Opiate of the Masses

A 2002 government study of 17 major areas across the United States found that heroin has surpassed crack "as the drug associated with the most serious consequences—that is, medically, legally, societally, or otherwise" and is considered to be "the most widely used illicit drug" in five of the sites. Purer heroin is more popular because it can be snorted instead of injected – attracting many first-time users who don't like the idea of shooting up. But high purity also means users get hooked more quickly, steadily upping doses to maintain their high and avoid withdrawal symptoms.

The impact of heroin, whose users number between 750,000 and 1,000,000 in the United States is being compared to the country’s crack cocaine epidemic of the 1980s. While overdosing is a problem, most of heroin-related deaths come from hepatitis B and C, and HIV -- from dirty needles. As Jack Leary, assistant chief probation officer at the South Boston Courthouse told NPR:

"I did not see in the community of South Boston, nor in other sections within Boston, certain sections had the crack-cocaine problem, the volume of mortality that we're seeing in the last five years and I'll put it in personal terms. My first 19 years of service, I do not recall this much trauma and tragedy as I've seen in the last five years of service because of the introduction of pure, cheap cocaine on the streets of Boston."

Massachusetts tops the nation’s list for use of illegal use of drugs and as well as for the highest percentage of young addicts. Boston Mayor Thomas M. Menino and others blame the epidemic for improved trafficking routes that allow drug-dealers to deliver directly to Boston, by-passing traditional stop-overs like New York City and effective marketing to kids. As the Boston Globe points out that in 2000, six percent of Massachusetts residents ages 12 to 17 reported illicit drug dependence or abuse, the highest in New England, compared with 5.6 percent nationally.

Dealers give children two bags of free heroin for every eight they sell in an effort to get them hooked, Menino said. Colombian cocaine cartels, which started showering the Massachusetts market with cheap heroin in the late 1990s, have employed sophisticated marketing tools to target young users, including brightly colored envelopes and brand logos like Batman, cartoon frogs, dynamite, and the Playboy bunny."

The east coast market is dominated by Colombian cartels, the west by the Mexican, though boundaries are fluid. Most of the heroin sold in the United States is grown and produced in Mexico and Columbia, with some coming from Afghanistan, the world’s largest heroin producer. When the operations of a major Mexican drug ring were disrupted in 2000, with the arrest of hundreds of people, investigators revealed that one of the ways Mexican black tar heroin was transported within the country was, as CNN reported, "through overnight delivery services or the U.S. mail, often hidden in lamps and other small appliances." A recent drug-bust in Colombia and the United States, in which 100 pounds of heroin worth $6 million was seized revealed other ingenious ways traffickers use to get goods in and profits out. As the Washington Times, citing Drug Enforcement Agency’s Administrator Karen P. Tandy, reports:

"The drug traffickers, she said, used both traditional and nontraditional smuggling routes and methods, including hiding heroin in drinking straws and placing them in boxes of seafood, and using internal body couriers to transport drugs from Cali and Bogota, Colombia, and Buenos Aires to major East Coast cities. Mrs. Tandy said the traffickers also used various methods to transport their illicit drug profits from the United States back to Colombia, including the use of body couriers who swallowed $100 bills rolled into cylinders and pressed, and a check-cashing business in Cali, Colombia, that could launder $25,000 a day in proceeds."

Heroin addicts entering drug-rehabilitation are usually put on methadone, an opiate like heroin, while they undergo treatment. Methadone has been controversial because it is also highly addictive. Some heroin addicts end up staying on methadone for years, prompting criticism that the "cure" only swaps one addiction for another. A new maintainence drug called Buprenorphin was approved by the Federal Drug Agency in 2002. Unlike methadone, it can be prescribed by doctors. Buprenorphin generated initial optimism as a faster and safer alternative to methadone.

In New Jersey, which does not have a clean-needle exchange program, heroin addicts’ use of dirty needles has revived the debate about whether helping to stop the spread of HIV and hepatitis through such programs is worth the risk that they'll merely encourage illegal drug use. According to the state’s Health Department, there are 153,000 people in the state requiring drug treatment, 36,700 of whom are injected users. 80-85 percent of these injected users are infected with hepatitis. Opponents of needle-exchange programs have so far succeeded, arguing that programs will only lower the threshold for potential users, do nothing to discourage addicts to kick their habit, and that clean needles dirtied by sharing may only feed the epidemic. Proponents counter, citing numerous studies, that these programs are effective in decreasing the spread of infectious diseases.

But, as the New York Times points out in an article titled, "It’s Not the Heroin, It’s the Needle", effectiveness unfortunately isn't the only criterion used for judging such programs.

"Assemblyman Reed Gusciora, a Democrat from Princeton, first proposed a bill to provide clean syringes in 1996 and has watched various incarnations die in nearly every legislative session since then. Mr. Gusciora, who also serves on the governor's AIDS council, said New Jersey had the fifth-highest rate of AIDS infection in the nation and was the only state in which the most common form of transmission was intravenous drug use. Still, he said, it has been impossible to push the measure through because many legislators are afraid to appear soft on crime or illegal drugs."