The “New” Heroin Crisis Is Old News—But We Need a New Response
My experiences as a social worker and recovering addict showed me long ago why people "graduate" from Rx opioids to heroin. As publicity belatedly builds, will we be able to avoid the knee-jerk reaction of revving up the drug war?
The media has been all over the nation’s “new heroin epidemic” since the governor of Vermont, Peter Shumlin, used his entire State of the State address to alert his fellow Vermonters to their “full-blown heroin crisis.” But the new heroin epidemic is not new. And while there’s recently been hope that the drug war is winding down, I fear that in the suburban and rural counties where new dope markets are springing up as painkiller supplies dwindle, it could rev back up if we resort to the same measures that failed previous generations. We cannot arrest our way out of the current generation’s drug “crisis.”
I like to think I speak with some authority because not only am I a social worker whose clients are felony drug offenders in the Philadelphia criminal justice system. But I also used to be addicted to opiates. I knew the OxyContin epidemic was going to create a surge in heroin use back in January 2004. That was when I went to detox for my own 320 mg per day OxyContin habit. I expected to be a detox anomaly, perhaps seen as not even a hard-core user because I was only snorting pills instead of shooting dope—like the first time I went to treatment, in the early ‘90s aged 21. But to my surprise the facility was jammed with young Oxy addicts in their late teens and early twenties.
For decades Philly had been a two-drug town—dope and coke—but it quickly became clear to me while sitting in rehab that something had shifted at the street level. Philly was now all about prescription drugs, or “pharms”: “Oxys” (Oxycontin) , “Zanies” (Xanax), “Percs” (Percocet), “Endos” (Endodan), “syrup” (codeine cough syrup) and even “Suzie Qs” (the antipsychotic Seroquel) were what young drugs users, most of whom had never shot heroin or smoked crack, were seeking in the black market.
But it wasn’t just that the treatment center was teeming with freshly minted new young Oxy addicts—who really had no interest in recovery—that made me realize that today’s young Oxy users were becoming the heroin users of tomorrow. Inside the facility these young people were mixing with older, more streetwise heroin addicts who deplored narc pharms as a tragic waste of money that was better spent on good dope. Heroin addicts measure their days in $10 increments; every penny counts and the quest for the purest possible bag is ongoing. That these kids were spending $40 for a pill that did the same thing struck them as rank idiocy.
The old heads evangelized the newcomers, explaining the economics of addiction, imploring them to come along for a ride “down the way,” as local heroin users call going to the Kensington neighborhood in Northeast Philly where heroin trades. There they could get a better deal on dope and a better ride by using a needle instead of snorting. I watched kids signing themselves out against medical advice on a daily basis, leaving the facility with older addicts to go find heroin and move into the next, more serious phase of their addiction.
In March 2006 I wrote this about what I was seeing:
“At some point in these [boastful detox] conversations [about how much OxyContin addicts had been using], an old-head heroin junky was bound to throw his two cents in, killing the fun and silencing the children with a booming voice that was full of the seasoned addict’s cold and calculating reason.
The old heads evangelized the newcomers, explaining the economics of addiction, imploring them to come along for a ride “down the way”—the neighborhood in Northeast Philly where heroin trades. There they could get a better deal on dope and a better ride by using a needle instead of snorting.
“‘Yo, man, fuck them Oxys, man. You motherfuckers actually pay 40 bucks for one of them, man, I can get five for four from my boy down on Eighth and Somerset, that’s 40 bucks for five bags of good dope. What’s that run you? For five of them pills, man, you’re paying fuckin’ 200 bucks and I get the same thing for 40. It’s stupid is what it is….Yo, for real, someday you knuckleheads are gonna figure that out and you come see me when you do, I’ll hook you up with some good dope spots and show you how to work a needle, you’ll thank me for it.’
“He had a point. On a dollar-for-dollar basis, heroin provided the bang for the buck….Not surprisingly, in detox most of the people hooked on OxyContin and other prescription painkillers were either young or new to opiate addiction; in either case the users hadn’t been fully sucked into the vortex of North Philadelphia and its violent and lurid junky culture….It made a perfect market for new dealers and users just cutting their teeth.
“However…that didn’t mean users wouldn’t at some point wind up strung out on heroin. Addictive drugs change the way people behave and think. As an addict gets hooked he starts constantly calculating and projecting how much he’ll have to spend getting high and always tries to identify new revenue streams that will allow him to get more….The dollar and how much dope it can purchase becomes king overall and price and potency factor into this. As users aged and became more experienced, they would confront the cold hard fact that OxyContin was expensive and heroin was cheap and at some point, if they didn’t manage to get clean, most of them would make the switch.”
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