“I’d go through, let’s say, 1,200 puffs in a week,” Kumar said.

Vaping became a crutch for them. Like losing a cellphone, losing a vape pen would set off a mad scramble.

“It needs to be right next to my head when I fall asleep at night, and then in the morning, I have to thrash through the sheets and pick it up and find it,” Kumar recalled.

They got sick often, including catching covid-19 — and vaping through all of it.

Kumar, now 24, eventually quit. But many of their generation can’t shake the habit.

“Everyone knows it’s not good for you and everyone wants to stop,” said Jacob Garza, a University of Colorado student who worked to raise awareness about substance use as part of the school’s health promotion program.

“But at this point, doing it all these years … it’s just second nature now,” he said.

Marketing by e-cigarette companies, touting the allure of fruity or candy-like flavors and names, led many teens to try vaping. As more high schoolers and younger kids experimented with e-cigarettes, physicians and it could lead to widespread addiction, creating a “Generation Vape.”

Research has shown to the brains of young people.

New data on substance use among adults ages 18-24 suggests that many former teen vapers remain e-cigarette users. National vaping rates for young adults increased from to .

It’s not surprising that many of them start in high school for social reasons, for all sorts of reasons,” said Delaney Ruston, a primary care physician and documentary filmmaker. “And many of them now — we’re seeing this — have continued to college and beyond.”

Her is “Screenagers Under the Influence: Addressing Vaping, Drugs & Alcohol in the Digital Age.”

In Colorado, the share of those 18 to 24 who regularly vaped rose by about 61% from 2020 to 2022 — to nearly a quarter of that age group.

“That’s an astounding increase in just two years,” Ruston said.

Trends in that state are worth noting because, before the pandemic, in youth vaping among high school students, surpassing 36 other states surveyed.

Nationally, vaping rates among high schoolers dropped from to , according to the Annual National Youth Tobacco Survey. But for many young people who started vaping at the height of the trend, a habit was set.

At Children’s Hospital Colorado, pediatric pulmonologist displayed on her screen a clouded X-ray of the lung of a young adult damaged by vaping.

For years, doctors like her and public health experts wondered about the potentially on pre-adult bodies and brains — especially the big risk of addiction.

“I think, unfortunately, those lessons that we were worried we were going to be learning, we’re learning,” said De Keyser, an associate professor of pediatrics in the .

“We’re seeing increases in those young adults. They weren’t able to stop.”

It’s no coincidence the vaping rates soared during the pandemic, according to several public health experts.

For the past couple of years, undergraduates have talked about the challenges of isolation and using more substances, said Alyssa Wright, who manages early intervention health promotion programs at CU-Boulder.

“Just being home, being bored, being a little bit anxious, not knowing what’s happening in the world,” Wright said. “We don’t have that social connection, and it feels like people are still even trying to catch up from that experience.”

Other factors driving addiction are the high nicotine levels in vaping devices, and “stealth culture,” said Chris Lord, CU-Boulder’s associate director of the .

“The products they were using had than previous vapes had,” he said. “So getting hooked on that was … almost impossible to avoid.”

By “stealth culture,” Lord means that vaping is exciting, something forbidden and secret. “As an adolescent, our brains are kind of wired that way, a lot of us,” Lord said.

All over the U.S., state and local governments have filed suits against , alleging the company misrepresented the health risks of its products.

The lawsuits argued that Juul became a top e-cigarette company by aggressively marketing directly to kids, who then spread the word themselves by posting to social media sites like YouTube, Instagram, and TikTok.

“What vaping has done, getting high schoolers, in some cases even middle schoolers, hooked on vaping, is now playing out,” said .

Juul agreed to pay . The company did not respond to requests for comment on this article.

R.J. Reynolds, which , Vuse, sent this statement: “We steer clear of youth enticing flavors, such as bubble gum and cotton candy, providing a stark juxtaposition to illicit disposable vapor products.”

Other , like Esco Bar, Elf Bar, Breeze Smoke, and Puff Bar, didn’t respond to requests for comment.

“If we lived in an ideal world, adults would reach the age of 24 without ever having experimented with adult substances. In reality, young adults experiment,” said Greg Conley, director of legislative and external affairs with American Vapor Manufacturers. “This predates the advent of nicotine vaping.”

The FDA banned flavored vape cartridges in 2020 to crack down on marketing to minors, but the .

Joe Miklosi, a consultant to the Rocky Mountain Smoke-Free Alliance, a trade group for vape shops, contends the shops are not driving vaping rates among young adults in Colorado. “We keep demographic data in our 125 stores. Our average age [of customers] is 42,” he said.

He has spoken with thousands of consumers who say vaping helped them quit smoking cigarettes, he said. Vape shops sell products to help adult smokers quit, Miklosi said.

Colorado statistics belie that claim, according to longtime tobacco researcher . The data is “completely inconsistent with the argument that most e-cigarette use is adult smokers trying to use them to quit,” said Glantz, the former director of the at the University of California-San Francisco.

For recent college graduate G Kumar, now a rock climber, the impetus to quit vaping was more ecological than health-related. They said they were turned off by the amount of trash generated from used vape devices and the amount of money they were spending.

Kumar got help from cessation literature and quitting aids from the university’s health promotion program, including boxes of eucalyptus-flavored toothpicks, which tasted awful but provided a distraction and helped with oral cravings.

It took a while and a lot of willpower to overcome the intense psychological cravings.

“The fact that I could just gnaw on toothpicks for weeks on end was, I think, what kept me sane,” Kumar said.

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Biden administration officials are hosting back-to-back events Thursday and Friday at the White House for about 160 health care officials, calling gun violence a “public health crisis” that requires them to act.

The strategy also reflects a stark political reality: Congress has been deadlocked on most gun-related legislation for years, with a deep divide between Republicans and Democrats. If Democratic President Joe Biden wants to get anything done quickly, he will need to look outside the Capitol. He has already enlisted educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told Ģ��ӰԺ Health News. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods.

In 2022, more than 48,000 people in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day, from Johns Hopkins University research.

Guns are the leading cause of death for children and teens.

Gun violence prevention advocates applauded the Biden administration for attempting to depoliticize the issue by focusing on its health impacts. The health-centric message also resonates with the public, said Fatimah Loren Dreier, executive director of the Health Alliance for Violence Intervention, who planned to attend the June 6 event.

“The idea that there can be a bipartisan-driven, apolitical way to address the gun violence problem has created tremendous opportunity,” she said.

But the initiative isn’t just about messaging. It’s about numbers and statistics. Relative to America’s other deadly threats — such as cancer, HIV, and automobile crashes — fewer federal dollars fund gun violence research, mostly because of politics.

In 1996, Congress cut federal funding for gun control research by the CDC, essentially shifting the responsibility for funding and conducting the research to the private sector and academia — and with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research, but public health experts say it’s not nearly enough. By comparison, roughly three times that amount was on the prevention and treatment of underage drinking in fiscal year 2023, and 10 times as much to Parkinson’s disease research.

Slashing CDC research funding for firearms created decades-long gaps in data — and hamstrung efforts to respond to the crisis, researchers and health officials say. For instance, there’s little government data available to researchers on firearms, even basic statistics such as firearm ownership by city and which guns are used in shootings.

More timely and comprehensive data could give researchers a better understanding of the trends behind gun violence — and the steps to take to prevent it, said Bechara Choucair, an executive vice president and the chief health officer at Kaiser Permanente, who planned to attend the June 6 White House event.

“Anytime you want to address a problem with a public health lens, you have to understand the data,” he said. “You have to understand the data at a granular level so you can design interventions and test interventions and see if it works or if it doesn’t work.”

The White House is asking state and local health departments, health systems, and hospitals to boost timely data collection on emergency room visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data likely will not count the roughly two dozen other people who were injured.

Collecting more detailed data could be costly for hospitals, whose ERs see most gunshot injuries, said Garen Wintemute, an ER physician and the head of a violence prevention program at the University of California-Davis. Right now, hospitals gather medical information about gunshot wounds and usually don’t get into other details, such as what type of gun or ammunition might have been used.

It’s not clear exactly what data hospitals will be asked to collect.

“It’s an intensive process,” Wintemute said. “The clinicians are going to gather the data that they need in order to treat the patient, and that may not include all the data that a researcher later would want to know about what happened.”

Some of this data is already being collected on a limited basis. The CDC collects of gunshot injuries from ERs in about a dozen states. The White House wants data from across the nation.

Wilcox added that federal grant dollars are available to health systems to conduct gun data collection through the , which Biden signed in 2022.

This year, Biden asked Congress to again boost funding for CDC firearm research in his proposed fiscal 2025 budget, but his previous efforts have failed in the GOP-controlled House of Representatives.

Lawmakers have yet to release a draft of their spending proposal for the Department of Health and Human Services.

“We should focus our CDC resources on infectious diseases, transmittable diseases, and certainly chronic diseases rather than controversial, political-charged activities,” of Biden’s 2024 funding proposal.

Surveys show most Americans — across political affiliations and regardless of gun ownership — that could reduce violence.

At this week’s meetings with health leaders, White House officials will also encourage doctors to talk with patients and the public about gun safety and securing guns.

When Wintemute talks with patients in the ER, he sits beside them and asks about their safety and the safety of others in their home, a practice he said many doctors already use to address an array of potential risks in a person’s life. The White House’s call for physicians to talk about gun violence legitimizes that, he said.

“A health professional can do what we do about tobacco and alcohol and other sorts of potentially risky behaviors, and talk with patients about how do we minimize the risk,” Wintemute said.

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Despite years of pleading for a two-lane road, lower speed limits, safety islands, and more marked crosswalks, residents say the county had done little to address speeding in this unincorporated pocket of southeastern Los Angeles. Since 2012, this half-mile stretch of Avalon Boulevard had logged 396 crashes, injuring 170 and killing three.

Olivares, 27, a civil engineer for the city of Los Angeles, became the fourth fatality when he was hurled across the street, hit by a second car, and instantly killed. Rivas Cruz was transported to a hospital, where she remained in a coma for two weeks. Once awake, the elementary school teacher underwent a series of reconstructive surgeries to repair her arm, jaw, and legs.

In the aftermath of the February 2023 crash, the county installed protective steel posts midway across the street. But residents, who had sought a platformed center divider and speed cameras, said that wasn’t enough.

“It’s just a band-aid on a cut. This is supposed to solve it, but it doesn’t, and that is what hurts,” said Rivas Cruz, who now at age 28 walks with a cane and lives with chronic pain. “I go to sleep, and I’m like, ‘It’s just a dream, it’s just a dream.’ And it’s not.”

The nation’s road system covers 4 million miles and is governed by a patchwork of federal, state, and local jurisdictions that often operate in silos, making systemic change difficult and expensive. But amid the highest number of pedestrians killed in decades, localities are pushing to control how speed limits are set and for more accountability on road design. This spring, and passed laws allowing local jurisdictions to lower speed limits. In Los Angeles, voters approved that forces the city to act on its own , mandating that the car-loving metropolis redesign streets, add bike lanes, and protect cyclists, transit riders, and pedestrians.

Still, there’s plenty of political resistance to speed enforcement. In California’s Statehouse, Sen. Scott Wiener (D-San Francisco) proposed requiring GPS-equipped smart devices in new cars and trucks to prevent excessive speeding. But after pushback, the state lawmaker watered down to require all vehicles sold in the state starting in 2032 to have only warning systems that alert drivers when they exceed the speed limit by more than 10 mph.

Although the Biden administration is championing — its commitment to zero traffic deaths — and injecting more than $20 billion in funding for transportation safety programs through the , road safety advocates and some lawmakers argue that the country is still far from making streets and vehicles safe, or slowing drivers down.

“We are not showing the political will to use the proven safety tools that exist,” said Leah Shahum, founder of a nonprofit organization advancing Vision Zero in communities across the country.

Still a Crisis

The need for safer roads took on urgency during the covid pandemic. Fatalities rose even as lockdown mandates emptied streets. , more than 42,500 people died on American roads, and at least 7,522 pedestrians were fatally struck — the highest tally of pedestrian deaths in more than four decades.

Experts cite several reasons for the decline in road safety. During the lockdowns, reckless driving increased while traffic enforcement declined. SUVs and trucks have become larger and heavier, when they hit a pedestrian. Other factors persist as streets remain wide to accommodate vehicles, and in some states speed limits have .

Early estimates of motor vehicle fatalities show a from 2022 to 2023, but pedestrian fatalities are still notably above . “It’s an encouraging start, but the numbers still constitute a crisis,” Transportation Secretary Pete Buttigieg of roadway deaths.

The Biden administration has directed to road safety until 2026 and in local grants to prevent roadway deaths and injuries. Under the U.S. Department of Transportation’s new “, states with 15% or more deaths involving pedestrians, bicyclists, or motorcyclists compared with all road deaths must match federal dollars in their safety improvement spending.

Road safety advocates argue the federal government missed an opportunity to eliminate outdated standards for setting speed limits when it revised traffic guidelines . The agency could have eliminated guidance recommending setting speed limits at or below how fast 85% of drivers travel on uncongested roads. Critics contend that what’s known as the 85th percentile rule encourages traffic engineers to set speed limits at levels unsafe for pedestrians.

But the Federal Highway Administration wrote in a statement that while the 85th percentile is the typical method, engineers rarely rely solely on this rule. It also noted that states and some local agencies have their own criteria for setting speed limits.

In response, grassroots efforts to curtail speeding have sprouted across communities. In April, Michigan granting local governments authority to when setting speed limits.

And after four years of lobbying, New York state passed Sammy’s Law, named after 12-year-old Sammy Cohen Eckstein, who was killed by a driver in Brooklyn in 2013. The law, which will take effect in June, allows New York City to lower its speed limits to 20 mph in designated areas.

“With this legislation, I hope we can learn more children’s names because of their accomplishments, their personalities, and their spirit — not their final moments,” said Sammy’s mother, Amy Cohen.

Push for Pedestrian Safety

Advocates would also like the federal government to factor in pedestrian safety on the five-star vehicle safety rating scale. However, the National Highway Traffic Safety Administration has proposed a separate pass/fail test that would be posted only on the agency’s website, not on labels consumers would see at the dealership.

Automakers like BMW of a program testing pedestrian protections in vehicles arguing that in European countries that adopted such a regulation, it’s not been clear whether it led to fewer deaths and injuries. According to the campaign finance site Open Secrets, automakers spent about lobbying in 2023 compared with spent by advocates for highway and auto safety.

“The federal government has the biggest punch when it comes to requiring improved vehicle safety design,” said Wiener, the California state lawmaker.

Although Wiener modified his proposal to restrict excessive speeding, he has advanced that would require Caltrans, the state transportation agency, to make improvements such as adding crosswalks and curb extensions on state-owned surface streets to better serve pedestrians, cyclists, and transit users.

When that bill was heard in a committee, opponents, including engineering firms and contractors, cautioned it would remove flexibility and hamper the state’s ability to deliver a safe and efficient transportation system. Lawmakers have until Aug. 31 to act on his bills.

In Los Angeles, hope for change arrived in March when voters passed , which requires the city to invest $3.1 billion in road safety over the next decade. Rivas Cruz’s house, however, sits eight blocks outside the jurisdiction of the city initiative.

It’s been more than a year since the crash, but Rivas Cruz finds reminders everywhere: in the mirror, when she looks at the scars left on her face after several surgeries. When she walks on the street that still lacks the infrastructure that would have protected her and Raymond.

Stories of pedestrians killed in this Latino working-class neighborhood are too common, said Rivas Cruz. In September, she attended a memorial of a 14-year-old who was killed by a reckless driver.

“There’s so much death going on,” the Los Angeles Unified School District teacher said from her mother’s living room on a spring afternoon. “The representatives have failed us. Raymond and I were giving back to the community. He was a civil engineer working for the city, and I’m a LAUSD teacher. Where is our help?”

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A pesar de años de súplicas por una avenida de dos carriles, límites de velocidad más bajos, islas de seguridad y más pasos de peatones señalizados, los residentes dicen que el condado hizo poco para abordar el exceso de velocidad en este sector no incorporado del sureste de Los Ángeles.

Desde 2012, este tramo de media milla de Avalon Boulevard ha registrado 396 accidentes, con 170 heridos y tres muertos.

Olivares, de 27 años, ingeniero civil de la ciudad de Los Ángeles, se convirtió en la cuarta fatalidad cuando fue lanzado al otro lado de la calle, en donde lo impactó otro vehículo, y murió en el acto. A Rivas Cruz la trasladaron al hospital, donde estuvo dos semanas en coma. Cuando despertó, la maestra de primaria se sometió a una serie de cirugías reconstructivas para reparar su brazo, mandíbula y piernas.

Después del accidente que ocurrió en febrero de 2023, el condado instaló postes de acero protectores en el medio de la calle. Pero los residentes, que habían solicitado un divisor central elevado y cámaras de velocidad, dijeron que no era suficiente.

“Es solo una venda en un corte. Se supone que esto lo solucionará, pero no es así, y eso es lo que duele”, dijo Rivas Cruz, quien ahora, a sus 28 años, camina con un bastón y vive con dolor crónico. “Me voy a dormir y pienso, ‘Es solo un sueño, es solo un sueño’. Y no lo es”.

El sistema de carreteras de la nación cubre 4 millones de millas y está gerenciado por un mosaico de jurisdicciones federales, estatales y locales que a menudo operan de manera aislada, lo que hace que el cambio sistémico sea difícil y costoso.

Pero en medio del mayor número de peatones muertos en décadas, las localidades están presionando para controlar cómo se establecen los límites de velocidad y para que haya más responsabilidad en el diseño de las carreteras.

Esta primavera, y aprobaron leyes que permiten a las jurisdicciones locales reducir los límites de velocidad.

En Los Ángeles, los votantes aprobaron que obliga a la ciudad a actuar según su propio plan de mejora de la seguridad vial, exigiendo que la gran urbe amante de los coches rediseñe las calles, agregue carriles para bicicletas y proteja a ciclistas, usuarios de transporte público y peatones.

Aún así, hay mucha resistencia política a la aplicación de límites de velocidad. En la Legislatura del estado de California, el senador Scott Wiener (demócrata de San Francisco) propuso exigir dispositivos inteligentes equipados con GPS en coches y camiones nuevos para evitar el exceso de velocidad.

Pero después de la oposición, el legislador estatal suavizó su para requerir que todos los vehículos vendidos en el estado a partir de 2032 tengan solo sistemas de advertencia que alerten a los conductores cuando excedan el límite de velocidad en más de 10 mph.

Aunque la administración Biden está liderando —su compromiso de cero muertes en el tráfico— e inyectando más de $20 mil millones en fondos para programas de seguridad vial a través de la , defensores de la seguridad vial y algunos legisladores argumentan que el país todavía está lejos de hacer que las calles y los vehículos sean seguros, o de reducir la velocidad de manejo.

“No estamos mostrando la voluntad política de usar las herramientas de seguridad probadas que existen”, dijo Leah Shahum, fundadora de , una organización sin fines de lucro que promueve Vision Zero en comunidades de todo el país.

Una crisis que persiste

La necesidad de carreteras más seguras se volvió urgente durante la pandemia de covid. Las muertes aumentaron incluso cuando los mandatos de confinamiento dejaron las calles vacías.

, más de 42,500 personas murieron en las carreteras estadounidenses, y al menos 7,522 peatones murieron al ser atropellados, el mayor número de muertes de peatones en más de cuatro décadas.

Expertos citan varias razones para el deterioro de la seguridad vial. Durante los confinamientos, aumentó el manejo imprudente mientras disminuía la vigilancia del tráfico. Los SUV y camiones se han vuelto más grandes y pesados, por lo tanto cuando golpean a un peatón. Otros factores persisten ya que las calles siguen siendo amplias para que puedan circular más vehículos, y en algunos estados los límites de velocidad .

Las estimaciones iniciales de muertes por accidentes de tráfico muestran de 2022 a 2023, pero las muertes de peatones siguen siendo notablemente superiores a las . “Es un comienzo alentador, pero los números todavía constituyen una crisis”, escribió el Secretario de Transporte, Pete Buttigieg, .

La administración Biden ha destinado a la seguridad vial hasta 2026, y en subvenciones locales para prevenir muertes y lesiones en las carreteras.

Según la nueva regla del del Departamento de Transporte de Estados Unidos, los estados con un 15% o más de muertes que involucren a peatones, ciclistas o motociclistas en comparación con todas las muertes en carretera deben igualar los dólares federales en su gasto en mejoras de seguridad.

Defensores de la seguridad vial argumentan que el gobierno federal perdió la oportunidad de eliminar los estándares obsoletos para establecer límites de velocidad cuando revisó las pautas de tráfico .

La agencia podría haber eliminado la recomendación de establecer límites de velocidad en o por debajo de la velocidad a la que viajan el 85% de los conductores en carreteras no congestionadas. Los críticos sostienen que lo que se conoce como la regla del percentil 85 alienta a los ingenieros de tráfico a establecer límites de velocidad a niveles que son inseguros para los peatones.

Pero la Administración Federal de Carreteras escribió en un comunicado que aunque el percentil 85 es el método típico, los ingenieros rara vez se basan únicamente en esta regla. También señaló que los estados y algunas agencias locales tienen sus propios criterios para establecer límites de velocidad.

En respuesta, han surgido esfuerzos de base para frenar el exceso de velocidad en las comunidades. En abril, Michigan que otorga a los gobiernos locales la autoridad para al establecer límites de velocidad.

Y después de cuatro años de cabildeo, el estado de Nueva York aprobó la Ley de Sammy, nombrada en honor a Sammy Cohen Eckstein, un niño de 12 años que fue atropellado por un conductor en Brooklyn en 2013. La ley, que entrará en vigencia en junio, permite a la ciudad de Nueva York reducir sus límites de velocidad a 20 mph en áreas designadas.

“Con esta legislación, espero que podamos conocer los nombres de más niños por sus logros, sus personalidades y su espíritu, no por sus últimos momentos”, dijo la madre de Sammy, Amy Cohen.

Impulso por la seguridad peatonal

Los defensores también quisieran que el gobierno federal considerara la seguridad de los peatones en la escala de calificación de seguridad de vehículos de cinco estrellas. Sin embargo, la Administración Nacional de Seguridad del Tráfico en las Carreteras ha propuesto una prueba separada de aprobado/reprobado que solo se publicaría en el sitio web de la agencia, no en las etiquetas que los consumidores verían en el concesionario.

Los fabricantes de automóviles como BMW de un programa que prueba las protecciones para peatones en vehículos, argumentando que en los países europeos que adoptaron dicha regulación, no ha quedado claro si llevó a una reducción de muertes y lesiones.

Según el sitio de financiamiento de campañas Open Secrets, los fabricantes de automóviles gastaron alrededor de en cabildeo en 2023 en comparación con los gastados por los que abogan por una mayor seguridad vial.

“El gobierno federal tiene el mayor poder cuando se trata de exigir un diseño de vehículos más seguro”, dijo Wiener, el legislador estatal de California.

Aunque Wiener modificó su propuesta para restringir el exceso de velocidad, ha avanzado que requeriría que Caltrans, la agencia de transporte del estado, haga mejoras como agregar pasos de peatones y extensiones de aceras en calles propiedad del estado para servir mejor a peatones, ciclistas y usuarios del transporte público.

Cuando ese proyecto de ley tuvo su audiencia ante un comité, los opositores, incluidas empresas de ingeniería y contratistas, advirtieron que eliminaría la flexibilidad y obstaculizaría la capacidad del estado para ofrecer un sistema de transporte seguro y eficiente. Los legisladores tienen hasta el 31 de agosto para actuar sobre sus proyectos de ley.

En Los Ángeles, la esperanza de cambio llegó en marzo cuando los votantes aprobaron la , que requiere que la ciudad invierta $3.1 mil millones en seguridad vial durante la próxima década. Sin embargo, la casa de Rivas Cruz está a ocho cuadras fuera de la jurisdicción que abarca la iniciativa de la ciudad.

Ha pasado más de un año desde el accidente, pero Rivas Cruz encuentra recordatorios en todas partes: en el espejo, cuando mira las cicatrices que quedaron en su rostro después de varias cirugías. Cuando camina por la calle que aún no tiene la infraestructura que la hubiera protegido a ella y a Raymond.

Las historias de peatones muertos en este vecindario de clase trabajadora latina son demasiado comunes, dijo Rivas Cruz. En septiembre, asistió al memorial de un niño de 14 años que fue atropellado por un conductor imprudente.

“Hay tanta muerte ocurriendo”, dijo la maestra del Distrito Escolar Unificado de Los Ángeles desde el living de su madre una tarde de primavera. “Los representantes nos han fallado. Raymond y yo estábamos devolviendo a la comunidad. Él era un ingeniero civil que trabajaba para la ciudad, y yo soy maestra del LAUSD. ¿Dónde está nuestra ayuda?”.

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Raised in New Orleans by a mother with untreated bipolar disorder who later killed herself and two others, Tipton said she endured layers of trauma that eventually forced her to seek treatment for crippling anxiety and hypervigilance. For 10 years nothing helped, and she began to wonder if she was “unfixable.”

Then she answered an ad for a clinical trial for MDMA-assisted therapy to treat post-traumatic stress disorder. Tipton said the results were immediate, and she is convinced the drug could help a lot of people. But even as regulators weigh approval of the first MDMA-based treatment, she’s worried that it won’t reach those who need it most.

“The main thing that I’m always concerned about is just accessibility,” the 43-year-old nonprofit project manager said. “I don’t want to see this become just another expensive add-on therapy for people who can afford it when people are dying every day by their own hand because of PTSD.”

MDMA is part of a new wave of psychoactive drugs that show great potential for treating conditions such as severe depression and PTSD. Investors are piling into the nascent field, and a host of medications based on MDMA, LSD, psychedelic mushrooms, ketamine, the South American plant mixture ayahuasca, and the African plant ibogaine are now under development, and in some cases vying for approval by the Food and Drug Administration.

Proponents hope the efforts could yield the first major new therapies for mental illness since the introduction of modern antidepressants in the 1980s. But not all researchers are convinced that their benefits have been validated, or properly weighed against the risks. And they can be difficult to assess using traditional clinical trials.

The first MDMA-assisted assisted therapy appeared to be on track for FDA approval this August, but a from an independent review committee challenged the integrity of the trial data from the drug’s maker, Lykos Therapeutics, a startup founded by a psychedelic research and advocacy group. The FDA will convene a panel of independent investigators on to determine whether to recommend the drug’s approval.

Proponents of the new therapies also worry that the FDA will impose treatment protocols, such as requiring multiple trained clinicians to monitor a patient for extended periods, that will render them far too expensive for most people.

Tipton’s MDMA-assisted therapy included three eight-hour medication sessions overseen by two therapists, each followed by an overnight stay at the facility and an integration session the following day.

“It does seem that some of these molecules can be administered safely,” said David Olson, director of the University of California-Davis Institute for Psychedelics and Neurotherapeutics. “I think the question is can they be administered safely at the scale needed to really make major improvements in mental health care.”

Breakthrough Therapies?

Psychedelics and other psychoactive substances, among the medicines with the , have long been recognized for their potential therapeutic benefits. Modern research on them started in the mid-20th century, but clinical trial results didn’t live up to the claims of advocates, and they eventually got a bad name both from their use as party drugs and from that involved dosing unsuspecting individuals.

The 1970 Controlled Substances Act made most psychoactive drugs illegal before any treatments were brought to market, and MDMA was classified as a Schedule 1 substance in 1985, which effectively ended any research. It wasn’t until 2000 that scientists at Johns Hopkins University were granted regulatory approval to study psilocybin anew.

Ketamine was in a different category, having been approved as an anesthetic in 1970. In the early 2000s, researchers discovered its antidepressant effects, and a ketamine-based therapy, Spravato, received FDA approval in 2019. Doctors can also prescribe generic ketamine off-label, and hundreds of across the nation. A is underway to evaluate ketamine’s effectiveness in treating suicidal depression when used with other psychiatric medications.

Ketamine’s apparent effectiveness sparked renewed interest in the therapeutic potential of other psychoactive substances.

They fall into distinct categories: MDMA is an entactogen, also known as an empathogen, which induces a sense of connectedness and emotional communion, while LSD, psylocibin, and ibogaine are psychedelics, which create altered perceptual states. Ketamine is a dissociative anesthetic, though it can produce hallucinations at the right dose.

Despite the drugs’ differences, Olson said they all create neuroplasticity and allow the brain to heal damaged neural circuits, which imaging shows can be shriveled up in patients with addiction, depression, and PTSD.

“All of these brain conditions are really disorders of neural circuits,” Olson said. “We’re basically looking for medicines that can regrow these neurons.”

Psychedelics are particularly good at doing this, he said, and hold promise for treating diseases including Alzheimer’s.

A number of psychoactive drugs have now received the FDA’s “breakthrough therapy” designation, which expedites development and review of drugs with the potential to treat serious conditions.

But standard clinical trials, in which one group of patients is given the drug and a control group is given a placebo, have proven problematic, for the simple reason that people have no trouble determining whether they’ve gotten the real thing.

The final clinical trial for Lykos’ MDMA treatment showed that 71% of participants no longer met the criteria for PTSD after 18 weeks of taking the drug versus 48% in the control group.

A March report by the Institute for Clinical and Economic Review, an independent research group, questioned the company’s clinical trial results and challenged the objectivity of MDMA advocates who participated in the study as both patients and therapists. The institute also questioned the drug’s cost-effectiveness, which insurers factor into coverage decisions.

Lykos, a public benefit company, was formed in 2014 as an offshoot of the Multidisciplinary Association for Psychedelic Studies, a nonprofit that has invested more than $150 million into psychedelic research and advocacy.

The company said its researchers developed their studies in partnership with the FDA and used independent raters to ensure the reliability and validity of the results.

“We stand behind the design and results of our clinical trials,” a Lykos spokesperson said in an email.

There are other hazards too. Psychoactive substances can put patients in vulnerable states, making them potential victims for or other types of abuse. In Lykos’ second clinical trial, two therapists were found to have spooned, cuddled, blindfolded, and pinned down a female patient who was in distress.

The substances can also cause shallow breathing, , and hyperthermia.

To mitigate risks, the FDA can put restrictions on .

“These are incredibly potent molecules and having them available in vending machines is probably a bad idea,” said Hayim Raclaw of Negev Capital, a venture capital fund focused on psychedelic drug development.

But if the protocols are too stringent, access is likely to be limited.

Rachel del Dosso, a trauma therapist in the greater Los Angeles area who offers ketamine-assisted therapy, said she’s been following the research on drugs like MDMA and psilocybin and is excited for their therapeutic potential but has reservations about the practicalities of treatment.

“As a therapist in clinical practice, I’ve been thinking through how could I make that accessible,” she said. “Because it would cost a lot for [patients] to have me with them for the whole thing.”

Del Dosso said a group therapy model, which is sometimes used in ketamine therapy, could help scale the adoption of other psychoactive treatments, too.

Artificial Intelligence and Analogs

Researchers expect plenty of new discoveries in the field. One of the companies Negev has invested in, Mindstate Design Labs, to analyze “trip reports,” or self-reported drug experiences, to identify potentially therapeutic molecules. Mindstate has asked the FDA to green-light a clinical trial of the first molecule identified through this method, 5-MeO-MiPT, also known as moxy.

AlphaFold, an AI program developed by Google’s DeepMind, has identified thousands of potential psychedelic molecules.

There’s also a lot of work going into so-called analog compounds, which have the therapeutic effects of hallucinogens but without the hallucinations. The maker of a announced in March that the FDA had granted it breakthrough therapy status.

“If you can harness the neuroplasticity-promoting properties of LSD while also creating an antipsychotic version of it, then that can be pretty powerful,” Olson said.

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Residential treatment facilities are usually nondescript homes tucked into neighborhoods. The state’s lowest-intensity homes can provide people with alcohol and drug addiction leaving inpatient care a bridge to independent living. They’re the final option of four tiers of clinical housing and aim to offer residents stability amid daily stressors.

But these particular houses have been disappearing — down to 10 sites today from 14 in 2022. That was the year the state started paying providers a blanket rate for their services through Medicaid, the state-federal program for people with low incomes and disabilities. At the same time, the state increased the homes’ staffing requirements.

State health department officials lauded the 2022 change as an expansion in access to care, saying it increased the houses’ pay and matched the cost to operate. But providers warned at the time that it could backfire because the rates weren’t high enough to cover the new staffing rules.

Terri Russell, who runs John “Scott” Hannon House, a treatment home in Helena, said it has been hard to break even since, and she’s watched other sites close under financial pressure.

“It’s the hardest thing in the world to watch a person leave treatment and go back down to the homeless shelter, or go on the street,” Russell said.

The new voucher program could help fill in some of the gap, Russell said. Approved by the state in April, it pays low-intensity treatment residences to house uninsured people as they sign up for Medicaid or other health coverage. The idea is to reduce barriers to care for vulnerable patients at a key point in their recovery. But the money is capped at $35 a day, with a $1,000 limit per resident a year.

“It’s like it was somebody’s idea for a band-aid,” said Demetrius Fassas, who runs Butte Spirit Homes, which has two eight-bed facilities.

He said the payments fall well below the cost of providing care. And, because of the vouchers’ cap, the aid could run out weeks before someone knows whether they qualify for Medicaid coverage.

Low-intensity programs vary in how long patients stay; it could be a few months or more than a year. Fassas said when things go as intended, clients find stable jobs. That success can lead to residents earning too much money to qualify for Medicaid but not enough to afford the full cost of care.

Providers have said funding issues are widespread for substance use disorder programs but that shortfalls especially hit these low-intensity homes. The tension in Montana mirrors challenges elsewhere around how to fund transitional treatment so that patients don’t fall off a cliff in their recovery because care is unavailable.

As of 2022, at least 33 states were using money from Medicaid to help run residential treatment programs, . Federal rules prohibit Medicaid dollars from going to room and board at transitional homes, though states can chip in their own money. In North Dakota, for example, lawmakers set aside state funds for a voucher program that addresses treatment barriers, which include the cost of room and board.

Montana once was among the states that let providers seek help covering room and board costs for its poorer residents. The money came from federal grants the state manages for addiction treatment and prevention.

But those room and board grants stopped when Montana’s health department shifted to higher, bundled Medicaid rates in 2022. According to , reducing the block grants to the low-intensity homes allowed officials to put that money toward other “prevention priorities.”

The new rules the state added at the same time brought the residential facilities up to American Society of Addiction Medicine standards. That included having on-site clinical services, a clinical director for each home, and an employee working anytime a resident was in the home, including night shifts.

Fassas, of Butte Spirit Homes, called the rules bittersweet. They increased the quality of care. But, Fassas said, he had to hire six additional workers to comply with the rules and the company now runs at a loss if he doesn’t find additional grants.

Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, said the new rates, $143 a day per Medicaid resident, were developed by a state-paid contractor as part of Montana’s effort to match the cost of care.

Ebelt said administrative costs were factored into the state’s Medicaid rate, and that traditional room and board expenses typically fall into that category.

Low-intensity homes’ rates haven’t increased since they went into place in 2022.

Malcolm Horn, chief behavioral health officer for the Rimrock Foundation, said the facilities need more help in covering expenses like the mortgage, repairs to the home, or feeding residents.

The Rimrock Foundation, which is based in Billings, is one of Montana’s largest mental health providers. Horn said after the new rules were implemented, Rimrock converted one of its two low-intensity homes for women with children into high-intensity housing, which pays more. The switch displaced families in the low-intensity program.

“We couldn’t actually sustain having both those houses,” Horn said.

Montana officials for the voucher program and estimated that money would help cover initial housing for 329 people in 2024.

Terri Todd, who runs the nonprofit Gratitude in Action in Billings for people in recovery, advocated for the program during the 2023 legislative session. She said the goal had been to follow North Dakota’s model to help cover addiction care for people facing barriers. But Montana lawmakers scaled that back, which Todd attributed to concerns about cost.

Todd said that while what survived the legislature is less than what she had hoped for, the voucher program is still a start in addressing barriers to care.

State Rep. Mike Yakawich, the Republican who proposed the program, said it was initially so broad, he learned, it overlapped with some existing efforts. But he said state staffers told him the low-intensity group homes’ room and board costs were an area that could use more funding.

Yakawich said securing any money felt like a win in a funding tug-of-war. More help to stabilize the state’s mental health system is coming.

Money for the vouchers is coming out of Republican Gov. Greg Gianforte’s HEART Fund initiative, which is due to invest about $25 million a year toward behavioral health programs. Separately, state that they’re creating grants to increase Montana’s bed capacity across residential facilities, including for substance use treatment providers. That money could go toward reopening closed facilities.

But Yakawich said even that infusion of money won’t provide enough to go around.

“Everybody wants a chunk of the pie, and not everyone’s going to get it,” he said.

The voucher program is scheduled to expire in three years, Yakawich said. By then, he said, maybe he can persuade lawmakers to renew the program — with more money.

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BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

Aquino has lots of company.

Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, . In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

Those factors helped drive a in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in and .

The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about in the U.S., according to the Centers for Disease Control and Prevention.

Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.

Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

Without warning, “a dark cloud came over me,” she said.

Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.

In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.

One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state .

Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

A new in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation.