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ST. LOUIS * Even after the drug K2 put Cassandra Clinton in a hospital for six days a few years back, she still fires up a joint once in a while.

"Now, I smoke a stick every now and then, but I need to quit," said Clinton, 28, who is homeless in St. Louis but originally from Mexico, Mo. "I've seen some people do some off-the-wall things on it."

Clinton, who hangs out at the New Life Evangelistic Center, a shelter downtown, has seen friends overdose in recent weeks while trying to get high on strains of synthetic drugs being sold cheaply on the street.

Almost 300 people, most of them homeless and stricken in the neighborhood around the downtown shelter, have been hospitalized since Nov. 7 from overdoses of synthetic versions of THC, the psychoactive ingredient in marijuana.

This month, police arrested six men for possession or distribution of a controlled substance. But prosecutors have yet to file charges. Two suspected dealers were seen on surveillance video making suspicious exchanges.

Synthetic cannabinoids, known as K2 or Spice, and cathinones, which are more commonly called bath salts, have been around for years. Bath salts mimic the effects of methamphetamine or cocaine.

Some of them are outlawed, but makers often tweak the formulas, using nuances of chemistry to argue that their products are legal. Law enforcement finds itself in a cat-and-mouse game.

Meanwhile, medical providers are struggling to treat victims who ingested unknown chemicals.

"It would be nice for the drugs to get off the streets," Clinton said. "But at the same time, as soon as they outlaw it, (drugmakers are) going to come out with something else."

K2 is the buzzword to describe hundreds of different synthetics sold in colorful packages with creative name brands. People on the street say a single joint may cost one or two dollars.

Potent, unknown chemicals

Officials say the synthetics circulating now are much different from those marketed legally as "fake pot" years ago. The new ones can be dramatically more potent and harmful than marijuana, in part because it is unclear what chemicals are in them.

"There have been deaths from these compounds, and there will continue to be deaths from these compounds," said Dr. Anthony Scalzo, director of toxicology for St. Louis University and Cardinal Glennon Children's Medical Center. "It's like Russian roulette because you don't know what's in them."

The Missouri Poison Center, at Cardinal Glennon, has tracked K2 cases since 2010. As of Monday, it had received 118 calls in November. That's the highest one-month total this year, and more than double the 51 reports in all of last year. The annual count has not been so high since the center received 286 calls in 2011 and 149 in 2012.

The total for synthetic cathinones, or bath salts, is far lower: 21 so far this year.

Symptoms linked to synthetic drugs include rapid heartbeat, high blood pressure, anxiety and hallucinations, Scalzo said. There is no easy way to test for these drugs and no antidote. Doctors are left to treat the symptoms and wait for the drug to wear off.

The compounds are as diverse as their brand names, which include Scooby Snax, Green Giant, WTF, Mr. Happy, Stona Lisa and Yellow King Kong. The chemicals usually come from Chinese suppliers and are sprayed on dried shrubs grown domestically and packaged in the U.S. for sale, law enforcement officials say.

Franklin County sheriff's Lt. Jason Grellner, president of the Missouri Narcotics Officers Association, said thousands of different substances are routinely sold in gas stations, corner stores and online as potpourri, incense, jewelry cleaner or even badger repellent, he said.

They are usually sold with a disclaimer printed on the packages that say "not for human consumption" to circumvent Food and Drug Administration rules. Until the substance is tested in a lab, it's impossible to know what's in it and whether it's illegal.

"The biggest issue that we're dealing with in St. Louis is that because these chemicals were never meant for human consumption, there are no blood or urine tests for these substances," Grellner said, so " ... we have absolutely no idea what chemical they're being metabolized into."

Prosecution is difficult

The testing process is time-consuming. It can take months for the Drug Enforcement Administration to prove a drug is harmful and being widely consumed before it can be added to the list of banned substances.

"It can take several months," said Scott Collier, diversion program manager for the DEA's St. Louis division. "The barn door is already open we're usually chasing the animals."

Another problem with tackling synthetic drugs is that prosecutors are reluctant to file charges because lab tests may not be entirely clear on whether the chemical makeup is illegal, Grellner said.

"We need prosecutors and scientists to get together and agree on the language of the law," Grellner said.

Ed Postawko, chief warrant officer for the St. Louis circuit attorney's office, said few cases have made it to court in recent years.

"In large part, we have to rely on what the lab says," Postawko said. "If the chemist isn't sure, how can we be? That's the thing - you make something illegal, then (drugmakers) change the chemical compound into something that's not illegal. Laws don't get changed overnight."

Chris Perry, 35, who is homeless, said he has seen some people have bad reactions but thinks the fears are overblown.

"I don't think it's that bad," Perry said. "I zombied out once. You build up a tolerance to it. They're making a big deal out of it because it's the homeless, and they're trying to clear us out. They want us out of downtown." He said an overdose "is the last thing I'm worried about."

Some people on probation for crimes choose synthetic drugs instead of marijuana, heroin or cocaine to avoid failing drug tests, said Bryan Goodlow, 28, who is homeless and on probation. He knows smoking K2 can be risky but said he does it anyway, despite seeing others overdose in recent weeks.

"I'm going to die one day, anyway," Goodlow said. "I just like getting high. That K2 is a mind trip. It pulls demons. If you don't know what you're getting into, if you're in some pain, then don't do it because when you hit that, your brain runs 100 miles an hour."

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Overdoses rise among St. Louis' homeless, as dealers keep ahead of the law

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ST. LOUIS * Even after the drug K2 put Cassandra Clinton in a hospital for six days a few years back, she still fires up a joint once in a while. "Now, I smoke a stick every now and then, but I need to quit," said Clinton, 28, who is homeless in St.

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BOSTON (Reuters) - Overdoses of drugs, particularly prescription pain-killers and heroin, have overtaken AIDS to become the leading cause of death of homeless adults, according to a study of homeless residents of Boston released on Monday.

The finding came from a five-year study of homeless adults who received treatment from the Boston Health Care for the Homeless Program. But its broad conclusions apply to homeless populations in many urban parts of the United States, the study's author and homeless advocates said.

The tripling in the rate of death by drug overdose reflects an overall rise in pain-killer abuse, said Dr. Travis Baggett of Massachusetts General Hospital, the lead author of the study, to be published next month in the journal JAMA Internal Medicine.

"This trend is happening across the country, in non-homeless populations too," Baggett said. "Homeless people tend to experience in a magnified way the health issues that are going on in the general population."

The study, which tracked 28,033 homeless adults from 2003 through 2008, found that of those who died, 17 percent died of drug overdoses, while 6 percent died of causes related to HIV, the virus that causes AIDS.

That is a rough reversal of the trend found in a similar study 15 years earlier, when 6 percent of deaths were due to drug overdose and 18 percent due to AIDS.

After the drug overdoses, the second- and third-leading causes of death in the most recent study were cancer and heart disease, which each accounted for about 16 percent of the deaths.

Homeless people are significantly more likely to die in a given year than their peers in the rest of the population, with those aged 25 to 44 nine times more likely, and those aged 45 to 64 four-and-a-half times more likely to die, the study said.

The decline in AIDS-related deaths reflected an overall decline in infection rates, as well as improvement in care and services for patients since the prior study, which was conducted during the peak years of the U.S. AIDS epidemic.

REGIONAL VARIATIONS

The study looked at a small slice of the roughly 2.3 million to 3.5 million Americans who go through a period of homelessness each year, according to data from the Urban Institute.

While drug abuse is not an uncommon problem among homeless people, the drugs most commonly used vary by region. Heroin and opiate pain-killers are the most available and most used drugs along the coasts, while methamphetamine is more common through the middle of the country and prescription pain-killers tend to be abused around large military bases, said Neil Donovan, executive director for the National Coalition for the Homeless.

"Fifteen years ago we were talking about homeless people drinking Listerine and that being a leading indicator, and now it's Oxycontin and heroin and it's a very different reality," said Donovan, whose group was not involved in the study.

Prescription painkiller abuse is somewhat more common in Boston than other cities due to the high concentration of hospitals and doctors, which make it easier for users to gain access to the drugs, he said.

CHANGES IN TREATMENT

The rise in deaths related to drug overdoses prompted the Boston Health Care for the Homeless Program to change the way it approaches care, said Dr. Jessie Gaeta, the group's medical director.

"We have to become expert in integrating addiction services into the rest of medical care," Gaeta said. "We have decided to take a very thoughtful and critical look at the way that we prescribe these opiods."

The nonprofit group is considering changes, including reducing the overall amount of pain-killers it prescribes and providing patients with another drug, naloxone, which can be used as an antidote to overdose, Gaeta said.

Chronic pain, related to causes ranging from cancer to arthritis, is a common problem among the homeless and the group's doctors continue to prescribe pain-killers to some of their regular patients, Gaeta said. They have stepped up their efforts to counsel those patients on properly using their drugs and also how to protect them from being stolen.

The relationship between homelessness and drug abuse is a self-reinforcing one, advocates noted. Drug abuse can increase the odds of a person becoming homeless, by making it more likely that they lose a job or fall out with family members, and also makes it harder for the homeless to find shelter, as some agencies will not house drug users.

"It's easier to be clean and sober in a bed than on the streets," said Donovan.

Reporting by Scott Malone; Editing by Sofina Mirza-Reid and Dan Grebler

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medical equipment : supplies and distribution (trbc)

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Drug overdoses top AIDS as main cause of homeless deaths

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BOSTON (Reuters) - Overdoses of drugs, particularly prescription pain-killers and heroin, have overtaken AIDS to become the leading cause of death of homeless adults, according to a study of homeless residents of Boston released on Monday. The finding came from a five-year study of homeless adults who received treatment from the Boston Health Care for the Homeless Program.

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A Study on Homelessness and Addiction

While prevailing stereotypes may dismiss much of the homeless as drug addicts and/or alcoholics, there is a true chicken-or-egg causative relationship between homelessness and addiction. Does addiction cause homelessness, or does homelessness cause addiction? As the National Coalition for the Homeless points out, the answer is that addiction is both a cause and result of homelessness.[1]

Mental illness often underlies addiction, which makes negative stereotypes about addiction all the more misplaced. While a century ago, alcoholism and drug abuse were perceived as a moral weakness, today there is reframing of perspectives on substance abuse. It is an illness, and although some may be more disposed to addiction than others, no one is immune from it.

Understanding Homelessness

According to research from the Substance Abuse and Mental Health Services Administration (SAMHSA), substance abuse is more common among the homeless than in the population in general.[2] While statistical data on homelessness is rife with data collection complications, given that this population is hard to locate or may not be want to be surveyed, SAMHSA research findings estimate that:

About 38 percent of the homeless abuse alcohol.

About 26 percent abuse drugs other than alcohol.

Alcohol abuse is more common among the older homeless population.

Drug abuse is more common among the younger set.[3]

A survey conducted by the United States Conference of Mayors asked 25 cities to provide the top reasons for homelessness in their jurisdictions. Sixty-eight percent reported that substance abuse was the number one reason for homelessness among single adults.[4] According to a separate research survey, two-thirds of the homeless who were interviewed reported that abuse of drugs and/or alcohol was a major cause of their homelessness.[5]

According the United States Interagency Council on Homelessness, 70 percent of homeless US veterans suffer from a substance abuse disorder.

Source: USICH

It appears from the research that substance abuse is a major factor that can contribute to or perpetuate homelessness. Falling behind on bills, having conflict with family, and losing a home can all lead to homelessness. To cope with these major life stressors, the newly homeless may turn to alcohol and/or drugs. As research supports, once drug dependence (including alcohol) forms, a person becomes all the more entrenched in drug abuse. Set this downward spiral against the backdrop of homelessness, and it is only too obvious that these circumstances are rife with obstacles to recovery. Social services agencies and non-profits working in homelessness reduction provide extensive outreach to locate people living on the fringe and to motivate them to seek recovery services. Homeless people are by no means beyond the pale of assistance, but special efforts may be needed to reach them.

Mental Illness and Homelessness

Reporting on research on homelessness, the Mental Illness Policy Organization notes that there are an estimated 744,000 homeless persons in America. Among this population, approximately 250,000 (almost one-third) suffer from mental illness such as schizophrenia and manic-depression.[6] Additional key findings regarding the 744,000 homeless include:

Two-thirds were single.

One-third were part of families.

About 25 percent were chronically homeless.

There is a greater incidence of mental illness among the chronically homeless and homeless women.

Since the 1970s, the homeless population has steadily increased, especially those with serious mental illness.[7]

A University of Pennsylvania study of 5,000 homeless persons in New York City found that they cost the public $40,500 annually, on average. This amount is comprised of prison, shelter, emergency room, and psychiatric hospital costs.

Source: Mental Illness Policy Org.

Shifts in American public policy over the last few decades may account for the high number of mentally ill persons living on the street. Theories abound, but one factor in the increase is the deinstitutionalization of the mentally ill. Over the last few decades, there appears to have been a shift from treating many of the mentally in a hospital setting to abandoning them to the street, where they either remained or became imprisoned. To illuminate the point, consider that while research found 250,000 mentally ill persons living on the street, (a separate) 90,000 were hospitalized.[8] It appears that the system for treating the mentally ill is itself ill.

Alcoholism and Homelessness

According to a study out of Bellevue Hospital in New York of 20 chronically homeless, alcohol-dependent persons, researchers found that all of the participants began drinking in childhood and became dependent on alcohol shortly thereafter.[9] The study further found that 13 of the 20 participants were the children of alcoholic parents, many had suffered abuse in their childhood home, and 19 of the 20 had either voluntarily or involuntarily left home by the age of 18.[10] Further, 11 had a psychiatric diagnosis in the areas of anxiety, psychosis, and mood disorder.

Although the number of participants was modest, the findings are illuminating and suggest that alcohol dependence in childhood may be a contributing factor to chronic homelessness among the alcohol-addicted subset of this population.

As the National Institute on Alcohol Abuse and Alcoholism (NIAAA) points out, persons with depressed finances will face challenges paying bills, including rent. An addiction to alcohol, and the associated costs, will only exacerbate limited resources. Further, a person with a substance abuse problem will most likely make feeding the addiction a priority over cost of living expenses. When an alcoholic cannot meet basic survival needs, including maintaining a home, the opportunity for treatment and recovery usually diminishes, and it can lead to low mood/depression which in turn fuels the alcohol abuse.[11] It is truly a vicious cycle and one that can spin out for an entire lifetime on the streets.

Anthropologist James Spradley, working on the streets of Seattle in the 1960s, found that men living on skid row bonded with one another over alcohol. The findings suggest that, however unhealthy, alcoholism among the homeless may have a secondary benefit of building community.

Source: NIAAA

In an effort to gauge the rate of alcohol abuse in the homeless, the NIAAA gathered data from different studies. The NIAAA notes that data collection is difficult for several reasons, including the fact that the homeless are not usually included in census data. Further, homeless persons who are studied in shelter situations may underreport their consumption if a condition of that shelter is abstinence. With these limitations and complications in view, the NIAAA reports the following findings from separate (third-party) studies:

43 percent of men and 19 percent of women at a NYC soup kitchen reported having 5+ drinks per day

4 percent of homeless youth in California reported alcohol use or dependence

3 percent of persons at a Rhode Island shelter reported lifetime alcohol abuse or dependence

58 to 68 percent of homeless men and 30 percent of homeless women reported having an alcohol problem[12]

An NIAAA-sponsored national study, the National Longitudinal Alcohol Epidemiologic Survey, did intake on 42,862 homeless persons and concluded that 7.4 percent met the standard of alcohol abuse or dependence set forth in the American Psychiatric Association's DSM-IV. The fact that different findings, with different results, has been presented here only confirms the complexity of studying substance abuse in the homeless. While it is difficult to know which study provides the most reliable benchmark, it is clear that alcoholism is both a cause and a result of homelessness. An added threat is that alcoholism fuels homelessness and vice versa. Many homeless alcoholics have not only slipped through the cracks, but it appears that odds are they will remain there.

Treatment of Substance Abuse in the Homeless Population

As the United States Interagency Council on Homelessness points out, substance abuse can perpetuate homelessness as many shelters and public housing resources require sobriety as a condition of occupancy.[13] This observation suggests that existing social policies may address homelessness, but are not tailored to address substance abuse, even though much of the research is clear that the majority of the homeless have substance abuse disorders (and many have co-occurring mental illness). The concern, of course, is that the level of care which substance-abusing and/or mentally ill homeless persons require involves high costs amidst national, state and local budget cuts. A single homeless person, especially one with co-occurring disorders, can present layered challenges to government social service agencies and non-profits, yet there is a general consensus that society should not abandon this already neglected population.

As the National Health Care for the Homeless Council (NHCHC) theorizes and discusses, the homeless population is in need of sensitive services that take a multipronged approach to addressing the many factors involved in homelessness.[14] Less than 25 percent of homeless persons with alcoholism or other substance abuse disorders receive treatment.[15] An NHCHC review of 20 facilities that provide effective substance abuse treatment for the homeless found the following common features at these facilities to be particularly helpful in serving this population:

Treatment of substance abuse in the homeless population can occur through residential (including hospitalization) and outpatient programs. The most common type of residential treatment that the homeless receive is hospital detoxification. The most frequently pursued outpatient treatment methods are individual counseling, outpatient detox, and 12-Step programs.[16]

Residential treatment services are often modified to address the special needs of the homeless population. In addition to the traditional services of therapeutic communities, providing care to the homeless usually also involves auxiliary services in housing placement, legal support, education and vocational training.[17] Research into the treatment needs of the homeless has found this population responds successfully to an approach based on positive affirmations rather than confrontation, a method sometimes used in traditional residential treatment facilities. Research also supports that psychotropic medications may be necessary to manage any existing psychiatric illness and to achieve substance abuse treatment goals.[18]

Traditional outpatient treatment services including one-on-one and group counseling will likely prove insufficient to meet the many needs of homeless persons with substance disorders. Intensive outpatient treatment, while not providing the homeless with housing, can provide a structured atmosphere that can lessen a homeless person's likelihood of exiting a treatment program and help them achieve stability in housing.[19] These programs are usually longer in duration than non-intensive versions.

A research project comparing outcomes for homeless persons enrolled in an intensive versus a regular day treatment plan found that clients in the intensive program showed slightly improved outcomes in relief from depression, employment, housing and substance abuse recovery.[20] A general deduction from this study is that homeless substance abusers are responsive to intensive therapy, however, obstacles remain as far as funding intensive programs and attracting homeless clients.

There is a healthy debate as to whether homeless substance abusers can effectively be treated without having a stable residence. Housing First, a national program dedicated to ending homelessness, takes the approach that the first step in ending homelessness is to provide housing as quickly as possible and then provide program participants with additional services as needed.[21] In other words, Housing First clients are not required to first pass through drug treatment. Residents are required to meet with a counselor once a week and will have a host of services, including drug treatment options, available to them. The program is controversial because many professionals in the addiction and social services field believe that resources should be allocated to treatment first.[22]

One upside of this model is that program participants who seek recovery services are motivated to do so. Providing the homeless with housing outright means that there need not be any concern that they are entering treatment mainly to receive a housing benefit. This model may therefore enable greater honesty in the relationship between the homeless and the program service providers.

Sharing her story with the National Public Radio (NPR), recovered drug addict Daney Hill, lived on a riverbed under a freeway overpass. Though Hill long had a sense of her intelligence, she cites a broken home, instability in her housing as a child, and a general feeling of not fitting in with her peers as some social factors that contributed to her drug abuse. In high school, she abused numerous drugs such as hallucinogens, cocaine, crack and marijuana. By the time she was 17, she had a daughter, but her addiction prevented her from raising her child. Despite numerous run-ins with the law, at the age of 34, Hill was arrested and experienced a shift in her feelings about her life. As a condition of her parole, and with help from family, Hill entered a residential treatment facility and participated in different treatment methods, including a 12-Step program. Hill remained abstinent, earned a university degree in business administration with Latin honors, and now works with women who live in a residential treatment facility with their children while serving out their prison sentences.[23]

Hill's story is an important illustration of how the paths to recovery are many. While Hill did not appear to have a mental illness such as schizophrenia or manic-depression, there are recovery services dedicated to Dual Diagnosis situations in the homeless. Although homeless substance abusers present a considerable expense to taxpayers, recovery services are usually more cost-efficient than not treating the substance abuse at all. Helping homeless substance abusers is not only humane, but is likely to benefit everyone.

[1]" Substance Abuse and Homelessness." (July 2009). National Coalition for the Homeless. Accessed Sept. 17, 2014.[2]Ibid.

[3]Ibid.

[4]Ibid.

[5]Ibid.

[7]Ibid.

[8]Ibid.

[10]Ibid.

[12]Ibid.

[15]Ibid.

[17]Ibid, p. 25.

[18]Ibid.

[19]Ibid, p. 28.

[20]Ibid, p. 29.

[22]Ibid.

[23]Hill, D. (April 13, 2014). "My Journey from Homeless Drug Addict to Magna Cum Laude." NPR. Accessed Sept. 1, 2014.

Speak with an Admissions Coordinator 877-345-8494

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A Study on Homelessness and Addiction | Michael's House Treatment Centers

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While prevailing stereotypes may dismiss much of the homeless as drug addicts and/or alcoholics, there is a true chicken-or-egg causative relationship between homelessness and addiction. Does addiction cause homelessness, or does homelessness cause addiction? As the National Coalition for the Homeless points out, the answer is that addiction is both a cause and result of ...

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Co-Occurring Disorders

The presence of a co-occurring disorder increases a person's chances of losing control of their circumstances, leading to a life on the streets.

Homelessness is a traumatic experience which deteriorates one's mental health, leading to co-occurring disorders. Studies indicate as many as one-third of destitute adults have co-occurring substance use and mental health problems. Nearly 35 percent of participants in the 100,000 Homes study had reported having co-occurring disorders.

Some common mental health problems among the homeless include:

These disorders can also be the cause of vagrancy. Many homeless persons are severely paranoid and mistrustful of those around them. Many believe they are under surveillance. They also experience heavy bouts of anxiety and routine panic attacks.

Co-occurring disorders can further complicate their respective situations. Researchers say these individuals have a harder time obtaining shelter, food, clothing and medications to treat their disorder. Over time, when combined with poor hygiene, these deficiencies can lead to physical ailments, such as respiratory infections, skin diseases and HIV.

Yet, often, self-care is not a priority. For many, behavioral needs take a backseat to more immediate desires, such as finding work or shelter.

Only one in four homeless adults did not report any mental health or substance abuse problems in the last year, per the Urban Institute.

Incarceration

Not only can shelters turn away individuals who are intoxicated or high, law enforcement officers can lock them up.

The National Healthcare for the Homeless Council estimated that between 25 to 50 percent of destitute persons has experienced incarceration. In contrast, 15 percent of the jailed population has experienced homelessness. Many are locked up because of minor drug crimes.

Upon their release, these individuals face an additional barrier: stigmatization. In the past, federal housing agencies and potential employers have turned people away because of criminal records. This can lead to increased criminal activity, which can result in continued substance abuse.

Death

Large chunks of the population engage in illicit drug use, from stimulants to opioids, yielding higher death tolls across the board. According to a study by JAMA Internal Medicine, drug overdoses led to nearly 17 percent of deaths among 28,000 current or former displaced adults from 2003-2008; opioids contributed to 81 percent of those mortalities.

In 2015, the National Health Care for the Homeless Council reported drugs and alcohol caused 29 percent of all homeless mortalities in Sacramento, California over a 12 year period.

Self-medication is also a problem. Many of these individuals, who lack insurance or money to see a physician, self-diagnose. Many of those who do so, in an attempt to remedy a drug problem or co-occurring disorder, have overdosed.

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The presence of a co-occurring disorder increases a person's chances of losing control of their circumstances, leading to a life on the streets. Homelessness is a traumatic experience which deteriorates one's mental health, leading to co-occurring disorders.