EFFORT TO REDUCE NUMBER OF HEROIN OVERDOSES IN SAN FRANCISCO

LINDA WERTHEIMER, host: From NPR News, this is ALL THINGS CONSIDERED. I'm
Linda Wertheimer.

ROBERT SIEGEL, host: And I'm Robert Siegel.

San Francisco is facing a deadly new health hazard: epidemic-level heroin
use. Last year, heroin overdoses were the leading cause of death among
young people in the city. Hepatitis runs rampant as well. To combat the
problem, researchers and activists at San Francisco General Hospital have
launched an aggressive project. It doesn't aim to end heroin abuse, but to
teach young drug users how to shoot up more safely and how to save each
other's lives in emergencies. As Frank Browning reports, the project has
drawn heavily from the city's punk rock music scene.

(Soundbite of music) OUR LADY OF NAPALM (Singing I get off, I get off
smashing glass. (Unintelligible smashing glass.) I cut myself right down to
the vein.' )

FRANK BROWNING reporting: 'I get off smashing glass. I cut myself right
down to the vein.' The group is Our Lady of Napalm and the lyrics, you
might say, are about rage and defeat and self-destruction and shooting
speed, or glass. Our Lady's drummer, Ivy McClellan ( doesn't shoot drugs,
but a lot of the people around the band and in the club where Our Lady
plays are drug shooters.)

They, the living and the dead, have been friends of Ivy's, which is why she
got involved in UFO, or You Find Out, a research and outreach project aimed
at saving heroin shooters' lives. This Monday afternoon, she's on duty at a
storefront on Haight Street.

Ms. IVY McCLELLAN (Drummer, Our Lady of Napalm) : OK. What's happening is
we pass out clean, filtered water, two cookers that they cook their drugs
in, these cotton pellets that are known as dental cottons.

BROWNING: Twenty-five or 30 street kids, most of whom call themselves the
crusty punks--they wear their dirt as a badge--are lined up to get
supplies, blood tests, vaccines for hepatitis, even a cup of soup and free
clothes. The objective, Ivy says, is simple.

Ms. McCLELLAN: For safer injection practices, and it's harm reduction,
getting people as safe as you can while they're using.

BROWNING: The key phrase here is 'harm reduction,' a public health strategy
that acknowledges that, while people do dangerous or even self-destructive
things to themselves, some of that danger can be reduced both for
individuals and for the public at large.

Epidemiologist and UFO director Andrew Moss says his team drifted into
studying drug overdoses from their 15-year research into the AIDS epidemic
and HIV prevention.

Mr. ANDREW MOSS (Epidemiologist/UFO Director): We started off to look at
HIV and hepatitis in this population, young injection drug users--basically
street kids. And we started off with HIV because that's the way everybody's
focused in public health, but it very rapidly became apparent to us here in
San Francisco that though there is some HIV in this population--there's not
a lot--and what they all get is hepatitis B and C. They all get infected by
the time they're in their late 20s with hepatitis B and C. So we set out to
try and figure what to do about this, but along the way, again, we found
out what they were actually dying of was heroin overdoses.

BROWNING: Indeed, San Francisco has the highest overdose rate in America,
mostly of young white kids in their teens and early 20s who've fled their
homes.

Mr. MOSS: About a half of all of them have overdosed, and we define an
overdose basically as turning blue for the purpose of the study; cyanosis,
not getting enough oxygen to your extremities, so that your lips or your
fingers are blue. And we asked people if that has happened to them and
about half of them say, 'Yes.' And we asked people if they witnessed that
happening to somebody else, and about three-quarters of them have seen it
happen to somebody else, and of those, about a tenth died.

BROWNING: Sugar, a 27-year-old woman with short blond hair and blue
eyelids, a dime-store chain that reads 'Sugar' around her neck, used to
shoot. Now she's a street outreach worker with UFO. Two years ago she shot
up with a friend and nearly died.

SUGAR (Street Outreach Worker, UFO): I had, like, a prescription for, like,
all kinds of pills at the time for anxiety, so we were, like, mixing them
and stuff. And then one night--it was maybe, like, the sixth or seventh
time I ever shot up with her, or at all--where it was, like, me and my
friend and her boyfriend and we were all--he had just gotten off the boat
from being on the Navy or whatever, and he shot up, I shot up, so did she,
and we all got really high. We were doing coke and pills and heroin. And
the next morning she's freaking out and he was, like, blue and, like, rock
hard. And so I haven't used--I haven't touched needles since that day.

BROWNING: UFO runs regular training sessions on how to save the life of a
person who's overdosed on heroin, namely call 911 and perform CPR to get
the person breathing again. Heroin overdoses kill by shutting down the
breathing impulse. Anything that gets victims breathing will usually save
their lives.

The key UFO message to users is not to shoot alone and never to let an
overdose go blue.

There are many drug outreach and treatment programs across the country, but
the distinctive thing about UFO is its merger of long-term epidemiological
research with street treatment. When Andrew Moss and his team of
investigators and outreach workers hit the streets, they find young drug
users who move up and down the West Coast, from Vancouver all the way to
LA, with San Francisco as a hub.

(Soundbite of street traffic, honking)

Ms. McCLELLAN: Do you need any other supplies, hygiene supplies or anything?

DAN: I'm doing all right. Do you guys have any deodorant, actually?

Ms. McCLELLAN: No, but I have, like, soap and razors.

DAN: Oh, I could go for a razor, absolutely.

BROWNING: The next day, Ivy was out on Polk Street, famous for young sex
hustlers who shoot up. She struck up a conversation with Dan, a young,
fresh-faced man with barely a wisp of a beard.

Ms. McCLELLAN: One or two? These are single blades, the jail style, but...

DAN: Two, please.

Ms. McCLELLAN: I have multivitamins, too.

DAN: I'm cool. I'm cool. I have my own vitamins that I take, actually.

Ms. McCLELLAN: All right. Have you ever heard of the UFO study?

DAN: I have not. I have not.

Ms. McCLELLAN: It's a street study for young users to find out--you know,
you do a survey talking about using and you get tested for HIV, hepatitis B
and C...

DAN: OK.

Ms. McCLELLAN: ...and you get paid $ 10 for that. And when you come back in
a week, you get paid $ 10 for results.

DAN: Yeah. I'd like to be a part of this study. That'd be cool, actually.

BROWNING: Dan had just arrived in San Francisco from Portland.

DAN: Yeah. I'm taking a year off college, actually, to kind of see the
world a little bit. I'll be a junior next year. Actually, I got to get
going because I'm going to take off with this guy right here.

BROWNING: OK.

DAN: But--hey, Joey!

BROWNING: The guy 'right here' was a stout, middle-aged man, the john, and
we were getting in the way of business.

Heather, a tall, striking woman of 27, has a rougher story. Raised in an
affluent conservative section of Houston, she was once a magazine and
fashion model. She's still striking. Her cheekbones are high. Her long
brunette hair still has a touch of luster. Her knuckles are scarred from
needles abscesses and, like many junkies, her voice and her story wander.

But she credits UFO with giving her a new chance.

HEATHER (Drug User): It's really rough and it provided things like, you
know, vitamins and doctors. And when I did the study, I didn't even think
about how much I put myself at risk and, you know, I never shared any of
the--it's more of having somebody to talk to about it, you know? The only
time I put myself at risk was the one time I got raped and they didn't just
give the test, they also provided me with counseling and places I can go
and people I can talk to about it, and...

BROWNING: At each field clinic, the UFO staff run through the case files on
each person who has come in for hepatitis and HIV screening, assessing the
needs of the individuals and picking those who will be followed long-term.
Unidentified Woman #1: He's hep C positive, hep B negative and HIV negative.

He drinks almost every day.

BROWNING: Those who are still uninfected with one of the viruses qualify
for the study.

Unidentified Woman #1: We'll vaccinate him for A and B today if he wants,
and I have to talk to him about drinking less.

Unidentified Woman #2: Mm-hmm.

Unidentified Woman #1: And also, he said that he takes heroin to sort of
balance out his chemistry 'cause he feels like he's hyper and he needs
something, so we gave him a referral to see if he can get some of that.
Unidentified Woman #2: Oh, good.

BROWNING: Even those who are infected get some counseling and medical
referrals. The business of training users to care for themselves is a key
element of the harm reduction approach to public health and it largely
emerged from the AIDS activism of the 1980s, says researcher Karen Ochoa.

Ms. KAREN OCHOA (Researcher) : So that we, as activists in the harm
reduction movement, demanded to have, you know, scientists working with us
in helping us to show that needle exchange worked, that it didn't promote
drug use, that it prevented HIV. And from that, you know, studies and
projects like UFO have grown, where we really look at the problem together
with those who are experiencing it--in our case, it's young injection drug
users--and try to find out, 'OK, what do we need to know in order to create
an efficient intervention?

What do we need to know in order to stop the spread of hepatitis or to stop
overdoses?'

BROWNING: For Andrew Moss, one of the country's pioneering AIDS
epidemiologists, this new epidemic of overdose deaths raises deeply
troubling issues. Worst, he says, is that most public agencies, most
shopkeepers and most neighbors simply want these young people to disappear.

Mr. MOSS: This population of street kids, they're a horrible-looking
population. That's how adults feel when they look at them. They are a bunch
of young people, kids--they're very early 20s and teens, a lot of them--who
are basically killing themselves in your face.

BROWNING: To which many people answer, 'Let them.' They are mostly
working-class or middle-class white kids who've chosen their own path, even
if they're running away from abusive homes, which UFO counselors say is
usually the case. The problem with that, Moss points out, is not only that
they harbor infectious hepatitis, they also cost the public a lot of money.
Last year, abscesses from bad needle injections cost San Francisco General
Hospital $ 18 million in unreimbursed treatment and was a leading reason
for admission to the emergency room. That, Moss points out, is on top of
the cost of treating the drug overdose cases.

Mr. MOSS: There is a self-interested argument for the city: prevent
overdoses. It'd be a good thing to do just strictly on a cash basis. You
can't be close to this population and maintain that point of view. If
you're close to them, you'll be sucked into the perspective 'it's your duty
to do something about their overdoses because you don't want kids to be
dying.' Right. At a more complex level, you could say we should be looking
at the things that we think are hard to look at. It'll tell us something
about what we do to children in America and it might be something that we
ought to know. I don't think we're very good at this, you know? I think
it's important to pay attention to the nightmare that's on your own street
because it may tell you something about yourself.

BROWNING: For NPR News, I'm Frank Browning in San Francisco.