When I started using heroin in New York City in 1985, I became part of the drug's long, twisted, and intimate relationship with this town. Introduced by Bayer in 1898 as a cough syrup and "non-addictive" morphine alternative, the opiate was sold over-the-counter before federal drug regulation began in 1906 (in large part, not surprisingly, as a response to related addiction issues). From the start, heroin's story here has been one of continuity through change.
Early on, the "hardest" drug became a sensation, especially after the importation of opium for smoking was banned in 1909. Soon, heroin itself was made illegal when, in 1915, the Harrison Narcotics Act that gave birth to American drug prohibition came into effect. Alcohol Prohibition was enacted in 1920, and in a whirl of newly illicit but readily available substances, the 20s began to roar.
Like 90 percent of heroin's first users as described by historian David Courtwright, I was a young, white New Yorker. However, in the early 1900s as now, addiction was more common among men than women. New York has always been America's heroin capital—and the drug spread along with the rise in inequality of the 1920s, in another parallel between this century and the last. In both periods, use has always been highest among the poor and economically struggling.
But the media prefers to highlight "middle class" addictions like mine, while politicians use drug laws to stigmatize and suppress minorities. Although President Richard Nixon's drug war of the 1970s and New York's tough Rockefeller laws of the same period tagged heroin as a vile drug that drove black men to crime, whites have actually made up the heroin majority for most of its history.
Over the years, of course, much has changed in the way heroin is sold, acquired and used. But there are just as many consistencies, which can be observed in the lives of people with heroin addictions and the way drug laws tend to exacerbate—rather than treat or prevent—the problem. All of these factors can be seen clearly in New York's heroin story. To explore these trends, I looked back at my own experience and talked with researchers and users from the last half-century of heroin in NYC.
The first time I snorted dope—we called it that, or "D," for Downtown—I was in a seedy hotel called the Carlton Arms. In the 1980s, the Carlton was one of many single-room occupancy welfare hotels clustered in the East 20s in Manhattan and rife with drug use. I was 20 years old and had been suspended from Columbia for selling cocaine.
After a life of over-achievement, I thought my future was past. Heroin embraced me and told me it would be OK; it made me feel loved and comforted—not constantly awkward and rejected, the way I usually felt.
Initially, I'd buy from a young addicted couple at the Carlton, who had given me my first taste. They were friends of my cocaine-connection/boyfriend. Soon, I also had several other "indoor" connects: people who bought from low-level wholesalers or smuggled it in themselves (literally) and sold only to people they knew.
The retail cost was around $600 a gram, with half of a tenth of a gram being the smallest unit sold. If your tolerance was low and the quality was good, half of that tiny packet could have you nodding for hours—even if you snorted it, rather than shot it.
I'd usually meet indoor dealers, all of whom were users themselves, at their apartments or cheap hotel rooms. A few lived in the West Village, some near Gramercy Park. If they were paranoid about having a suspiciously high number of visitors, we'd meet instead on the street, furtively exchanging cash for drugs or sometimes trading coke for heroin.
But when no one was around, I'd have to buy from strangers "outside"—or have someone do so for me because I was terrified of getting arrested. Mainly, I'd score in the East Village, going down to Alphabet City with a friend and waiting around the corner while she copped. By that time, I was injecting and needed about ten $10 street "bags" a day to get high—rather than simply avoid being sick. These tiny glassine envelopes weren't sold by weight, and their quality and the quantity they contained varied from enough to produce an overdose after shooting half of one to complete placebo with no effect whatsoever.
Unlike many other illegal drugs, heroin bags have brand names or marks. Some are darkly funny—"Poison," "Overdose," "Seven to Life," "Game Over." Others reference popular culture and politics: recent ones include "Obamacare," "Nike: Just Do It," and "Fresh Direct." Many are simply marked with a logo like a skull, a star, or a colored stripe.
Heroin branding itself is a New York innovation, according to Ric Curtis, professor and chair of anthropology at John Jay College of Criminal Justice, who has studied the city's street heroin and cocaine markets for decades. Introduced in the 1970s, these brands exist for the same reason legal products are branded: to identify them uniquely to users. Obviously, this carries risk. If your product is strongly linked to you, that connection can identify you to police, not just customers and competitors. But the benefit is that good quality can be recognized and purchased again—at least until sellers of "beat" or inactive heroin counterfeit the label.
Since heroin was first prohibited, New York has swung between extremes of enforcement and times when sales were so blatant and open that customers literally lined up in the streets. Crackdowns on dealers often alternate with crackdowns on police corruption linked to dealing, but in either case, the market never dries up for long.
Howard Josepher, founder and executive director of Exponents, an agency that helps active and recovering drug users with health, harm reduction, and other services, started using during a period of increasing enforcement. In 1961, he was in his 20s and studying acting, hanging out with a group of people that he describes as "sort of the hipster crowd between the beatniks and the hippies." A friend turned him on to snorting heroin and he soon progressed to injecting, which at that time took serious dedication. Cheap, plastic syringes weren't yet available, and glass syringes were hard to come by.
"Needles were made of steel and you stole them from a doctor's office or a clinic or a hospital," Josepher recalls. "But to make a set of works you needed an eye dropper."
Since eye droppers weren't designed to be fitted with needles, users had to get creative. To ensure a tight seal, they would create what was called a "collar," typically using paper ripped from a dollar bill. To maximize the efficiency of the injection, they'd use the suction part of a baby's pacifier, attached to the dropper end with a rubber band. Given the difficulty of obtaining and assembling the "works," they were often shared. That, of course, eventually made New York the epicenter of the American HIV epidemic in IV drug users, as well as spreading other blood-borne illnesses like various types of hepatitis.
Violet finds the branding of her drugs amusing. 'It's some kind of fucked up alternative universe of American capitalism.'
In Josepher's day, he says, Manhattan heroin dealers were mainly concentrated on the Upper West Side and in Harlem. To score, he'd typically visit the basement apartment of a brownstone, on a side street, somewhere between 72nd and 96th street, between Broadway and Columbus Avenue. He'd knock on the window to be admitted and buy either a two or a three dollar bag, which were the precursors of today's standard $10 bags.
In one shooting gallery, he says he was actually rousted by the two cops who later became known for breaking up the "French Connection," made famous by the eponymous movie. At the time, related traffickers supplied a large portion of city's heroin. The drug was processed in Marseille, using poppies grown in Turkey or Southeast Asia. "They had a notorious reputation for being ruthless," Josepher says of the officers involved in dismantling the cartel. "They would bust the door down, flashing their guns, flashing their badges." But since they didn't want to waste their time making low level drug arrests while on the trail of the kingpins, they'd tell the users to get lost and only arrest dealers, Josepher says. He kicked his habit in 1967, becoming one of the first graduates of the Phoenix House rehab.
Josepher's heroin-using career encapsulated the era in which he shot smack. He had started the year of a famous shortage, known as the "panic" of 1961, which was caused by parts of the Mafia pulling out of the business. At the time, they believed heroin selling to be unpatriotic and linked to Communism—and wanted no part of it, according to Curtis.
Of course, other mobsters had no such scruples. One of the first big French Connection busts occurred in 1962, a seizure of 64 pounds, which was much celebrated. Ten years later, however, authorities learned that their big haul hadn't even taken any drugs off the street—when bugs started eating evidence bags, they were found to contain cornstarch or flour, not heroin. To this day, no one knows who stole some $73 million in drug evidence from storage during those years.
By the 70s, the Lower East Side had become the place to go for heroin. Ironically, an investigation into police corruption known as the Knapp Commission, which began its work in 1971, had led enforcement to shift its focus to busting high-level dealers, rather than policing street markets. According to sociologist Lynn Zimmer, having only selected officers focused on top-level narcotics policing was a way to reduce the chances that the rest of the force would be tempted by bribes from street dealers.
Consequently, in a poor neighborhood that was then filled with abandoned buildings in a city close to bankruptcy, some streets became blatant, open-air bazaars. Richard Lloyd, the dazzling guitarist for the band Television, which helped put the club CBGB's on the map, recalls his experience of buying at that time. "It grew to such an extent in Alphabet City, that there were places where there were lines as if you were going to a hit movie," he says.
"There was a door that you put your money in the slot at the top," Lloyd adds, "You said what you wanted and the dope came out the bottom, whether you wanted heroin or cocaine." On the line were "old ladies, guys with briefcases and suits, drawn out junkies, ordinary people, rock people, people that you recognized." Employees of the dealers would police the line, he recalls.
"They'd be like, 'Single file. No singles. Fives and tens only. Tell the man what you want. Put your money in and get the hell off the block right away.'"
By the time I began using in the 80s, these open markets were starting to shrink. Ronald Reagan had re-declared war on drugs and users and street level dealers were prime targets. With 1984's Operation Pressure Point and the NYPD's Tactical Narcotic Teams (TNT) strategy that started four years later, thousands of New Yorkers were arrested and put into the system, often repeatedly.* I was lucky to avoid getting swept up in it before I went to rehab and started recovery in 1988.
Soon, the streets were retaken, and dealers no longer operated as if they expected impunity. Nonetheless, by the early 1990s, the Lower East Side heroin trade had bounced right back. Sean, a writer who did not want to use his real name, lived in an apartment near a corner that was famous for street sales for decades: Stanton and Ludlow. A daily user of all types of drugs since his teens, Sean decided he wanted to try heroin when he was 22, in 1994. Since dealers hung out in the doorway of his building, he didn't have to go far to get it.
"It was essentially as easy and sometimes easier to get dope where I was living than it was to get a taco," he says.
When he first tried heroin, Sean simply left his apartment and bought from the first person who offered. "I went into a McDonald's with this guy who then reached in and pulled the bag out of his ass," he says. "I was like, I guess that's what happens." It wasn't until later that he realized that this was an atypical scoring experience. Sean spent the next few years shooting up and in and out of rehab, successfully kicking in 1997.
While over a century of law enforcement efforts has failed to curb heroin addiction, drug policy isn't entirely without influence. It often determines whether or not people survive the experience—and unfortunately, it typically increases harm.
The next shifts in the heroin market were driven not by enforcement, but by far more powerful forces: technology and real estate development. Together, they conspired to make the scene much less conspicuous. These days, while there is still heroin available on the Lower East Side, in Harlem, and some outer borough neighborhoods, it's hard to see obvious signs of sales, and if you don't know anyone, it's much more difficult to score. According to Curtis, the anthropologist, the shift from street markets to delivery services was nearly complete by 1999.
Violet*, a 32-year-old heroin user who lives in Williamsburg, Brooklyn, and works in advertising, doesn't even have to go outside to buy. As we talk on the phone, she answers the door to receive and pay for Chinese food she'd ordered for dinner. "It's just as easy as that," she says, describing the delivery of her drugs. She can text a dealer, day or night, whenever she wants, and can afford heroin.
Violet and her boyfriend got into heroin through a partying scene in which they'd previously done blow. Their first connection came via a bar, where he worked. Such bar sales are common, according to Curtis, whose research has explored the marketing strategies that replaced the outdoor bazaars. Beyond bar sales, he notes there are mainly home delivery services run by low-level freelancers, often users, who sell to people they know. While large corporate style franchise delivery services exist, they mainly sell pot.
These marketing methods have significant advantages. For one, they dramatically reduce violence: there is no turf to fight over and discreet, mobile dealers are less likely to be robbed, so they tend not to arm themselves. For obvious reasons, the reduced violence and reduced visibility of the market is better for neighborhoods and families.
Secondly, from the perspective of both users and dealers, there is less risk: Selling to known customers and repeatedly buying from the same dealer increases trust and decreases the likelihood of rip-offs on either side, not to mention cutting risk of arrest by reducing the odds of being observed by or selling to strangers who could be cops.
Violet finds the branding of her drugs amusing. "It's some kind of fucked up alternative universe of American capitalism," she says. "I wonder how it starts: imagine the marketing meetings."
She talks about the brands she's used. "One really good one was called 'Chase,' with the logo of the bank. One was called 'No Regrets,' which I thought was ironic—like any one of us would say that! Sometimes, they get a little more sinister, like 'Grim Reaper' or 'DOA.' They want to convey that it's so powerful that it can kill you."
Indeed, heroin users I interviewed from every period described how brands that are known to have caused fatal overdoses become more popular, not less. "A lot of people here, if someone happens to die from something, they want to buy it," Violet says. Lloyd, Josepher and Sean each independently made the same grim point.
While we no longer shoot up with works made from with eye droppers or wait in lines on otherwise-desolate streets, people with heroin addictions across time still share much in common. Addiction itself is marked by repetition; crave, use, repeat. But while media coverage and public concern rises and falls, our numbers don't actually vary all that much.
In 1975, when national statistics first started being kept, only 1 percent of high school seniors reported using heroin in the past year. The highest proportion ever recorded was 1.2 percent, in 1997. The most recent number, from 2014, is 0.6 percent. For young adults, aged 19-28—the age when heroin use is most common—around 0.2 percent, or two tenths of a percent of the population are current users who have taken it at least once in the past month.
These statistics probably do miss a significant portion of people with heroin addiction: they don't include teens who have dropped out of high school or people who are homeless or incarcerated. However, when the Office of National Drug Control Policy has tried to come up with an estimate that includes these more marginal populations, again, the numbers are reasonably consistent. In the 90s, they estimated that America had 1 to 1.5 million current heroin users—and a similar number was arrived at in 2010.
Still, while over a century of law enforcement efforts has failed to curb heroin addiction, drug policy isn't entirely without influence. It often determines whether or not people survive the experience—and unfortunately, it typically increases harm.
For example, before a 1991 court case spurred by ACT UP and other activists forced New York to legalize needle exchange, more than half of all IV drug users here were already infected with HIV. But by 2012, after widespread implementation of needle exchange and legalization of over-the-counter syringe sales, that rate had plummeted to just 3 percent. Though needle use accounted for a third to one half of all new HIV infections in New York in the 90s and 00s, this number is now down to 5 percent.
Police crackdowns and incarceration also do damage: When people fear arrest, they are less likely to use safer injection techniques, for one. Moreover, being jailed without access to drugs lowers tolerance within a week— the days immediately after release multiply overdose death risk by an incredible factor of between 40 and 129.
Treatment provision—and barriers to it—can further have a life or death impact. Studies show that making indefinite maintenance treatment with methadone available reduces mortality by over 70 percent among people with heroin addiction; similar results are likely with other maintenance treatments, like Suboxone.
Methadone maintenance was first studied and introduced in New York City and is probably more available here than anywhere else in the United States. Nonetheless, even here, most addicted people and their families don't seem to know that only maintenance—not expensive rehabs or other abstinence-only treatment—has been shown to reduce death risk. Moreover, our drug policies have usually worked to limit maintenance access, rather than increase it. For example, insurers often cap coverage and methadone is the most heavily regulated drug in America—only legally available for addiction treatment at specialized clinics.
While doctors with no special training can treat an unlimited number of patients with opioids for pain, extra education is required to treat addiction with Suboxone and one doctor isn't allowed more than 100 patients.
Fortunately, however, for the first time in more than 50 years, there is real hope for change. The visibility of heroin as a white problem—and the clear failure of current approaches—is starting to cause politicians to rethink. Some police departments have realized the futility of arresting users—and are now offering services or treatment instead. The Obama administration is attempting to expand access to maintenance treatments and reduce barriers—like resistant drug courts and ideologically-driven treatment providers.
New York's heroin story shows how unlikely it is that we will ever eradicate opiate use. But it also suggests that we can do much more to ensure that those who get entangled with it live to tell the tale.
Follow Maia Szalavitz on Twitter.
*Name has been changed.
Correction 12/14: An earlier version of this story said the Tactical Narcotics Team program was launched in 1987. In fact, it was 1988.