Nodding Off Into Eternity -- Heroin-Overdose Deaths Climbing; Seattle Addicts Say They Know Why
WHEN NIRVANA lead singer Kurt Cobain committed suicide in April, with traces of heroin in his blood, vigils and national magazine articles followed. There were news stories again last week when Kristen Pfaff, bass player for the band Hole - which includes Cobain's widow, Courtney Love - was found dead in Seattle of an apparent drug overdose. For heroin addicts, though, friends die every week, quietly and without headlines. And things are getting deadlier, addicts say, because of a little-noticed trend in combining heroin with another sedative. Last year deaths in Seattle jumped by more than 60 percent.
Late last year, a phone call awakened a woman in her Capitol Hill apartment. She answered the phone, talked for a minute and cuddled back into her boyfriend's arms, not realizing he was dead.
A little later, she looked at her boyfriend's face and saw his long blond hair strewn over his face. Taking care not to wake him as she got out of bed, she moved his arm and saw it move back to where it had been.
"I guess rigor mortis had set in," she said. "The coroner's report said I'd probably been sleeping with him for six hours."
They'd done a shot of heroin before bed. Her boyfriend apparently got up in the middle of the night, did another shot and overdosed.
She was thinking of him the other afternoon as she leaned over her new boyfriend, who sat slumped on a couch, his eyes almost closed, his head nodding forward. She shook him by the shoulders and implored in her sweetest voice, "Come on baby, how much did you do? A gram? A half-gram? A quarter-gram?"
Each time the young man nodded in a slow zigzag, so it was impossible to tell whether he was indicating yes, no, or simply nodding off. The woman said they'd gotten into a bad argument and he'd taken a few Klonopin pills, an anti-seizure sedative that junkies in Seattle say they're increasingly using to stretch out their heroin highs.
Eventually, the woman gave up her questioning and struggled to get the man to his feet. She pulled up the man's jeans, slung his arm around her neck and lured him outside for a walk, promising to buy him Snapple, his favorite drink.
"Please, baby, stay with me for a few more days," she said as they stumbled down the street.
It's a common scene in heroin circles these days as the opiate continues to take a greater toll. A recent tally by the King County medical examiner's office found that 95 people died from heroin last year, up 61 percent from the 59 people who died the year before, and nearly three times as many as the 32 who died in 1986.
In an apartment building near Broadway on Capitol Hill, a place where neighbors are more likely to come looking for heroin than a cup of sugar, junkies say death is like a roommate without a life: always there.
Drug affects breathing
On a recent Saturday night, a couple of young men in one of the apartments were making the other junkies nervous. One stuck himself in the wrist. The other injected himself in the forearm, then set his needle on the table. His blood fogged the clear plastic of the syringe.
Moments later, their chins dropped and eyelids drooped as they began what junkies call nodding off.
The heroin depresses the part of the brain that causes breathing, so a strong dose, or a regular dose enhanced by Klonopins or alcohol, can make junkies stop breathing unless somebody keeps waking them up.
So every few moments, someone looked over and called the two men's names. They would look startled, look around, say thanks and begin nodding off again, oblivious to a gunfight on television.
During a moment of lucidity, one of the young men said the first time he nodded off, it scared him. "I didn't know what was going on," he said. "I started drinking cup after cup of coffee, but of course, it didn't do any good."
One of the older junkies, who sat cross-legged on his small space on the floor, said: "You should be scared. That's how people die. They drift off and they never come back."
The bloody needle on the table also made the others nervous, although none of those in the room thought they had the AIDS virus.
"AIDS is probably what junkies are afraid of most," said one. The others, seated on the floor or on mattresses, nodded.
Heroin can also be smoked, which takes away the risk of picking up somebody else's needle and getting the human immunodeficiency virus from it. But the effects are not as powerful as injecting it directly into the bloodstream, so these addicts still rely on the needle.
"Every night when I go to sleep, I go over my day and think if I did anything that could give me AIDS," the young man said. "I lay there and I think: This sucks."
But he said, "Heroin addicts don't think in the long term. The next morning when I wake up, and I'm starting to go through withdrawal, all I can think about is getting my next shot."
One of the older junkies, who is in his 40s, said, "None of us expect to go gray. You just hope it happens quick and painless."
Later that night, they were remembering the dead.
Names of the junkies they'd seen die in the past few months. A woman said she's known 17 junkies who died from overdoses, suicides or AIDS-related illnesses in the past year.
When Kurt Cobain killed himself, with traces or heroin in his blood, his gentle, lightly stubbled face adorned the covers of magazines. But the woman said hardly anybody noticed when her friends died. The story goes that when "Dirty Danny" slumped over a cup of coffee in a cafe in the neighborhood, a waitresses unknowingly walked by his body until another addict noticed he was dead.
The thought of dying alone and anonymous makes the woman sad. The woman, who is in her mid-20s, said the deaths should be remembered because too many people in her generation are glamorizing the heroin they see popular musicians like Cobain use.
The woman said that in addition to more rehabilitation for people already using the drug, a stronger message needs to be sent that life on heroin means seeing those closest to you die one after another, until it eventually kills you, too.
Living with death has made her hard and made her think she's lost part of her former self. The first time she saw somebody die of a heroin overdose, the woman said, she had nightmares for months about his eyes. She remembers that he was a used-car salesman and that the eyes that stared up at her as she tried to revive him were fixed and dilated, and stayed that way.
"Now I feel numb about things like that," she said. "You have to."
The heroin helps make her feel numb. That's what the drug does and why a lot of junkies start using it.
`Can't feel normal without it'
Unlike cocaine, which users say sharpens the senses, heroin seems to give a feeling of comfort and insulation. Many of the addicts in the building talked about sexual abuse as children or traumatic experiences like losing fingers in an automobile accident, and said heroin was the only way they've found to deal with it.
"I can't feel normal without it," said the woman, who has been talking about getting on the legal heroin substitute, methadone. "When I'm completely straight, I'm always crying. I'm always afraid."
But it leads to a vicious cycle. Taking heroin means being able to "cop out" of dealing with their problems, the woman said. Eventually, they begin stealing or prostituting to support their habits (a typical habit can cost $80 to $250 a day). They feel ashamed of themselves, and how do they deal with it? They take another shot of dope.
"That's one of the hardest things about withdrawal," said the woman's boyfriend. "All these feelings you haven't been dealing with come back in a rush when the dope wears off."
A neighbor took a pensive drag from his cigarette and said he feels alone. He said seven of his friends have died in the past year, including a woman who came out of detox, took a shot of heroin in a car outside the clinic and died because her body had grown unaccustomed to her usual dosage.
"I don't feel like I can get really close to anybody," he said.
King County health officials said more people are dying because more people are using. But the junkies said the increasing popularity of Klonopins, the anti-seizure sedative, is also adding to the deaths. The drug often is prescribed for depression, and junkies say they know which doctors prescribe the pills freely.
As the two young men were nodding off that night, an older, clear-eyed junkie got righteous. He would never do pills, he said.
"Look at me. You can't tell I did a shot a little while ago, right? You see them, that's the Klonopins."
He and others in the little room said the sedative has always been around the heroin scene. But it has been getting more popular because the quality of black-tar heroin seems to be worsening and highly potent Asian heroin, China White, is hard to come by. Taking "pins" means having to do less heroin, which is more expensive than the pills.
The trend has gone unnoticed by health officials. Egle Weiss, a forensic toxicologist at the state Health Department, said no heroin overdoses have been attributed in the past two years to a combination of heroin and Klonopins. But she said toxicologists didn't know the two were being used together and hadn't been testing for Klonopins in overdose cases.
Ron Jackson, director of Evergreen Treatment Services, a rehabilitation center near the Kingdome, said he began hearing stories from addicts about the rise in Klonopin use about a year ago. He said the pills probably do account for some of the rise in heroin overdose deaths. He said it boosts the effect of the opiate in the blood.
"What might might have been a normal dose," he said, "becomes a fatal dose."
Copyright (c) 1994 Seattle Times Company, All Rights Reserved.