by ANDREW EDWARDS
Oh, I've seen the needle
and the damage done,
HEROIN'S SCIENTIFIC NAME IS DIACETYLMORPHINE, but that's not what it's called.
Smack, junk, China White, Black Tar, Chiba, Aries, Big Harry, that's what it's called.
Or Blanco, Bonita, Dyno-pure, George, Golden girl, Hong-yen, Jee gee, Noise, Old Navy, Predator, Rambo.
You want more? How about Rawhide, Reindeer dust, Scott, Shit, the beast, the witch, thunder, train, white nurse, witch hazel?
After last year's terrorist attacks, addicts thought up two more names: Bin Laden and WTC.
The variations, actually, are endless. But then maybe that's because the word itself -- "heroin" -- carries such dark weight, like "dread" or "death." Easier to say "let's do train," after all, than "let's do heroin."
"Even other [types of] addicts have a stigma toward heroin addicts. You'll ask people: You smoked pot? Yes. Ecstasy? Yes. Mushrooms? Yes. LSD? Yes. Coke? Yes. Heroin? Heck no! That stuff's bad!" said Mike Goldsby, program director at St. Joseph Hospital's family recovery services and coordinator of addiction studies at College of the Redwoods.
Despite heroin's nasty reputation, its use has been rising in Humboldt County since the mid-'90s, especially among young people. In 1994, there were 74 admissions to Humboldt County hospitals in which heroin was the primary problem. By 1999, that number had nearly tripled: 214 admissions followed by a corresponding rise in drug-related deaths.
In 2001, there were 17 deaths in Humboldt County directly related to heroin use. There have been 11 so far this year.
"It's an epidemic," said Dr. Ann Lindsay, Humboldt County's public health officer. [photo at left]
Exactly how many heroin users live in Humboldt County is hard to determine. The Humboldt County Drug Task Force estimates there are 300 to 500 hard-core users, but based on the rising number of heroin overdoses of late, county public health says the number could be as many as 1,600.
"People are very committed to keeping their addiction secret," Goldsby said. "There are the stereotypical (lower-class) subcultures people think of, but then there [is] the functional middle-class [and even] a few upper-class people."
Almost all of the heroin that comes into the county is Mexican in origin. It's known as black-tar heroin because of its dirty brown color. It has a low purity -- 2 to 6 percent on average.
It is made by cooking morphine with acetic anhydride, a vinegar salt, which produces a substance four to eight times stronger. Morphine itself is concentrated from opium, the dried milky sap of an unripe poppy seed-pod.
'A terrible thing'
Originally created by the Bayer Co. in Germany in 1898, heroin at first seemed a miracle drug. Unfortunately its addictive side-effects were soon found to outweigh any pain-killing benefits.
"It's a terrible thing -- a terrible, terrible thing," said John, who was addicted to heroin for 35 years. "Heroin is a real euphoric. It holds all the emotional as well as all the physical pain and gives you the illusion that you can live your life loaded and everything's going to be fine. And then it turns on you like a rabid rottweiler. But by then it's too late to do anything about it."
It can also be ruinously expensive. An addict shoots up, smokes or snorts heroin a minimum of two times a day but usually more like three to five times per day. In Humboldt County, that can add up to a $100- to $200-a- day habit. Just to take enough to stave off withdrawal costs $40 a day.
That may sound costly. But it's actually fairly cheap compared to the way it used to be.
"It's cheap, dirt cheap (now), like less than 100 bucks a gram, sometimes less than 60 bucks a gram," said Ron Prose of the California State Bureau of Narcotics Enforcement, which supervises the Humboldt County Drug Task Force. "Back in 1983, when I started here, it was 350 to 400 bucks a gram. We just have a lot more coming up from Mexico now; it's a competitive market and that brings (the price) down."
According to John, the price of heroin has been dropping since the Carter administration.
"When Nixon was in office the dope got worse. It was more expensive and harder to find," John said. "When Carter came in it was cheaper and a little better; you didn't have to drive 25 miles into some Mexican barrio and ask for some guy name Juan. But about six months after Reagan came in the market just got flooded with tar. The price came down to $200 a gram. It went down to $150 with Bush senior. With Clinton it went down to about $80 and it's probably even lower now."
John said he couldn't explain the connection between the occupant of the White House and the street price of heroin. Perhaps it has something to do with different approaches to combating the heroin scourge, with Republican presidents tending to favoring enforcement while Democrat chief executives look more to treatment.
Whatever the case, the average street price in California is currently $40-$100 per gram depending on the purity level. It is generally sold in $5, $10 or $15 bags that contain an eighth of a gram.
Cheap -- and popular with youths
It's this cheaper heroin that has been catching on recently in Humboldt County, especially among young adults.
"For a long time there was hardly any heroin use. [What little there was] was mostly older people, holdovers from the `60s and `70s," said Dr. Wendy Ring, medical director of the Mobile Medical Clinic. "But about two years ago we started seeing younger people using heroin, not high-schoolers but young adults. It's horrible to see these younger people wrecking their lives."
But it's not only cheap prices that have increased heroin use: New modes of delivery have made it more socially acceptable.
"When people are doing drugs together and someone asks if they want heroin, they say, `no, I don't use needles.' And then the person says, `no, you can smoke it or snort it,'" Goldsby said.
He said there is a false belief among young users that heroin isn't addictive if it isn't injected. Several people who smoke heroin have called his clinic saying they didn't even know they were addicted until their supply dried up and they went into withdrawals.
Withdrawals from heroin are no picnic.
Heroin is an opiate, a class of drugs that produces feelings of relaxation and well-being. Often used as painkillers, they induce sleep. Heroin makes people feel comfortable and warm, it causes their pupils to get very small, it dries up their mucous membranes, their tear ducts. It causes constipation. Addicts in withdrawal, which lasts anywhere from five days to two weeks, experience the exact opposite of each effect.
"I've heard it described as a very bad case of the flu in a person who has lowered their tolerance to pain," Goldsby said. [Mike Goldsby in photo at right]
The pain is supposed to be indescribable: coming from deep within bones and muscles and not going away. That -- along with lack of sleep, diarrhea, dilated pupils, eyes that won't stop watering and intense anxiety -- is the reason that more than 80 percent of addicts who attempt to clean up with an abstinence-based program go back on the drug.
"Among users to quit doing heroin, [to go] into withdrawals, is called `getting sick,'" said Goldsby. "Using more heroin is called `getting better.'"
Seeking a way out
At some point, if he or she isn't already dead or in prison, an addict hits rock bottom and starts scrambling for a way out.
In Oregon, there is a program called "forced de-tox" in which addicts are totally sedated and kept that way as their body goes through the withdrawal period, so that when they come out their symptoms are gone.
Another option is methadone clinics, which have been in use over much of the country for about 25 years. Their purpose is to replace heroin with methadone, a synthetic opiate but one that can be orally administered. That eliminates the need for needles, which carry the risk of infection. Additionally, because methadone is more socially acceptable, it gets addicts out of the dangerous quarters of society heroin users tend to inhabit. Finally, because it's readily available, there's no longer a constant urge to "score." Methadone can help take the drug out of the center of the addict's life.
"It can be a wonderful thing for stabilization, employment and participation in family life," Lindsay said.
It doesn't work for everyone, however -- primarily because it still perpetuates the addiction to opium.
"I was on methadone for 12 years," John said. "I hated my life for 12 years. I hated the high, I hated the fact that I was an addict, but I just couldn't stop."
John eventually went back to heroin for several years before quitting opiates altogether.
When Lindsay became the county's public health officer in 1993 she immediately started a campaign to create a methadone clinic in Eureka, but the project was foiled by budget constraints and opposition from people who didn't want the clinic in their neighborhood. According to Lindsay, the funding problems have been cleared up, but she said the not-in-my-backyard problem remains.
Without a methadone clinic, most of the locally available addiction-treatment programs require the addict to go cold turkey.
There are programs centered around Christianity, such as the year-long program at the Eureka Rescue Mission, which involves a one-month lock-down period and two-months of chaperoned excursions. Applicants are religiously instructed and advised to replace their love of heroin with love for Jesus.
There are traditional 12-step programs patterned on Alcoholics Anonymous, which rely on admission of addiction, mutual support and faith in a higher power of some sort to conquer addiction. Narcotics Anonymous has several support groups that meet throughout the county that include heroin addicts.
There are medical-based programs such as Goldsby's at Family Recovery which use prescription drugs to offset the symptoms of withdrawal and monitor patients' progress over the course of a year of weekly check-ups.
Overall, however, there is a shortage of narcotics treatment programs in Humboldt County.
"We don't have nearly enough treatment available locally, particularly for people who are addicted to opiates (like heroin)," Dr. Ring sad.
Reducing the infection hazard
One notable exception to the abstinence-based treatment programs in the county are needle-exchange programs, which seek to reduce the infection hazard by providing junkies with clean needles.
Critics say this simply encourages drug use. But supporters say needle exchange programs recognize that there are some users who are not going to quit anytime soon, but who need help maintaining their health while in the throes of addiction.
There's no question about the danger of dirty needles.
Almost three years ago the county did a "seral prevalence" study, where over 300 intravenous drug users were paid to have their blood tested for infectious diseases.
The study showed that over 70 percent of IV users in Humboldt have Hepatitis C, which can cause liver failure and death, a staggering rate of infection. There are about 300 cases of chronic Hepatitis C reported in the county each year, 144 so far in 2002.
As a result, in January 2000 the Humboldt County Board of Supervisors declared a state of emergency relating to the transfer of Hepatitis B and C and HIV through contaminated needles. This allowed state and other public funds to be made available for needles -- even though, strictly speaking, needles amount to illegal drug paraphernalia.
To ensure continued funding, the supervisors have renewed the emergency declaration every two weeks ever since.
By limiting the number of needles exchanged at one visit by one individual to 20 and having health consultations with every addict that comes in, the clinics try to maintain the health of the addict community and give addicts hope for the future.
"Most of the people who come in are now immunized against hep[atitis] A and B, immunized against TB (tuberculosis) and screened for AIDS," said Dr. Ring, who directs a needle exchange program in Eureka. "People start thinking `If the people in this clinic care enough about my health to do this with me and talk about this, maybe my health is important and maybe I'm important.'"
A vaccine has yet to be developed for Hepatitis C.
Even with some limits, however, the needle programs in Humboldt County exchange and destroy over 17,000 needles a month. That's a large number, but the fact is that a single addict can go through 600 needles in a month.
Unfortunately, things don't always work out best for those hooked on heroin.
"We had two patients this year from our needle exchanges die from overdoses," Ring said. "Most of the people I see in my clinic are really good people. They may have drug problems, but they're kind and have good hearts and help people, and it's really sad to lose one of them."
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