United States | Heroin in the Midwest

A hydra-headed scourge

How the Midwest is battling a drug epidemic

|CHICAGO

EVEN street-savvy former gang members are shocked by the spread of heroin to Chicago’s suburbs. Earlier this year, when Roberto Hernández, a Puerto Rican, was in the final stages of preparation of a big push by Gangs to Grace, a church ministry on the west side, to save Latino gang members from lives of violent crime, he explained that white girls from the suburbs go to neighbourhoods even he wouldn’t set foot in to buy heroin. Many of them are as young as 14 or 15. Some prostitute themselves to fund their addiction.

“We have the worst heroin problem in the nation in the Chicago area,” says David Cohen, a recovering heroin addict who counsels addicts at Insight Behavioural Health, a treatment centre. Greater Chicago has the highest number of emergency-room visits related to heroin in the country with 24,627 visits in 2011 (the latest year for which records exist), compared with 12,015 in New York. In Chicago 35% of substance-abuse treatment admissions are for heroin, compared with 16% nationwide. And demand, especially from young women, keeps rising: on the city’s west side business is booming at what insiders say is the largest open-air drug market in the country.

Heroin hit the Midwest harder than other places because the coasts learned to deal with the problem in the 1960s, and are thus better able to handle its resurgence, says David Ferguson, a medicinal chemist at the University of Minnesota (see chart). Midwesterners, especially in rural areas, are less aware of the dangers. They had to learn how to fight drug traffickers, mostly from Mexico, who use Chicago as a transport hub for their wares. The Midwest and the South also have far fewer treatment centres for addicts than the north-east.

The heroin epidemic in the Midwest is closely linked to the rampant opiate epidemic. As doctors prescribed opioid painkillers such as OxyContin more and more liberally, their abuse grew. Sales of prescription opioid painkillers have increased 300% since 1999, according to the federal Centres for Disease Control and Prevention (CDC), even though the amount of pain Americans report to their physicians has not changed.

Three-quarters of heroin addicts used to take prescription drugs and switched to heroin, which is cheaper and more easily available on the black market. A gram of pure heroin costs less than half what it did in the 1980s, in real terms. “This is a doctor-caused epidemic,” says Tom Frieden, boss of the CDC. In states with higher prescription rate of opioid painkillers, such as Michigan, Ohio and Indiana, the number of heroin addicts is higher too.

In depressed areas in the Rust Belt, where poverty and unemployment rates shot up as factories shut down and jobs disappeared, the drug epidemic is ravaging once-idyllic communities. Indiana had a brutal wake-up call earlier this year when Austin, a small rural community just off the interstate between Indianapolis and Louisville, was the epicentre of the largest outbreak of HIV infections ever seen in the state. Nearly 200 people were infected in a population of just 4,200 because addicts injecting Opana, a prescription painkiller that delivers a potent high, shared needles, which is the fastest way for an infection to spread. “We have never documented anything like it,” says Mr Frieden.

Indiana and Illinois are lagging behind in efforts to fight the drug epidemic. “If we want to make the heroin problem worse, we are headed in the right direction,” warns Kathie Kane-Willis, the director of the Illinois Consortium on Drug Policy at Roosevelt University. According to a study published last month by the consortium, Illinois dropped from 28th in the nation for providing state-funded treatment for addiction to 44th in just five years. Illinois is the least equipped state in the Midwest to provide treatment for the growing number of heroin addicts, says the study, and Indiana is only slightly better. This suggests the needles and spoons are here to stay.

This article appeared in the United States section of the print edition under the headline "A hydra-headed scourge"

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