The Bronx’s Quiet, Brutal War With Opioids

In the Bronx, which lost more residents to drug overdoses last year than any other New York City borough, the heroin epidemic has latched on to a vulnerable population.

Comments: 217

  1. At 63, I have lost more friends to heroin than any other single cause -- and that was before this epidemic.

    These epidemics seem to sweep through the country in waves: in the 80's, it was the crack epidemic. Eventually, users either die or straighten out, and the next generation rejects the drug, having seen its effects on the last.

    They are not and have never been limited to minority communities. Every one of the victims to which I referred was white and middle class. They had better resources and support networks, so their slide was more gradual and less visible.

    What strikes me about these epidemics is how ineffectual our prevention efforts, whether or oriented towards law enforcement, treatment, or education have been. There has been since the 60's a basic breakdown in trust as young people use illegal drugs that have been banned by the government, often absurdly. Measures like the distribution of naloxone are essentially useless, since the junkie saved from one overdose will merely move on to another.

    I don't know what the solution is but I'm inclined to believe that it either entails a retreat from outright prohibition, which has never worked well, or a more active approach to the junkies themselves -- commitment with mandated treatment and long-term monitoring, with treatment in a secure facility each time they slip.

    Junkies stop when they hit bottom, not when their hands are held. This might isolate the contagion, as addiction spreads from one person to another.

  2. What you said, Josh. My own nephew died of a heroin overdose this past February; he was 29. He was white, came from an upper middle class family and was raised in affluence -- had every opportunity -- the family paid for FIVE (5) rehabs, at luxury facilities, to no avail.

    When he overdosed, he was already living in a halfway house for "recovering" drug addicts, so that gives you some idea of how effective such stuff is. And his fellow residents ignored his decaying corpse for about 4-5 days, in WINTER, with the heat on. Think about that for a minute.

    Most junkies do not stop. Reviving or treating them is a waste of our precious, limited resources. They are lost souls, and while that is sad, they are beyond helping. And as you say correctly -- holding their hands, patting them and telling them it isn't their fault and "don't judge them" -- makes the problem 20 times worse.

  3. As a former user, my epiphany was to stop lying to myself. I wasted years telling myself that I wanted to quit, but failing again and again. In the end, it was the realisation that what my psyche wanted was to go back to the beginning and become a casual (once-in-a-while) recreational user.
    After living on the edge for years, I finally realised that that wasn't possible, because as soon as you touch it again, you just want more, then more again.
    The only solution was to stop completely, or die. I didn't want to die, so I stopped. That was not a very comfortable few weeks, physically, but with some valium and vodka to take the edge off, I got through it. 6 years now and I don't miss that at all. BTW, I tried the 12 step stuff like NA, but religion just isn't my thing (make of that what you will).

  4. A HUGE part of the solution is to tie BIG PHARMA's hands. How do you think an epidemic starts ... all of a sudden a massive number of people just start craving heroin? No, it was BP pushing opioids left and right (in form of pills) because ... PROFIT. And who participated ... pharmacies, Dr.s, hospitals. Because ... PROFIT. DISGUSTING AMERIKA!!!

  5. This opiate epidemic is happening to the US among all racial and socioeconomic groups 150 years after the Opium Wars when the British and American navies forced the Chinese to import opium at gunpoint, leading to estimates that some 30% of the Chinese population were addicted to opiates by 1880. Only 150 years later is China finally starting to crawl out of its complete societal collapse at that time.

    Some may call it karma.

  6. The US Navy was never involved in the Opium Wars in China. Some American merchant ships were involved, but that it a different thing entirely.

  7. I thought some of the "founding families" of the U.S. so to speak were among the most prominent of 19th century opium traffickers - particularly those in New England.

    I read a book that noted that the symbol of the Yale Skull and Bones Society actually originated from the flag flown by some of the ships that the U.S. opium trafficking families used in China.

    Opium addiction in the lower socioeconomic classes in England during that period was also commonplace.

  8. I want to know more about "The Hole..."

  9. Why???? It has been "cleaned up" and blocked off by the City. I imagine users/homeless people still go there to use. The Hole is an old cargo rail line that is no longer used and some ideas were thrown around about making it a park similar to the Highline for the hipsters/monied elites moving into the area.

  10. An unmentioned reason politicians wait too long to talk about opioid crises in their communities is to avoid a reputation that discourages the prospects for new business to move in, which is a quick killer for property values.

  11. Good on the NYT for continuing to devote weekly front page space to the opioid epidemic. This is a topic that really benefits from relentless coverage in a way that others topics do not.

  12. The deaths are going up because of the use by drug sellers of fentanyl. This synthetic is easier to get and amatuer dealers are trying to get into the business having no idea how to dilute this powerful synthetic properly, resulting in dosages that are unpredictable to the user.

  13. Not every social problem is about race. It isn't just white people who are aware that using heroin is dangerous -- people of color know this, too.

    If one knows it's dangerous but does it anyway, why should the rest of us (white or not) care?

  14. If you eat fatty foods and have a heart attack, why should the rest of us care? If you drive fast and have an accident, why should the rest of us care? If you smoke and get lunch cancer, why should the rest of us care?
    Slippery slope.

  15. Maureen: the cumulative risk of eating fattening food, or smoking is vastly lower than shooting up heroin (especially contaminated with fentanyl) -- it takes 50-60 years or more to kill a fat person with a heart attack or a smoker with lung cancer. And they mostly just hurt themselves, not others. You don't see fat people burglarizing homes to get cash to buy Fritos.

    On the other hand, driving fast and getting in accidents actively harms those around you -- so it is a very poor analogy.

  16. Getting difficult to have much sympathy for junkies that have no self control/ respect and load the healthcare system down with heavy costs and valuable time needed elsewhere.

    Very difficult.

  17. BCY really you're going to go there? Leukemia, cancer, etc. don't choose to get those diseases addicts choose to stick a needle in their arms. Obese people choose to eat a quart of ice cream instead of one scoop. Obesity is not an addiction. There's something called personal responsibility. More people ought to exercise that option.

  18. I worked at an addiction center, and the hardest thing for me to accept was the oft-repeated statement that "an addict is no different from the three-year-old who gets cancer." Sorry, but I think the parents of said three-year-old would beg to differ. The three-year-old did not choose to get cancer; and while no one chooses to get addicted, they do choose to take drugs despite knowing the dangers.

  19. No, your moral compass is not just fine because you say it is. You are sorely lacking in empathy and compassion.

  20. In order to save these people they have to want to save themselves first. Sad situation.

  21. The photo of the outreach worker holding the needle he found, which is bent... ("meaning that whoever used it may have been infected with a disease and didn’t want anyone else to use it")... demonstrates the humanity of that heroin addict... one who cares enough to attempt to prevent another addict from contracting his or her disease. These are human beings, and despite their serious problem, have feelings too.

  22. I am so glad you noticed this, it was one of the most important details of this article in my opinion. Addicts suffer from loss or exclusion from the social contract...yet they retain this compassion even when gravely ill. Many of us could learn from this.

  23. Jill - are you saying they aren't human beings and don't have feelings?

  24. Oh PUL-EEZ! modern needles are very thin, and can be bent easily -- I have to give daily insulin injections to my cat, and I've learned a LOT about injections lately. I have bent lots of needles just injecting my cat, or messing up when I try to put the cap back on the needle for disposal (often early AM when I am woozy with sleep) and I've also given myself needle sticks.

    Probably that addict just pushed too hard on that syringe and bent the needle by accident.

  25. excellent article, just to sad for me in these grey morning of fall. I will try to finish it later.

  26. In order to fix it you gotta face it.

  27. Stay safe out there everybody. Every nightmare has an end.

  28. The media needs to stop calling this a "war", which is language used for many decades to justify discriminatory criminal enforcement against people of color. I think "epidemic" is the correct term, and implies a medical and social services approach to dealing with the problem. Come on Mr. Delreal, why the sensational and very fraught term? Come on NYT, use some editorial discretion.

  29. Waging war on this, that, or the other is such a part of our aggressive, militaristic, and insensitive view of the world. When we approach each other locally and far away with compassion, empathy, humanity, and yes, love, the world will change. Stop looking where to apply blame.

  30. Sounds like AIDS - the level of concern and resources available rose as the epidemic hit more affluent (and white) communities...

  31. Exactly. While the opioid epidemic is horrific, hearing about all the heroic efforts people are making to combat it makes me so mad to think of the crack cocaine epidemic in stark contrast.

  32. Goes on and on with out any success in bringing an end to it. 55 years later my old Mott Haven neighborhood is still a wreck. I witnessed OD deaths then and they continue today. Where is City Hall ? NYPD?

  33. Where is personal responsibility?

  34. Why hasn't the so-called President given this the emergency attention it deserves. This entire country is being brought to its knees by this epidemic - urban, rural, suburban, rich, poor, all races and religions. If you think that heroin isn't where you live - think again.
    Local governments in many places have been nothing short of heroic in trying to address this, but it is bigger than them. The federal government needs to treat this like a national security issue, because it is, and devote the resources needed to combat it.
    All you need to know can be learned by looking at the homeless populations of major cities (where people from all over end up) - it used to be old men with an occasional woman, now it is mostly young people and nearly all of them are there because of opiates.
    Trump is too busy making fun of people on Twitter. What a disgrace.

  35. Indeed. To truly address this "American carnage" would require intelligence, compassion and an ability to understand the interconnection and subtlety of the complex problems involved. Our so-called president and the religious rightwing congress have none of those qualities. I see them like the president in the current movie Kingsmen, where each death is nothing more than a self-solved problem.

  36. The previous president took effective action? This is hardly a new problem.

  37. Maybe it's just too close for comfort. One of Donald Trump's brothers was addicted to alcohol, and died from it. This experience would make some people more empathetic and concerned for others in similar straits, but apparently not this person. Maybe tweeting is, if not an addiction, at least a compulsive behavior.

  38. A few are guilty, all are responsible.

  39. Assuming the pill mills are shut down and far fewer new addictions happening, is there an estimate for when this situation will simply burn itself out? I know this sounds harsh, but will the addiction population eventually die off?
    Or is the addiction population high enough to keep these deaths happening for many years?
    Or is my initial premise wrong, that we are not stopping new addictions?

    I am pessimistic for recovery, for both individuals and the nation. Thank you to the people who are trying hard to prevent and mitigate the problem... you have more hope than I do, and I wish you well.

  40. This crisis should be labeled a drug addiction crisis - NOT an opioid problem implying that chronic pain patients are responsible - THEY'RE NOT.

    To answer your question this won't 'burn itself out' - until the country - and especially the media - gets this story straight we're going to continue on a dual crisis - chronic pain patients can't get pain medication and the drug addiction crisis will just continue unabated.

    No one (sadly including the media) really wants to hear the fact of what's going on though so things are going to get worse for everyone.

  41. Dr Oberg, Your comment is so very very important. Thank you, it is indeed a dual crisis. Even triple: people who need pain medication for acute pain following severe injury or invasive surgery.

    From a former burn patient, over 25% of my body impacted.

  42. @ Richard Oberg M.D.

    Many thanks for pointing out that distinction.

    It has also been indicated by another person here that the crisis is mainly due to Heroin & Fentanyl causing the major portion of the tragic deaths being reported.  It is very sad that the flow of illegal narcotics are not stopped.

  43. I grew up in the Bronx, so I can tell you about the heroin situation in the 60's and 70's. There were so many addicts back then that churches and synagogues were frequently repurposed as methadone clinics. The Bronx has come a long way since that time, but problems remain for many. Hundreds of millions are spent on band-aid welfare programs, but few focus on the deep-rooted cultural problems of fatherless children, whose parents lack the communal and religious ties that new immigrants and others rely on to prosper. We must, of course, deal urgently with this most heartbreaking crisis-I don't mean to diminish its severity--but the social problems of many longstanding Bronx residents, lacking family structure and communal ties, require much farther-reaching solutions.

  44. So drug addiction is caused by the lack of family structure and communal ties that lead to prosperity?

    Tell that to rich prosperous families who lost a loved one to drug addiction.

  45. Out here in NJ the same thing is occurring.

    The dead turn up in porta potties at construction sites and in libraries.

    There isn’t enough room in the morgue for all the dead.

    What happened to the governor’s big plans with the federal government to fight this scourge of death?

    All hot air.

  46. You're mixing apples and oranges on Bronx demographics.

    According to a 2013 Census estimate, 46% of the Bronx is white. That's simply because many Hispanic people check off "white" rather than "Hispanic."

    So when you say that the highest rate of overdoses in the Bronx is among white residents, that's not necessarily the 10% who are non-Hispanic white.

  47. Out of this entire story,
    that's what got you?

  48. FYI: Hispanic is not a race. That's the reason why they check off "white". Hispanics can be full or a mix of European, Native American and/or African.

  49. Correct, Hispanic is not a race. I'm Hispanic, family from Uruguay, and 100 percent European. I think this comment gets made on every single story where it's mentioned. And, Hispanics can also be Asian. We Americans love counting beans, don't we.

    And what is the importance of this in relation to the story?

  50. The reality is heroin is one of the hardest drugs to kick long term. My uncle overdosed on a bad batch in California in the early 90's, but he started using in the South Bronx where we were all born and raised. He had quit, moved to CA in the mid/late 80's to start over fresh near his father. He had a good job and a nice apartment. He was dead in that apartment for days before they found him.

    In 2005 I worked at an optical store across from St. Barnabas hospital. Next door was a methadone clinic. I have never seen a more heartbreaking and pitiful group of people. It's very difficult to stay sober permanently. Too easy to fall back into old habits, especially when you are surrounded by friends, acquaintances, and even significant others and spouses still using regularly. Not to mention the problem of facing the damage one has done to their life while addicted. The despair that comes with lost jobs, lost children, lost time, criminal records, and the obvious decline in health and appearance.

  51. It is a public health crisis, a societal breakdown crisis, of huge magnitude. Social connection, family strengthening, economic supports and opportunity...are what will reduce the underlying problem which leads to people escaping despair through drug use.

    All the natural disasters we are seeing are forcing us to help each other; they could bring us closer as a society and I hope they will. I am looking at all these workers in the photos...I'll bet they have some compelling life stories and strong senses of compassion. How did this compassion develop? I think that would be a fabulous story to tell.

  52. At some point, we have to stare at this epidemic squarely. For many Americans, of all colors, life has become so painful, hopeless, and meaningless that it is not worth living unless one is high. This is not people turning their backs on a happy, healthy, productive existence. This is them turning their backs on a dreary existence that is none of that and has no likely prospect of ever becoming that. This is why risks of death and imprisonment are no deterrent. It is also why therapies based on disease metaphors are largely doomed, however better than redresses based in moral culpability. A national drug epidemic is a collective judgement on the life a society offers its citizens. America is failing its people, and one need not raise one's head to look beyond drug abuse to see plenty further evidence of failure.

  53. "A national drug epidemic is a collective judgment on the life a society
    offers it's citizens.America is failing it's people,.."

    No it's not. If you believe that, how do you account for the millions who
    are not addicted to drugs ?

  54. Maybe you're all just spoilt first world people who do not know what hardship and struggle really is. Life is meaningless because you don't really have to do anything much to fight to have a life. Compare yourselves to a large part of Africa, the Middle East and Asia, where life is really hard. Many of them would come to the US in a heartbeat.

  55. I'm still not entirely convinced that this is a problem. People still have to take the drugs themselves. Maybe when the day comes when people are running around forcibly shooting other people up against their will, then maybe. Maybe nobody wants to be here anymore so whose fault is that?

  56. This is the second featured article in today's NYT mentioning the Opium War in China 150 years ago when Great Britain forced China to accept opium as legal tender in lieu of silver for payment of exports. Along the way, GB also seized Hong Kong and burnt the summer imperial palace as the British General known as "Chinese Gordon" made his way to Peking with soldiers and gunboats.

    As a result, what had been a "recreation" or "pain reliever" in most of the world became an addiction. Sorry, however, that so many poor whites are dying from opioids. Maybe Mr. Trump will now declare a national emergency instead of "just say No to drugs."

  57. Let's make the stuff legal and free between now and December 26, 2017. Set up cots and juice in a big warehouse. Invite everybody to come in for treatment. Seek out those who may be too shy or infirmed to ask for help. Engage the medical community, the ER experts, the Red Cross, and FEMA (well, maybe not FEMA). This is akin to doing a blitz on this disease. Then sign people up for the Affordable Care Act for the after-care that these fellow citizens will need. Issue six months of free cell phone service and cell phones to let these folks get back in contact with family and friends. And then starting January 1, 2018, study the results.

  58. If opioid prescription is an "epidemic", what causes it? It seems to me that those pious do-gooders who insist we should ascribe no moral responsibility to addicts, want to have their cake and to eat it to: to regard addiction as a disease and yet to outlaw inquiry into its etiology. At the bottom of it, there is a moment in every addict's life when he or she makes a choice. What makes them take a life-threatening pill when they have seen dead bodies in their neighborhood? Perhaps they actually want to die. If they are adults, why shouldn't we honor their decision? The US is number one in the world in the abuse of opioids. Certainly it's not poverty that drives the epidemic. So what? I am waiting for an article by a social psychologist explaining the motivation behind the addict's choice rather than more tear-jerkers about the consequences of this choice.

  59. My son had what his surgeon called, "the most badly broken hand he had ever seen". He was 21, and was given oxycontin for the pain. He also has schizophrenia. The negative symptoms of schizophrenia include anhedonia, apathy, and lack of motivation. Any wonder he became addicted to opiates?

    Pragmatically, and for "utilitarian" reasons perhaps it's a toss-up for some as to which disease; addiction or mental illness, would have my son cast out from help. But he did receive help (and the tax-payers did not pay for it). He now receives depot injections of naltrexone (an underutilized medication, I believe), works part-time, and is living a simple, but opiate-free life.

    "A nation's greatness is measured by how it treats its weakest members." Perhaps we should look to Portugal?

  60. Methadone is a worse drug than heroin--more addictive, they say, and more toxic--so why not give the addicts heroin in diminishing doses to cure them?

  61. Can we continue calling this a heroin or prescription opioid epidemic when the fact is that more people are dying from 'fentanyl', a synthetic made in China.
    The problem is deaths from 'fentanyl' are hugely rising.
    All of this is a good argument for registering addicts and giving them medically overseen shooting galleries. Or we can continue having them OD in public places and leaving their toxic kit debris in parks, playgrounds, school grounds and beaches. This is not going away on its own.

  62. Yes, you are so correct. FENTANYL is a killer and there is not enough press going out into the public arena about this problem.

  63. "Epidemic" is an accurate term. Diseases don't spread evenly across the map, they flourish in areas that are able to sustain them. To really understand what's going on with the opioid epidemic, we have to ask, "Why here?" and "Why now?"

    I believe that addiction occurs when people don't have strong ties to their community, or lack access to support systems and to opportunities. Economists talk about "income inequality" as if it was some abstract, neutral phenomenon. But income inequality -- caused by unfair economic policies and institutionalized prejudice against race, gender, sexuality -- plays out in the lives of ordinary people as alienation, pain, despair. The unendurable personal pain of unfairly-treated people what causes epidemics of addiction. But, the epidemic of addiction is a symptom of a larger disease: the disease of a government and culture that will not deal with the unfairness of income inequality and the unfairness of racism.

  64. I was struck by the absence in the article to any reference to the economic conditions of the people. Poverty and lack of well-paying meaningful work lead to despair and a desire to numb oneself -- even an unspoken willingness to die.

  65. the state and city need to spend billions on drug treatment and education programs for all the drug addicts in the city, and provide medical care and housing.

  66. If we were serious about tackling this epidemic we would start implementing the drug policies of Portugal.

  67. In these plagued neighborhoods there is aboundant knowledge and witness to the devastation caused by drugs. I feel for the addicts but they are the ones who stuck the needles in themselves to begin and they are the ones that have to somehow gather the will to stop. At some level we have to be responsible for our own actions.

  68. It is not just in "these" neighborhoods. It is in yours too. Care yet?

  69. Apparently that is not the consensus. Apparently it is the job of the Federal government to tackle and then the taxpayers pay for it.

  70. Yes, they initially made a mistake for whatever reasons. But I doubt they thought of wanting to be an addict, and before the needle there is a long list of other steps that lead to the needle. They have to use an organ that is diseased in order to make this decision (not will). Once the decision is made, treatment options based on Suboxone I think is the easiest and most effective. Like I said, they have to use a diseased and damaged organ to make the decision which is a tall order in and of itself, but without support, it becomes that much order.

    I've known many recovered addicts of all kinds and many have been sober for decades and have never gone back to their drug of choice for an instant and some are incredibly successful. Most would say that the support of friends and family is what got them treated.

  71. The context of addiction is usually severe oppression and inability to escape that oppression. The oppression isn't just at the level of the individual but also at the community level. The community is disempowered, disorganized, and scattered from its physical basis by the authorities and the real estate industry. During the 1970's, we had the combination of landlord abandonment of buildings and the cuts in fire service that allowed hundreds of thousands of housing units to burn. The 1980's-early 1990's spike in drug deaths and violence followed this community destruction. Now we have gentrification that forces poor communities to unravel. What does the Mayor expect? Homelessness and precarious housing is part-and-parcel of the drug epidemic along with unemployment and underemployment.

    It is outrageous that the fire department allocation of units remains in the form that burned down whole neighborhoods in the 1970's although population has risen greatly and development occurs in the formerly burned down areas. Just as attention to OD deaths seems race-determined, fire protection and many other services are also still race-determined, a determination that creates the context and driving force for community vulnerability to addiction.

  72. Valid arguments but they don't explain the middle class soccer moms and kids with solid, loving homes that get hooked.

  73. "The context of addiction is usually severe oppression and the inability
    to escape that oppression.The oppression isn't just at the level of the individual but also at the community level.The community is disempowered, disorganized
    and scattered from it's physical basis by the authorities and real estate industry."

    Given your belief, how do you account for the heroin epidemic sweeping some
    of the the wealthiest areas on Long Island ( &elsewhere ) ?

  74. ". Eighty-five percent of those deaths involved opioids, and about 76 percent involved heroin or fentanyl specifically."
    So the vast majority of overdose deaths don't involve prescription drugs, those being only 9%. While 9% is certainly unnecessary, it is hardly an epidemic. This should be pointed out in the article, since the title implies all opioids are evil, and the vast majority of prescribed opioids are used safely and intelligently.

  75. Yes. I keep hearing screams about the opioid epidemic - so no pain pills for legitimate patients. Which conveniently ignores that these deaths are due to illegal drugs, heroin, fentanyl, stolen prescriptions - pretty much everything EXCEPT regular people going to the doctor and getting Norco for their excruciating pain. I'm a little tired of being denied pain pills for legitimate reasons because heroin addicts in Queens are ODing in record numbers. What does the one have to do with the other?

  76. This is going on all over the United States and still we have radical liberal democrats against building the wall to help reduce the flow of these drugs.

    Their political agenda is more important to them than people's lives.

  77. I am no "radical', but I am intelligent enough to know that a wall isn't going to stop anything.

  78. Not true

  79. Dago you conveniently ignore the part of the article about deaths from heroin.

  80. I walked passed a corner street next to Montefiore hospital in grand Concourse in the Bronx one morning last month and there it market of drugs came in a form of pills . I saw in one's palm a different shapes /colors of pills! A woman after she gave rolls of cash to the seller and got one pill in return and popped it her mouth ...right there in this open street market of drugs ! Good luck to people work and help to eradicate this deadly epidemic . They really have a lot to do!

  81. "In 2016, 1,374 people died from overdoses in New York City, up from 937 in 2015, according to the New York City Office of Chief Medical Examiner. The vast majority of those lethal overdoses involved opioids, a drug classification comprising prescription painkillers like Oxycodone and Percocet, morphine, and the illegal street counterpart, heroin."

    Do not be fooled by local, state and Federal government agencies (and sadly, even the New York Times) lumping legal and medically necessary pain medications in with the illegal street drug heroin for the purpose of inflating overdose statistics. This statistical chicanery is a key part of an empire building scheme by law enforcement agencies - specifically the Drug Enforcement Administration - to expand their powers into regulating prescribed painkillers, which many Americans need. Anybody with chronic pain issues should stand up and fight this sorry and dangerous power grab by the DEA. Just say NO!

  82. "rate of deaths per person"? Surely anything over one is a miracle.

  83. I knew a woman who worked at Odyssey House in the East Village of Manhattan, when Dr Judyann Denson Gerber set up that drug rehabilitation program 48 years ago.

    Why has nothing changed in over 48 years in America? In New York City?
    In East St Louis? In Bedford Stuyvesant? In New Orleans? In Detroit?

    I have my answers. The problem is that many people do not think it is their responsibility. Will we ever be one family -- one country? W are still fighting the Civil War, killing our own.

    Trump said, "I alone can fix it." No, not you alone sir. It takes a village, not a country club.

  84. Until you realize that the life
    of the woman in the Yankees hat
    and your life are connected,
    that what happens to her
    impacts what happens to us all,
    that her story
    and your story
    and our story are linked,
    that if she is sick,
    and the Bronx is sick,
    then America is sick,
    and we've all got to kick this, together.
    Even if you never took a drug in your life.
    Even if you wish that sad picture wasn't so.
    There it is.
    And it will remain so until we rearrange it.
    And the woman in the Yankees hat,
    and the woman who is feeling her pain,
    they need everyone's help.
    This crisis cannot be isolated
    by a screen
    or a jail
    or a gated community.
    It has to be faced.
    Until you come to grips with that,
    we got nothing to talk about.

  85. People are looking at this narrow-mindedly. This opioid issue, obesity climate change, and other crisis are being caused by Industry influence on Washington.

    Many prior crises such as automakers reluctance to standardize seat belts, the tobacco industries quest against plain packaging laws, etc,. are all caused by money in politics, Industry leaders, and their lobbying arms.

    Buckley v. Valeo is a case with the most disastrous of consequences. No other democracy in the world has such laws. The US needs to come together and change the way its representatives are elected. Remove money in politics, remove gerrymandering and only then will these problems be solved. Or else the US will just move on from problem to problem. And all that money will only serve to divide it further.

  86. At around age 8 or 9, I woke up in the middle of the night to the sound of our dog whimpering excitedly. I got up and found him standing at the basement door. I opened the door to our finished basement and heard my brother screaming and crying and occasionally some words from my parents. I sat at the top of the stairs and held our dog - trying to comfort him and figure out what was happening. Suddenly my mother appeared at the bottom of the stairs and said "[Jane], go back to bed now." I did and took our dog with me. What I learned was that my hippie, drummer (in a band) brother was experiencing Cold Turkey. After that experience, he never touched heroin again.

  87. There always has been and always will be a segment of the population that makes terrible and self destructive choices in a free society like ours. Thirty years ago public education about the perils of drug addiction was absent or weak. But in the 21st century its now taught in elementary school, so there is no excuse for ignorance and diminishing room for sympathy.

    As Americans, we all enjoy the wonderful liberty of individual choice, and of course bear its responsibility. So there is no government solution to self inflicted social problems like this, nor should there be. Many NYT commenters don't seem to understand that this is not socialistic Europe where government interference trumps personal liberty. As John Stark famously inferred, in America we all have the innate right to live free or die. These people have made their choice and we should respect it.

  88. With all due respect,your post saddens me. I have worked as a RN for 30 years, and have dealt with addicts of all kinds, in my middle class community.I would not call it "their choice". Nobody would ever choose to be an addict.I don't have any answers ,unfortunately. I agree with you, the present system is not working, but disagree with you that we give up.

  89. BearBoy, if Americans are so free to make their own choices and live or die, then why are the drugs illegal in the first place? Stating that America is a free society is a relative statement. In 2001 Portugal decriminalized possession of all drugs, and now hardly anyone dies from overdosing. We do not have that kind of freedom here in America.

  90. The American right to "live free" and belief in "individual freedom" doesn't stop the government from imprisoning American for drug offences at far higher rates than European ones do and for longer terms. So if ideals of "liberty" don't make the government hesitate to punish its citizens, why should they be used as an excuse not to try to help?

  91. Its very similar to the "Big Tobacco" issues, follow the money.

    My sister has been an addict on Opioids since around 1996. Prescibed for an aching back (she was 42 at the time) . The only reason that she is still on them is that the doctors keep prescribing them to her because MEDICAID pays for them. The US has paid around one million dollars for her in emergency medicine, (when she runs out of pills before she has her monthly pain pill appointment) the procedures that the greedy pain management doctors get when they force her to get these unproven , painful procedures like shots and epiderals and x-rays and CT scans. So when you become dependent on these drugs, there goes your job, so you can then get Medicaid, Social Security (SSI) (around 750.00) per month average. Then you get your supportive living housing (if you are lucky). These people become a dollar sign for the hospitals that bill the government around 8,000 per emergency room visit (I get her bills), the pee test that the pain doctors bill Medicaid (around 1200.00monthly) the pharmacy (Walgreens right now) that bill the government about 500.00 per month (at least) for all the other drugs that she has to take for constipation (from the opioids) , anxiety drugs(from the opioids) sleeping pills (from not being able to sleep from the opioids) the heartburn meds (opioids) .
    her children and family cannot have a normal conversation with her because she has now turned into a zombie. And I am a socialist BTW.

  92. We need to expand methadone clinics and allow addicts to take heroin pills under the supervision of a doctor. Addicts can become responsible users who can hold jobs and live a decent life.

    Opiate maintenance treatment has been shown to work in Great Britain. For those who feel that they live better with opiates, it is time to reduce the harm they suffer from opiate use, and particularly from overdoses.

    Harm reduction is the answer. For those who can, we need to provide help - but not coercion or exploitation - in ending addiction to opiates. For those who feel they need opiates, we can provide a safe, medically-assisted use which will allow them to live and work peacefully.

  93. Shall the taxpayer pay for this life time supply of heroin for those "who feel they can live better with opiates." Rather than reduce the deficit, improve schools or build a greener city, shall we supply free opiates to those who choose such a life style? I think not.

  94. A better solution for maintenance is suboxone, which contains buprenorphine, which is a partial opiod receipt agonist/antagonist, and also naloxone. There is no reason for anyone to be on methadone unless they are allergic to buprenorphine.

    KayGeeJay: better to have a productive, health individual who pays taxes than someone who wastes their lives and costs taxpayers more in healthcare costs and other damage. I'd say that suboxone treatment is guaranteed to work if you really want to stop (this is the key point, the addicts have to make a decision to quit using an organ that is affected by the use of the drug). I don't think the vast majority of addicts choose to be addicts.

  95. My sister-in-law apparently had an anxiety attack in the middle of the night on Monday. Her chest pain was so bad that she went to the hospital. They did the usual tests to check her heart but they also gave her Percocet for the pain. She was there for a while and they subsequently gave her codeine or some other opioid pain killer. When she was released they gave her a prescription for 30days worth of additional pain killer. And for many ordinary people the slide into addiction is just this easy.

  96. As a patient you have the right to decline ever hear of Tylenol? I was given Oxy after I had oral surgery, I took one it didn't agree with me told the doctor asked if I could take something else. He told me try extra strength Tylenol worked like a charm. Got rid of the Oxy. Flash ahead two years same doctor another major procedure lots of pain he tried to write me a scrip for the same Oxy told him to rip it up and that I would take the Tylenol. Some people don't learn including so called smart doctors. Don't these supposed smart people know how addictive they are? I did. Educate yourself, take personal responsibility for yourself stop blaming the doctors that excuse is too simple.

  97. I remember when a woman could get a prescription of Quaaludes just by exposing her breasts to the doctor.

    Humans killing each other softly.

  98. Baloney. It is possible that you don't know what pain is. Percocet and Tylenol with codeine is a long way from heroin.

  99. Isn't it curious how when we were fighting the illegal, immoral war in Vietnam the drug flooding the streets was heroin, the local product, then when we were involved with the illegal, immoral wars in central and South America the drug flooding the streets was cocaine, the local product, and now that we are involved in the illegal and immoral war in Afghanistan the drug again flooding the streets is heroin, again, the local product? Much of the fentanyl comes from Mexico now, but the heroin? Just asking. Does anyone else see a pattern here? And to call it the "War *on* Drugs" seems so cynical. It seems more like a war *with* drugs.

  100. Wow, interesting.

  101. Social Workers need to be paid more!

  102. Yes! They are the true living Christs of society!

  103. Dear lord!

  104. Every prescription opiate has a MD's signature behind it. Saying the pills were obtained "illicitly" is a runaround unworthy of the New York Times. Lots of doctors made a lot of money by being overly generous with opiates which they knew to be addictive. Now many of them are scared of lawsuits and the addicts have turned to street drugs. Successful long-term rehabilitation from opiate addiction is rare but a whole new industry has grown up to take advantage of the current crisis.

  105. The pharmaceutical industry puts hundreds of millions of dollars in the pockets of politicians so don't expect Congress to do anything about getting the present problem under control. There's an old saying that was never more true than today. We have the best Congress money can buy.

  106. A Federal Study should be conducted why so many patients became addicts by simply following doctors orders for prescriptions for physical and mental pain. Who are these doctors, how much did they get paid for a quick 5 minutes spent with the patient, what interaction took place between doctor and manufactories. Somebody made a quick buck obviously knowing very well the permanent disaster caused to the patient and taxpayers. Who is going to pay for this.

  107. I wonder how many of the overdose deaths are intentional? We're not only drowning in opioids, we're also sinking into despair from which there seems only one relief.

  108. I'm glad that Mr. Delreal distinguishes between heroin and opioid-based painkillers.
    The number of people dying is horrible, and the fact that so many people still regard addicts as people who have brought this suffering on themselves, is one of the great tragedies of this whole matter.
    But as someone who has suffered with intractable chronic pain, I also know that without access to opioid-based painkillers, I would be dead.
    It remains important to understand the difference between the addiction of the non-pain based user versus the physical dependence created for pain patients.
    It is essential to notice the class and race-based assumptions that are made and who is getting help and who is being treated as criminals.
    And it is essential that this country not throw away a class of drugs that are saving lives because it's also available in a "street" version that is not regulated.
    I don't have any answers, but I am pleading with the press to educate themselves and their readers about how to tell the difference between addiction and physical dependence. Even starting there would help.

  109. As an addiction medicine physician practicing at an Opioid Treatment Program in NYC, I am growing weary of seeing the same basic article recycled over and over again by influential newspapers like the NYTimes.

    Instead of detailing another area hit by the "opioid epidemic" and Naloxone training(a band-aid on an oozing abscess at best), devote space to basic education about what substance use disorders are and what they arent't.

    Educate the public about the chronic, relapsing nature of this BRAIN disease. Explain how opioid use starts in different ways for different people, but has a FINAL COMMON PATHWAY that could care less about race, age, gender. That pathway is where biology drives behavior: dysregulated brain regions cause compulsive substance use, despite consequences.

    You can throw Naloxone at the problem, but you'll be chasing your tail unless we make substance users, their family, their communities, understand how effective treatment works and why it's not just "replacing one substance with another."

    And finally, though it's eye catching to show substance users in a park shooting up, we have to be mindful that by the numbers, alcohol is the real killer. Alcoholics rarely overdose, but they die bit by bit, as all their organs fail and they finally die of liver disease, or heart disease, or alcohol-related cancer.

    Alcohol use disorder and risky alcohol use have increased dramatically over the last 10 years. Maybe that should be your next story.

  110. I agree 100% Doctor. I too am tired of alcohol being sidestepped in our society which kills and destroys more lives. For some reason it's the acceptable or legal way of mass suicide.
    Where I live they are dead set against Medical Cannabis yet go ahead and drink yourself to death, that's o.k.

  111. Thank you for your thoughtful comment.

  112. Am I a bad person for feeling like the opioid epidemic is a self-inflicted wound across our ? Surely a large percentage of these people weren't dealing with prescription drug habits due to physical pain. I remember, as a child in elementary school in the early '70's, being shown where the heroin life leads. Do we not show children these graphic images anymore? If not, why not?

  113. Not only does this draw further attention to one of the most pressing issues in American society, it lays bare the inequities associated with the response to the tragedy. Peoples' conception of the epidemic resides among white people, whether low-income in Appalachia, or middle-class in the suburbs. Yet this battle rages everywhere - and little attention has been paid the toll of the opioid epidemic among people of color. Such is typical of American social crises. AIDS was, initially, largely ignored as it was associated primarily with a sidelined and maligned group of people. We need more articles like this that bring light to the fact that this epidemic is critical among ALL people, not just white people.

  114. "In fact, in 2016, the highest rate of overdose deaths in the Bronx was among white residents, followed by Hispanics, and then African-Americans. Just 9 percent of Bronx residents are classified as non-Hispanic white."

    For those of you who don't think this current national concern/outrage over the opioid situation is more about race than anything else, think again. For decades, the South Bronx, Harlem and other communities of color nationwide have been ravaged by the influx of heroin pumped into these already depressed communities by the Italian Mafia and their partners in crime, the police and the politicians, who made billions of dollars poisoning these communities. Only now that the tide has turned and this "epidemic" has crept into the mainstream (read white America), all of a sudden its now a major cause for alarm. Ever take a stroll down scenic 116th St in Harlem on a hot summer day back in the 70's and 80's? If that scene wasn't enough to create an outcry, then nothing was. But oh wait, those were colored folk up in 70's and 80's Harlem, no cause for any concern there, right? For the naysayers, bet you shook your head affirmatively as Mike Ditka, in his all knowing wisdom (chuckling), stated that there hasn't been any oppression of People's of Colour for 100 years. Sad!!!

  115. 'war on drugs' Broken, Bad

  116. Folks take a guess from what country we get most of the heroin......we have been militarily involved there for over 17 years....

  117. Carfentanil is now appearing in MA as the bodies continue to pile up.
    Carfentanil is a synthetic elephant tranquilizer 10,000 times as potent as morphine. There is no end to this epidemic in sight with drugs like these being cut into heroin.

  118. We should take a page out the Netherlands playbook and provide free heroin to addicts. Addicts can take heroin but only in clinics attached to hospitals and under medical supervision. This will take out crime and the problem of overdose out of the picture. Freed from searching for the next fix, the Dutch experience shows that this program creates space for recovery for most addicts who are themselves sick and tired of their current state.

  119. There's confusion around the use of the word 'addiction' and how it gets thrown around in relation to mental health disorders. We hear about 'gambling addiction' or 'sex addiction' and it sounds easy to get some counseling and just get your head straight to overcome your addiction.

    Opioid addiction is something quite different. There is a mental aspect where addicts crave their next fix, but there is also a very real physical imperative. Heroine addicts become violently ill when they stop using. The effect of their nerves coming back online after being high can cause immense physical distress.

    It's been the legalization of opioid-based painkillers in the early 90's that has led us to this point. I suspect very few of the people dying from an overdose would have ever considered shooting up a dangerous drug if their body had not been introduced to it via an easy-to-take pill.

  120. My body was "introduced to it( opioids ) via an easy to take pill."-following surgeries, and a sprained neck. I took those pills very judiciously, fearful of becoming addicted. Most remained in the bottle.

    I never considered "shooting up", though I did fantasize about shooting myself with the gun I did not own, to put myself out of the agonizing post-surgical pain .
    which was exacerbated by an orthopedic surgeon who was so terrified of getting into trouble such that he would not a post surgical patient more than a 3 day supply of Percocet.(which did little or nothing to dent the agonizing pain.)

  121. As a former spouse of an addict and the receiving end of violence, pain, lies and trauma inflicted by an addict, I have no sympathy or care left for them. I did all I could to get the addict into rehab and stay there, at a point we have to recognize that the addict has to WANT to change and recognize the destruction..otherwise please just die. Do everyone a favor and spare them from all the pain so that they may mourn you sooner than waste their lives suffering.

  122. I understand your pain. My cousin married her high school sweetheart, who was an addict. One Christmas eve I spent roaming the streets looking for her 4 year old son. Her husband said he was going to the barber shop and never came home. Fortunately, another addict for the small sum of $15 delivered the 4-year old to me in a park, physically unharmed. The deadly overdose of the addict was a relief.

  123. A long time ago, probably 1965 when I was 8 years old I introduced myself to a new neighbor who lived on my block. Small talk, obviously, I was 8 years old. Anyway, I inquired if she had any children. She replied, yes, but her child was dead and that he was a drug addict. I told her that I was sorry and she replied: thank you - at least I know where he is now.

    Wow, I will never forget that.

  124. "Please just die.Do everyone a favor and spare them from all the pain so that they may mourn you sooner than waster their lives suffering."

    Yes,you certainly have no sympathy or care left for them.Your wish that addicts die in order to"Do everyone a favor "is extremely disturbing.

  125. In Singapore the punishment for drug trafficking is death. Other asian countries are similarly intolerant of these crimes we have been dealing with for decades. Perhaps, the solution isnt making these drugs legal and/or pushing for more social workers. Tolerating drug users and dealers only creates incentives to sell more drugs, and this becomes the status quo. The violence created by users in this country is felt across borders and destroys countries and economies in central/south america. In Europe it feeds drug money to the Taliban.
    These people do ridiculous amounts of damage to our society and others with both violent and economic repercussions. There comes a point where we have to evaluate the costs vs benefits of trying to help addicts and tolerate trafficking as opposed to punishments that impose real consequences on these people.

  126. Wow, kill drug users. I am speechless. We have a hard enough timing trying to decide if people are guilty of murder in this country. In your world, you realize, if a cop wants to kill you then they just need to plant a few oz of heroin and let the system do the rest. Check out the Philippines if you want to see how great things are when you start killing over possession.

  127. Prisons are full of addicts.Imprisonment hasn't helped. Are you proposing
    capital punishment ?

  128. I fear that every societal crisis this country faces will result in more suffering as a result of the president we have in office. And if you are poor it is worse. And if you are not white, it is worse still.

    The ethnocentric nationalism flourishing in this country can only further disrupt and devastate our society.

  129. Ouch.

  130. The Taliban came close to eliminating opium production in Afghanistan in 2000. Prescription pain killers seemed to be all too available in the US at the time

    After the US has been in Afghanistan for 15 years we now have a full out heroin epidemic - with many of the new users starting with prescription pain killers which are seeing crack downs. We hear stories of Afghan warlords operating with impunity - eerily similar to stories of cocaine importers during Iran CONTRA and Laotian warlords growing opium during Vietnam.

    But then after Gary Webb's death, this topic seems to be off limits.

  131. This 'epidemic' was not accidental. Far from it.

  132. Afghanistan first became a major producer of heroin during the reign of the Taliban. Taxation of poppies was one of the few sources of income for the Taliban so they encourage poppy production, rationalizing that only infidels use heroin. By 1998 the Taliban began to mandate the growing of poppy and production soared.

    Then in 2000 they outlawed the growing of poppy - for one year - after being promised aid money and political recognition. After 9/11 this became a moot point and the Taliban once again returned to encouraging and taxing poppy the Taliban heartland, Kandahar and Helmand provinces. Since then 90% of Afghanistan's heroin has come from areas controlled by the Taliban in Kandahar and Helmand provinces.

  133. Being a white male who reached drinking age in the 70's, I never knowingly associated with heroin addicts of any color. To me, heroin addicts were either rock stars or street. I became addicted to alcohol--the legal more socially acceptable drug. Now that I'm living in a small town in northern Illinois where heroin addicts sometimes outnumber alcoholics at a 12-step meeting, I've gotten to know black and white addicts who, like me, found themselves unable to live without their drug of choice. So for me it wasn't out of prejudice toward people of color that I didn't become involved with helping addicts. I simply didn't associate with them until the they started showing up at meetings I attended and it turns out that we have a lot more in common than I ever knew.

  134. Doctors seem to be the first step in creating opioid addicts - how much money are they paid doing this.

  135. As I have said before, in this day and age there is no way tens of millions of grams of H can be smuggled from Afghanistan without the knowledge of the CIA.

  136. Make no mistake. This epidemic was not accidental.

  137. Heaven forbid we stigmatize drug users in any way! (It's not all their fault, I get it. But can they at least pick up after themselves?) And of course we can't talk about where the heroin is coming from (Mexico) because that gets into a politically incorrect subject.

  138. After following the "drug epidemic" issue for several years I have reluctantly come to the conclusion that funds currently available for treatment should be reallocated to information programs describing the dangers of misuse and addiction. Having been warned, we as a society could then justify ignoring those who then chose to use/abuse these drugs. I suppose this seems heartless but I suspect that such education would prove more effective than treatment in reducing deaths.

  139. In nations like Portugal, or Switerland, where substances are regulated, not prohibited. drug use has fallen to 10 or 20 percent of what it once was.

    The question to ask, is why is our government promoting drug use through prohibition, when regulation and taxation would reduce drug use and afford treatment programs so desperately needed.

  140. Our country will let anybody that can fog a mirror have as many guns as they want but won't let an educated licensed physician prescribe pain medication. Why? The CEO of CVS has announced they will not fill prescriptions for more than seven days of pain medication. What in the heck is happening in this country of morons?

  141. The entire country is dealing with the opioid crisis and the East Coast is no exception. Areas like the Bronx, with high drug use, have become overwhelmed with overdose deaths. Heroin is readily available for purchase on street corners and is often laced with fentanyl. This powerful synthetic opioid has led to many overdose deaths on the streets of the Bronx and throughout the country. Many of the people using these street drugs suffer from untreated mental health conditions. They have found a way to numb their symptoms and emotional torture because there is a lack of adequate mental health treatment in our country. In order to begin ending this horrific epidemic, we must stop focusing on the symptoms of addiction alone and treat the individual based on their unique medical, social and emotional history.

  142. Anyone looking at the photo of this broken woman, needs to ask if being judgmental is the best approach. We don't see this, at least outside, in healthy communities with strong jobs, schools and decent housing. Some of this is where we are born and to whom . . . .no choice in that

  143. Politicians don''t want to support treatment programs so as not to be seen as 'soft on crime/drugs'. It's time we got a little soft.

  144. 3 days ago we took in a young family friend who we learned was addicted and homeless. He's a nice kid and wants to get better and we're doing all we can (room and board, and giving him some work). Beyond that we don't have a clue...what should we do?

  145. hide your valuables. When the urge hit..and it will despite their best "intention" or what they tell you sober.. your stuff will be gone. Put him a specialized center to get clean and through withdrawals..if you are asking this question here then you are NOT equipped to handle his addiction.

  146. Bless you for your kindness and empathy.
    Here is what you should do, in my opinion - tell your young man that a condition of his accommodation under your roof is that he attend a Narcotics Anonymous meeting every day, that he investigate detox and treatment, and that he absolutely, under no circumstances, use drugs in your house.
    You have the unequivocal right to place these demands and expectations on your houseguest but don’t be disappointed if the job is too much for him.
    Above all, you have the right and responsibility to protect yourselves and your family from the consequences of his disease in your own home.
    As a matter of practicality, you should keep all portable items that can be easily sold under lock and key. This is the reality of addiction; it doesn’t matter how nice your houseguest is, or how many times he assures you that he won’t let you down, unless he’s ready to stop he’ll do whatever he has to do to get the money to buy his drug and that includes stealing from you.
    I say this as a recovering heroin addict myself. I have said and done all these things. My loved ones did whatever they could to help me but the reality of my disease was that, unfortunately, it didn’t matter when it came to avoiding the sickness of withdrawal.
    Bless you for opening your hearts and your home to this young man.
    Please be practical and sensible and set very strong boundaries and limits.
    Good luck.

  147. This is wise counsel indeed.

  148. It is only until the addicted person makes the choice to end the cycle of self imposed abuse will any type of outreach or assistance help them overcome their nightmare.

    If you are religious or not, the adage “God helps those who helps themselves” bears an absolute and distinct truth.

  149. Interestingly, that phrase appears nowhere in the Bible. It's strictly an invention of your compassionate, loving Christian heart.

    If Christ walked the Earth today, he would be down in that park amongst the junkies. In fact, if you actually are a Christian rather than a scared and ignorant tribesman looking for an excuse to hate people who aren't like you, you'll recognize the image of Christ in the people there right now.

  150. i've had constant access to opioids, legally prescribed for me, for 20 yrs, & not because i have chronic pain or disease.

    i stockpile them, mainly because on rare occasions when i've experienced extreme temporary pain it's been impossible for me to get them & the relief they provide. reputable MDs are generally simply unwilling to prescribe them in sml amounts for this. so when this type of pain shows up, i "self-medicate" (typically a loaded term).

    generally, i stockpile because [a] they're truly a miracle drug for relief of temporary pain, [b] they're impossible to get legally except under limited circumstances, and [c] i take them responsibly, per standard instructions, when i'm sure they'll help and over-the-counter options won't.

    i had minor back surgery 3 years ago, woke up with minimal pain, & took the train home next morning with a script for 90 percocet (not requested).... for which i'm very grateful! i have 75 left. i've used them rarely when i've needed them, will continue to do so, & will continue to stockpile them when they're legally available to me.

    in 20 yrs i've never used opioids recreationally, have no plans to do so, & can't imagine doing so. why would i when risk of addiction & death is so high?

    anything wrong with this picture?

    it's a shame that opioids are not more readily available to those who'll use them responsibly because those who don't, no matter the context or excuse, have made them nearly impossible to get.

  151. I take one half milligram of Alprazolam
    a day for anxiety, one ten milligram pill
    of Montelukast for my sinuses and a vitamin D supplement for iron deficiency
    and I have two vodka tonics before dinner.
    I walk half an hour each day and exercise in my apartment for 15 minutes.
    my yearly checkup was two weeks ago:
    blood pressure 118/70,heart in great shape ,a few pounds to lose,but generally
    just fine.
    last winter,same thing at the cardiologist.
    both doctors know I have a drink or two.
    the cardiologist said "have one for me."
    my point is that these articles always use
    the worst elements of society as the norm.
    many people live decent,if not perfect lives, adjusting as well as they can to the
    pressures of their lives.
    those who choose street drugs and street
    lives make bad choices ( as we all do at
    times)but their choices are self destructive and often times fatal.
    by the way,I am writing this while listening to a great performance of Mahler' s third symphony:
    not everyone who uses drugs,for legit
    reasons,is doomed to a death in some
    dark alley.

  152. I have not found opioids necessary for pain relief after going home post surgery or after having my wisdom teeth out. Three Advils work pretty well.

    Be careful if you use old Percocet--the time release wears off and the full drug will hit you at once.

  153. Who is your doctor ?I couldn't pry more than 15 Percocet out of my surgeon.
    I was in such horrific pain such that I prayed for death.

  154. A world where people don't feel they must escape its horrors through heroin. That's what we must build. That means you. And me.
    Give people education and art and health care and meaningful work and a community that cares and we won't have this. It's not complicated folks. It's just the fiendish way we have of making it complicated that makes it complicated.

  155. Sir Thomas More wrote of such world, a place called Utopia.
    ( De optimo rei publicae deque nova insula Utopia).

    It was in a place we now call America.

    Then the cut off his head.

  156. If it is not complicated, then why ? cash cash cash

  157. from a community psychiatrist's point of view:
    -Is addiction a disease? Don't worry about it but basically yes. Don't get stuck on whether the addict is a victim or a perpetrator. There were bad decisions and behavior along the way but once an addiction has gained momentum the brain itself is changed and it doesn't change back. The anatomy and physiology don't work right anymore.
    -Doesn't giving addicts the message that they have a disease just increase their lack of accountability and encourage people around them to make excuses for them? No because basically the goal of all long-term treatment is to stop the drug abuse and only the addict can do that. If an addict has told you different they're trying to deceive themselves and you (this is common and not unexpected).
    -Why does it matter if Joe Public sees this as a disease or a moral failure? It matters because while the willingness of the addict to get well is a necessary ingredient for change it is by no means enough. There also need to be a will on the part of the public to help. Medical and social resources are needed to get addicts clean and sober. It not an either/or proposition. Its both/and.
    -Why does it matter to my family? Because exposure to opiates leads to addiction. Your children are at higher risk now than 10 or 20 years ago simply because they're more likely to be offered an opiate. They will continue to be at higher risk until todays addicts are helped.

  158. It is time to go after the pushers and the producers with a vengeance.

  159. Good luck with that now that Erik Holder rearmed the Mexican drug cartels. Or did I misunderstand "Fast N Furious"? Not that they really needed his help in the first place. Let me give the DEA the same advice Rick gave the Germans in the movie Casablanca with this paraphrase, "Frankly, there are some places in Mexico I would suggest you don't go."

  160. Yeah. Right.
    So we should go to battle with big pharma and doctors answering to the dark side of easy cash ?
    Talk about battling windmills....

  161. Just as planned, tens of thousands of the under-classes are being exterminated through this method.

    No one objected when ten trillion dollars of heroin was produced in Afghanistan which we have presided over since 2002.

    No one thought twice about the fact that NO heroin was produced in Afghanistan in 2001, and the drug cartels could not suffer this shortage coupled with the declining reliability of Myanmar, previous number one producing heroin nation in the world.

    No one, not even a member of Congress objected when engineers said WTC 1, 2, and 7 were brought down, neatly, with controlled demolitions after the Saudi jetbombed 1 and 2.

    So here we are.

    Nutzee extermination campaign in 21st Century looks quite different than their previous campaigns.

    But sure as salt, over a million Iraqi were killed, in a war that was mostly a security action for the world's oil companies operating there, and the heroin cartels operating in Afghanistan.

    And tens of thousands of under-class Americans are being killed with the Afghanistan poison, that our own military helped to ensure was produced in record amounts in Afghanistan.

    Why is Congress still asleep?

  162. I worked in the Bronx for nearly 30 years - this is the worst I have see of overdose deaths.

  163. I really appreciate having an in-depth article like this on such an important current issue. As a former NYC native, reading about the plight of fellow New Yorkers touches me deeply. That's why it's such a shame that the writing is so bad. The phrases are clunky, disjointed, and hard to follow, and I found myself rereading entire paragraphs just to figure out what they're saying. I'm not blaming the investigative journalist who obviously contributed so much amazing work for this piece. The NYT, however, should be better than this. Don't they have someone who can edit well and make the writing smoother and more comprehensible?

  164. Contrary to what many of the commenters believe most of the the US heroin production comes not from Afghanistan but from poppies grown in Mexico, Columbia and other Latin American countries. Afghanistan supplies the Asian and European markets. Our long war in Afghanistan has many problems but heroin supply to the US is not one of them.


  165. Hopefully, some day, our society will come to understand the part that prohibition plays in "dramatic rises" such as these.

    It's worth noting that more Americans die every year from ingesting the drug alcohol than die from ingestion of EVERY OTHER RECREATIONAL DRUG COMBINED! That's right, lump together ingestion of MJ, cocaine, meth, heroin, LSD, Xtasy, shrooms, every other upper, downer, or sideways known to mankind and the number of Americans that die from alcohol usage is greater EVERY YEAR than it is from all the others combined. 300% more Americans die every year from alcohol than do from GUNS!

    We made the manufacture, distribution, sale, and ingestion of alcohol entirely illegal back in 1920, and everything got worse. More usage, more deaths, more criminal crossfire when the black market took over all those things.

    History is repeating itself. Actual heroin, the byproduct of the poppy plant is FAR LESS DANGEROUS, and DEADLY than the synthetic stuff that is replacing it on the streets due to decades of prohibition of the more natural, and less deadly stuff.

    Prohibition never fails to make matters worse.

  166. We should keep doing what we are doing but without the availability of cheap heroin and fentanyl the problem wouldn't be as big. What we never seem to read and hear about regarding this epidemic is anti-drug efforts aimed at the Mexican and South American Cartels and whomever else is importing and distributing this poison.

  167. Comes in mostly from China in shipping containers i believe...

  168. So the Bronx alone is on track to have more than 1 overdose death *every day* this year. This isn't a rural problem or an urban problem. It's a national problem. And so far our so-called leaders in D.C. have only paid lip service.

  169. No one (politicians, this means you) really cared, for decades, about heroin and opioid addiction until the white middle class got hooked and started OD'ing on Fentanyl.
    This ONLY became an issue after the DEA clamped down on doctors and prescription opioid painkillers.

    Trump should stop blaming immigration and start strict enforcement and inspection of ALL inbound cargo from China.

  170. You know why reports about the epidemic and its ravages have been mostly centered on Staten Island. It is because Staten Island is mostly white. The drug epidemic has only take center state because it is now affecting white communities. When it was ravaging black communities, it was considered a moral failing of those communities.

  171. In my corner of the country, I see all sorts of reputable folks hopelessly hooked on cigarettes. Addicts. They tip the scales on healthcare and insurance.
    No one is free from needing help.
    Nicotine or opiates, nothing gets fixed by blaming.

  172. The racist observation that the public only cares about the opioid epidemic because a growing number of the victims are white does not square with the data. This problem is killing about four times as many people as died at the heart of the crack epidemic. It kills more people than guns or auto accidents. It's a much bigger scale, and heroin does not cause the same kind of violence as crack, either. Attacking people's sympathies because of race might help liberals feel smug and superior in this Trump era, but it is not helpful in conquering this epidemic or healing this country.

  173. Pictures from the Bronx seem mainly Black and Hispanic.

  174. none of what you offered supports the original position you advanced. on the other hand, the problem has existed for decades, and is only receiving the attention it is now because it is extending the demographics it affects.
    Also, the article had a heavy focus on the actual problem and its effects, rather than a political bent of any sort. Acknowledging actual data patterns and their causes doesn't mean a sinister agenda is afoot.

  175. People in the Bronx ARE mostly black and Hispanic.

  176. In my opinion, the Bronx has lost the war on opioid addiction because the war is rigged against the residents. How is it that it is easier to obtain illegal opioids than it is to get a legal job in the Bronx? How do the opioids get to the Bronx? Who are the suppliers? If the government really wanted to win the war on opioids in the Bronx they would arrest the suppliers and stop the drug from entering the community.
    As the situation exists now, it's full employment for social workers, addiction therapists, and a bull market for drug suppliers and their money laundering assistants.

  177. How is it that it is easier to hire a guest worker from China or India than a local US citizen or local US college grad?

  178. It's terribly sad to me that so many people can only find happiness and peace in a drug.

  179. It is sad that opioid addiction is criminalized rather than treating the immediate cause of these "overdoses" by prescribing pharmaceutical grade opioids to stave off the perils of withdrawal, unadulterated and properly administered. The Portugal model serves as an example, but do note that any program to decrease harm should include options for medically supervised withdrawal and ongoing support when the addicted person is ready for that step.

  180. And near the end, they don’t even find happiness and peace. Near the end, the need for higher doses to achieve the same affect kicks in. But for a true addict, “more” is never enough. It’s a horrible and lonely place to be.

    And addiction does not respect race, religion, color, gender - addiction takes everyone. Some are predisposed genetically, others because they DO experience happiness and peace when they first start using these drugs and want more.

    All of them need compassion to have a hope of starting the road to recovery, a lifelong process. No one gets cured. And at one very vital point, the addict - himself or herself - must make the decision to take that first step. It’s not about supply or price - but most efforts aim too hard at stopping supply.

    Addiction is a humanitarian crisis. Addicts also do terrible things to people they love, making compassion hard, sometimes impossible.

    Just please show a little kindness, a little compassion to anyone you may know or suspect is an addict. It’s ironic that people addicted to painkillers lead lives of incredible pain, shame, and regret.

    I am one. Six plus years sober. It can be done.

  181. Despite what Democrats are trying to sell you, this is NOT an "Opiate" crisis - it's a heroin crisis. According to the NIH, only 17 deaths in 100 are due to prescription opiates - 83% are still the old 'needle in the arm' type.

    Sad, I know, for many of you liberal Democrats to accept. It would be so much easier to blame pharmaceutical companies.

  182. Dear California Man
    I am a liberal Democrat and I wholeheartedly agree with you . Out of the patients that need Percocet for pain relief , a very very small percentage get " hooked " . I get furious when I hear the term
    " opioid" crisis . You are absolutely correct - it is a HEROINE crisis .
    I've had two periods in my life where I suffered from very painful injuries- once a serious back injury from a car accident and most recently from recurring various ankle injuries. I needed the Percocet as I was in excruciating pain . Why should I have to be denied pain medication because other people are taking heroine ??? It's ridiculous . I never got addicted. As the injuries healed , I didn't need the meds .
    But now the Damn government is sticking its nose where it doesn't belong . Leave drs to treat patients and stay out of my medical care .
    And you are correct - it's the Democrats leading the charge / and our NJ stupid governor .
    Whoever wants to get heroine will get it . It has nothing to do with legitimate pain meds .
    Medical care and drs should NOT be regulated by some governor . It's a travesty.
    Medical care is between a dr and their patient - not the govt . Same concept as abortion - between patient and doctor .

  183. California Man - the "conservative Republicans" are convinced there is an opioid crisis and that it stems from prescription pain killers. This has nothing to do with political leanings so get your chip off your shoulder.

  184. California Man - the "conservative Republicans" are convinced there is an opioid crisis and that it stems from prescription pain killers. This has nothing to do with political leanings so get your chip off your shoulder.

  185. In all seriousness, there are zombies everywhere and the entire nation is seeing a growing segment of the living dead.
    No program or system can make anyone quit any type of drugs until they want to quit or are forced to quit.
    I don't like it that way but the history is there and everyone knows someone that battled drugs.

  186. In all seriousness, have you never known
    a gate that didn't swing back?
    I've seen far too much recidivism and relapse.
    Getting beyond the gate is the objective.

  187. In all seriousness, what's your point?

  188. And therefore . . . ?

  189. there but for the grace of god go i.

    I grew up in 70s experimenting with all types of drugs. If I could do it over, I would not take that path. from alcohol, marijuana, hash, opium, mushrooms, lsd, cocaine. seemed like we would try everything EXCEPT heroin. Even then we knew that heroin was too GOOD a drug. that people that took it never stopped.

    Addiction is evil and we know so little about it, with all our advances, we still cannot identify it or address it. We spend 3 billion a year for DEA that makes it worse.

    and from a lifetime of living with an alcoholic, who was finally in rehab this year in a month long treatment after a week of detox, Every single opiate user in the group relapsed within a few weeks of leaving the rehab.

    We should be truthful with our kids. In that say, drugs make you feel good, we know that, but if you do heroin you cannot stop, and you might as well put a gun to your head and pull the trigger. It is too good a drug.

  190. re "people that took it never stopped":

    ....and then there are other people who take what is, unless i'm mistaken, identical: oxycod / oxycodone for relief of temporary pain.... and then they DO stop.

    rationality & personal responsibility make all the difference. i'm not recommending recreational drug use. i'm saying that we need a sensible policy for opioid-based pain relief that doesn't punish those who practice those 2 things (and can reap sane & tangible benefits from the drug).... because there are others who don't.

  191. “Really, the reason we care about the opioid epidemic is because it’s affecting populations that are white and affluent.”
    - Dr. Cunningham, Montefiore Medical Center, Bronx (extract from the article)

    What would it take for the community to care about the other types of people?

  192. So what's more dangerous? Heroin lined with fentanyl or an oxy from a pharmacist? Another in a long list of reasons why all drugs should be legal. The pharmacist in the Bronx was engaging in harm reduction.

  193. I have 4 siblings. We were raised in a two-parent middle class family. We have graduate and professional degrees. Two are addicts, one to alcohol and the other to drugs. Yes there is a genetic history on both sides of the family to contend with, but personal choice (at least in my view) is the main reason they succumbed. At some point, the weakness of the individual must be accepted as the primary reason the individual chooses to remain addicted. Its nice to blame society, capitalism, racism, history, politics and the rest of the "isms" that are used to avoid personal responsibility. In college I discovered that I needed to stop using alcohol because I couldn't control it. I managed to stop. If I had become an alcoholic, who should I have blamed? Do I have empathy for persons shooting up in public? Yes, but they are a danger, both as a negative example to children and a threat to the safety of others. Please don't try and argue that a junkie shooting up in public does not have the capacity for violence against a person, child, or property. Addiction is a public safety issue. No child in the Bronx, or any other place, should grow up believing that public addictions are just a part of life, or that no one cares enough to make them safe. Junkies choose their addiction. Do not foist ideologically fueled "cures" tied to class or race politics on the true victims of drug addiction: the non-addicted public.

  194. Self-pity is a choice as well.

  195. People die of accidental overdoses because they are using drugs that have zero quality control. Their potency and additives are unknown. Yesterday's just-right dose is tomorrow's deadly dose.

    Two groups benefit from the drug war: 1) organized crime and 2) people who need someone to despise and have learned to aim their rage at addicts.

    To save lives, bankrupt drug crime syndicates, and greatly reduce muggings and burglary, end the drug war. Let physicians dispense low-cost opioids that are controlled for quality and dose size. Addicts will no longer have to steal to pay for their next dose.

    Create more jobs that pay a living wage, so people won't turn to drugs in despair. Stop throwing addicts into prison, since a prison record makes them unemployable for life. Treat their addiction instead of punishing them for it.

    Read Johann Hari's "Chasing the Scream" to learn the ways drug prohibition has had the same damaging effect on American that alcohol prohibition had.

    (No, I'm not an addict; yes, some of my loved ones have abused drugs.)

  196. Bravo to the Teamsters' Union, for going after the distributors of opioids. The union realizes that this epidemic has hit their members and members' children and are acting to do something about it. Hopefully, other groups with power will step up.

  197. I grew up next to the second biggest heroin epicenter in Germany in the 80`s.
    -Needle excange is very important because at they get spared most soars.
    -Blue light in dark corners/ bath rooms makes it impossible to find a vain.
    -The Austrians had a program where they dosed down the opioid junkies over month under medical control with tremendous succes. Fully capable members of society.

  198. When it was in the black community it was a crime, now we call users vulnerable populate. Make it legal already, with easy and safe places to use. Better still give everyone a country whose bankrupt culture doesn't want to make them nod out.

  199. The photos in this article are just breath-taking; they are so poignant, they literally take your breath away. These stories are just so, so profoundly sad. I just want to reach out and take the pain away of those who are still sick and suffering.... Our Father.....

  200. Our students from John Jay college spent a year tending to user's needs in the Hole before we were forced out by police. Our new project attempts to shine a light on the severity of the issue in the south Bronx. The Fanteca project is a crowd source funded project. please check it out.

  201. Alcohol kills more teenagers than all other drugs combined.

  202. By all means, lets put some money, resources and people together for The Bronx. The poorest borough in NYC is always shortchanged. Of course this is where the most drug overdoses will be.

  203. Come to Appalachia. We're way ahead of you Yankees.

  204. Cape Cod during the wintertime is an Appalachia.
    So aren't parts of New Hampshire and Maine.

  205. Neighborhoods such don't have addiction problems people do. The NYT is always trying to absolve people from personal responsibility be it the junkie who deliberately breaks the law and uses illicit drugs, to the illegal alien, to crook who resists arrests and then gets injured or the gambler who tried flipping property during the real estate bubble and lost.

  206. Opioid addiction, at least manufactured, is mostly a marketing and profit choice. This crisis is mostly manufactured. No less horrible, but a choice. Much like mass murder by automatic weapons, though not as noteworthy. No NRA out there selling fentanyl, but the same idea.

  207. Pretty much a poor person genocide.
    Be it the rural poor or urban poor.
    We spend billions fighting and rebuilding in foreign lands, instead of investing in our poor communities.
    We act like we can't stop the flow of drugs. As if our mighty military couldn't prevent a Mexican cartel invasion just because the cartels have planes, boats and ladders.
    We don't care about our poor.

  208. There were many street dealers here in Los Angeles as recently as 2 years ago that could provide one with practically limitless prescription opiates , real ones, that could go as high in price as 30 or 40 times as much per pill on the street as in a legal pharmacy (say, Oxycontin 40mg, at $25 per pill). Where did these come from? Theft and fraud? Nevertheless, you could get what you needed.

    Slowly, as the new, stricter opiate prescription laws took hold, these dealers were not able to continue to supply their longtime customers with those pills and also continue their own usual income streams. So where did the street pill customer turn? Heroin-even cheaper than said Oxy @ $25.
    Some of these folks know not how to deal with this change, in dosage strength and administration.

    Dealers traditionally want to ''step on'' (dilute) strong batches of the powders with harmless material to make them go further and be more profitable, while giving the customer the same, consistent high. This can be tested with test kits. Are drug slingers getting 50 times more value with the inclusion of Fentanyl etc. into their heroin trading and passing that on to the user? This, as well as claims that users are unknowingly getting drugs that are 50 times more powerful than what they had previously had makes no business sense.

    The bottom line is a direct correlation between overdose deaths and the rise of stricter opiate prescription laws.

  209. Prohibition made alcohol illegal. As it was illegal, there was no regulation of its purity or potency. The public's demand for an illegal product for human consumption promoted organized crime, tainted alcohol, and desperate people. When Prohibition ended, the public had access to legal, taxed alcohol, and that commodity ceased to be a profit center for organized criminals.

    Seems to me we are in a parallel situation with illegal drugs. Because they are not available at low cost through legal channels, criminals supply a product that is overpriced, and often of a quality that kills. Users become a drag on society, and themselves may resort to criminal behavior to raise the money to feed their addictions.

    Why can't we devise a system where bona fide addicts can register, and by registering, have access, on a medically supervised basis, to drugs formulated to be consistent and pure? These addicts would no longer be a source of revenue to the illicit drug industry, and therefore the profits would disappear. No profit usually results in no more activity. Addicts would be able to access treatment and recovery programs, but would not be forced to do so. A drug addict taking affordable pure drugs is better than an addict dead in an alley.

  210. People need to realize that drugs dont give a crap what race you are.

    Im a white ex-heroin addict who has been sober for years. I was doing heroin way before it was like it is today, and I find it disgusting that liberals seem to believe that the opiate crisis is some sort of racial payback.

    The Opiate doesnt care what race you are, and it effects all races in the same way. The Opiate is what we should be fighting, not each other.

    Besides, if you look at data we see that during the crack epidemic the death rate per 100000 people went from 2 to 3 and 90% of that increase was seen in dense metro areas. Today the death rate has risen from 3 to 16.3, and the death rate is increasing accross ALL. demographics, not just rural whites. Comparing the crack and opiate epidemics is something that liberals profess to hate: FALSE EQUIVALENCE

  211. Meanwhile the Life of those, and their caretakers, who need opiates to get by some modicum of peace is downright wrecked, made miserable by fear of doctors to exercise their judgement. My mother, 91, with severe cellulitis among the other many things that come with age had to go to the ER by ambulance to get some relief because the doctor would not help her. Thank u Medicare for paying for this.

  212. The most successful Treatment Center in the Metro Region of NYC is in Mendham, New Jersey: Dayton Mendham - an independent stand alone TC founded in 1992. Recovery is tracked: 80-90% 5 year.

    The New York Times would do well to visit - and learn. There is a reason for these numbers over so many years.

    Addicts will not do well unless they wish to do well. There's no magic. It's will power and desire. The teens on route 24 west of Morristown do well. They voluntarily abandon tobacco... or they cannot gain admission. Staff the same.

    Judges probate and the line forms.

    I founded this center during a probation period of three years - to honor a pleading that was obliged by dishonest counsel - addressed by President Clinton in the only pardon ever issued to a Wall Street executive.

    And my life time ban issued by the SEC was vacated to silence from the complicit journalists that played along to gain access to Giuliani's robust horror show that would be outed as a disgrace if decent reporting replaced those that wished to pump that man.

    The book I have not written would provide the detail. The list of those that did not want what happened to happen is long.

    So is the list of kids that have recovered to live again with one year spent at the Mendham TC run by Jimmy Curtin, a former heroin addict that quit tobacco when challenged by the kids he saved.

    It's a great story, all of it.

  213. The two women in the lede picture are addicts. Both are.

    Adult treatment centers often take two years to rehab with any hope of success.

    Teen centers take one year at most.

    The cleaned up teen becomes a force. Adults remain at risk for life.

    These are facts. You will not read them in the newspaper. Reporters do not ask.

    The cost of rehab for a teen is a fraction of the cost for a repeat offending adult.

    And the likelihood of success with the willing teen suggests the cost.

  214. The photograph at the top of this article is reminiscent of a Picasso (The Tragedy) or Leonardo's recently (re)discovered Salvador Mundi. We (OK, I'll speak for myself - I) occasionally need reminding that those affected by this scourge are not nameless faceless junkies but real people, and so are those who help.

  215. All kinds of substance addictions that can result in premature death.. Add cigarettes probably alcohol as well as ... and heroin..(now and then).

    Eventually we will understand the mental or other pathways at a cellular level that cause some people to be addicted easily and others not.

    Best not to get started... and in some cases it is the scripts... In others, the desire to experiment.. find out what it's really like. Opioids seem lighter than and are less dangerous than the heroin that is currently out there.

    BIG $$$at all ends of the spectrum..

  216. Legalize opium. Let opium cravers have access to opium in opium cafes/dens. When opium was legal we didn't have this scourge of needle based opioid addiction with attendant death and disease. Sure, opium users/addicts were looked down upon, but they weren't dying and most had an otherwise normal life. The addict would just retire to the opium den for a few hours of drugged meditation. It is very difficult to overdose on opium. The user would get violently sick before they reached the point of overdosing. Bad opioids have driven out "good" opioids, all due to prohibition, which does not work, never has worked and never will work.

  217. Fentanyl. coming across the border and distributed with a Amway/ Amazon efficiency. build the wall what ever form.