This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.


All heroin addicts who registered for methadone treatment in Albuquerque in 1969–1971, 1019 in all, were the subjects of this follow-up study, conducted in 1991–1993. The cohort was almost entirely of Hispanic (Chicano) ethnicity, 86% male, with median age 27 at entry. We located 776, dead or alive, and we were able to interview 243 concerning many aspects of their lives. At least one-third of the original group had died during the 22-year period, representing standard mortality ratios 4.0 for males and 6.8 for females. Drug overdose, violence, alcohol, or suicide accounted for nearly all deaths of which the causes were known. Despite the availability of treatment, including methadone maintenance, both heroin use and criminality continued at a high rate. Of the 428 known survivors, 48% were currently enrolled in a methadone program after 22 years. They were using significantly less heroin, alcohol, and other drugs (except nicotine) than those not on methadone. Similar beneficial effects of methadone maintenance were reported retrospectively at interview. Our findings offer an insight into heroin addiction as a chronic lifelong relapsing disease with a high fatality rate.¹

Sarah and Ramone: Hunts Point, Bronx. Courtesy of Chris Arnade.

The pallor of addiction is grey. Or maybe it's the pallor of the dirt under torn fingernails.

Grey face, slack jaw. Upright coughing until hands land on knees for a few heartbeats, head down. Sarah.

"You didn't set the alarm? It's 4:20. Fuck. How could we sleep that long?" Ramone's accent, low and fast, uncurling from under the bridge. A father's urgency.

"Oh god. I was supposed to see my babies from 3 to 6." Her babies, a toddler and a three month old, taken when opiates were found in Sarah's system at her youngest's birth. (Methadone, she said.)

The foster mother brings the babies with symmetrical sets of matching bows in their downy hair to visit the foster agency. Scheduled, supervised visits, newly instated. Today, Sarah and Ramone could catch 45 minutes of the judge's three-hour allotment.

Sarah and family, before: Hunts Point, Bronx. Courtesy of Chris Arnade.

The sound of spit gathers in Sarah's throat, but she's drymouthed and can't levy enough throat effort to muster spit. Her face and neck exhibit dirt streaks like brushstrokes. She's been coughing for a while now, between abandoned house and bridge homes. Ramone has outpaced his 102-degree fever.

"We can still make it but can't go sick. We'll get straight, then go." It wouldn't take too long to find drugs.

Her feet have bandaids in twin spots, on the second toe. They're dirty, stubbornly so, requiring a wash and re-wash in an open hydrant. Just her feet, not her body. Today she doesn't remove her clothes and expose her sores like she has before, when she bathes in emptier roads' hydrants. There isn't time for that.

Sarah: Hunts Point, Bronx. Courtesy of Chris Arnade.

To Sarah: Happy 33rd birthday, dear woman in a place where aging is frenzied but no one is old.


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