Focus on drop in drug use hides lethal trend

Drug-related deaths and emergency-room visits have been on the rise,disproportionately affecting minorities.

Like an increasing number of affluent youngsters, Oscar Scaggs was fighting a heroin addiction. And last fall, friends say, he appeared to be winning.

But on New Year's Eve in a ratty hotel in San Francisco, the son of blues singer Boz Scaggs died of what his family calls "an accidental overdose."

The tragedy makes the young man the latest prominent victim of a hidden trend in the American war on drugs. While the overall use of illicit drugs in the United States has declined since its peak in the late 1970s, the drug use that remains has become much more dangerous.

"There's been more than a 10-fold increase in the number of cocaine and heroin-related emergency room visits, and a fivefold increase in the number of deaths from 1980 to 1996," says Ernest Drucker, professor at the Montefiore Medical Center/Albert Einstein College of Medicine in New York.

The reasons for the increases are varied, from the availability of much cheaper, purer, and more-deadly heroin than ever before, to the aging population of hard-core addicts. But Professor Drucker also blames the enforcement of harsh drug laws that "force drug users into a life of crime, increase their risk of infectious diseases ... and expose people around them to higher levels of violence."

Robert Weiner of the Office of National Drug Control Policy notes the number of cocaine- and heroin-related deaths and emergency-room visits has leveled off in the last two years. He believes the rates will continue to go down.

"Other indicators indicate a downward slide in drug use, and therefore a likely downward slide in the number of deaths," says Mr. Weiner.

"The consequences always tend to lag behind the use data," adds a researcher in Weiner's office who asked not to be named.

The young Scaggs was part of new cohort of heroin users that for the last few years have been showing up in increasingly greater numbers in emergency rooms from Plano, Texas, to Orlando, Fla., to New Orleans. Young, hip, and affluent kids have taken to snorting the drug. Its heightened purity still provides the same anesthetizing high without leaving telltale needle tracks.

Because neither the US government nor the dealers regulate the heroin on the street, users have no way of knowing whether the powder they buy is 20 percent or 80 percent pure. Such disparities can turn an afternoon high into a deadly last fix.

But that uncertainty hasn't appeared to stop young people from experimenting. The rate of increase for new heroin users is now "comparable to the increases seen in the epidemic of the late 1960s" according to the Substance Abuse and Mental Health Services Administration, an agency of the US Department of Health and Human Services.

These young, wealthy, predominantly white users have garnered much of the press attention in the last two years, but Drucker's study concludes the most damage is being done in minority communities.

WHILE the proportional rate of drug use is essentially the same across the races, African-Americans and Hispanics suffer disproportionately large health consequences. According to Drucker, blacks are 3.5 times as likely as whites to die of a drug overdose, and 7.5 times as likely to go to the emergency room.

"The thing that is different between blacks and whites is not the rates of use, but the application of criminal sanctions - blacks get arrested and incarcerated much more for drugs than whites," he says. "We've relegated the punishment to poor neighborhoods."

Drucker believes that has forced the drug trade further underground and away from resources that could help addicts. He contends the nation's drug policy should be changed to emphasize treatment and prevention over the application of tough mandatory minimum sentences.

But others argue the drug crackdown has worked to bring overall drug use down, and shouldn't be abandoned.