heroin

Carl Hart, a neuroscientist and professor of psychology at Columbia, recently declared that he is entering his fifth year as a regular heroin user. This surprising public statement brought new attention to Hart’s long history of advocacy for the decriminalization and legalization of most drugs. Based on his research, Hart believes that illegal drugs, when used properly, have overwhelmingly positive effects on the human psyche.

The Department of Health has distributed 70,000 pamphlets about safer heroin use. But some city officials fear the information only encourages addiction. A New York City Department of Health and Mental Hygiene pamphlet advising safety guidelines for heroin has recently come under fire by several city politicians. And the debate is especially relevant in Morningside Heights, where a drug bust on Jan. 13 at the Grant Houses development on Amsterdam from 123rd to 125th streets incriminated Crips and Bloods gang members for selling heroin, as well as crack and cocaine. But issues of harm-reduction models for heroin usage is a citywide debate that has become increasingly contentious with the introduction of a new government-sponsored pamphlet. Criticism was so strong that the city recently removed the pamphlet from its website. TAKING CHARGE The Department of Health created the 16-page brochure, titled "Take Charge Take Care," in 2007 as a harm-reduction model for current heroin users and those at risk to become users. Categories of advice include how to prevent and treat overdose, prepare drugs carefully, and take care of veins—for example, "Use with someone else," "Know your tolerance," and "Don't mix drugs," as well as a list of overdose symptoms and instructions for rescue breathing. Critics, such as New York City Council Member and Chair of the Council's Public Safety Committee Peter F. Vallone, charge that the pamphlet may in fact encourage drug use rather than decrease the problem. "The councilman is very much opposed to it," said Kathleen Sims, Vallone's Chief of Staff. "The pamphlet goes too far. It basically spells out heroin use," Sims said. "He believes it is a gross misuse of taxpayer money," she added. NYC Special Narcotics Prosecutor Bridget Brennan agreed with Vallone, calling the brochure "a how-to for the uninitiated." She said, "The brochure was probably well-intentioned, but extremely misguided." The DOHMH defends the pamphlet on its website, stating that "many people with substance abuse problems eventually get off drugs, and simple steps can keep them reduce harm to themselves until then. The Take Charge, Take Care pamphlet is a simple but valuable tool for people who need this information." Jessica Scaperotti, spokesperson for the DOHMH, said in e-mail, that the pamphlet was created "to help people who are injecting drugs to reduce the harm associated with this type of drug until they are able to get into treatment." She said that accidental overdose is the fourth leading cause of early adult death in New York City, although unintentional overdose deaths declined by 25 percent from 2006 through 2008. During that time period, the brochure—designed "to get people off of drugs and into treatment"—was available both in hard copy distribution and online. CRITICISM AND RESPONSE Brennan said that her biggest concern with the brochure is the "upsurge in a new user group composed of young people, who may become addicted to opiates from prescriptions in the medicine cabinet and might then move onto heroin." She said that she would not have any problem with the brochure were it to omit tips on safer usage while injecting the drug in favor of only information about needle exchange, HIV/AIDS testing, and seeking treatment. She added that she is not opposed to harm-reduction strategies, but said that the money spent on this effort should be matched by money spent on education, and that such a brochure should include more about how to seek help and about the negative effects of drugs. The 70,000 copies of the pamphlet have reportedly cost city taxpayers $32,000. But some criticize the city for devoting resources to a document that does not include encouragement to stop using and to prevent the spread of such needle-related diseases as hepatitis and HIV/AIDS. As part of its "Don't Share" category, the pamphlet urges its reader to "Protect yourself and others. Don't share syringes or equipment." It advises "free syringes and equipment from a syringe exchange program" to be disposed of following use "in a thick plastic container, such as a laundry soap bottle," labeled as hazardous waste, and dropped off at a hospital or clinic. It also urges users to seek out HIV testing, hepatitis tests and vaccinations, treatment for depression that may accompany drug use, and drug treatment programs with replacement therapy for heroin and other opiate addictions. As the Department of Health and Mental Hygiene notes, "because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment." But Brennan said that the pamphlet does not address every issue properly. "It's not just about reducing the harm addicts are producing for themselves, but also about preventing a new generation of users," Brennan said. Following an outpouring of criticism, the pamphlet was taken down this month from the DOHMH website, although it still remains in circulation, is still posted on non-affiliated sites, and can still be found on web engine searches. HEROIN IN MORNINGSIDE Brennan has seen consistent problems with usage in Morningside Heights along the 125th Street corridor and within the housing developments between 112th and 115th streets, as well as north into Harlem. She also said that there is currently "a lot more heroin in the New York City drug market," and that her worry "is about college students, even high school students. There is more heroin, but it is only valuable to dealers if they have a market to sell it." While the pamphlet initially assumes drug use and offers information for users to better understand and reduce their risk from using heroin, it also suggests the common methadone replacement therapy treatment as a way to help addicts stop using. Clinics and hospitals offering methadone replacement treatment in Morningside Heights and Harlem include the ARTC Manhattan Clinic 21 on125th Street, which also offers drug-free treatment and HIV/AIDS counseling and care, the Beth Israel Medical Center on 125th Street, and the Harlem Hospital Center on 118th Street. According to the DOHMH, heroin is the number-two substance related to drug abuse admissions treatment in the city after cocaine. And Brennan said that historically, heroin use has been a major problem in Harlem and Morningside Heights. On Jan. 13, 11 Crips and Bloods gang members were busted for selling heroin, as well as crack and cocaine, in the Grant Houses at 1320 Amsterdam Ave. The dealers were caught after a long investigation that involved the gangsters advertising their activity on MySpace web pages, calling themselves the "M-Set Grant Houses Crew." The New York City Housing Authority declined to comment on the arrests, stating policy of no comments on crime. THE BIG PICTURE Some public health experts said the pamphlet is a valuable part of the effort to minimize risks associated with drug use, for both users and surrounding neighborhoods. Joanne Csete, MPH '81, an associate clinical professor at the Mailman School of Public Health and director of the school's Department of Population and Family Health, praised the brochure's methodology. "The city's pamphlet is based on sound science and good sense," said Csete, who has focused much of her research and teaching on health services for drug users and others vulnerable to HIV. "Policy-makers have rarely faced the fact that all drug users can't become abstinent at a given moment. This pamphlet is based on the real-life urgency to help those who still inject to protect themselves from the most harmful consequences of injection," she said. She added, "There is no evidence that giving drug users information of this kind will lead to new drug use in the population." "Take Charge, Take Care" is also targeted at reducing the spread of HIV/AIDS and Hepatitis C, which can have effects beyond the users themselves. "There's another big issue here—HIV and AIDS," Scaperotti said. Needles still spread HIV in the U.S., with one third of Americans infected with HIV having been infected through injection-drug use. Syringe exchange programs, like those promoted by the pamphlet, have been operating in the city since 1992, and Scaperotti said that such programs have reduced HIV prevalence among injection-drug users by more than 75 percent since, with hepatitis C infections falling by a third. Through syringe exchange programs, injection-drug users can obtain clean needles. Scaperotti said, "We also can't lose sight of the importance of preventing HIV transmission." elizabeth.foydel@columbiaspectator.com