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With a Foreword by David E. Smith, M. D., and Richard B. Seymour
Page iv
Hazelden Center City, Minnesota 55012-0176 1-800-328-9000 (U.S., Canada, Virgin Islands) 1-651-213-4000 (outside U.S. and Canada) 1-651-213-4590 (Fax) http://www.hazelden.org
1998 by Humberto Fernandez All rights reserved. Published 1998 Printed in the United States of America No portion of this publication may be reproduced in any manner without the written permission of the publisher
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Library of Congress Cataloging-in-Publication Data Fernandez, Humberto, 1950 Heroin / Humberto Fernandez. p. cm. Includes bibliographical references and index. ISBN 1-56838-153-0 1. HeroinHistory. 2. Heroin habit. 3. Heroin habit Treatment. 4. Methadone maintenance. I. Title. HV5822.H4F47 1998 362.29'3dc21 98-9564 CIP
Book design by Will H. Powers Typesetting by Stanton Publication Services, Inc. Cover design by David Spohn
Editor's note
The Twelve Steps are reprinted with permission of Alcoholics Anonymous World Services, Inc. Permission to reprint the Twelve Steps does not mean that AA has reviewed or approved the contents of this publication, nor that AA agrees with the views expressed herein. AA is a program of recovery from alcoholism onlyuse of the Twelve Steps in connection with programs and activities which are patterned after AA, but which address other problems, or in any other non-AA context, does not imply otherwise.
All the stories in this book are based on actual experiences. The names and details have been changed to protect the privacy of the people involved.
Page v
FOR James, Carlos, Vanessa, and Julian
Page vii
CONTENTS
Foreword
by David E. Smith, M.D., Founder, Haight Ashbury Free Clinics, and Richard B. Seymour, Managing Editor, Journal of Psychoactive Drugs
ix
Acknowledgments
xiii
Part I: The Drug
1 The History of Heroin: The Discovery of Opium and the China Trade
3
2 The History of Heroin: Heroin in America and the World Trade
19
3 The Pharmacology and Physiology of Heroin Use
45
Part II: The Addict
4 The Psychology and Culture of the Heroin Addict
67
5 Case History: Heroin Addiction
81
Page viii
Part III: Treatment
6 Treatment for Heroin Addiction: The Behavioral Model
103
7 The Politics of Methadone Maintenance
134
8 Case Histories: Methadone Maintenance
153
9 Pharmacological Approaches to Heroin Addiction Treatment
166
Part IV: Society
10 Heroin and the AIDS Epidemic
187
11 Organized Crime, Heroin Distribution, and the War on Drugs
199
12 Heroin and the Criminal Justice System in America
245
13 Heroin, Popular Culture, and the Media
281
14 Heroin Addicts: Beyond Redemption?
295
Notes
303
Index
317
About the Author
327
Page ix
FOREWORD
The Drug That Never Went Away
Celebrity drug overdose deaths involving heroin, such as the death of comedian Chris Farley from a heart attack induced by using a speedball (cocaine and heroin), have raised the visibility of heroin as though the current wave of addiction were something new. Actually, heroin addiction never went away. Until recently, however, it's been eclipsed in the media by the phenomena of runaway crack cocaine and methamphetamine abuse. In reality, even though America has experienced a period of intensified stimulant abuse, unfortunately with methamphetamine abuse still rising and yet to reach its peak, the need for treatment of heroin addiction has continued to be a prominent feature of the American drug scene. Every stimulant abuser is a potential heroin addict, because of the well-known upper-downer cycle, a drug pattern observed at the Haight Ashbury Free Clinics every decade for the past four decades. Viewed from a statistical, public health standpoint, the focus on specific drugs of abuse is a matter of degree, not totality.
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