A Film About The Return of Heroin.

Show: FRESH AIR
Date: APRIL 13, 1999
Time: 12:00
Tran: 041301np.217
Type: FEATURE
Head: Steven Okazaki
Sect: News; Domestic
Time: 12:06

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

Heroin has made quite a comeback, and in some cities like San Francisco the teenage population is particularly hard hit. One of the reasons for this epidemic is black tar, a potent and cheap type of heroin.

My guest Steven Okazaki has directed a new documentary about five teenaged addicts in San Francisco. The movie follows them over a period of two years. It premieres on HBO tomorrow night. Two of Okazaki's earlier films are about the Japanese-American internment camps during World War II. He won an Academy Award and a Peabody for one of those films, "Days of Waiting."

He also directed the feature film "Living on Tokyo Time." Steven Okazaki told me that before he made his new documentary, "Black Tar Heroin," he spent several months helping out a needle exchange program where he established a relationship with the teenagers who became the subjects of his film.

STEVEN OKAZAKI, FILMMAKER, "BLACK TAR HEROIN: THE DARK END OF THE STREET": There was one of the kids who's in the film, Jessica, was sitting -- sitting on the ground reading "One Flew Over the Cuckoo's Nest," and these other kids came up and said "what are you reading?" And they started having these literary conversations.

One said you should William Burroughs; someone else said you should read Arthur Rimbaud, he's a good heroin poet. And I just got very interested in the group of kids, and they were -- I don't know, there was something about them that reminded me of being in grammar school where a new kid would come in the class and everyone was sort of interested in them and you'd sort of become friends. But then the next semester came and they were gone and you just didn't know what happened to them.

And these kids were interesting that way. They were very bright. They sort of subscribed to the romanticism of the drug. And at least in the beginning they were fun to talk to, fun to hang around. As filming went on for two years it became more and more difficult.

GROSS: One of the young women in your movie, Tracy (ph), gets arrested and she's sent to prison and serves six months of, I think, a nine month sentence.

OKAZAKI: Mmm-hmm.

GROSS: She's released after six months and she talks to you as soon as she gets out of jail and says she wants to go back to school, she wants to have kids and she can't do any of this if she's back on junk. So she insists that she's going to never, you know, touch heroin again because she got clean while she was in prison.

And within eight hours she's shooting up again. What happened?

OKAZAKI: Well, I think two things happened. I think, one, once she was out of jail she -- we see her sort of when she gets out of jail she wants to buy some new clothes. She goes and buys new tennis shoes and gets a T-shirt, and then she goes to her hotel. And then we're sitting in her hotel with her and she just got bored and, you know, after just 20 minutes and wanted to go out on the street and see her friends.

And her friends are all users, and she just sort of fell into it again. And it was also compounded by -- she was released on a Friday, and on Monday she was supposed to see her parole officer. But when she got out she called the parole officer and she was supposed to go in for a urine test. And she knew that if she used drugs it would show up on the urine test.

But she called the parole officer on Friday and he said, "you know, you sound really good. Don't bother coming in on Monday. We'll just talk on the phone." And so it sort of gave her license to go and use the drugs.

I mean, I think, again, it's sort of an example of how the bureaucracies just, you know, don't help at all and in fact compound it.

GROSS: It must have been very difficult for you as the filmmaker to watch her go back on drugs after having given them up. And I'm wondering even if you tried to like talk her out of it. If you felt that you were in the position to intervene at all, or whether that was inappropriate.

OKAZAKI: Well, I think that when we were doing the film we sort of, you know, we didn't make bargains with kids. We tried to make sure they wanted to be in the film, and at the same time our, you know, we sort of had to make a bargain with ourselves not to just film their lives.

Of course we always said to the kids if you want to go into rehab we'll help you, you know, we'll get you down there; we'll find a list of places to go. In one case we bought an alarm clock because Jessica said she couldn't get up in time to go down to rehab for the first meeting.

And so, because we were trying to be objective observers we could not, you know, take them or force them to do -- to go to the rehab. I mean, regularly --I mean, the sad thing is people are always saying tomorrow, you know, I'm going to get ready to quit and I'm going to be ready to quit in a week. And we would always sort of anticipate that and it would never happen.

GROSS: The young people whose stories you follow in your documentary shoot something called "black tar." What is it?

OKAZAKI: Well, black tar heroin is kind of what crack is to cocaine. It's sort of a cheap sort of refined alternative to what the white powder heroin that people are used to seeing in movies. It's kind of -- the heroin market in California and the West Coast has completely been taken over by black tar heroin, which is grown and refined in Mexico.

And brought up in -- well, smuggled up. And it's -- while we were making the film black tar heroin just completely took over and I think crack use and other use started to slip away and heroin is really the sort of drug of choice among young white kids in San Francisco and up and down the coast.

And it's -- the appeal is it's very cheap. The average user uses about three or four times a day, and each hit costs about $15. So they need only raise $45 to $60 a day, and most of them are able to do that. It's a struggle, but it's much easier to maintain that habit.

You get high and you stay high for 6 to 8 hours as opposed to crack, which you want another hit in 20 minutes.

GROSS: How does a black tar high compare to heroin?

OKAZAKI: The black tar heroin is perhaps as much as 10 times more potent than the powder heroin that people were using 10 years ago.

GROSS: So it's cheaper and more potent.

OKAZAKI: It's cheaper, more potent, way more abundant. And in San Francisco you see kids as - when we were out there - and now there are kids as young as 13 and 14, boys and girls turning to prostitution. And there seems to be not a lot of interest from the law enforcement to regularly bust them.

Particularly when they're, you know, even underage prostitutes work fairly freely in San Francisco.

GROSS: And they're -- a lot of them, you're saying, are working to get money for the black tar.

OKAZAKI: Yes. Prostitution tends to be the easiest, most efficient way of getting enough money quickly.

GROSS: A couple of the young people who you follow in your movie turn to prostitution, and these are people who do it in part because they don't want to steal.

OKAZAKI: Mmm-hmm. Well, I think -- I think Jake in the film had a sort of moral stand that he would not steal from people. And so instead -- I mean, I think, it's typical with, you know, the kids we hung out with. They might commit crimes like breaking into cars and stealing CDs and things like that, but they were not violent and their crimes are all -- they don't hurt other people. They hurt themselves.

GROSS: Why don't we hear one of the young people in your film, Jake, talking about why he's turned to hustling.

(BEGIN AUDIO CLIP -- SCENE FROM THE HBO DOCUMENTARY "BLACK TAR HEROIN")

JAKE, YOUNG BLACK TAR HEROIN USER: That seems to be the only thing that I'm any good at as far as making money. I'm not any good at breaking into cars, or I have too much of a conscience, you know, to rob innocent people. I've been raped four times in my life of prostituting, and it's really hard.

I don't like it. I mean, it's very degrading, you know. And the people that pick me up they do -- they try to make you feel -- I mean, they try to degrade you as much as possible. I mean, they get off on that, you know. They get off on making you feel like it piece of meat.

GROSS: That's an excerpt of the new documentary "Black Tar Heroin: Dark End of the Street," directed by my guest Steven Okazaki.

Steven, there's someone else in your movie named Jessica who turns to prostitution to raise money for drugs.

OKAZAKI: Well, I think that in Jessica's case she was sexually molested from age 5 to 11 by a relative. And I, you know, I think she, throughout her life, has gotten used to sexual abuse and in being used sexually. You know, I think their main interest every morning when they get up is getting their heroin and prostitution is just an efficient way of doing it.

I think if they can get around it, they do. You know, Jake said sometimes he would just try to breakdown and cry and maybe the john would just give him money anyway. And Jessica, I think, has turned to ripping off her tricks; as soon as they give her the money jumping out of the car and things like that.

GROSS: Mmm-hmm. You know, at the beginning of your movie there's something almost loving and almost sexual about the way these young people are shooting themselves up, you know, and they seem to be very tenderly holding the needle, and it seems almost stylish the way it was shot.

By the end people are searching desperately for veins and their bodies are just kind of getting ruined. They're totally bruised and marked with needle marks. You know, their veins are just gone.

What was that like for you to see how their bodies changed over the course of the two years that you made your movie?

OKAZAKI: Well, I think that the kids in the film initially, I think, they liked the ritual of the needle. I mean, there's all this preparation that goes with it. You get to melt it down with a lighter and they get very into the paraphernalia that goes with it.

GROSS: I can't help but thinking too that you've seen this in movies; you've seen movie stars doing this in movies. You've seen - you've read about really hip bohemian people doing it in literature; now you're doing it yourself.

OKAZAKI: Well, I think -- I think they fall in love with the imagery, fall in love with the ritual of preparing the dope and shooting it up. And then -- one thing about black tar heroin it breaks your veins down very quickly so within two years they're struggling -- their veins have collapsed.

They're shooting up in any part of their body. And in the end many of them are just jabbing it into their muscles, which causes a lot of medical problems: abscesses and various other things. I think the most desperate moment that we filmed was when Jake had some blood clotting problems because his veins were such a mess.

He had, I think, injected and infected himself. So he went into the hospital and they found a vein that they could fit him with an IV and he - a sort of light bulb went off in his head that he could use that IV to inject his drugs. So he sneaks out of the hospital, and for about a week he kept the IV sort of clean. He would rinse it out and he just shot his drugs into the IV.

And when that clogged up he readmitted himself to the hospital. He had been told by the doctor that if he didn't stay in the hospital he could lose -- he could lose his arm or possibly die. And he stayed in there a couple of days, and again snuck out -- used the IV to shoot up.

And he eventually he's had -- he did not deal with the problem. And he eventually had a couple of fingers amputated and I think they want to amputate his hand now.

GROSS: I was wondering if he was still love because I just had a feeling he wasn't going to last very long by the time the movie was over.

OKAZAKI: Well, I think it's -- I constantly felt like this kid has just a couple of month's left. And then he would bounce back a little. I think, you know, I'm 46 years old and if, you know, if I just ate the Twinkies and other sugar products and slept as little as they do I'd be a mess.

But they're, you know, Jessica's -- the youngest in the group - is 18 and their bodies take a tremendous amount of abuse. It's rather shocking how -- terrible shape they can be in and still walk around. But they're young.

I think when you see older addicts that can barely move, that just collect their welfare, trade-in their food stamps, get their dope and just stay in their rooms. I think that's when you realize it does kill you, but a young body can fight off an awful lot.

GROSS: My guest is Steven Okazaki. His new documentary, "Black Tar Heroin: Dark End of the Street," premieres tomorrow night on HBO. We'll talk more after a break.

This is FRESH AIR.

BREAK

GROSS: My guest is Steven Okazaki. We're talking about his new documentary, "Black Tar Heroin: Dark End of the Street."

Steven, where did the young people who you made your movie about get their drugs?

OKAZAKI: The drugs are plentiful, you know, there are a couple of different street corners in San Francisco that you can go to. And the drugs start -- the dealers come out from the suburbs; they're usually Mexicans who if they're arrested are just deported.

And they're out there at 6 a.m., and the drug addicts get up early and get their first hit. And when we would -- that's when you see the -- you know, how many different kinds of people take drugs when you see the, you know, as well as the kids in our film we'd sit there and watch the business people with their briefcase come up and pick up their heroin as well.

The biggest day though I think for the addicts is the first of the month. They call it "Mother's Day;" when everyone gets their welfare checks and food stamps and trades them in for dope. And that's rather startling how much drugs come into the city around the first of the month.

Towards the end of the month it gets very desperate, and people start if there's not enough heroin they start mixing their drugs -- taking speed, mixing their heroin with cocaine. There is still a fair amount of mixing -- if you, you know, each neighborhood has a sort of specialty.

If you go to this neighborhood you get this kind of dope. You go to another neighborhood it's cheaper. You go to another neighborhood it's mixed with cocaine. But it's so frighteningly easy to get in San Francisco.

GROSS: Your film is about teenagers who are using heroin. Is the teenage heroin culture, do you think, different from the subculture of older heroin addicts? Is it a separate world and do you think the culture is much different from, you know, heroin?

OKAZAKI: Well, I think that the young people using heroin in San Francisco split off into little scenes. There's a sort of the, you know, the Goth heroin addicts, the punk rocker heroin addicts, and the William Burroughs heroin addicts. And, you know, I think there's a bit of, you know, there is, you know, it is sort of the trendy drug of choice right now for a lot of young people.

And in that way it's -- I suppose it's different than the older population. But, you know, there are, you know, I think the one really sad similarity is -- I -- for a few days I hung out with older addicts and they'd say the same thing.

They'd say I think I'm getting ready to quit. I've just got to get my stuff together and I'm about ready to quit. And in that way they were exactly like the young kids who were always just about ready to quit.

GROSS: Right. What was the difference between the Goth, the punk and the William Burroughs heroin addicts?

OKAZAKI: Well, the punk rocker -- the punks seem to mix alcohol with their heroin, which a lot of heroin addicts that I know didn't like alcohol. And they hung out more in the Haight Ashbury scene. And there are several heroin scenes in San Francisco.

There's a scene in the Mission District that's very violent and sort of crosses over a crack scene. And we followed the, you know, the sort of intellectual William Burroughs heroin addicts who roamed between the Tenderloin District and the Polk Street area in San Francisco. And they don't mix that often.

A few people -- one of the characters in the film, Jessica, moves freely between the three groups. But she's very tough and she could handle herself in most situations.

GROSS: I know that there's a lot of, you know, romance about drugs in our culture including heroin, but on the other hand heroin is so obviously a frightening drug. I mean, you know that people get addicted to heroin, everybody knows that.

And I think most people have some sense of what heroin does to the body. And so, you have to ask yourself why does someone start? Unless they're totally ignorant, why would they mess around in the first place with a drug like heroin? And I'm wondering if you got a sense of that from the people who you documented. What were they thinking when they started?

OKAZAKI: I think there were a lot of initially -- when you talk to kids initially they -- there's a lot of superficial reasons: because they thought it was cool because they read a book about -- or they read a book by William Burroughs that was in a rock song.

But, you know, I think -- sitting there watching them I really begin to feel -- not having done any studies on it -- I feel that 90, 95 percent of the kids are out there because there's something inside of them that won't be quieted any other way except by taking heroin. There's a pain in them -- usually from parental neglect, sexual and physical abuse.

And, you know, the film notes, you know, a couple of really extreme cases. But I think it can happen in any family. And I think, you know, that's -- I think it's the thing that everyone ignores. Everyone talks about funding more police or funding rehab, but I think to me it's really about paying attention to child abuse and sexual abuse and parental neglect as really important issues in this country.

And building more prisons and putting more police on the street don't address it in any way.

GROSS: Steven Okazaki's new documentary "Black Tar Heroin: Dark End of the Street" premieres tomorrow night on HBO. We'll talk more in the second half of the show.

I'm Terry Gross and this is FRESH AIR.

BREAK

GROSS: This is FRESH AIR. I'm Terry Gross.

Back with filmmaker Steven Okazaki. We're talking about his new documentary, "Black Tar Heroin: Dark End of the Street." The film follows five teenaged heroin addicts in San Francisco over the course of two years. The film premieres tomorrow night on HBO.

This film certainly made me think about something that I of course already knew, but it still made me think about it a lot; was how difficult it is to give up an addiction. I mean, there were so many reasons for each of these young people to stop, and it was so hard for each of them to say no. And most of them didn't even bother to try. I mean, most of them don't even try to kick in the film.

OKAZAKI: Well, I think that -- I think once you've started physically kicking I think is not as hard as doing it emotionally. I think that as a heroin addict most, you know, if you've been doing it for several years you've probably destroyed pretty much everything in your past life: your relationships to your family, to your friends, your job opportunities and things like that.

The hard thing is you've seen these -- most often I'd see kids kick and they just didn't have anything to replace the drug and that's why they go back to it. I think you sort of obliterate everything around you, turn everyone against you. And I think that's what makes it hard is what do you replace it with.

You need to have a life. You need to have people that care about you that aren't addicts around you supporting you. And Tracy, I think, has found that recently. She has gotten involved in an organization of ex-prostitutes and drug addicts, and so they know what she's been through. They know how to support that.

But I think most people don't have that. Most people - and these kids have really difficult relationships with their parents, and I don't think they can get well without some support from their parents or from, you know, someone like their parents.

GROSS: In the first part of the interview the young people seem to be almost showing off, and I thought there was even an element of like heroin chic. And they seem to just -- it seems almost like a fashion statement the way they shoot up and everything.

By the end of the movie they seem so consumed by their habit and so desperate and so just used up. There's one young man in particular whose story I just found particularly troubling because he seems so bright early on, and just so articulate.

And by the end he's very sick. He has AIDS. He's living on the street. He's one of those people who you see around -- walking around alleys talking to themselves, and you're wondering how do they get into this predicament. And your movie kind of answers that question.

I'm wondering what it was like for you to watch the descent of these young people.

OKAZAKI: Well, I think, you know, initially we picked these five kids because they were excited about being in the film and they were all very articulate. And particularly Jake, the kid you're talking about, is one of the most brilliant kids I've ever met.

And they were, you know, initially all sort of caught up in the coolness of being a drug addict. There's a sort of supportive scene around them. There's a sort of music scene around them that, you know, a lot of them were interested in. And there are different cliques, and they can always compare notes about how they got their drugs and stuff.

And there's a lot of dope talk. A lot of them get into the ritual of preparing the dope, and fixing and then nodding out -- get into a little ritual.

Some of them are so into the rituals -- like Alice, who is in the film would -- if she didn't have drugs she would shoot up beer because she likes the needle so much. She, I think, sort of associated the pain of the needle with watching her -- watching her sister get beaten up when she was a kid.

But, you know, initially, most of the kids liked the -- liked the romance of the drug and -- but, you know, the startling thing in the film is at the end of two years they are all hard-core drug addicts. They look and talk -- they're not kids anymore. They look and talk like adults who have one thing on their mind at all times, and that's getting their heroin.

And that sort of tragic flaw was really difficult to watch. You wanted - when we were finished filming for the day we would always ask them, you know, what do you want to do? Is there something, you know, we can do to turn this around? And the kids were not interested in that. And by, you know, by the end of the film they, you know, they seemed to be incapable of finding a way out.

GROSS: I was wondering if the young people in the film watched the film after it was completed, and what their reaction was to watching their earlier selves when they were healthier, when they spoke more clearly, when they weren't as desperate.

You know, earlier into their habit, because several of them just kind of had slipped so badly during the period it took you to make the movie.

OKAZAKI: There are five kids in the film and we've only shown it to one of them.

GROSS: Why?

OKAZAKI: Well, we've tried to -- four of them -- the other four are in such bad shape, I mean, they're in unimaginably bad shape at the end of the film, but they're even worse now. And I -- we are right now trying to find a couple of them that we haven't been in contact for a while.

But I'm really afraid, you know, I'd like to see them in slightly better shape before they watch the film. Tracy, who's in the film, is actually clean right now. And she watched the film and was just astounded. She did not believe that was her in the film.

She's, you know, she is healthy right now. She's clean. And I think she was just speechless after watching it. She said I know that's me, but it's hard to believe. But it's - I'm really worried.

I mean, the kids are in such vulnerable conditions. Two of them are suicidal. And if, you know, we're sitting down and talking to them right now and maybe trying to set up situations where they can watch the film, but I don't think we'll do it without perhaps a social worker or a therapist there with them.

GROSS: After having made a documentary about a few young people who have become heroin addicts, what's it like now when you're just walking the street and you see young people who you assume are heroin addicts because of how they look and how they're behaving; and they seem kind of desperate and they seem really strung out? What do you think about when you see them that's different from what you used to think?

OKAZAKI: Well, I think filming on the street for two, three years you actually can see the street now. And now I can -- I think before I did the film you'd drive down or walk down the street and you cannot see what's going on. Now I walk down the street and I can see the little petty crimes going on, people stealing dollars out of parking machines and things like that. And you can see the drugs moving around because you know what you're looking at.

Regularly you will see these new -- these new potential hard-core drug addicts from the suburbs, you know, and it's -- you want to stop and pull them aside and send them home. But, you know, it's -- it's -- it feels so hopeless. It feels really hopeless in San Francisco.

The drug scene seems to just be thriving.

GROSS: Well, I want to thank you very much for talking with us about your movie.

OKAZAKI: Thank you, Terry.

GROSS: Steven Okazaki's new documentary, "Black Tar Heroin: Dark End of the Street," premieres on HBO tomorrow night and will also be shown April 19th, 23rd, 27th and 29th.

This is FRESH AIR.

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TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 877-21FRESH
Dateline: Terry Gross, Washington, DC
Guest: Steven Okazaki
High: Filmmaker Steven Okazaki talks about his movie "Black Tar Heroin: The Dark End of the Street." It will show on HBO tomorrow night. The film tracks five teenage addicts in San Francisco over a two year period. As a filmmaker, Okazaki won an Academy Award in 1991 for his film "Survivors," which told the stories of several Hiroshima survivors. He also directed "Living on Tokyo Time," a comedy about a Japanese dishwasher.
Spec: Television and Radio; Drugs; Children; Abuse; Lifestyle; Culture; Steven Okazaki

Please note, this is not the final feed of record
Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Steven Okazaki

Show: FRESH AIR
Date: APRIL 13, 1999
Time: 12:00
Tran: 041302NP.217
Type: FEATURE
Head: Dr. David Smith
Sect: News; Domestic
Time: 12:40

TERRY GROSS, HOST: Dr. David Smith has worked with teenaged addicts since 1967 when he founded the Haight Ashbury Free Clinic in San Francisco. He's still the clinic's medical director. He's also medical director of the California State Department of Alcohol and Drug programs, and the past president of the American Society of Addiction Medicine.

I asked what he thought was behind the current heroin epidemic and what's been described as "heroin chic."

DR. DAVID E. SMITH, FOUNDER, PRESIDENT, HAIGHT ASHBURY FREE CLINICS: I started the Haight Ashbury Free Clinics in June of 1967, and this is basically the third heroine epidemic that I have been through. And there always seems to be a cultural alteration that seems to start it.

In 1969, '70, '71 it was when all the Vietnam Vets came back strung out from heroin. In addition, every time you see an upswing in stimulants like amphetamine or cocaine -- every stimulant abuser is a potential heroin addict. And the thing that's real popular now is speedballing, which is a combination of cocaine and heroine or amphetamine and heroin.

So there are these transition points. The heroin chic, I think in part, got started around the smoking of heroin, heroin as the ultimate rebellion, they lied to us about other drugs, heroin can't be is bad as they say it is, only the weak get addicted. And I started seeing it around things like models.

They would smoke heroin; throw up; feel good; and swear they'd never stick a needle in their arm. And then suddenly they tried to stop and were junk sick, and then they stuck a needle in their arm.

GROSS: Now you mention models, do you think that for some young people heroin is the ultimate diet drug?

SMITH: Oh, yeah. Heroin is a marvelous diet drug. When you use you throw up, and you feel good. And it can kill your appetite. And, you know, that heroin chic got started around that whole concept of being thin and kind of emaciated. I think that helped set a cultural reference point for the middle and upper class.

The majority of heroin addicts, you know, are the hard-core street addict, which is what we treat here at the Haight Ashbury Free Clinics. But when you're talking about an epidemic you look at new users, and the new users are stretching into the middle and upper class where it kind of disappears.

For example, our Haight Ashbury Free Clinics has a waiting list of about 400 uninsured heroin addicts that don't have any money waiting for treatment. And that gives the impression that that's where all heroin addiction exists.

My wife and I also have a small private practice of people that won't come into public programs, and we're finding that there's a lot of heroin in the middle and upper class that's hidden. And it doesn't take the character, initially, of the street addict but...

GROSS: ...is this the first time that you've seen weight loss as one of the reasons to try heroin?

SMITH: I would say it's a bigger aspect of it now than it had been in the past.

GROSS: What are some of the other things that are new about this particular heroin epidemic?

SMITH: I think the entry point being potent smoking of heroin and the blatant marketing of that entry point to young people. In other words, if you recall the cocaine epidemic, it first started around cocaine freebase which you had to get some cocaine; you had to get apparatus; you had to freebase. That's how Richard Pryor, you know, got the freebase fire.

Then they came along and invented crack cocaine, which was pre-prepared cocaine freebase that was in small quantities, easily accessible and available on the street. In a certain sense, that's what's happening to the heroin scene. It's very easy to get into the heroin scene for young people now.

You don't need much money. You can buy small quantities. It's attractively packaged. It's very pure -- 60 to 80 percent pure. That's why we've had all these heroin overdose deaths.

GROSS: I'm wondering, you know, you've been working with young people who have drug problem since the late '60s. Do you think that the reasons that teenagers are using heroin today or the rationales or self-delusions that they have about the drug are any different from the ones you heard back in the '60s?

SMITH: Well, in the '60s the transition to heroin came on the back of methamphetamine here in the Haight Ashbury. Our clinic coined the term "speed kills" in 1968. And one of the things that we learned is the upper-downer cycle.

Anytime you have a stimulant epidemic it will be followed by heroin epidemics. So those aspects are similar. We've got a big increase in amphetamine and cocaine. The cultural acceptance of heroin in the '90s is substantially greater, I think, than it was in the '60s.

I think the youth population is more problem too, particularly in the homeless population. We're the major service provider of the homeless youth here, and they are -- this isn't the idealistic '60s, make love not war, end the war in Vietnam. This is a very problemed (ph) dual diagnosis group that comes from all over the country.

They come to California for geographical cheer, hope that life is going to be better than their dysfunctional family at home in Des Moines, Iowa or wherever. And they find that life on the street is very hard. They're a very alienated population.

Our Haight Ashbury Free Clinics has community outreach workers that go out of our facility into the middle of the population. The good news, however, is that we know a great deal more about the neuro-science of addiction; we know a great deal more about treatment; we know a great deal more about recovery.

Our clinic serves as a site for about 50 12-step recovery group meetings per week throughout the Bay Area. And the myth that the dominant culture has that the youth carry with them was that once a junky you can't get off, we can now do a better job with.

GROSS: My guest is Dr. David Smith, founder and medical director of the Haight Ashbury Free Clinics. We'll talk more after a break.

This is FRESH AIR.

BREAK

GROSS: We're talking about the current heroin epidemic with Dr. David Smith, founder and medical director of the Haight Ashbury Free Clinics.

For a lot of young men who become heroin addicts, I mean, they're using heroin when -- at a time in their lives when young men are usually obsessed with sex and at the height of their sexual urges.

And I'm wondering why you think heroin addicts are willing to kind of give up that sexual urge for the drug. It's something that most young men -- you know, sex is something that most young men value so much and so many heroin addicts basically lose any interest in sex.

SMITH: Well, of course they don't know that in the beginning. And in fact that's exactly what we emphasize in high-risk prevention in our films and our lectures and our education. When they go into this they don't know any of that.

In fact, in the beginning it may enhance their sexual functioning. They may have premature ejaculation and it delays their ejaculation. We found a lot of the young women that get into heroin have been victims of incest and sexual abuse and they have (unintelligible) pain on intercourse, and in the beginning heroin helps them.

And they say, hey, this is great. And then down the line they get strung out and the men have no sexual desire, can't have an orgasm. The women stop -- periods stop. They lose all sexual desire. They stop functioning sexually except that they get into sex for money.

So these are all issues of high-risk prevention. We talk about that. In addition, many of these young people are dual diagnosis. They might have depression. Some of them might even have schizophrenia, and they find that when they use heroin it self-medicates their underlying psychological symptoms. They actually feel better.

GROSS: Do you try to deal with that when you're helping somebody kick the habit, to kind of medicate their depression with a prescribed drug rather than heroin?

SMITH: Oh, yeah. That's what you do with proper treatment. We have a large dual diagnosis segment of our clinic. So we detoxify them from heroin, evaluate them and find that they have underlying psychiatric disorders. So we'll put them on an antidepressant medication.

We might put them an on an anti-psychotic medication if that's appropriate. And get them into a dual diagnosis group. So you have to have specialized groups for dual diagnosis populations.

There is a very high incidence of psychopathology in the street population, and treatment has to be based on diagnosis. And treatment has to be more flexible than it was in the past.

GROSS: Do you like to work with methadone or do you find methadone to be either unnecessary or problematic?

SMITH: Methadone maintenance is a valid treatment modality for those patients that require methadone maintenance we certainly support it. We do not run a methadone maintenance program, we're one of the few programs that focuses on the detoxification of heroin addiction and getting the individuals into drug-free recovery.

My only comment is that there are these statements that the only thing that works for heroin addiction is methadone maintenance. That's not true, particularly for the young user. We just had a 14-year-old strung out on heroine, got pregnant.

The standard protocol is to put a pregnant 14-year-old on methadone maintenance. Methadone maintenance very often becomes a lifetime. She'd only been strung out for about three to four months. So we worked with this young woman. She is now in Narcotics Anonymous. She is now in drug-free recovery. And she is not on a lifetime of methadone maintenance.

So methadone maintenance is a valid treatment modality, but is not the only treatment modality. And I would like to make sure that, particularly the young new user, has a good shot at drug-free recovery. Because remember, the way methadone maintenance is run now they're highly regulated clinics usually in less desirable parts of the city, and you sit around with a bunch of old line junkies and learn how to be in addict.

Well, what I think is important is that we not only have greater expansion of drug-free recovery, but we also have office based opioid (ph) maintenance therapy. So these patients can go to their doctor with their family and if appropriately diagnosed, can get their treatment in a medical setting in addition to the methadone maintenance programs.

We need much more treatment than we have now.

GROSS: You've been working with addicts for over 30 years. It must be so frustrating for you to see teenagers who think heroin is really hip, or that they're so hip that they're never going to get addicted because they can try it and not get addicted because they're just too cool or they know better or whatever.

SMITH: Yeah, it's -- there's a generational (ph) forgetting. You know, we've learned these lessons, but a new generation has to write their own story. That's one of the missions of the Haight Ashbury Free Clinic is to give nonjudgmental information that the young people will listen to.

I think that government also has to look at why their messages are not being listened to. In other words, we have to develop information delivery systems that the young people will accept.

Music is a very important vehicle, we're working with Boz Scaggs on that for example. Young people go into treatment and the first thing they say is you can't ever go to a concert again because that's a slippery place. Well, to these young people music is the most important thing in their life. That's like a death sentence.

So we say work with music and recovery and have relevant role models in recovery. The painful aspect of this is this last year I've been to three funerals of families that I have known -- good families -- whose sons have died of heroin overdoses. That is -- the personal part is very rough. I see death all the time in my medical practice.

It's tough, but you build a wall. It's when you know the family, when you know the kid that's painful. On the other hand, the thing that keeps me going in this field is recovery, because I also see a lot of people undergoing the miracle of recovery from addiction. Their lives are so much better. They're doing so much better.

So addiction is a life-and-death issue, but the power of recovery is the thing that keeps me going. And I believe that if people recognize that there was a quiet revolution of recovery in the United States where thousands and thousands of people are recovering from this potentially fatal disease, then we would have a better understanding of what's happening.

GROSS: Well, I want to thank you very much for talking with us.

SMITH: OK.

GROSS: Dr. David Smith is the founder and medical director of the Haight Ashbury Free Clinics.

I'm Terry Gross.

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Dateline: Terry Gross, Washington, DC
Guest: Dr. David Smith
High: Dr. David E. Smith is founder and president of the Haight Ashbury Free Clinics in San Francisco. He is a specialist in treating drug addicts, including heroin. He talks about the rise in heroin's popularity in the 1990's.
Spec: Medicine; Drugs; Abuse; Lifestyle; Culture; Dr. David Smith

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Copy: Content and programming copyright 1999 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1999 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Dr. David Smith
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