By David Cruz
Nearly fifty people streamed inside a cafeteria at a church basement in the South Bronx for a meeting. Handshakes followed by hugs and kisses opened the gathering that would last ninety minutes.
The signs of fellowship are the usual standards at Narcotics Anonymous. Judgments are left at the door. Sorrow is there but not dwelled upon. Humility is forthwith. Coffee brews in the back. Multi-colored pamphlets on the program are organized neatly on a table. Users know the first step to recovery is admitting they’re an addict. At a church in Morrisania, the confession is even more cathartic. In the Bronx, the scene is played out in community centers, housing projects and other houses of worship—survivors looking to hit the reset button.
Middle aged African Americans and Hispanics were mainly present, pouring their soul on how much drugs consumed them. For several, heroin was their drug of choice.
Heroin, by many measures, has remained a constant in the Bronx, a borough that’s made some headway in revamping its identity.
But unlike Staten Island, which has seen a recent uptick of heroin use due to prescription drug abuse, the heroin crisis has long shot into the vein of the Bronx, immersed in Mott Haven tenements, the outskirts of Hunts Point (a “shooting gallery” dubbed the Brickyard is known by many users there) and in private homes where heroin is stashed, packaged and trafficked to northern states. The origin of heroin comes from Colombia’s Sinaloa cartel, selling the drug to Mexican traffickers who use the Bronx as a hub and marketplace.
“What we’re finding is where 15-20 years ago [Drug Enforcement Agency] in New York was arresting a lot of Colombians dealing, we’re now arresting a lot of Mexicans dealing heroin,” said Acting Special Agent-in-Charge James Hunt with the Drug Enforcement Agency.
Some users often convert their homes into drug dens, charging addicts $2 to use in their home. Its reputation over the years has led the Office of National Drug Control Policy to label the Bronx a High Intensity Drug Trafficking Area.
Its presence in the borough has consistently led to the most heroin overdose deaths in the city, according to 2010-2013 statistics by the New York City Health Department. Even more telling is that Hispanic men aged between 35-54 are most vulnerable to lethal heroin overdoses, according to figures. In 2013, Hispanic men contributed to 65 percent of heroin overdoses, a spike from the year before, when the rate was 56 percent.
This is the state of heroin in the Bronx.
And if these commonplace statistics are a metric for 2014 trends, estimates will likely once again show that the Bronx suffering from the most lethal heroin overdoses even as media attention focuses on Staten Island and Long Island. Experts suggest that Hispanic men will once again be the most likely to die from an overdose even as steps from the state level are working to quell the problem.
A Decades Long Problem
In recent years heroin use has risen throughout the boroughs, but in the Bronx, the problem has never quite laid dormant. Initiatives by the Cuomo administration intended to tackle the problem have been introduced in recent months, including expanded availability and usage of Naloxone to revive users, an initiative pushed by Assemblyman Jeff Dinowitz. But the campaign largely targets young middle class users, the new demographic of heroin users.
The second heroin epidemic, as Special Narcotics Prosecutor Bridget Brennan views it, really appears to refer to other parts of the city where heroin has never been this prevalent. It simply seems accepted in the Bronx.
Statistics by the New York State Office of Alcoholism and Substance Abuse Services (OASAS) show that the same high risk areas in the year 2000, mainly neighborhoods with high poverty rates such as Hunts Point, Morrisania, Mott Haven and Melrose, overlap with the same high risk areas of today.
The stubborn 2010-2013 numbers by the New York City Health Department also indicate a problem that has not sprung overnight—heroin, as many experts and users confirm, has stood the test of time. The epidemic runs parallel to attempts made by the Bronx to shed its image of despair. It’s made even more complex by the effects borne of usage—poverty, crime (the Bronx District Attorney’s Office prosecutes 35 percent of drug cases) and a virtual lifetime of addiction.
“We see drugs that come and go. For a long time we were seeing ecstasy. It kind of fades away,” said Debra Vizzi, the executive director of VIP, an inpatient/outpatient drug rehab clinic. “Heroin has stayed.”
The drug worked its way into the Bronx during the 1970s, when New York City was gripped by an explosion of heroin. At VIP Services, one of sixty community-based clinics in the Bronx, the numbers indicate that the heroin problem just won’t quit.
Nearly 50,000 clients walk into the doors of the Arthur Avenue treatment center annually, seeking to get clean for reasons that range from the threat of jail, children removed, or social entitlements suspended. An older demographic makes up the majority of VIP’s clientele, different when compared to the younger demographic of clients across the city.
Vizzi, who has a background in social work, is an enemy of heroin dealers. On any given day, a dealer often loiters just outside the Tremont clinic, tempting any user to disrupt their progress for a quick hit.
“We’re a magnet for drug dealers. So I’m always fighting that battle, and I have the scars to prove it,” said Vizzi. “Ice picks in my tires, death threats, gang members talking to me because I’m stopping the supply.”
Dealers these days have gotten desperate given the large quantity arriving to the borough and a copious stream of dealers canvassing Bronx streets.
“There’s so many dealers and there’s so much supply and so much demand that their income has whittled down substantially,” said Vizzi. “Basically, you walk down the street and everybody’s a dealer, this one’s a dealer that one’s a dealer. And there’s constantly a demand of addicts.”
But for the dealer, sometimes dealing is all they know.
“The biggest impediment is that there’s no high school diploma,” said Vizzi. “So when you have someone who is not educated, it impedes everything.”
And with an influx of dealers comes a drop in revenue, fueling a cycle of desperation that’s in line with an addict.
Trifecta of Stigma
The Bronx is still grappling with remnants of the first heroin epidemic of the 1970s. An older population is the more common profile of an addict in the borough. Some have been on the narcotic for so many years it has often transformed into a basic survival mechanism.
“You have to get high just to function,” said Vizzi.
Fueling usage is a “trifecta of stigma,” a phrase Vizzi used to link culture, poverty and language barriers to addiction. As far as Vizzi sees it, the trifecta has engulfed the Bronx.
“We’re not seeing that kind of trifecta like you would in some of the other boroughs,” said Vizzi. “You see it in pockets, community pockets, but not the whole borough.”
Getting Turned On
Though the Bronx encompasses an older demographic of heroin users at its core, the borough still faces a new class of users—a wave of immigrants arriving from Central and South America with little to no exposure to English. This poses a problem as tips on how to properly use without overdosing are ultimately lost in translation, raising the potential for an overdose, according to Vizzi.
“The directions of, ‘take more, take less, do this, do that’ can get confusing,” said Vizzi. “We’ve seen a lot of our patients here who say, ‘I didn’t understand.’”
It’s a contributing factor, Vizzi suspects, to why it’s mostly Hispanics who are prone to dying.
In many instances a father, mother, sister or brother may be using heroin. Experience on the drug is often enough to convince their family member to dabble with heroin simply because it’s cheaper than most drugs and will produce a longer high.
Hispanics are especially susceptible. With strong family bonds, Hispanics turn to drugs simply because the family is turned on.
It happened to Janet Camacho, an employee at VIP. A Mott Haven resident, Camacho began using drugs at age 12 after hanging with her sister and older friends. By the time she was in her 20s, nothing mattered to her.
“Nothing became important to me,” said Camacho. “Not my children, not my home, not my parents. I robbed and stole. If you were the drug dealer in the neighborhood that had the money, I would hang out with you.”
Years of addiction resulted in failed Santeria rituals in attempts to rid the drugs, the murder of her son, her children placed into foster care, a tenure at a paramilitary school to scare her straight, and finally recovery through Narcotics Anonymous. Camacho admits, recovery is lifelong and a support system is critical. This is especially needed when the recovering addict returns to the environment that got them hooked in the first place.
“I still live in the community where I used at, and I still see people using drugs that I used drugs with 23 years ago,” said Camacho, who adds that family members respect her sobriety by not drinking alcohol in front of her.
Preventive Measures Lost
In tackling heroin use, experts have found clinics, Bronx Treatment Court and law enforcement agencies working in a vacuum and running in circles.
“There’s no integration model,” said Vizzi, adding that no treatment component can be found in a court setting, which could bring rehab to the addict and not the other way around as it currently stands.
“We’ll be conjoined with them in providing all of their drug treatment, instead of them going to the courts and getting mandated to a hundred other agencies,” said Vizzi. “But it doesn’t work that way in reality.”
The experience leaves the user discouraged in navigating a bureaucratic system, particularly those with poor education.
In some cases, prevention strategies have been downgraded to nearly nothing, though the Cuomo Administration has tried to reverse that by introducing anti-drug campaigns in CUNY and SUNY schools. That’s not happening in the public school system, with the same message hovering past the older heroin user in the Bronx.
“There’s substantially fewer counselors and fewer prevention specialists in the New York City schools right now than there were twenty years ago,” said John Coppola, the executive director of Alcoholism & Substance Abuse Providers Inc.
The preventive strategy can likely save the federal government nearly $200 billion—the cost of fighting the war on drugs, according to a 2007 study from the Office of National Drug Control Policy. Monies typically go toward treatment and incarceration.
With the Affordable Care Act in effect, Medicaid expansion will open more doors for users seeking treatment, a boon to the Bronx, where at least 29 percent the population can apply for Medicaid.
But even if treatment is possible, with Medicaid often covering the costs for low-income Bronxites, those with private insurance could be at a loss since many policies allow for 28-day inpatient treatment. Vizzi notes that if an inpatient’s 28 days expire, they still have to leave since insurance has expired.
“So we have to discharge you knowing full well that you may be sleeping on a bench and that could trigger a relapse,” said Vizzi. “So it’s like a never ending cycle.”