DRUG-INDUCED HOSPITAL VISITS SOAR IN S.F.

SAN FRANCISCO (AP) -- Some show up in handcuffs, screaming, jittery and
looking for a fight. Others -- groggy and blue-faced -- arrive at the
emergency room on stretchers, brought in by paramedics or worried friends
who tried unsuccessfully to snap them out of a drug-induced haze by
slapping them or putting ice on their nipples or testicles.

It's happening more and more in San Francisco, a city long known for its
drug scene and that -- 30 years after the Summer of Love -- is seeing a
re-emergence of overdoses and drug deaths, especially as the price of
heroin has dropped and its purity increased since the early 1980s.

``San Francisco has a reputation in the world among all people that
epitomizes Timothy Leary's 'Turn on, tune in and drop out,''' says Darryl
Inaba, director of the Haight Ashbury Free Clinics detox programs. ``The
belief is that you can get any drug you want....''

The resurgence is at odds with recent reports from some parts of the
country. A preliminary federal report compiled by the Drug Abuse Warning
Network (DAWN) says that, in 1996, overall drug-related hospital visits
leveled off in much of the country, compared with 1995.

But not in some urban areas, including San Francisco, where heroin and
methamphetamine, also referred to as speed, and LSD are leaving emergency
rooms swamped. Other cities, such as Baltimore, Newark, N.J., and Boston,
have similar problems with heroin, while speed continues to vex West Coast
cities such as Phoenix, San Diego and Los Angeles.

Doctors say San Francisco hospitals also are seeing more overdoses of the
newer ``rave,'' or party, drugs, such as ecstasy and GHB, or gama
hydroxybutyrate, which has become popular in clubs for its alcohol-like
effect.

One of the hardest hit is city-run San Francisco General Hospital, which
handles much of the city's under- and un-insured patients and, thus, the
bulk of the fallout from the city's drug trade.

``Can you hear me? Do you know where you are?'' Dr. Karl Sporer, an ER
physician, asks several groggy patients who lie on gurneys in crowded,
often stinky hallways. Sporer presses his fingers into their sternums,
gently but firmly rocking them back and forth until he gets a response.
``Talk to me, and I'll leave you alone. Come on, talk to me.''

The majority of the patients -- found crammed into examination rooms and
hallways at any time of the day -- are passed out or vomiting from the most
common drug of all: alcohol. But, these days, Sporer says he and his fellow
staffers are seeing three to four patients a day who've overdosed on heroin
and two to four a day who come in strung out on speed, or methamphetamine.

``It's the bane of our existence,'' he says, noting that someone dies from
heroin every third day in San Francisco.

In fact, medical examiners reported 126 heroin-related deaths in San
Francisco in 1995 and 4,178 nationwide, according to the most recent
statistics available from the federal Substance Abuse and Mental Health
Services Administration, which publishes the DAWN report. There were 488
deaths related to methamphetamine nationwide in 1995.

Overall, hospital admissions for heroin -- the deadliest of the drugs --
have increased 66 percent in San Francisco between 1986 and 1995, according
to the Irvine-based Public Statistics Institute.

Whatever the drug, nurses say there's often a rush of overdoses after the
first and 15th of each month -- the days public assistance checks arrive.

``You can see your tax dollars at work,'' quips one nurse, who overhears
his colleagues discussing the matter as he rolls a patient into an
examination room.

A few days after those waves of overdoses, the ER is filled with patients
with skin infections related to ``popping,'' or injecting the drug into
skin after overused veins wear out -- a huge reason for patient admissions,
Sporer says.

Take Robert Cerda, who comes hobbling into the crowded hospital with a
painfully swollen foot. The 33-year-old addict says he's never overdosed
but can't really say why.

``Whatever I get, I shoot, so I guess I've just been lucky,'' he says.
Usually, that means a $5 to $20 bag of heroin, which he buys in the city's
Tenderloin and Mission districts.

``Five bucks will get you `well,''' Cerda says, using the street term for
``high.'' ``It gets you on your feet to get more.''

The city's health department estimates that San Francisco has about 15,000
intravenous drug users -- some of them homeless, others middle-class
professionals who manage to use and hold a job.

At least 3,000 of the 15,000 are thought to be younger than 30 -- many of
them teens who travel to San Francisco in search of freedom and their first
serious high in the city's Haight-Ashbury neighborhood. From there, police
say, the downward spiral into addiction often takes new users to the
harder-core drug havens, including the Tenderloin and so-called
South-of-Market districts.

But the large number of users may not be the only reason why San Francisco
ranks among the top three U.S. cities for hospital visits related to
methamphetamine, heroin and LSD.

``We have a city that believes addiction is not a crime, it's an illness,''
Inaba, of the Haight Ashbury Free Clinic, says. ``So people feel more
comfortable going to a doctor or emergency room for help without fear of
being arrested.''

Heroin users in particular risk overdose because of the varying purity of
the drug shipped into San Francisco from Mexico, Asia, Africa and South
America, Inaba says.

Tar heroin, for example -- a gummy, black substance from Mexico -- often
varies widely in purity, specialists say. A drug user may get one hit
that's 30 percent pure and later one that's more than 60 percent pure,
sending them to the ER.

``What's a user to do? They have no FDA to make things pure,'' says Douglas
Anglin, director of the UCLA Drug Abuse Research Center.

He adds that hospital visit statistics vary in many cities, in part, due to
``brand loyalty,'' meaning that users in particular regions tend to stick
with the drugs they know.

Methamphetamine, for example, remains largely a West Coast drug that, for
many years, was found mainly in cities such as Sacramento and San Diego.
Cocaine use is still strong on the East Coast.

And then there's heroin -- new to a generation of users, many of whom
weren't even born in its former heyday.

``We're following the same script,'' Inaba says of renewed interest in
drugs from the 1960s. ``But, if it's cyclical, we can only hope that it's
due to pass.''