New York Times “New Violence Seen in Users of Cocaine” By Peter Kerr March 7, 1987 In New York and other cities where crack use has become widespread, the police and drug treatment experts say they are being confronted by an increasing number of cases of violent, erratic and paranoid behavior among heavy cocaine users, and the growing appearance of a condition known as cocaine psychosis. In one dramatic example, a man apparently using cocaine held four people hostage for 30 hours in an East Harlem apartment and demanded baking soda, which the police feared he would use to process powdered cocaine into smokable crack. He surrendered quietly Thursday night. 'Emotional Roller Coaster' Although the police say it is too early to say exactly what role cocaine played in the incident, officials point out that as crack has replaced heroin as the drug of choice in the inner city, they are seeing rising numbers of homicides, people resisting arrest and violent, unpredictable behavior among drug abusers. ''Last night was as classic case of an emotional roller coaster,'' Deputy Chief Francis Hall, head of the New York City Police Department's narcotics division, said of the 30-hour siege with the gunman, Ismael Igartua. ''The escalated use of cocaine has truly changed the drug problem. Heroin maintained people on an even keel; it was sort of a tranquilizer. Cocaine causes a very different reaction.'' At a city-operated unit at Interfaith Medical Center in Brooklyn that specializes in crack cases, doctors say more than 20 percent of crack addicts who appear for treatment arrive with symptoms mimicking schizophrenia. Banging Down a Door ''By comparison, heroin addicts were pussycats,'' said Dr. Jochanan Weisenfreund, the director of psychiatry at Interfaith. ''In my opinion, the police should approach a crack addict as they would approach someone with acute psychiatric disorder.'' For example, in one case at the hospital now, Dr. Weisenfreund said, a patient entered saying he was capable of jumping from building top to building top. Other experts cited examples of a patient who ran into a liquor store claiming he was followed by a mad dog, or another banging down an apartment door under the belief that he was being chased by a mob. The condition called cocaine psychosis was first described by Freud in 1884, when a patient given cocaine over weeks described swirling white snakes, the sounds of voices and intense paranoia, according to Dr. Jeffrey S. Rosecan, who heads the cocaine addiction program at Columbia-Presbyterian Medical Center. Scientists now believe that the psychotic symptoms are caused by the effect of cocaine on dopamine, a chemical that sends messages between nerve cells. Dopamine levels suddenly rise when cocaine enters the body, resulting in a profound sense of euphoria, and drops again as the drug wears off. Psychotic symptoms can develop after dopamine levels rise repeatedly. And even in cases where full-fledged psychosis does not develop, users tend to be highly agitated and prone to violence. With powdered cocaine taken through the nose, cocaine psychosis can take years to develop, and most users have never experienced the condition. But when powdered cocaine is taken regularly over many years or is smoked, particularly in daylong binges as it is among crack addicts, psychosis becomes much more common. Problem at Crack Houses Thus during the first years of widespread cocaine use in the United States in the late 1970's, relatively few people experienced addiction or psychotic symptoms, and some experts even perceived the drug as harmless. But after many years of widespread use, and particularly with the rise of crack over the past 18 months, reports of crime and psychiatric difficulties associated with cocaine have risen dramatically, experts say. The problem is particularly acute at crack houses, where groups of people gather to smoke crack. There, a blend of paranoia, weapons and money often leads to dangerous confrontations, said William Hopkins, the supervisor of the street research unit of the New York State Division of Substance Abuse Services. Smokers often search the floor for specks of crack that do not exist, accuse each other of stealing crack they never had and attack each other with knives or with the butane torches used to smoke the drug. Homicide Rate Rises The police say homicides, which were up 18 percent in New York in the first 11 months of 1986, compared with 1985, had their greatest rise in northern Manhattan and other areas where crack use is extremely heavy. In Florida, where levels of cocaine use are among the highest in the country, Arthur Nehrbass, the executive officer of the special investigations division of the Metro Dade police, said his officers were increasingly faced with the problem of recognizing a victim of cocaine psychosis before he became extremely violent. Dr. Charles Watli, the deputy chief medical examiner for Dade County, said his office had discovered a syndrome called cocaine-related delirium, in which the police found people who had used cocaine wildly yelling, screaming or running through the streets. In more than a dozen cases, the victims had to be restrained and then died suddenly, even though the level of cocaine in their blood did not indicate an overdose. New York Times “In Heroin Crisis, White Families Seek Gentler War on Drugs” By Katharine Q. Seelye OCT. 30, 2015 NEWTON, N.H. — When Courtney Griffin was using heroin, she lied, disappeared, and stole from her parents to support her $400-a-day habit. Her family paid her debts, never filed a police report and kept her addiction secret — until she was found dead last year of an overdose. At Courtney’s funeral, they decided to acknowledge the reality that redefined their lives: Their bright, beautiful daughter, just 20, who played the French horn in high school and dreamed of living in Hawaii, had been kicked out of the Marines for drugs. Eventually, she overdosed at her boyfriend’s grandmother’s house, where she died alone. “When I was a kid, junkies were the worst,” Doug Griffin, 63, Courtney’s father, recalled in their comfortable home here in southeastern New Hampshire. “I used to have an office in New York City. I saw them.” Noting that “junkies” is a word he would never use now, he said that these days, “they’re working right next to you and you don’t even know it. They’re in my daughter’s bedroom — they are my daughter.” When the nation’s long-running war against drugs was defined by the crack epidemic and based in poor, predominantly black urban areas, the public response was defined by zero tolerance and stiff prison sentences. But today’s heroin crisis is different. While heroin use has climbed among all demographic groups, it has skyrocketed among whites; nearly 90 percent of those who tried heroin for the first time in the last decade were white. And the growing army of families of those lost to heroin — many of them in the suburbs and small towns — are now using their influence, anger and grief to cushion the country’s approach to drugs, from altering the language around addiction to prodding government to treat it not as a crime, but as a disease. 1 (A photo of Courtney Griffin, who died of a heroin overdose in 2014, with her sister Shannon, left, and her mother, Pamela. Credit Katherine Taylor for the New York Times) “Because the demographic of people affected are more white, more middle class, these are parents who are empowered,” said Michael Botticelli, director of the White House Office of National Drug Control Policy, better known as the nation’s drug czar. “They know how to call a legislator, they know how to get angry with their insurance company, they know how to advocate. They have been so instrumental in changing the conversation.” Mr. Botticelli, a recovering alcoholic who has been sober for 26 years, speaks to some of these parents regularly. Their efforts also include lobbying statehouses, holding rallies and starting nonprofit organizations, making these mothers and fathers part of a growing backlash against the harsh tactics of traditional drug enforcement. These days, in rare bipartisan or even nonpartisan agreement, punishment is out and compassion is in. The presidential candidates of both parties are now talking about the drug epidemic, with Hillary Rodham Clinton hosting forums on the issue as Jeb Bush and Carly Fiorina tell their own stories of loss while calling for more care and empathy. Last week, President Obama traveled to West Virginia, a mostly white state with high levels of overdoses, to discuss his $133 million proposal to expand 2 access for drug treatment and prevention programs. The Justice Department is also preparing to release roughly 6,000 inmates from federal prisons as part of an effort to roll back the severe penalties issued to nonviolent drug dealers in decades past. And in one of the most striking shifts in this new era, some local police departments have stopped punishing many heroin users. In Gloucester, Mass., those who walk into the police station and ask for help, even if they are carrying drugs or needles, are no longer arrested. Instead, they are diverted to treatment, despite questions about the police departments’ unilateral authority to do so. It is an approach being replicated by three dozen other police departments around the country. “How these policies evolve in the first place, and the connection with race, seems very stark,” said Marc Mauer, executive director of the Sentencing Project, which examines racial issues in the criminal justice system. Still, he and other experts said, a broad consensus seems to be emerging: The drug problem will not be solved by arrests alone, but rather by treatment. Parents like the Griffins say that while they recognize the racial shift in heroin use, politicians and law enforcement are responding in this new way because “they realized what they were doing wasn’t working.” “They’re paying more attention because people are screaming about it,” Mr. Griffin said. “I work with 100 people every day — parents, people in recovery, addicts — who are invading the statehouse, doing everything we can to make as much noise as we can to try to save these kids.” An Epidemic’s New Terrain Heroin’s spread into the suburbs and small towns grew out of an earlier wave of addiction to prescription painkillers; together the two trends are ravaging the country. Deaths from heroin rose to 8,260 in 2013, quadrupling since 2000 and aggravating what some were already calling the worst drug overdose epidemic in United States history. Over all, drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day. Here in New England, the epidemic has grabbed officials by the lapels. The old industrial cities, quiet small towns and rural outposts are seeing a near-daily parade of drug summit meetings, task forces, vigils against heroin, pronouncements from lawmakers and news media reports on the heroin crisis. 3 New Hampshire is typical of the hardest-hit states. Last year, 325 people here died of opioid overdoses, a 68 percent increase from 2013. Potentially hundreds more deaths were averted by emergency medical workers, who last year administered naloxone, a medication that reverses the effects of opioid overdoses, in more than 1,900 cases. Adding to the anxiety among parents, the state also ranks second to last, ahead only of Texas, in access to treatment programs; New Hampshire has about 100,000 people in need of treatment, state officials say, but the state’s publicly financed system can serve just 4 percent of them. Since New Hampshire holds the first-in-the-nation presidential primary, residents have repeatedly raised the issue of heroin with the 2016 candidates. Mrs. Clinton still recalls her surprise that the first question she was asked in April, at her first open meeting in New Hampshire as a candidate, was not about the economy or health care, but heroin. Last month, she laid out a $10 billion plan to combat and treat drug addiction over the next decade. She has also led discussions on the topic around the country, including packed forums like the one in Laconia, N.H., where hundreds of politically engaged, mostly white middle-class men and women, stayed for two hours in a sweltering meeting hall to talk and listen. One woman told of the difficulties of getting her son into a good treatment program, and said he eventually took his own life. Another told Mrs. Clinton of the searing pain of losing her beloved son to heroin. Many of the 15 Republican candidates for president have heard similar stories, and they are sharing their own. “I have some personal experience with this as a dad, and it is the most heartbreaking thing in the world to have to go through,” Jeb Bush, the former governor of Florida, said at a town hall-style meeting in Merrimack, N.H., in August. His daughter, Noelle, was jailed twice while in rehab, for being caught with prescription pills and accused of having crack cocaine. Carly Fiorina, the former chief executive of Hewlett-Packard, tells audiences that she and her husband “buried a child to addiction.” And Gov. Chris Christie of New Jersey released an ad here in New Hampshire declaring, “We need to be pro-life for the 16-year-old drug addict who’s laying on the floor of the county jail.” Some black scholars said they welcomed the shift, while expressing frustration that earlier calls by African-Americans for a more empathetic approach were largely ignored. 4 “This new turn to a more compassionate view of those addicted to heroin is welcome,” said Kimberlé Williams Crenshaw, who specializes in racial issues at Columbia and U.C.L.A. law schools. “But,” she added, “one cannot help notice that had this compassion existed for African-Americans caught up in addiction and the behaviors it produces, the devastating impact of mass incarceration upon entire communities would never have happened.” Now, all the political engagement around heroin has helped create what Timothy Rourke, the chairman of the New Hampshire Governor’s Commission on Alcohol and Drug Abuse, says is an impetus for change, not unlike the confluence of events that finally produced a response to the AIDS epidemic. “You have a lot of people dying, it’s no longer just ‘those people,’ ” he said. “You have people with lived experience demanding better treatment, and you have really good data.” A More Forgiving Approach Among recent bills passed by the New Hampshire legislature in response is one that gives friends and family access to naloxone, the anti-overdose medication. Mr. Griffin, a few months after his daughter died, was among those testifying for the bill. It was set to pass in May but would not take effect until January 2016 — until Mr. Griffin warned lawmakers that too many lives could be lost in that six-month gap. At his urging, the bill was amended to take effect as soon as it was signed into law. It went into effect June 2. Other parents like him have successfully lobbied for similar measures across the country. Almost all states now have laws or pilot programs making it easier for emergency medical workers or family and friends to obtain naloxone. And 32 states have passed “good Samaritan” laws that protect people from prosecution, at least for low-level offenses, if they call 911 to report an overdose. A generation ago when civil rights activists denounced as racist the push to punish crack-cocaine crimes, largely involving blacks, far more severely than powder-cocaine crimes, involving whites, political figures of both parties defended those policies as necessary to control violent crime. But today, with heroin ravaging largely white communities in the Northeast and Midwest, and with violent crime largely down, the mood is more forgiving. “Both the image and reality is that this is a white and often middle-class problem,” said Mr. Mauer of the Sentencing Project. “And appropriately so, we’re having a much broader conversation about prevention and treatment, and trying to be constructive in responding to this problem. This is good. I don’t think we should lock up white kids to show we’re being equal.” 5 So officers like Eric Adams, a white former undercover narcotics detective in Laconia, are finding new ways to respond. He is deployed full time now by the Police Department to reach out to people who have overdosed and help them get treatment. “The way I look at addiction now is completely different,” Mr. Adams said. “I can’t tell you what changed inside of me, but these are people and they have a purpose in life and we can’t as law enforcement look at them any other way. They are committing crimes to feed their addiction, plain and simple. They need help.” Often working with the police, rather than against them, parents are driving these kinds of individual conversions. Their efforts include attempts to recast addiction in a less stigmatizing light — many parents along with treatment providers are avoiding words like “addict” or “junkie” and instead using terms that convey a chronic illness, like “substance use disorder.” Parents are involved in many ways. To further raise awareness, Jim Hood, 63, of Westport, Conn., who lost his son, Austin, 20, to heroin three years ago, and Greg Williams, 31, of Danbury, Conn., who is in long-term recovery from substance abuse, organized the Oct. 4 “Unite to Face Addiction” rally in Washington. Featuring musicians like Sheryl Crow, it brought together more than 750 groups that are now collaborating to create a national organization, Facing Addiction, devoted to fighting the disease of addiction on the scale of the American Cancer Society and the American Heart Association. “With heart disease or cancer, you know what to do, who to call, where to go,” Mr. Hood said. “With addiction, you just feel like you’re out in the Wild West.” Ginger Katz of Norwalk, Conn., has equally lofty goals. After her son, Ian, 20, died of a heroin overdose in 1996, she founded the Courage to Speak Foundation to try to end the silence surrounding addiction, and she has developed a drug-prevention curriculum for schools. For Doug and Pam Griffin Courtney is still their focus; her pastel bedroom is as she left it, with the schedules of meetings of Narcotics Anonymous taped to what she called her “recovery wall.” “We’ve pretty much given up what used to be our life,” Mr. Griffin said. But in addition to grieving and testifying at hearings and forums, the Griffins take calls day and night from parents across the country who have read their story and want to offer an encouraging word or ask for advice. They are establishing a sober house, named after Courtney. And they host a potluck 6 dinner and church service once a month on Sunday nights at the First Baptist Church in nearby Plaistow, where they held their daughter’s funeral, for people with addictions and their families. At last month’s service, more than 75 people filled the pews, including the family of Christopher Honor, who was Courtney’s boyfriend. He was also addicted to heroin. Last month, almost a year after her death, Chris, 22, died of an overdose — the 23rd overdose and third fatal one this year in Plaistow, a town of 8,000 people. Chris’s mother, Amanda Jordan, 40, wanted to attend the Sunday night service last month, but it was just two weeks after she had buried Chris, and she worried it might be too soon to go back to that church, where Chris’s funeral was held. She sometimes thinks Chris is still alive, and at his funeral she was convinced he was still breathing. She was afraid she would fall apart, but she and other family members decided to go anyway. During the service, her son Brett, 18, became so overwhelmed with emotion that he had to leave, rushing down the center aisle for the outside. Ms. Jordan ran after him. Then a family friend, Shane Manning, ran after both of them. Outside, they all clutched one another and sobbed. “I’m a mess,” Ms. Jordan said after coming back inside and kneeling in front of a picture of Chris. In addition to yearning for her son, she had been worried that the Griffins blamed her for Courtney’s death. But at the church, they welcomed her. In their shared pain, the families spoke and embraced. Ms. Jordan, one of the more recent involuntary members of this club of shattered parents, said that someday, when she is better able to function, she “absolutely” wants to work with the Griffins to “help New Hampshire realize there’s a huge problem.” Right now, though, she just wants to hunt down the person who sold Chris his fatal dose. “These dealers aren’t just selling it,” she said. “They’re murdering people.” Correction: October 30, 2015 Because of an editing error, an earlier version of this article erroneously included one drug among the prescription opioids contributing to 44 deaths each day from overdoses. While OxyContin is a prescription opioid, heroin is not. END 7 8
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