LOSING THE WAR ON DRUGS It was a day to celebrate at least an intermediate victory in the war on crime in Lawrence. Last July 27, before assembled neighborhood group leaders, city officials and business leaders, Lawrence Mayor Patricia A. Dowling and Police Chief John J. Romero laid out the numbers: Violent crime -- murder, rape, robbery, aggravated assault -- had dropped by an average of nearly 50 percent in the past two years. Burglary and larceny were down by similar amounts. The only major category police had failed to dent significantly was auto theft. But hidden beneath those pleasing statistics is a different, much more grim number. In Lawrence alone, so far this year, police say there have been 11 confirmed deaths from heroin overdoses, with another three virtually certain. That's more than four times the homicide rate of three so far this year. During a one-month period beginning in June, four men were found dead from heroin. And that is just one, tragic piece of evidence of a stark reality: Three decades after the nation launched the War on Drugs, heroin is cheaper, purer and more accessible than ever before. While there are no hard numbers on overdose deaths, virtually everybody in public health and law enforcement says they are up. According to a recent federal study, drug addiction is up, nationwide and in Massachusetts. State Sen. James P. Jajuga, D-Methuen, a former state police officer, says Essex County has been and continues to bea major drug-trafficking destination. In Lawrence, the problem may well be worse than police can even say. Those 14 deaths are just the ones police know about. If a person dead or dying of a drug overdose ends up at a local hospital without any police involvement, there is no legal requirement to notify law enforcement. The hospital's only mandate is to notify the state medical examiner's office. "I'm sure there are others, but if we (police) aren't involved in finding them, we don't know about them," says Lawrence police Capt. Michael S. Molchan. Of course, it isn't a crime to die from a drug overdose. The cops can't arrest a packet of heroin residue. But those deaths are a direct spillover from the criminal drug trade. State Commissioner of Public Health Dr. Howard Koh, an Andover resident, calls drug overdoses "one of the major public health issues of our time. And it doesn't just affect the individual user," he says. "The impact on the community is extraordinary. It fuels joblessness, child abuse, homelessness, violence, driving under the influence." Dr. Wayne Pasanen, head of emergency services at Lowell General Hospital and medical director of Habit Management Institute, the methadone clinic in Lawrence, agrees. That's why it is a mystery to him that it tends to float below the radar of public awareness. "One of the most dramatic experiences I've had recently as an emergency room physician was when they brought in a young man who was dead on arrival froma drug overdose," he says. "There were nurses, pulling back the sheet, looking at the body, who seemed to be totally unaffected by it. The police were coming in, looking at the body like it was a piece of meat. "And I said to myself, 'How biased and ignorant are we, that we don't get upset about this?' There is all this hysteria about the West Nile virus, when we don't even have one case of it in the region, while all around us, people are dropping like proverbial flies." Of course, nobody chooses to get bitten by a mosquito, while overdose victims tend to be addicts, who made a choice to start taking drugs, and who live below the public radar anyway, so when they disappear, it causes barely a ripple. "At one level it's a problem," says Essex County District Attorney Kevin M. Burke, "but at another level, it's not something that affects the community directly." The War Over The War Still, while heroin overdoses may not be creating public hysteria, they are prompting increasingly shrill debate over the seemingly endless "War on Drugs." Those in law enforcement, while acknowledging a "public health" dimension to overdoses, contend that the best way to deal with the problem is to continue the war, with better strategies and more money. Their opponents -- an expanding coalition of grassroots organizations, political parties, treatment specialists and even some front-line police officers -- say the drug war doesn't work, is far too expensive, is essentially a war on people rather than drugs and is as doomed as Prohibition was in the 1930s. And in the war over the War, it is still law enforcement that has the money, the votes in Congress, and the law -- in other words, the full weight of government -- on its side. At the federal level, U.S. Attorney Donald Stern, responding to pleas from Lynn Police Chief John Hollow and Mr. Burke's office, conducted a pilot project in Lynn during 1999 that found, to nobody's surprise: "Large numbers of people are overdosing and dying" from heroin. Actually, the numbers in Lynn were not nearly as bad as they are in Lawrence. According to the study, 30 people died in Lynn during a period of a little less than four years, ending in August 1999. Nearly half that number died in Lawrence in less than nine months. Those dying of overdoses typically had "extensive prior court involvement," including arrests for violent offenses and restraining orders. Perhaps more surprising, however, was the finding that "neither the law enforcement nor the public health system has systematically tracked the numbers of deaths from heroin overdoses." In other words, while officials know that overdoses are killing perhaps hundreds each year statewide, there is no collection of data that shows precisely how many and where those deaths occurred. So Mr. Stern's "action plan" calls for better data collection. But it also calls for the traditional approach in the drug war -- "increased sanctions on offenders." Meanwhile, at the county and local levels, a similar "enforcement" battle continues, pretty much as it has for years. Mr. Burke's office reported earlier this year that the Essex County Drug Task Force had made 1,059 drug-related arrests and seized large quantities of cocaine, heroin, marijuana and Ecstasy in 1999 -- close to the numbers it had for 1997 and 1998. In Lawrence, where the problem of drug dealing is the most acute in the region, there are almost weekly headlines about it. Lawrence police Officer John M. Ragosa, of the department's Crime/Disorder Analysis Unit, says there were 841 narcotics-related arrests for the first eight months of 2000, up from 752 the previous year. The department conducted 15 narcotic sting operations, many of them producing dozens of arrests. Throughout the region, most other police departments don't collect statistics on drug arrests, seizures and overdoses, but officers in those departments all say the numbers, especially regarding heroin, are up. "If we really pushed it, you can't imagine the number of arrests we could come up with," says Methuen police Lt. Ted Hoyle. "The use of heroin is definitely up." The war is not all punitive. It does include "treatment and prevention." According to Dr. Koh, there are 115,000 yearly admissions statewide to the drug-treatment system, which includes inpatient residential services, acute detox, residential recovery homes, outpatient clinics with methadone support, counseling and "pharmaceutical interventions." Locally, besides Habit Management Institute, there is a wide range of drug treatment and counseling available in Lawrence, including the Pegasus Youth Residential home for recovering teens, and Women's View, a residential recovery home for women. Greater Lawrence Family Health Care, on Broadway, has a drug-treatment program at Centro Panamericano on Amesbury Street. And there is the Lawrence Teen Coalition, with services covering everything from drug abuse to teen pregnancy, suicide, abuse and neglect. Then there is the public relations effort. September was National Alcohol and Drug Addiction Recovery Month, and the Massachusetts Organization for Addiction Recovery sponsored a day of "information, awards, open discussions and guest speakers" on Sept. 27 at the Statehouse. Chronic Habits With all that, one might expect a press conference announcing a 50 percent drop in drug dealing, addiction and use. Instead, things seem to be headed in the other direction, even with few hard statistics on such things. Heroin is more plentiful, more pure and about as cheap as it has ever been. Lawrence police Lt. Anthony Lorenzo says a decade or more ago, a bag of heroin that was about 8 percent to 10 percent pure cost $30. "Now it is about 90 percent pure, and costs $5 to $6 a bag if you buy in a pack of 10, which most people do," he says. And the addictive hold of the drug remains powerful, even years after people have remained clean. Indeed, the faces of addiction are everywhere. If addicts are among the enemies of the War on Drugs, Lt. Lorenzo says he saw a familiar one just during the past couple of weeks, when a man he had known in school, and then later as an addict from about 10 years ago, was cruising through one of the neighborhoods. "I knew exactly what he was doing," he says, "so I let him go around a corner, and then I came around the other way. There was a dealer walking up to his car, and he took off as soon as he saw me. I pulled up and the guy got out of the car. He said, 'Hey, Tony, I didn't know it was you.' I asked him what he was doing, and he said he was working at Raytheon, but since they had been on strike, he didn't have anything to do. "I told him, 'Well, you're not doing the right thing here.' " Another is Nancy Drew, a sweet-faced, 44-year-old Haverhill resident who sits in an office at Habit Management Institute, talking proudly about her 8-month-old grandson. Ms. Drew has been coming to the methadone clinic for eight years. She says she will have to continue coming for the rest of her life, because for the 22 years before that, starting when she was 11 years old, she was a heroin addict. "I was very mature, physically and emotionally, she says, "and I had a boyfriend who was much older. He was 20." He was also an addict, who introduced her to heroin. "My curiosity got the best of me," she says, admitting that she "liked what I saw that it did for him. It made him feel better. And I was depressed, socially and because of things in my family." For more than two decades, she had a string of boyfriends who were all dealers. "They took care of me," she says. But those relationships, and the heroin that came with them, destroyed her health. "I have hepatitis B and C. I have kidney problems. I have diabetes," she says now, without a trace of bitterness. "It's (heroin) a killer." Dr. Koh, simply repeating what every counselor or treatment expert knows, says that drug addiction is "a chronic, relapsing disease." At Pegasus, director Julie C. Vaux says one 18-year-old client was in his 23rd treatment. "You do have relapses. It's a process," she says. Irresistible Forces Those realities, say opponents of the War on Drugs, are just a few of the reasons that it should be ended. Carla Howell, the Libertarian Party candidate for U.S. Senate who is challenging Sen. Edward M. "Ted" Kennedy, calls it "another Vietnam that has failed." By now, the Libertarian screed against the drug war is becoming more familiar: Mandatory minimum sentencing (which Sen. Kennedy supported) has doubled the prison population, filling cells with nonviolent drug offenders -- a large percentage of them minorities. By creating a black market, the drug war promotes high prices and high profits, which are always attractive to organized crime. Civil liberties suffer, as citizens become subject to random urine tests, highway checkpoints and government scrutiny of financial transactions. As in Prohibition, the drug war makes the drug problem worse. According to Ms. Howell, "in the 1920s, thousands died of alcohol overdoses or poisoning" from adulterated booze. "Now, it's so rare," she says, "that when something happens like the young man (Scott Krueger) who died at MIT, it's so unusual that it's in the papers for months." Most drug users are not addicts, and are otherwise law-abiding citizens. The cost of incarcerating peaceful drug users squanders money that would be better spent on violent crime. It breaks up families, by jailing otherwise good, productive citizens. Obviously, the Libertarian take on the drug war is not yet shared by enough of the population to have changed the law. Its contention that the drug war creates high prices is just plain wrong, given that heroin is cheaper than ever. But an increasing number of experts, like Dr. Pasanen, believe that the war needs to shift to much more emphasis on treatment. Those who are waving the white flag include even some front-line law-enforcement officials, who agree with Methuen's Lt. Hoyle that, "If there ever was a war, it was lost a long time ago. I'll probably get in trouble for saying this, but I cannot, for the life of me, figure why we arrest people with a medical problem," he says. Dr. Pasanen says he doesn't favor legalizing drugs, although he says he has seen no serious health or public-safety problems from marijuana. But he says heroin addiction must be treated as a disease, not a crime. "Yes, you do make a choice to start using heroin," he says, "but nobody -- nobody ever starts using it with the intention of becoming an addict. "What happens," he says, "is that, with regular use, heroin shuts off some kind of switch that the body uses to produce its own endorphins. I equate it to something like diabetes, where one day your body decides to stop making insulin. "So you lose the ability to choose. Can you imagine going in to see your doctor with diabetes, and hearing him suggest that you should try to control your blood-sugar level with will power? Addiction is one of the most powerful forces known to man. It's like thirst, hunger or sleep." When it comes to cost, Dr. Pasanen says, the choice should be obvious. "It costs about $36,000 to keep somebody in prison for a year, and we can treat them with methadone for about $100 a week," he says. What about spin-off crime? Dr. Pasanen says a well-known study that tracked addicts in New York City and Philadelphia found that those placed on a methadone maintenance program dropped from an average of 230 "days of crime" per year to less than 10. And to those who say methadone is simply switching from one addiction to another, Dr. Pasanen says those on methadone are not high or impaired, and can live productive, sober lives. Indeed, Ms. Drew says, methadone "saved my life. I absolutely wouldn't be here without it." Her friend "Mary," who didn't want her real name used, says she has been on methadone for five years -- too late to save her marriage, but soon enough to rescue her relationship with her children and grandchildren. "One of my daughters gives me a piece of gold for every year I'm sober," she says witha smile. "I'm working on six, now." Don't Make It Worse But if there is an end to the war, even against just users, it will probably be a long time coming. While there is clear agreement from both sides that drug overdoses are a public-health problem as well as a crime problem, those in law enforcement are not about to agree that it is time to decriminalize drug use. That, they say, will make things much worse than they are now. Andover Police Chief Brian Pattullo is one who believes users should be targeted as aggressively as dealers. "I believe if we start hitting the users, the dealers are going to feel it," he says. "If we weren't making these arrests, how bad would it be? Everything can always be better, but without the war on drugs, we'd be in a lot worse condition. It's not just drug use, but what follows from it. It's very expensive for society." District Attorney Burke says he believes in treatment for drug users. "But when you're dealing with an addictive personality, you need the hammer as well," he says. "You're not going to get people participating in treatment unless you force it. Addicts are nothing if not creative." His office has also been able to prosecute some drug dealers for manslaughter, after drugs they sold killed a person. In two decisions handed down in 1990, the state Supreme Judicial Court ruled that dealers could be charged with manslaughter for "wanton and reckless conduct," in selling to addicts. Still, First Assistant District Attorney Robert Weiner admits that such cases are very difficult, since the prosecution has to prove the dealer sold the drugs, and that it was those specific drugs that killed the victim. Lawrence Chief Romero says he believes "you just have to keep chipping away," at drug use and crime. "This is a very profitable business, and people are willing to take the risks," he says, "but where I came from in Washington Heights (part of New York City), we cut homicides from 119 in 1991 to nine in 1998. And most of those were drug-related. Drugs fuel crime. Even if they were legalized, people would still need the money to get drugs and would still commit the crimes." U.S. Attorney Stern's "action plan" for Lynn, which he says he hopes to expand throughout the state, calls for better data collection, increased sanctions on offenders and targeted prevention programs. However, nearly a year after that plan was announced, little of it has been implemented. Better data collection may require legislation, which the statewide association of district attorneys is considering filing, that would allow hospitals to report drug overdose cases as they are brought in, without being liable for violating patient confidentiality. But so far, there has not been so much as a meeting to discuss possible legislation. Holy Family Hospital President William Lane says he is more than willing to talk about it. "Anything we can do to alert the public without violating people's privacy -- we're happy to take that step," he says. Mr. Lane says he has heard talk of district attorneys setting a meeting with the Massachusetts Hospital Association, "but that hasn't been scheduled yet." Mr. Stern admits to being "disappointed that we have not made better progress," but he says the Lynn project is a partial success. He says his office has "gotten the right people together" to talk about better data collection. And we have to remember that this (drug addiction) is one of the most intractable, difficult problems around." He says those who call for decriminalization are "crazy, if they think it's going to make it (heroin) less available. Like Mr. Burke, he says the fact that drug users can be charged with a crime gives law enforcement the leverage it needs to force such people into treatment. "Part of the concern Kevin (Burke) and I share is that people using heroin are getting younger and younger. There used to be a stigma to it, because it involved needles. But now, because of its purity, it is smokable and snortable," he says, adding that he does believe law enforcement emphasis should be on sellers more than users. But he still firmly believes the war must go on. "Do we solve the problem? No," he says. "But do we make a dent? Yes."
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