The international heroin trade affects the lives of millions of people worldwide.  It is destructive for producer and user countries, if in different ways.  For heroin users, addiction often means a life of misery and despair that is difficult to overcome.  Jeff Swicord introduces us to an addict in Baltimore, Maryland. 

Sandra has endocarditis, an infection of the heart lining. Her Hepatitis C can damage her liver and lead to cirrhosis. Her teeth are rotting. All are common for heroin addicts.

Thirty-four-year-old Sandra is one of 6,000 heroin addicts in the east coast city of Baltimore. She lives in this abandoned and dilapidated row house on the west side of the city.  She agreed to let us follow her for part of a day.

"This is where a lot of people do sleep, and they get high here," Sandra said. Sandra first tried heroin six years ago.

"This is what a normal junkie's purse looks like, all paraphernalia.  Hypes," she said.

Her life is consumed by one thing:  feeding her addiction. "That's only half a pill because I did the other half earlier. But that is what heroin is," she explains.

Afghanistan, Burma and Colombia produce most of the world's heroin. The United Nations estimates there are eight million addicts worldwide. 

Baltimore is known for its neighborhoods with charming row houses. But the port city, north of Washington D.C., is also known as the heroin capital of the U.S. The U.S. Drug Enforcement Administration or DEA says one in ten of the city's 6,000 residents is a heroin addict. Carl Kotowski is Assistant Special Agent in Charge of the DEA's Baltimore office.

Carl Kotowski

"The heroin that is being distributed in Baltimore City is not very expensive whatsoever," Kotowski said. "So, that makes it very lucrative for the abusers."

Most of the heroin in Baltimore comes from South America and Central Asia.

Sandra says she does not care where her drugs come from.  She says heroin does not give her a high anymore.  Her concern is the painful withdrawal she feels when her body craves more heroin.

She has been arrested three times and spent six months in jail.

  Sue Doyle, an addiction counselor in Carol County, Maryland, which borders Baltimore, says that is common. "Once they become addicted, they now have to chase the drug," Doyle said. "It becomes not any fun anymore because they are constantly looking for the drug, looking for the money to get the drug.  And they start doing things they said they would never do.  They are stealing from their parents.  They are stealing from their neighbors.  They are prostituting themselves."

Sandra survives by working as a street prostitute.  She says she needs to see three clients a day to earn enough money for drugs and food. She says violence is a constant threat. 

"I have had a knife put to me and my money robbed.  But as far as really getting beat up - I did have a trick, trick is what we call our dates, actually try to rape me.  And, that was a weird experience," Sandra said. She shows her leg. "This is what somebody's legs looks like that shoots drugs for a long period of time," she said.

Sandra has health problems related to her addiction. She has endocarditis, an infection of the heart lining.  Her Hepatitis C can damage her liver and lead to cirrhosis. Her teeth are rotting. All are common for heroin addicts.

When we asked Sandra if she would ever stop using heroin, she said: "I am hoping I end up in rehab before I end up out here dead.  I really don't know."

Doyle says there are four options for addicts: death, jail, hospitalization or rehab.  She says rehab is probably the most difficult. "Most of our clients don't get recovery on the first try," Doyle said. "It is a chronic long-term disease.  We correlate it to diabetes or high blood pressure.  You don't give one treatment and say you are done."

Sandra recently tried to enter a city rehab clinic.  She was turned away.  In Baltimore, the wait list is more than a month long. 

For now, Sandra remains on the streets surviving day by day and living with addiction as best she can.