Editor's note: Some of the last names of the subjects in this story have been withheld.
There's nothing about Sarah that would lead you to believe heroin nearly sucked the life out of her — on so many occasions, during so many ambulance rides to the hospital, she can't put a number on them.
Sitting across from her ex-boyfriend Brian at the Majestic diner on Ponce, Sarah glows with good health and positive energy. Her long, flaxen blond hair frames a golden complexion, and the green stones in her silver rings heighten the color of her pale, sage eyes.
One night 10 years ago, when she was 17, she and some friends were driving home from a pool hall when a car pulled out in front of them. The impact tore the muscles from the bones in Sarah's back. The guy sitting behind her in the back seat was in a coma for weeks.
While recovering from her injuries, Sarah relied on a cocktail of prescribed drugs, including the pain killer Percocet and muscle relaxer Soma. Then she ran out of insurance money. She no longer had access to the narcotics to which she'd grown attached. So she started buying prescription pills from a drug dealer. That went on for a few months, until the time when she gave her dealer $100 for some Soma, and he gave her a half-gram of heroin instead.
She snorted a little, just to ease the pain. The next time, she snorted a little more. It was bliss. "My world was kind of crooked my whole life," she says. "And I started doing heroin, and everything kind of evened out."
Of course, her heroin use wasn't something she wanted to broadcast, not even to her closest friends. Eventually, though, she mentioned to one of them that she'd been snorting a little smack here and there. Her friend replied that she'd tried heroin before, and that she had a spare needle. Sarah started shooting up.
She quickly retreated into another reality. She became disengaged from the rest of the world and enamored of her every waking moment. She began to think of heroin as a companion. It was like being in love. "It didn't even seem like a substance," she says. "It was like a being or something."
Then she met Brian.
Tall and muscular, with a ruggedness softened by boyish features and pale green eyes that mirrored Sarah's own, he seemed a perfect match. They'd grown up in the same neighborhood, in Snellville, and though he'd known Sarah's brothers, they'd never met. For the past two years, since he was 18, he'd been living on the streets in northern California. He'd only just come home. He and Sarah hit it off immediately.
She soon let him in on her secret. He was intrigued. At around the same time, Sarah got a $25,000 settlement from the traffic accident a year earlier – the accident that, indirectly at least, had led to her heroin use. Now it was as if the accident was pushing her to use even more.
With a big chunk of cash in her pocket and an enthusiastic partner, Sarah entered the abyss. "We just went on a mission," she says. "It lasted for some years."
She and Brian typically bought their heroin from a dealer in East Point. They were going through $300 in drugs per day, each. Life became a constant struggle – a journey not to be sick. The $25,000 went fast.
"That's when it gets bad," Sarah says. "You start hitting your low points, and your morals start bending a little. You start changing a little bit as a person."
She tried to detox. She'd lie in bed for days at a time. She would get up, barely able to move or see, slowly realizing that her only escape was to score more drugs. "At that point in my life, I didn't ever think about being where I am today," she recalls. "I just was like, 'I'm going to live this way the rest of my life.' I got to a comfortable point of just living at the bottom."
Heroin's glamour quickly wore off for Brian, too. "You start off doing it and you're like, 'Wow, it numbs you to the whole world,'" he says. "Like, everything's OK, even if it's not.
"And it's not until you get to a certain point, where you're either out of money or you're like, 'Well, maybe I just don't want to do it today,' that you realize how severely you need it. It's almost like being a vampire. You have to drink the blood to survive."
Traditionally, Atlanta hasn't been much of a heroin town. Cocaine is the city's drug of choice, with crystal meth a close second.
"I hear what's going on in other cities," says Dr. Brian Dew, a Georgia State University professor and the Atlanta representative for the National Institute on Drug Abuse. "And Atlanta, to be honest with you, has the lowest heroin problem of any major U.S. city in the country."
By some accounts – including Dew's research for NIDA – heroin use in Atlanta has remained steadily low, with treatment admissions decreasing.
But there have been hints here and there – a string of fatal overdoses in April, as well as other national studies – that suggest heroin, if not exactly reaching epidemic proportions in Atlanta, is gaining new and younger users.
In a 2006 study (the most recent year available), the U.S. Substance and Mental Health Services Administration found that Georgia, the nation's 10th most populous state, ranked 15th in its number of heroin users. But it ranked seventh when it came to the number of people who'd tried heroin in the past month or year.
What's more, of 20 major cities surveyed, all but three – Atlanta, Tampa and San Francisco – saw drastic declines in heroin use from 2002 to 2005. Atlanta, in fact, more than doubled its number of heroin users in that time, rising from No. 19 to No. 6.
Dew says some new users likely have been drawn to heroin through the "increasingly popular" use of prescription narcotics. He points out that prescription opiates including OxyContin, Percocet, Lortab and Vicodin are readily available on the street in Atlanta. He says those drugs can have "a gateway-type effect." It's easy to cross over from them to heroin.
It also seems that the availability of heroin in Atlanta – including its source – is changing. In October, the U.S. Drug Enforcement Administration made a surprising discovery. Undercover agents orchestrating a deal in a Gwinnett County subdivision discovered a kilo of black-tar heroin, as well as 22 kilos of cocaine and 270 pounds of marijuana.
Though the amount of heroin confiscated was relatively small, the type was significant. Black tar is usually seen on the West Coast. East Coast heroin, on the other hand, is typically finer and whiter in appearance, and South American in origin. The mere existence of the crude, Mexican-made, black-tar variety is indicative that heroin is coming to Atlanta from new sources – namely the Mexican drug cartels that have dominated the Atlanta drug trade over the past decade.
What's more, the discovery that the heroin was available in suburban Gwinnett County suggests the heroin trade is expanding beyond its traditional boundaries.
For years, the only real marketplace for heroin in Atlanta has been a Westside neighborhood called "the Bluff," bounded by the old Bankhead Highway (now Donald L. Hollowell Parkway) to the north and MLK Drive to the south, and spreading west from Northside Drive.
Jack Killorin, who heads the local branch of the federal narcotics task force called HIDTA (for High Intensity Drug Trafficking Area), says he doesn't want to sound "overly alarmist" when discussing what, for years, has been Atlanta's rather tame heroin market. But he does say there have been signs of change.
"Usually, if you stayed within the parameters of the Bluff you were seeing what was the majority heroin problem for the state," Killorin says. "But some of the suburban counties have reported seizures, and there's been some discussion in the law enforcement community of folks seeing more heroin."
Along with heroin's emergence in the suburbs, there is a growing curiosity among younger users. Even the NIDA study, which showed that overall heroin use was down in Atlanta, concluded that a growing number of young metro Atlantans were seeking treatment for heroin addiction. NIDA reports that while more than 80 percent of people seeking help for heroin were older than 35, most of the rest – 12 percent – were less than 17 years old.
One person who closely watches suburban drug use says addicts seeking treatment have gotten progressively younger.
"Most of what we see are pretty young," says Gina Hutto, director of addictive diseases for the Gwinnett-Newton-Rockdale Community Service Board. "I would say probably early 20s, 18 to 25 range, if even that."
Hutto says that in her experience, young people have gotten more daring and experimental in their drug use. While heroin users still account for a relatively low proportion of suburban drug users, she's seen a slight increase in them recently – and a general change in young people's mentality toward drugs.
"Years ago, you saw people that had one drug of choice," Hutto says. "Cocaine came on the scene, and then of course meth. But the kids nowadays just use anything and everything. You just didn't see that years ago. It's scary."
On a Friday in early April, Bridget became the first to die.
Two days earlier, she and some friends had gone to a bar in Atlanta. She broke away from them, to use the bathroom. After 20 minutes went by, her friends went looking for her.
As it turned out, Bridget had nodded off in the bathroom. The needle she'd shot up with was still clinging to her arm. The remainder of her heroin stash was tucked in her purse.
Paramedics worked to revive the 24-year-old woman with golden highlights in her wavy hair and a tattoo of a small, pink flower on her ankle. At the hospital, she even regained a pulse. She managed to hang on for two days. But on Friday, April 4, the overdose got the better of her.
Eerily, her MySpace page, which she'd last logged onto a few days earlier, hinted at her impending, accidental death: "I'm starting to feel alone and betrayed," she wrote, "somebody help before I waist [sic] away."
Bridget didn't know Lisa, but they shared a similar fate.
Twenty-one years old and with a taste for the macabre, Lisa wore black polish on her toenails and slender silver barbells in her nose, lip and navel. A tattoo of a jack-o-lantern ringed by red hearts grinned up from her back. As with Bridget, Lisa had been drawn to heroin, and paramedics were called to revive her following an overdose. They hooked her up to an EKG machine to restart her heart. They ran a tube down her throat to open up her airway. But in the end, the dose was too much.
Five days after Bridget, heroin killed Lisa, too.
Outside their circle of friends and family, Bridget's and Lisa's deaths went largely unnoticed. That wouldn't be the case two days later, when a 21-year-old Georgia Tech pitcher died in bed at his Northside Drive apartment. Michael Hutts' death was ruled to have been the result of a heroin overdose – a story that made the pages of the Washington Post and USA Today.
Within a week of Hutts' overdose, another Atlanta death made headlines. Sean Costello, a renowned bluesman and guitar prodigy, was found dead in a Cheshire Bridge hotel room the day before his 29th birthday. His death was later attributed to a mix of heroin and prescription drugs.
In the space of 12 days in Atlanta, heroin had cut across social circles to take the lives of four people, all of them in their 20s. The deaths came at a pace the Fulton County Medical Examiner's Office previously hadn't seen. And the victims were of a younger demographic. By comparison, over the previous four months only four heroin deaths, total, were recorded in Fulton County. Only one of the deceased was younger than 30.
"I don't know if there's more heroin being used or whether it's becoming more potent or what the deal is," says Fulton medical examiner Geoffrey Smith. Smith conducted three of the four autopsies and explains that, because his office only sees the worst cases ("the tip of the iceberg," he calls it), it's hard to tell whether the deaths are indicative of a trend or a mere anomaly.
"It seems to be cutting across a spectrum of young people," Smith points out. "Is heroin making a comeback? Who knows."
Amy grew up in Gwinnett County, the daughter of an ex-military man. Her plan was to go to nursing school. Aside from a wild couple of years in her early teens, she considered herself a good kid. She played by the rules. She appreciated the highly organized structure of her life -- at least for a while.
"I had been the responsible child for so long," she says. "I had my head on right. Everything was going according to my plan. It just got old. I wanted to try something different."
She was 20 and in her second year of college, working at a local bar to help cover her expenses, when she fell for one of her co-workers. He was Eastern European, dark and mysterious. After dating for a month, they moved in together.
She quickly jumped into using coke and meth with him. She didn't think it was a big deal. She'd tried coke before, in high school, and both drugs were pretty well-circulated among her friends and co-workers.
Most people she knew, herself included, had drawn the line at heroin.
"Heroin was something that I thought that only bums on the street corner used," she says. "I never thought that somebody like me, who came from the family that I came from, an educated person, would do that."
Then her boyfriend's coke and meth connection dried up. He was having a hard time tracking down a replacement. So he opted to get some heroin instead. He'd used the drug before, and he knew he only had to drive down to the Bluff to score. But he didn't want to do it alone.
Amy went with him. But the stuff he got was bad. They didn't get high.
The next day, he went back. That time the heroin was good. But for Amy, the experience wasn't all that great. She thinks she probably shot up too large a dose.
She threw up several times. She was nauseated for 12 hours, and high for another 12. But she wasn't afraid. Nor was she deterred.
"I wasn't really scared of needles," she says, "because I was going to school to be a nurse – as ironic as that sounds."
The next time was better.
"You're not in your body," she says. "You're just floating. Your mind's somewhere else. Everything looks different, feels different. You have more energy whenever you're doing it – at first."
Those early days felt like perfection. She and her boyfriend would drive down to the Bluff to buy dope. Since they were already so close to downtown, they'd head over to Centennial Park. It was springtime. Everything was in bloom. They'd gaze at the sky and soak in the sun. That was how it went for March and April. They only used on the weekends.
By May, their heroin schedule began to bleed over into the week. They went from using two days a week to four, then five. By June, they were shooting up every day. She thought she was doing it because it felt so good. She didn't think she was addicted.
Then she stopped sleeping. The crook of her arm would throb so badly it kept her awake. It felt like a pulled muscle, right in the spot where she shot up. It was as if her veins were begging her.
"I didn't realize at first that it was withdrawals," she says. "I thought it was stress. And then I kind of put two and two together. I realized that whenever I used, this wouldn't happen."
That summer, her boyfriend left town for a week. He went to Europe to settle the estate of his mother, who'd recently died. While he was gone, Amy had to go down to the Bluff without him. By then, she needed to use so badly that she couldn't wait until she got back to their apartment. She started shooting up in the car. She kept a spoon, a needle and some cotton swabs on hand. She used the seatbelt as a tourniquet.
During one of those trips, she was pulled over. She stuck out in the neighborhood, a young white girl in a new Honda Accord with dealer tags. She stuffed the dope into her bra, but the cops saw the spoon and swabs. She was charged with disorderly conduct, and she bonded herself out of jail.
When her boyfriend returned from Europe, she checked herself into a weeklong detox program. She told her parents she was on vacation. It was miserable. "Your skin doesn't feel like it's your own," she says. "You're hot. You're cold. You don't want to sit down. But you don't want to stand up."
The idea was for her to get clean, then for her boyfriend to go in the day she got out. But it didn't work as planned.
When her boyfriend picked her up from the treatment center, he was clearly high. Back at the apartment, she came face to face with needles and heroin on the kitchen counter. It looked strange to her from the vantage point of a week of sobriety. How odd that this is what her life had become.
She quickly caved. Before she even had a chance to drop off her boyfriend at the treatment center later that day, she drove down to the Bluff to buy some smack.
A week later, after her boyfriend got out, they started using together again, a warped reunion – only they were using a lot more than they had before. Her boyfriend had received a sizeable inheritance from his mother, and they were both making good money as bartenders. They could keep up the charade.
Amy was planning to finish up her prerequisites that fall so she could start nursing school in the spring. But her addiction derailed her. By October, she and her boyfriend had blown through his entire inheritance – $80,000. And their bartending salaries couldn't keep up with their appetite for heroin. She started pawning off their stuff: the TV, the stereo, their DVDs, clothes and jewelry – anything that had any value at all. "We totally gutted that apartment," she says. "It's crazy; you work so hard for all of these things you've accumulated over the years, and in a matter of a few months you lose it all."
But before the money ran out, the cops caught up with her. She was driving to pick up her boyfriend at work, swerving all over the road, when she was pulled over. She told the officer she was exhausted. He put her in the back of his patrol car and called her parents to pick her up.
As her parents were on their way, the officer found a baggie filled with brownish-white powder in the side pocket of Amy's purse. She was still in the back of the patrol car when her parents arrived, and the officer told them their daughter was using heroin.
Peering through the window, she saw that her father, never the emotional type, was more sad than she'd ever seen him. Tears were running down her mother's face.
Once she was bonded out of jail, on charges of DUI and possession of narcotics, Amy expected yelling and screaming from her parents. That didn't happen. They were deflated by the news, she says. They were also in a state of disbelief. "Parents don't really want to believe that their daughter is using heroin," she says. "They were in denial for a long time."
After getting out of jail, she lived at her parents' house. She totaled her car, so she started driving theirs. Then she ran out of money, so she started stealing from her parents. The denial stage was over. Amy's parents started locking their car keys, cash and credit cards in a safe. But Amy found a way to pop the lock with a knife.
Finally, her dad sat down with her and said, point blank, "My daughter is a junkie." He told her he wasn't sure how long she had to live.
At that point, Amy saw herself for what she really was: She had no friends. No emotions. No attachments. No goals. Her veins were bruised, her arms permanently scarred. She'd dropped 30 pounds, weighing in at just more than 100. She was a shell of her old self.
She told her father she wanted to check herself into rehab. She went in the following week, Jan. 16, 2006. She stayed for a month. This time was different. She wanted to stop. And she had her family there to support her. "They retrain you how to function in everyday life," she says.
More than two years later, she hasn't touched heroin. Nor has she seen her ex-boyfriend. Not once. She's engaged to someone else. She and her fiancé are trying to buy their first house. She finally made it to nursing school.
She doesn't try to ignore her past. She considers herself among the lucky ones.
"It's not something that I'm proud of, but it's not something that I'm ashamed of, either," she says. "It could happen to anyone."
All too often, heroin addiction doesn't end with recovery. Many times, it ends with incarceration. Sometimes, it ends with death.
Tracking those deaths has proven difficult.
The Fulton County Medical Examiner's Office does keep a tally of fatal heroin overdoses – but only since December, and only because the state crime lab got so backed up that the Fulton office had to outsource blood toxicology tests to a private lab. Unlike the state lab, the private one has the ability to determine the type of drug responsible for an overdose. As a result, the past year offers a rare glimpse into Atlanta's heroin fatality rate.
The four deaths that came in rapid succession in April (the autopsies for which were finalized in late May and early June) were surprising.
"I am aware that we have had some high-profile cases," GSU's Dew says. "I was not aware of the four overdoses within those few days."
One possible explanation, he says, would be "a really strong batch." He also says it would be up to law enforcement to investigate the deaths – and up to the medical examiner's office to alert law enforcement to them in the first place.
"I would absolutely 100 percent believe that there would be communication between the medical examiner's office and the state investigative unit," Dew says. "I mean, there would have to be."
After an initial interview, John Cross, director of the Fulton Medical Examiner's Office, could not be reached to confirm whether he had alerted law enforcement to the deaths.
The past eight months aside, the medical examiner's office only has tracked the wider category of opiate overdoses – which also includes deaths from prescription drugs such as OxyContin and methadone.
In 2007, the office recorded 25 deaths from all opiates. Since the office began to track heroin deaths specifically, there were 15 opiate deaths in the first half of 2008 – eight of which were attributed to heroin.
In an earlier interview, Cross said of the pre-2008 data: "It makes it a little more disconcerting in trying to figure out the numbers – and trying to figure out what you're seeing. They may be heroin, and they may not be heroin. We just don't know."
Sitting in a booth at the Majestic, I press Sarah and Brian about how hard they hit rock bottom while struggling with their addictions.
"You can turn the tape recorder off for that one," Brian jokes.
"There might be a statute of limitations," says Sarah.
"It's nothing too, too bad," Brian reassures me. "But bad enough."
"We never hurt anybody," Sarah says.
"No robbing people at gunpoint or anything," says Brian. "A lot of 'recycling.'"
"Oh yeah," says Brian's current girlfriend, who up to that point had been sitting quietly next to him, giggling nervously from time to time. She's pretty and waifish, with huge, dark eyes and a pink T-shirt dotted with rhinestones.
"We didn't bother anybody's well-being," says Sarah, jumping back in. "And I wasn't going to whore myself out. But, you know, you have to get a huge amount of money. So you come up with these crazy hustles."
During one of Brian's hustles, he was arrested on a robbery charge. His parents bonded him out of jail, and he and Sarah tried to get clean. It lasted three weeks.
Eventually, Brian was sent to a work-release program. That meant Sarah was on her own. Her overdoses, which Brian had once been able to help her control, got worse. There was one time, in the back of an ambulance, when the paramedic couldn't find a vein that hadn't been blown apart by repeated drug use. Another time, a cop shined his flashlight on Sarah's arms and called his fellow officers over to see. Her arms were purple with abscesses. She'd kept hitting the same vein, over and over, with a needle that had grown more blunt with every use. She used to draw little notches on her needle, one for each hit, to determine how worn it was getting. The more notches, the harder she'd have to jab it into her arm.
She racked up $10,000 in hospitals bills from the overdoses. She'd nod out for longer and longer stretches of time. But that didn't deter her.
After one of the countless trips to the hospital, Sarah was finally charged with heroin possession. Two weeks after she was bonded out, she got pregnant. By then, she was alternating her living space between a hotel and a Buick.
Finally, her parents got through to her. "I was in denial about being pregnant," she says, "and they kind of shook me into going to the doctor."
Four weeks after her son was born, she started using heroin again. Then she went to court on the felony possession charge. Her choice was to go to rehab or to prison.
"That's when I finally stopped," she says.
It's been more than two years since she touched the stuff.
"Now I blend in with everyone else," she says. "Sometimes I feel like I'm trapped in this world that's not really me, and that I'm really this junkie. But I'm also this person who recovered."
She says her son is her inspiration to stay clean. "He saved me. He gave me a reason to live. There are plenty of days when I want to give up and just say, 'Fuck it.' But that's just such a selfish decision."
Sitting across from Sarah in the booth at the Majestic, Brian's girlfriend perks up at the mention of the little boy. Up to that point, she'd been nodding off, her dark hair dangling dangerously close to the ketchup pooled on her plate.
She congratulates Sarah for quitting heroin while the child was still a baby.
"You don't ever have to explain anything to him," she says, suddenly lucid.
For Brian and his current girlfriend, the struggle with heroin has continued.
Once Brian got out of the work-release program in 2006, he'd been clean for a year and a half. But he was having a hard time coping with the outside world – particularly with the loss of his mother, who died from cancer while he was still in the program.
He says that six months after his release, he started using again.
"It was more than six months, though," his girlfriend says, stumbling over her words. "'Cause like, what happened was, like, when I met him, he had it. And, uh, he showed it to me. And I was like, 'Well, I guess I could do it.'"
At that point, her voice trails off, too gravelly and frail to comprehend.
Brian plows ahead with his story. He says that when he started back up, along with his new girlfriend, they were only using on the weekends. In no time, though, he was using every day. It went on like that for nine months. Then, one weekend in July, he and his girlfriend decided to quit. He says he hasn't used in more than two weeks.
Up to this point, he says proudly, "I never kicked the habit without incarceration."
By the time he makes his admission, his girlfriend is no longer able to form sentences. She makes an attempt, but nothing comes out – aside from, "I'm gonna go ... yeah."
She tries to get up, bracing herself in a standing position, hands on the table and hair hanging in her face. Finally, she begins to walk, hesitantly, away. When she starts to slump, Brian hurries to her side.
His arm slung around her tiny, hunched frame, he guides her through the restaurant, and out the door.
Correction: This story has been amended to correctly state the date of Bridget's death.