Breaking Good

A petite 21-year-old woman named Emilia sits outside Counter Culture Café on a sunny afternoon, eating a sandwich as large as her head. She's still high from the shot of heroin she injected hours earlier. On the surface, Emilia, whose thin and kindly face gives her a childlike air, seems alert. But she's been using the drug daily for the past year, and she says she's desperate to end the routine for the sake of her future, her daughter and her sanity.

"I'm tired of waking up, thinking of having to do [heroin]," says Emilia, whose real name was changed at her request. "I can't do anything. I can't, like, step into mommy mode unless I have done [heroin] because I am sick, laying in bed."

She speaks lucidly about her 4-year-old daughter and the husband she married at the spur of the moment just days before. She talks about her brief time working in retail, where she rose to the role of supervisor at Kohl's Department Store, and the three-bedroom apartment on Airport Road she once rented that is now, like her job and the stable life she once enjoyed, no longer hers.

She stumbled into heroin when she couldn't find a tablet of Percocet to ward off her symptoms of withdrawal from the prescription painkiller. Puncture marks on the tops of her hands and along the length of her arms bear evidence of this abuse. Her face is beginning to take on a sickly, ashen complexion. Her large brown eyes are glazed and dulled by years of advancing addiction.

It's surprising that a woman who stands barely five feet tall and weighs just 90 pounds can weather the extent of her habit. Emilia, too, is sometimes amazed at her own durability. But she is exhausted by the whole routine.

"I haven't had anything for a year," she says. "I lived with my family and stuff for a year. I want my own place, and a good job like I had. That's what I want."

The next day, Emilia would check herself into the Santa Fe Recovery Center, a residential detox program off Airport Road. She's waited a month for a bed to open up, and now that the opportunity has presented itself, she's excited by the promise of being entirely clean—not just for her sake, but also for her daughter's.

"I just want to be a good mom," she says simply. "I want to be a good wife."

Santa Fe's efforts to combat the sale and use of heroin have become a burdensome game of one step forward, two steps back. In May, the Santa Fe Police Department reported a significant drop in the number of burglaries committed in the city—its lowest number in a decade. This decrease, a 20 percent decline in property crime since 2012, is largely attributed to the increase in drug-related arrests.

"The number of arrests for heroin have gone up, and the reason why is, we made that the drug to really focus on and target here in Santa Fe, and [identified] that drug as the most addictive drug," explains an undercover narcotics sergeant with SFPD, who is also deputized with the Region III Drug Enforcement Task Force. (The sergeant asked not to be identified because of the nature of his work.)

Since SFPD changed its focus to heroin in July 2011, the department has taken down four separate drug trafficking organizations—each of which dealt a variety of narcotics—that were operating in the area. More than 20 individuals were arrested in these stings, according to SFPD spokeswoman Celina Westervelt.

Although there was a slight drop in the amount of heroin seized in New Mexico in 2012, heroin seizures tripled between 2009 and 2011, according to a 2012 New Mexico High Intensity Drug Trafficking Area report. The largest heroin seizures took place in Santa Fe, Rio Arriba and Bernalillo counties.
But the drug remains affordable, especially compared with the price of prescription painkillers like hydrocodone and oxycodone.

"You can get a gram of heroin for $100 to $120. What would take the place of a pill is a 'bb,' which is an equivalent to one pill, and that is $20," says Ernie Ortiz, regional director of New Mexico HIDTA. Prescription painkillers, on the other hand, can cost up to $80 a pill—four times the price.

Still, the recent stings in Santa Fe have caused the price of heroin to skyrocket. Now, police say, an ounce of heroin in Santa Fe can cost up to $500 more than it would in Albuquerque.

But that doesn't keep addicts from needing the drug—and doing whatever they can to get it. According to the HIDTA report, levels of heroin addiction and drug-related crime remain "unacceptably high" in northern New Mexico.

"I think it's gotten worse since the recession," Santa Fe Mayor David Coss tells SFR. "I think the availability and affordability of the drug have gotten worse, and I think people feel they don't have much to live for."
The result, he says, is not merely a crime crisis, but also a health crisis.

For Emilia, using heroin was a conscious decision: She needed it.

"It was all because of pills and cold sweats," she says.

Emilia was born in Arizona and grew up dividing her time between Albuquerque and Santa Fe. Her father managed a landscaping business, and her mom worked in retail. She was the second eldest of seven girls, and they all enjoyed what she remembers as a warm, comfortable upbringing. By age 15, she was on the high school cheerleading team, and she was in love.

She was at a friend's party one night when she met Mark, a short, scruffy young man she quickly fell for. They started dating and, by age 16, Emilia was pregnant.

"I didn't want kids," she says. "I was 16, so I was like, 'I'm not going to get to party, I'm not going to get to do this,' you know?"

At the time, she was living with her father in Albuquerque. He was a tough man who at times could be verbally abusive, she says. He wanted her to have an abortion. She did not.

"It's not her fault I made that choice," Emilia says of her decision to keep her daughter. "All I could do is make the best out of it."

While she kept clean during the pregnancy, Emilia says her boyfriend turned to meth. By the time their daughter was born, he proposed to her. Two weeks later, he disappeared.

Emilia returned to Santa Fe and enrolled in the Teen Parent Center at Santa Fe High School. To make ends meet, she took a side job at Kohl's. In six months, she worked her way up to the role of supervisor. Her boyfriend returned, they rented a three-bedroom apartment on Airport Road, and the prospect of a long and happy domestic life seemed tangible.

But soon thereafter, Emilia became friendly with a classmate of hers at the Teen Parent Center who abused prescription pills.

"She used to do pills, and I would hang out with her, so she would like, you know, crush them up," Emilia recalls. She would snort 10-milligram pills of Percocet. She liked the high the pills gave her. She felt energized and "loopy." She claims the pills didn't limit her ability to take care of her child, although the shame of abusing Percocet in the same house where her daughter lived was unavoidable.

"I felt guilty—kind of like, 'What the hell am I doing?'" she says.

The pills helped her "block out reality, make it better than what it is, cope with it better." Her habit graduated from one 10-milligram pill of Percocet a day to several 30-milligram pills from morning to evening.
One day, when she couldn't find any pills to use, she started feeling the symptoms of withdrawal: cold sweats, anxiety, "hot flashes" and nausea.

Her dealer didn't have any pills on him. He offered her "tar" heroin instead.

"I was like, 'Heck no!'" she recalls. "But then, you know, I'm sick, so I'm like, 'Well, if it's going to make me feel better...'"

Her dealer showed her how to put the "tar" in a spoon with water, burn it into a syrup and then snort it with a broken pen.

"I threw up, threw my guts up. It was disgusting," she says. "I wish I would have listened to my gut. I wish my fear of it was, like, stronger than me wanting to try it."

When she told her dealer about her first heroin experience, he suggested that she try smoking it instead. She did so the next day, burning the drug on a piece of tin foil and moving it in a circular motion as she sucked its vapors through a straw. There was no nausea this time. Instead, she tasted something that was foreign and good. Indescribably good.

Soon, she was smoking the drug every day. A friend of hers would smoke with her. When money got tight, her friend said that "slamming," or injecting, the narcotic was more cost-effective than smoking it.

"I was like, 'OK, well, I am going to try it tonight.' And she did it for me—and the next day, the same thing," she remembers. "Then we started slamming it every day."

Her obsession with the drug would prove all-consuming. She relished each anticipatory moment of shooting up, from the frantic attempts to scrounge up enough money to buy, to the euphoria of scoring a hit.

"All day I would figure out how to get money, buy it," she says. "It was the same thing over and over, all day long."

To get one of the 23 beds available at the Santa Fe Recovery Center requires a good deal of patience and luck. The center allocates a certain number of beds each to the state, the county and to the Native American tribes it has contracts with. Of those beds, only eight are reserved for female inpatients.

Like many treatment facilities, it must balance the challenge of limited resources with the reality of seemingly unlimited demand.

"If we relied entirely on state funding, we wouldn't be able to be sustainable, so we diversify our funding," Yolanda Briscoe, the center's executive director, says.

The center's inpatient and outpatient programs treat roughly 100 people a month. Briscoe would not disclose the exact amount, but says the cost of both programs is "a lot of money."

Still, not all patients choose to come here.

"We have people here who come because this is what they feel that they need to do; we have individuals who come here because of family pressure; and we have others because it's part of their court-ordered [treatment]," Briscoe explains.

Around 50 percent come for opiate addiction, she says; the other half are there for alcohol and any of a variety of narcotics. But by the end of April, the center had seen a dramatic jump in the number of patients in treatment for intravenous heroin use—evidence that law enforcement efforts to curb dealing operations is having a trickle-down effect on drug users.

"If you were to do a census today, you would find that probably 65 percent of our patients are IV users. We just happen to have empty beds, and they just happen to be using heroin instead of just drinking," says Marshia Gyuricz, the director of nursing at the center.

Lorinda Salazar, the center's intake coordinator, says she worries about the increase in heroin users.

"It is a concern, because where is all this coming from?" Salazar says. "Every call I get, someone is an IV user, and it's heroin they're shooting up."

The waiting list for a bed can be long. When the state or county doesn't have a patient in need of a bed, it then goes to someone on the waiting list. An addict can wait as little as a week or as long as a few months.

Waiting is a common consequence for heroin addicts seeking recovery. Many treatment centers have waiting lists for admission. Some doctors in the area who prescribe Suboxone—a brand prescription used to treat opiate addiction—have lists of patients who want the drug, but can't get it due to federal mandates on how many patients a doctor can prescribe it to. (Doctors are limited to treating a total of 30 patients in an office-based setting for their first year of prescribing buprenorphine, one of the active ingredients in Suboxone. The doctor can then apply to have that list expanded to 100 patients.)

"I've got 65 patients on my waiting list," says Rollin Oden, the medical director at the Santa Fe Community Guidance Center. Oden is one of the few doctors in Santa Fe who can prescribe the drug. Suboxone's official website lists just three Suboxone-approved doctors in Santa Fe County; statewide, just over 300 doctors have received waivers to prescribe Suboxone, according to Bradford Stone, a spokesman for the US Substance Abuse and Mental Health Services Administration. The state ranks 22nd for the number of physicians with waivers to prescribe Suboxone, Stone says.

"It's woefully low. Just look at the fact that I've turned away people who come in for consults," Oden says. "I turn two to three [patients] away a week."

Many heroin addicts turn to the black market for Suboxone, which can be lucrative for those who sell it. Historically, the drug came in pill form; this March, Reckitt Benckiser Pharmaceuticals Inc., which makes Suboxone, agreed to sell a sublingual version to reduce the risk of pediatric exposure.

It's also a valuable commodity in the Santa Fe County Adult Detention Facility. Last year, the prison had 374 inmates undergo opiate withdrawal treatment, according to Pablo Sedillo, director of the Santa Fe County Public Safety Department.

"We're finding that a good percentage of the contraband is Suboxone, and we are actually doing a very good job in regards to intercepting it in our facility," Sedillo adds.

Yet Emilia's husband Mark, who has a Suboxone prescription, successfully evaded that oversight when he was in jail earlier this year—and reaped the benefits.

"For three and a half [Suboxone] films, I made $1,500," he says.

While Suboxone is technically intended to help opiate addicts get clean, many black-market purchasers are merely using it to stave off the symptoms of withdrawal before using drugs again.

"This will bridge you from one bag of dope to another while you are trying to procure your next bag of dope," Gyuricz says.  

But law enforcement's crackdown on property crimes and drug use has another side effect: increased incarceration rates. Last week, the Santa Fe New Mexican reported that a rise in incarceration meant the county would need an additional $185,000 to close out the fiscal year.

There are, however, alternatives.

Coss, who will leave office next year, has proposed implementing a Law Enforcement Assisted Diversion program as a means of treating low-level drug offenders with wraparound services that emphasize treatment for addiction while also easing the burden on SFPD and local jails.

"There is pretty good abuse treatment if you are in jail, but if you are out of jail and there are long waiting lines to get into treatment, what are you supposed to do?" he says.

With LEAD, a heroin addict arrested for a low-level crime would be put on a Suboxone or methadone treatment program, see a therapist and also be assigned a career counselor, among other services.

"It's not just them coming down off of the drug; it's the ongoing treatment," says Coss, who adds that the process of treating an addict through LEAD can take two to three years.

That model is already in place elsewhere.

Seattle, for instance, is currently experimenting with a four-year-long pilot program of LEAD in two of its neighborhoods, Belltown and the Skyway Area of King County. The programs for both neighborhoods are privately funded by a group of foundations. Together, the two programs cost roughly $950,000 per year.

"Of the 120 individuals we are working with, we are going to reduce their recidivism, and we are much more effective in helping these defendants with wraparound services," says Ian Goodhew, deputy chief of staff of the King County Prosecuting Attorney's Office. Data from the program has yet to be released.

A task force assembled by Coss is expected to present its findings on the benefits of using LEAD in Santa Fe at the City Council meeting in June.

The night before Emilia entered rehab, she gave herself a shot of heroin. The following morning, she woke up feeling sick. She "slammed" a film strip of Suboxone, which she dissolved in a spoon with water, to ward off the feelings of nausea.

She slept through most of her first day at the center. That evening, the medical staff gave her a dose of Suboxone.

"I went to classes; I showered normal. I was shaky a little bit, but I was fine," she says.

By her second day, the treatment was already having a transformative effect. Color had returned to her face. She seemed alert, even perky.

"I know everyone says they want [recovery], yada yada yada, the whole schpiel," she would later say. "But I went in there wanting to give it my all, so I had a positive attitude."

On her sixth day at the Santa Fe Recovery Center, a random urinalysis test revealed that Emilia still had opiates in her system. She had also tested positive for a benzodiazepine, a class of prescription drug she says she had not used in years. The center says it frequently administers random drug testing to ensure a drug-free environment, as well as to prevent patients from mixing drugs like benzodiazepine with Suboxone, a combination that can prove fatal.

"I asked them to retest me, because I didn't believe that," Emilia says. They wouldn't, and they asked her to leave immediately.

"I wasn't going to use in rehab. I was really trying. On my second day, I was attending all my classes, even though I was feeling like crap," she says, her voice trailing off. Emilia believes that the center did not give her enough time to clean the opiates from her system.

"We never ask anyone to leave based on one drug test," says Sylvia Barela, the center's chief operations officer. (Barela would not comment specifically on Emilia's case.) "We don't take action until we have more than one piece of information that shows that one person has in fact used an illicit substance during treatment."

"We make every attempt to accommodate individuals needing treatment, and do so with integrity and compassion," Briscoe adds. "Asking an individual to leave is done with great concern, collaboration, and not taken lightly."

Emilia's mom picked her up and brought her home.

"I couldn't stop crying. I was mad; I was honestly, like, 'Fuck it,'" she says. Once home, she shot up heroin. She has gone back to using every day.

On a sunny, breezy afternoon in May, Emilia sits at an outdoor table at Salvador Perez Park. Her two youngest sisters, ages 9 and 7, are playing in the playground with her daughter. When she stands with them, it's easy to mistake the petite Emilia as their friend rather than their guardian.

Mark, his arms and neck covered in sparsely designed monochrome tattoos, is with her. He has just left his job working as a landscaper in Pojoaque and is visibly high on heroin, his head nodding off as he listens to his wife talk about having to leave the Recovery Center.

"I was pretty irritated," Mark says, his speech slurring. "I didn't understand how after six days of Suboxone, she was testing positive."

"I just kind of figured, you know, maybe she did use?" he adds.

They got married before she left for rehab. She had bailed Mark out of jail for a parole violation, and they held the wedding at the Santa Fe courthouse. A judge who once sent Mark to jail on drug charges officiated the marriage. Married life has been challenging.

“Addiction really kills our relationship,” Emilia says. Mark keeps an eye on their daughter, slowly smoking his cigarette. “[There are] the put-downs: ‘It’s not fair, you’re getting more [heroin] than me; you don’t do nothing; we need money,’” she says. “We fight over our addiction, pretty much.”

The color in her face has faded back to the wan complexion she had before she went to treatment. The heroin in Santa Fe now is “junk,” she says, but that doesn’t stop her from using.

“They cut it so much that it’s not even worth using,” Mark agrees. “The best is not in Albuquerque. It’s in Chimayó.”

Since leaving treatment, Emilia has picked up a part-time job selling knives. Despite having been kicked out of its inpatient treatment program, Emilia was allowed to enroll in the Recovery Center’s intensive outpatient program. Earlier that same morning, she interviewed for a sales position with Dish Network. She’s hopeful that, if hired, she’ll get closer to getting her own place. In 30 days, she can reapply to the Recovery Center.

But she’s still scared. She doesn’t know if she’ll ever get clean. She fears her addiction will be hereditary.

“I’m deathly afraid of that. I cry sometimes,” she says. “I don’t want my daughter to be like this. That’s why I’m like, ‘I need to do something about it now.’”

Santa Fe Reporter