Heroin, Survivor of War on Drugs, Returns With New Face

In the 1970s, frustration over heroin related, urban crime led to the War on Drugs. Today, heroin is back. But the users, and the response, are very different.

By Clyde Haberman
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United States military operations in Afghanistan, now in their 15th year, are routinely described as America's longest war. For overseas combat, that is true. But nothing tops the domestic “war on drugs” that an American president declared more than four decades ago. The casualty rate has been exceedingly high.

Nearly 44,000 Americans a year — 120 a day — now die of drug overdoses. Neither traffic accidents nor gun violence, each claiming 30,000-plus lives a year, causes so much ruination. The annual drug toll is six times the total of American deaths in all wars since Vietnam.

There are obviously many historical aspects to this calamity: the crack cocaine epidemic that once laid siege to urban America, for example, or the spread of H.I.V. infection through shared needles. Retro Report, a series of video documentaries that examine major news stories of the past and their continued impact, trains its lens on a heroin scourge that menaced cities in the late 1960s and early '70s. It was an era when some soldiers, too, came home from Vietnam with a heroin problem.

Even as that plague was beginning to wane, President Richard M. Nixon announced his war on drugs in 1971, and threw a good deal of federal money into it. Treatment programs were part of this enterprise. But rising crime rates, and fear, soon shaped government policies nationally and locally. Preventing and treating addiction took a back seat to locking up users and their dealers for long stretches. The Sentencing Project, an advocacy group on prison issues, says that from 1980 to 2009, the number of people incarcerated for drug offenses rose to about 500,000 from 40,000. It was lost on no one that these inmates were disproportionately African-Americans.

Now heroin is back, big time. (The drug, an opium derivative, was synthesized by Bayer, the German pharmaceutical company, and introduced in 1898 as a cough suppressant. “Heroin” was originally a brand name, said to have been taken from heroisch, German for “heroic” and meaning “strong” when applied to medicines.)

The crisis today is markedly different from its predecessors. It has settled not so much in large cities as in suburbs and rural America. New users are mostly white. Indeed, a study last year for JAMA Psychiatry, a journal published by the American Medical Association, found that in the last decade whites accounted for 90 percent of those who tried heroin for the first time. Typically, they were young people who initially got hooked on OxyContin, Percocet or other widely prescribed pain relievers belonging to a class of drugs known as opioids. Heroin, also an opioid, became desirable because it is a lot cheaper than those medications, and readily available. Its users are estimated at 330,000, triple the number a decade ago.

Death has come calling. Of the 43,982 drug fatalities recorded in 2013 by the Centers for Disease Control and Prevention, 8,257 were heroin-related. That was 39 percent more than a year earlier and four times the toll in 1999. Deaths from other opioids have leveled off in recent years — there were 16,235 in 2013 — but they are nonetheless quadruple the 1999 figure.

Something else is different about this crisis: In and out of government, among Republicans as well as Democrats, the pendulum has swung from the “lock-'em-up” ethos that long prevailed. The emphasis now is more on treating addiction as a disease, not a police matter.

The Obama administration has significantly increased, to about $12 billion, the federal budget for drug prevention and treatment. In the last few weeks, it granted early release to several thousand imprisoned drug offenders deemed nonviolent. Not everyone is thrilled with this. Some law enforcement officials predict that at least a few of the newly freed inmates will return to crime.

But compassion is the ascendant spirit. One reflection of this is a spate of state laws enabling relatives of addicts and other nonmedical people to administer the drug naloxone, known by its brand name, Narcan. It rapidly reverses an opioid overdose, and is a proven lifesaver. On Wednesday, the Food and Drug Administration approved a nasal spray to go along with injectable versions of Narcan already in use.

Is it purely a coincidence that the pendulum swung from punishment to caring at the same time that heroin abuse became a crisis largely affecting whites, not blacks? Perhaps, although many would doubt it.

In any event, the shift is welcomed by key figures like Kurt L. Schmoke, a former Baltimore mayor and now president of the University of Baltimore. During his City Hall years, starting in the late 1980s, Mr. Schmoke was a prominent critic of the drug war, urging that the focus instead be on treatment and on decriminalizing drug use. He faced considerable resistance back then, including from some fellow black politicians.

In an interview with Retro Report, Mr. Schmoke spoke ruefullyabout “the lives that could have been saved, the families that would have remained intact” had less-punitive approaches been pursued. “The war on drugs was pretty devastating to the United States,” he said, “and hopefully we’ve seen the error of our ways and are going to move in a different direction.”

Similar sentiments were expressed by John R. Dunne, a former New York state senator who in the early 1970s was instrumental in enacting the Rockefeller-era drug laws, named for Gov. Nelson A. Rockefeller. At the time, drug-fueled crime seemed to be spinning out of control. The Rockefeller statutes were the sternest in the country, mandating long prison sentences even for first-time offenders caught with small amounts of narcotics. They embodied the punitive mood that spread across the state of New York and the country.

In 1971, the year of the infamous and bloody Attica prison uprising in northern New York, the state’s inmate population totaled 12,500. After passage of the Rockefeller laws in 1973, that number rose, and then kept rising. It peaked at 72,584 in 1999. Now, with less crime afoot, it has shrunk to about 53,000. Several detention centers have been closed, though not without bruising political fights. Prisons mean jobs in the rural areas where many are. For those regions, big-city crime amounts to their economic development.

New York prosecutors generally endorsed the tough drug laws, but the critics ultimately prevailed. In 2009, the Rockefeller statutes were swept aside by a law permitting judges to send low-level offenders to treatment programs (though drug kingpins were not spared firm prosecution). By then, Mr. Dunne had long become a penitent. He was convinced, as he said to Retro Report, that the stiff laws he had helped create were a mistake that did little to stem the drug trade while they condemned vast numbers of blacks and other minorities — and their families — to lives of despair.

Might a strongly punitive approach make a comeback? It is always possible. Pendulums, by their nature, swing. But even if that were to happen, narcotics seem unlikely to disappear.

That was the sense of Daniel Patrick Moynihan, a four-term United States senator from New York. Mr. Moynihan, who died in 2003, wrote an essay in 1998 on the 100th anniversary of heroin’s introduction that offered this observation: “Since the desire of man to alter his state of consciousness is as old as human history, and technology continues to provide a breathtaking array of drugs capable of producing everything from oblivion to nirvana, I think it safe to assume that we may never win a ‘war’ against drugs.”

CLYDE HABERMAN, a regular contributor to Retro Report, has been a reporter, columnist and editorial writer for The New York Times, where he spent nearly 13 years based in Tokyo, Rome and Jerusalem. Subscribe to our newsletter here and follow us on Twitter @RetroReport.

This article first appeared in The New York Times.