Commentary: When Gotham was heroin’s capital

Fentanyl, currently the top stratum of New York’s narcotic history, is by no means its thickest. That distinction belongs to heroin. For most of the 20th century, New York City was the nation’s heroin capital. During the 1950s and 1960s, years when 4% to 5% of the U.S. population lived in the city, between 43% and 50% of the addicts listed in the Federal Bureau of Narcotics registry were city residents. In 1985, an estimated one in 40 city residents was a heroin addict. Justice Francis T. Murphy Jr., who reported the statistic, blamed the federal government for failing to stop illegal imports.

Whatever Washington’s derelictions, New Yorkers’ problems with heroin and other narcotics had a long history rooted in an unusual degree of access and exposure. Since the early 19th century, the city served as the country’s main port of entry for opiates. Opiates arrived either as taxed, legal imports or as contraband smuggled to avoid custom duties.

Refined opium, which smokers used, was the most heavily taxed, frequently smuggled, and widely condemned form of the drug, owing to its Chinese and criminal associations. 

The first opium smokers were Chinese immigrants. Though the census lists only 731 Chinese residents in the city in 1880, and though only a minority of these were dependent daily smokers, they passed on the vice to adventuresome members of the city’s flourishing white underworld. Some criminals preferred a syringe of morphine to a pipe of opium; still others, a new drug called cocaine, whose nonmedical use spread rapidly in the 1890s.

Not all Victorian-era morphine addicts were gamblers or prostitutes. To the contrary, as the New York Times noted in 1878, two-thirds were men and women “from the best classes of the white race” who had become addicted as a result of medical treatment for various ailments. These doctors relieved with injections of morphine. And relieved, and relieved, and relieved.

If medical addicts were numerous in the Victorian era, they were also secretive, isolated and ashamed. They seldom spread addiction to others. Not so their counterparts in the underworld addict subculture, which attracted newcomers and which persisted long after doctors wised up and quit addicting as many patients to narcotics. 

As age and illness thinned the ranks of medical addicts, New York was left with a self-sustaining core – to police, a hard core – of nonmedical addicts. By the early 1920s, New Yorkers had taken to calling them “junkies,” after their habit of picking through junkyards for bits of saleable metal. Needing pricey daily fixes to keep withdrawal at bay, they were apt to pick pockets and locks as well. 

Increasingly, the money they hustled went to purchase heroin. Introduced as a cough suppressant and analgesic in 1898, heroin became, during the 1910s, a mainstay of New York’s addict subculture. A derivative of morphine, heroin provided a powerful rush. Dealers liked it because it was easy to cut. Adulterated or pure, heroin could be sniffed, a bonus for those who shunned the needle. And it staved off withdrawal for those who could not score prepared opium, whose legal import was banned in 1909, or morphine, whose sale and prescription were subject to stricter controls between 1914 and 1920.

Not every heroin user was a confirmed opium or morphine addict. The drug caught on with young drug users, mostly men from poor immigrant neighborhoods. Friends introduced them: Here, take a whiff. Some kept whiffing. 

There were more whiffs to go around in New York than elsewhere. The city was home to the nation’s largest pharmaceutical heroin distributors — it was a prescription drug in those days, and some of their merchandise leaked into the street market. Shady New York pharmacists would also sell to customers without legitimate prescriptions, or no prescriptions at all. 

In 1924 the federal government forbade the importation of opium for the manufacture of heroin. Yet heroin continued to gain in underworld popularity. Gangsters such as Arnold Rothstein bought heroin from European manufacturers, then shipped it to New York disguised as ordinary merchandise. One consignment, labeled bowling equipment, turned out to be 225 pounds of heroin, seized after delivery to a toy store. Mid-level dealers had other dodges. Customers of a Cobble Hill barber shop slipped money under the shaving towel. An undercover agent who secured half an ounce of heroin in this way delayed the arrest, being, the Times reported, “in too perilous a position in the barber’s chair.” 

During World War II, New York temporarily lost its heroin crown. Military purchases drove up opiate prices, and the war interrupted international shipping and smuggling routes. Arthur, one of several dozen older addicts I interviewed in the early 1980s, described the results:

There were no drugs in New York during World War II, no drugs in Philadelphia, no drugs in Chicago — there were no drugs on the East Coast. No drugs. We traveled around in “wolf packs.” Somebody would come and say, “There’s some drugs on 42nd Street!” We’d yell, “Taxi! Taxi! Taxi!’” Everybody would run down there; as soon as you’d get there it was out. Then another group would come and say, “There’s some drugs up on 131st Street and Madison Avenue. Somebody’s got something that came through.” Everybody’d jump in cabs and run up there…

Arthur became so desperate that he boiled down paregoric, an opium tincture used against diarrhea. He dissolved and shot Nembutals, barbiturates purchased on the streets. After the war he returned to heroin, only to be disappointed by the quality. He supplemented with Dilaudid, a semi-synthetic opioid secured with prescriptions from elderly doctors in Manhattan and the Bronx. Catch as catch can. “I used anything I could get to maintain, to function normally every day.”

Other users remarked on the increasing adulteration of heroin, which some blamed on Mafia greed. “It was a beautiful thing when the Chinese and the Jews had it,” one recalled nostalgically. “But when the Italians had it — bah! — they messed it all up.” Messed up or not, heroin was easier to come by in postwar New York than in any other American city. “New York is the seaport of the world for dope,” said another addict, who sometimes traveled from Los Angeles to buy heroin. “I’ve never known a place where you score as well as in New York City,” recalled another. “This is the master.”

The master’s master was Harlem, epicenter of the postwar addiction epidemic that followed heroin smuggling’s revival in the late 1940s. Most of the new addicts were young African-American and Puerto Rican men, often the children of immigrants. Doctors who interviewed them noted the psychic traumas of racial discrimination and slum life, but also the easy availability of the drugs that soothed them. One block in Harlem had 13 dealers. They did business at all hours. It was easier to buy marijuana and heroin than cigarettes, the patients reported. 

Young whites dabbled too, though they had to venture to entertainment districts like Times Square or bohemian enclaves like Greenwich Village to buy heroin. It did not come to them the way it did to residents of East Harlem. 

“The act of living near a drug-selling zone put someone, particularly an adolescent, at higher risk of using drugs,” historian Eric Schneider wrote in “Smack!”, his 2008 survey of the city’s heroin history. Access was the “fundamental precondition”: witness the postwar spike in heroin addiction among African Americans. Life was no picnic for African Americans in the early 20th century, yet they had the lowest rate of narcotic use of any of the country’s major racial groups. Not so after the great urban migrations.

Youthful experimentation with readily available drugs in impoverished, segregated neighborhoods was also the basis for the much larger wave of baby-boom heroin addiction that engulfed the city in the late 1960s and early 1970s. “I did it out of curiosity, because that’s what was happening,” a 17-year-old boy told reporter Dick Severo, who interviewed him at a Hunts Point treatment center in 1969. Asking around, Severo discovered the means by which young addicts, hardened beyond their years, supported their habits: stealing, robbery, burglary, forgery, prostitution, dealing. A 15-year-old sold rat poison as heroin, killing two other addicts in the process. Asked why, he said he needed cash to buy his own heroin.

The city’s late-1960s heroin crisis sparked two policy shifts. The one liberals preferred was expanded access to methadone. A long-acting oral opioid, methadone was the basis of an experimental maintenance treatment launched by Drs. Vincent Dole and Marie Nyswander of Rockefeller University. Though they violated the taboo against providing narcotics to ambulatory addicts, well-run methadone programs provided clear-cut evidence of improved behavior and health. No more bags of rat poison. Addicts fed up with bad heroin could resort to legal substitution. 

“I wasn’t high, but I wasn’t sick,” a musician recalled of his first methadone trial. “My next aim then was to get on a program, although I continued buying heroin when I couldn’t find the street methadone.”

Conservatives had another answer for the heroin-related crime that was gutting the city. Rockefeller called for mandatory life sentences for traffickers. “This has to stop,” he declared during his State of the State address. “This…is…going…to…stop.” Two-thirds of New Yorkers agreed with him. Punitive legislative, famously and forever known as the Rockefeller drug laws, soon followed.

Narcotic trafficking continued anyway. The city’s heroin scene flourished throughout the 1980s and 1990s despite competition from crack cocaine, the redeclaration of a national drug war, and the onslaught of HIV/AIDS. What fueled it were new sources of increasingly pure heroin, notably from Colombia, and an abundance of retail outlets. A young writer living in a Lower East Side apartment near Stanton and Ludlow, who started using heroin in 1994, discovered that he had to venture no farther than his doorway. It was a hangout for local dealers. 

Beepers and cell phones further simplified access. By the 1990s, heroin could be delivered like pizza. It was, and not just in New York City. Mexican immigrants driving beat-up cars, the Xalisco Boys memorialized by journalist Sam Quinones, fanned out across the country. They sold cheap but potent black-tar heroin in mostly mid-size cities to mostly white customers. Hello, Columbus. Convenience and discretion were in, guns and violence out. The Xalisco Boys avoided the gang-dominated urban drug markets on the East Coast. Their endeavors nonetheless undercut New York’s dominant position. The city, Quinones wrote, was “no longer the country’s sole heroin hub.”

Another, unexpected development in the 1990s and early 2000s nationalized narcotic supply and, for a time, altered the pattern of narcotic addiction in the city. Dr. Andrew Kolodny saw it firsthand. A young psychiatrist who began practicing in Manhattan and treating addicted patients with buprenorphine — basically, methadone lite — Kolodny was surprised in the early 2000s by an influx of white, middle-class addicts from New Jersey, Westchester County and Staten Island. 

They used prescription drugs like OxyContin and Vicodin. They did not use heroin — not yet, anyway. They got the opioid painkillers from their doctors, who had again begun prescribing them as analgesics. Or they got them from friends and dealers who siphoned them from the expanded legal trade in prescription opioids. Either way, access and exposure were again at work.

With a twist. Opioid prescribing for chronic non-cancer pain, promoted by pharmaceutical marketing, was a national phenomenon. The capitals of this type of opioid addiction were places like Huntington, West Virginia, not ports of entry like New York. The geography of addiction was no longer determined largely by where the Mafia landed its heroin. The new keys were Pharma-shaped prescribing behavior and distributor failures to stop opioid orders to suspect outlets like internet pharmacies or off-the-interstate pill mills.

In the 2010s, as prescription opioids became harder to come by (or, in the case of reformulated OxyContin, harder to abuse by snorting or shooting), the narcotic kaleidoscope turned again. The most conspicuous shift was to heroin, which was readily available, relatively cheap and highly potent. Active cuts, fentanyl or one of its analogs, further increased potency, often lethally so. 

Here too was something new. Mid-20th-century dealers often adulterated heroin with inactive cuts such as powdered milk or baby laxative. Overdoses occurred when addicts, especially relapsed addicts with reduced tolerance, mainlined unexpectedly “good” heroin containing too little inactive cut.

Fentanyl flipped the script. Overdoses now occur because of too much active cut. That is true not only for heroin, real and nominal, but for other street and counterfeit prescription drugs into which fentanyl is often mixed, unevenly and fatally.

This is why methadone or buprenorphine remain effective treatment options for opioid addicts. Reduced to essentials, the history of narcotics in New York City is a history of changing prices and availability for drugs that an unusually large number of addicts needed on a daily basis to keep from getting dopesick. Necessity dictated risky tactical choices in a shifting sellers’ market of unpredictable product purity. The surest way out of the trap was, and is, supervised medical maintenance with licit opioids of known strength and quality, prescribed with safeguards to minimize further leakage. There are enough drugs on New York’s streets.

Editor’s note: This commentary originally ran in Vital City.