Nation: Kids and Heroin: The Adolescent Epidemic

Doctor: Do you think you’d like to die, Ralphie?

Ralph: No.

Doctor: Then why do you want to go home?

Ralph: ‘Cause I want to.

Doctor: Are you going to shoot more heroin?

Ralph: I dunno.

An ex-addict, 16: You gonna shoot dope, Ralphie. You gonna be in jail or you gonna be dead. The pushers ain’t gonna disappear just ’cause you comin’ home, Ralphie.

RALPH DE JESUS is twelve years old, a 60-lb. wisp of a boy barely four feet tall, with gentle eyes and pale arms so thin that it is almost impossible to believe that they could take a needle. But Ralphie is a junkie. He has not only used heroin, but he has also taken part in muggings and sold drugs to his friends in order to support his habit. Last week Ralphie was in Manhattan’s Odyssey House, in a group therapy session with a psychiatrist and a dozen ex-addicts aged 14 to 18. Ralphie wanted to go back home to The Bronx. The doctor, Judianne Densen-Gerber, founder of Odyssey House, and Ralphie’s young friends there were trying to make him recognize that if he left them, he would have no chance to break out of the vicious circle of heroin addiction. Ralphie stayed for two more days. Then he went home.

The Odyssey House branch on Manhattan’s East 87th Street, one of the few public or private facilities for treating young addicts, is a grubby tenement from the outside. Inside, it is crowded but neatly kept; the kids have replastered falling ceilings, and they do all the work of cleaning, cooking and asking for food from neighborhood merchants. Though discipline is strict, they are cheerful and friendly. The members huddle in frequent bull sessions and gather regularly for group therapy with a trained psychologist. In those agonizing meetings—the one with Ralphie is typical—the kids are by turns affectionate and caustic with one another. Whatever the mood at any one moment, they show a passionate seriousness and a deep mutual concern that is overwhelming to an outsider.

From Ghetto to Suburb

Ralphie got to Odyssey House from a hospital, where he had been seriously ill with hepatitis, contracted from a dirty needle he used to mainline heroin by injecting it into a vein in his arm. He is probably the youngest addict to surface for treatment in a terrifying wave of heroin use among youth, which has caught up teen-agers and even preadolescent children from city ghettos to fashionable suburbs, from New York —where the problem is still most severe —to the West Coast. One 17-year-old at Odyssey House knew Walter Vandermeer, 12, who died in Harlem of a heroin overdose last December (TIME, Dec. 26). He asks Ralphie what he thinks of Walter’s death. “That’s his business,” Ralphie mutters, staring grimly at the floor. It is plain that the ideas of death or imprisonment are beyond the twelve-year-old’s grasp.

Less than a week before, Dr. Densen-Gerber—an outspoken, sometimes abrasive woman of 35, “Doctor Judy” to all who know her—took Ralphie to testify before a New York State legislative committee investigating addiction among the young. Now she asks him: “Why did I take you there?” “I guess you wanted to put me on TV,” Ralphie answers. “No,” she tells him. “The only reason I took you there is that only if they saw you would they understand that tiny little people like you are doing things they shouldn’t do. You are an example of hundreds of other children, Ralphie. Ralphie is not special.”

The gathering tragedy is that Ralphie is not special. Heroin, long considered the affliction of the criminal, the derelict, the debauched, is increasingly attacking America’s children. Part of the dread and the danger of the problem is that it spreads all too invisibly. No one knows how many heroin addicts of any age there are in the U.S. But in New York City alone, where most experts think roughly half the heroin users in the U.S. live, 224 teenagers died from overdoses or heroin-related infections last year, about a quarter of the city’s 900 deaths from her oin use. So far this year, over 40 teenagers have died because of heroin. There may be as many as 25,000 young addicts in New York City, and one expert fears the number may mushroom fantastically to 100,000 this summer. Cautious federal officials believe that heroin addiction below age 25 jumped 40% from 1968 to 1969. However imprecise the figures, there is no doubting the magnitude of the change, or the certitude that something frightening is sweeping into the corridors of U.S. schools and onto the pavements of America’s playgrounds. It has not yet cropped up everywhere, but many experts believe that disaster looms large.

“A heroin epidemic has hit us. We must face that fact,” says Dr. Donald Louria, president of the New York State Council on Drug Addiction and author of Drug Scene. Dr. Elliot Luby, associate director of Detroit’s addict-treating Lafayette Clinic, concurs: “Addiction is really reaching epidemic proportions. You have to look at it as an infectious disease.” Epidemic, of course, is a relative term, but as a Chicago psychiatrist, Dr. Marvin Schwarz, says: “Now we’re seeing it clinically, whereas before we weren’t. The kids on heroin all have long histories of drug use.” At the California-based Synanon self-help centers for addicts, the teen-age population has risen from zero five years ago to 400 today. In San Francisco, Dr. Barry Ramer, director of the Study for Special Problems, calls heroin now “the most readily available drug on the streets.” He adds: “In my wildest nightmares, I never dreamed of what we are seeing today.”

From Rush to Scramble

Heroin itself is a nightmare almost beyond description. By any of the names its users call it—scag, smack, the big H, horse, dope, junk, stuff—it is infamous as the hardest of drugs, the notorious nepenthe of the most hopeless narcotics addicts, the toughest of monkeys for anyone to get off his back. On heroin, the user usually progresses from snorting (inhaling the bitter powder like some deadly snuff) to skin popping (injecting the liquefied drug just beneath the skin) to mainlining (sticking the stuff directly into the bloodstream).

First there is a “rush,” a euphoric spasm of 60 seconds or so, which many addicts compare to sexual climax. Then comes a “high,” which may last for several hours, a lethargic, withdrawn state in which the addict nods drowsily, without appetite for food, companionship, sex—or life. Heroin, says one addict bitterly, “has all the advantages of death, without its permanence.” After the high ends, there is the frantic scramble for a new supply in order to shoot up once again, to escape one more time into compulsive oblivion. As the junkie develops tolerance for the drug, he must use ever increasing amounts to reach the same high—thus the price of a habit can run as high as $100 a day. If he shoots too little, he does not get the kick he wants; if he shoots too much, he risks coma and death from an overdose. An overdose depresses the brain’s control of breathing, slowing respiration to the point where the body simply does not get the oxygen it needs. If he tries to stop suddenly—cold turkey—he must endure the screaming, nauseating, sweating agonies of withdrawal.

Junk has been common even among teen-agers in the ghetto for 20 years. Around 1950, Harlem-bred Claude Brown writes in Manchild in the Promised Land, “horse was a new thing. It was like horse had just taken over.” Now, says Criminologist Roger Smith, director of a drug therapy center near San Francisco, “the emerging junkie of the 1970s is a middle-class junkie as well as a junior junkie.” Here are some of those contemporary junkies who have shaken the habit—at least for now:

SHEERA is 14, red-haired and wholesome-looking, the teenage girl next door. Her father manages a restaurant in New York City; her mother works in the records department of a city hospital. “I didn’t start using heroin until I was 13. I guess I started using drugs to be like everyone else. There were older kids that I looked up to, but there were kids my age, they were also using drugs. I wanted to try it too. I messed around with pills and pot. Then I went to Israel for a summer and came back, and all my friends were on heroin. I snorted a couple of times, skinned a lot, and after that I mained it. I was sent to a school for emotionally disturbed children. Getting drugs there was easier for me than on the streets. Except for heroin. There wasn’t too much of that.

“I don’t know if I would have been accepted by my friends if I hadn’t used drugs. My feelings are that I wouldn’t have been. I wanted to be like them. They were all using drugs because they got bored with things. My parents never spoke to me once about drugs before I got involved. After I got involved, I used to see my father, but my father wouldn’t say anything. My mother used to lay down a few rules. I talked to them about it. I used to go and tell my mother, kind of hoping that she’d say to me ‘Stop and that’s final.’ But she never did.”

TED, 15, tall and somewhat gawky, is in serious trouble with the law: several burglary charges in a Chicago suburb where he lives, possession of narcotics, and truancy. He has taken overdoses twice in recent months; his parents found him sprawled out, unconscious. “In eighth grade I started glue sniffing. It was the only thing around and it was pretty widespread, but I got bored with it after the first few times. Drugs were starting to catch on then, and some older guys turned me on to marijuana.” Then it was LSD and amphetamines, and finally heroin. “I knew people who shot, and I wanted to see how it affected them. I wanted to get stoned. I shot smack nine or ten times. After the first quarter of freshman year, I didn’t care. I didn’t have the will power and I just cut out. I was going for anything that would give me a high. I’ve shot a lot of cocaine and gotten stoned on smack. I never really worried about a habit because I’d known people who’d taken a lot more than me and stopped. After a while, though, kids don’t care if they get hooked. I feel I can learn a lot from all this. It’s like burning your hand. Now I really have no desire to go back on drugs. I want to stay clean.”

Ted’s father, a conservatively dressed public relations executive: “We asked about drugs, but he denied that he was taking anything. He’s been burning incense for years, reading books about the East. And I thought he was going Oriental. In late January, I saw needle marks in his arms. I’d say ‘Those look like needle marks,’ and he’d answer ‘Just a bruise.’ There just isn’t any help —not the family doctor or the hospital or the police or the school.”

Ted’s fortyish, attractive mother: “It was like he was bewitched. People kept saying he’d grow out of it. It took a while to sink in. You just don’t want to believe it. It’s the helplessness that’s the worst part. You’re scared to get up in the morning. You don’t know what you’ll find. The real need is where to get help, someone to talk to, somewhere to turn.”

BILL is 16, pale and a bit withdrawn; his father is a New York City librarian. “There were no big problems with my family. The main thing is that the friends I was with—there was so much drugs that everybody was using them. My friends would say let’s get high. I didn’t want to say no, so I got high with them. I’d just say all right. I got started through drinking and then smoking reefers. I started heroin when I was 14. I wasn’t really strung out [badly addicted]. I wouldn’t get sick and upset. I used to take money from my father’s drawer and ask for money on the street, some change sometimes. I used to get heroin from anywhere. I’d get it in my building, the next building, on the street corners. I got arrested with my friends. We were shooting up in the hallway, and a cop came along and busted us.

“My sister used to tell me all the time that I was stupid. My father, he’s 37 or 38. He used to talk to me when he found out; he used to sit down for about 45 minutes or an hour and talk to me and then I’d say O.K., I’m not going to use it no more. He used to touch me sometimes, and I would cry. Once I left the house and went back out, it might be in my mind for a little while not to use drugs, but once they showed it to me and I had money, I’d just say well, I’ll get high. Right after my father talked to me, I’d go right back out and get high.”

Bill’s mother confesses: “We knew nothing. Billy used to come in after a high, but he would act animated and alert. A couple of times we found him passed out on the couch. We just figured he was tired. He could have stayed right on the couch and died of an overdose. We wouldn’t have known.” Adds his father: “Last summer, we thought Billy was on something. We hoped it was pills or pot. What if it’s heroin? What can you do then? You just kind of wish it away. Now I feel as if I have nothing left.”

JEFFREY, 19, slight and almost frail, started on marijuana at 15 and went through LSD and amphetamines before he got into heroin at 18. “I started on smack exactly on the third anniversary of the first time I smoked pot. I’d never stuck a needle in my arm before, and I was petrified. I didn’t know what to expect. A friend hit us up. For me, it was a thrill thing. I spent whole weekends hitting up. I was enjoying it more and more. I started hitting up once a day, and a couple of months later I started shooting two and three times a day.

“It’s not the high with heroin. It’s that rush for the first minute, when it hits your bloodstream. It’s one minute of heaven, that first jolt. Right after, you feel good. In two or three hours you get nervous, wondering where your next fix is coming from. I started begging, doing anything. All my time was spent raising money for a fix.”

Except for marijuana, Jeffrey has now been clean—off drugs—for several months. “Heroin is a death trip,” he says today. “I really enjoyed it. But once you get the habit, you’re in trouble. One good friend is in the hospital with an $80-a-day habit. Another is almost dead from hepatitis. Two others I know, one a girl, died from overdoses. Every time you stick that needle in your arm, you’re playing with your life.”

Jeffrey’s father, a prosperous Chicago wholesaler: “A psychiatrist told me and our doctor that Jeff would grow out of it. I say if you feel they’re on anything, that’s the time to stop them. Explain to them that they’ll go on to something worse. We never denied him anything. Maybe we were too easy. But we always felt he respected us. We don’t drink. We don’t run around. We lead a good conservative life. The hopeful thing to me: he does want help. My son? Ridiculous—until it happens to you.”

Jeffrey’s mother, expensively dressed, beautifully coiffed: “We have a religious home. We were totally ignorant. We knew he smoked marijuana, but he never got into trouble. He was always a good boy. He never gave us any problems. I don’t think I’ll ever be the same. I’m always wondering—is he taking it or not? If he starts again, it’ll kill me. I couldn’t take much more.”

Respectability for Heroin

Obviously, one of the obstacles to early detection of heroin addiction in a teen-ager is the unwillingness of middle-or upper-class parents to acknowledge the idea that their son or daughter is seriously hooked on heroin. The customary last resorts in personal crisis are undependable. Parents tend to trust doctors implicitly, for example. But one 17-year-old girl from New York’s suburban Westchester County arrived in a New York hospital for a checkup with fresh needle marks all over her arm. “The doctors kidded me about it,” she says. “They said, ‘Oh, oh, we know what you are doing.’ ” Yet they never told her parents.

Once parents discover that their child is using heroin, inevitably they blame themselves; in such tragedies, families can spend a lifetime unraveling the twisting threads of guilt without ever resolving where it lies. More immediately, however, it is important that parents learn how to recognize the symptoms of addiction (see box above). If they do not, or if they refuse to accept the harsh evidence, the chance of saving their child from an early death or a ruined life can be irretrievably lost. One well-to-do Washington, D.C., father, whose 16-year-old started on heroin at 14 and is now in a Virginia detention home, says bitterly: “I would not trust my son in my house. They’ll just have to keep him away until he straightens himself out. I’ve been kicked in the teeth so many times.”

Heroin’s New Image

Why have children and heroin come together now in this deadly combination? According to Dr. Eugene Schoenfeld, who has treated young addicts in San Francisco and writes a popular “Dr. HIPpocrates” column in the Berkeley Barb, explains: “There is a growing use of heroin among young people because young people tend to value the respect of their peers above everything else. Taking the most dangerous drug you can find is -a way of gaining that respect. It’s a kind of machismo thing.”

Says New York’s Dr. Donald Louria: “We are seeing an era of multiple use of any and every kind of drug. And it is moving so fast that it is different this year from last year.” The traditional barriers between much of society and the users of such hard drugs as heroin, cocaine and morphine are collapsing. “Heroin has become respectable,” says Mrs. Harriet Benjamin, a worker at Synanon in Santa Monica, Calif. “The image of the dirty old man in the schoolyard is dead.” Ten years ago, middle-class high school kids looked down on heroin users; now it has shed the fear and the lower-class taint. Heroin users are no longer an exclusive club. Heroin is part of the larger drug scene.

Part of the problem is that to the young, the adult world sets only a hypocritical example. Parents warn their children against pot, which most kids find harmless. Many of the young smoke marijuana and leave it at that, although Dr. Louria warns that “if a young person smokes marijuana on more than ten occasions, the chances are one in five that he will go on to more dangerous drugs.” As Larry Alan Bear, New York City’s addiction services commissioner, sees it: “In some cases, the attitude toward the straight world is, ‘Look, you kill yourselves with cigarettes and booze; let me use what I want to.’ Other times, it’s simply an ‘up-yours’ attitude.”

In the ghetto, alienation from the rest of society is nothing new. The children of affluent middle-class America have just begun to turn to narcotics in frustration or perhaps boredom with the world. They may be taking the permissiveness in which they were raised too literally. Sociologists William Simon and John Gagnon suggest: “We have become, as a nation, a population of pill-takers. Both the actual miracle and the myth of modern medicine have made the use of drugs highly legitimate. Our children, in being casual about drugs, far from being in revolt against an older generation, may in fact be acknowledging how influential a model that generation was.” Add to that the painful adjustments that every adolescent must endure—the physical and emotional challenges of puberty, the hazard-strewn search for self-discovery —and any drug can mean danger to all but the most stable. Like alcohol, marijuana may not be risky for a secure adult, but to an anxious teen-ager it offers a seductive release from the hard reality of growing up. His judgment is unformed, and he may all too readily go on to harder drugs.

A Flower at the Beginning

Rooting out illegal dealing in heroin poses vastly complex problems. The heroin market is enormously profitable, and drying up the sources of supply involves an incredible tangle of such fractious forces as foreign governments and the U.S.’s own Cosa Nostra.

The flow begins with the white-to-purple-flowered opium poppy, Papaver somniferum, an annual plant grown as a cash crop in Turkey, Mexico and the “golden triangle” of Southeast Asia: the northern portions of Burma, Thailand and Laos. The U.S. is putting heavy pressure on Turkey to end legal poppy growing, so far without much success. Raw opium is converted into so-called morphine base; much of the U.S. supply is refined into heroin at simple clandestine laboratories in southern France. It has come into the U.S. concealed in the toilets of international jets, in cans carrying Spanish fish labels, in hollowed-out ski poles, in automobiles, in false-bottomed wine bottles and crates, in shipments of electronic equipment—the smugglers’ ingenuity is inexhaustible, and the supply of lawmen to deal with it is not large. The Bureau of Narcotics and Dangerous Drugs has 850 agents. They have not always been above temptation: 14 were indicted in 1969 for drug trafficking. U.S. Customs men are spread thin; in New York there are only 15 on the drug beat at the airports and on the entire waterfront. Says one: “This is like being a blind goalie in a hockey game.”

Much of the heroin traffic, notably in New York City and Miami, is financed and handled by the Mafia, but over the past five years more and more independents and amateurs have crowded into the act: Cubans, Puerto Ricans, blacks, even a few hippies. Top Mafia bosses supposedly banned all dope peddling in 1957 to clean up their image and avoid prosecutions, but, as Informer Joe Valachi said in 1963, “there is always somebody sneaking.”

What Can Education Do?

That is not surprising, considering the temptation of astronomical profits. One kilogram—2.2 Ibs.—of morphine base is worth $350 in Turkey; after it is refined to heroin in France, the price jumps to $3,500; unloaded in New York City, it is worth $18,000 before dilution. By the time the heroin gets to the street pusher, it is in one-ounce lots of 25% heroin—the rest is usually milk sugar or quinine—that cost the pusher $500 each. The pusher further cuts the diluted drug into glassine packets of 5% heroin, which he sells for $5 each—the so-called “nickel bag”—to the user. The original kilo has now grossed $225,000 for suppliers, traffickers, pushers and peddlers. The first user often splits the nickel bag into even smaller quantities that he resells for $2 or $3, making a profit that he himself can use to help support his habit. Because the addict often does not know just how strong the stuff he has bought really is, he can easily give himself an overdose that makes him unconscious or even kills him.

Federal officials concede that law enforcement alone is not enough. “To talk only in terms of eliminating the illicit drug supply is, in my judgment, a shortsighted approach,” says John Ingersoll, the BNDD director. “What we need is a concomitant long-range program that will eliminate the demand.” To that end, the bureau sends out speakers and brochures to teachers, school administrators and community leaders. In the New York City school system, drug education now starts in the fourth grade.

Irwin Tobin, who runs the New York City program, insists that “the drug problem was not created by the schools, and it will never be solved by the schools alone.” He adds: “Some principals still don’t think they have a problem, or just don’t want to admit it.” At Manhattan’s Robert F. Wagner Junior High School, Principal Bernard Walker has group sessions for parents and kids, and every day he reads a news article about drugs over the school public address system. Are drugs available at Wagner? “I don’t think so,” Walker answers carefully. “I don’t think so.”

Education programs are of no use to children who are already using drugs. “They can keep showing those movies in school for ten or 20 years and the kids are going to keep snooting up in the bathroom,” says an 18-year-old New Yorker who has been on drugs most of his teen-age life. “When I was shooting up, I liked to read about other junkies in the papers. It fed my sickness. I liked to hear about the ODs [overdose cases], and I’d think I was brave for taking it.” For kids on junk, of all the forms of treatment or temporizing that have been tried (see box, page 20), the residential group therapy center seems to provide the strongest support. The theory is that kids get each other on junk, and kids can help each other get off it. Parents are not quite helpless, but their children are often more immediately influenced by schoolmates and friends.

Blacks are understandably resentful that the problem of teen-age heroin addiction is suddenly getting attention because it has reached the white middle class. They have lived with it for two decades in the ghetto, and they are rightly enraged when a Narcotics Bureau official says that it was a problem—”but it was one we could live with.” A 20year-old in the New York City Phoenix House program, who started on heroin in Harlem at twelve, complains: “Up there it’s easier to get it than to avoid it. This is a good reason why the blacks are so mad that the police don’t bust all the very obvious pushers. They don’t because they are paid off.”

Warren Blake, a black police community relations officer in Harlem, asks: “You know what the people up here are saying? Now that white people’s kids are involved, the politicians are worried.” There is undoubtedly truth in that plaint, though everyone dealing with teen-age addiction vehemently agrees that governmental efforts in law enforcement, education, treatment and rehabilitation are so far barely more than a gesture; most U.S. cities have simply no facilities whatever for handling teen-age addicts, and even New York officially has no public funds specifically for treating addicts under 18.

At Synanon, where success with adult addicts who stay within the supportive framework of the house is high but sadly lower with those who leave completely, Synanon Official Bill Ullman contends: “There is no cure for heroin.” Dr. Densen-Gerber believes that teen-agers will be easier to help than adult addicts, if only because they are more resilient physically and emotionally and highly responsive to peer group influence inside a treatment center. But she is at a loss to deal with the Ralphies, the pre-teen junkies who are unable to comprehend that the alternatives to treatment are jail or death. “The more children his age we get,” she says, “the more new theories will we have to develop. How are we going to reach the Ralphies?” She adds: “Each child infects other children. We cannot let them walk around. We have to treat them. We have no choice. If there were thousands of kids afflicted with smallpox, would you let them roam the streets?”