Tuesday nights at the Chateau Remix are all the way live. The sound of go-go music pumping through the speakers is distinct and so D.C. It looks and feels like a throwback basement party, but it’s a mid-week jam for adults with special needs who are there to release some energy. In the DJ booth, Cedric Carter is spinning the records that keep everyone shaking to the beat on the dance floor. As the last song winds down and the attendees file out the front door with their helpers, Carter and another worker start an informal call and response. “Next week! Next week!” Carter thoroughly enjoys playing music for this group.
“Old dreams are awakening,” he reflects. Carter has survived a 30-year addiction to heroin that took him and his loved ones through hell. He started using as a teen in the 1970s, but at 58 he says he has been on this side of sobriety for 12 years. And he is determined to stay clean. “I’ve always wanted to be a musician,” he says. “I played an instrument when I went to Shaw Junior High School. I followed Chuck Brown and the other popular groups and DJs in this town. Now I DJ. And it’s for a group of people I like doing it for.”
While other jurisdictions across the country grapple with opioid overdoses among their white residents, the District offers a unique perspective. The majority of opioid-related deaths in the city fit a select profile: male, between ages 50-59, and black, according to a 2017 report from the D.C. Office of the Chief Medical Examiner.
America has a long-standing relationship with heroin. Historians trace its presence in D.C. as far back as the late 1930s, and by the 1960s heroin addiction reached epidemic status in the city. During that epidemic, a young Harvard-trained psychiatrist named Dr. Robert DuPont was working in the D.C. Department of Corrections. He found that nearly half of the men who came into the D.C. jail between 1968 and 1970 tested positive for heroin.
DuPont went on to serve as administrator of the city’s Narcotics Treatment Administration under Mayor Walter Washington and drug czar under Presidents Richard Nixon and Gerald Ford. He has been a professor at Georgetown’s medical school since 1980.
In 1972, DuPont authored a report titled “Where Does One Run When He’s Already in the Promised Land,” referring to people who had escaped the Jim Crow South for northern cities. He found that 13.5 percent of males born in the District in 1953 were addicted to heroin, that in “large sections of Washington” the addiction rates were double that, and that addiction was concentrated among young, lower class black men.
“The heart of the heroin epidemic in the 1970s was in a population of people who were born between 1945 and 1957. That group is the group that is now aging,” says DuPont. “The teenagers of the 70s have become 50 and 60 year olds. I’m amazed at the the tenacity of the problem.”
Cedric Carter is that teenager of 1970s D.C. who is now between 50 and 60 years old, and though he has been beating heroin every day for more than a decade, many of his friends have not.
Reared in the Shaw neighborhood in the late 1960s by his mother and grandmother, Carter spent many days playing with friends and searching for his father, a numbers writer taking bets from people on 9th Street NW and reporting them to bookies. The good times were rolling in and out of the nightclubs along the U Street NW corridor. So were the drugs and alcohol. Many entertainers who came to perform at the Howard Theatre would spend their after hours in pool halls and clubs. Drugs were just a part of “the life.”
“It kinda started when I first had an experiment with drugs in 1970,” he says. “I was hanging out with my little friends and we started experimenting with marijuana. That went on from elementary to high school.”
During Carter’s 10th grade year at Cardozo High he dropped out of school and fell in with heavier, more addictive drugs. “That’s when my curiosity really took off,” he says. “The community had a lot of PCP and angel dust. It was real big in the early 70s. Then we moved on to other substances like cocaine and heroin. In 1979 I really started to indulge in more heroin activity, particularly because of the way it made me feel. It was a downer. I didn’t have to worry about anyone bothering me. It took me away from reality. And because of that activity, I lost track. I lost my focus. I didn’t want to do anything anymore.”
When the drugs got stronger, so did his urge to satisfy the addiction, and so did the turmoil his family suffered. Family members go through a myriad of emotional highs and lows. And when the storm is over, if it is ever over, it leaves broken bonds in its wake.
“When I was really heavily involved with dope I had to find a way to support it,” he says. “We steal from our families. A little bit of money, mama’s furniture, a television. I had to feed that addiction. I robbed my family of things. I robbed my mother and grandmother and family of their peace of mind. They were constantly worried about what’s going to happen to me. That phone call. That knock on the door. I had my family members go as far as paying drug dealers off so they wouldn’t hurt me. That’s the ugly side.” Behind his stoic facial expression is deep regret. He knew it was wrong then, as he does now.
He tried to stop. Five or six times on his own by his count. In Carter’s mind, he could do it. In reality though, he could not. In 2005 he hit the wall. “I went through D.C. General detox. It’s the strangest thing. Everything at D.C. General is right there. We had the hospital. We had the jail. We had the detox. And we had the morgue. I had a choice to make. So I chose to go to building 12. I did the 7-day detox.” Detox led to Narcotics Anonymous which led to a 28-day stint at the Samaritan Inns’ drug treatment center in Columbia Heights.
Carter credits God for his sobriety. “God put me in a place around folks that are just like me. We battle with the disease of addiction. I got a sponsor and a network of people who have my best interest [at heart]. I stay away from the corner, the after hours places, and things of that nature. I just try to stay focused on what I need to get better. I never get well; I just get better.”
Now Carter bears witness to another side of addiction: losing friends. The “bad batch” that is stealthily infiltrating the drug supply on the streets is taking Carter’s friends out. He explains in low tone, “People that I used to use with are still using. I’ve had the opportunity to take some of them to their graves because of fentanyl. I just walked a friend of mine to his grave two months ago.”
Fentanyl, a synthetic opioid originally used to treat pain, is the substance cut into heroin in recent years that has killed so many across the nation. Although heroin can be cut with a number of substances, such as baking soda, over-the-counter painkillers, and rat poison, fentanyl is the deadliest of cuts. It is 30 to 50 times more potent than heroin and similar in color and texture, making is undetectable to the naked eye.
“These gentlemen who have been using for many years are teetering on this line of safety,” says Dr. Tanya A. Royster, Director of D.C.’s Department of Behavioral Health. “They know how much to use. They know when to use. They know where to get it.
“Now that these new things are introduced into the opioid supply, like fentanyl and some of the other synthetics, they are much more lethal and much more deadly. So what they have been doing for the last 20 or 30 years is not necessarily safe. That’s our message to them: What you’ve been doing isn’t working anymore because the supply has changed.”
The Department of Behavioral Health has had its eyes on this problem for a long time, setting up prevention centers across the city and hotline numbers. Royster’s goal is to reach the users before fentanyl does. “We have two approaches to recovery,” she says. “One is abstinence, which is: Stop using or don’t start using drugs. The other is harm reduction. If you’re going to use a drug, use it in the safest, least harmful way—trying to reduce the amount of damage. So we try to make sure you have good healthcare. We make sure you have clean needles.
“Many of the the older black men are in the harm reduction category. We know that they’ve been using for a long time. They have been very clear that at this point in their lives, or at no point in their lives, have they been willing to stop using. So the strategy is, how do we keep them healthy and alive while we continue to encourage and support treatment?”
Harm reduction is a controversial option. It involves supplying addicts with clean needles for drug use and methadone, an opioid medication, to reduce withdrawal symptoms. Abstinence supporters say that this approach is complicit and counterproductive, while harm reduction advocates argue that it is a more effective method to treat addiction and that it decreases the rates of other comorbidities such as HIV and Hepatitis C infection.
As of fiscal year 2017, a total of 2,316 people are enrolled with one of D.C.’s three medication-assisted treatment providers contracted by the Department of Behavioral Health to dispense methadone and counseling services. Out of that total, nearly 77 percent are 50 years of age or older.
Two years earlier, in 2015, D.C.’s Fire and EMS Department and DBH worked together to conduct the Heroin Screening, Brief Intervention, and Treatment Pilot Program, an effort to gather more information about the types of calls they received and how often they received them. The data they collected during two months in the summer of 2015 showed that 97 suspected heroin overdose patients had generated at least 1,032 EMS responses in D.C. over the prior eight years. The demographics of the patients showed that 66 percent were African-American males and that the median age was 55 years.
The men of Carter’s set may get swept up in current efforts to address today’s nationwide opioid crisis. President Donald Trump’s opioid task force recommends lifting the Medicaid provision that prohibits federal money from going to residential mental health and substance-use facilities with more than 16 beds. If realized, this could mean more help for black men.
The task force report states that only 10 percent of residential facilities use Medication Assisted Treatment, or MAT, even though it is broadly considered to be the most effective treatment for opioid users. This is a costly solution, given that a 30-day stay in a private residential facility runs about $15,000 on the low end and and can go for well over $30,000.
The D.C Council returned from summer recess ready to tackle this issue. First up: proposing legislation focusing on decriminalizing drug addiction. At the September 19th council meeting Councilmembers David Grosso and Vincent Gray co-sponsored three opioid-focused bills: the Safe Access for Public Health Amendment Act of 2017, the Opioid Abuse Treatment Act of 2017, and the Opioid Overdose Prevention Act of 2017. (For the latter two, additional councilmembers co-introduced the bills.)
The Safe Access bill would apply practices that reduced the spread of HIV and other diseases to the opioid crisis, expanding access to clean drug paraphernalia. Syringe exchanges would be allowed to distribute things like checking kits, which enable people to check drugs for fentanyl before using. The Opioid Abuse Treatment bill provides for hospitals and doctors to have better training on how to treat opioid addiction and to develop protocols for possible overdose cases. And under the Opioid Overdose Prevention Act, D.C. police officers would be equipped with naloxone rescue kits. Trained first responders can use naloxone to stop an overdose in progress, often saving a life.
The bills are currently in various committees and will be the subject of hearings and markups before they go before the Council for a vote.
Why would anyone want to surrender to a drug that makes them sick, broke, and despised in their community? A drug that strips away their family, livelihood, and dignity. A drug that accelerates death.
For the men of Carter’s generation in D.C., it’s complicated. The reasons are diverse. Some are like him—curious adolescents who got caught up in something more powerful than they expected. Others have lurking mental health conditions that are exacerbated by drug use. Still others picked up the habit while serving their country abroad. In all cases they have dealt with macro and micro aggressions as they move through the world. And now they have a self-medicating habit that helps them cope. They have made room in their lives for this habit.
Heroin users are often able to hide in plain sight. You don’t need to look on street corners or in homeless shelters to find them. You work with them. You attend church with them. They are workers and neighbors and friends. They are single men and women, married, parents and grandparents. Some are Vietnam veterans who never kicked the habit. Some are chronic pain sufferers who take hits just to function throughout the day. They may be working and attending family functions, albeit late or sleepy. But these people have a private, chemical-based habit that has, in many cases, been a part of their lives for decades.
Chronic heroin users in D.C. are very much like Carter: men past their prime looking to comfortably age in place in the only home they’ve ever known.
Ask a heroin user if he remembers overdosing, he will probably shrug that question off. You could try asking if he has a drug problem, but chances are he will shrug again. He might shift the subject of the conversation to talk about his other physical ailments which lead him to use medications. He may want to address other things that bother him or prevent him from getting well again.
Here is where the gap between addiction and treatment widens. Concession means surrender, and on the streets men never surrender. Surrender is a sign of weakness. The street code is to die with your boots on. You don’t talk about the drugs, where they came from, how the game works, or admit that you need help. Your silence is your bond. Addicts live by this code. You can catch them nodding off, but according to them it’s not because of the dope. It’s because they worked late last night. Or the medication they take makes them sleepy.
Drugs are a stubborn and formidable foe—a song on repeat until someone rouses the DJ.
Carter is awake. He has adjusted to the sober life by finding joy in being a grandfather and a mentor to the youth. “When I look back on it, I ain’t where I used to be,” he says. “I’m grateful I ain’t there anymore. I’ve always been a giver. If I get an opportunity to go out and help some other people, I do it. I believe in reaching down and pulling somebody up, but they gotta want it. They gotta want to stop using. Once they stop using, they’ll see that the opportunities are out there.”