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The scene: It is dusk. The setting is a video game-like depiction of a typical suburban house. In a messy bedroom upstairs, a soccer ball leans against an unmade bed while digitally animated teenagers Chris and Alex hover over a small plastic baggie filled with white powder.
“Chris, are you sure this is OK?” asks Alex, shoving his hands into the pockets of his red hooded sweatshirt. “I mean, pills are one thing, but this is heroin.”
“Relax, man,” replies Chris. Shaggy blond hair and light stubble suggest Chris is the older of the two. “The guy we got this from is cool, and this stuff is really good,” he says. “We don’t have to shoot up. We can just snort it.”
The plot: Alex, a high school student, has been spending a lot of time partying with Chris — and his girlfriend, Kim, is not happy about it. When she confronted him recently about rumors that he’d been using drugs, Alex shrugged off Kim’s concerns by saying, “Yeah, I’ve tried them once or twice, but you know I’d never get into that kind of stuff.”
Kim isn’t the only one who’s noticed a change in her boyfriend’s behavior. Alex’s grades have slipped. He recently got in trouble for slacking at work, and he’s had to borrow money from friends more than once. The casual experimentation with drugs has slowly become a habit, and it’s taking a toll.
Now Chris is pushing him to raise the stakes.
“Wish we could stick with pills, but nobody’s got any these days,” he tells Alex.
“I guess it’s OK if we just snort it,” Alex says.
The scene above is lifted from a new interactive software program being used in the suburbs of Chicago to teach middle school and high school kids about heroin. Chris and Alex are fictional, but Alex’s story is based on the real life of Bill Patrianakos, a high school honor student who grew up in a middle-class suburb outside Chicago and enrolled in a pre-med program his first year of college.
By the time Patrianakos turned 22, he was addicted to heroin.
The now 28-year-old software developer's path from prescription pills to needles is emblematic of a deadly national trend that has captured media attention, prompted federal government action and — for the first time since the early ’90s — turned drug abuse into a presidential campaign talking point.
Democratic candidate Hillary Clinton has been the loudest voice so far. She unexpectedly added measures to fight heroin and other substance abuse to her list of key 2016 campaign issues shortly after announcing her run for president.
Clinton said she was compelled to take on the typically taboo topic after a number of roundtable talks in New Hampshire and Iowa. Voters there revealed widespread concern about addiction and, in particular, heroin’s emergence in these early primary states and beyond.
This week, Clinton unveiled a $10 billion plan to tackle the nation’s drug problem in a variety of ways, including calling on states to beef up teen drug prevention programs, providing greater access to drug treatment, arming more first responders with overdose-stopping drugs, requiring drug abuse recognition training for health care providers and sending more nonviolent drug offenders to treatment instead of jail.
A quiet crisis
Heroin has quietly reemerged over the past decade, wreaking havoc in communities across the United States. According to data from the Substance Abuse and Mental Health Services Administration, 169,000 Americans ages 12 and over tried heroin for the first time in 2013 — more than twice the number of first-time users recorded in 2006.
“This is tearing families apart, but it is below the surface. We aren’t talking about it because it is something that is hard to deal with,” Clinton said on May 18 during a campaign stop in Iowa. “But I’m now convinced I have to talk about it. I have to do everything I can in this campaign to raise it, to end the stigma against talking about it.”
Social stigma and hesitance to talk opening about heroin is a big part of the problem, and has made it difficult to fight the growing trend of abuse. But that is not to say its deadly rise has gone unnoticed.
Over the past few years, an unprecedented spate of fatal overdoses among promising and often privileged young people like Patrianakos in places like Vermont, Indiana and suburban New Jersey have prompted a number of in-depth news reports on “the new face of heroin.”
Other presidential hopefuls have also taken note. Before throwing his hat into the Republican primary ring, New Jersey Gov. Chris Christie had been very vocal about widespread opioid addiction in his state, and he signed a series of new laws this year aimed at blocking the drug’s path of destruction.
This week, Christie released a new campaign ad articulating his belief that “the way to really win the drug war is to treat the addict.” Fellow Republican candidate Carly Fiorina has spoken openly about her stepdaughter’s death at 34 after years of battling drug and alcohol addiction. “Drug addiction shouldn’t be criminalized,” Fiorina told reporters on a conference call shortly after announcing her candidacy back in May. “We need to treat it appropriately.”
Still, the fact that Clinton’s new focus on opioid abuse was prompted not by statistics, but by conversations with voters is an indication of just how grave the situation has become. That an issue previously discussed only in whispers, if at all, came up repeatedly at public meetings with one of the country’s most public figures suggests that the problem’s severity might finally outweigh its stigma.
It might also signal the budding success of efforts to shatter that stigma on the ground in places like the Chicago suburbs, one of the unexpected epicenters of Hurricane Heroin.
The Chicago effect
Historically a national transportation hub, in recent years Chicago has emerged as a major thoroughfare for drugs being smuggled into the U.S. from Mexico. In 2013, Bloomberg reported that according to the Drug Enforcement Administration, “80 percent of the heroin, cocaine, marijuana and methamphetamine — with a street value of $3 billion — that flood the Chicago region each year” comes from Mexico’s Sinaloa Cartel. Before his dramatic arrest in 2014, the Chicago Crime Commission, a crime-tracking group, named Sinaloa’s elusive leader, Joaquín “El Chapo” Guzmán (who pulled off his latest prison escape this summer), “Public Enemy No. 1,” a title held previously only by Al Capone.
Chicago’s South Side has become a reliable source for cheap heroin, attracting not only city dwellers but also suburbanites who are able to get their fix with a quick trip down what the local media dubbed the “heroin highway.” But until recently, the approach to heroin use in the picturesque neighborhoods of the city’s sprawling suburbs has largely been “don’t ask, don’t tell.”
The nonprofit Robert Crown Center for Health Education has provided health education to schools in Chicago’s western suburbs since the 1970s, but its heroin prevention program is less than three years old.
According to the Centers for Disease Control and Prevention (CDC), the rate of heroin-related deaths rose nationwide between 2000 and 2013, but the greatest increase during that time period took place in the Midwest. In 2010, the Chicago area had the most heroin-related hospital visits in the country.
But statistics can only make so much of an impact. Sometimes it can take a tragedy, or several, to get the attention of communities that have never before had to confront the effects of widespread drug abuse.
Heroin got the attention Roger Hruby, a suburban resident, in July 2008 when his 24-year-old grandson Reed died of an overdose. So distraught by what he soon discovered was a problem plaguing many families in his community, Hruby called on the Robert Crown Center to create a drug prevention program focused specifically on heroin — one of the first in the nation — and provided $340,000 to fund it.
“It’s hard to get the public to acknowledge the problem if they think they’re not at risk,” said Katherine Leibforth, the Robert Crown Center’s communications manager. She said the perception in suburban areas has been that “the kids at risk are from poor neighborhoods who aren’t kept busy enough," and that "this kid came from a good family, had an education. He was not a stereotypical heroin user.”
But the truth, Leibforth said, is that he was.
Busting the stereotype ... with a video game?
Statistics show that the geography and demographic of the heroin epidemic — once the scourge of urban black and Hispanic communities — have shifted over the past decade, attracting increasingly younger, whiter and more affluent users.
A March 2015 CDC report found that opioid-related deaths (i.e., deaths caused by heroin and prescription pain relievers in the same drug family, like OxyContin) had nearly tripled between 2010 and 2013.
In 2000, the CDC reported that the nation’s highest rate of heroin-related deaths was among non-Hispanic black people between the ages of 45 and 64. By 2013, the demographic had shifted dramatically to non-Hispanic whites ages 18 to 44.
In an effort to combat persistent stereotypes that mask the real face of the problem, the Robert Crown Center set out to demonstrate just how easily an educated kid from a “good” suburban family could fall under heroin’s spell. That’s when they enlisted recovering addict (and computer programmer) Patrianakos for help.
Like many others, Patrianakos began his swift spiral into opioid addiction with OxyContin. He took his first morphine-like painkiller when he was 19, following his first and only year at Chicago’s Loyola University.
Patrianakos, the one-time honor student, dropped out of the school’s pre-med program after a challenging freshman year, deciding he no longer wanted to become a doctor. He moved back in with his mother in the suburbs and spent many nights driving around smoking weed with friends from high school.
He had long suffered from feelings of anxiety and depression and, up to that point, marijuana had been his drug and self-prescribed treatment of choice. Then a friend brought OxyContin on one of their nightly drives, crushing up 10 milligrams so they could both snort it.
“It was just the best feeling I’d ever had in my life,” Patrianakos said.
He spent the better part of the next four years trying to replicate that feeling. After dedicating a year to OxyContin and not much else, he moved on to heroin and only stopped after he got caught counterfeiting money — a scheme he’d cooked up to fund his costly habit. Lucky for Patrianakos, he evaded a real prison sentence by going to drug court, where he agreed to go to rehab, restart school and get a job.
Patrianakos had been sober for about three years when he first heard about the Robert Crown Center’s new project. He’d spotted a flier at his doctor’s office one day for something called the Heroin Epidemic Relief Organization (HERO), a local support and awareness group started by a pair of suburban Chicago dads who’d both lost their sons to heroin.
Patrianakos had recently started working for himself as a computer programmer, and he called the organization to ask if it wanted help building its website. “They had the most hideous flier I’d ever seen,” he said. He ended up getting invited to speak at a few of their events and met the program’s directors.
Patrianakos agreed to collaborate with the center on a software that would be used in its new heroin prevention program, lending his personal experience to create an interactive timeline of an average teenager’s journey from prescription pills to heroin — and, eventually, overdose — complete with snippets of text messages and social media interactions.
“No one was ever honest about these topics when I was a kid,” Patrianakos said, reflecting on his own drug education and what he wished someone had taught him. “It was always approached with the old-fashioned point of view that all drugs are the same — if you do them, then you die or you become homeless. If you touch a drug, everything bad will happen to you right away.”
No one ever mentioned that “people do drugs because they feel good,” he said. “They just make it seem like this horrible thing, that people who do drugs have something wrong with them, and you don’t want to be like them.”
He said one of the most important things for teenagers to understand about drug use is the gray area: “If you do a drug, you won’t get addicted right away.”
There’s no ‘how-to’ for heroin — and that makes it more dangerous
Though illegal for teens, experimentation with cigarettes, alcohol and marijuana has become so ingrained in mainstream American culture that drinking and smoking are not only widely acknowledged as teenage pastimes, but they are also often glamorized or treated as nostalgic rites of passage.
There is a sort of folklore surrounding those substances. Between older siblings, friends, parents and countless movies, the average American teen has no shortage of resources for knowledge on how to properly take a hit from a bong or smoke a cigarette without coughing.
So rather than simply preaching abstinence — or blindly hoping that their students won’t drink or do drugs — many high schools now assume that they will and, while still pushing a message of prevention, require lessons on what to do if something goes wrong.
But when it comes to heroin, there’s no handed down “how-to” culture. The advice from parents, teachers, friends and siblings is simply, “Don’t do it.”
As the data shows, the abstinence-only approach isn’t really stopping people from using heroin, but is instead forcing them to do it in a vacuum, which Kathleen Kane-Willis, director of the Illinois Consortium on Drug Policy at Roosevelt University in Chicago, said makes it that much more dangerous.
“Most people who use drugs don’t use them every day — until they do,” Kane-Willis said. “If you didn’t grow up in a community that hasn’t seen that [kind of drug use], why would you know that?”
Patrianakos’ own experience reflects this. He recalls that he often felt sick between OxyContin fixes but, completely convinced that he was not addicted, never realized that he was experiencing withdrawal.
When he decided to try heroin, he didn’t know anyone else who used it, let alone anyone who sold it. So, recalling local news reports about the heroin highway, he did what any resourceful millennial would do and turned to Google, typing “Chicago heroin busts” in the search bar.
“I had no idea who was going to be out there. I just saw all the red dots on the police map, and I headed straight for where the most red dots were,” he said. “It kind of is a good idea.”
Patrianakos drove around the South Side of Chicago asking random black men if they knew where to get heroin. One said he didn’t know, another was offended by the question, but the third time was the charm. Patrianakos had found his fix and a new dealer. He took the baggie home to his dad’s house in the suburbs and snorted it alone in his bedroom.
“It’s the best bad idea ever,” he said. “I was a really innovative addict.”
Innovation — and Google — would continue to be Patrianakos’ partners in crime as what he’d promised himself would be a one-time “treat” quickly escalated into a full-blown addiction. The more trips he made to the South Side, the greater his tolerance grew. When snorting eventually became too expensive to sustain, he went online to research what kind of syringes to buy and how to use them.
Kane-Willis points to such isolated, uninformed heroin use as a contributing factor to the large number of overdoses seen in areas where the drug hasn’t historically been popular.
“Whether someone is using heroin in a wealthy suburb or a rural community, there is no one around to teach them the things that longtime drug users learn, like safe injection practices,” she said. “Instead, people who are not addicted are initiating other people, and then they all at some point become addicted.”
Successful prevention, however, doesn’t only require educating would-be users. Even the most involved helicopter parents can be blindsided by heroin — their ignorance about the drug and their inability to recognize its effects turns them into unintentional enablers.
Being part of the solution
Blindsided is exactly how Chelsea Laliberte described her family’s reaction to her 20-year-old brother Alex’s fatal heroin overdose in 2008. Alex had managed to keep his addiction a secret from his parents and sister until the day it killed him. Like Hruby, only after the death of a family member did Laliberte see how deeply heroin had infected the picturesque upper-middle-class suburb where she and Alex grew up. But once Laliberte’s eyes were opened, she couldn’t look away.
“Once I really realized that this problem was so systemic and embedded in our culture, it enraged me,” Laliberte said. “I realized I wasn’t focusing on my work, I just wanted to dive into a Wikipedia black hole of addiction.”
Laliberte, then 23, quit her marketing job in Los Angeles, moved home to Chicago and started working for Kane-Willis. Her parents had started a charity called Live for Lali about a month after Alex’s death but weren’t quite sure what to do with it. They just knew they wanted to help.
Laliberte took the knowledge she gained at Roosevelt and turned Live for Lali into a community center for heroin education and overdose prevention. Now bolstered by a team of 50 volunteers, Live for Lali offers a variety of educational programs for students, parents and school staff that focus on the realities of heroin use as well as how to recognize the signs of drug abuse and overdose prevention.
“You have a lot of ‘keeping up with the Joneses’ in these upper-middle-class suburbs,” Laliberte said. “My own parents would bribe me not to say things about my brother to other people. They didn’t want attention on them, didn’t want people to think they were bad parents.”
Laliberte sees this image-conscious culture coupled with the safety and seclusion of the suburbs and easy access to prescriptions as a deadly combination.
“Risk-taking is a part of being a human,” said Laliberte. “I don’t think those behaviors are any different now than they were for kids in other generations. We just have stronger drugs, and we’re a lot less educated about what’s in them.”
Live for Lali aims to pull back the curtain, replacing stigma and stereotypes with facts and realistic solutions. And while there’s still much work to be done, Laliberte said, she’s amazed by the change she’s already observed in the years since Alex died.
“The first time we started to discuss addiction as a community, no one understood what was happening,” she said. “People are starting to talk about it more like a disease. They’re realizing that this is a common problem. The more we move in that direction, the more we realize this is a human issue and not a moral failing.”
“It’s going to take a very long time,” she continued. “But we want to make a dent in the death toll at least.”
How history can help prevention
In 1998, a National Institutes of Health-funded report found that heroin use among young African-Americans in New York City — a population that had been plagued by the drug since the 1970s — had practically ceased to exist.
At the time, it wasn’t exactly clear why. But 17 years later, researcher Richard Curtis says he now believes African-American New Yorkers didn’t drop heroin as a result of any formal prevention program; they quit the drug after witnessing its deadliest effects firsthand.
“It was seeing their older brothers and sisters, aunts and uncles succumb to AIDS, really, and the violence of the street-level markets,” Curtis, a cultural anthropology professor at New York’s John Jay College of Criminal Justice and one of the lead researchers in the 1998 study, told Yahoo News. “I think it was pretty disturbing to them at that age.”
Curtis has in recent years focused on a strategy of “harm reduction.”
He has helped create a number of harm reduction programs throughout New York City that provide access to sterile syringes, primary and mental health care, legal aid, housing and a variety of other services aimed at improving the quality of life of those impacted by HIV, AIDS and heroin addiction.
The newest of these programs, Community Action for Social Justice, was started in Long Island three years ago. While Curtis said his city-based programs have drawn increasingly more young, white suburbanites over the past 20 years, bringing his operation to their turf hasn’t been easy.
“Harm reduction is a new concept to some of these communities; there is some resistance to talking openly about this problem,” Curtis said. “But it’s at the point where they’ve got to do something because kids are dying. We want to keep them alive long enough to get them into treatment and on the road to better lives.”
Meanwhile, the Robert Crown Center is hoping the computer program it built with Patrianakos will reach the next generation of young people so they are armed with information about heroin well before a harm reduction strategy would be necessary.
Leibforth, the program communications director, said that by the time the program was up and running, people were finally starting to embrace the heroin conversation, from parents to school administrators to the county coroner. The conversation is finally started in the open, and that will be key.
“Nobody wants to be the first to say, ‘We have a major drug problem,’” she said. “Neighborhoods and major school districts don’t want that stigma in their schools, but they’re becoming much more open to it now out of necessity.”
More than 7,000 students, 400 parents and 1,400 school staff members served as guinea pigs for the new program, which was piloted in 11 high schools and middle schools across four Chicago-area counties during the 2012-2013 school year.
Two years later, the Robert Crown Center evaluated the program by surveying the students who had participated: 93 percent reported understanding heroin’s effects on the brain and body, 87 percent said they knew how to avoid heroin use and 90 percent could identify at least three aspects of their lives that would be improved by not using heroin.
“Addiction is expensive,” Leibforth said. “It’s expensive socially, financially, politically. But if you can get prevention first, it's far less painful to families and to humanity.”