Pubdate: Sun, 07 Apr 2002
Source: Trenton Times, The (NJ)
Copyright: 2002 The Times
Contact:  http://www.njo.com/times/
Details: http://www.mapinc.org/media/458
Author: Donovan Slack
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

HARD TIMES, FALSE DREAMS FOR CITY'S HEROIN ADDICTS TRENTON

At the crack of noon, Charlotte rolls over and scrunches into a fetal 
position, hoping the pain will subside. She would rather stay in the shabby 
suburban motel room and sleep, but the beast in her belly won't be 
silenced. Shivering with cold sweats and aching bones, she pulls on 
yesterday's clothes, lights a cigarette and heads into the city for the 
day's first bag of heroin.

"I just gotta get it in me," she says, out of breath and feeling sicker 
after the hour-long walk from home.

Boo is working his normal corner, just down from city hall. When he sees 
Charlotte, his eyes light up. He knows all the drug fiends after servicing 
their habits and his own for more than 10 years.

"Boo, I'm sick. Can you help me out with one?" Charlotte pleads. "I'll pay 
you back later, yo." He nods and scuttles inside a nearby row house to dip 
into his stash. He emerges and palms Charlotte a small wax-paper bag with a 
polar bear stamped on the front. "40 below" is etched in small blue letters 
under the bear. Charlotte's step quickens to a near run as she makes her 
way down the few short blocks to the "condo," one of about 2,000 vacant 
houses in Trenton. She pulls back the board propped against the front door 
and steps inside. "Yo, that's the bomb," she exclaims, snorting the 
ash-brown powder through a plastic tube she salvaged from an old pen. She 
rips open the bag to get to the last granules, then throws it on the floor 
into a heap of broken beer bottles, used syringes and other trash that 
clutters what used to be a living room.

Charlotte springs to life. "I gotta do something," she says, stepping out 
into the crisp March air. "I can't do this anymore. My body isn't up to 
it." Charlotte is 38 years old but looks closer to 50. Her skin is a pallid 
white, and her shoulder-length brownish hair has thinned to wispy tufts 
that she smooths back from her face. A pink and white jacket hangs on her 
tiny 5-foot-2 frame.

She's been a crack addict for 19 years and a heroin addict for six. Yet she 
is quick to laugh, and there is an unmistakable smile in her glassy brown 
eyes. Every day she battles the beast, and every day she says she has to do 
something to get clean.

"I can't kick on my own, and there ain't nothin' in Trenton," she explains. 
"Word on the street is there's a two-month waiting list for detox, and even 
then, you're lucky if you get in." The word on the street is dead-on.

Thousands of addicts in Mercer County - between 1,300 and 3,300, the state 
says - have to wait weeks or even months before they can get detox 
treatment. In the meantime, they have to keep using to stave off the pain 
of withdrawal.

In the past five years, every detox facility serving impoverished and 
uninsured addicts in Mercer County has closed. The county Department of 
Human Services now distributes funding for 265 bed days, according to 
Sylvia Mulraney, department director and chief of addiction services. With 
typical stays lasting three to five days, that means between 53 and 88 
addicts can get a county-funded detox slot each year. Another 20 to 30 
indigent users get detoxed each year, but only because some providers are 
willing to barter for insured Mercer addicts.

Still, the number served doesn't come close to meeting the need.

Victor Lopez works as a project manager in a small gray office at the 
Trenton Treatment Center on East State Street. From 9 a.m. to 3 p.m., 
Monday through Friday, he screens and refers indigent addicts to available 
treatment. "I had two people in here crying with their bags packed 
yesterday," he says matter-of-factly. "There were no beds. I had nowhere to 
send them."

The addicts had no money and no insurance. He told them they would have to 
wait until a bed opened up in three weeks at Maryville Inc., a residential 
treatment center in Williamstown, Gloucester County. "If you've got 
insurance, you've got it made," he says. "If you don't, they don't want to 
talk to you." Two of every three addicts need treatment that is far more 
extensive than a brief detox to kick their habit, experts say. They need 
continuous inpatient or outpatient care for weeks, months or even a year. 
Lopez says he expects this year's public funding for detox beds will dry up 
before summer.

"Right now we have to tell people to just hang in there until a spot opens 
up," Lopez says. "In two months, I'll be telling people to go cold turkey 
because there's no money."

A brisk wind whips an empty Cheese Doodles bag down the sidewalk and past 
the stoop where Charlotte sits briefly, waiting for her regular clients to 
drive by. She took up prostituting last year to pay for her heroin needs - 
plus a little crack cocaine to top off the high. She says she learned the 
craft by watching "the girls" on Greenwood Avenue.

Charlotte's ex-husband used to give her money, but he doesn't support her 
habit anymore. He does support her two teenage children in his North Jersey 
home. She left them six years ago when heroin consumed her life. "It was 
just too much," she says, scanning the passing cars on Genesee Street. "I 
didn't want my kids to see me how I was." A middle-aged man driving a green 
minivan slows and pulls over to the curb. "You all right?" the driver calls 
out. "Need a ride?" Charlotte runs over, leans in the passenger window for 
a few seconds, then returns to the stoop. Within 15 minutes, the scenario 
repeats two more times with different drivers.

"Got a cigarette?" says the third one. Then, the magic words: "How much?" 
After a brief negotiation, Charlotte jumps in the gold Honda and disappears 
around the corner, returning after about 20 minutes. "I charge $25 for 
(oral sex) yo, but people who don't know how to negotiate pay $40," she 
says. The Honda driver didn't know how to negotiate. Charlotte fingers the 
two crisp 20s as she makes the trek to Walnut Avenue to cop some crack.

She makes a quick stop at a neighborhood store, where she asks for the 
crack-smokers' special: "Hey pops, can I get a flower, some Chore Boy and a 
lighter?" She pays $3 and receives a crack pipe, a lighter and a piece of 
copper mesh to use as a pipe screen.

Vendors skirt drug paraphernalia laws by packaging the glass tubes with 
small, artificial flowers and billing them as novelty items for loved ones. 
The Chore Boy copper mesh is a household cleaning product. Charlotte says 
she spends between $70 and $100 every day on drugs - usually buying six 
bags of heroin, which cost between $10 and $15 apiece, and four $5 "nickel 
bags" of crack.

It's about 3:30 p.m. when she makes the day's first crack deal at Walnut 
Avenue and Chestnut Street. Then she heads for the Trenton Train Station, 
where a stall in the women's restroom provides the necessary privacy for 
crack smoking.

She emerges 10 minutes later with wings on her feet and a glint in her eye. 
But the beast in her stomach is growling again, so she hikes down to Bridge 
Street to pick up another heroin blast before catching the after-work 
customers back on Genesee Street.

When she reaches Centre Street, she runs into Blackie, who's also trying to 
cop some dope.

"Shop's closed here," says the athletic-looking woman, emerging from an 
apartment building known as the "projects." "What's wrong with you?" 
Charlotte exclaims. "I ain't never seen you looking like this." "I know," 
Blackie replies. "My old man keeps telling me to get off the (stuff). It 
ain't that easy." The two women find another heroin "shop" down the way 
where someone's selling "Scorpion" for $10 a bag.

Heroin, trick, crack, heroin, trick, crack. Stockton, Genesee, Walnut, 
Bridge, Genesee, Walnut, Stockton. Like hundreds of Trenton addicts, 
Charlotte spends all day, every day, going in circles like a trapped 
hamster running in a wheel and never getting anywhere.

Geetha Arulmohan smiles as she looks out her window at a parking lot filled 
with state workers' cars.

"I used to work with lepers in India. Now I work with untouchables here," 
she says. "When I tell people I work in Trenton detox, they say, 'Can't you 
get out of it?' " Arulmohan began working at the Trenton Treatment Center 
in 1998, two years after she finished school at the Princeton Theological 
Seminary and four years after moving to the United States.

The treatment center boasted one of Trenton's few detox facilities until it 
was shut down in 1997 for building code violations. The decrepit former 
motel at 541 E. State St. now houses only a referral service and a 
partial-care intensive outpatient program.

"They said they will give us the detox in a new location eventually," says 
Arulmohan, now the director of United Progress Inc., the nonprofit company 
that runs the treatment center. "The detox part never worked out. In place 
of a detox, they are giving me a transitional house." The new Escher Street 
facility, which will offer Trenton Treatment Center's intensive outpatient 
addiction services by day and transitional housing by night, is scheduled 
to open this month.

"I come from a country where there was no money but lots of motivation for 
change," Arulmohan says. "Here there are lots of resources but no 
motivation." Area hospitals stopped offering detox services a few years 
ago. Jon Nelson, mental health director for Capital Health System at Fuld, 
says the state changed the reimbursement levels for detox services, and 
hospitals could no longer afford to offer the treatment to those unable to 
pay for it. "Detox is a very scary medical condition," Nelson says. "The 
government just doesn't recognize the whole package. They only give you a 
quarter for a dollar's worth of services." Addicts who go to emergency 
rooms seeking recovery help but are unable to pay for it are referred to 
agencies such as the Trenton Treatment Center, which compete for the 
elusive publicly funded slots. While addicts wait the days, weeks and 
months necessary to secure a slot, life on the streets continues.

"A heroin addict cannot go without for one day," Arulmohan says. "I can't 
tell them 'don't use.' The withdrawal will be so bad." As a result, the 
junkies keep spinning the wheel, running from the beast and chasing the high.

Charlotte is one of 15 children born to a couple in North Jersey. Her 
father worked as a minister. Her mother suffered from mental illness and 
was hospitalized for much of Charlotte's youth.

Charlotte struggled to find her individuality among the brood. After 
graduating from high school, she found a way to stand out from her siblings 
while fitting in with her peers.

She began drinking and partying on weekends and eventually tried cocaine at 
the age of 19.

"I think I snorted three lines, then I went straight to smoking," she says 
of her crack habit. In her 20s, Charlotte married and gave birth to two 
children - all while drugging most of her nights away. "I wasn't a crack 
addict," she says. "I was a rock star." That's how the cocaine made her 
feel, until her husband drew the line. She quit doing drugs for nine months 
at his insistence but fell back one night, smoking crack with a friend. As 
she was driving home at dawn, she told her friend she couldn't go straight 
home because she was too wired. "My husband would have known, yo," she 
says. The friend handed her a bag of powder and said to snort it, it would 
even out her high. "It felt like I had smoked a whole ounce of pot at one 
time," she gushes. "The high was so good, I called him up the next day and 
asked him if he had any more." He did. After a three-day binge, she says 
she found out it was heroin and stopped doing it immediately. She 
experienced mild flu-like withdrawal symptoms. "I'm thinking, 'Is this 
it?,' " she says. " 'Well, this is nothing, yo. I can do it when I want to 
and kick it, no problem.' " She snorted heroin every day for the next year 
before realizing she had to do four bags a day "just to feel right." Heroin 
attaches itself to receptors in the brain, causing dopamine levels to 
skyrocket and triggering feelings of intense pleasure. But over time, users 
build up tolerance, and if addicts don't use enough or stop using the drug 
completely, withdrawal begins.

Charlotte wakes up every morning with severe abdominal cramps and dripping 
with sweat. Then the pain crawls down her legs.

"That's why they call it kicking," she explains. "Last time I tried to 
kick, I wanted to cut off my legs, it hurt so bad." Promising new drugs 
such as buprenorphine (Buprenex), which minimize the pain, are offered at 
detox centers.

With the death of Charlotte's mother last September, her father, now 85, 
moved to the area and began ministering at a local church. He thinks his 
daughter is living straight, and this spring, for the first time in a long 
time, she really wants to be.

Indigent fiends haunt the streets of Trenton and Mercer County, unable to 
find detox treatment, but the situation statewide is equally grim. The 
major conclusion of a study released in August last year put government on 
notice. "Persons who are medically indigent have significant problems 
accessing any type of substance abuse treatment in New Jersey, especially 
detoxification and residential care when they are incapacitated," concluded 
the New Jersey Substance Abuse Prevention & Treatment Advisory Task Force 
in a report to the state Department of Health and Senior Services. The 
governor's office released a statement with the report, recognizing that 
fewer than half of those who want treatment in New Jersey are able to find 
it. About 71,000 people are unable to get care because of limited treatment 
capacity, the statement said. Still, the office of acting Gov. Donald T. Di 
Francesco said the annual allotment of $48,000 given to each county - $1 
million total - would remain the same. The McGreevey administration has not 
increased detox funding either, according to Dennis McGowan, spokesman for 
the state Department of Health and Senior Services. The National Center on 
Addiction and Substance Abuse concluded New Jersey spends $6.17 per capita 
on prevention, treatment and research, while the national average is $11.09.

Mulraney, the chief of addiction services in Mercer County, paints a bleak 
picture of what that spending gap means at the local level. "We obviously 
know that we need more detox beds," Mulraney says. "When we talk about 
services for indigent care, there are so many agencies pulling on the same 
pot of money. What is available is available. We know we don't have what we 
need." Trenton city officials, who with city funding intended to include 
detox beds at the new Escher Street facility, dropped the idea after 
realizing the cost would be prohibitive.

"It seemed like an unreasonable amount to expect," says April Aaronson, 
director of the city Department of Health and Human Services. "Medical 
detox is an incredibly intensive level of care in a hospital setting. We're 
going to concentrate on developing a number of intensive outpatient 
programs in the city." Aaronson considers drug abuse the premier issue 
facing the city of Trenton but said the city does not want to duplicate 
what the county is doing, funding more detox beds in other counties.

"It's not a perfect world," she says. "We feed into the system where we can."

After snorting a bag to subdue the morning beast, Charlotte sits in a 
rundown chair at the Trenton Treatment Center, smoking nervously and 
waiting for an intake counselor.

At 3:15 p.m., 30 minutes after her arrival, Victor Lopez comes bounding 
down the stairs and introduces himself. He apologizes for the wait. He was 
talking on the phone to another hopeful addict who wanted detox. His 
button-down shirt and dress slacks seem out of place in the battered lobby, 
which is starkly furnished with two chairs and a rickety, unoccupied front 
desk.

He leads Charlotte into a small office off the lobby and begins assessing 
her drug habits and her lifestyle. But first, a caveat: "I have to tell 
you, the chances of finding you a detox bed today are almost impossible," 
he says, "but I'll do what I can." With a sarcastic, "I-told-you-so" look, 
Charlotte tells Lopez she may not want to quit in a few weeks time. "I 
can't wait that long, yo." "You're preaching to the choir," he retorts. 
"The detox centers in Mercer County have closed down so I need to try and 
find you a bed elsewhere. There's only so many charity beds. Let's see what 
we can do." Then, the questions begin: Do you have insurance? No. What's 
your drug of choice? Heroin. How much? Three to five bags a day. How often? 
Every day. Who's the president of the United States? Bush. Have you had 
treatment before? I've kicked six times before. When did you last use? 
Three hours ago. "You're not appropriate for our program here because you 
need detox first," he concludes. "Let's go upstairs and make a phone call." 
Charlotte begins to cry, partly because of the life splayed open by his 
questions, and partly because she feels the earth-shattering fear of a life 
she has never known. If he finds her a detox bed for five days, then the 
quest starts for the additional drug treatment services Charlotte will 
need. After detox, she will need a two-week inpatient program and after 
that a 28-day residential stay and finally, six months of outpatient care - 
if she gets that far. The scenario presents an overwhelming number of 
chances for both her and the system to fail miserably. Most daunting at 
this moment, though, is the prospect of a showdown with the beast - an 
all-out fight to the death.

After almost an hour of trying one number, then another and another, Lopez 
puts down the phone triumphantly.

"You've got a bed!" he proclaims. "That never, ever happens. Maryville has 
an opening today, but you have to get there by 7." "I'm going to go for it, 
yo," Charlotte says, biting what's left of her thumbnail to the quick.

But Williamstown is at least an hour drive. It's 5 p.m. and the treatment 
center driver left for his other job an hour ago.

She says goodbye to Lopez, pledging to find a way to get to Maryville. 
Instead, she ends up running the streets, drugging hard, trying to numb the 
strange sensation of coming close but not close enough. At 6:30 the next 
morning she returns, high as a kite, to the small hotel room she calls 
home. She pulls a small bag from her pocket, loads up her flower and draws 
deeply on the crack stem.

She probably will never know Maryville held that bed for two days. "My 
daddy's coming home from his mission tomorrow," she says to the man who 
pays rent on her room. "I miss him. He'll give me money. Then I can get 
some Buprenex in Newark and try and kick here at home." Unfortunately, just 
another pipe dream.
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MAP posted-by: Terry Liittschwager