Pubdate: Tue, 09 Jan 2001
Source: New York Times (NY)
Copyright: 2001 The New York Times Company
Contact:  229 West 43rd Street, New York, NY 10036
Fax: (212) 556-3622
Website: http://www.nytimes.com/
Forum: http://forums.nytimes.com/comment/
Author: Evelyn Nieves

AN OLD NEMESIS KEEPS SCARRING SAN FRANCISCO

At 5 a.m. in San Francisco's seedy Tenderloin area, the drug addicts are 
just about the only ones out.

A young woman with matted blond hair stumbles down the street with her eyes 
closed; a man in a red spandex dress and silver pumps nods out against the 
door of a single-room-occupancy hotel; small clusters of hollow-eyed men 
and women hover on corners. It is no wonder the police call this strip of 
the Tenderloin the heroin corridor. Everyone on the street looks either 
high or hung over.

Later in the day, Matt Dodman, a blond, angelic-looking 26-year-old, is 
sitting in a cafe in another, hipper neighborhood, the Mission. A heroin 
user for three years, he avoids the Tenderloin drug scene. "I'm not part of 
a hard-core drug clique," he said, taking a sip of mineral water. But down 
the block, a dozen of his friends and acquaintances -- all heroin addicts 
in their teens and 20's, and all disheveled and homeless, as he is -- sit 
on the sidewalk outside a community center and wait to be tested for 
hepatitis C. More than half will test positive, as do the larger population 
of San Francisco heroin users who have been taking the drug at least five 
years.

Heroin was supposed to be over, yesterday's drug. But almost 20 years after 
AIDS made injecting it deadlier than it had ever been, it is as common in 
some neighborhoods here as Starbucks. A draw for drug experimenters since 
the heyday of Haight-Ashbury, the city remains a place where "old" heroin 
addicts -- those who have been using the narcotic for 20 or 25 years -- 
feed their habit. But more and more young people as well are using it.

And not just here. Hospitals and treatment centers in other large cities, 
especially in the West, are seeing record numbers of heroin cases. Chicago 
officials attribute a surge in life-threatening cases of asthma to 
increased use of heroin among the young. And while H.I.V. and AIDS are down 
among users, needles used to inject heroin are responsible for an increase 
in hepatitis C, which can cause liver failure. In fact, hepatitis C is 
growing across the United States and in Vancouver, British Columbia, a 
major trafficking point for a drug pipeline that extends from Canada to 
California.

The estimated number of heroin users in the United States has risen to 
980,000 from 600,000 at the beginning of the 1990's, while cocaine use has 
decreased 70 percent, according to the White House Office of National Drug 
Control Policy. The agency attributes the resurgence in heroin use to new 
forms of the drug, smokable and snortable alike; to a prevailing myth among 
the young that heroin is safer when not injected; and to the "heroin chic" 
look of models in the early 90's.

Washington State, Oregon and California have the highest incidence of 
heroin abuse in the West. Elsewhere, New York, New Jersey, Michigan, 
Massachusetts and Delaware also have big problems with it, according to the 
Substance Abuse and Mental Health Services Administration, an agency of the 
Department of Health and Human Services. Dr. H. Westley Clark, the agency's 
director, says its household surveys show that from 1996 to 1998, an 
estimated 471,000 people used heroin for the first time, with a quarter of 
the new users under 18 and 47 percent age 18 to 25.

Heroin is not only cheaper than it once was, "it's cleaner, purer," said 
Joseph A. Califano Jr., who was secretary of health, education and welfare 
in the Carter administration and now directs the Center for Addiction and 
Substance Abuse at Columbia University. "And too many young people think 
they can snort it and they won't get hooked." Eventually, Mr. Califano 
added, they do get hooked, and turn to needles to achieve a more potent high.

"The next drug czar, in the Bush administration, is going to have to deal 
with heroin in a big way," he said.

Public health experts see the big increase in heroin use as further 
evidence that the nation's 20-year-old war on drugs, with its emphasis on 
punishment rather than addict treatment, needs a new approach.

Here in San Francisco, heroin users, like homeless people (many are both), 
are part of the landscape. The city draws young people with troubled 
backgrounds from all over the country, even as it tries coping with 
inveterate users who have lived on the streets for years.

The new people, like Matt Dodman, from Michigan, arrive with no money and 
no plans. Often they end up in loose-knit communities of homeless drug 
users, scorned by the rest of the city and consumed with a need to get 
their fixes. People cross the street to avoid them. "They look at us like 
dogs," Mr. Dodman said.

To support his habit, which costs him $20 to $30 a day, Mr. Dodman steals. 
Or he "boosts" -- steals an item from a store, then returns it for cash. He 
has panhandled, but says he does not "have the patience for it."

Dr. David E. Smith, founder and president of the Haight-Ashbury Free 
Clinics, drug treatment centers here, has described the city's young addict 
population as people looking for "geographical cheer" -- hope that life is 
going to be better in San Francisco than it was in Des Moines, say. 
Instead, they become alienated. The same is true of neighborhoods that 
attract young transients in Seattle and Portland. Officials in both cities 
consider heroin use at epidemic levels. In 1999, Portland had the nation's 
highest rate of death from heroin overdose.

"You look back into the early 90's, and the heroin deaths are one to two 
dozen per year, and then in 1999 it was 111," said Gary Oxman, director of 
the Multnomah County Health Department in Portland. The department expects 
the final number for last year to drop to the low to middle 70's, he said, 
in part because of aggressive education programs.

San Francisco has stepped up efforts in recent years to divert drug users 
to treatment. Such programs are making the city a model for California now 
that a statewide voter initiative, to take effect on July 1, makes 
first-time drug offenders eligible for treatment rather than jail. But more 
people keep coming to San Francisco than the city can help.

Matt Dodman was one of several addicts, young and old alike, who said in 
interviews on the streets that they could not find a program that would 
accept them. Another was R. J., who said he had been using heroin for 40 of 
his 49 years and could not find a space in the city's detoxification centers.

R. J., who would identify himself only by his initials, saying he wanted to 
spare his four children, is a walking sign of what heroin can cost. He has 
overdosed five times. He has been stabbed and raped while selling himself 
to support his habit. He has done time behind bars, almost nine years in 
all. And his inner forearms have so many needle tracks that they look striped.

By selling his body, R. J. earns enough money to pay for his heroin, if 
nothing else. "When I see young people, I tell them, 'Don't end up like 
me,' " he said. "I tell them, 'Look at me.' "

Gloria Clay, like R. J. a Tenderloin regular, is a little luckier. At 35, 
she is in a detoxification program and says she is on her way to kicking a 
heroin habit she picked up two years ago, after being addicted to crack.

Her scars keep her motivated. While on drugs, she was kicked by her 
drug-addicted boyfriend, a beating that cost her an eye and permanently 
damaged her spine.

Although infected sores in heroin addicts are the leading cause of 
admissions at San Francisco General Hospital, and while San Francisco 
consistently ranks among the worst metropolitan areas for emergency-room 
visits related to heroin, health officials here are more worried about the 
drug's long-term effects.

Experts compare heroin users to smokers, in that risk accumulates over 
time. Many people infected with the hepatitis C virus, for example, do not 
exhibit symptoms for many years, said Dr. Andrew Moss, professor in 
residence of epidemiology and biostatistics at the University of California 
at San Francisco. But, Dr. Moss said, a segment of those afflicted will 
develop liver disease, cancer or cirrhosis, and hepatitis C is very infectious.

In San Francisco, where young users as well as old overdose routinely, the 
young are very difficult to reach, because their problems transcend drug 
use, Dr. Moss said. "They're America's damaged children," he said.

Matt Dodman is not worried. He is sure he will not overdose, and certain he 
will remain free of disease. Why? "Because," he said, "I know so."
- ---
MAP posted-by: Jo-D