A heroin addict's call for help: another fix
San Francisco in throes of nationwide epidemic

BY JEORDAN LEG+N
Mercury News San Francisco Bureau
Page 1

SAN FRANCISCO Rushing by a blur of tourists waiting for cable cars,
Tara, a grungylooking 22yearold heroin junkie, desperately searches for
her pusher.

Her joints ache from withdrawal; she feels nauseated. The cigarettes
she's chainsmoked since waking a halfhour ago can't compose her.
Today, she can't reach her regular dealer, who usually handdelivers
her ``brown sugar'' what she calls the Mexican heroin that soothes
her. So she buys off the streets no problem in a city where heroin abounds.

``It's everywhere, as easy as cigarettes,'' says Tara, who wouldn't give
her last name. She scores from a pusher near a stylish hotel off Union
Square. ``But I like to know who I'm dealing with.''

Addicts such as Tara are part of a recent national resurgence in heroin
use, one that's hit particularly hard in San Francisco, long associated
with the drug culture.

This new heroin chic has helped the city earn what's now the highest rate
of heroinrelated hospital admissions in California: almost 314 per 100,000
people more than four times the statewide average, according to the
nonprofit Public Statistics Institute in Irvine.

That means San Francisco ranks third for heroin admissions among U.S.
metropolitan areas. The number of heroinrelated deaths in the city more
than doubled from 1990 to 1995, the most recent figures available from the
county coroner.

Drug experts are hardpressed to say what makes San Francisco's heroin
problem rank above Miami, Los Angeles, Seattle and other larger
international ports of call.

But they agree that the city has the right recipe for disaster:
wellfinanced and highly organized smuggling operations; cheap prices
on very pure, highly addictive heroin; a growing trend of smoking
instead of injecting the drug, making it easier to use; an ample
supply of aging addicts left over from the '60s; and plenty of young
ones quickly lured in by heroin's mesmerizing highs.

For the past decade, San Francisco has led the state in heroin use, drug
experts say. But the recent rise in heroin junkies has reached such
staggering proportions that it's pushing overburdened city health care and
drug treatment services to the brink.

Alltoofamiliar crisis

At San Francisco General Hospital, Dr. Karl Sporer said, on average, the
emergency room staff treats three heroin overdoses a day, and every third
day, someone dies from using the drug. The top reason ER patients are
admitted, Sporer added, is abscesses and other swollen infections caused by
shooting up
heroin with dirty or damaged needles.

The city's needle exchange program, which attempts to keep heroin users
from contracting the AIDS virus, distributed about 2.1 million sterile
syringes last year making it the largest program of its kind in the
country. But program directors say they still can't meet demand.

San Francisco police add that so much heroin is flooding the streets,
prices have fallen from $300 a gram in the '80s to less than $80 a gram now.

``It's in the workplace; it's on street corners; it's in the homes,'' said
San Francisco police Sgt. John Murphy, who frequently participates in
undercover heroin busts.

Heroin users say San Francisco's reputation for tolerance, its
citysanctioned needle exchange program and the ample drug supply are major
draws for them. But San Francisco Supervisor Susan Leal said the city's
responsive attitude toward addicts and such programs as its needle
exchange are not to blame for the boom in heroin use.

``We're trying to prevent a deadly disease,'' she said. ``These are people
with addictions. Either they're going to use a clean needle or they're not.
But they're still going to use.''

Dr. Alex Stalcup, who has researched drug trends in Northern California for
10 years, said San Francisco isn't alone in its battles with heroin. Use of
the drug is up in all Bay Area counties, according to the Public Statistics
Institute.

For example, in 1995, Santa Clara County hospitals treated 752 heroin
overdoses a 56.3 percent increase from 1986. And Alameda County
experienced a 76.6 percent increase during the same nineyear period. But
San Francisco remained the state's heroinuse capital because it continues
to be a major hub for heroin smugglers, Stalcup said.

``San Francisco is just unlucky to be in front,'' Stalcup explained.

Stalcup, who's also worked with addicts in San Francisco's HaightAshbury
neighborhood and now heads a private treatment facility in Concord, said
heroin's increasing availability is also a function of an almost doubling
of the drug's production worldwide since 1987, which is backed up by the
Public
Statistics Institute's estimates.

Tons of that harvest end up in San Francisco every year through Latino,
Asian and Russian immigrants who maintain a heroin pipeline from their
native countries, he said.

``Frankly, it's overwhelming,'' Stalcup said. ``Everywhere you look, heroin
is coming into San Francisco. And where heroin goes, its use follows. It's
like a disease.''

The high number of intravenous drug users 17,100 by city estimates
also makes it more difficult for them to obtain treatment to kick the habit.

Every day, anywhere from 1,300 to 1,700 drug addicts are turned away from
overloaded drug rehabilitation programs, said Larry Meredith, director of
the city's community substance abuse services.

The city's health department is getting an $8 million funding increase to
provide better drug treatment for the poor, homeless and young. But county
officials say $15 million to $18 million more is needed to treat everyone
who requests it.

The money spent on prevention is worth it, Meredith said, because official
estimates calculate that the city loses $1.7 billion every year as a result
of drug addiction everything from police and court costs to losses in
productivity and tourist dollars.

Avoiding the pain

An addict for almost 25 years, Michiko, 46, a JapaneseAmerican woman with
graying hair who didn't want her last name used, said she'd love to quit
but is afraid of her wrenching pain without the drug.

``It's like every cell of your being is calling out for it,'' said Michiko,
a welfare recipient. ``After 25 years, this is the only thing I know.
Bottom line is, I can't live without it.''

Her routine includes pumping $40 worth of heroin into her veins a day and
trading in 40 used syringes for clean ones weekly at a citysanctioned
needle exchange across Ellis Street from Glide Memorial Church.

In some ways, overdosing from too much or a bad batch of drugs is the least
of an addict's worries. The city estimates that 16 percent of its
intravenous drug users are HIVpositive. From 1981 to 1996, 2,735 heroin
addicts died of AIDSrelated causes.

The city's needle exchange program is larger than those in New York,
Detroit and Philadelphia, with 10 sites and 120 volunteers. One site even
offers child care so that female addicts can shield their kids from seeing
them exchanging dirty ``works'' for clean ones.

A sorrowful task

Dori Ehrlich, 21, of San Francisco began volunteering with the project
after working at an anonymous HIV testing site. One of her most difficult
duties there came the day she told a 15yearold heroin addict that she had
the AIDS virus.

``It broke my heart,'' she said. ``I felt I had to do something to try to
keep other young people from going through the same thing.''

Needle exchange volunteers are there to help addicts avoid HIV infection
and pass on information on drug treatment, housing and health care, Ehrlich
said. For those reasons, Tara, the young, strungout addict, uses the
service.

After buying drugs, Tara, who has been on the streets since age 14, raced
back to her rundown hotel and her 29yearold boyfriend, who would give his
name only as Ojai.

In her dingy room, she placed a tiny brown rock on a spoon, added some
water, heated it with a lighter until the heroin melted, and used a small
bit of cotton as a filter. Then Tara handed the rig to Ojai not
flinching as he injected the ``brown sugar'' into one of the arteries in
her neck.

Less experienced, Ojai, a Hawaii native, struggled to find a vein in his
armpit, pricked himself and began to bleed. ``How much dope is in this
rig?'' he asked Tara.

``Yeah, Ojai. Yeah. You may not want to use the whole thing. May be too
much for you,'' Tara struggled to say too doped up to think clearly.

She blurted out that she's saved 11 people from OD'ing by putting them into
cold showers, pounding their chests or even putting ice cubes on their
genitals. Overdosing, she said, ``is almost inevitable. It's the best way
to go.''

Ojai used twothirds of the syringe and seemed fine. ``Yeah, I agree. That
way it's lights out, you're dead,'' he said. ``No pain. No nothing.''

Published Monday, September 15, 1997, in the San Jose Mercury News