Newsday - November 2, 1997
Laurie Garrett - Staff Correspondent

To "walk the thread," the two men must first trek across a broad field that cuts Palermo off from the city. The field, littered with syringes that crunch underfoot no matter where you walk, is used 24 hours a day by hundreds of addicts who can't wait to inject their drugs, sharing needles in small groups huddled on the bare ground. Then, the men must wind their way through the dangerous alleyways that zigzag between concrete fortresses surrounded by steel walls with hand-sized holes used to quickly, anonymously, exchange money for drugs.

It as an area, city officials say, inhabited by an estimated 10,000 Gypsies and their "slaves," addicted adolescents who work as runners and testers for nothing more than a daily hit of narcotics.

This night, Artur and Oleg swiftly walk the thread to the concrete mansion of Luba, a middle-aged woman who is dressed in the shiny, multicolored clothing favored in the neighborhood. They make their deal and, with dried poppy plants in hand, return quickly to Oleg's apartment, which he shares with his mother and grandmother.

There, Artur grinds the poppy into powder in the kitchen, as Oleg sits in the living room, talking with his mother, Svetlana, and a reporter. He tells them he is no longer an addict, and promises his mother that he will not inject the drugs with Artur. "If I slip down again," the university graduate says, "I want to die."

But Svetlana is not convinced.

Oleg has already lost a good job and a wife because of the drugs, she tells the reporter, adding, "If you have an intelligent son, you really grieve when he becomes a drug addict." Her voice breaks on the word "narkoman," Russian for drug addict.

Throughout the former Soviet Union, young men and women - starting as early as age 8 - are sniffing, gulping, smoking and injecting themselves with narcotics at levels unprecedented in the region's history, a crisis reaching such huge proportions it is the single largest concern for public health advocates. A major contributor to exploding levels of associated diseases such as HIV, hepatitis, cardiovascular disease and depression, it has spiked levels of violence and suicide and is helping to rip apart the fabric of family life.

"What we face is unprecedented, colossal," Dr. N.F. Gerasimenko of the Russian Academy of Medical Sciences told the Russian legislature in May.

In the communist days, Soviet-dominated cities from Kamchatka to Berlin had narcology hospitals that functioned as punitive, forced-treatment centers for users who were either snared by police, or who had gone to other hospitals suffering from hepatitis or overdose, said Dr. Oleg Zykov, a Moscow-based substance abuse expert. "And if somebody was arrested a second time in the process," he said, "they were automatically sent to prison."

But in 1991, the rules changed, Zykov said. When the Soviet system fell, many hospitals and prisons were closed due to a lack of funds and the end of the repressive system that supported them. And those whose job it was to fight the war against drugs, and deal with its victims, were suddenly adrift in a world in which criminal gangs are virtually unchecked, where borders are insecure, medical resources scarce or non-existent, and addicts face dramatically higher risks than their American counterparts.

Indeed, experts say this drug explosion is so new and has grown so quickly that everyone - the gangster who smuggles it, the pusher who sells it, and even the young addict who uses it - is improvising, making every traditional target of existing health programs, and old-fashioned law enforcement, unpredictable.

An examination by Newsday of more than 20 cities in five formerly communist countries supports that conclusion. It found that illegal narcotics and amphetamines are purchased easily and openly by individuals of any age.

In Moscow, Dutch physician Murdo Biji, of the volunteer group Doctors Without Borders, has labored for more than a year with young drug addicts, trying to understand the step-by-step process that has facilitated passage of the human immunodeficiency virus and several types of hepatitis viruses into the young adult community.

The problem, he says, is that the government - including both its health care establishment and police - has no clue as to the shape of the current epidemic, or where it may be headed.

"There is no research done here," he says, noting that police don't know how many addicts are out there, what they're using, why they got involved in the first place, and what it will take to get them off the addiction treadmill.

And the anecdotal evidence is both confusing and frightening, he says, pointing to weekend addiction that probably involves a majority of Moscow's 14- to 18-year-olds, an extraordinarily naive group who generally do not believe they are addicted or face health risks.

"It is the '70s here," Biji says, noting that ex-Soviet youngsters today are taking drugs with the same carefree attitude western youth exhibited 25 years earlier, before the age of AIDS.

He thinks this group would respond well to organized peer education programs, or to drug counselors trained to help occasional users, public health outreach programs common in other societies. Unfortunately, he says, Russians have no expertise in running such programs and are distrustful of them. Where they exist, he said, they are largely European funded and inspired, and have little support from either the public-health establishment or the police.

Beyond the part-timers, Biji said, is another subset of teens and young adults who have graduated to full-time abuse, injecting poppy straw extracts, heroin, amphetamines, or a Polish-invented mixture of drugs called compote. Though this group is much harder to influence, they need to be made more aware of the problems inherent in shared needles and sloppy preparation, Biji said.

In discussions with scores of addicts in the region during the past year, Newsday found that virtually all share needles, even when an individual has a separate supply. What the full-time users need, Biji said, are programs that provide acceptable alternatives such as methadone, a heroin substitute that can help rachet down addiction, and sterile syringes, which can reduce associated diseases.

But methadone is banned in Russia. And while there are some needle exchange programs funded by outside agencies, such as Doctors Without Borders and UN AIDS, they are frowned upon by much of the narcology establishment, who argue that they encourage drug use.

"The official narcology service is very arrogant," said Dr. Zdenek Jezek, the UN AIDS representative in Moscow. "They think this outbreak of drug use is due to changes in legislation."

Evgeny, 22, a former professional soccer player in Estonia, began at his friends' urgings, he says, using chornie and amphetamines to dull the pain from several injuries. The practice landed him in Tallinn's Merimetse Hospital this summer with dual hepatitis B and C infections.

"I never shared needles. I use my own," Evgeny insisted. "But maybe the drugs were contaminated. I've heard that some people sample the drugs and put their own blood in it."

In fact, the manufacture and use of these drugs often involves exposure to blood, Newsday found.

In Odessa, for example, dealers who make huge batches of chornie test the potency of the drug on so-called "slaves," addicts who work in exchange for drugs. The "slaves" dip their needles into these batches, often plunging down on the syringe before pulling up a sample. In this way, the "slaves" pass their viruses into the larger brew.

In Moscow, Biji has documented cases in which some Moscow addicts, who don't have acetic anhydride on hand to home-brew chornie, inject their own blood into the pot to replace the missing chemical. Dr. Grigory Latyshev of St. Petersburg said he's found many cases in which addicts use their own blood to "flush out" tiny bits of narcotics left in syringes used by other addicts and the original cooking pot. They then inject it back into their own bodies, along with any diseases carried within the group.

These practices, experts say, go directly to the lack of education among regular users, a deficit Newsday found clearly evident in the region.

"I was very addicted to chornie," said 16-year-old Anatoly, who was in Moscow's Narcology Hospital No.17, suffering a severe case of hepatitis C, which is likely to cause cirrhosis and, possibly, liver cancer over the coming years of his adult life. "I think I got it [the illness] because of Gypsy magic."

While such comments are worrisome, some in the international health community say it is more frightening that youngsters like Anatoly seem to be such a mystery to officials responsible within government for preventing epidemics, and to law enforcement intent on stopping drug use.

Today, Zykov says, "The official narcology is going through a severe crisis . . . The narcology service in 1991 had a choice: to lobby for repressive forms of alcohol and drug addiction control, or to look at other models." They opted for the former, he said, and continue to seek dramatic funding increases to expand their hospitals at a time of economic shortfalls. They also are seeking a return to a past system that puts education and safe needle dispersal at risk.

Many police say they are overwhelmed by the drug abuse explosion, and the huge amount of money that supports it.

Dozens of interviews throughout the region ended with the characteristic shrug when police were asked why they allowed drug sales to continue openly on the streets of their cities. They often cited the lack of resources, manpower and willingness among their leaders to take on such a battle.

In Moscow's Pushkin Square subway station, two uniformed officers toting Kalishnykov rifles strolled through a heroin sale while a Newsday reporter stood nearby. They obviously saw what was going on, but took no action. "They don't care," a drug addict said. "They see this every night."

Additionally, users and dealers suggest rampant corruption is a main reason for police inaction.

"We always know in advance when a real raid is going to be made," laughed one St. Petersburg dealer. "The only people who get arrested are us [addicts]," says Alex, 17, in Moscow, whose father was a former KGB official. "The cops pick us up sometimes, beat us, take our money and watches and jackets and dump us back on the streets."

While it's difficult to determine if police corruption is as widespread as most suggest, the World Bank cited law enforcement and judicial corruption in its latest annual report as a key factor holding back development of the former Soviet states. World Bank surveys suggest more than half of business and criminal justice negotiations involve bribes.

And the gangsters who control the drug trade are slowly moving the young addict populations from cheap poppy straw to the more lucrative heroin market, experts say.

"Heroin use, which is already 30 percent of all drug use in the country, is still on the upswing," said psychiatrist Pavel Bem, who is one of Eastern Europe's leading experts on drug abuse and chair of the Czech government's anti-drug commission.

Bem said there are two main problems for governments in the region: The ready availability of drugs and the low cost. "The weakening of our border controls and our police forces" have contributed to these factors, he said.

Additionally, he said, the gangsters who supply the drugs have been good students of capitalism, "holding their prices way down at introductory levels" in order to reach the largest number of people in an ailing economy.

In Moscow, which has the third highest cost of living among the world's major cities, a daily supply of high-grade heroin averages $17. The same quality drug would cost two to three times as much in New York.

And the gap is wider elsewhere in the region, according to interviews with users, dealers, health experts and police. High-grade heroin sells for $10 a dose in Odessa, for instance, and a low-grade poppy straw is available for $6.

The cheapest high is vint, an extract of ephedrine allergy pills that are chemically oxidized to ephedrone, a powerful hallucinogen. In Moscow, vint costs about $3 for a daily dose, and is frequently sold by elderly women who supplement pensions by getting free pills from the government for "allergies," then making vint in their kitchens.

One of the principle selling spots for vint in Moscow, witnessed repeatedly by Newsday, is Lubyanka Square, directly across from the headquarters of the Russian police known formerly as the KGB.

In the old days, many Russians said, alcohol and violence were the main problems seen among people in their mid-20s or older. But now, this one-two punch from the past is merging with the growing epidemic of drug use by teens and young adults to create a potentially cataclysmic situation.

In Russia, for example, arrests for drug-related crimes among teens have doubled since 1991. And health professionals say drug abuse is also a major contributor to the sharp rise in suicides among teens in the region.

Today, the path to self-destruction can start very young and continue through an often short lifetime, experts say.

"Do you sniff glue often?" 10-year-old Arsen is asked after a reporter finds him and 13-year-old Yosha filling a plastic bag with model-airplane glue in a shopping mall in downtown Novosibirsk, Siberia's largest city.

"Yes, I like it!" the boy answers, covering his face with the bag, and inhaling.

Psychologist Anna Terentjeva, of the Moscow-based drug group NAN, which stands for "No to Alcoholism and Drug Addiction," says drug use is becoming rampant in ever younger communities. She and her staff have just completed surveys in Moscow colleges, she said, that reveal a startling 100 percent of the students have tried drugs, while half say they use heroin, other narcotics or amphetamines regularly.

But the drug use upsurge is most pronounced, experts say, in industrial areas built, for the most part, during or immediately after World War II, as the Soviet Union built itself into a superpower.

Millions moved to these cities during the 1960s and '70s, mostly voluntarily. The pay was good and Moscow gave its top industrial centers highest priority for shipments of fresh food, new clothing, televisions and consumer products. In times of great scarcity for the rest of the Soviet Union, workers in Novosibirsk, Nor'ilsk, Kemerovo or Narva had tomatoes in February.

But with the collapse of the Soviet Union has come a tough transitional economy in which the industries of the past have closed.

In Estonia, the Russians built a heavy-industry complex in the old medieval village of Narva, near Russia's northwestern border. Prior to 1991, Narva was prosperous. Now nearly all the cement, textile and metal factories are closed and 39 percent of the people are unemployed. "Democracy is good, but it's better when you have something for young people to do," moans Narva's Deputy Mayor Viktor Veevo. The Estonian-born Russian estimates that 3,000 people in Narva between the ages of 14 and 25 are drug addicts, or about one out of every five residents. "I'm trying to set up things for them to do," he shrugs. "You know, democracy equivalents of the Young Pioneers and Komsomol."

Which seems laughable to Ramon, 23, recovering in Narva's infectious disease hospital from dual infection with hepatitis B and C, acquired after six months of shooting poppy straw. The unemployed, divorced father of a 2-year-old girl started using drugs because "everybody does. It used to be alcohol; now it's drugs."

But, no one told him drugs could hurt your health, or that shared needles could spread hepatitis. Ramon vows he will find a job when he recovers, but that's a tough prospect for a former Russian, now that the Estonian government has passed laws requiring Estonian language skills to gain citizenship, and citizenship papers to attain employment.

"He will never stop," clucks nurse Irina Odnolko. "They never do. I say to them, `Why don't you do something with yourself?' And they say, `Life is already gray. There's no point.' "

The incidence of hepatitis B and C is up 400 percent in Narva since 1992, said Dr. Olev Silland, the director of that city's hospital, and his guess is there's as many as 10,000 IV drug users in the city, or one of every eight residents.

In more affluent Prague and Moscow, different dynamics are at play, says the psychiatrist, Bem.

"If you look at young teens today," Bem said, "to build a career and to be valuable to society, it means you have to fulfill a lot of very difficult tasks. And a lot of young people say, `We cannot do it! We cannot fulfill this demand. We are not counted.' It's senseless. They have no sense of grounding."

Under the fashionable Arbat shopping district in Moscow, 17-year-old Alex and his teenage buddies laugh loudly as a drunk man in his 30s mistakenly tries to enter the subway through an exit turnstyle, and collapses with a moan. "Only fools drink bad vodka," the young drug addict tells his friends.

Later, in a nearby restaurant, the teenagers - who admit they are heroin addicts - explain themselves in terms that echo Bem's comments.

Alex, the youth whose father works for the KGB, describes how he graduated from vint to chornie, and finally to heroin when he was 16. He insists, and Vlad agrees, that "80 percent of teens 14 to 18 use drugs now. And the other 20 percent have at least tried it."

The two teens met in the hospital, where they were being treated for hepatitis C infections. They say they know there are risks, but they are willing to take them. "I just don't think about them," Alex says. "I prefer a short, bright life to a boring one. The only thing I'm scared of is an overdose."

Back in Odessa, meanwhile, Oleg continues trying to comfort his anxious mother, while Artur cooks their ground poppy straw in a succession of highly flammable, putrid chemicals that include acetone and paint thinner. Often the first interaction such young drug users have with the health care system is on the burn wards after kitchen explosions.

After three hours of shopping, grinding and cooking, Artur reveals a saucepan containing about four tablespoons of a smelly, dark brown concoction. He draws half of it up into his 20cc syringe, while the other half awaits Oleg's attention. Then, the two men make eye contact, pause, and - as promised - empty both the syringe and the pan into the sink.

For one night, they are no longer addicts stuck in a system that seems determined to defeat them. For one night at least, Oleg has kept his promise.

TOMORROW: The Plague of Alcohol

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