In War on Drugs, Battle Against AIDS Falls Behind : Remedies: As crackdown on users busts up ‘safer’ routines, addicts increasingly grab for dirty needles.

BROOKLYN, N.Y. —  The cop was shouting, “OK, junkies, get the f--- out of there!” And as the four haggard dope fiends slowly filed out, he rapped each on the back with his nightstick, then stalked up the back stairs into the “shooting gallery.” It disgusted him to look at the wretched little room where these people shot up, this nest of AIDS and tuberculosis and who knew what else.

Patrolman Kenny Brenkert stomped on a small pile of sterile syringes, knocked over a table that held small bottles of bleach disinfectant, swung wildly with his stick at the bedsheets that kept the windows hidden from the street. He breathed the air, which was thick and stale.

The policeman began to curse, f------ junkie this and f------ junkie that, until his partner stopped him. The other cop was scared. His hand flapped at a swarm of insects that whirled up out of the trash. “C’mon, let’s get out of here,” he said. “These flies bite you, it’ll kill you.”

So ended another skirmish in the long, wearying War on Drugs. The police had shooed off some dope fiends, a kind of scuffle repeated thousands of times, day after day, sea to shining sea. In this instance, it closed down the drug spot at 384 Melrose St. for an entire 6 1/2 minutes. And it did one more thing. It made those addicts a little more nervous, a little more hasty and a little more likely to spread the AIDS virus that steeps in their blood.

Shooting drugs is a common way of passing HIV, and galleries are the most likely spots where the million or so injecting drug users (IDUs) share the dirty needles that harbor the virus. During other times, with other priorities, this might have provoked a major public health effort, its centerpiece being a vast expansion of drug treatment programs.

But the human immunodeficiency virus hit amid other preoccupations. In the 1980s, drug policy was defined almost entirely as a law enforcement problem--a war. Billions were spent on high-seas interdictions, aerostat balloons above the Mexican border, military operations in South American jungles. On the tough streets of poor neighborhoods, small-time dealers and users--mostly minorities--were snared like shrimp in a dip net. The prison and jail census doubled to 1 million.

There was less enthusiasm for treatment. Underfunded drug programs overflowed. By 1990, according to the National Institute on Drug Abuse, 107,000 Americans were on waiting lists--waiting to just say no.

For heroin addicts, the nation’s switch to a war footing had some odd and unintended effects. A drug habit is a brutal taskmaster; addicts look for stable routines. They need reliable ways to get cash and drugs. And they covet dependable spots to inject, sheltered places with a stash of needles, where other addicts are nearby to share a shot or help them “hit” an ornery vein.

By standards of supply and demand, the presence of more cops on the street has had little effect on the heroin trade, according to federal studies. But it has caused addicts to inject in a rush, especially those who are homeless. They make hurried visits to the galleries. Or worse yet, they shoot up outside, in an alleyway or the tall weeds of an empty lot, all the more likely to ignore sterile needle practices that might save them from the virus.

“Addicts like predictability; if the police keep them running around, they can’t maintain established networks and they end up getting high in as many places as they can and as many times as they can,” said cultural anthropologist Richard Curtis, who has studied street life here in the Bushwick section of Brooklyn. “I guess society has to decide which is worse: the drugs or the AIDS.”

In 1990, the National Commission on AIDS chastised the federal government for its “failure” to confront “the close and deadly link between the sharing of injection drug equipment and HIV.” It recommended a system of drug treatment on demand as well as the removal of legal barriers that most states (including California) have to the possession of syringes for illicit purposes.

Instead, needles have remained a mainstay of the black markets. Georgie Vega, who last summer ran the gallery on Melrose, partially kept up his own dope habit by selling them at $2 apiece. Georgie, 38, was a 25-year veteran of the hustles of heroin addiction. He understood the cat-and-mouse games between junkies and cops--and appreciated the fact that the addicts of Bushwick were harassed but seldom arrested. Their safety was in their own insignificance.

“The courts are too crowded,” Georgie said. “So all the cops do is chase you away or beat you up. If they take you in, they have to come in with you, and then who’d be around to hold down the street? Just look at the streets.”

On nearby Knickerbocker Avenue, the trade in crack and heroin was as wide open as a carnival midway. Forty dealers often worked a single corner, some touting and some holding, their bags of dope in their socks and their cash in a tennis shoe. Every other day, the Tactical Narcotics Team came in and busted people in spurts, easy as bagging groceries. But the trade never shut down.

A squad car slowed in front of the burned-out house that was Georgie’s place maybe 20 times a day. The cops rarely walked up, though an addict never knew what might happen when they did. Georgie was there the day Brenkert ransacked the place. The cop came out grumbling about how much he hated the whole rotten neighborhood, how he’d been doing this for six years, getting spat on and shot at.

Oddly enough, Georgie and the others concluded that Brenkert was an OK guy, even if he did louse up their sterile needles. At least he did not get rough with anyone. “Now if it had been Rogers, this cop that walks the beat, then you’d have seen people getting bumped all up and down,” Georgie said.

And everyone at the busy corner of Melrose and Knickerbocker agreed, one-upping each other with stories of Officer Patrick Rogers.

*

For weeks, the threat of Rogers hovered over the gallery, though there were other reasons for jumpiness, the biggest being the wild use of cocaine. Addicts liked to mix their heroin shots with coke--or shoot up the cocaine alone. This provided a pleasing surge, but the sensation was often bedeviled by a grim rippling of paranoia. “Bugging” was the junkie term.

There was a demented quality to the chatter then. Noel Marquez, usually serene, would change into a different, chemical self, hyperventilating and ripping his clothes to tatters with his hands and teeth. Jo-nice Williams imagined things crawling out of a gash in her foot. “Maggots go in and out of that hole,” she muttered. “They’re breaking down my cells even faster than the HIV.”

When Georgie shot up too much coke, he would hide behind the rusted-out washing machines in the abandoned place next door. Usually, however, he was one of the steady hands, a kindly uncle to the nervous and sick.

One afternoon, he tried to calm a jittery guy named Robbie, whom Georgie knew from prison. Robbie kept springing to his feet, peeking through an eyehole in a wood panel for a look-see at the street. “There’s police out there!” he whispered urgently.

“Don’t worry,” Georgie said. He was reading a book about astronomy that he had fished from the garbage. “Sit down. They won’t come up.”

“Oh, God, no, I know they’ll come up.”

“Quit buggin’.”

They sat in silence, Robbie rocking on a cot with his elbows in his palms. The only sound was the jingling of an ice cream truck. Suddenly, a hand yanked the sheet off the open window of the back wall. Rogers was standing on a mound of rubbish and staring in, at a bad angle to glimpse Georgie in the corner but able to look right at Robbie.

The policeman had no interest in arresting anyone, but he did want to empty the room. He hurled a clump of plaster that whistled as it flew inside. It caught Robbie in the mouth and then splattered to pieces.

*

American attitudes toward narcotics have teetered between extremes, dating back to opium remedies that were popular before 1800. There have been periods of relative tolerance when an addiction was likely to be seen as a personal affliction--and other times when it was viewed as a willful, anti-social act, requiring the retribution of handcuffs and jail cells.

In recent decades, public sentiment has been reflected in the federal drug budget: whether more money was channeled to treatment and prevention (demand reduction) or to police work (supply reduction). In 1972, even during the rhetorical heat of an earlier drug war, treatment was favored. A largely white, middle-class, pot-smoking “counterculture” had flourished, and the Nixon Administration aimed two-thirds of its budget at the demand side.

By 1986, under Ronald Reagan, the drug budget had doubled, and 74% of it was targeted instead toward supply. Cocaine in $5 bits of smokable crack was hitting the streets in a wildfire of ghetto marketing: Inner-city crime rates soared, crack babies were born to addicted mothers. When the good people in bad neighborhoods complained, they were obliged with the police drug sweeps; in New York, 92% of those arrested for drugs in 1989 were black or Latino.

In the midst of this war, public health experts suggested something quite unwarlike, an approach tried in Europe: Give clean syringes to IDUs to slow the spread of HIV. This idea not only seemed folly to drug hard-liners, it angered minority leaders, many of them liberals. If the government handed out needles, wouldn’t kids conclude it was OK to shoot up? The whole notion struck many as a “cooperation with evil” and even a “genocidal mentality.”

New York City was an early battleground over “needle exchange.” In 1988, its health commissioner began a program that offered clean syringes for dirty ones. Resistance was so intense that the only distribution site was an old X-ray clinic at the Health Department, an intimidating location for addicts, beside the criminal courts building and a jailhouse known as The Tombs.

That program failed, though another, limited “exchange” was started a few months ago. The extraordinary rate of HIV among minorities--as well as its heterosexual spread from addicts to others--has changed many minds. There are now sanctioned needle programs in several cities, including Boulder, Colo.; Honolulu; New Haven, Conn.; Portland, Ore.; and Seattle.

“Needle exchanges” provoke obvious questions for researchers. Do they actually reduce the spread of HIV? Do they entice more people to inject drugs? The experts sort through the limited data; it is unlikely they will ever agree conclusively. Potential studies would have to be as complicated as the addicts themselves--matched control groups among subjects out of control on dope.

For its part, the Bush Administration has a stand. Bob Martinez, director of the Office of National Drug Control Policy, said in July: “Needle exchange programs squander our nation’s hard-earned gains in the drug war.”

He suggested instead: drug treatment.

*

Under the Bush Administration, the drug budget has doubled once again to nearly $12 billion. The favored strategy is still to emphasize supply rather than demand, roughly 70% to 30%, but with the huge increase in total spending, the money for treatment and prevention has gone up dramatically. Is it enough yet?

Dr. Herbert Kleber, until recently the White House’s chief adviser on treatment, said the system is still sadly lacking. He estimated that the nation has the treatment capacity for 1.8 million addicts with all kinds of drug problems--and said that services for at least 2.5 million are needed.

“The Republican Administration has failed to ask for sufficient funds, and the Democratic Congress has failed to give the President even what he asked for,” said Kleber, now at Columbia University. “And the public? There’s no outcry. No one gets punished politically for voting against drug treatment.”

By Kleber’s calculations, decreases in the IDU population could be achieved at a fraction of the cost of imprisoning the same number of addicts. “But prison has been the more popular idea,” he said.

New York’s Beth Israel Medical Center has the largest treatment network in the country. Waiting lists for a detoxification program usually run five days to three weeks; waits for methadone maintenance--intended to replace heroin use with regulated doses of a synthetic drug--sometimes range up to one year. (In Los Angeles, the average waits are 19 days for detox and 29 days for methadone maintenance, according to county officials.)

“In essence, we have 200,000 heroin addicts in New York and 33,000 methadone maintenance slots, all of which are always filled,” said Dr. Robert Newman, head of Beth Israel. “These are people who are killing themselves and who are a plague on the rest of us. Out of our own self-interest, voting, tax-paying, drug-free Americans ought to provide more treatment.”

The federal government has an Office for Treatment Improvement. Its director, Dr. Beny J. Primm, agrees that the system is in bad shape but insists there are enough treatment beds. It is just too difficult for addicts to find those with vacancies and present the IDs required for Medicaid reimbursement.

He said: “The system is too arduous, especially so if you are under the influence of drugs; and if you are a minority, it is triply arduous; and if you have a prison record, it is quadruply arduous.”

The system is designed for people who make rational choices. Heroin addicts are not like that. Their decisions about seeking treatment are not stop-go, on-off. The craving for drugs and the desire for salvation exist side by side, the craving almost always the stronger. When the urge for salvation does get a leg up, the impulse often lasts only a short time; it does not return for an appointment three weeks down the road at a location across town.

“They should have a thing where a hospital takes you the same day, without you having to prove who you are,” said Georgie Vega. “What else do they need to know? You’re a dope fiend; you want treatment. (Needle) tracks on the arms are all the identification the cops seem to need.”

*

Heroin addicts have a slogan: “It’s so good, don’t even try it once.” The drug is such a pretty little poem without any words. At first, only curiosity needs to be satisfied. Then, after repeated doses, the body itself pushes for more. The user tries to inch right up to a scary edge without slipping into the mudslide. But that edge--addiction--is hard to gauge. And once into its slide, it is hard to climb out and stay out.

Treatment is no silver bullet; failure rates are often 50%. Some programs are better than others--and each addict brings a different commitment to recovery. The hardest people to save are those without roots in jobs and families, those whose roots have sunk only into the drugs themselves.

At the gallery, most of the 100 or so who came around each day had some experiences with treatment. They talked the talk. Jeannette, a prostitute, introduced herself by saying, “I’m from a dysfunctional family.” Jose Abizuri, 29, was already in a methadone program and only came upstairs for the cocaine.

There were intricate tales of reform and relapse, misadventures of despair that were awful with violence and crazy love and all the demons of self-hatred. Marilyn Rodriguez, middle-age now, blamed her parents. “They ruined my life,” she said. But her friend Speedy saw it otherwise. “They only ruined your childhood,” she corrected. “It’s you who’s ruining your life.”

Some hated the preachiness or regimentation of the drug programs or refused “to trade a heroin habit for a methadone habit.” Others were discouraged dropouts. “I’m in this for good now,” said Harry Hocknell, who once ran away from a treatment center. “There’s no way back to the other life now.”

Acquired immune deficiency syndrome has made it all the harder. Even before, there were those who doubted whether treatment was worth it. They had been ripping and running with dope for 10-20 years. There was a hole in their lives like missing footage in a home movie. What could they achieve now, some dead-end job sweeping up and a room in a fleabag?

With the virus, most everyone at the gallery had a death sentence. Why not stay with the slide downhill? That was how Jo-nice Williams felt. She had HIV and tuberculosis. Her daughters were going to grow up without her anyway. “Drugs is the only thing in life I enjoy,” she said. “Why stop now?”

Too often, Georgie Vega felt the same way. Other times, he thought this matter of dying required some attention. If he had to face Judgment, he wanted to demonstrate faith to his Maker. He spoke of getting into one of “those Christian treatment programs,” ready to detox with God as his therapist.

One night, Georgie went without sleep, intent on throwing himself at the mercy of a program when it opened at daybreak. He walked along Irving Avenue toward his mother’s house, where he kept his few ID papers. And that is when he saw it, an open office.

“The dope fiend mentality took over,” he said. “I had to check it out. You know, the Bible says: Resist the devil and he shall flee. But I couldn’t do it. I found two radios inside and got $15 for one and $20 for the

other. The devil told me, ‘Here, Georgie, go get yourself some dope and a coke.”’

*

A few days later, Rogers, the feared cop, was back. His partner, Isidro Arroyo, was the first up, wheeling at the top of the stairs, gun drawn and surprised to see the room so full. Who knew what to expect in there?

Four junkies froze at the sight of the shiny firearm, all except Georgie and a guy named Puggie. Georgie tossed aside an empty syringe. Puggie had been “booting,” playing with a hypo in his forearm, making his blood go up and down the barrel of the syringe. His thumb gave the plunger a final shove.

Officer Arroyo was in a lecturing mood. “We constantly try to treat you like human beings, and you constantly try to act like animals,” he said. “If you want to use drugs, this is not the place. There are kids who live on this block. Last year, we had a kid stuck in the foot with a needle.”

One of the addicts appeared much cleaner than the others, though he, too, was a longtime junkie. Arroyo told him, “Look at how you’re going to look in a couple of weeks. You’ll be full of disease, like all the rest.”

He put his gun away and motioned for his partner to come up. Rogers eyed things for a few seconds, then sniffed the air. “You’re pigs,” he sneered. “. . . If you were clean, you’d be all right. But I’m going to treat you just like where you live, like garbage.”

Then, this particular time, the cops simply left. Georgie shook his head from side to side, struck suddenly by waves of personal shame.

“The cop was right about the kids,” he said softly. “We’ve got to watch where we throw the needles.”

*

Police efforts notwithstanding, some experts fear America is on the verge of a new heroin epidemic. There are ominous signs: The purity of Southeast Asian heroin has improved while its price has dropped, probably because of increased supply. Among new users, many seem to be in their thirties, refugees from hectic years on the crack pipe. Of the teen-age converts, it is popular to “chase the dragon,” slang for smoking heroin off a piece of tin foil.

The needle, of course, is a more efficient conveyance than the nostril. If the supply of heroin were to suddenly decline, devoted sniffers would probably switch to syringes. With hypodermics sometimes hard to obtain, this would increase the need for sharing and start new brush fires of HIV infection.

Georgie Vega got his syringes through various connections, including diabetics who had prescriptions. He was thought to be an ethical merchant, unlike others who used a needle and then resealed it in its plastic sock.

Ever since Georgie found out he had the virus, thoughts about dying made him feel like a pallbearer in an endless succession of funerals. Other people always wanted to borrow one of his used needles, and he would tell them to bleach it out. “I tell them I’ve got HIV, and some don’t even give a damn,” he said.

Even among the careful ones, precautions were incomplete, limited to the needles themselves. Addicts went ahead and shared other paraphernalia of the injection ritual: the rinse water, the cotton filters, the bottle caps where they cooked up the shot. The virus could live in each of those things.

Bleaching was a common preventive at the gallery, addicts reusing syringes after quickly flushing out the barrel. But recent research at the National Institute on Drug Abuse shows that even this may not be fail-safe.

“When HIV gets into coagulated blood and dried blood, such as in a needle, it’s not clear how effective bleach is,” said Dr. Marvin Snyder, NIDA’s acting deputy director. “It may be killed in 10 seconds or it may take a minute or a minute and a half.”

Public health experts were initially skeptical that the AIDS epidemic would make heroin addicts change their injection behaviors. But few IDUs are self-destructive to the point of death; they merely want to chase the high.

Fear keeps many from these infectious shadowlands, the galleries. “In ’70 or ‘80, about 50% of the injectors in New York would have used galleries; sharing needles was a normal part of injecting,” said researcher Don Des Jarlais. “Now there’s only a small number who share on a regular basis, but probably half still share occasionally.”

A big concern are the new users, those sniffers not yet in the high-risk category. Few of them visited the Melrose gallery, a place too far down the mudslide for an initiate. One who did was Carlos De Jesus, 34 and born again, a chatty man who said he was hit by a car as a boy and felt the Holy Spirit rescue him from death. He boasted that he would “never, ever” inject.

“You hang around here, you’ll be shooting up and pretty soon you’ll have AIDS,” warned Ruben, an older man, 32 years on drugs.

“I don’t believe I will,” answered Carlos, respectful of his elder.

“You’ll have no choice. It’s never the way you want it to be. Let me give you some advice: Don’t come around here any more.”

*

A few weeks later, Carlos was on the needle, absent-mindedly carrying around a syringe as if it were an extra finger on his hand. He almost scraped it against one of the newer regulars, an imposing guy just out of prison, Alfredo (Big Al) Lozado.

“Hey, stay away from me with those works,” Big Al barked.

Carlos was barely aware someone was talking to him. “We’re all sons of God, right?” he said and then waited, hanging impaled on his own question.

“I don’t know about God and that s---,” Big Al answered. “Just don’t point those works at me.”

Syringes were in scarce supply that day. Georgie had no inventory. To get cash, he had begun selling one of the local brands of heroin, “Overtime.”

It made him nervous, being out in the open, dealing to strangers. He was ripe for a bust by the undercovers--or even one of the beat cops.

But it would not be Patrick Rogers. The feared patrolman was not coming around by then. He had been hit in the head with a bottle, his sergeant said.

Someone along those wicked streets had hurled it from a rooftop.