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That distinction belongs to heroin. In , an estimated 1 in 40 city residents was a heroin addict. Justice Francis T. Murphy Jr. Opiates arrived either as taxed, legal imports or as contraband smuggled to avoid custom duties. Refined opium, which smokers used, was the most heavily taxed, frequently smuggled and widely condemned form of the drug, owing to its Chinese and criminal associations. The first opium smokers were Chinese immigrants. Some criminals preferred a syringe of morphine to a pipe of opium; still others, a new drug called cocaine, whose nonmedical use spread rapidly in the s. Not all Victorian-era morphine addicts were gamblers or prostitutes. These doctors relieved with injections of morphine. And relieved, and relieved, and relieved. If medical addicts were numerous in the Victorian era, they were also secretive, isolated and ashamed. They seldom spread addiction to others. Not so their counterparts in the underworld addict subculture, which attracted newcomers and which persisted long after doctors wised up and quit addicting as many patients to narcotics. As age and illness thinned the ranks of medical addicts, New York was left with a self-sustaining core — to police, a hard core — of nonmedical addicts. Needing pricey daily fixes to keep withdrawal at bay, they were apt to pick pockets and locks as well. Increasingly, the money they hustled went to purchase heroin. A derivative of morphine, heroin provided a powerful rush. Dealers liked it because it was easy to cut. Adulterated or pure, heroin could be sniffed, a bonus for those who shunned the needle. And it staved off withdrawal for those who could not score prepared opium, whose legal import was banned in , or morphine, whose sale and prescription were subject to stricter controls between and Not every heroin user was a confirmed opium or morphine addict. The drug caught on with young drug users, mostly men from poor immigrant neighborhoods. Friends introduced them: Here, take a whiff. Some kept whiffing. There were more whiffs to go around in New York than elsewhere. Shady New York pharmacists would also sell to customers without legitimate prescriptions, or no prescriptions at all. In , the federal government forbade the importation of opium for the manufacture of heroin. Yet heroin continued to gain in underworld popularity. Gangsters such as Arnold Rothstein bought heroin from European manufacturers then shipped it to New York disguised as ordinary merchandise. One consignment, labeled bowling equipment, turned out to be pounds of heroin, seized after delivery to a toy store. Mid-level dealers had other dodges. Customers of a Cobble Hill barber shop slipped money under the shaving towel. Military purchases drove up opiate prices, and the war interrupted international shipping and smuggling routes. Arthur, one of several dozen older addicts I interviewed in the early s, described the results:. No drugs. Arthur became so desperate that he boiled down paregoric, an opium tincture used against diarrhea. He dissolved and shot Nembutals, barbiturates purchased on the streets. After the war, he returned to heroin, only to be disappointed by the quality. He supplemented with Dilaudid, a semi-synthetic opioid secured with prescriptions from doctors in Manhattan and the Bronx. Catch as catch can. By the early s, New Yorkers had taken to calling addicts 'junkies,' after their habit of picking through junkyards for bits of saleable metal. Other users remarked on the increasing adulteration of heroin, which some blamed on Mafia greed. Most of the new addicts were young African American and Puerto Rican men, often the children of immigrants. Doctors who interviewed them noted the psychic traumas of racial discrimination and slum life, but also the easy availability of the drugs that soothed them. One block in Harlem had 13 dealers. They did business at all hours. It was easier to buy marijuana and heroin than cigarettes, the patients reported. Young whites dabbled too, though they had to venture to entertainment districts like Times Square or bohemian enclaves like Greenwich Village to buy heroin. It did not come to them the way it did to residents of East Harlem. Not so after the great urban migrations. Youthful experimentation with readily available drugs in impoverished, segregated neighborhoods was also the basis for the much larger wave of baby-boom heroin addiction that engulfed the city in the late s and early s. Asking around, Severo discovered the means by which young addicts, hardened beyond their years, supported their habits: stealing, robbery, burglary, forgery, prostitution, dealing. A year-old sold rat poison as heroin, killing two other addicts in the process. Asked why, he said he needed cash to buy his own heroin. The one liberals preferred was expanded access to methadone. A long-acting oral opioid, methadone was the basis of an experimental maintenance treatment launched by Drs. Though they violated the taboo against providing narcotics to ambulatory addicts, well-run methadone programs provided clear-cut evidence of improved behavior and health. No more bags of rat poison. Addicts fed up with bad heroin could resort to legal substitution. Conservatives had another answer for the heroin-related crime that was gutting the city. Rockefeller called for mandatory life sentences for traffickers. Punitive legislation, famously and forever known as the Rockefeller drug laws , soon followed. Narcotic trafficking continued anyway. What fueled it were new sources of increasingly pure heroin, notably from Colombia, and an abundance of retail outlets. A young writer living in a Lower East Side apartment near Stanton and Ludlow, who started using heroin in , discovered that he had to venture no farther than his doorway. It was a hangout for local dealers. Beepers and cell phones further simplified access. By the s, heroin could be delivered like pizza. It was, and not just in New York City. Mexican immigrants driving beat-up cars, the Xalisco Boys memorialized by journalist Sam Quinones , fanned out across the country. They sold cheap but potent black-tar heroin in mostly mid-size cities to mostly white customers. Hello, Columbus. Convenience and discretion were in, guns and violence out. The Xalisco Boys avoided the gang-dominated urban drug markets on the East Coast. Another, unexpected development in the s and early s nationalized narcotic supply and, for a time, altered the pattern of narcotic addiction in the city. Andrew Kolodny saw it firsthand. A young psychiatrist who began practicing in Manhattan and treating addicted patients with buprenorphine — basically, methadone lite — Kolodny was surprised in the early s by an influx of white, middle-class addicts from New Jersey, Westchester County and Staten Island. They used prescription drugs like OxyContin and Vicodin. They did not use heroin — not yet, anyway. They got the opioid painkillers from their doctors, who had again begun prescribing them as analgesics. Or they got them from friends and dealers who siphoned them from the expanded legal trade in prescription opioids. Either way, access and exposure were again at work. With a twist. Opioid prescribing for chronic non-cancer pain, promoted by pharmaceutical marketing, was a national phenomenon. The capitals of this type of opioid addiction were places like Huntington, West Virginia , not ports of entry like New York. The geography of addiction was no longer determined largely by where the Mafia landed its heroin. The new keys were Pharma-shaped prescribing behavior and distributor failures to stop opioid orders to suspect outlets like internet pharmacies or off-the-interstate pill mills. In the s, as prescription opioids became harder to come by or, in the case of reformulated OxyContin , harder to abuse by snorting or shooting , the narcotic kaleidoscope turned again. The most conspicuous shift was to heroin, which was readily available, relatively cheap and highly potent. Active cuts, fentanyl or one of its analogs, further increased potency, often lethally so. Here too was something new. Midth-century dealers often adulterated heroin with inactive cuts such as powdered milk or baby laxative. Fentanyl flipped the script. Overdoses now occur because of too much active cut. That is true not only for heroin, real and nominal, but for other street and counterfeit prescription drugs into which fentanyl is often mixed, unevenly and fatally. This is why methadone or buprenorphine remain effective treatment options for opioid addicts. Reduced to essentials, the history of narcotics in New York City is a history of changing prices and availability for drugs that an unusually large number of addicts needed on a daily basis to keep from getting dope sick. The surest way out of the trap was, and is, supervised medical maintenance with licit opioids of known strength and quality, prescribed with safeguards to minimize further leakage. Sign up for our newsletter. Sign up. David Courtwright December 13, A brief history of what opioids have done to the city. David Courtwright is presidential professor emeritus at the University of North Florida. Up next

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Government agencies estimate that as many as one in 10 of the city's residents are addicted to the drug. Wanda, 42, was one of them. Wanda, who asked that her last name not be used, says she began using heroin at the age of Now she is in a treatment program at the Center for Addiction Medicine in downtown Baltimore. She has been drug-free for more than two months. A year-old woman who asked to be identified only as 'T' is also undergoing treatment. She says her heroin addiction turned her from a ballet student into an exotic dancer. Jonathan, 18, says he contemplated suicide before he quit using the drug only last Friday. The U. Drug Enforcement Agency says the city has the highest per capita heroin addiction rate in the country. Estimates of the total number of addicts in the city vary, but experts agree it's staggering. In a city of ,, the Baltimore Department of Health estimates there are 60, drug addicts, with as many as 48, of them hooked on heroin. A federal report released last month puts the number of heroin addicts alone at 60, The problem in the city is so acute that the federal government has designated Baltimore part of what it calls a High Intensity Drug Trafficking Area, making it eligible for special federal assistance to local police. Stream on. Part I: Baltimore Is the U. Heroin Capital. By ABC News. March 13, , PM. Oct 20, PM. US intelligence on Iran attack appears leaked. Trump mocks Harris' story at a McDonald's. Details from Liam Payne's partial autopsy revealed. Oct 21, AM. Oct 12, AM. ABC News Live.

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