IV Drug Abuse: Inside the Clinic

An exclusive look inside one of the country's best IV drug treatmentunits

By PT Staff, published on May 01, 1993 - last reviewed on October 18, 2004

PT listens as patients discuss addiction, AIDS and the promise of a new life without drugs

Harlem Hospital Center

Harlem Hospital Center occupies an architecturally diverse compound on 135th Street and Lenox Avenue in New York City. Although sizable, the 720 bed hospital is virtually alone in serving the medical needs of a community of approximately 500,000. And this is no ordinary community. Since the mid-1980s, the drug problem in its streets and tenements-always a powder keg for health and public safety-has grown geometrically worse. The well-documented crack epidemic has exhausted police, social services and health workers, but it's consequences are many, and not immediately obvious.

Some months after crack first appeared in New York nearly 10 years ago, police began to see a huge rise in the number of heroin arrests. Addicts would often turn to heroin, an opiate comparatively out of favor in Harlem since its hey-day in the mid-'70s, to ease the horrific edges of a crack binge. Dirty needles were shared for the injections among many users in the condemned houses and abandoned lots littering the East Side. As a result, the HIV virus, which causes AIDS (also a newcomer to the inner-city in the early '80s), was given an ideal environment in which to spread.

An already badly outnumbered and overworked staff at Harlem Hospital Center was soon forced to revamp their substance abuse program when a random sampling of heroin and crack addicts revealed an alarmingly high incidence of HIV infection. Suddenly, the clinics had to cope not only with the users who sought treatment, but also with the wives, husbands, lovers, and children of these users who were infected by HIV in the womb or through sexual contact.

Dr. James Curtis, director of psychiatry at the hospital, directs the operation of the four IV-drug-use clinics in Manhattan. "Without intervention," Dr. Curtis says, "any addict told that he is infected with HIV may well become desperate and possibly go on even more destructive binges, affecting his loved ones and their loved ones in turn. The clinics are very much on the front lines. We very often must deal with those who have simply run out of resources to live a life on drugs, and by that time, they're lucky if they can make it here given their mental and physical state."

It is Dr. Curtis's and the clinical staff's precarious responsibility to offer counseling to these people, to establish their medical condition and convince them that life without heroin is better, even in the face of a deadly disease for which there is currently no cure.

PSYCHOLOGY TODAY received special permission by Harlem Hospital's directors to attend this group-therapy session. The following is a direct account of remarks offered by patients of the IV-drug-treatment program conducted by Dr. Curtis's associates, Dr. Michael Scimeca and Dr. Gopal Ram. The names of the patients are fictitious.

"I was told three years ago that I was HIV positive," said Mary, a forty-year-old mother of three daughters, ages 2 to 12. Last January, Mary began to show the first signs that her immune system was rapidly breaking down. Ordinary colds would last weeks ... then months. During the fall, her T-cell count, a prime indicator of her body's ability to fight infection, had plummeted from a relatively normal level of 1100 to below 200. Her youngest was born with AIDS in 1991.

"I'm scared all the time, but not of getting sick. I live with feeling sick. Being sick is as much a part of me as my arms and legs now. I'm scared for my family. When I have to go to the hospital, what will my daughters do? I don't have no insurance to help them, not to mention the medical costs of having me on my back. I know that they will line me up and say that I'm just another dope fiend or crack head. And I'm not. I've been straight for seven years now."

"What makes you think that you'll be treated so badly?" asked Dr. Ram.

"Now come on. Someone walking into a hospital with no money is going to die from AIDS one hell of a lot quicker than someone with a big check book. When I delivered my baby, I nearly died in the emergency room before I could get close to a doctor."

"I don't know how to reassure you about that," said Dr. Ram. "I cannot speak for those who delivered your baby, but we certainly do what we can in the facility at Harlem. I'd be lying to you, though, if I denied that communities have only so many resources to help people with, and in many ways, doctors are as puzzled about AIDS as you are. But it is similar to all other diseases in that how you act and how well you take care of yourself has a tremendous impact."

"How many of you here are HIV positive?" asked Dr. Scimeca.

Nine of the 12 members of the session raised their hands.

"I know that some of you are taking medication. We have been distributing AZT from this clinic for years now. Do you think that the medicine has helped?"

"I can't sleep at all since I tried it," offered a woman staring into her folded arms. "I can't get no one to help me get to sleep. And you know I've been to see you about this before Dr. Ram."

"Helen, I know you can't get to sleep, and you know that we have been trying different ways of helping," Dr. Ram replied. "AZT has a different effect on each patient, but I think your sleeplessness has more to do with your being depressed than with the medicine you're taking."