outbreaks of infectious hepatitis A, are in the news on California streets. The sidewalks of the state’s major cities are homes to piles of used needles, feces, and refuse. Hygienists warn that permissive municipal governments are setting the stage – through spiking populations of history’s banes of fleas, lice, and rats – for possible dark-age outbreaks of plague or worse.
— Victor Davis Hanson, “America’s First Third-World State,” National Review, June 2019
Conditions of squalor, which may be found in a refugee settlement or on the streets of a third world country, appear to be rapidly increasing in certain places in the United States over the past several years. This phenomenon is evident not only in a growing number of cities in California – including San Francisco, Oakland, San Jose, Los Angeles, and San Diego – but in cities in Oregon, Washington State, Colorado, and elsewhere. During the past several years, similar signs of deteriorating conditions have also become increasingly evident in New York City and Washington, D.C.
The more people attracted to these locales, the more overwhelmed law enforcement and all social service providers have become. As a result, the attractions for some to these locales may include being able to obtain, use, and possess drugs, including marijuana, without risking arrest or interference. This raises many questions for preparedness professionals, which include:
- What might some of the reasons be for these increases in the homeless population, especially in these locales?
- Why would those who are homeless gravitate to some areas rather than others?
- Why would there be a notable increase in certain places in the last few years?
- Might many, if not most of the people gravitating to these locations do so for some of the same common reasons?
- Might they be attracted to locations where they are able to get by without the undue interference of law enforcement and other government authorities?
- Might many of the now homeless who gravitated to these locales have done so, at least in part, because law enforcement no longer enforces what in the past would have been treated as infractions of the law?
Surely not all homeless persons use drugs and not all are mentally ill. Living in squalor, however, can certainly take a toll. Homeless persons can find themselves in a downward spiral. If they had not used mood-altering and psychoactive substances before, they might well begin to use them after they enter the ranks of the homeless. Users or would-be users living in jurisdictions where marijuana use was illegal and where marijuana and other drug laws were previously strictly enforced, might well be attracted to locales where marijuana possession and use are legal and readily obtainable or where such drug use is no longer strictly enforced.
Lessons Learned From Colorado & Seattle
Users and would-be users may also have been attracted to locations where it is possible to use drugs of all kinds without fear of penalty or jail. This appears to have been the case in Colorado. The increase in the number of homeless and in the number of encampments of homeless have been noticeable since the legalization of marijuana in Colorado in 2014. So too has been the increase in polydrug use in general and in opioid use and addiction.
In October 2016, Dr. Karen Randall, an emergency room physician in Pueblo, Colorado, tells a heart-rending story of what has happened in Pueblo since the legalization of marijuana. There has been an influx of homeless, accompanied by widespread abuse by many of these non-residents of the social service system. Some of the most “enterprising” of these homeless individuals have admitted that they have advertised on Craigslist in order to find a local resident whom they can pay in order to use that resident’s address. Thereby, they establish a “faux” residency and become eligible for benefits and social services that they would not otherwise be eligible to receive.
There was an influx of people coming from out of state to Colorado beginning at the time that marijuana was legalized in that state. This pattern may be repeated elsewhere where drug laws and their enforcement has radically changed or ceased. Understanding what happened in Pueblo may well help explain similar kinds of problems involving the growing number of homeless in California and elsewhere.
Perhaps drug use, not just of marijuana, but of all psychoactive drugs and opiates has increased at least in part to the changing laws concerning marijuana use. Christopher Rufo of the Discovery Institute Center on Wealth and Poverty authored a report in December 2019, entitled “Compassion With Results: Action Plan on Homelessness for American Cities,” which addresses the impact of changing laws. He states that “many cities have pursued a policy of decriminalization that has led to a significant increase in public disorder.” In that report, Rufo also quotes a former Seattle crime adviser Scott Lindsey who reflects as follows on the connection between “street disorder” and drugs in Seattle:
The increase in street disorder is largely a function of the fact that [hardcore drug] possession has been largely legalized in the city over the past several years. The unintended consequence of that social policy effort has been to make Seattle a much more attractive place to buy and sell hardcore drugs.
A reduced effort on the part of law enforcement or laxity with respect to law enforcement can be found in the disinclination of law enforcement to enforce laws on the books regarding everything from panhandling, to sleeping on the sidewalk or in a public park, to pitching a tent on a sidewalk, to urinating and defecating in a public place. Crimes – including home and car break-ins, and thefts – are on the increase, contributing greatly to the degradation of the quality of life in the community.
Legalized and “legitimized” marijuana use and the poly drug use that has been associated with it are major contributing factors in the growth of conditions similar to refugee camps, massive homelessness, mental illness, violence, crime, and a myriad of health and safety problems that are now found in once beautiful cities and areas of the country. Emergency services are being called on increasingly to address this spreading combined “epidemic” of drug use, addiction, and homelessness. As a result, law enforcement, medical services, and social services are becoming overwhelmed as well.
Randall is one of a group of several hundred Colorado physicians who have been on the “front lines” of what has happened since marijuana was legalized in Colorado. Many of these physicians have told their stories in what is known as the Code Red series of video presentations. In one of the presentations, Randall provides a vivid picture of the effect that the legalization of marijuana has had in Colorado and on Pueblo in particular. She describes the impact on the growth of refugee camp-like settlements of homeless. She notes that large numbers of people began to move into the Pueblo area from other states since 2014, many drawn by the fact that marijuana use had become legal and could be legally obtained. Some were drawn by the possibility of employment opportunities in the industry.
Randall tells of the increasing numbers of patients in the emergency room suffering from psychotic breaks, some of whom have needed to be restrained owing to their violent behavior. She has also discussed a condition known as “cannabis hyperemesis syndrome” (CHS), which she has treated numerous times, a condition increasingly suffered by chronic marijuana users. CHS has the nickname of “scromiting” because the condition typically involves severe vomiting that is so painful that those experiencing the pain scream uncontrollably. Those developing this condition can become seriously dehydrated. In a few cases, CHS has resulted in death.
A successful treatment of CHS can be a very curious one; one such treatment involves the closing down of the pain receptors by having the individual take extended long hot showers. The individual must also stop using marijuana for the condition to improve. This can be difficult to accomplish since some users reject the possibility that their use of marijuana is responsible for their condition. Indeed, thousands of dollars may be spent on medical workups when the person suffering from CHS rejects the diagnosis or when those treating the individual have not recognized or identified the cause of the symptoms.
Many marijuana users have long ago decided that marijuana is a “relatively” harmless drug, reasoning that, “after all, it is a natural substance.” Jimson weed, hemlock, ricin, and belladonna are also natural substances, but would never be taken for recreational purposes. Many users of marijuana are not inclined to believe that marijuana use could trigger health problems such as scromiting. The vaping of Tetrahydrocannabinol (THC) can have the most serious health consequences, with many hundreds being hospitalized and a growing number of deaths occurring.
Marijuana users can readily purchase marijuana from other sources than the “legal” state-licensed dispensaries. To save money, users may begin to purchase their drugs from the black market. It should be noted that the activities of drug cartels and the black market have exploded in jurisdictions – including Colorado, California, Oregon, and the State of Washington – that all have “legal” licensed dispensaries. A reason that drug use of all kinds has exploded is that black marketers can easily undercut the prices of “legitimate” dispensaries. In her 2014 article for the AP entitled “Legal pot in Colorado hasn’t stopped black market,” reporter Sadie Gurman describes an account of this phenomena. There have been a number of documentaries on the topic as well.
As users become customers of black marketers, they can be and are too often introduced to a variety of other drugs, including methamphetamine, cocaine, and opioids. Indeed, black marketers may purposely sell heroin at lower prices than marijuana, this way ensuring that their client becomes a chronic user. This has increased substantially not only the number of marijuana addicts, but the number of polydrug users, and opioid addicts as well.
Call to Action
The nation’s drug crisis is having demonstrable ill-effects on the health and safety in many areas in the United States. These patterns have become increasingly apparent in jurisdictions where:
- Marijuana use has been legalized;
- Drug use of marijuana and other drugs is no longer being treated as an illegal activity; and
- Users are not remanded to drug court-type programs or other programs that provide education, counselling, treatment, or rehabilitation services to enable them to cease their drug-taking behavior and their reliance on drugs.
The “cure,” if there can be one, may well require a “full court press” on the part of all relevant institutions. Efforts to turn around current trends will require that all in the community and those at all levels of government in roles of responsibility for the health, safety, and welfare of citizens do their jobs. Indeed, a multi-disciplinary approach involving a multi-pronged strategy is needed that is designed to make inroads into the drug use and addiction problems of the homeless person and to help those involved in drug-taking behavior to reorient their lives and become fully functioning human beings.
What has happened in parts of Pueblo, Colorado, can be seen as a microcosm of what is happening in many cities in the nation. The result has been the establishment of refugee-camp-type situations, where illnesses are rampant and squalor is widespread. Conditions can be likened to a war zone or the aftermath of a major natural calamity that has resulted in widespread devastation. They can be likened, as Victor Davis Hanson has pointed out, to life in third world countries.
The first step in successfully addressing a problem is to identify the factors fueling the problem. Emergency management and emergency services are on the front lines of protecting public health and safety and observe these factors every day. To stop this “epidemic,” it is critical for those on the front lines to work with decision-makers and inform them concerning the nature and scope of the crisis, with emphasis on the following:
- The gravity of this public health and safety disaster is threatening to spread further in the nation.
- The recent rapid threat negatively affects the quality of life and public safety in metropolitan areas.
- Practices that are being used by those illicitly growing marijuana contribute measurably to the degradation of the environment. “Legal” as well as illegal marijuana “grows” are having a devastating impact on the nation’s natural resources, including depletion of already scarce water and pollution of natural resources and destruction of wildlife.
- Connections exist between the widening use of drugs, laxity regarding addressing the problem of drugs, and diminishing attention to enforce the most basic laws that help sustain a first world quality of life.
It may be up to those in emergency management and emergency services to help policymakers understand the necessity of implementing a full-court press approach to addressing the growing crisis. In this way, significant steps may be taken that result in safeguarding the health and safety of the public and getting people off the streets and on their feet again.