In the 25 years since she snatched her first line of methamphetamine at a club in San Francisco, Kim has redefined "normal" many times. First, she says that meth seemed to bring her back to her true self – the person she was before her parents divorced and before her fathers moved into 19459024. "I felt normal when I first did it, like, "Oh! There I, "she says.
Kim is 47 now and has chased" normal "all his adult life. That chase has brought her to some dark places so we agreed not to use her last name on her request. For a long time, meth, known as speed, was Kim's chosen drug.
Then she added heroin to the mix, trying it for the first time while in treatment for meth.
April Dembosky / KQED
"It puts me on a nine-year run of using heroin," says Kim. "And I thought," Oh, heroin's great. I'm not speeding anymore. "For me, it saved me from the tweaker ness," she says, referring to the agitation and paranoia that many meth users experience and how heroin, an opiate, calmed it.
Now Kim has just completed dependence treatment for both drugs.
She was part of the last meth wave of the 90s, and now she is part of a new metapidemia that sweeps through parts of the US, especially the West. up Hospitalizations are up.
With meth and opioids for a "synergistic high"
Researchers who have tracked drug use for decades believe that the new meth crisis got a kick-start 19659009] "There is definitely an association," says Dr. Phillip Coffin, director of drug research at the San Francisco Department of Public Health.
In the United States, f Learners and more opioid users also use methamphetamine, from 19% in 2011 to 34% in 2017, according to a study published in the journal Drug and Alcohol Addiction last year. The biggest increases were in the western United States.
This research suggests that efforts to make doctors cut down on writing opioid prescriptions may have driven some users to buy meth on the streets instead.
"Methamphetamine acted as opioid replacement gave a synergistically high and balanced opioid effects so that one could function normally, the researchers write.
It's a bit like having a cup of coffee in the morning to wake up and a glass of wine about The evening to shut down – or to use meth on Monday to get to work and heroin on Friday to ease the weekend.
Amelia says it's how her drug use evolved to include meth.
In the beginning drug was just a fun thing she wanted to do over the weekend – ecstasy and cocaine with her friends. On Monday, Amelia will just go about her work week.
"I am a horse trainer so I worked really hard but I also participated very hard, "she says.
Then a weekend when Amelia felt a kind of hungover from the night before, a friend passed her a tube and said it was opium.
" I thought it was like smoke grass or hash, you know? "says Amelia now, "I just thought it was."
She says she grew to like opium products and eventually contacted her friend's dealer.
"The woman said," How long have you been doing heroin? "and my jaw nearly hit the ground," Amelia says. "I was just really honestly shocked. I was like," What have I done heroin all the time? "I felt really naive, really stupid not even putting the two together." Almost soon, Amelia began to get sick around the same time every day. It was withdrawal symptoms – a clear sign that she was addicted to the drug. Her weekend smoke became her daily morning smoke. Then it was part of her lunchtime.
"I just handed it over and decided," Screw it, "she says." I just want to keep doing it. Of course I still work, I'm fine. ""
A heroin habit is expensive. Amelia worked six days a week to pay for it. Any horse to ride, all lessons to be taught, she said yes because she wanted the money.
But bankrolling heroin use was exhausting. One day, one of the women she worked with at the horse fair offered her some meth as a pick-up.  Meth is relatively inexpensive these days. It became the thing that kept Amelia going so she could make enough money to buy heroin.
"Heroin was the most expensive part," she says. "It was $ 200 a day at a time. And meth was $ 150 a week."
This pattern lasted three years until Amelia discovered she was pregnant. As soon as she was born, she entered a home care program in San Francisco – Epiphany Center – that would accept her and her baby.
"I was ok to be drug addicts," Amelia says. "I was ok with what was my life." she says. "But I wasn't okay with having children and being a part of my life."
Rehab hospital admissions for heroin and meth mixers
Access to drug rehabilitation for heroin has remained stable in recent years in San Francisco. But the number of heroin addicts reporting methamphetamine as a secondary drug problem has increased. In 2014, 14% of heroin users who entered rehab in San Francisco said meth also a problem. Three years later, 22% said meth was also a problem.
"It's very loud," says Dr. Dan Ciccarone, Professor of Family Medicine at the University of California, San Francisco, who has been studying heroin for almost 20 years. "It is alarming and new and exciting and needs to be explored."
Speedball – heroin plus cocaine – is a classic combination, he says.
"It's like peanut butter, right chocolate and peanut butter together," he says. "Methamphetamine and heroin are an unusual combination."
The combo meth and heroin are called in daily speech as a goofball, Ciccarone adds, because it makes the user feel "a little stupid and a little blissful."
For Kim, methamphetamine use came first. Then she added heroin.
"I ended up doing both at the same time every day, both," she says.
For Kim, it was always about finding the recipe for what was normal. Start with meth. Add some heroin. Touch the speed.
"You are like a chemist with your own body," she says. "You are balancing and trying to figure out your own recipe for how to make you feel good."
Now Kim is trying to find that balance without drugs. She has been sober for a year. Then Amelia, horse trainer. Her recent anniversary is the same as her daughter's birthday.
This story is part of NPR's health reporting collaboration with KQED and Kaiser Health News.