Heroin Deaths Soar, Making It the Top Killer Among Drugs

While recent public attention has turned to celebrity deaths from cocaine use, the number of deaths attributed to heroin in San Diego County each year has tripled since 1981.

Statistics show that 56 people died from heroin in 1985, compared to 15 in 1981, according to a report issued in June by the county Department of Health Services. And the number of emergency-room admissions related to the drug has doubled in the last five years, the report said.

In 1985, the number of deaths attributed to heroin increased by 40% while fatalities attributed to cocaine declined by 30%. Last year, more than 4 out of every 10 accidental deaths blamed on drugs were caused by heroin, used alone or in combination with other narcotics.

As heroin-related deaths have been escalating, the number of people using the drug has remained relatively stable during the last five years, said Melinda Newman, director of the County Drug Program.

The reason for the rising death rate, police and health department officials say, is the changing nature of the heroin being used. There is more high-quality heroin available on the street, and addicts are using new, more potent forms of the drug such as laboratory-produced fentanyl and “black tar” heroin.

“In 1980, the average strength of the heroin on the street was 4% or 5%. Today it’s 10% or 15%,” said Ron D’Ulisse, local spokesman for the Drug Enforcement Administration. “With ‘black tar,’ we’re probably talking 60% or 70% pure.”

D’Ullisse said that San Diego’s proximity to the Mexican border means the strength of heroin being sold here is about twice the national average. And with the near-collapse of the Mexican economy, producers and importers of the drug have proliferated, raising bumper crops in Mexico to supply the United States with 90% of its heroin, D’Ulisse said.

“When you have inexperienced people processing the drug, they tend to skip some of the steps, leaving more of the alkaloids (active elements) in,” said Robert Kahn, who runs several heroin treatment programs in the county. “The result is a product that is less pure (but) stronger and more unstable.”

“Black tar” heroin, D’Ulisse said, was initially produced by small families who were diverting some of the opium away from the organized distributors and marketing the cruder grade of heroin through family connections. Today “black tar” is being imported by larger drug organizations as well, he said.

The increased potency may tempt some heavy users to push the doses they inject up to fatal levels, but most of the deaths are probably mistakes, he said. Because there is virtually no way for a user to test the strength of the heroin he uses, the danger of accidental overdose is always high--especially among inexperienced users.

The risk is compounded because heroin is used in such small concentrations that it is easy to miscalculate the dosage, yielding a variance that is more dangerous than with other drugs used in larger quantities.

“Every time an addict shoots up, it’s like Russian roulette,” Kahn said. “He never knows when he’s going to hit the cylinder with the bullet in it.”

“If you go milligram for milligram, heroin is the most dangerous drug around,” D’Ulisse said. “With cocaine a fatal concentration is reached at 8,600 nanograms per milliliter of blood. With heroin it takes only 500 nanograms to overdose.”

A nanogram is one-billionth of a gram, or one-thousandth of a milligram.

“With cocaine the average purity is 40%, so when someone gets hit with a batch that is 70% pure it’s not that bad; there’s almost a built-in safety factor,” D’Ulisse said. “But when a heroin user who’s accustomed to 10% purity scores some that is 70% pure, it’s a sevenfold increase in strength. There’s a much higher chance of winding up dead.”

D’Ulisse predicted that the number of deaths will level off as users become more accustomed to the higher concentrations.

Despite the sharp increase in fatalities, the underground character of the heroin world--the virtual absence of social users--has served to keep the drug out of the public eye, Newman said.

“Heroin isn’t considered a glamour drug,” Newman said.

Rather than using the drug openly at parties, heroin users are likely to keep their habit secret from everyone but fellow addicts.

“I know one painter who is now on a methadone (a heroin substitute) program and has never told his wife and children that he was a user,” Newman said. “He’s too afraid that they might feel tempted to try it as well.

“He is able to work and has stayed clean but he’s afraid that if he went off methadone he’d start shooting again.”

Based on various indicators--including overdoses, emergency room admissions and hepatitis cases--health officials estimate that there are 15,000 addicts in the county, but that figure is little more than a guess.

“As long as heroin is illegal, addicts are going to do their utmost not to be counted,” Kahn said.

The statistics that are available describe a discouraging profile for those who would seek to bring the problem under control.

Of those who use heroin regularly in the county, about 75% will remain users for the rest of their lives, D’Ulisse said. Among those who have become physically “dependent” on heroin--a process that takes between two months and two years--the number who kick the habit and stay clean drops below 5%.

The savageness of the sickness that accompanies heroin withdrawal is well-known, but experts now believe that the drug may also cause long-term damage.

Medical research indicates that long-term use of heroin may permanently change a user’s chemical balance, destroying his ability to manufacture essential substances known as endorphins, which are released by the pituitary gland during times of stress so as to counter anxiety and pain.

“What researchers now believe is that heroin dependency causes the pituitary gland to atrophy to the point where the body can no longer produce endorphins on its own,” Kahn said. “When someone who is dependent gets into a high-pressure situation, they may be physically unable to diffuse the stress in a normal way.”

The consequence is that addicts are forced back to the drug to deal with stress--even the normal stresses of everyday life.

One solution is to go on to a methadone maintenance program. Methadone is provided legally to long-term addicts who have failed to kick the drug through other means.

While on methadone--which cures the symptoms of heroin withdrawal without producing a high--a user is able to function normally and hold a job.

Withdrawal from methadone, however, is even more severe than withdrawal from heroin, and the users must visit a clinic each day to receive their doses.

Newman said that many addicts may use the methadone detoxification program--during which the dose of methadone is gradually reduced over a 21-day period--to “manage” their habit, rather than to kick heroin entirely.

“Sometimes we’ll have women who are pregnant come in so as to deliver a healthy baby,” he said. “Other times people will get to the point where they have to spend hundreds of dollars a day to get high and decide to use this as a way to cut down their need.”

People accepted to any methadone program must prove they no longer use heroin, but those who have qualified for such programs say that the urine tests used to verify the claims are easy to alter. Thus, many continue to shoot up with heroin while receiving their daily dose of methadone.

But others manage to stay off heroin and lead normal lives for years through methadone maintenance programs, Newman said.

The options are few, however, for addicts who want to get off drugs entirely.

There is only one publicly funded detoxification program in the county, and it is run by the McAlister Institute (MITE), which operates a six-bed facility in East County and another in North County. MITE maintains a waiting list of up to 50 addicts, director Jeanne McAlister said.

In September a third county-financed detoxification facility will be opened in the southern part of the county.

While at the MITE detoxification center, addicts are supervised 24 hours a day and counseled on how to stay clean, according to McAlister, who noted with pride that MITE’s 4% long-term success rate is “somewhat better than the national average.”

Another place where heroin users manage to kick the drug on a regular basis is in jail. In California, those discovered to be dependent on the drug are placed in County Jail for 30 to 90 days, where heroin is presumably unavailable, D’Ulisse said.

However, ex-addicts say that some jails have active heroin traffic, and D’Ulisse admitted that “with little or no follow-up, they (addicts) tend to fall back into the pattern of heroin use pretty quickly” after leaving jail.

Several hospitals in the county--including Scripps Memorial, Mission Bay and Harbor View--offer detoxification and rehabilitation programs for a variety of drugs, including heroin.

But fees for the three- to four-week programs range from $5,000 to $30,000 and, as Newman remarked: “The typical junkie is unlikely to have medical insurance.”

There is also an abundance of outpatient counseling and rehabilitation programs, many of which are funded by the county and charge according to a heroin user’s ability to pay. But the addict needs to be clean of drugs before he or she will be admitted.

“It’s a total Catch-22,” said Jerry Ringgold, a reformed addict who started his 18-year habit at the age of 17 and now works with alcoholics at Volunteers of America.

“Rehabilitation programs won’t take you unless you’re clean, but how the hell are you going to get clean if you’re out on the streets? The people who are using can’t even listen to you, so trying to talk them out of it is absurd,” he added.

Ringgold, who kicked heroin while at a live-in detoxification program in New York City, said that the heroin life style holds addicts prisoners as much as the drug itself.

“After a while you don’t feel at home in the straight world,” said Ringgold, who taught himself forgery to support his habit. “The addict thinks he’s special because he has to feed his habit, which is something most people couldn’t do.”

When he went into treatment, Ringgold resolved to abandon his wife, who was also a user, his children and all his former friends.

“In order to get clean, you have to completely change your environment,” he said. “You need to realize that you’re not so clever after all, to suspect that perhaps there’s another way of looking at things.”

Meanwhile, heroin users are susceptible to infectious diseases--ranging from skin infections and abscesses to hepatitis and acquired immune deficiency syndrome, or AIDS--because the majority of addicts inject the drug, often sharing the hypodermic with others.

Perhaps because users in San Diego are more likely to inject in their homes than in the communal “shooting galleries” that are common in some cities, the number of AIDS cases diagnosed among drug users here has been small thus far, according to Newman.

But Kahn believes that addicts may become the major source of transmission from the homosexual to the heterosexual population.

During the last 15 years, there has been a broadening of the socio-economic groups that use heroin, Kahn said.

“What we’ve seen is a transition from the traditional addict, who was unemployed, poverty-stricken and for whom heroin use was considered quite ‘normal’ by the standards of the community from which he came, to an addict population that is whiter, more evenly split between men and women, better-educated and more middle-class,” he said.

“In San Diego you have an addict population that is 50% female, and a lot of those women are sleeping with men who are not addicts. Once this gets going, heroin users will be the means of commingling with the heterosexual population.”

In the last year, Kahn has instituted a voluntary testing program for those using methadone. Of 100 people tested, two registered positive for the AIDS antibodies, meaning they could be carriers for the disease.

Increased crime is another way in which heroin addiction manifests itself in society. While police have no reliable figures on crimes that addicts commit to support their habits, it is thought that the majority of addicts resort to illegal means to come up with the money they need.

“When you have to come up with hundreds of dollars every single day, while taking a drug that makes you unfit for employment, there’s only a few ways to do it, and they’re all illegal,” said Sgt. Dennis Sesma of the San Diego Police Department’s Narcotics Street Team.

Burglary, robbery, forgery and prostitution are among the crimes in which junkies are most likely to be involved, Sesma said. Because stolen goods are sold for far below their value, police believe that users must often steal property worth 5 to 10 times more than what they must spend on drugs.

Surrounded by confiscated drug scales and laboratory equipment, Sesma sat in his office at police headquarters downtown and impassively described how the street team employs a net of informants and undercover operations to track the activities of those in the subculture.

The street team’s top priority is to reduce the number of secondary crimes associated with use of the drug.

Although it is difficult to say how much effect police have on reducing total heroin use, “you no longer see 10 or 12 addicts standing on the street together too often,” Sesma said. “By keeping them off the street you reduce the potential for them to rob and hassle other citizens.”

Asked whether heroin use is concentrated in any one area of the county, Sesma replied: “There is absolutely no way to predict what type of person is going to start using drugs.”

When it comes to eliminating heroin, cutting off the source is the most commonly suggested solution.

Under the Reagan Administration, the amount of money devoted to reducing production and importation of drugs has increased substantially, while funds for drug education and prevention have been slashed by $100 million since 1983, Kahn said.

“Any attempt to eliminate the supply of heroin is completely hopeless,” Kahn asserted. “Right now, there are over thousands of square miles of opium poppies under cultivation in Mexico alone. Out of that, 7.9 square miles is enough to supply the entire American addict population.

“With opium you get a new harvest every 90 days. It’s an incredibly efficient crop.”