CAN WE TURN OUR BACK ON THESE FACTS?
“In January 2020, the number of homeless Arizonans was nearly 11,000. As of December 2021, that number is estimated to have increased by nearly 30 percent. While the factors contributing to homelessness have always been varied and complex, the growing shortage of affordable housing has significantly impacted low-income individuals and families with incomes. Compounded by unemployment, physical and behavioral health issues, domestic violence, and substance abuse, homelessness continues to impact both rural and urban communities statewide.” (State of the Homeless Homelessness in Arizona Annual Report 2021 Arizona Department of Economic Security | December 2021 EXECUTIVE SUMMARY)
“In order to estimate the level of unsheltered homelessness in the Tucson/Pima County Continuum of Care (CoC)–aka Tucson Pima Collaboration to end Homelessness (TPCH) in 2021, a multi-level modeling approach was used to identify CoC/county-level economic factors significantly associated with changes in homelessness year-to-year. Within this multi-level model, we examined the association of five local economic factors (unemployment, poverty, median rent, homeownership rate, and the rental vacancy rate) with year-to-year change in the CoC-level unsheltered homelessness rate for the years 2013-2020 at the first level of the model. A preliminary step in these analyses is to determine the specification of the time, or the growth, parameter that best describes trajectories of the dependent variable. It was found that a second order polynomial for quadratic change (the inclusion of time and time-squared in the model) was the most appropriate growth model for these data. The second level of the model allows one to test whether stable CoC-level factors contribute to both initial levels of the outcome (the CoC -level rate of unsheltered homelessness in 2013) and differences in overall trajectories of change in the outcome (the slope of change in the rate of unsheltered homelessness from 2013-2020). Average CoC-level unemployment for the years 2009-2012 is added to control for the fact that states hit with higher unemployment rates during the 2007-09 recession would likely have more room for reductions in their homeless populations in the subsequent recovery. Model results confirm that states with higher average unemployment in the years 2009-2012 had higher levels of unsheltered homelessness in 2013.” (SW Institute for Research on Women, 2021)
Addressing chronic homelessness is a priority focus in Arizona’s efforts to end homelessness. ‘Chronically homeless’ means a person has experienced homelessness more than four times in the past three years or has been homeless for one or more continuous year and has a disabling medical, mental or addictive condition. Jim became homeless when he stepped out of a program by a mental health agency helping him with rent. The apartment complex was filled with other challenged people and was very chaotic. Jim has Epileptic seizures which make communal living (shelters) difficult. He determined that the safest place to sleep was on the sidewalk with those who call Safe Park (on Church between Congress and Broadway) their home. Finding this ‘not so safe,’ he made a decision to move to a rural community and even found housing there, but he is now without needed medical care for his Epilepsy.
Chronically homeless individuals make up the most vulnerable, the most visible, and the most difficult population to serve. Many have lived on the streets for years and have difficulty transitioning to housing and reconnecting with community. They are predominately single (94 percent) and are the highest users of emergency rooms and hospital services. They are also the most likely to die on the streets if a system to house them is not provided. John is 60+ and unable to obtain an AZ Identification card as he was born at home in TX and there was no record of his birth. He is always seen with an overflowing shopping cart with food and items to help improve his camp. John cannot get services or even a low income bus card due to his lack of ID. (“John” was a victim of COVID in 2021)
Unaccompanied homeless youth, often referred to as “youth on their own”, are the most difficult subpopulation of homelessness to quantify. This category includes young people who have run away from home, been thrown out of their homes or abandoned by parents or guardians. It also includes youth who have aged out of the foster care system and have no resources or family connections on which to rely. Leslie, having gone from foster home to foster home, was now 18 and opted to go out on her own. She quickly found she was no longer welcome on friend’s couches and now sleeps in a drainage tunnel, often resulting to prostitution to buy necessities.
StreetSmarts: Your homeless news source:
Courtesy of the Community Emergency Medical Responders Foundation which provides educational services and support directly on the streets to those in need in Tucson, Arizona. For more info, log on to: www.c-emr.org
Meth + Heat = Death from low salt
Hyponatremia is a condition that occurs when the level of sodium in the blood is too low.
• Meth, MDMA and spice users are particularly susceptible
• Key symptoms: weakness, fatigue, nausea, memory loss, and confusion
• Make sure to seek medical help immediately if experiencing these symptoms
You’ve read the flyers for prevention: “avoid dehydration”, “drink adequate amounts of water”, “drink water — don’t wait until you feel thirsty”
Well, the first two statements (“avoid dehydration” and “drink adequate amounts of water”) constitute very solid advice. The last statement “drink water — don’t wait until you feel thirsty” used to be widely accepted, but is now considered by the latest consensus guidelines to be somewhat problematic (especially if you haven’t eaten and you’re planning on a self-medicated summer escape).
We’ll explain this in detail in a bit, but first … the impetus for today’s article came from a friend on the streets who came into Sunday’s C-EMR first aid station at the Z Mansion. Without mincing words, he walked in and loudly announced, “Why the f*** do you guys give water and Gatorade to the f***ing meth and Spice heads at the library?”
Good question. The answer comes in the form of an equation:
• Meth and/or Spice use + heat + plenty of water – adequate food = high risk of death from low levels of salt.
Here’s the explanation we promised:
“A lower-than-normal concentration of sodium (salt) in the blood” is called hyponatremia. According to the Mayo Clinic, “In hyponatremia, one or more factors — ranging from an underlying medical condition to drinking too much water during endurance sports — causes the sodium in your body to become diluted. When this happens, your body’s water levels rise, and your cells begin to swell. This swelling can cause many health problems, from mild to life-threatening.”
BTW, being homeless on the streets in Tucson during the summer IS an endurance sport. Think of our community — given prolonged daily exposure to extreme heat and near constant physical activity — as unwitting athletes trapped in an unremitting athletic event. And much like one out of every seven marathon runners (see study here), many of the homeless in Tucson suffer from hyponatremia.
What are the symptoms of a lower-than-normal concentration of sodium (salt) in the blood? According to a 2015 study published in theJournal of the American Geriatrics Society, the most common symptoms of profound hyponatremia are:
• Generalized weakness (Found in 69% of patients)
• Fatigue (59%)
• Nausea (44%)
• Disturbance of memory (36%)
• Disturbance of concentration (35%)
• Disturbed gait (31%)
• Disorientation to person, location, time, or the situation (30%)
• Vomiting (30%)
• Headache ( 27% )
Hyponatremia is potentially deadly and should be treated as a medical emergency. In addition, your risk for hyponatremia is even deadlier if you use:
1) Meth and/or MDMA (Ecstasy)
According to a 2006 study published in the AAPS Journal, “MDMA and METH produce other acute physiological changes such as changes in body temperature, hyponatremia, and hypertension ….”
Unfortunately, hyponatremia is not the only deadly condition caused by the combination of excess heat and meth. Per a 2016 study in the journal Clinical Case Reports, “(Methamphetamine) may cause hepatotoxicity, rhabdomyolysis, cardiotoxicity, nephrotoxicity, and neurotoxicity separately or sometimes together as multisystem toxicity, mostly as a serious condition requiring hospitalization. Nephrotoxicity generally presents as acute kidney injury, hyponatremia, and hypertension.”
But, you’re smart. You know that if you do meth or MDMA you should drink plenty of water to avoid overheating, right? Exactly. And that, according to a 2014 study published in Case Reports in Internal Medicine, is yet another reason why meth and MDMA users are prone to the deadly effects of hyponatremia. Per the study, “Users of MDMA learn to increase their oral water intake as a preventive measure for hyperthermia, resulting in potentially severe cases of MDMA-associated hyponatremia.”
The same problems are found in the use of a drug we profiled just two weeks ago. That wretched drug is:
According to a 2015 study published in the journal Swiss Medical Weekly, “‘Spice’ drugs have become popular alternatives to marijuana among teenagers and constitute an exceptionally large class of novel psychoactive substances …. Although the use of novel psychoactive substances mostly produces minor or moderate poisonings, serious complications occur. (Examples of these complications include) acute serotonin syndrome, hyperthermia, seizures, and hyponatremia.”
So, what can you do to avoid hyponatremia? As an endurance street athlete, start with:
• “Avoid dehydration” and
• “Drink adequate amounts of water”
Then, change the older advice (“Drink water — don’t wait until you feel thirsty”) to:
• “Drink according to thirst”
According to the 2015 Consensus Guidelines for Preventing Deaths Due to Exercise-Associated Hyponatremia, “In all cases, blanket statements that can be found on the internet such as ‘don’t wait until you feel thirsty’ make little sense for the majority of casual athletes and have the potential for disastrous consequences as they promulgate the idea that near constant fluid ingestion during athletic events is a reasonable and even necessary thing to do.”
So, what prevention techniques can an endurance street athlete use to rehydrate while preventing hyponatremia? Per the consensus guidelines, “The first is perhaps the most physiological and simple:drink according to thirst. Our thirst sensation is a finely tuned regulatory mechanism that protects plasma osmolality from rising more than a few percentage points above normal. Thus, our thirst sensation will prompt drinking and help to guard against excessive dehydration. … Overriding these mechanisms with continued volitional drinking behavior is unnecessary and potentially dangerous.”
So — when you see the C-EMRs in the blue caps handing out water downtown — take an ice cold bottle and drink it when you’re thirsty.
Together we can fight the deadly effects of dehydration and hyponatremia.
Free Bottled Water & Water Bottles at The Z Mansion.
The C-EMR First Aid Clinic opens every Sunday morning at 9 am at the Z (the big, blue house at 288 North Church just north of the library). There you can pick up free bottled water and refillable water bottles. In addition, the nurses and doctors at the clinic can assess you for heat-related illness and discuss ways to help prevent this life-threatening condition.
Find out the latest at tucsonhomeless.org
Just a reminder that you can find the latest information about food, shelter, and services for the homeless at www.tucsonhomeless.org. (And be sure to send us your from-the-street-updates so we can keep everything current. Thanks!)
Have a safe week!
In case of an emergency, dial 911
Nigro, Nicole, Bettina Winzeler, Isabelle Suter-Widmer, Philipp Schuetz, Birsen Arici, Martina Bally, Claudine Blum, Roland Bingisser, Andreas Bock, Andreas Huber, Beat Müller, Christian H. Nickel, and Mirjam Christ-Crain. “Symptoms and Characteristics of Individuals with Profound Hyponatremia: A Prospective Multicenter Observational Study.” Journal of the American Geriatrics Society J Am Geriatr Soc 63.3 (2015): 470-75. Web.
“hyponatremia.” McGraw-Hill Concise Dictionary of Modern Medicine. 2002. The McGraw-Hill Companies, Inc. 16 May. 2016
“Hyponatremia.” Mayo Clinic. Mayoclinic.org, 28 May 2014. Web. 16 May 2016.
Hyponatremia in marathon runners
Almond, Christopher S.d., Andrew Y. Shin, Elizabeth B. Fortescue, Rebekah C. Mannix, David Wypij, Bryce A. Binstadt, Christine N. Duncan, David P. Olson, Ann E. Salerno, Jane W. Newburger, and David S. Greenes. “Hyponatremia among Runners in the Boston Marathon.” New England Journal of Medicine N Engl J Med 352.15 (2005): 1550-556. Web.
Meth, MDMA and hyponatremia
Quinton, Maria S., and Bryan K. Yamamoto. “Causes and Consequences of Methamphetamine and MDMA Toxicity.” The AAPS Journal AAPS J 8.2 (2006)
Gurel, Ali. “Multisystem Toxicity after Methamphetamine Use.” Clinical Case Reports Clin Case Rep 4.3 (2016): 226-27. Web.
Chang, Julia Chia-Yu, Jiin Ger, and Chen-Chang Yang. “Late Diagnosis of MDMA-related Severe Hyponatremia.” CRIM Case Reports in Internal Medicine 1.2 (2014): Web.
Spice and hyponatremia
Liechti, M. “Novel Psychoactive Substances (designer Drugs): Overview and Pharmacology of Modulators of Monoamine Signaling.” Swiss Med Wkly Swiss Medical Weekly (2015): Web.
Hyponatremia and fluid intake
Rosner, Mitchell H. “Preventing Deaths Due to Exercise-Associated Hyponatremia.” Clinical Journal of Sport Medicine 25.4 (2015): 301-02. Web.
McKinley, Michael J., and Alan Kim Johnson. “The physiological regulation of thirst and fluid intake.” Physiology 19.1 (2004): 1-6.