From the Sept. 18 edition of Street Roots.
On a sunny Monday during the early afternoon, a 27-year old homeless man only wanting to be identified as “Joe” for this story walks down a hill overlooking I-405 and sits on a piece of cardboard laid out among, bushes, empty bottles and litter. The sounds of cars and buses are all around. Joe takes out a blue bag, unzips it, and takes out a twisted-up piece of white wax paper. Inside the paper is an almost imperceptible amount of a gooey, dark brown substance. Joe says it’s a couple dollars worth of black tar heroin.
“I treat this like a medicine,” Joe says. “Oh shit, a cop just went down the street.” He quickly gets up to move.
“You’re focusing on doing something pretty intricate and you have one eye scanning so you don’t get caught and hemmed up,” he says as he walks down the street.
Stopping at an intersection, Joe looks around. “I think we’re good,” he says. He walks down along a hill overlooking another part of I-405. Tucking himself in between two bushes and setting his backpack next to him, he takes out a needle from a Ziploc bag of 10 he recieved at Outside In’s Syringe Exchange Clinic. Holding it in one hand, he takes the tin cup out of his backpack and puts the heroin in it. He also takes out a small water bottle, puts it on the ground, and puts a red lighter on his leg.
Pulling the syringe with his mouth, he pulls water out of the bottle and shoots it into the tin cup. Holding the cup with a twisted bread tie, he heats it for about 20 seconds with the lighter.
With the syringe’s plunger, Joe mixes the liquid. Licking the end of the plunger, he sucks the heroin into the syringe.
“She didn’t give me a tourniquet,” he says, looking through the Ziploc bag.
He takes off his belt and wraps it tightly around his bicep. His veins begin to pop out, and faintly lining his arm are the scabs and scars from previous injections.
Slowly, he inserts the needle, his fist clenched. But he doesn’t inject. Instead, he moves the needle left to right inside his arm, looking for and missing the much-sought-after vein. Murmuring to himself in pain, he pulls the needle out. A small bead of dark blood follows.
“Maybe there’s something wrong with this needle,” Joe says. “I’m just used to having the tourniquet.”
Swiping the blood onto his fingertip, he licked it off. Every time Joe saw a drop of blood as he poked his arm three more times, he’d lick—not to miss a single grain of heroin.
On the fourth injection, Joe stopped moving the needle. Holding it still for a moment, he slowly pushed the plunger with one finger, staring at the point of entry the entire time, watching until every drop of light amber fluid disappeared into his arm.
He loosens the belt before he lets the needle out. Blood trails down his arm. Wiping his arms with his hands, he licks his fingers.
“Sometimes it turns into a bloody mess and you’re just trying to get your fix,” he says as he uses an alcoholic wipe given to him at the needle exchange clinic operated by Outside In.
Joe says he does not feel that much different after taking the heroin. “This is even for me,” he says, not describing the high any further.
On his way up the embankment, Joe stops to talk to a panhandler sitting at the corner. Crossing the I-5 bridge back to downtown, he quickly walks in the direction of a surplus store, his gait almost gliding.
Joe says he will probably shoot up in another four to six hours.
A growing trend
Dennis Lundberg and Mike Reese rarely see eye to eye. But recently, the outreach worker for the homeless youths organization Janus Youth and the commander of the Portland Police Bureau’s central precinct have found common ground on a unlikely topic: the rise of heroin use in Portland.
Heroin use, Lundberg and Reese say, ebbs and flows in Portland with the seasons. Summertime is when the presence of the drug reaches it peak, coinciding with the presence of a seasonal homeless population frequenting downtown. As the weather cools and dampens, the amount of heroin declines as some youths leave town.
Last summer, the trend predictably played itself out, but Lundberg and Reese were taken by surprise when they saw how much heroin was present in Portland.
“We saw a remarkable increase last summer,” Lundberg says.
Unexpectedly, heroin use did not drop off in the fall, as it normally did. “This year it’s even worse,” Reese says.
The number of arrests for heroin possession has risen. In 2008, there 467 arrests, a slight increase from 2007’s 464 arrests. This year, however, the number of arrests for heroin possession has already reached 408, a 25 percent increase from last year, says Mary Wheat, the police bureau’s public information officer. Wheat says that the Portland police are making arrests for heroin possession every day.
Nationally, the number of heroin users is rising. According to the 2008 National Survey on Drug Use and Health, published by the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of current heroin users in the United States increased from 153,000 people in 2007 to 213,000 in 2008.
The rise of heroin use on Portland’s streets is due to its almost rampant availability and affordability. For people like Joe, who, as he looked for a place to shoot up, spoke about using his engineering skills to build hybrid bicycles and other vehicles with little environmental impact, that accessibility has destroyed his obvious potential and become a “medicine,” even as it creates physical and mental pain whenever he tries to quit.
Tar junkies of all ages
The most marked increase in heroin use, according to local agencies, is among youths. Marc LeJeune, the manager of Outside In’s Needle Exchange Clinic, says the number of people the clinic is serving between the ages of 19 and 24 has increased by 35 percent. In 2009, 20 percent of the clients served by the Multnomah County Health Department’s four needle exchange clinics were 18 to 24, a 13 percent increase during the past four years.
While the number of people accessing the county’s needle exchange clinics has steadily increased, Graham Harriman, the manager of the STD/HIV/Hep C Program at the Multnomah County Health Department, says “the increase that we’re seeing is primarily among youths.”
“It seems a little more chic or trendy for kids to dabble in it,” says Officer Mike Jones, a narcotics investigator with the Portland Police Bureau’s Drugs and Vice Division.
LeJeune says that the clinic has seen a “substantial” increase in the number of visits and needles given out. In it’s fiscal year 2008/09, Outside In’s clinic had 25,000 duplicated visits and issued 533,000 syringes. So far this year, the clinic has had 30,000 visits.
LeJeune says the clinic normally receives a minimum of 2,000 visits a month. During one month last year, it had 2,700. “We’ve never seen [that] before,” LeJeune says. “We saw those numbers every month last year.”
This year, the county’s needle exchange clinic has had 4,079 duplicated visits. Last year, it handed out 572,000 syringes. Taken together, Outside In’s and the county’s needle exchange program issued a total of 1,105,000 needles in 2008. That is approximately two needles for every person living in Portland.
“This could be an indication that people are more effectively accessing harm reduction services,” Harriman says. “It’s not a good indication that there’s more use.”
Advocates and consumers say the boon of exchange clinics is not that they enable drug use, but that they reduce needle sharing, which can cause HIV and Hepatitis C infection. John Duke, Outside In’s Clinic Director, says that needle exchange programs also are, many times, the first point of entry to services for people with addictions.
“Syringe exchange programs catch people when they are concerned about their health,” Duke says.
It may be the case that youths are being introduced to heroin at an earlier age than when Joe was first exposed to drugs. A man walking out of Outside In’s Clinic who identified himself as Jason said that he would have taken the time to be interviewed by Street Roots, but he “had to find five bucks.” As he walked down the street towards the Park Blocks, he yelled back, “I’ve been doing [heroin for] eight years and now there’s like — fuck — 14-year-olds doing it.”
In general, police and social-service providers say heroin use has increased in part because it has become popular to smoke the drug, rather than inject it. “Most people injected it in the past,” Reese says.
“It’s potent enough now that they can just smoke it a tiny bit and then they don’t feel like they’re a drug addict, because they’re not using a needle,” says Jake, a user.
Jones says the decreased availability of methamphetamine, caused by Oregon’s crackdown on the drug and its ingredients in recent years, has made people turn to heroin.
“We’ve seen a corresponding increase in heroin and cocaine,” says Mark McDonald, who prosecutes drug cases for Multnomah County’s District Attorney’s office.
LeJeune thinks younger heroin users are self-medicating mental illness and anxiety. “I think there’s a lot more stressors on people’s plate when they’re younger,” he says.
“People are hurting really bad,” Lundberg says, noting that the recession may be driving people toward addiction. “For young people whose ability to project into the future is not fully developed yet, it’s really bleak.”
Joe says he has been on heroin since he was 17. While in high school, he says he rollerbladed “semi-pro.” The father of one his friends was pretty competitive.
“There was no excuse for not competing,” Joe remembers.
The father was also a doctor. If Joe was in pain and a game was coming up, he would be given “candy pills, pain pills.”
“Makes you a little woozy, then Adderall,” Joe says. “I was an addict before I knew I was an addict.”
Joe started using OxyContin, an addictive synthetic opiate often prescribed as a painkiller. “It got too expensive” on the street, he said, costing him $150 a day. Joe started snorting and smoking heroin, and eventually started injecting it. All of a sudden, his drug addiction dropped to $5 a day. “It was economic pressure that got me on heroin,” Joe says.
LeJeune says that Joe’s experience of moving onto heroin from prescription drugs is not uncommon. “Almost every young person I’ve talked to, that’s where they started off. That was the gateway,” he says.
Coming from Mexico or South America, the heroin on Portland’s streets is known as black tar heroin, a black, gooey substance that is mixed with water, melted, and injected. “[It’s] everything we see here,” Jones says.
Addicts and law enforcement sources say that the heroin found in Portland may be the purest of any major city in the country. While he was pulling the heroin into a syringe, Joe described the potency of the drug he was using as “extremely concentrated.”
“The quality seems to be a lot better in Portland than San Francisco,” Jake says, who adds that the heroin in Portland began getting purer in the past three years. “Seattle, it’s terrible, terrible quality.”
Sources say that Portland’s purer heroin may be one reason why there has been an increase in overdoses in Portland and in Oregon.
According to the annual report by the Multnomah County Medical Examiner’s office on the number of drug-related deaths in Oregon, heroin-related deaths have slowly increased since 2005 when there were 86 related deaths, just over half of those in Multnomah County. In 2008 there were 119 deaths in Oregon, 71 of them in Multnomah County. Dr. Karen Gunson, Oregon’s medical examiner, says this year’s total will probably be in the “140 range.”
Tracking the number of non-fatal overdoses is more difficult, because many heroin users who overdose may not go to the emergency room for treatment. Liana Haywood, a spokeswoman for Oregon Health and Science University, says that “anecdotally, it appears that ... more heroin addicts are coming in with overdoses than normal, but this is not something we track in detail.”
Jake, 30, says that has been addicted to heroin for 15 years. In that time, he says he has overdosed at least three times, known 50 to 60 people who have overdosed but not died, and known six to eight people who died from overdoses.
Roby Day Williams, 47, was outside the public library in downtown Portland rolling a cigarette when he overhead this reporter asking people if they knew, or were, heroin addicts. In recovery from heroin addiction for nine months, he says he used every day for 15 years, sometimes three or four times a day. “I got incredibly strung out for a number of years,” he says.
Thinking about that time, and almost beginning to cry, Williams guesses he overdosed on heroin nine times. During his addiction, Williams thinks he knew 6 or 7 people who died from heroin overdoses, and at least “30 in this town” who overdosed, but did not die.
Jones says that the people dealing heroin in Portland are using “somewhat sophisticated organizations.” The dealers normally operate outside of Portland, sending people into the city for drug sales. Jones says that many of the Portland area’s professional drug dealers are coming directly from Mexico.
“I think there are probably several — five, 10, 20 — different organizations bringing in large quantities, pounds and pounds,” Jones says.
According to Jones, half a gram of heroin — equivalent to one hit — is selling on the streets for approximately $40 to $50, making it slightly less expensive than meth.
Joe says he goes to Outside In’s clinic every day to pick up and exchange 10 needles. Taking three to five shots a day, he says his habit probably now costs $20 a day. To pay for it, he panhandles.
Lundberg and Reese both say they are seeing more people panhandling for drug money. It is one way addicts maintain their habit. Often, they are pushed to commit petty crimes. Lundberg fears there may be a rise in youth prostitution. Reese says that property crimes, theft, robberies, and assault have been on a rise as an effect of drug use as well.
To blame the rise of heroin use in Portland solely on youths, or on the homeless population, would be a mistake. LeJeune says that many of the Outside In clinic’s clients are housed.
“They’re still a lot of guys out there in their 40s and 50s that are shooting heroin,” Reese says. “It crosses all ages.”
According to Harriman, 66 percent of the clients using the county’s needle exchange services are between 30 to 54, which is the same age range of the majority of people Gunson says are dying from heroin overdoses. “It’s not young people,” she says. “It’s people who have plenty of needle tracks in their arms.”
Tripping like it’s 1999?
When speaking about heroin in 2009, sources kept mentioning 1999, sometimes in tones suggesting that year is now a part of Oregon drug lore. That year, 250 people died from a heroin-related deaths.
“We had a huge year in 1999,” Gunson says. “It was the number one cause of death among illegal drugs.”
Although the number of heroin-related deaths in Oregon isn’t anywhere near that number, Gunson also says, “We’re pretty much steadily growing.”
“I would stop short of calling it an epidemic,” Lundberg says.
“It’s not like what meth was in 2004,” says McDonald with the Multnomah County District Attorney’s office. “I would call that an epidemic. This is a very serious problem, much more of a problem than people realize.”
An epidemic of the proportions seen in the late 90s may not happen in Portland because of the presence of needle exchange clinics and other harm-reduction strategies.
In 2008, Outside In received funding from the Substance Abuse and Mental Health Services Administration to start the Rise Program, which provides case management and permanent supportive housing to homeless youth who are 18 to 24 years old who have a mental illness and substance abuse addiction. The program administers Suboxone to people in the program, a mixture of Buprenorphine, an opiate blocker, and Narcan, a drug that can instantly revive someone from an opiate overdose.
Duke thinks that to effectively respond to the increase of heroin use in Portland, there will have to be increased accessibility to Suboxone in treatment programs, more low-barrier treatment programs to more easily target people with addictions, and have treatment programs focus on harm reduction strategies as much as drug treatment.
After moving to Portland from San Francisco in 2007, Peter Geissert founded Portland’s chapter of the Portland Overdose Prevention Project in 2008. The Project is a grassroots non-profit assisting agencies and individuals in developing response plans and skill sets to decrease the risk of overdose.
In July, Geissert taught a training course at Janus Youth for the agency’s staff and people using the services that presented the risk factors for overdose, how to recognize someone who is overdosing, and how to get individuals out of the overdose, whether that meant breathing for them or reviving them with Narcan.
Lundberg says that he and his staff are now more “planful” and aware of some of the drug-related problems Janus’s clients might have.
Calling Oregon’s drug laws “the most lax of any state on the West Coast, if not the nation,” McDonald thinks that people who use and deal heroin are not properly punished. The maximum sentence a person in possession of heroin can receive is 30 days in jail, if there are beds available. More typically, McDonald says, people caught possessing heroin are given 10 days in jail, then placed on probation.
Rather than entering a drug treatment program, McDonald says “it’s much easier” for an addict “to just plead guilty” because of the lack of punishment for drug possession.
“I think there needs to be some increase in penalties. I’m not calling for everybody going to jail, but there needs to be some deterrent, and some incentive for people to go into treatment,” McDonald says.
Ultimately, McDonald says, Portland and Multnomah County can do little to control the drug trafficking across the Mexican border, and thinks that heroin use in Portland won’t truly drop until the federal government tackles drug importation.
Joe thinks he probably will never get off heroin, and he isn’t interested in treatment.
“I have to learn how to live with it,” Joe says, calling himself a “responsible junkie” and thinking of heroin as a medicine keeping him from being sick.
Joe says there was a period of two years when he was clean. But he said he “wanted to die the whole time” because the physical pain from withdrawal was too much. “You don’t sleep. You twitch. It’s as close to hell on earth as you can get.
“Heroin changes you,” he says. “You never feel the same. Life is never good again.”
By Amanda Waldroupe, Contributing Writer
Photos by Ken Hawkins