NORTHWEST HEROIN USE IS EPIDEMIC

SEATTLE - The junkies drift along downtown streets, scrounging for change
and another hit. They cluster in alleys waiting for community vans to
arrive with clean needles. And by the hundreds they straggle into Kim
Murillo's health clinic here every month, doped up and wiped out by heroin.

"We're seeing so many people," she said. "Many of them are desperate to
quit, but the habit can be extremely hard to break. They think they need it
to survive. It's such a vicious cycle."

It is also an epidemic. No region in the country is having a deadlier
struggle with heroin than the Pacific Northwest. The problem is not new,
but all signs suggest that it has been getting worse.

Deaths from heroin overdoses have more than doubled in King County, which
includes Seattle, over the last decade. They have risen so much in the
nearest metropolitan area, Portland, Ore., during the same time that the
drug is now ranked among the leading causes of death among white men there
age 25 to 54.

Treatment centers in both cities are handling record numbers of heroin
cases. Needle exchange programs are besieged with demand. Jailed criminal
suspects commonly test positive for the drug. By some estimates, there are
now as many as 20,000 heroin addicts around Seattle. In a report this
summer, the federal Centers for Disease Control and Prevention called some
of those statistics the most severe in the nation. Heroin use has been
rising across the country, but the overdose fatality rate in the Northwest
is twice as high as the national rate.

"We have a pretty big chronic user population, and it seems like more and
more young people here keep getting recruited to the heroin scene," said
Gary Oxman, the director of the Multnomah County Health Department, which
covers Portland. "It really is exacting a large social toll on the community."

Heroin has become a drug of choice, and a public health scourge, in the
Northwest for many reasons. It is plentiful, usually smuggled into the port
here or north of the border in nearby Vancouver, then whisked down the
Interstate 5 corridor by a sophisticated network of traffickers. It is also
getting cheaper, often sold for only about $20 a dose. And what's available
on the streets is mostly a crudely refined "black tar" heroin made in rural
Mexico. Its potency is wildly unpredictable and thus more dangerous for
addicts.

Both Seattle and Portland also are magnets for transient youths fleeing the
otherwise largely rural Northwest. Without steady jobs or any other ties to
the area, they easily can fall prey to the heroin culture because it is
communal and easy to find. "For some this seems to fill a spiritual void,"
Murillo said.

Drug counselors say that underground circles embracing the drug have
thrived particularly since Seattle became popularized last decade as a hip
haven for "grunge" slackers, artists and musicians. Some local officials
even wonder if the frequently rainy, cloudy weather in the region
contributes to heroin use.

In Portland, Oxman said he believes the heroin problem in the Northwest
intensified when traffickers changed their marketing strategy and
essentially put the drug on sale. "They figured out it was more profitable
to have more people hooked at a lower price," he said.

The clinic that Murillo directs, Stonewall Recovery Services, aids one of
the most troubled groups of addicts, young gay men and lesbians. Some live
on the streets of the clinic's neighborhood, which is near downtown and
filled with fashionable coffee shops and restaurants. But it is also a hub
for the heroin trade.

Murillo's staff counsels about 400 addicts a month. The clinic distributes
about 36,000 clean needles to heroin users each month, hoping to protect
them from diseases such as hepatitis or AIDS. It also enlists a brigade of
recovering addicts to roam the area and try to persuade other drug users to
get help.

"A lot of people want to quit, but the availability of heroin around here
makes it almost impossible for them to stop," said one of those outreach
workers, a 26-year-old addict named Luke, who declined to give his last
name for fear of arrest. "You can find it almost on any corner."

Dressed all in black with a ponytail, he said that some addicts resist
treatment because they no longer see any other way to live. "Once you
experience the escapism, it can become your god," he said. "But people are
dying. Some of this stuff is so bad that when they do a big slam, it knocks
them out."

Here and in Portland, officials are fighting the problem in part by
expanding programs that provide addicts with methadone, an opiate that
satisfies a craving for heroin without the same destructive effects. They
are also dispatching more health workers into the field to seek out and
help heroin junkies. But hundreds of addicts still spend months on waiting
lists for treatment.

Seattle Mayor Paul Schell recently appointed a community task force to
study how the city can better treat heroin addiction. Health officials also
are urging the county and the state to shift its philosophy more toward
"harm reduction" than abstinence. Giving addicts CPR lessons or safe
injection rooms supervised by nurses, they say, could save lives, reduce
crime, and slowly but surely lure junkies in from the street for medical
help to break their habit. But some elected officials say the steps could
promote more heroin use.

Police also are cracking down. Last month, after a two-year undercover
investigation, Seattle narcotics investigators and federal agents arrested
nearly two dozen people and charged them with running one of the more
organized heroin distribution rings in the city. But they suspect other
traffickers are still rolling up and down the Northwest's I-5 corridor. "If
you're transporting anything like this, Seattle is conveniently located,"
said Capt. Jim Pryor, the commander of Seattle's vice and narcotics unit.

The recent raid temporarily dried up some of the heroin market in Seattle.
Yet it also could have some dire consequences. Health officials are bracing
for a new rash of overdoses because heroin addicts desperate for a fix that
has been harder to find lately apparently have been buying and injecting
even cruder forms of the drug, or mixing it with other drugs.

"They have been needing much more to get high," Murillo said. "But then
something stronger suddenly comes along and they don't realize it."

Last year, about 110 people each in metropolitan Portland and Seattle died
from heroin overdoses. More than 1,500 heroin addicts are now in treatment
around Seattle.

Officials say the victims are a diverse group. Some are middle-aged and
middle class and held a wide range of prosperous jobs until they succumbed
to addiction.

"They aren't necessarily just the young, inexperienced, rock-crazed types
that people expect," said David Solet, an epidemiologist in the King County
Health Department.

In both Portland and Seattle, public health officials say they are starting
to see encouraging results from recent steps to expand treatment and needle
exchanges and from the greater use of recovering addicts as mentors to
junkies. Overdose deaths have even declined a bit lately. No one is
predicting a swift end to the heroin crisis, though. A decade of soaring
overdose rates suggests the problem is hardly just a passing fad.

"We're making progress, but we're in for a long struggle," Oxman said.
"Among young people, this has become just another drug. And I wouldn't say
that heroin has just been glamorized to them. The main thing is that it has
been normalized. It's regarded with a lot less concern and fear than it
once was."