Summer House

BALTIMORE, Maryland (CNN) — "Heroin, cocaine, alcohol…whatever was on the table, I wanted it," recalls Baltimore native Tyrone Lewis, who struggled with drug addiction for most of his life.

His addictions made it impossible for him to hold a job very long. For a time, he was homeless.

"After a while you just feel … alone," says Lewis. "That made me want to give up. "

But that all changed when he met Galen Sampson, a five-star chef who offered Lewis the chance to join Chefs in the Making, a culinary training program that offers jobs and education to people who’ve been homeless, incarcerated or have struggled with addiction. For Lewis, it was the chance of a lifetime.

"He was offering me a free education," Lewis says. "What he was doing gave me hope."

For many years, hope has been in short supply in parts of Baltimore. While some areas have been revitalized, much of the city is plagued by crime, poverty and drugs. According to the Census Bureau, nearly 23 percent of residents live below the poverty line and the city has an estimated 60,000 addicts.

As a chef at one of Baltimore’s elite hotels, Sampson often saw his employees struggling with these problems in their own families. When he met his wife, Bridget, a writer who ran literacy programs in the city, he got involved with her work and wanted to do more.

"I was a chef; that’s what I was good at," Sampson recalls. "How could I apply what I did to help?"

Sampson had always dreamed of having his own restaurant. So in 2005, he and Bridget decided to create a socially responsible business that could address some of Baltimore’s problems. They decided that part of their restaurant would be a training program, and Chefs in the Making was born. 

In many respects, Chefs in the Making is run like any other culinary school. Apprentices take classes four hours a week and the rest of the time, they work at The Dogwood, Sampson’s restaurant, which also includes a deli and catering business. Students not only earn a living and learn a trade, but they also build a job history.

The program has partnered with other programs to give apprentices additional support; there’s even a counselor on staff who meets with them every couple of weeks. For Tyrone Lewis, the restaurant itself is a refuge.

"Here there are no secrets," Lewis says. "Most of us just know we are people who are trying to get our lives back together. " 

Sampson admits this unorthodox approach had its skeptics.

"A lot of people think we’re crazy. We’ve pretty much put everything that we have into this project," he says.

But for Sampson, it’s well worth the risk.

"To see what our apprentices have been able to do here has been very rewarding. I think we’re setting the foundation for something good," he says.

In 2008, Chefs in the Making intends to provide training/jobs to more than 30 people. Apprentices make up about 25 percent of the restaurant staff and Lewis’ own situation suggests what potential the program has to change lives.

"Ten years from now, I see myself owning a home, maybe owning my own business," he says.

It’s a future that he wouldn’t have dreamed was possible before meeting Sampson.

"A lot of people say they want to help," says Lewis. "Galen actually makes a difference."

DALLAS, Texas (CNN) — A cheap, highly addictive drug known as "cheese heroin" has killed 21 teenagers in the Dallas area over the past two years, and authorities say they are hoping they can stop the fad before it spreads across the nation.

"Cheese heroin" is a blend of so-called black tar Mexican heroin and crushed over-the-counter medications that contain the antihistamine diphenhydramine, found in products such as Tylenol PM, police say. The sedative effects of the heroin and the nighttime sleep aids make for a deadly brew.

"A double whammy — you’re getting two downers at once," says Dallas police detective Monty Moncibais. "If you take the body and you start slowing everything down, everything inside your body, eventually you’re going to slow down the heart until it stops and, when it stops, you’re dead." (Audio slide show: A father describes his teen son’s death)

Steve Robertson, a special agent with the Drug Enforcement Administration in Washington, says authorities are closely monitoring the use of "cheese" in Dallas.

Trying to keep the drug from spreading to other cities, the DEA is working with Dallas officials to raise public awareness about the problem. Authorities also are trying to identify the traffickers, Robertson says.

"We are concerned about any drug trend that is new because we want to stop it," he says.

Why should a parent outside Dallas care about what’s happening there?

Robertson says it’s simple: The ease of communication via the Internet and cell phones allows a drug trend to spread rapidly across the country.

"A parent in New York should be very concerned about a drug trend in Dallas, a drug trend in Kansas City, a drug trend anywhere throughout the United States," he says.
Middle schoolers acknowledge ‘cheese’

"Cheese" is not only dangerous. It’s cheap. About $2 for a single hit and as little as $10 per gram. The drug can be snorted with a straw or through a ballpoint pen, authorities say. It causes drowsiness and lethargy, as well as euphoria, excessive thirst and disorientation. That is, if the user survives.

Authorities aren’t exactly sure how the drug got its name "cheese." It’s most likely because the ground-up, tan substance looks like Parmesan cheese. The other theory is it’s shorthand for the Spanish word "chiva," which is street slang for heroin.

By using the name "cheese," drug dealers are marketing the low-grade heroin to a younger crowd — many of them middle schoolers — unaware of its potential dangers, authorities say.

"These are street dealers, dope dealers," Moncibais recently warned students at Sam Tasby Middle School. "They give you a lethal dose. What do they care?"

Moncibais then asked how many students knew a "cheese" user. Just about everyone in the auditorium raised a hand. At one point, when he mentioned that the United States has the highest rate of drug users in the world, the middle schoolers cheered. (Watch middle schoolers raise hands, admit they know drug users Video)

"You know, I know being No. 1 is important, but being the No. 1 dopeheads in the world, I don’t know whether [that] bears applause," Moncibais shot back.

Authorities say the number of arrests involving possession of "cheese" in the Dallas area this school year was 146, up from about 90 the year before. School is out for the summer, and authorities fear that the students, with more time on their hands, could turn to the drug.
‘Cheese’ as common a problem as pot

School officials and police have been holding assemblies, professional lectures, PTA meetings and classroom discussions to get the word out about the drug. A public service announcement made by Dallas students is airing on local TV, and a hotline number has been created for those seeking assistance.

Drug treatment centers in Dallas say teen "cheese" addicts are now as common as those seeking help for a marijuana addiction. "It is the first drug to have even come close in my experience here," says Michelle Hemm, director of Phoenix House in Dallas.

From September 2005 to September 2006, Phoenix House received 69 "cheese" referral calls from parents. Hemm says that in the last eight months alone, that number has nearly doubled to 136. The message from the parents is always, "My kid is using ‘cheese,’ " she says.

Phoenix House refers them to detoxification units first, but Hemm says at least 62 teens have received additional treatment at her facility since last September.

Fernando Cortez Sr. knows all too well how devastating cheese heroin can be. A reformed drug user who has spent time in prison, Cortez had spoken to his children about the pitfalls of drug use. He thought his 15-year-old son was on the right track.

But on March 31, his boy, Fernando "Nando" Cortez Jr., was found dead after using cheese heroin. "I should have had a better talk with him," he says. "All it takes is once. You get high once and you die, and that’s what happened to my son." He knows it’s too late for his son. Now, he is using his son’s story to help others. "All I can do is try to help people now. Help the kids, help the parents."

VANCOUVER, British Columbia (CNN) — I didn’t know quite what to expect when I entered the injection room at Insite, the world’s busiest supervised drug clinic.

Inside the Vancouver facility, I found more than a dozen people taking illegal drugs, such as heroin and cocaine, under the watchful eye of trained nurses. These drug users were among the more than 700 people who visit the facility every day, bringing their drugs with them. Insite’s goal is to reduce the risk of overdose and limit the spread of diseases like HIV by giving addicts clean needles and a safe place to use them.

"People need to be kept alive long enough in order to get treatment," said Liz Evans, a nurse and founder of Insite.

The clinic, which is sanctioned by Vancouver’s health department, opens each day at 10 a.m. and stays open until 4 a.m. the following day. Many of the people in the clinic on the day we visited had tattered clothes, missing teeth and glassy eyes. They swayed as they struggled to keep their balance. Video Watch people shoot up in the Vancouver clinic »

Outside of the clinic, police patrolled the streets to keep people from buying and selling illegal drugs. Inside, patrons were given access to Insite’s clean needles, injection booths and nurses. Similar facilities can be found at 65 locations in eight different countries. San Francisco health officials recently held a day-long conference on the Vancouver drug clinic, with an eye toward possibly opening a similar one. But San Francisco Mayor Gavin Newsom said the city is unlikely to do so.

"You had a lot of health officials there that did participate in the pros and cons. But my director of the department of public health doesn’t feel the city should move forward," Newsom said.

Defenders of the Vancouver clinic say more than two dozen peer-reviewed studies have shown its benefits. One study found a 45 percent reduction in public drug use as a result of the clinic; another showed 33 percent of addicts are more likely to go to drug detox after using Insite. Dr. Thomas Kerr, a University of British Columbia research scientist who has studied the program, believes Insite benefits the wider community.

"In the absence of such a facility, not only would [drug users] be high out on the street, but they would be leaving their syringes in school yards, in parks and on city streets," Kerr said.

Dr. David Murray, chief scientist for the White House Office of National Drug Control Policy, opposes opening drug injection clinics in the United States. He believes they do little to help addicts overcome their additions.
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"It is a cruel illusion because they are still addicted, trapped, trying to get out and dying by the virtue of the drug itself," he said.

Nurses at the Vancouver clinic say they get all kinds of people using their facility, from an old grandma who comes to inject her pain medication to men in business suits hiding their addictions from their families.

At the clinic, we met Lorraine Trepanier, 50, a longtime drug user. Trepanier said she used to sell her body for drugs, but now relies on a friend to give her the $20 she uses every day to buy cocaine and heroin.

"I get up in the morning and I make sure I have one down or half a down," she said, referring to her heroin fix. Trepanier believes Insite has helped keep her alive by giving her a supervised setting in which she can take drugs.

Evans and other operators of Insite say that rather than chase addicts from corner to corner and alley to alley, it is more effective to encourage them to use their drugs in a supervised setting.  In the more than four years Insite has been open, there have been roughly 800 overdoses at the facility, but there have not been any deaths. When someone does overdose, nurses try to revive them. If the drug user is in critical condition, they are sent to a hospital.
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Trepanier doesn’t care what critics have to say about Insite. All she wants is a chance to get her next fix in a clean facility, until the day she finally works up the willpower to kick her drug addiction.

"I don’t want to be down here all my life," she said. "I don’t want to be chasing this all my life."

About 1 in 20 high school seniors now acknowledges taking OxyContin, a prescription drug for managing severe pain that, when abused, can be powerfully addictive. In its annual survey of teen drug use, the National Institute on Drug Abuse reports that OxyContin use by 12th graders is up 40 percent nationwide in just three years. Five times as many 12th graders report using OxyContin than report using methamphetamine. The results have been tragic.

Fast-Forming Addiction

Prescription drugs are the second-most used drugs among teens, behind marijuana. Teens are doing stimulants, barbiturates and painkillers. Many don’t realize how highly addictive and dangerous some of these pills can be — OxyContin in particular.

“I was sick as a dog and I was in bed and I couldn’t believe it. I was actually scared,” recalls 17-year-old Ryan, a high school senior from Tewksbury, Mass.

Ryan, who asked that NPR use only his first name, is enrolled at a drug-treatment clinic at Children’s Hospital in Boston. He says he first tried OxyContin at a party when he was 16. Kids crush up the 12-hour time release pills and snort them, so they get hit with all the opiate at once. Ryan says pot made him feel “weirded out.” OxyContin just made him feel good — warm and relaxed. And it’s easy to get.

“There’s always someone who has it,” he says. “There’s kids selling it. I know alone, like, 10 kids selling it themselves.”

But just a week after he started using OxyContin, Ryan realized that if he didn’t get a pill every day or two, he’d start to feel sick. So he kept using it. He says he had no idea how bad he was hooked until the next time he tried to stop.

“It was like somebody was inside of your head with a hammer,” Ryan recalls. “You feel like you’re going to die. Just laying there in the bed, sweat pouring off of you… Then five minutes later, you’re freezing… then you’d be throwing up.”

A Pricey Habit

OxyContin is very expensive on the street: $80 for one pill. To pay for his habit, Ryan says he cashed $7,000 in savings bonds his aunts had given him on birthdays. He sold his PlayStation, leather jackets, cell phone — everything he had — just to stay high and keep from getting sick. He finally broke down and asked his parents for help. Looking back on it, Ryan says he didn’t think using OxyContin would be that dangerous because it was a prescription pill — that made it seem safe. Many different kids at his high school were playing around with it, he says: “People from every sort of group — the burnouts, athletic kids, the geniuses and, like, girls playing wicked-good softball [who were] offered scholarships to places — they would be using it.”

That sentiment is echoed by 18-year-old Mike, a recovering OxyContin addict in Winthrop, Mass. Mike says he was always an athlete and played football. Until his sophomore year in high school, he attended a prep school with wealthier students; he later transferred to the local public school. He says that, if anything, he saw more OxyContin at the prep school.

“All the popular kids — that was the cool thing to do,” Mike says. “It seemed like it was cool because it was so expensive, this big rich drug. And a lot of rich kids were doing it because the poor kids couldn’t afford it.”

OxyContin is so expensive that many teens turn to stealing to support their habit.

“I stole so much money from my parents,” says Katie, 18, who is also a recovering OxyContin habit. She says she and a friend both stole their parents’ ATM cards to support their habits. “I stole $5,000 from my parents in two months.”

Katie also wrote checks from her mother’s checkbook. Katie’s parents say she and her friends stole cameras and jewelry from their house. Somebody stole her father’s wedding ring out of his top drawer.

“It’s like someone just punched you in the stomach,” Katie’s father said in an interview with NPR. “You know you’re never going to get it back. And what did it get used for? The addiction.”

Gateway to Heroin

Katie’s parents say they feel lucky to still have their daughter. More than a year has passed since they enrolled her into a treatment program. She’s relapsed twice. Doctors say OxyContin addiction can plague people for years. And some users move on to heroin. It is much cheaper than OxyContin, and it satisfies the same craving. Instead of $80 a pill, heroin costs about $5 a bag around Boston. One night when Katie was getting sick and desperate, she called a women she’d used OxyContin with before whom she knew also used heroin.

“I didn’t think if she had heroin I would do it,” Katie recalls, “but then when I had that option — to be sick or do this — I did that.”

Deadly Consequences

All the teens interviewed for this story said they knew at least one young person who had overdosed and died recently either on OxyContin or on heroin after first getting hooked on OxyContin. Cheryl Oates of the middle-class suburb of Burlington, Mass., knows the deadly repercussions of OxyContin addiction all too well. Two months ago, her 19-year-old son, Christopher, died of a heroin overdose.

Oates says her son was not the kind of teen one would expect to become a drug addict. He was a captain of his football and wrestling teams at Burlington High School and popular among his teammates. He got good grades and didn’t have behavior problems, Oates says.

“He was the kind of kid who would walk through the mall with me and hold my hand,” Oates says. “He didn’t care what other people thought and said. Christopher was just his own person.”

But by his junior year, Christopher was experimenting with Percocet, another opioid painkiller. It had been prescribed to him for a football injury. By his senior year, he and some friends were using OxyContin; they got hooked. Soon after he graduated, he started using heroin, too.

“The night before Christopher overdosed, we sat in the kitchen and we talked until three in the morning,” Oates says. “And he said he knew he needed help. He was such a good kid and he loved so much. And he got grabbed by something that was greater than him.”

Oates says she’d tell other parents to keep all prescription medications in a locked cabinet, just to make it harder for teens to start experimenting with them. She says it is frightening that more than 5 percent of high school seniors nationally now report using OxyContin in the past year.

Dozens of opiates and related drugs (sometimes called opioids) have been extracted from the seeds of the opium poppy or synthesized in laboratories. The poppy seed contains morphine and codeine, among other drugs. Synthetic derivatives include hydrocodone (Vicodin), oxycodone (Percodan, OxyContin), hydromorphone (Dilaudid), and heroin (diacetylmorphine). Some synthetic opiates or opioids with a different chemical structure but similar effects on the body and brain are propoxyphene (Darvon), meperidine (Demerol), and methadone. Physicians use many of these drugs to treat pain.

Opiates suppress pain, reduce anxiety, and at sufficiently high doses produce euphoria. Most can be taken by mouth, smoked, or snorted, although addicts often prefer intravenous injection, which gives the strongest, quickest pleasure. The use of intravenous needles can lead to infectious disease, and an overdose, especially taken intravenously, often causes respiratory arrest and death.

Addicts take more than they intend, repeatedly try to cut down or stop, spend much time obtaining the drug and recovering from its effects, give up other pursuits for the sake of the drug, and continue to use it despite serious physical or psychological harm. Some cannot hold jobs and turn to crime to pay for illegal drugs. Heroin has long been the favorite of street addicts because it is several times more potent than morphine and reaches the brain especially fast, producing a euphoric rush when injected intravenously. But prescription opiate analgesics, especially oxycodone and hydrocodone, have also become a problem.

In anyone who takes opiates regularly for a long time, nerve receptors are likely to adapt and begin to resist the drug, causing the need for higher doses. The other side of this tolerance is a physical withdrawal reaction that occurs when the drug leaves the body and receptors must readapt to its absence. This physical dependence is not equivalent to addiction. Many patients who take an opiate for pain are physically dependent but not addicted: The drug is not harming them, and they do not crave it or go out of their way to obtain it.

Detoxification

For some addicts, the beginning of treatment is detoxification — controlled and medically supervised withdrawal from the drug. (By itself, this is not a solution, because most addicts will eventually resume taking the drug unless they get further help.) The withdrawal symptoms — agitation; anxiety; tremors; muscle aches; hot and cold flashes; sometimes nausea, vomiting, and diarrhea — are not life-threatening, but are extremely uncomfortable. The intensity of the reaction depends on the dose and speed of withdrawal. Short-acting opiates, like heroin, tend to produce more intense but briefer symptoms.

No single approach to detoxification is guaranteed to be best for all addicts. Many heroin addicts are switched to the synthetic opiate methadone, a longer-acting drug that can be taken orally or injected. Then the dose is gradually reduced over a period of about a week. The anti-hypertensive (blood pressure lowering) drug clonidine is sometimes added to shorten the withdrawal time and relieve physical symptoms.

Methadone Maintenance

Since the 1970s, professionals who care for opiate addicts have reluctantly recognized that many of them will not or cannot stop taking the drug. The solution is maintenance — dispensing opiates under medical supervision. More than 100,000 American addicts are now using methadone as a maintenance treatment. Although it is still politically controversial, this practice has better scientific support than any other treatment for any kind of drug or alcohol addiction.

Because there is a risk of diversion to the illicit market, addicts must come to specialized clinics for methadone, which they take daily in liquid form. A single dose lasts 24–36 hours, and there are few side effects. Some methadone clinics also provide other medical and social services.

Addicts who switch from illicit opiates to methadone avoid the highs and lows and the medical risks of intravenous injection and the criminal behavior that supports it. Studies show that they are less depressed, more likely to hold a job and maintain a family life, less likely to commit crimes, and less likely to contract HIV or hepatitis. Methadone can be continued indefinitely, or the dose can be gradually reduced in preparation for withdrawal. It has been estimated that about 25% of patients eventually become abstinent, 25% continue to take the drug, and 50% go on and off methadone repeatedly.

Buprenorphine

A promising approach to maintenance is the partial opioid agonist buprenorphine. This drug is taken three times a week as a tablet held under the tongue. It occupies opiate nerve receptors and produces a mild opiate-like effect. At higher doses, it continues to produce the same weak effect while displacing more potent drugs. In a person who is physically dependent on opiates, buprenorphine causes a withdrawal reaction. There is some risk of abuse if the tablet is dissolved and injected, so buprenorphine has been made available in combination with the short-acting opiate antagonist naloxone, which has little effect when absorbed under the tongue but neutralizes the effect of injected opiates.

The main advantage of this combination, sold under the name Suboxone, is that patients do not have to come to clinics to take it, because there is no illicit market and no danger of diversion. Since 2002, individual physicians with proper training and certification have been allowed to prescribe buprenorphine in their offices for patients to take home.

Brad Renfro, the former child star whose later career was hampered by drug and alcohol problems, has been found dead at his Los Angeles home. He was 25.According to reports, Renfro’s body was discovered at 9am yesterday. The cause of death has yet to be determined, although the actor is believed to have been out drinking with friends the night before his death. "He was working hard on his sobriety," Renfro’s lawyer Richard Kaplan said yesterday. "He was doing well. He was a nice person."

Raised by his grandmother in Knoxville, Tennessee, Renfro was plucked from obscurity at the age of 12 to star alongside Susan Sarandon and Tommy Lee Jones in the 1994 blockbuster The Client, based on the bestseller by John Grisham. The following year he won the Hollywood Reporter’s "young star" award. Renfro went on to enjoy a fitfully successful acting career with a starring role in Bryan Singer’s Apt Pupil and supporting turns in the likes of Sleepers, Bully and Ghost World. He recently completed work on the Bret Easton Ellis adaptation The Informers, in which he stars alongside Winona Ryder and Tommy Lee Jones. But Renfro’s career was often overshadowed by his off-screen trials. In May 2006 he served 10 days in jail after attempting to buy heroin from an undercover police officer in LA’s Skid Row area. More recently, Renfro claimed he was making efforts to stay clean. "I’m tired of paying the consequences," he said.