REPORT: HEROIN TOPS COKE ON MASS. STREETS

Despite ambitious state and local campaigns to combat heroin
addiction, a new report shows that heroin, for the first time in more
than a decade, has surpassed cocaine as the drug of choice on the
streets of Boston and throughout Massachusetts.

The new report, scheduled to be released this week from the state's
Department of Public Health, also notes that, for the first time,
heroin leads cocaine - and even alcohol - as the drug most frequently
mentioned in drug-related deaths in Boston.

"Heroin, indeed addictions of all kinds, remain one of our greatest
public health challenges," acknowledged state health commmissioner
Howard Koh, in an interview with the Sunday Herald.

"While these are very challenging health issues, they are treatable
and ultimately preventable," Koh said. "But progress is slow, and it
is an issue where we need to redouble our efforts."

The state's report shows that heroin use across Massachusetts has
climbed steadily for the past three years, accounting for a
substantial jump - from 25 percent to 32 percent - of the admissions
at state-funded substance abuse treatment centers. At the same time,
admissions for cocaine addictions have held steady, at about 22 percent.

In Boston, officials are still grappling with ways to accurately
measure the scope of the problem. Under design is a comprehensive
database that will record overdose-related EMS calls, emergency-room
visits and deaths to help local and federal authorities zero in on
where heroin and other illicit drugs are being sold. City officials
say a consultant has been integrating databases from several agencies
during the past four months and expects to have a cohesive system up
and running by Labor Day.

Statewide, the Department of Public Health said it has added 135 beds
to its contingent of 1,900 at residential drug treatment centers
across Massachusetts.

While drug counselors say that has helped, they maintain there still
is a serious shortage of slots for women. And when it comes to
state-funded, out-patient services for recovering heroin addicts,
counselors say the situation is grim.

"The rate that (outpatient centers) are reimbursed to treat heroin
addicts by the Department of Public Health has not changed in 11 years
- - and costs have skyrocketed," said Mark Kennard, executive director
of Project COPE, a nonprofit drug treatment center in Lynn. Kennard
said the funding crunch has made it tough to draw competent doctors
and staff.

For the past several years, those working the front lines of the
state's drug offensive have reported an ominous and rising tide of
cheap, potent heroin flowing into Massachusetts and New England from
New York.

As the prices plummeted, the number of overdoses soared.

Experts say the drug's abundance - at $4 a bag, it is often cheaper
than a six-pack of beer - has attracted a new generation of users who
are snorting or smoking heroin, rather than injecting it.

"Due to high purity, snorting is the common starting route of
administraton for new and younger users," noted the state report.
"However, progression to injection is widely reported, due, perhaps,
to the increased effect from a given amount of heroin and the need to
buy fewer bags to support a habit."

Missing from today's younger psyches is the image of strung-out
addicts injecting heroin, images that frightened many of their parents
away from the drug a generation ago.

"Some of the teenagers who might experiment with heroin, thinking it's
not as pernicious if you don't inject it, don't understand that they
will not be able to use it occasionally, and fairly rapidly are
getting addicted," said John Auerbach, executive director of the
Boston Public Health Commission.

Three years ago, a string of teen heroin overdoses and suicides in
South Boston shocked the city. At that time, many suggested the heroin
problem was unique to Southie.

Few are saying that anymore.

"We are seeing it in East Boston, Charlestown, Dorchester. It's our
top dog right now," said Deputy Superintendent Patrick Crossen,
commander of the Boston Police Department's Drug Control Division.

While South Boston is still struggling with teen heroin use, Crossen
said the community has made considerable strides in acknowledging the
problem and devising creative treatment services to attack it.

For instance in April, community leaders invited heroin addicts to a
meeting where law enforcement officials bluntly told them they were
going to be cracking down with more arrests. But health officials then
got up and told the addicts they could choose a different path: help.
They offered immediate detox treatment beds to anyone who was interested.

Officials who attended the meeting say only a few of the 100 addicts
there may have entered treatment. Still, they said, the gathering helped.

"One person got up and said, `I was a heroin junkie and now I am the
face of AIDS,' " Crossen said. "I think that got the attention of some
of the kids. About half of those in attendance were teens."

The rising heroin problem hardly stops at Boston's borders. Listen to
Essex County District Attorney Kevin Burke, whose jurisdiction covers
34 cities and towns, and 700,000 people.

"There is no urban city in Massachusetts that isn't having some sort
of heroin overdose problem," Burke said.

One community that is knee-deep in the drug is Lynn, where heroin has
claimed nearly twice the number of lives than homicides have in the
past four years.

"The good news is that we are bringing the community together around
this. The bad news is that we really are not having the impact we
would like to see," said Lynn's deputy police chief, John Suslak.

Among the strategies Lynn tried was to assign three police officers,
full time, to investigate all drug overdoses, hoping to find ways to
head them off. After a year, and little impact, the city went back to
the drawing board.

More recently, a task force has pulled together law enforcement,
school and public health officals.

"We're convinced that law enforcement, by itself, is not going to fix
this problem," Suslak said. "Treatment is something we ought to commit
to, but treatment that makes sense - with accountability built in."

This time, the task force hired a Boston-based research firm to
analyze each reported overdose, with an eye toward future treatment
strategies.

While many other researchers have concluded that heroin's cheap price
and incredible purity are driving its popularity and, ultimately, its
high overdose factor, the Lynn research turned up one other intriguing
angle.

"Our data shows it's not necessarily the purity of the heroin that's
killing people, but the mixing of the drug, particularly with
anti-anxiety drugs such as Klonipin," said Carolyn Keshian, director
of Safety First.

"These anti-anxiety drugs are all prescription drugs, either obtained
legally from doctors or on the black market," Keshian said. "Now we
are looking very closely at educating physicians about patients coming
in to them and asking for these drugs, and letting them know we are
seeing a large number of people using those drugs who end up
overdosing."

As experts in Lynn and across Massachusetts dig in to beat back
heroin, the state's latest report on drug abuse signals yet another
potent invader at the doorstep - a designer drug known as ecstasy.

While the report notes that hospital emergency room and arrest data
for ecstasy, which is a stimulant that comes in pill form, are still
low, "other sources continue to suggest a rapid increase in its use,
especially among high school youth."

That worries Crossen, the Boston Police Department's drug control
czar.

"It seems like it's cyclical. When we start paying attention to a
drug, over time, the use goes down. Maybe heroin came back because we
didn't pay attention, and now it's back with a vengeance," Crossen
said.

"Are the designer drugs going to pop up now and take the place of
heroin?"