There is a set standard procedure for bringing a person who has overdosed on heroin back from the brink. It’s fairly simple and it’s also widely misunderstood – largely because of the famous scene in Pulp Fiction. There is no adrenaline shot to the heart – there is no adrenaline at all – what there is, is a large dose of a drug called naltrexone, given intravenously to any available vein. Naltrexone is a nasty little drug, a life-saver, but a nasty little drug all the same. It works by muscling the opiate molecules off the receptors in your brain, then it sits there. In essence, to the user, it means a complete and rapid withdrawal. It saves many lives.
The views of ambulance crews towards their heroin using patients vary. One crew will give sympathy, the other will sigh heavily and take less care with fragile veins and a bewildered return to consciousness. Some addicts overdose in flats and are simply rolled out onto the pavement, others are collapsed in cars, on sofas, and on bathroom floors. One client of mine overdosed on methadone – he’d just gotten too greedy one evening with 100ml of the green juice he’d bought – and had gone over in his parents house, come back round, then spent eleven hours sitting naked sideways on the toilet so he could vomit into the sink while he shat himself. He was ten hours into it when I turned up and called an ambulance. They didn’t rush.
And overdosing on heroin is incredibly easy. Smoking it drastically reduces the risk, but injecting the stuff is almost like running blindfolded across a busy motorway. Some develop better hearing and survive, others are lucky, but there are more than you’d think who get hit. How much would it take to kill you or me right now – assuming you aren’t cultivating a heroin habit of your own at the moment? Well tolerance varies, but in my former professional opinion you and I would be turning blue if we injected just the residue left in a cigarette filter used to cook up a hardcore user’s normal morning hit. It’s that small. And it happens.
Steve left jail with all the hopes in the world. At 27 he still had a long life to look forward to. He was intelligent, good looking, and savvy, real street quick-brained which he could have turned to anything. Eton educated stockbrokers had nothing on Steve in terms of his wit and ability to problem solve. About a month after he was released I got word he was dead. He’d overdosed from an injection prepared from the used filter of another mate’s dig. No extra heroin at all. Just the residue of a cooked up fag filter. It was a miniscule amount. He’d lain dead for two weeks in the summer heat in the flat he’d just taken out a rent agreement on. When they found his bloated body it was apparent his “friends” had robbed him of what little property he had, they had even taken his jeans from his body, and his trainers. He lay face down, semi naked, dead from misadventure, or so they’d define it.
The trick of heroin is that to achieve the desired result – a warm and fuzzy half-sleep – you need to tread as close to the edge as possible. The closer you get to it, the better the experience, but the consequences of stepping an inch over the thin line are severe. Pleasurable peace and tranquility lay on one side, death on the other and there is never any way of telling where the line is or how quickly you’ll get to it. Some toddle up gently and back off, others rush forwards at great speed and keep going. Few ever really get it right. It’s the curse of heroin.
When I learned of Steve’s death I wasn’t just sad, I was angry that it had to happen. I questioned why I was working in the field I’d fallen into and I desperately tried to figure out how anyone could learn from it. The truth, sadly, was that nobody learned anything new of any use whatsoever except perhaps his mother – who discovered a whole new level of pain. The life of a heroin addict is cheap, and that’s just how the government likes it. A dead addict can’t steal, can’t clog up A&E departments with their collapsed veins and deep vein thrombosis, and they won’t ever pester you for small change in the street. Being a heroin addict defines who you are and the given definition is “scum”.
I like to think something will change at some point, but I’m not holding out for it. Not enough people are really bothered about the underworld, the fractured lives of the underbelly of society. And in any case, change now may come too late. It did for Steve.