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The pain, Hakim recalls, was relentless and brutal, as it seared through his body, gnawing at his resolve to battle on. Barely 18 days ago, Hakim, too, was lying in the same corner, pumped full of a cocktail of sedatives and sleeping pills, enduring the almost unbearable withdrawal symptoms of a heroin-addict gone cold turkey. Hakim, a haggard, emaciated year-old, whose Hawaiian-print shirt hangs loosely from his shoulders, his legs covered in scars and scabs, shrugs: Every of the 20 patients has experience the same hell, once they arrived at this small, Spartan recovery house, where addicts sleep five to a room on metal bunk beds. Inside, hand-written, faded posters extol the addicts to follow the '12 steps of addicts anonymous. It's here, to this nondescript house, a short drive from Zanzbiar's capital Stonetown, tucked away behind a huge wall and surrounded by the gated homes of the East African island's middle class, that Zanzibar's most desperate turn for help: Those men - and often women, too - who saunter up to foreign tourists on the Zanzibar's picture-perfect beaches, their eyes blood-shot and glazed, sometimes begging, sometimes offering beaded necklaces, dolphin safaris — or a shot of heroin. For in Zanzibar, the drug is endemic. Since the s, East Africa - and in particular this small island - has been a major landing point for heroin shipped from Afghanistan to Africa via the Indian Ocean. But recently, there seems to be an even bigger surge, due in part an increase in opium production in Afghanistan. Since , heroin seizures have been on the rise — with figures ranging between to kilograms seized in a given year, according to David Dadge, the spokesman for the United Nations Office on Drugs and Crime. He concedes that it may be down to a better capacity of law enforcement agencies. But, he confirms, anecdotal information does point to an increase in the use of heroin in Tanzania and particularly semi-autonomous Zanzibar. And many shipments continue to slip through: Zanzibar's coastline is porous, and isolated inlets and remote beaches provide an ideal landing spot for traffickers, who use the strategically located islands as a transit point. While much is shipped on along the Southern Route, as it is often referred to, to Central and South Africa and even Europe , a lot is feeding into a burgeoning domestic market. After all, a joint of heroin mixed with marijuana is cheap: roughly one dollar, the equivalent of island's average daily income. It's hard to come by official figures — some media reports claim that as many as 7 percent of the 1. But the government contends that that figure is closer to one percent and points to a newly rolled out methadone program and public awareness campaign it initiated in schools. The twelve sober houses on Zanzibar and Pemba are run privately, relying on donations from international and domestic donors. But despite these programs, one thing is for sure: tiny Zanzibar is struggling to fight the international cartels, Jumah Abdul Rahman Zidikheiry says. The smart, poised man with the confident air of a senior official, heads the island's Investigation and Drug Combating unit. His agency, he says, is working very well. But the cartels use state-of-the-art technology. You get a mosquito net, a repellant — and you're done', Zidikheiry says. Zanzibar, he adds, desperately needs international help, be it from the US or European countries. Because the drugs are affecting the country's economy - and tearing apart the social fabric. Take Hakim: He lost everything. He used to work as a tour guide, taking foreigners to Zanzibar's beaches, spice plantations and organizing luxury safaris for them on mainland Tanzania. But eventually he lost first his job to his addiction and then his flat. Soon he living rough in Stonetown, after his family disowned him. In predominantly Muslim Zanzibar, drug use is a taboo and addicts are often shunned. Many end up on the street, sharing syringes - and deadly diseases: More than 40 percent of users are estimated to be infected with HIV and hepatitis is wide-spread. The pretty, shy year-old, a blue shawl wrapped loosely around her slight body, first became addicted to heroin as a young teenager, when her brother, who worked as a mule, smuggling heroin from Pakistan to Zanzibar, introduced her to drugs. But soon, heroin began to dominate her life: Married to a drug dealer, she and her husband would sell to men and women to pay for their habit, introducing many of their friends and acquaintances to drugs. The price was high, she say: She lost many of her friends and even her own brother, who had first introduced her to heroin, to the drug. The details remain murky, but she's convinced that he was killed by police in Pakistan last year during his last drug run. But in the end, it was her six-year-old son who made her decide to come to the sober house. He doesn't know she's addicted, she says, and she desperately wants him to have a better future. It's her second stint at the recovery house, which caters exclusively for female addicts, many of whom have stories of abuse and prostitution to foreign tourists to pay for the next high. For the relapse rate is high: Some forty percent of addicts manage to remain clean, according to the rehabilitation centre's manager, and many relapse several times in the process. Hakim, for one, is adamant that he will stay clean and, somehow, manage to rebuild his life from scratch: he dreams of a new home, maybe even a girlfriend. It's an uphill battle, but at least, he has a chance: unable to pay the modest fee of roughly 60 US dollars for the ten month treatment at the sober house, countless others are left to fend for themselves. Latest videos Latest audio. Latest audio Latest videos. In focus. It's hard to tell whether he's breathing. Hartlep In Zanzibar, heroin is endemic It's here, to this nondescript house, a short drive from Zanzbiar's capital Stonetown, tucked away behind a huge wall and surrounded by the gated homes of the East African island's middle class, that Zanzibar's most desperate turn for help: Those men - and often women, too - who saunter up to foreign tourists on the Zanzibar's picture-perfect beaches, their eyes blood-shot and glazed, sometimes begging, sometimes offering beaded necklaces, dolphin safaris — or a shot of heroin. Zanzibar is a transit route for the international drug trade And many shipments continue to slip through: Zanzibar's coastline is porous, and isolated inlets and remote beaches provide an ideal landing spot for traffickers, who use the strategically located islands as a transit point. Zanzibar is a major landing point on the drug trafficking route from Asia to Africa After all, a joint of heroin mixed with marijuana is cheap: roughly one dollar, the equivalent of island's average daily income. Hartlep 'The war on drugs is not an easy one' And, they're armed, making the fight a lethal one. Nadjma: Used to work as a drug dealer to pay for her habit. Hartlep Many addicts relapse But in the end, it was her six-year-old son who made her decide to come to the sober house. Skip next section Explore more Explore more Bombing coral to catch fish. Bombing coral to catch fish Off the coast of Tanzania, fishermen use homemade bombs to catch fish. Those who try to stop them do so at great peril. Experts say one blast can kill all living organisms within a meters radius. Coral reefs that teamed with life are reduced to rubble. Turkey targets Gulen schools in Africa. Turkey targets Gulen schools in Africa Turkish government anger with the Gulen movement, over its alleged involvement in the failed July 15 coup, has spread to Africa. Governments are being pressured into closing down Gulen schools.

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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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