From left: Donte Franklin, Montesha Williams, and Alexis Milligan work at Highland Hospital's Bridge Clinic, which treats substance use disorders, including opioid and meth addictions. Credit: Amir Aziz

This is the first article in a three-part series examining the realities of methamphetamine use in Oakland and efforts to address this growing public health crisis.

In an older wing of Oakland’s historic Wilma Chan Highland Hospital Campus, a patient waits on an examination table. He is there to receive a monthly dose of Sublocade, the brand name for the injectable form of buprenorphine, a medicine that helps people suffering from opioid addiction curb cravings and avoid withdrawal symptoms while trying to get clean. 

He twitches only slightly when Dr. Monish Ullal, a physician at the Alameda Health System’s innovative Bridge Clinic for substance use disorder, inserts the needle into his abdomen. He prefers to come to the clinic on Wednesdays, when Ullal is on the floor, because of his gentle touch. 

“It really helps with the cravings,” says the patient, who has been clean for 10 months. “Except for some,” he clarifies. “Except for meth.”

Methamphetamine, a highly addictive stimulant drug, is on the rise in Oakland. In both its quantity on the streets and the number of people who die from using it, meth comes second only to opioids (including fentanyl and heroin) in Alameda County. But unlike fentanyl and other opioids, which have buprenorphine as a medicated treatment option, there isn’t yet a drug on the market that can treat patients’ meth addictions. 

Over the past five years, meth has become more available, potent, and cheap than ever before. As a result, the number of people who use meth has soared, making the drug a serious public health problem.

Dr. Erik Anderson, an emergency medicine physician at Oakland’s Highland Hospital, described fentanyl and meth as by far the most harmful illicit drugs impacting Oakland today. Originally from the Midwest, Anderson specializes in addiction medicine. He said there is an unmet need for substance use disorder treatment across the country. 

During his years at Highland, Anderson has seen meth become more prevalent and dangerous in ways that mirror the trajectory of the opioid crisis.

“People have been using meth for a while, including in the East Bay, but it has become even more common,” he said, painting a picture of how Oakland’s drug scene has changed over time. “It’s not an opioid, but it has seen increasing mortality, hospital visits, and emergency department visits associated with its use.” 

Because of the drug’s low cost and stimulating effects, meth usage is especially prevalent in Oakland’s unhoused population. Charles Hawthorne, who has worked in harm reduction for seven years as an educator and program manager, runs training sessions for addiction professionals that emphasize how substances, including meth, have utility for the people that use them. 

“Meth helps people stay awake, navigate pain, have less feelings of hunger, and stay safe on the streets,” said Hawthorne, who works as an equity and harm reduction project manager at CA Bridge, a state-wide addiction treatment and hospital training program based in Oakland that grew out of the work done at Highland. For people experiencing homelessness, the stimulating effects of meth can help them survive the challenging realities of living unhoused. “If you’re a person who is living on the streets, every time you fall asleep, you risk being robbed, assaulted, or killed,” said Hawthorne. 

But today’s meth is more dangerous than it was a decade ago. Across the state, the supply is laced with fentanyl, causing deadly overdoses. Even unadulterated meth is more potent than ever and can cause behavioral health issues or psychosis at an astonishing rate.

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Dr. Monish Ullal helps treat patients at Highland Hospital’s BRIDGE Clinic. Credit: Amir Aziz

Despite this reality, the meth crisis is being given far less attention in the media than the harms caused by fentanyl. And experts say that the public health system is in many ways playing catchup to the problem. The Alameda County Public Health Department has made strides in its initiatives to reduce the harm caused by opioids, but its website is virtually devoid of materials on meth. A basic search for “methamphetamine” yields a single article about a fentanyl overdose from January 2020. But the department does acknowledge there’s an increase in meth’s prevalence in the county in recent years.

“Currently a significant percentage of individuals who meet criteria for methamphetamine-use disorder experience methamphetamine-associated psychosis, anxiety and mood disorders,” said Neetu Balram, a spokesperson for the public health department. “[M]ethamphetamine use and psychiatric symptoms precipitated by methamphetamine use are major drivers of psychiatric emergency services and psychiatric hospitalizations in Alameda County.”

The medical professionals and addiction experts we spoke with are in universal agreement: meth is a growing issue in Oakland. They say that its rise is one piece in a larger puzzle of socio-economic and health crises facing the community. 

“One thing that we hear all the time in California and nationally is ‘we don’t have an opioid problem, we have a methamphetamine problem.’ This is a constant conversation,” said Sarah Windels, a founding member of CA Bridge.

“It’s just wildly common,” said Anderson of meth’s wide reach in Alameda County.

To better understand the growing meth crisis in Oakland and Alameda County, The Oaklandside spent time talking with public health experts, social workers, and law enforcement officials who treat addiction, assist communities disproportionately harmed by the influx of dangerous drugs, and gather data on the scale of the problem.

In part one of this three-part series, we lay out the fundamentals of meth’s impact in Oakland. 

In the coming weeks, we will look at the frontlines of the crisis from the perspective of health care providers and outreach workers, who see firsthand how methamphetamine use is linked to social issues such as homelessness and racial inequity, and we will discuss how public health professionals are searching for a solution, which might involve important new research being done right here in Oakland.

“It just looks like people dying”

The methamphetamine crisis is felt in ways that extend far beyond the number of people who overdose. Meth addiction often coincides with mental health problems and can also induce psychosis in individuals, leading to long-term psychological harm. It also causes a range of serious chronic health problems, including damage to people’s hearts and brains, leading to an increased risk of heart attacks and strokes. Liver, kidney, lung, skin, and teeth damage are also common. What’s more, addiction can be economically and socially harmful for people who use and their families, and racial and economic disparities amplify the meth crisis for certain communities.

Still, overdose numbers are an important starting point. They are one of the clearest indicators of how the meth crisis is impacting Alameda County and California more broadly. The data paint a striking picture of the heightened mortality and pain caused by increased meth distribution and usage in recent years.    

According to the California Overdose Surveillance Dashboard, in 2016 and 2017, psychostimulant overdoses (the category that includes meth overdoses) had plateaued at around 1.7 deaths per 100,000 residents in Alameda County. By 2021, that number had risen to 6.3 deaths per 100,000—an increase of 250% in just four years. 

Within the county, eight out of the 10 zip codes with the highest rates of psychostimulant overdoses are within Oakland, including downtown, West Oakland, and Temescal. 

Dr. Andrew Herring, an emergency medicine physician and associate director of research at Oakland’s Highland Hospital, said 2018 was a turning point. 

“You can see that overdoses have gone up in Alameda County by about six or seven times since 2018,” said Herring, referring to overdoses from all substances. “It just looks like people dying.”

Herring founded Highland Hospital’s Bridge Program in 2017. A year later, in 2018 he helped launch the state-wide CA Bridge program. Over the past four years, Bridge Clinics around California have distributed over 100,000 units of Narcan (a nasal spray medication that reverses opioid overdoses) and seen over 180,000 patients with substance use disorders. There would have very likely been far more overdose deaths in the past five years had the clinics not been launched.

“We put in a lot of things to try to fix the problem, and the problem is just way, way bigger than people anticipated,” Herring said.

Oakland’s meth statistics are not an isolated trend. Nationally, the number of deaths attributed to psychostimulants has spiked over the past two years. In 2020, just over 24,000 people nationwide died of a psychostimulant overdose. In 2021, that number had reached nearly 33,000, according to the CDC and the National Vital Statistics System, an increase of over 30% in just 12 months.

At the local level, records provided by the Alameda County Coroner’s Office paint an even bleaker picture. They suggest that the number of methamphetamine-related deaths has grown as much as sixteen-fold over the past five years, from 10 deaths in 2017 to a shocking 166 deaths being attributed at least in part to methamphetamine use in 2022.

Most meth-attributed deaths are the result of a fatal mix of substances. In 2022, 117 of the 166 meth-related deaths investigated by the county coroner listed a version of “Acute Polydrug Toxicity” as the cause of death. The term means an overdose of more than two substances, with most combinations including meth and fentanyl. In the same year, 49 deaths were attributed to methamphetamine use alone. In some of these cases, meth is an indirect cause of death that exacerbates existing health conditions or spurs psychosis in a way that leads to a traumatic incident that causes death. 

Nonetheless, the data show an undeniable increase in meth’s presence in Alameda County, a phenomenon that is further supported by what law enforcement agencies are seeing on the ground. In 2020, Alameda County’s Narcotics Surveillance Task Force seized over 24,000 grams of methamphetamine (compared to 22,000 grams of heroin). Sheriff’s Sgt. Michael Gallardo, who has commanded the task force since 2020, confirmed that his deputies are seizing increasing quantities of drugs compared to prior years.

Bob Bepis, Acting Special Agent in Charge of the DEA’s San Francisco Division Office, whose jurisdiction spans from the Oregon border to Bakersfield, is struck by the volume of meth that is being distributed around the state. “In terms of pounds, methamphetamine is right at the very top,” he said. 

In 2018, the San Francisco DEA Division seized 1,825 pounds of meth. In 2022, they captured a whopping 5,500 pounds.

“It’s cheap and it’s strong”

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Medical supplies like Narcan, as well as daily essentials like shampoo and lotion for unhoused patients, line the clinic’s walls. Credit: Amir Aziz

Meth has been in the East Bay in one form or another for a long time. “Speed” emerged in the 1960s, followed by so-called “Biker meth” in the 70s and 80s, which was distributed by groups like the Hells Angels. Crystal meth made from ephedrine products (often pharmaceutical-grade pseudoephedrine like Sudafed) gained popularity in the 80s and 90s.

Still, heroin and cocaine were reliably the drugs of choice in the East Bay until just over a decade ago, at which point synthetic opioids, including fentanyl, took over. Because it’s so deadly, fentanyl has to some extent eclipsed meth and dominated discussions among policymakers and in the media.  

Why has meth suddenly become so common?

Meth is relatively easy to make and fast to get to market. Naturally derived drugs like marijuana, heroin, and cocaine are harvested from plants that take time to grow. Synthetically manufactured drugs like meth, on the other hand, can be produced quickly in vast quantities. This transition from agricultural to synthetic products has fundamentally changed the American drug market and means that much higher volumes of substances are able to be distributed in a city like Oakland within a short period of time.

To Herring, it’s an irreversible switch that has made it that much harder to fight addiction. “It’s not going away,” he said. 

When it comes to meth, quick production means that it gets sold at an extremely low cost, both because it’s inexpensive to produce and because drug cartels—sophisticated and violent criminal organizations that make and traffick vast quantities of controlled substances—need to keep the product moving. 

“The meth [manufacturing] process scales very well. You can make massive amounts of high-quality meth for cheap,” said Hawthorne.

Today, meth is the most affordable drug on Oakland’s streets. “The main thing that people talk about is just that it’s cheap. It’s cheap and it’s strong,” said Herring.

Economic forces are also at play: with a vast supply, prices have dropped to create more demand. Traffickers who previously ran cannabis operations have switched to meth and adapted to market swings by lowering their prices to carve out a new market of people using the substance. “When fentanyl became more popular, meth became cheap,” Hawthorne said.

Meth’s low price makes it a particularly appealing drug for people who use substances  living in urban centers like Oakland, where the housing affordability crisis has pushed thousands of people onto the streets. As Oaklanders struggle to afford not only housing but also basic necessities like groceries, utilities, and health care, drugs like meth are available and, for some, offer a reprieve. 

“Things are expensive, things are hard, and drugs are cheap,” said Hawthorne. “It is cheaper to get high for a week than to go to the movies.”

But the spread of opioids over the past two decades can’t be ignored, either. Herring explained that the pharmaceutical industry’s commercial onslaught of OxyContin in 1995 created a population of people using synthetic drugs at a scale previously unseen. From that point forward, addictions to prescribed opioids not only normalized synthetic drug use but also created a vast new market of addicts seeking relief. 

The cycle is seemingly unending: the expanded base of people using prescription opioids created a heightened demand for other substances like illicit fentanyl and meth, which as a result also became more readily available, leading even more people to develop addictions. 

“The narrative here is so incredibly clear,” Herring said. “Each of these successive epidemics builds on top of each other and brings more and more people into this cohort of folks that have a problematic relationship with addictive substances.”

Potent meth is worsening people’s mental health

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BRIDGE Clinic staff Montesha Williams and Alexis Milligan prepare to meet a patient at the hospital entrance to bring them in by wheelchair. Credit: Amir Aziz

The problem is exacerbated by the fact that people who use meth today are exposed to a more pure, and potent, version of the stimulant. When DEA Agent Bepis started on the job in the early 2000s, the purity level of meth his agents seized was usually between 20% and 40%. Now, purity levels are closer to 100%.

“Now, everything that we’re getting is over 97, 98, 99%. [It’s] very pure meth, highly addictive,” he said.

The substance found on the streets of Oakland today, often called “new meth,” isn’t cooked up using pseudoephedrine at all. Instead, it comes from a chemical called phenyl-2-propanone, or P2P, the same compound used to make biker meth in the 1980s. Some (but not all) experts think today’s P2P meth has particularly detrimental effects on the human brain.  

Chronic meth use has always led to changes in brain function. However, people on the frontline of the crisis in Oakland have noticed that individuals who use meth today are developing behavioral issues and symptoms of mental illness at a disturbing pace.

Katie O’Bryant is the outreach coordinator for West Oakland Punks with Lunch, a harm reduction program that provides food and vital supplies, including Narcan and clean needles, to Oakland’s unhoused population. 

“What I see is way more psychiatric deterioration,” she said. “There seem to be really permanent effects on the brain.”

Members of the medical community agree. “It does seem to be true that there is a faster progression towards this sort of severe disease that turns into a confusing syndrome of an underlying psychiatric disorder or psychotic disorder and a substance use disorder,” said Anderson. 

New meth’s sweep across Alameda County puts some Oakland’s most vulnerable populations, the aging and the homeless, at risk. Said Herring, “If you look at someone who has been using black tar heroin and cocaine for twenty to thirty years, those folks, when they transition to fentanyl and methamphetamine, their mortality goes through the roof.”

Meth use disorder needs to be treated like any other chronic disease

Back at Alameda Health System’s Bridge Clinic, Dr. Ullal tells me about the challenges of treating meth addiction in a room that appears to double as a harm reduction warehouse. Rubber bins containing clean clothing line the walls while boxes of Narcan spray displaying the Bridge Clinic’s patient hotline are neatly stacked under a window.

“There aren’t good meds, and if you use it long enough, it basically starts to affect your brain in ways that fentanyl or opioids do not,” he said. “Those two properties of meth use make it really hard to quit.”

But there are some promising options that the addiction professionals at Highland are eager to start offering to patients. 

Soon, they hope to roll out a contingency management program, giving patients positive rewards, like cash, in exchange for not using meth. This form of behavioral therapy has been criticized by some who fear that offering money to people who use drugs sets a dangerous precedent, but to Ullal and his colleagues, it is an important treatment advance for a life-threatening disease.

“It’s a harm reduction benefit that you’re providing someone. It’s a treatment. It’s medical. It’s a chronic disease that they [the patients] have. It’s not a choice that they’re making,” Ullal said. 

“From that lens, it’s a no-brainer.”

Robin Buller is a freelance writer, researcher, and editor. She holds a doctorate in history from UNC Chapel Hill and has written a book about immigrants in 1920s Paris. Originally from Canada, she has lived in the East Bay since 2018.