Pubdate: Wed, 2 Apr 2008
Source: New York Times (NY)
Page: 18, Section A
Copyright: 2008 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Erik Eckholm
Bookmark: http://www.mapinc.org/find?132 (Heroin Overdose)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)
Bookmark: http://www.mapinc.org/topic/Narcan

A GRIM TRADITION, AND A LONG STRUGGLE TO END IT

ESPANOLA, N.M. -- Eric Lucero has been addicted to heroin for three 
decades and says he has known at least 100 people in this pastoral 
county who died from overdoses, some in his presence.

But Mr. Lucero has recently become a popular -- and, he would argue, 
safer -- injection buddy. Seven times, he says, he has revived 
companions by using an anti-overdose drug, Narcan, which the state 
now hands out to addicts and their relatives as part of its effort to 
reduce the toll of one of the country's most pervasive epidemics of 
narcotics use.

Mr. Lucero, 48, said, "People know I'm good at saving them."

Rio Arriba County, just north of Santa Fe, is a Georgia O'Keeffe 
landscape of juniper-dotted desert and mountain valleys populated 
mostly by Hispanics who proudly trace their lineage to settlers of 
the 1600s -- and who, a decade ago, discovered that their county had 
the nation's highest per capita rate of deaths from overdoses. 
Hundreds of families are struggling to live with a multigenerational 
plague of narcotics; Mr. Lucero's own son is addicted.

Federal data released in March showed that the county ranked first in 
drug fatalities for 2001 to 2005, with a death rate of 42.5 per 
100,000, compared with a national average of 7.3.

Heroin use in the county jumped in the 1970s, as world production 
soared and some Vietnam veterans returned as addicts. It zoomed in 
popularity in the 1980s and '90s, abetted, surprisingly, by the 
tradition of close-knit extended families. "We start our addiction 
getting high with our uncles, then we turn on our own nephews," said 
Manuel Anaya, who was an addict for 26 years and now runs a drug 
counseling program for Hoy, the county's largest treatment group.

Intensified law enforcement and a flurry of new treatment programs 
have failed to stem the use of narcotics here. So New Mexico has 
adopted the country's most sweeping effort at "harm reduction," a 
strategy to eradicate disease, suffering and death among addicts that 
includes exchanging used needles for clean ones and dispensing 
Narcan. Last year, the state adopted the country's only law limiting 
the ability of the police to arrest users who call 911 to save an 
overdosing companion.

There has been no evidence yet of a decline in addictions, perhaps 
because of a scarcity of treatment facilities. And the seemingly 
contradictory impulses to stamp out drug use and safeguard addicts 
can lead to difficult situations for relatives.

In Cordova, a valley hamlet with peach and apricot orchards, Dolores 
S. emerged from her adobe house to greet the state's needle-exchange 
van. A nonuser who lives with seven relatives, four of whom are 
addicts, she said trading hundreds of used syringes each week for 
fresh ones "makes me uncomfortable."

Her face tightened as she admitted to giving money for heroin to her 
addicted son, slouched nearby, who is in his 20s. "I'd rather give 
him money than see him panhandle or steal," said the woman, who does 
housework for a living and spoke on the condition that her last name 
not be used, to protect her family. "A lot of mothers here are in the 
same situation."

Needle exchanges and Narcan distribution are opposed by federal 
officials, who say they amount to endorsing addiction. Bertha K. 
Madras, a deputy director at the White House Office of National Drug 
Control Policy, has said that Narcan, the trade name for naloxone, 
should be administered only by medical professionals and that it 
could make addicts feel safer and less likely to seek care.

But Bernard Lieving, director of the harm reduction program at the 
New Mexico Department of Health, said, "These programs have just the 
opposite result." Mr. Lieving said studies elsewhere had shown that 
needle exchanges greatly increased the chances that users would enter 
recovery programs.

"Unfortunately," he said, "it's very difficult to get people into 
residential treatment immediately, right when they express interest, 
because there aren't enough beds in the state." But field workers 
provide counseling, acupuncture therapy and social services to 
addicts who say they are ready, which Mr. Lieving called important first steps.

Addicts remain a small minority of the population, and drug use 
remains largely hidden behind the closed doors of trailers and small 
metal-roofed homes. But nearly everyone here seems to have friends or 
relatives who died from drug use or are addicted to cheap Mexican 
heroin, cocaine, prescription painkillers or, increasingly, 
combinations of the above, often mixed with heavy alcohol use.

Peggy Ulibarri, a state health official who distributes Narcan in Rio 
Arriba County, said clients had told her of using the antidote 
hundreds of times. Without Narcan, Ms. Ulibarri and others say, the 
number of deaths would certainly be higher. Instead, recorded deaths 
have been steady, around 20 a year in a county of 41,000. Meanwhile, 
the health department trades about 12,000 clean syringes for used 
ones in the county each week.

Dealers are arrested, but users found with syringes now flash a card 
showing enrollment in the needle exchange program and are often let go.

Proximo Martinez, 35, of Chimayo, counts 38 drug-related deaths in 
his extended family, including his brother and sister, and is a vocal 
crusader against drug abuse. Yet he recently collected syringes from 
the van -- sterile needles to protect his brother-in-law and other 
relatives -- as well as kits with a new form of Narcan that is 
sprayed in the nose rather than injected.

Mr. Martinez said he had administered Narcan about 20 times. "But 
some can't be revived," he said. "People have died in my house."

Many in the fight against drugs, including Ben Tafoya, the director 
of Hoy, believe the heavy use of drugs and alcohol is rooted in a 
shared sense of loss, starting when the United States refused to 
recognize many Spanish land grants in the mid-19th century and 
building more recently as struggling families, accustomed to farming 
and ranching, became dispirited as they had to sell land.

An obvious factor is poverty -- more than one in five residents is 
below the federal poverty line and far more are just above it. Yet 
many working-class people are users, too.

The family role is sometimes a sad reversal of expectations. 
"Addiction can become a source of bonding between parents and their 
children," said Angela Garcia, an anthropologist who was born in Rio 
Arriba County and studied drug use here.

The Rev. Julio Gonzalez, the pastor at the Holy Family Roman Catholic 
parish in Chimayo since 2001, said he had buried overdose victims "of 
all ages, including people you'd think were pillars of the community."

"It's not just the youth, it's all generations here," Father Gonzalez said.

James Garcia, who is now clean, used and sold heroin and cocaine in 
Espanola until 11 months ago and said he had encountered at least a 
dozen families in which grandparents, parents and children all 
injected drugs, with some working and others selling drugs or 
stealing to sustain habits that can cost $40 to $100 or more each day.

Lawrence N., an Espanola man in his early 50s, said he had been 
addicted to heroin, pills and cocaine since 1970, including during 18 
years in prison.

The man, who would not allow his surname to be used, is disappointed 
that his two sons, in their 20s, use heroin, too. "I had them deliver 
to me in jail," he said. "Maybe that had something to do with it."

Dr. Fernando Bayardo, director of the Espanola Hospital emergency 
room, called overdoses "only a small fraction of the deaths and 
disease caused by substance abuse," which include liver disease and 
blood infections as well as car accidents, marked by omnipresent 
roadside crosses bedecked with plastic flowers. The county has been 
spared a major epidemic of AIDS, but testing in drug clinics 
indicates that a majority of needle users here are infected with hepatitis C.

The county built a residence that now houses about 25 patients and 
has a program to counsel youths at high risk, said Lauren Reichelt, 
the county's director of Health and Human Services. But there is no 
county center for medically supervised detoxification, and the wait 
list for the one in Albuquerque is long.

The most successful treatment, used on 75 patients at the community 
health clinic, is the opiate replacement bupenorphrine, which can be 
dispensed at doctors' offices and is rapidly catching on around the 
country despite costing up to $450 a month.

In the backyard of the house he shares with his elderly, ailing 
mother, Mr. Lucero, the 30-year addict, raises chickens and pigeons, 
saying, "This is what keeps me sane."

He survived five overdoses, he said, turning apologetically to his 
mother. "She would find me in the yard with a needle in my arm, all 
purple, or lying on the floor in the kitchen."

He has been more careful, or luckier, in the last several years. But 
just in case, his mother took a quick lesson in Narcan administration 
the other day. She and her son watch over each other, she said. Every 
night, before going to bed, she checks to make sure he is breathing.