TEACHING ADDICTS TO SAVE LIVES

The Life Of A Fellow Drug User May Be In The Hands Of A Partner

Barry Belinsky couldn't hear the siren racing toward the Mission
District hotel where he lay dying.

Belinsky, 36, ended up greeting the day twice: once with a wake-up
hit, then later as medics rescued him from the overdose. "When the
paramedics got there," he said from San Francisco County Jail in an
even-toned understatement, "I wasn't all right."

Users say the 180 "unintentional poisoning" deaths in San Francisco
last year likely occurred in the same manner. They tell stories of
panic and abandonment, of still-breathing bodies thrown into
Dumpsters, and of equating a siren with a looming arrest.

With heroin holding at rock-bottom prices -- and with each day
bringing more of its victims to area emergency wards -- San Francisco
has started a program to teach jailed drug users like Belinsky to not
only phone 911 for an overdosing partner, but to resuscitate them as
well.

The first of its kind in the nation, the program plays to addicts'
reluctance to help a partner due to their fear of police. "Most
people won't shoot up alone," said Dr. Joshua Bamberger, San
Francisco's medical director of urban community health, "but they die
alone."

The jail classes, begun a few weeks ago, come amid the passage of
California's Proposition 36, which mandates treatment over
incarceration for initial drug offenses, and parallels efforts in
other West Coast cities where the supply of heroin knows no end.

But only San Francisco is asking addicts to undertake a heightened
level of responsibility for each other.

"We're saying, 'Do the best you can, because something is better than
nothing,' " said Harold Borrero, manager of the CPR Center at the
University of California at San Francisco. "What if that was you?" he
asks. "You might give (a fellow addict) a chance to live."

VOLUNTEER LEADS CLASSES

Borrero designed a course curriculum after being approached by
Bamberger, and now conducts twice-a-month, 90-minute classes at the
jail. Every other Wednesday, he hauls 15 resuscitation dummies inside
and teaches about 50 inmates, many of whom are there on drug-related
offenses. Minutes into class, inmates are performing rescue breathing
while yelling for someone to call 911.

Borrero, a 45-year-old former San Francisco medic who volunteers his
time to teach the classes, admits to initial unease in the jail. That
faded, he said, after meeting his students.

"All they need is a chance," said Borrero after a recent class.
"Oftentimes, we have the perception
that they're not good people." Now, he said, "they're all faces to me."

With only a few sessions behind him, Borrero says he hopes San
Francisco can establish a good precedent, and that it can spread
nationwide.

Though some experts see Proposition 36's comfortable passage as an
indication of growing sympathy toward addicts, critics say survival
classes are neither appropriate nor effective. Borrero said that even
some UCSF colleagues have told him he's wasting his time.

The classes are "a Band-Aid on a wide open, bleeding wound," said Dr.
Herbert Kleber, medical director for the Center for Addiction and
Substance Abuse at Columbia University. "It may stop a little blood
coming out, but it isn't going to stop most of it."

Kleber, who served as deputy drug czar under William J. Bennett, said
San Francisco should be putting every ounce of effort into making the
heroin-weaning drug methadone available to struggling addicts. And he
doubts that most addicts will behave differently after a class from
Borrero.

"One of their colleagues may pass out," Kleber says of a junkie, "and
they may be too intoxicated to do anything about it."

MOBILE METHADONE CLINIC

The city is working to make it easier for addicts to access
methadone, which is dispensed through city-funded hospital clinics
and private, licensed programs.

With some 300 people on the waiting list for the syrupy elixir, the
city is pondering a mobile methadone clinic -- an experiment
undertaken in Seattle and Baltimore -- and is moving to have it
available to addicts at primary care clinics.

Although the classes will do little to cut the city's heroin
epidemic, backers say the effort is still worthwhile because it will
save a few lives.

"I have revived people (while) under the influence and brought them
back," said Tracey Helton, a former addict who accompanies Borrero
into the jails. "You can't necessarily say what the condition of the
other person will be. Not everybody gets loaded to the point where
they can't function. Some people use drugs just to maintain."

"People don't want to let somebody die -- my example proves that it
works," said Helton, 30. She told nodding inmates: "All that time you
were trying homemade cures and throwing (victims) in the shower, you
could have been calling 911."

But fear that an arrest may follow a 911 call is difficult to
overcome. Take Belinsky: Saved by medics and a partner's impulse to
alert them, he had a drug partner overdose only to call 911 and run
away as well, feeling "that if the person dies on you, they're going
to give you manslaughter."

THE SANTA CRUZ PRECEDENT

Or take fellow inmate Christopher Van Pell, 29: During time spent
homeless in U.N. Plaza, he would see fellow addicts in trouble but
hesitate to call for help. Many appeared just to be sleeping, he'd
think, "and then I would see the ambulance pull up."

While health professionals often tell inmates that police aren't
likely to arrest the addicts who call them, there's no guarantee.
Santa Cruz County prosecutors recently charged 18-year-old Joseph
Crouchman with second-degree murder in the Aug. 30 overdose death of
his friend, 16-year-old Dustin Arnwine.

Prosecutors allege he supplied the heroin to Arnwine, but Crouchman's
lawyer argues he was merely present when authorities arrived.

That perceived contradiction -- of phoning for help that brings
trouble -- has a chilling effect on addicts' behavior and fuels the
fear that outreach attempts to dispel, said Heather Edney-Meschery,
executive director of the Santa Cruz Needle Exchange Program.

"We've kind of halted our whole 'Call 911' thing ever since this kid
got charged, until we know it's safe," she said. "The message is
going to have to change (to): 'You hear those sirens, get out.' "

Some undoubtedly will do just that much, Borrero concedes -- which he
feels is a start. "Teach them well," he said, "and they will want to
do it."

At the jail, Borrero had a willing pupil in Van Pell, who financed a
crack addiction with the occasional petty crime until he was arrested
while snatching a purse. On a recent Wednesday, he was breathing into
a mannequin and practicing his yell for help as cars bound for the
Bay Bridge flitted past a nearby window.

The effort, Van Pell said, "helps my own pride. I'm grateful for
that." Scheduled for release in the spring, he's undecided whether
he'll return to his native New Jersey or stay here instead, seeking
treatment in a place he believes is trying to help him.

"San Francisco," he said, "is a pretty forgiving city."