The Controversial Answer To America’s Heroin Surge

This is a fantastic article on heroin use and harm reduction. If drug reform, harm reduction or drug use in general is interesting or important to you, please read!

First published on, May 15, 2014, at 8:26 p.m. by John Knefel

“On a chilly Monday morning in mid-March on Coney Island, down Surf Avenue from the famous Wonder Wheel and Cyclone, a parked

Dodge van blasts its heater. Stuffed with all manner of injection-drug paraphernalia — needles of different gauges, cookers, ties, pearl-sized cotton balls, alcohol wipes — as well as plastic bags of nonperishable food items called “pantry” and thousands of condoms and lube packets, it’s a clinical stockroom meets therapist’s office on wheels. The van has these supplies to make using drugs safer, all for free — though getting high in the van is not permitted.

Ian, 60, sits in the back of the van, rubbing his hands to keep warm. “I used for over 45 years. Last 25 years was basically crack,” he says. He suffered what he calls “three minor strokes” that doctors said should have killed him, but kept getting high. So when someone slid a flier under his door for something called harm reduction — an approach to combating drug use that allows the person to continue to get high, but in a safer way — he was interested. Slowly, he decreased his use from daily, to weekends, to monthly — until he could finally quit. Now he works for FROST’D (Foundation for Research on Sexually Transmitted Diseases) — one of New York City’s harm reduction programs and the organization that runs this mobile unit — as a peer educator, a paid, part-time position that serves as a bridge between the staff and the communities they serve.

Next to him, Scott Spiegler, 28, flips through a binder of anonymized client information. Scott is one of FROST’D’s outreach workers, and delights in explaining safer sex practices to anyone who enters the van, which is parked here every Monday and Thursday — and regular corners throughout the boroughs other days of the week. Later this afternoon he’ll tell one woman, a new client named Brooke, that flavored lube for blow jobs “is like dinner and a movie: You can give head and eat a peach.” When she tells Scott she’s never heard of a female condom, he lights up. “I love telling people about the female condom,” he says. “It’s, like, my jump-off.”

Around 11 a.m., the first client of the day shows up. Willy, late forties, knocks on the van’s sliding door and hops inside. In limited English, he says he’s homeless and has been sleeping a few blocks away on 22nd Street with his wife. Scott offers to connect him with their housing program, but Willy doesn’t like shelters. “Too many people stealing,” he says. He’s been using heroin for three years (including this morning) and has cirrhosis of the liver.

He’s come to the van today just for the pantry — pasta, cans of beans — and he’s already taken home plenty of clean needles. “Do you know about alternating veins?” Scott asks. Willy does, but he says he has trouble finding others. After showing him (with a capped needle) the 15-degree angle he’ll want to aim for if he decides to shoot up in his hand, Scott warns him about the powerful, fentanyl-laced heroin that’s going around — the type that Philip Seymour Hoffman was initially thought to have used when he overdosed. Willy wants nothing to do with it. “No, no, I don’t want to die,” he says with a smile.

Willy is one of the approximately 669,000 people in the United States who used heroin in 2012, a 65% increase from rates in 2002, according to the most recent National Survey on Drug Use and Health. Other trends also show heroin use and availability is increasing at alarming rates. The same survey found that people “with heroin dependence or abuse in 2012 (467,000) was approximately twice the number in 2002 (214,000).” According to DEA numbers, heroin seizures at the Southwestern border “increased 232 percent from 2008 (558.8 kilograms) to 2012 (1,855 kilograms).” Drug overdose is now the leading cause of accidental deaths, eclipsing car crashes, though pill abuse far outpaces heroin use. More than 12 million people in 2010 abused painkillers, according to the Centers for Disease Control and Prevention, and data supports the much-repeated narrative that many newer heroin users got started on pills.

But Willy, and many of the people who use FROST’D’s services, are not the kind of people the media has put forward as representatives of the endlessly touted heroin crisis. The face of the new crisis is a familiar one: the white, middle-class kid who should never have become a junkie. Whether the story is in Time, any number of local reports from major cities, or small-town Wisconsin, the takeaway is always the same: Heroin use among young, middle-class users in the suburbs and rural areas is increasing. And that number will undoubtedly rise as pain pills continue to get more expensive.

And even though a 2013 study shows that people with an annual household income of less than $20,000 were much more likely to begin using heroin than those in higher income brackets, the perception that the crisis is primarily affecting middle-class America seems to have had an effect on the potential for political action. There’s the just-passed plan to have New York City police officers carry a heroin “antidote” to reverse overdoses, part of a $5 million program; the state legislature passed a Good Samaritan law to protect users who call 911 if they witness an overdose and another law that decriminalizes heroin residue in used needles. At the federal level, Attorney General Eric Holder has endorsed first responders carrying similar kits, and a spokesperson for the Drug Enforcement Administration echoed support for the programs. But a significant reason for the shift in lawmakers’ attitudes is the advocacy work done on the national level by groups like the New York City-based Harm Reduction Coalition, and the local organizing that groups like Brooklyn’s VOCAL-NY are doing on the city and state level.

Over the next five hours on Surf Avenue, 10 more clients will come to the van and request condoms and needles and cookers, as well as phone numbers for detox and rehab programs. One young Ukrainian woman was clean until she ran into friends and had a party weekend. One guy just got out of a 30-day bid in Rikers for having a cooker, and despite the methadone they gave him in jail, the withdrawal was terrible.

Some of their bodies will show signs of drug use — scabs, bruises — and some will not. Some will express disgust at their habit (“I’m fucking sick of this shit,” one guy spits, standing outside the van), while others will say they want to keep using heroin. But all of them will walk away with tools that, for today at least, workers at FROST’D say make it less likely they’ll contract HIV, hep C, or any other communicable disease from reusing needles or having unprotected sex. And that idea — meeting people where they are without judgment — is at the heart of harm reduction, a philosophy that, after decades of false starts, is finally finding political traction, and not a moment too soon.


The Controversial Answer To America’s Heroin Surge



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