As Afghan president Hamid Karzai prepares to meet with President Bush on Monday to discuss topics including the narcotic aspect of the war on terrorism, reports from the United Nations and various agencies point to the continuing persistence of opium and its offspring, heroin.
That drug's growing and purer supply, amid recent efforts to tailor it to the middle class, have led to what some health officials in the United States and abroad fear may be a deadly new trend of addiction in America.
The city of Chicago may well illustrate the complexity of what some call a high-purity heroin epidemic and its impact on the nation as a whole. For one scholar studying heroin use there, it's time to adjust the popular perception of exactly who heroin addicts are.
"The user of today is not the user of the 1970s," said Kathleen Kane-Willis, assistant director of Roosevelt University's Institute for Metropolitan Affairs and lead author of a study last year on heroin use in Chicago. "The user of today defies the traditional stereotype of being minority, urban, male and poor."
In Chicago, 'demographics have shifted'
The Roosevelt study found that in 2002 there were almost 13,000 heroin-related visits to Chicago-area hospital emergency rooms — the highest number in the United States for the fifth straight year.
"What I've seen in the Chicago area is there is a rise in middle-class users," she said in a May 2004 interview. "The demographics have shifted. ... It's no longer just an inner-city urban problem."
Other cities with recent or emerging heroin consumption problems include Rochester, N.Y.; Vancouver, Canada; Baltimore; Lewisburg, Pa.; and New York City.
For Kane-Willis, social forces have defused the aura of danger surrounding heroin. "I've heard of heroin showing up at rave parties," she said. "The ability to be able to inhale it removes the 'junky' stigma. It becomes just another drug choice, in a sense."
The rise of heroin use in America follows "heroin chic," the name given in the late 90's to pop culture's fascination with hard-drug use — an allure reflected in the "waif look" of gaunt runway models and the popularity of such films as "Pulp Fiction," "Trainspotting" and "The Basketball Diaries." Pop-culture's appeal persists today; New York federal authorities recently told NBC affiliate WNBC of a Bronx-based heroin ring that adopted pop culture-inspired brand names for its wares, names like "Sean John" and "J. Lo."
That explains a great deal.
In this blog, we have looked extensively at how heroin is tied in with the "War on Terror", on both sides; we have also seen how Washington, D.C., is awash in heroin money.
Now we know why: with the new demographic of heroin user, there is far more money to be made -- at the expense of America's middle-class teenagers.
"Because it's been so long since we had the last heroin epidemic, we might be in a process of generational forgetting," Kane-Willis said, alluding to the drug epidemic of the late '60s and early '70s.
"Middle-class users were probably never exposed to the epidemic of the 1970s. They might not know that the consequence of using can be addiction and death," Kane-Willis said. "That forgetting makes perfect sense if you live in an area where there aren't active drug users and it hasn't been made clear in your drug education. If you got it in fifth grade, do you remember it now?"
She also cites the current crop of anti-drug ads on TV. "They're not specific to heroin, they're specific to marijuana," she said. "I don't know that there's been much education about heroin use."
With such widespread use of marijuana, and with so much talk of legalization of marijuana, kids who don't know a great deal about heroin, but who compare it to marijuana, might think that being an occasional user of heroin is similar to being an occasional user of marijuana -- and that idea could kill them.
Heroin traffickers may be exploiting this lack of education. Drug interdiction officials have found that, in their bid to reach U.S. middle-class customers, traffickers have taken a page from a marketing handbook, all but adapting the language of infomericals to target the middle class: It's Improved! Cleaner! No Messy Needles! No Fear of Getting HIV/AIDS!
According to a March 2004 report by the International Narcotics Control Board, the U.N.'s Vienna-based drug monitoring agency, heroin smuggled into the United States increasingly is being packaged for inhalation instead of injection, "making it more acceptable to many middle-class Americans.'
"This shows how the illicit market operates in a very smart way by selling a drug to a new class of users by telling them, 'Use it in a different way and you won't become addicted,'" said Rainer Wolfgang, a member of the U.N. board.
Of course, it's just marketing -- opiates are highly addictive.
Authorities say many users prefer inhaling heroin because they don't have to worry about contracting blood-borne diseases like hepatitis and AIDS through needles, and because it spares them the physical discomfort of injection.
For IV users, risk vs. reward
But addicts usually ending up injecting the drug, Kane-Willis said. "There's kind of a cost-benefit analysis to it," she said. "They have to think of the cheapest modality there is, and that's injection. It's economically more efficient."
Heroin users who smoke the drug face a relatively new and dangerous risk. A 2003 study by the University of British Columbia found that heroin smokers have a higher risk of contracting toxic leukoencephalopathy, a sometimes fatal disorder that affects smokers more than other users of the drug, impairing motor and speech functions of the brain.
Another option: liquefied heroin in an inconspicuous squeeze bottle, much like a container for any over-the-counter nasal spray.
"Trafficking groups who want to continue to make money are constantly looking for new illicit marketing strategies to increase their profits... this is one of their cleverest tricks yet," Herbert Schaepe, secretariat of the U.N. agency, said in a March 2004 interview with The Observer (U.K.).
However the drug is administered, use of heroin has led to new and sometimes controversial approaches to controlling its worst effects. In February, hard-core heroin users began participating in a test program in Vancouver, British Columbia.
Researchers in the North American Opiate Maintenance Project study (NAOMI), with approval of Canadian health officials, are providing addicts with free heroin, in an attempt to find whether steadily decreasing doses of heroin is more effective than methadone use in weaning addicts off heroin.
U.S. agencies that monitor drug use have been curiously at odds in their assessments of whether heroin is a growing problem.
"Heroin use in the United States and the number of new initiates have been relatively flat," said Dave Murray, an analyst with the U.S. Office of National Drug Control Policy in Washington. "I don't think there's much that's new. We have a reasonably good picture of heroin use in the U.S. as relatively unchanged in the last decade."
But Murray's assessment runs counter to analyses from other U.S. agencies.
The 2002 survey by the Substance Abuse and Mental Health Services Administration found that the rate of heroin use among youths ages 12 to 17 and adults 18 to 25 increased between 1995 and 2002.
While the annual number of new heroin users between 1988 and 1994 ranged between 28,000 and 80,000, the number of new users climbed between 1995 and 2001 to a number "consistently greater than 100,000," the study said.
Moreover, Murray's own office found that by June 2003, the number of hard-core heroin users in the United States had reached somewhere between 750,000 and 1 million — a sharp increase from the 630,000 users in 1992, according to the U.S. Drug Enforcement Administration (DEA).
Stay tuned for Part 9!