This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty and prostitution in Hunts Point, Bronx. For more on the series, look here.
A heroin addict steps over mirror shards in seek of the far side of the enclave, crooks his elbow, applies elastic tension below his right bicep, hides his eyes behind a low-hanging concrete support beam. 45 seconds, done. Tossing the syringe atop others of its kind amongst the covered embankment's litter, he returns at a slower loping pace, eyes hooded, speech pause-ridden and dulled, courtesy of his opioid depressant. "Okay, now I can interview."
Roland, Hunts Point. Courtesy of Chris Arnade
Twenty-one-year-old Roland has injected the opium poppy derivative for several years, since leaving his childhood group home. "My heroin addiction's ruined my life so far. I promised myself I'd never do it; my mom passed away from heroin addiction."
Despite the desperate want to be rid of the needle, the opiate enslaves parts of the brain's message transport system. Heroin (a few biochemical processes down) triggers the overproduction of a neurotransmitter in the brain called dopamine, eliciting a euphoria that heroin abusers come to crave. As users become reliant on the drug, the body adapts to the heightened amount of dopamine and seeks what has becomes its normalcy: a raised level of the neurotransmitter. Over time, addicts need more and more of the drug to feel the same initial high, and when off heroin they become "dope sick," feeling the debilitating drop in dopamine production. The perpetual upping of the drug dosage ante becomes a reckless cycle, both in life and in neural pathways, causing chaos in the brain's signal transport system.
In Hunts Point, Bronx, addicts like Roland occasionally find themselves court mandated into rehab programs, many of which include methadone treatment, a form of opiate-abuse therapy that stabilizes the amount of dopamine released. After a pattern of opiate abuse, the brain cannot fill the divots of dopamine shortage on its own, and needs a physical crutch to stabilize the neurotransmitter level swings associated with heroin cravings. If such a crutch isn't found, an addict reaches dope sick withdrawals -- nausea, headaches, insomnia. Methadone stops the craving cycle, taking residence in needy receptors that have previously been occupied by heroin and regulates dopamine release. Once taken, methadone blocks heroin's violent highs and malaise lows.
Some addicts abuse methadone just as they do heroin, and therefore avoid it. Others line up at the methadone clinic doors at 6 a.m., waiting for their plastic cup dispensary only to regurgitate their swallowed methadone some minutes later at a nearby fast food chain, profiting on the remix sale. Still others use it properly.
Annette, East Tremont, Bronx. Photo courtesy of Chris Arnade
The trouble is, like most things, methadone can be abused, but also, it must be consistently sought and taken. Patients start with a dosage ranging from double digits to several hundred milligrams then ween themselves off over time, sometimes over a period of years. Annette, for instance, is at 20 milligrams after two years in treatment. For many heroin abusers, rules call for clinics to administer methadone in liquid form on site. But for homeless addicts, appearing at the methadone clinic 5 or 6 a.m. on the daily isn't a consistency conducive to street life.
Brenda, Hunts Point. Photo courtesy of Chris Arnade
On the streets without treatment, hits are $10 apiece, with most needing one to start the day, one to go to sleep at the end of it and a few to cope with the in-between. Brenda needs six to seven, while others needs upwards of 10. She hooks to get her $70, plus some for food and shelter if she's lucky. $100 on a good day. If short, the sickness comes. With everyday mind set on earning enough to outpace immediate withdrawal, long-term treatment notions hide amidst far-flung dreams of leaving the neighborhood. "I can't live this life anymore. I'm an addict, but I'm a good person. I just got into a life of drugs, and I'm tired. I just want to be sober."