One brisk evening last fall, I took my 15-year-old daughter out for a driving lesson near our home in Portland, Oregon. We were in our old Ford pickup, and I was cheering her smooth downshifts and complimenting her feel for the clutch and gas when she made a left onto an unlit street. Suddenly, we were surrounded by tents, piles of garbage, grocery carts, old bicycles. A few figures sat in the shadows. Ahead and to the right, a man squatted in the dark, firing a blowtorch over something near the ground.
When a car approached from the other direction with no room to pass, my daughter braked, then stalled. The car stopped a few feet in front of us, headlights in our eyes. “Mom, Mom, I can’t reverse, and I can’t get around him,” my daughter whispered. The driver of the car in front of us leaned out his window. One of the figures on the street approached. They exchanged words, and something else.
I said to my daughter, “It’s okay. It’s fine. We’re fine.”
I am a physician who treats addiction for a living. Many of my patients sleep in cheap motels or shelters or live in tents on dark city streets. Some of them use blowtorches to vaporize and inhale their drugs. I wanted my daughter to know that the shadows hid men and women just trying to survive, and that just because the scene looked scary, it didn’t mean the people were. I wanted to be the kind of person who saw past the darkness, who could tell her we should love the man with the blowtorch like our brother.
But I didn’t love him. He was scary, and as we sat there in the cab of our old red Ford, my palms got sweaty. I felt small, unprepared. I wanted to get out of there. I wanted to feel safe.
In his 2021 book, The Least of Us, journalist Sam Quinones documents the rise and spread of fentanyl, which is fueling our current crisis of opioid overdose, and “P2P meth,” a newer, cheaper, and more ubiquitous methamphetamine. Much of the book is brilliant. Quinones details the mass production of these drugs in China and Mexico and explains how our population has been made vulnerable to them in multiple ways—brains addicted to the pleasure hits of processed foods and sugar, a culture that values big houses and social media over personal connection and purpose, and entire communities dependent on opioids marketed as quick fixes for every form of pain:
We turned healthy self-reliance into a grim isolation. Then pain pills were marketed grotesquely and supplied beyond reason. They were overlaid on the mass marketing of legal, addictive substances. Beneath that lay reservoirs of childhood trauma, stress, depression, community destruction, and PTSD from fighting two wars using the same small minority of people while the rest of us got a tax cut.
I want to underline that passage, highlight it, and underline it again.
Then Quinones turns his attention to drug users, specifically those who use P2P methamphetamine. Though he offers no scientific evidence for it, he argues that the drug fundamentally changes users’ brains. They become “zombies,” “deprived of memory and personality,” “howling, hysterical, starving,” “deranged,” and “notoriously unwashed, with open sores, matted hair, and rotting teeth.” He describes horrific scenes of rape and abuse in Los Angeles tent cities where even a service dog is “repelled by Skid Row’s smell of urine, the screaming people, and the meth-tormented energy.” He suggests drug users should be forced into treatment, most efficiently through arrest and the threat of incarceration.
Portland has also experienced a rapid rise in the use of methamphetamine in the past decade along with the spread of communities clustered in tents or living in old cars and RVs patched up with duct tape and tarps. Residents and business owners complain of increased crime and trash. Some are relocating, or threatening to do so.
Quinones discussed his book on the radio and on CBS Saturday Morning. A long excerpt appeared in The Atlantic. His ideas were shared widely on my Twitter feed, where one user bemoaned the “cerebral catastrophe” caused by P2P and another wondered whether, as damaged as they are, users of P2P could ever be stably housed. One post on Nextdoor (the site where neighbors connect to neighbors to “cultivate a kinder world”) expressed a sense of relief: “This could help to explain what we are witnessing with a range of issues, from mental illness to violence.” Another post read, “With the new meth (P2P) running in our city for years now, we truly have vacant souls. The zombie apocalypse.”
Cerebral catastrophes, zombies, vacant souls. The story is terrifying.
Here is a different story: the morning after my daughter’s driving lesson, I went to work, where a line of men and women waited to be admitted. Our treatment center accepts Medicaid and has an indigent fund. Sometimes our patients sleep on nearby sidewalks so that they can be first in line when we open. Sometimes they are high, sometimes in active withdrawal. Most of them have methamphetamine in their systems, along with other drugs, and many live in tents or patched-up RVs. If we don’t have room to admit everyone—and we often don’t—it is wrenching. Too many times it’s the morning one patient finally had the bus money to get here, or the day another promised her mother/father/partner/child she would quit.
The Least of Us includes interviews with federal agents, drug runners, chemists, men and women in recovery, family members who have lost loved ones to addiction, and organizations doing hard, important work to address addiction and crime in their communities. But none of the stories Quinones tells comes from conversations with active drug users or with residents of tents or shelters.
My job is to talk to drug users—not just about quitting or cutting down, but also about why they want to. My patients tell me they want their kids back. Or that they want to make their parents proud again, to return to the job they loved, to go fishing. Twice in one week, sad, stooped men grinned as they described the joy of a boat, the water, a fishing pole in hand, the whole day in front of them.
I’m not saying that people don’t do destructive things when high or seeking a high. My patients have lost homes, jobs, and families because of using, and some have committed crimes—in certain cases, terrible crimes—along the way. I also know that many drug users don’t seek treatment. And some of my patients do come to us nearly out of their minds. One woman arrived clutching a backpack, pacing, seeing things no one else could see, sometimes crying, sometimes rocking. But she made it to our door and was able to focus on one moment, one tiny connection, at a time. She accepted a cup of water and was so sorry for spilling it. She thanked the nurse for the granola bar, then the shower, the bed. Even while having trouble tracking what was true in the world and what was true only in her mind, she wanted help. She wanted at least one night without using. One night of peace.
I admitted a man the other day, a kid really, not yet old enough to drink, wearing brown bedroom slippers in the rain. He was withdrawing from methamphetamine and fentanyl and said his shoes had been stolen. When I asked to examine his feet, he said no. Please, no. They were too dirty, the nails were too long, and there was an ugly rash between his toes. It would be the last straw, he said. Please. Just let me wash.
When I try to explain all of this to people outside of work, I’m often met with realities hard to refute. The woman in line at the grocery store, with one baby in a stroller and another on her hip, who says, “I can’t take my kids to the park anymore.” Or my hairdresser, who moved to Portland with her wife because she believed they would find a welcoming community in the city: “The last time I used the bike path, a dude chased me with a metal pipe. He was high, and I am so fucking mad. That’s a public space, and the public can’t use it.”
Plus, I have my own moments. The strip of grass just beyond our office parking lot is lined with makeshift shelters. When I go out for coffee or lunch, I take the long way around, avoiding tent openings and the men milling nearby. There is a distance between the people on the street who scare me and those who come for help, and I don’t know how to bridge it. I don’t even know how wide the gap is.
In December 2022, Portland Mayor Ted Wheeler revealed his plan to crack down on unsanctioned camps. “Once you use this P2P meth,” Wheeler told city business leaders, “it very quickly scrambles your brain permanently—meaning some of the individuals who you see who are addicted to P2P meth, they will never be able to function on their own again. They will be institutionalized, or they will be relegated to the streets for the rest of their lives.” Again, no evidence exists to back this up. There is only a feeling, which is fear, and the need for a tidy explanation.
Of course, it is possible that research may eventually find that this form of methamphetamine is fundamentally different. It is also possible that this methamphetamine scourge is the reason I can’t take my daughter driving at night or let her stay out with friends in the park after dark. Maybe it is the reason I now check the locks every night and why my husband asked for outdoor security cameras for Christmas this year.
Maybe. But there is no question—no “maybe”—that this explosion of despair on the street is happening in a context of skyrocketing housing prices, widening income disparities, a devastating pandemic, and increased rates of depression, anxiety, and suicide. There is also no question that it is much easier for my patients to obtain cheap methamphetamine than it is to find a primary care doctor, a counselor, or—that true unicorn—a psychiatrist who accepts Medicaid. Finding drugs is certainly easier than obtaining housing, or even a shelter bed.
No question: there are only humans at the heart of this complicated mess. No zombie horde. Only fathers, mothers, brothers. Fishermen.
My colleague Jenny recently bought a house near work, close enough for her to walk. Unlike me, Jenny is not fearful, and she does not avoid the encampments near the parking lot. She walks straight through them every morning, sometimes bearing apple cakes, pear tarts, or oatmeal cookies.
The other day, Jenny told me that while cleaning out her shed, she found a pool cover amid the debris. She lugged it to the encampment, offering it up as a tarp alternative. I thought of Quinones’s tale of tent communities filled with howling drug users so saturated with the smell of urine that even a service dog avoided them. Jenny said that the man who took the tarp was friendly, not screaming. No scent of urine. He thanked her and said he thought he could find a use for it. When a freak April snowstorm hit a few days later, she was gratified to see that he had turned it into a kind of mega tarp, covering several tents in a row and tucked in at the sides “like a burrito.”
The driver in front of us last fall eventually rolled up his window, backed up, and drove away. My daughter got the truck started again, and we crawled our way toward home. We were mostly quiet. She didn’t ask me to explain the tents, the propane, the exchange. And if she had? I suppose I might have given an account of absurd housing prices, structural inequalities, inadequate health care. Or I could have told tales of burritos, baked goods, and fishermen. I could have told her any or all of that and still not gotten it right, because I do not have a story that explains life in a tent on a street near my house. Neither does Sam Quinones, or Nextdoor, or even sweet Jenny, Patron Saint of the Displaced and Discarded. Only the people on that street know the full truth of their stories.
But my daughter didn’t ask me to explain, and I was tired, so I didn’t bring it up. When we got home, I told her I was turning in. Then I locked the doors, all of them, and went to bed.
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