Chapter 2
Heroin Abuse in the United States

During the three decades that heroin use was legal in America, heroin abuse occurred throughout the country and affected people of both sexes and of all social classes and races. When heroin was made illegal in 1924, however, abuse of the drug became most prevalent in the inner cities. As a result, heroin abuse faded from the view of mainstream America, and addiction stopped being considered a problem that could affect nearly anyone. Instead, the drug would come to be dismissed by most Americans as something that could affect only the inner-city poor.

However, during the 1960s and again in the 1990s, heroin abuse rose among the wealthy and the middle class. Heroin's renewed widespread popularity served as a reminder to American society that heroin abuse is a problem that does not discriminate along lines of socioeconomic standing, race, or age.

Heroin Moves to the Inner City

The relocation of most of the nation's heroin addicts into the American inner city during the 1920s was the result of a well-meaning, if illconceived government program that dispensed free heroin from medical clinics in these densely populated places. The majority of the nation's approximately 200,000 heroin addicts flocked to the big cities to gain daily access to these clinics. During the five years that preceded Congress's decision to make heroin illegal in 1924, addicts who registered at these clinics received daily heroin dosages, with the strength of their daily dosage being gradually decreased over time in an effort to wean them off of the drug. This program did not serve to reduce the number of addicts, however, but instead served only to compound the nation's heroin problem in a variety of ways. Not only did these efforts to cure existing addiction fail miserably, but, as the U.S. Drug Enforcement Administration notes, people who were not already addicted to the drug began to show up to get it, and "statistics showed that these clinics actually raised the number of addicts."⁸ Further, since the forced closure of these clinics in 1924 left innercity addicts needing nearly every dime for the purchase of heroin, they stood little chance of getting out of these places.

After heroin was made illegal, all that most Americans came to know of the drug and its users was what they read in the evening news. They read of the crimes committed in the inner city by addicts who needed money to purchase the drug, of the rising percentage of the nation's prison population that was serving sentences for such crimes, and of the even higher percentage of the nation's prison population (a full one-third by 1928) that was serving sentences for possession of the drug.

With the disappearance of heroin clinics in 1924, the demand for heroin was met by individuals and small-scale criminal organizations. When international political pressure tightened controls on the manufacture and sale of European pharmaceutical heroin, however, black-market (illegally manufactured and sold) heroin became increasingly difficult for these small-time smugglers and dealers to obtain. As a result, the purity of street heroin in the United States was quite low and the price was high.

The U.S. heroin trade underwent a dramatic and permanent transformation during the early 1930s, however, when gangster Salvatore C. Luciano, known to the world as "Lucky" Luciano, became the head of the Mafia. Under Luciano, the Mafia entered and soon dominated the lucrative markets of heroin and prostitution, and instituted an integrated system of smuggling, promotion, and sale of the drug in major cities around the country. The Mafia soon found that heroin dealing and prostitution complemented one another, since heroin-addicted prostitutes were virtually guaranteed to remain in the servitude of an employer that had an endless supply of the drug. The fact that many prostitutes were now heroin addicts, and were associated with the Mafia, helped to foster the assumption of many Americans that heroin could hold appeal only to immoral, inner-city criminals.

The Mafia became part of a sophisticated, international crime syndicate that had begun manufacturing and trafficking heroin in response to the disappearance of European pharmaceutical heroin from the black market. The majority of the heroin smuggled into the United States originated in the poppy fields of the "Golden Triangle" countries of Laos, Thailand, and Burma, and was processed in clandestine laboratories in Shanghai and Tientsin, China. "Owned and operated by a powerful Chinese secret society," explains author Alfred

The French Connection

Following World War II, as the international heroin trade resumed, a number of heroin refineries appeared in Marseilles, France. These refineries, which have come to be known as "the French Connection," were run by a Mafia family known as the Lucchese crime syndicate. The refineries processed opium from the Middle East, and supplied a tremendous amount of heroin to the rapidly expanding U.S. black market for nearly two decades. In 1961, however, the Lucchese family was indicted in what was then the largest heroin-smuggling case ever in the United States, after New York police seized a car that had been shipped to the United States from France, and which had $32 million worth of the drug hidden within it.

Though the interception of this smuggled heroin resulted in the convictions of a number of high-ranking members of the Mafia family, a strange twist in this case occurred a decade later when the seized heroin was stolen from the closely guarded evidence storage facilities of the New York Police Department, and presumably, sold on the streets of the United States after all. The resulting investigation revealed that the theft had been a joint effort of the Lucchese crime family and corrupt U.S. officials.

W. McCoy, "these laboratories started to supply vast quantities of illicit heroin to corrupt Chinese warlords, European criminal syndicates, and American mafiosi like Lucky Luciano."⁹ Additional heroin came to the United States from laboratories in Marseilles, France, where newly formed criminal organizations processed opium grown in the "Golden Crescent" countries of Iran, Afghanistan, and Pakistan.

The Great Depression and World War II

With these established smuggling pipelines and a comprehensive heroin distribution system in place in American cities, dealers began doing a brisk heroin business in the early 1930s. They likely would have expanded their sales substantially throughout the decade if the Great Depression—a worldwide economic slump—hadn't interrupted their plans. The economic hardship of the depression postponed further spread of heroin use in the inner city, since money for the purchase of the drug was largely unobtainable by any means. Further, World War II brought international drug traffic to a complete halt. McCoy explains:

Wartime border security measures and a shortage of ordinary commercial shipping made it nearly impossible for traffickers to smuggle heroin into the United States. Distributors augmented dwindling supplies by "cutting" [mixing] heroin with increasingly greater proportions of sugar or quinine; while most packets of heroin sold in the United States [in 1938] were 28 percent pure, only three years later they were less than 3 percent pure. As a result of all this, many American addicts were forced to undergo involuntary withdrawal from their habits, and by the end of World War II the American addict population had dropped to less than twenty thousand. In fact, as the war drew to a close, there was every reason to believe that the scourge of heroin had finally been purged from the United States.¹⁰

By the time the war ended in 1945, consumer demand for the drug was the lowest it had been in fifty years. Supplies were nonexistent, and international criminal syndicates had fallen into disarray.

Within several years, however, criminal syndicates had regrouped, the poppy fields had begun to flourish once again in Southeast Asia, and new heroin refineries began to appear both in Marseilles and Hong Kong. In the United States, the heroin trade quickly and quietly resumed as the Mafia, still led by Lucky Luciano, flooded the American inner city with inexpensive, high-purity heroin. Despite their forced withdrawal during the war, America's addicts quickly resumed their use of the drug, and the estimated twenty-thousand active addicts at the war's close in 1945 nearly tripled by the decade's end.

This abundance of heroin in the streets of the destitute inner city after the war also created new addicts among the influx of primarily minority and immigrant workers who had flooded there in search of employment during the war. Author Jara A. Krivanek notes that heroin was introduced by longtime users to the African-American and Puerto Rican communities who had come to the cities looking for work:

Like all new immigrants, they worked at the lowest economic levels, settled in slum neighborhoods, and endured unemployment, poverty and discrimination. From 1947 to 1951 the use of heroin spread steadily among these and other lower class, slum-dwelling people. . . . The increase was gradual, and did not attract much attention. Most of the users were in their twenties and thirties.¹¹

By the mid-1950s, heroin abuse began to spread to the teenagers of the inner city and was particularly popular among street gangs. Unlike many of the drug's older users, whose wartime jobs had provided them with the skills needed to obtain gainful employment after the war, these teens relied for the most part on crime to support their habits. As a result, the crime rate and associated arrests in the inner city began to rise, and the nation's assumptions that the drug could affect only the inner-city poor were further reinforced.

The Heroin Epidemic of the 1960s

During the 1960s, however, these long-standing misconceptions about the potential scope of heroin's appeal were rocked as heroin and other drugs gained popularity among middle-class teens. These teens, many of whom were involved in the anti–Vietnam War movement in America, had grown mistrustful of the establishment and sought to defy its codes of behavior. Author Margaret O. Hyde notes that the reality of heroin abuse forced itself into the American psyche:

[Heroin abuse] moved out of the slums and ghettos to infect the sons and daughters of well-to-do citizens of middle-class America. The alarm sounded across the country at that time did not emanate from concern about the long-standing drug abuse problems in racial ghettos, but rather was a result of "dope" reaching white youths in "good" neighborhoods. Patterns of narcotic use dominant in the well-known drug communities . . . "rippled out" to other communities: Palo Alto, California; Ann Arbor, Michigan; Phoenix, Arizona; Grenell, Ohio; and Bar Harbor, Maine, are just a few. . . . Shocked, distraught, unbelieving parents who discovered that their son or daughter was a heroin addict demanded government and community response to deal with the crisis. Investigations revealed that young, teen-age white boys and girls, just like the boys and girls in the slums, rob, steal, and prostitute themselves, or "hustle," on the streets to support drug habits of $25, $50, and even $150 a day.¹²

Heroin also became an increasing concern of the U.S. military throughout the Vietnam War as American military personnel stationed in Southeast Asia encountered heroin that was inexpensive, pure, and readily available from the nearby "Golden Triangle." Military officials eventually estimated that one out of every five U.S. soldiers had become addicted to the drug during their tour of duty in Vietnam.

By the decade's end, law enforcement and health officials estimated the number of heroin users in the United States to be in excess of 1 million. In response to this startling statistic, President Richard M. Nixon declared a war on drugs in a statement to Congress, and urged them to pass a $370 million appropriations bill to fight the heroin epidemic. The bill led to the implementation of federal programs to educate the public, expand treatment opportunities, and strengthen drug traffic control. Additionally, the military's new Special Action Office for Drug Abuse Prevention instituted mandatory drug testing and required returning Vietnam War veterans who tested positive for the drug to undergo treatment. In 1973 the number of heroin users finally began to subside and would be fewer than four hundred thousand by the decade's end. Hyde attributes this decline in use to "changing public attitude and increased financial support for education, research, and treatment, as well as a more balanced law enforcement approach toward the control of the distribution and supply of heroin."¹³

Baltimore: The Heroin Capital of the United States

Though Baltimore already had an abnormally high degree of heroin abuse before the U.S. heroin epidemic of the 1990s, the city came to be widely considered by health and law enforcement officials as the heroin capital of the nation at the beginning of the twenty-first century. When Baltimore became a key East Coast distribution point for high-purity South American heroin during the mid-1990s, its street heroin became more pure, and thus more addictive and more deadly, than that of most other cities in the nation, and its heroin use rate began to skyrocket.

In the year 2000 alone, there were more than three hundred fatal heroin-related overdoses in Baltimore and a similar number of heroin-related hospital emergencies. With official estimates of one out of every ten Baltimore residents addicted to heroin by 2001—some sixty thousand men and women, the majority of whom were believed to use the drug intravenously—the problem became so serious that the federal government designated the city a "high intensity drug trafficking area," making it eligible for special federal assistance to local police.

As heroin use diminished during the 1970s, however, cocaine use caught on with the American middle and upper classes, and its widespread popularity would eventually help widespread heroin use to reemerge. Cocaine use became increasingly accepted in society as a sign of social status and affluence during the 1970s, and media coverage of the drug's use among the rich and famous enhanced its glamorous image and legitimized its use in society. "For many Americans," explains Hyde, "cocaine became the symbol of fast-track living which lasted well into the 1980's. . . . In this period of liberalization, only the social consensus against heroin held firm, largely because . . . its use had long been associated with criminals and social outcasts." ¹⁴ With its estimated 2.2 million users by the late 1980s, however, cocaine use also escalated to epidemic levels. Connotations of status began to fade as cocaine addiction wrought increasing havoc in the lives of users across the American socioeconomic spectrum—but particularly among crack cocaine users in the inner city. By the early 1990s, cocaine lost its standing as the nation's drug of choice, and the number of users significantly declined.

Cocaine Cartels Enter the Heroin Trade

With cocaine sales rapidly diminishing in the United States during the early 1990s, drug cartels in Colombia who had supplied the lucrative cocaine market for nearly two decades began to diversify from cocaine to the higher-profit, more easily manufactured heroin. They hired experts from Southeast Asia to teach them opium-cultivating and heroin-processing techniques, and expansive poppy fields began to appear along the eastern slopes of the Central Andean Mountain ranges in central Colombia. Just as cocaine had been, raw opium was transported from the fields, often through hidden jungle trails but also through sea and air routes, to concealed laboratories that were far from the opium-growing regions of the country.

Though new to opium growing and heroin manufacturing, the drug cartels needed no lessons in the secrets of drug trafficking. Their location close to the United States had always been extremely strategic for smuggling. Colombia's coastlines on both the Pacific Ocean and the Caribbean Sea provided smugglers a near-infinite variety of air, land, and sea drug-smuggling routes.

Heroin, like cocaine, was smuggled over the U.S. border in many ways. Couriers swallowed small quantities of heroin in balloons or hid the drug inside hollowed-out shoes, luggage, and clothing. Large shipments of the drug were concealed within manufactured goods that were imported into the United States from Latin America.

To compete in the U.S. heroin market, which had long been dominated by Southeast Asian heroin, these Colombian cartels did what had proven so effective for the Mafia earlier in the century: they undercut the competition with inexpensive, high-purity heroin. The entrance of these new suppliers into the American heroin market had dramatic repercussions—not only in the United States but also on the entire global heroin market. When Southeast Asian heroin began to match the purity level and price of Colombian heroin, an ongoing price and purity war resulted. As more and more people around the world began to experiment with this super-potent and inexpensive heroin, a global heroin epidemic began. By 1995 there were an estimated 10 million heroin users worldwide, with large numbers of users in Canada, Great Britain, and the United States, as well as in Europe, the former Soviet Union, and Asia.

The Global Heroin Epidemic's Impact on the United States

In the United States, this competition between heroin suppliers brought unprecedented levels of heroin purity. "During the [1980s]," states the Drug Enforcement Administration, "the purity of street heroin ranged from one to ten percent; more recently, the purity of heroin, especially that from South America, has skyrocketed to rates as high as 98 percent."¹⁵ This newfound purity brought significant changes in the way the drug was used. In the past, when heroin had been of low strength, its use was limited to those who were willing to inject the drug to obtain a strong high. With this dramatic increase in the purity of heroin during the 1990s, however, it became possible for beginning users to use noninjection methods to obtain an extremely strong dosage of the drug. One method that gained popularity was the snorting of "lines" of heroin in the same manner that cocaine was used. Another popular method was heroin smoking, often referred to by users as "chasing the dragon" because of the curly, dragonlike wisps of smoke that rise from burning heroin.

This ability to use heroin through noninjection methods made the drug far more attractive and less frightening to many Americans. Heroin came to have connotations of style and glamour with increasing numbers of middle- and upper-class adults, just as cocaine had in the 1970s and 1980s. Though heroin was still available on the streets of the inner city in twenty-five to fifty-dollar bags, spoons, or balloons, under nicknames such as H, horse, boy, skag, and smack, it was now also sold in chic nightclubs and suburban living rooms. A 320 percent usage increase between 1992 and 1994 alone created an unprecedented heroin epidemic in the United States, with entirely new demographics of users.

The drug's new popularity among adults was matched by increased heroin use among the nation's teens, as evidenced by the nearly quadrupled number of heroin-related emergency room episodes among youths aged twelve to seventeen between 1991 and 1995. Widespread addiction resulted among many of these illinformed young users. Dr. Alan Leshner, director of the National Institute on Drug Abuse (NIDA), notes, "Many young people have a naive belief that because they are snorting or smoking heroin and not injecting it, their heroin use is not addictive. This is a dangerous misconception."¹⁶

Heroin Snorting on the Rise

According to a survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), a significant increase in the number of Americans experimenting with heroin snorting accompanied the rise in the purity of street heroin in the United States during the early 1990s. The survey, which was conducted between 1988 and 1993, revealed that the annual number of hospital emergency department visits related to snorting or sniffing heroin jumped by 470 percent, from eleven hundred to six thousand. However, the hospital emergencies related to snorting composed just 20 percent of the total increase in heroin-related emergencies over this period.

Throughout the 1990s, a growing number of young heroin users found that they had grossly misjudged the drug's addictiveness, and that their once-casual use had quickly become a daily habit. In 2000, statistics confirmed what health officials had feared about the widespread experimentation with heroin among teens: increasing numbers of them were turning to injection as a more efficient means of using the drug. Further, many adult users who had previously avoided the drug because of the social stigmas attached to the use of needles now found that they, too, had insatiable intravenous heroin habits—because their fear of injecting the drug had been surpassed by their fear of the drug's painful withdrawal symptoms.

The Epidemic Continues

By the late 1990s, the heroin marketplace in the United States shifted yet again as drug cartels in Mexico began to eclipse Southeast Asian heroin suppliers as the main competition of Colombian heroin cartels. Mexican drug syndicates quickly seized a rapidly growing share of the U.S. heroin business, and by the decade's end had come to dominate the heroin market west of the Mississippi River. As a result of these new entrants into the U.S. heroin arena, the price and purity wars that had spawned the epidemic during the early 1990s were still present as the decade drew to a close.

Though the alarming growth rate of the epidemic had slowed and even reversed in some regions of the United States by the year 2000, it had increased in others—particularly in the northeastern seaboard, where much of the nation's Colombian heroin was smuggled into the country—leaving experts divided on the question of whether the heroin epidemic in America had finally begun to subside. While the NIDA believed that the nation's overall use of heroin in America was in decline, other estimates suggested that the epidemic had yet to reach its peak. In either event, with an estimated 1.5 million heroin users from across America's socioeconomic spectrum at the dawn of the twenty-first century, 980,000 of whom are believed to be hard-core addicts, it is once again clear that the drug holds allure to people from all socioeconomic standings, races, and ages.