The shuffle of somnolent, zombie-like figures in the shadows tells an old story: heroin. The inner-city scourge of the 1970s has reappeared in an epidemic of narcotic addiction fueled by an efficient distribution network to a generation of addicts cut off from prescription painkillers.
The bleak transition back to heroin is borne out in stark statistical patterns: Overdosing is now the leading cause of accidental death in the US, accounting for more deaths than traffic fatalities, or gun crime and suicides.
According to the US National Institute on Drug Abuse, between 2001 and 2013, there has been a fivefold increase in the total number of fatal heroin overdoses to 8,200. Across the northeastern states, where the epidemic is focused, US authorities report overstretched emergency services, surging rates of hepatitis C in rural communities and police struggling to interrupt distribution channels controlled by Mexican prison escapee Joaquin “El Chapo” Guzman’s Sinaloa cartel.
Illustration: Mountain People
In a development that has further alarmed health and law officials, the epidemic is appearing in demographic groups with typically low rates of heroin use, including women, the insured and the comparatively well-off.
On the streets of Reading, Pennsylvania, a run-down industrial town best known as the birthplace of Taylor Swift, the cat-and-mouse game between dealers and their customers, and police patrols and emergency services goes on through the last warm nights of the year: young men looking for K2, or “wet” — a Chinese-produced herb dipped in hallucinogenic chemicals, including embalming fluid — middle-aged women in cheap makeup on crack cocaine. Then there is the slow, rangy foot-traffic for heroin, or “raw” in the street vernacular.
In August, a nearby county recorded 16 overdoses in 24 hours; 25 over two days.
“Heroin is no longer just the inner-city drug it was,” said Pasquale Leporace, detective sergeant with the Berks County district attorney’s office. “The abusers are younger and from more affluent backgrounds.”
Phelicia, a 23-year-old single mother, was prescribed the painkiller Percocet after dental surgery.
“I liked how it made me feel,” she said.
When a crackdown on loose prescribing and “pill mills” reduced availability, she began buying “20s” — 20mg strength pills — on the street. Prices soared and heroin presented itself as a stronger, and dreamier in its effects, alternative.
“They didn’t understand that you can’t just cut people off. They’re going to find other means and ways. It became a lot easier and cheaper to get heroin,” Phelicia said.
In August, the White House announced increased funding for programs to trace where heroin is coming from, and how and where it is being cut with additives that have caused a rash of fatal overdoses across the northeast.
The growing alarm has registered with US presidential candidates: Hillary Rodham Clinton proposed a US$10 billion plan to counter the “quiet epidemic” of heroin addiction.
Clinton said that she never expected to be questioned about her drug-addiction policies so early in her campaign.
“The very first question was: ‘What will you do about the heroin epidemic?’” she said.
New Hampshire Governor Maggie Hassan is being urged to declare a state of emergency over the heroin epidemic. Her counterpart in neighboring Vermont, Peter Shumlin, last year devoted his entire annual address to the state’s heroin crisis.
In academia, five US universities announced they would stock the overdose antidote naloxone on campuses to try to stem the tide of student fatalities.
The US Drug Enforcement Agency says the increased supply of heroin is largely down to the Sinaloa cartel, the world’s largest, most profitable drug-dealing organization. It is estimated that more than 102 tonnes of heroin was smuggled into the US last year, almost all of it across the border with Mexico.
“In this region, we used to see heroin coming from the Golden Triangle,” agency spokesman Patrick Trainor said. “Now most of the heroin we’re seeing on the east coast is coming from the Sinaloa cartel.”
In addition to expanding into the cultivation of poppies and production of refined heroin, some believe the cartel might be a conduit for heroin manufactured in southeast Asia — the trade once controlled by the Sicilian mafia through the so-called French Connection — and trafficking Mexican and Colombian-manufactured drugs by return.
Drug counselors in the Reading region say that, despite a series of recent highly publicized seizures, availability remains robust.
“There are dealers everywhere, all over the county,” counselor Jorge Acevedo said. “You can pretty much buy heroin anywhere.”
Rehabilitation groups are looking to take progressive steps to curb the drug’s toll. Last month, Reading’s Council on Chemical Abuse began a pioneering program to hand out nasal spray kits containing naloxone, a drug that reverses acute morphine intoxication.
Program director George Vogel said heroin and opiates have replaced alcohol as the main reason for people who have come to him seeking help.
Vogel said he hopes that the kit, which resembles an asthmatic’s inhaler, will become commonplace.
“I want everybody to have it, moms and dads, sons and daughters, in the event they come in and find someone in their family tied off [with a tourniquet] and unconscious. Now anyone can be a first responder,” he said.
It is a controversial position, with local police departments saying they favor leaving such procedures to trained medical personnel. There have been a record 18 heroin deaths in the county this year and medical emergency personnel carrying naloxone have logged more than 150 overdose “reversals.”
However, just as the new heroin epidemic was seeded by over-prescription of pain medications, the prosecution of prescribing doctors has sent a chill through the medical profession.
In a trial under way in California, Lisa Tseng is charged with murder in the deaths of three patients to whom she had prescribed painkillers. A successful prosecution could set a precedent by making a medical practitioner responsible for the misuse of drugs by a patient.
Dianna Pagan, head of Reading Risk Reduction, a needle exchange in the city that has seen demand for clean syringes triple to 6,000 a month over two years, says merely placing the blame for the surge in heroin with the medical profession comes with risks.
“The short answer is yes: The massive problem we’re seeing is because some doctors were giving out narcotics like candy,” Pagan said.
Now patients who require pain medication might no longer be able to receive it, she said.
“The pendulum has swung the other way. Doctors don’t want anything to do with pain medication,” she said. “So now even people who need prescriptions ... are transitioning from pills to heroin.”
Still, there is some optimism that a gradual move toward a rehabilitation-based approach to addiction could begin to turn the tide in the long-running “war on drugs.”
“If you eliminate supply and you eliminate demand, you could have a fairly clean city,” Vogel said.
However, on Penn Street in downtown Reading, or on the corner of Sixth and Spruce, that seems like a distant reality. In this ever-evolving consumer market, with its niche groups and focused distribution, several men were looking for K2, a drug that can turn users into psychotic zombies, but is cheap and does not show up in court-mandated drug testing.
For both reasons, one street drug user and part-time dealer, who gave his name as Eric, said he has come to favor K2 over heroin.
“Crack is still here and meth. And heroin is huge, but I think K2 will be the heroin of our generation,” he said.
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