The New Face of Heroin

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Today, the waiting list for those seeking treatment in Vermont stands at more than 500, with the wait taking months, not days. In this, the state is far from unique. Addicts in northern Kentucky wait six months for one of the region's few beds, while those in Ohio, New Jersey and Delaware face similar predicaments. The discouragement this roots in one addict spreads to others, and a perception forms among users that help is but an elusive wish. While Shumlin is intent on eliminating waiting lists this year, doing so only begins to address the hurdles. Maintenance drugs like methadone and Suboxone have helped countless addicts find stability and hope, but the substances are controversial. Powerful opiates, they have been stolen and sold on the street as substitutes for heroin, fostering the idea, almost always exaggerated, that clinics are as much havens of drug abuse as they are bastions of sobriety. Last May, when HowardCenter was preparing to open a clinic in South Burlington in the fall, residents held protests resembling those seen outside abortion clinics in Christian-right strongholds: driving around the building, honking nonstop, demanding its closure.

"No one was protesting the cardiologist's office that was here before us, which was filled with drugs just as powerful as the ones we're distributing," says Bob Bick, who oversees substance-abuse services for the HowardCenter clinics. Sitting in the South Burlington clinic's kitchen on an early morning in February, the 250 patients treated daily filtering in despite a blizzard outside, he wears a fleece vest over a white button-down, and speaks in a raspy voice that emphasizes his jaded perspective on the matter. In his 40 years in the treatment business, Bick has grown fatigued by what he believes is a myopic view of the current epidemic. "Since the beginning of time, we have been promoting elixirs with the promise of easing pain," he says. "Turn on the TV, and you're assaulted with ads. Pills to give you an erection. To make restless-leg pain go away. To eliminate headaches, back pain. But when people turn to substances that we don't condone? We stereotype and stigmatize." He knows how he can sound: frustrated, even overzealous. Then again, heroin was first trademarked and introduced to the masses by Bayer, the German pharmaceutical company, and sold as an over-the-counter cough suppressant from 1898 to 1914. "Look, we do good work here," says Bick. "But as long as we keep thinking of addicts as 'those people,' we're not going to make any progress."

Treating addiction is an imperfect science. What works for some fails for others; relapses are part of the process; and compared with the money that goes into the prison system, both private and public, the funds directed toward treatment remain fingernail-thin across the country. In the effort to galvanize public opinion and replace fear with empathy, officials today emphasize that addiction does not discriminate: destroying, and sometimes ending, the lives of everyone from suburban teens to beloved actors. "But what about the people who aren't addicted, but who use functionally?" asks Jill Harris, managing director of strategic initiative at the Drug Policy Alliance. "Are they in less need of compassion? Do we leave them alone? These are important questions that are hard for people to get their heads around." For those seeking treatment, meanwhile, the socioeconomic factors can't be ignored; addiction can affect anyone, but its effects on the less fortunate are generally more damaging. An addict with disposable financial means can afford to use without turning to crime, and when he decides to get clean he can check in to a rehab center for as long as he needs. Users on Medicaid in Vermont who qualify for residential treatment are generally allowed two weeks, and while Shumlin often mentions that he can treat an addict for $136 a week – compared with the $1,138 it costs to care for someone in jail – even those who get past the waiting lists can discover that the outpatient support is less than adequate.

"I had my first dose today – finally," says Mike Maniery, a 31-year-old from Rutland, referring to the 30 milligrams of methadone that a nurse watched him swallow that morning at the new clinic in town. Now it is evening, and as Mike tucks himself into a booth inside a chain restaurant, the symptoms of withdrawal are beginning to take hold: the anxiety and muscle aches that will give way to vicious, flulike symptoms that can last for days. Mike has been using heroin for more than a year, having shot up for the first time on Halloween 2012. Prior to that, he mainly used Percocet, though the crackdowns in prescriptions had caused the price to double, from $20 to $40 a tablet. "I can't really tell you how or why I started," he says. "Boredom, mainly. It's boring as fuck around here, if you haven't noticed." For Mike, who is gay, his sexuality makes the limitations of living in a rural area all the more acute. "You can basically forget about ever finding a serious boyfriend here," he says.

A 2005 graduate of Green Mountain College, Mike owns a marketing consultancy. "But what I am is an addict. What I do is drugs." Wanting help, he called the clinic in Rutland the week it opened last year, but by then it was full, and he was put on a waiting list. When he learned he was accepted last week, he was hopeful, though already he is skeptical. "They want me to get sick tonight," he says, "so they can figure out the proper dosage. But I've been using 30 bags a day, and it's not like anyone's calling me to see how I'm doing."

At the restaurant, Mike's edginess increases. He picks up his phone, puts it back down. It is 12 hours until he is supposed to arrive at the clinic. He picks up his phone again, this time sending a text. "Fuck this," he says, and leaves to meet his dealer. Heroin users like Mike do not talk about the drug in terms of "getting high," but as a way to "get well" – the paradox of a lethal drug being used to stave off feelings associated with death. After he shoots up, the signs of physical illness, so visible before, recede almost instantaneously.

Shortly after witnessing the murder in Massachusetts, in 2012, Eve Rivait entered Serenity House, a rehab clinic in Rutland, and managed to stay clean for a year until relapsing last fall and entering the clinic again. She'd been kicked out of the apartment she was renting and was forced to give up her horse. She had nowhere to go. "That last relapse," she says, "I really lost everything." On her second day of detox, a doctor called her into his office to go over some of the tests all patients have to take upon entering, which is when Eve discovered that she was five weeks pregnant. Eve chose to keep the baby, a decision that has served as a stronger motivation to stay clean than any offered at the clinic. After leaving rehab, she had been promised a bed at the Lund house, in Burlington, a rehab center that serves pregnant women, but when she called she was informed that she needed to be at least 20 weeks pregnant to qualify. Soon Eve was crashing at the only place where she was still welcome – the house of a friend who was still using – but after a couple of weeks she opted for her car, where, as Gov. Shumlin spoke of the heroin crisis spreading throughout the state, Eve fell asleep imagining a different life. "I just want to give this baby a home," she says. "My goal is just to be a normal, boring person."

By March, after three months without a home, Eve has been given a bed at Lund. Still, she would like to find a way out of Vermont. "Once you've seen it the way I have," she says, "it can't go back to the happy place everyone thinks it is." She pulls into a gas station in Burlington, across the street from the promenade overlooking the frozen expanse of Lake Champlain. Shivering as she fills up her car, she is overcome by a bout of sneezing, hardly abnormal, though it catches the eye of a young man in a hooded fleece walking past. Sneezing is a common symptom of heroin withdrawal.

"Hey, baby, you sick?" he asks. "I think I have something that can help you."

This story is from the April 10th, 2014 issue of Rolling Stone.

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