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An Addict, Now Clean, Discusses Needle Exchanges And 'Hope After Heroin'

Mar 8, 2016
Originally published on March 11, 2016 3:40 pm

When she was 17, Tracey Helton Mitchell was prescribed an opioid pain killer after getting her wisdom teeth extracted. The medicine helped her deal with the pain related to the extraction, but when the prescription ran out, her desire for its euphoric high remained. That's when she turned to heroin.

As a teenager, Mitchell imagined heroin to be glamorous, but she found it wasn't once she became an addict. She tells Fresh Air's Terry Gross that the drug ruined her health and her self-esteem. She lived in an alley, shot drugs into the bottom of her feet, sold her body for money and was jailed several times. She was also featured in a 1999 documentary about addicts called Black Tar Heroin.

At one of her lowest points, Mitchell says, "I was having heart palpitations, because I was using stimulants, and I thought, 'They're going to pull me out of this hotel, I have no ID, my parents, my family ... will never know that I died and I'll just be a Jane Doe and this is how I'm going to expire in this place.' "

But Mitchell didn't die from her addiction. Rather, with the help of the secular program LifeRing and other support groups and therapies, she eventually stopped using and became a certified addiction specialist. She has been clean for 18 years.

In her new memoir, The Big Fix, Mitchell writes about her addiction and her path to recovery, and also shares insights into today's heroin epidemic. When it comes to our current treatment system, Mitchell says we would do better to reach out to addicts as individuals, by recognizing each user's unique needs and motivations.

Our current method of treatment is "sort of a one-size-[fits]-all approach," she says. "We need to have a variety of different kinds of treatment interventions that address people's needs."


Interview Highlights

On what it's like to watch Black Tar Heroin now that she's clean

It can be painful to watch, especially when I think about my life now and I contrast that. ... My legs did look like I was dropped in a dumpster and picked out by rats. I had, I think, 34 or 36 abscesses. I have scars that have healed, but I had to have surgeries on some and in the summertime when everybody else is wearing shorts and stuff like that, I see those things — even right now sitting here at the table I can see one of the scars on my arms. It's a good thing in that it reminds me of where I was, but then it's also very challenging, because this documents a very unpleasant part of my life that can't be changed.

On why she agreed to be filmed

I really believed that I was going to die, or be murdered. There was lots of evidence to make me feel that way, and I wanted it to be something that people would see after I was dead that showed that heroin was not the glamorous thing that I had thought it was when I was a teenager and had imagined it. I wasn't paid for the film; it was a huge inconvenience in my life, but I feel like it still is sort of my legacy to the world, because it's something that's watched today. Millions of people still watch it.

On black tar heroin in the '90s versus heroin today

There's still tar heroin. The heroin that most people get today is much, much stronger. We didn't have to worry about fentanyl — of us dropping dead from an overdose, because no one cut it with fentanyl. The thing that we really worried about was getting flesh-eating [bacteria, necrotizing fasciitis] ... or getting some kind of wound botulism or getting abscesses. There certainly were overdoses then. You could get arrested for overdosing and a lot of people were rolled out at the hospitals or left outside to die ... but there wasn't this culture of heroin where heroin is prevalent absolutely everywhere. It was more localized to big cities, more urban areas.

On 'hitting bottom'

I don't believe in the concept of a bottom. I think that if the opposite of addiction is connection, that addicts or people who use drugs are really seeking out — they need some kind of connection with people. And I would say I've had a wide variety of bottoms, but I wasn't ready to stop until I started to believe that there was a possibility that I actually could stop and saw reasons for myself to stop, and my motivation is totally different.

On being ready to get clean

One of the myths about addiction is that you come to this incredible moment of clarity and that you decide that you're going to stop. And so over the course of my using I had various moments of clarity and I had various points where I had wanted to stop, but they were not always congruent with my opportunities.

So there [were] very few opportunities where I really could truly try to stop, but I would stop using for a few days, I'd try to kick on my own, I'd switch to different drugs, I'd move to different places. I tried different things to stop, but I wasn't completely ready, because all these different traumas had accumulated in my life, and I wasn't prepared to deal with the emotional consequences of all these different things. And that's what to me being off drugs meant — was that I would have to then figure out how I was going to fix all these things on my own. And it wasn't until I got an idea that maybe other people would help me, talking to my mother, knowing that I would have some kind of emotional support where I'd start seeing [that] maybe I don't have to totally do all of this on my own.

On needle exchange programs

At the time there was no needle exchange at all [in Cincinnati] and so you would use the same syringe over and over again and hopefully it didn't break off in your arm. Until the numbers wore off of it, you would sharpen it on a matchbook, and it was just horrible; it was like a rusty nail sticking in your arm.

So I came to San Francisco and they had needle exchanges, which was a revelation, because so many people in the country were suffering from HIV and AIDS, particularly AIDS, because there was no anti-retrovirals. ... So the syringe exchange people provided me education about my drug use. ...

I've seen in my life so many examples of where not having a clean syringe never stopped anyone. I've seen people pick them up out of the gutters. Even here in San Francisco, where there's a lot of access, people break open sharps containers that they've stolen from hospitals because they needed a syringe and they don't have one. ... It doesn't stop people. All it does is spread a public health crisis.

On harm reduction and the argument that harm reduction enables users

My answer is, you can't get clean if you're dead, so there has to be harm reduction. We're not encouraging people to do anything, we're taking a look at their public health behaviors and then addressing what the particular needs are, so look at the cost of one syringe versus the cost of someone getting hepatitis C and having to take care of them for a lifetime.

Look at the public health cost of various other medical conditions that a person can have. From not using sterile water or alcohol pads, someone having endocarditis or some other infection, so having a safe system for people to take care of themselves and treating addicts, users not just addicts, there's plenty of people who use who are not necessarily considered on the spectrum of drug addicts, treating people humanely and having them have access to public health services and the things that they need.

On coping with depression since becoming clean

Part of the reason why I wanted to write The Big Fix is because I felt like there's no ... real education on long-term recovery about what really happens over time. So dealing with topics like untreated depression and anxiety and all the other kind of things that you go through when you take the drugs away, and then you have new issues, because before you use drugs, you didn't have all these guilty, shameful things that you ... now have to deal with, if you're a person like me and you get off drugs.

So I've had a very complicated relationship with my emotions in the past 18 years that I've been clean. I've dealt with very serious post-traumatic stress disorder, being very checked out and dissociative at various points, having to deal with the constant specter of depression, every once in a while having suicidal thoughts. And one of the things that I try to do is really normalize those feelings when people want to know what recovery is really like. It's like, some days you really feel crappy. You really have some things that are going on with you, and I think the prevalent idea is that you get clean and everything is supposed to be great. ... You can have a great life and still not feel all that great.

Copyright 2016 Fresh Air. To see more, visit Fresh Air.

Transcript

TERRY GROSS, HOST:

This is FRESH AIR, I'm Terry Gross. My guest, Tracey Helton Mitchell, was 17 when she was prescribed an opioid painkiller after getting her wisdom teeth extracted. Her search to recapture that euphoric feeling eventually led her to heroin. She became an addict. There were times she lived in an alley and sold her body for money. She was in jail a few times. She sold drugs. She was one of the five young heroin addicts profiled in the 1999 documentary "Black Tar Heroin." She's been sober 18 years. She's a certified addiction specialist who works with addicts through the public health system and is part of the harm reduction movement. She's married and has three children. Mitchell's new memoir, "The Big Fix," is about her addiction and recovery. She also shares her insights into today's heroin epidemic. Before we hear what she has to say, let's listen to a clip from the documentary, "Black Tar Heroin." In this clip, she's living with her boyfriend who's also an addict. They're both trying and failing to kick. Her boyfriend speaks first.

(SOUNDBITE OF DOCUMENTARY, "BLACK TAR HEROIN")

UNIDENTIFIED MAN: She's doing really good. She's cut way, way back. I mean, she was doing like two grams a day and now she's down to maybe not even a half gram a day. So she's getting on the right direction and the right path. But I just don't - she's a totally better person, man, when she's not on it. And when she is on it, she's, like, completely, completely, just out of it. I mean, she just lays in bed, and we have no relationship. You've got to [expletive] be a man about it and just do it.

TRACEY HELTON MITCHELL: He loves me more than heroin. I just, you know, I keep saying...

UNIDENTIFIED MAN: She's a baby, man, about it.

MITCHELL: ...I can't do it, you know? And then what is he going to do if I come home with a fix? Is he going to be like, oh, no, I don't want it?

UNIDENTIFIED MAN: When I make the decision of that's it, I'm going cold turkey, and if she's not going to do it, no matter how much I love her, I'm going to have to leave because my life's more important to me than heroin. Heroin when you're off heroin leaves a big, big void in your life, man.

MITCHELL: We've recently all, like - I've been thinking what am I going to do when I quit doing heroin? And it's like I see it and I go over it for hours and hours and hours - like, my plans and this, that and the other thing. It seems like getting there should be so easy. All I need to do is kick...

UNIDENTIFIED MAN: Don't do it.

MITCHELL: What am I going to do? What am I really going to do? It's been so long since I've had a straight job or gone to school. It's like...

UNIDENTIFIED MAN: I know. That scares me.

MITCHELL: ...Even if I didn't have - even if I wasn't doing heroin, I don't know what the [expletive] I would want to do with my life. I would have just done it. This is just from the past year from hitting in my legs. I mean, if I wanted to live a different kind of life, you can't even cover that stuff with pantyhose. It looks like, you know, I've been [expletive] dropped in a dumpster or something like that and just been picked at by rats.

GROSS: Tracy Helton Mitchell, welcome to FRESH AIR. You know, most recovering addicts don't get to see a film that shows what they looked like when they were addicted to heroin. What was this like for you the first time you saw the film?

MITCHELL: So the first time I saw the film, I already been clean over a year. You know, it can be painful to watch. I mean, my legs did look like I was dropped in a dumpster and picked at by rats. I had, I think, 34 or 36 abscesses. I have scars that have healed, but I had to have surgeries on some. And, you know, in the summer time when everybody else is, you know, wearing shorts and stuff like that, I have to - I see those things. Even right now sitting here, I can see one of the scars in my arms. And it's - you know, it's a good thing in that it reminds me of where I was. But then it's also very challenging because this documents a very sort of unpleasant part of my life that can't be changed.

GROSS: Why did you agree to be in this documentary? Most people who are addicted to heroin would not want the world to see that in part for legal reasons - like, you become a target.

MITCHELL: I really believed that I was going to die or be murdered. There was lots of evidence to make me feel that way. And I wanted it to be something that people would see after I was dead that showed that heroin was not the glamorous thing that I had thought it was when I was a teenager and had imagined it. You know, I wasn't paid for the film, it was a huge inconvenience in my life, but I feel like it still is sort of my legacy to the world because it's, you know, something that's, you know, watched today. Millions of people still watch it.

GROSS: So compare the kind of heroin you were doing back in the '90s - black tar heroin - with what's available today.

MITCHELL: Oh, it's so different now. I mean, there's still tar heroin. The heroin that most people get today is much, much stronger. We didn't have to worry about, you know, Fentanyl - of us dropping dead from an overdose because no one cut it with Fentanyl. The thing that we really worried about was getting some kind of wound botulism or, you know, getting abscesses. There certainly were overdoses - then you could get arrested for overdosing or - and a lot of people were rolled out at the hospitals or left outside to die - not me personally, but I'd known friends where that happened to them. But there wasn't this culture of heroin were heroin is prevalent absolutely everywhere. It was more localized to big cities, more urban areas.

GROSS: Marijuana was not your gateway drug to heroin. Your gateway drug was a prescription drug. You had your wisdom teeth pulled when you were 17 years, and you were prescribed opiates. You liked the feeling, and you sought it out some more. You found friends who had - whose parents had opioids in the medicine cabinet, so you snuck some of those. How did you actually start shooting heroin?

MITCHELL: So the first drug I shot was some other kind of prescription drug. I think it was either - it was Vicodins or Percocets that someone had done a cold-water extraction, which is this process where you get the Tylenol out of it. And it was just a sort of like a spur of the moment thing when - and we decided to do it. So heroin was a large process in getting it where we had friends who had gone to New York and then we had to - you know, so you'd send them with money or they would come back and they would sell it to you. And, you know, it wasn't something you could get every day. And then so - a few friends of ours decided to try it. And actually, before I even did mine, one of the people I was with overdosed and we had - you know, at the time, we didn't know about Naloxone or rescue breathing. We put him in the shower and had to revive them. And, you know, it was this completely terrifying experience. And then they were like, well, do you still want to do it? And I was too - I just was - I was so invested in it. I was like, well, yes. So they said, well, we'll just give you half. And it started a whole love affair with this drug that, you know - it just ruined my life eventually.

GROSS: You were terrified of needles...

MITCHELL: I was. I remember one time I had to get shots - I forget how old I was - but they had to have all the different medical personnel hold me down just to get my vaccinations.

GROSS: So how did this affect your life as a heroin addict?

MITCHELL: So the first year that I did intravenous drugs, I had other people do it for me, which I think is a very common experience, especially among females where if you can come up with the money, there's plenty of people who will facilitate your addiction. Sometimes I call it vampires making vampires where people that use don't necessarily want to use alone. And then if someone else has the financial resources, they end up becoming using buddies and using together. So that really, you know, impacted my first year of using is that I - you know, I worked, I had, you know, different financial resources where I was willing to contribute. And then other people were, you know, willing to shoot me up.

GROSS: There's this common belief that addicts start to become recovering addicts after they've hit bottom. It seems to me you hit bottom several times. I mean, you were in and out of jail for a while, you were living on the street in an alley for a while, you sold your body for money. So you had friends who hit bottom in many ways and never got clean - some of them overdosed. So do you think that that whole idea of expecting that when somebody hits bottom, that's when they're going to turn their lives around - do you think that that's a meaningful belief, that there's truth in that?

MITCHELL: I don't believe in the concept of a bottom. If the opposite of addiction is connection - that addicts or people who use drugs are really seeking out, they need some kind of connection with people. And I would say my very - you know, I've had a wide variety of bottoms. But I wasn't ready to stop until I started to believe that there was a possibility that I actually could stop and saw reasons for myself to stop. And my motivation is totally different. I think among users, their motivation to quit is completely different. And that's why our treatment system is so messed up because it's sort of a one-size-fit-all approach when we need to have, you know, a variety of different kinds of treatment interventions that address different people's needs.

GROSS: If you're just joining us, my guest is Tracey Helton Mitchell. She's a public health worker who works with heroin addicts. And also, she's part of the harm reduction movement. Now she has a new memoir about her addiction and her recovery. It's called "The Big Fix: Hope After Heroin." Let's take a short break, then we'll talk some more. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. And if you're just joining us, my guest is Tracy Helton Mitchell. Her new memoir is called "The Big Fix: Hope After Heroin." She became a heroin addict when she was in college. And she has now been sober for 18 years. You may have seen her in the 1999 documentary "Black Tar Heroin" that was about five young addicts.

One of the ways that you hit bottom was being in jail, then out of jail, in jail again. Did you use drugs in jail? Were you able to find drugs?

MITCHELL: Yes. I definitely used drugs when I was in there. So when they had asked me if I wanted to go to a treatment program, I wasn't interested at all because I knew that I wasn't - I was going to get out of jail and I was going to use. I didn't see any point in having my parents get a second mortgage on their house or doing, you know, this treatment program when I knew that I wasn't going to stop using.

GROSS: Why weren't you going to stop?

MITCHELL: I just couldn't stop. I mean, so one of the kind of myths about addiction is that you come to this incredible moment of clarity and that you decide that you're going to stop. Over the course of my using I had various moments of clarity. And I had various points where I had wanted to stop. But they were not always congruent with my opportunities. So there was very few opportunities where I really could truly try to stop. But I would - you know, I would stop using for a few days. I would try to kick on my own. And I would switch different drugs. I would move to different places. Like, I tried different things to stop. But I wasn't completely ready because all these different traumas had accumulated in my life. And I wasn't prepared to deal with the emotional consequences of all these different things. And that's what, to me, being off drugs meant was that I would have to then figure out how I was going to fix all these things on my own. And it wasn't until I got an idea that maybe other people would help me, you know, talking to my mother, knowing that I would have some sort of emotional support, where I started seeing, well, maybe I don't have to totally do this on my own.

GROSS: So you were in jail several times and used drugs or just used them as soon as you got out. But the time when you actually kicked for real was in jail and then rehab. So what was the difference between what jail was then and the times that you were in jail determined to keep using?

MITCHELL: So it wasn't the jail. It was actually my friend of mine. So in the months prior to me going to jail, I had made up my mind that I was going to try to quit for good. I had gone and tried to get on - I had gone and gotten on methadone. That wasn't successful for me because of the lifestyle that I was living. But I had pretty much made up my mind when I started shooting up in the soles of my feet that I was going to quit. But I needed some kind of intervention and I wasn't sure what that was. And I had said to myself, you know, I'm on probation. If they catch me and I go to jail, I'm going to ask to go to some kind of treatment facility. And I had never been to some kind of treatment facility, so I thought the chances were pretty good that I would be able to go. And I was kind of waiting. I actually had a suitcase packed in my closet the night that I was arrested so I would have things when I went to the rehab or the treatment facility. And there was this moment when they clicked the handcuffs on me and I looked back and I saw the suitcase and I saw the room, the filthy conditions of it, and I said, you know what, I don't want to come back to any of this. I don't want to come back to this room. I don't want any of that stuff. I don't want this life anymore. I don't know what's going to happen when I go to the jail. But whatever it is, I want it to be something completely different and not involving drugs.

GROSS: Now, I want to step back a second. You mentioned that one of the turning points for you is when you started shooting up in your feet. Why was that different than shooting up in your legs or in your upper body? Why was that a turning point for you?

MITCHELL: Well, I had no veins left. And I - you know, I had all these abscesses. There is one hotel in particular. And I would sit there and I would have, like, a 10-pack of syringes. And there would be, you know, blood all over me because it would take me, you know, sometimes up to an hour to get a hit. And I would do this like, you know, five or six times a day or more - sitting there, poking myself with needles. And so I was shooting up at the bottom of my feet. I could barely walk. I was having heart palpitations because I was using stimulants. And I thought, they're going to pull me out of this hotel. I have no ID. My family, my parents will never know that I died. And I'll just be a Jane Doe. And this is how I'm going to expire -in this place. And that got the wheels in my mind turning, like I really need to figure something out here because I'm not going to last much longer.

GROSS: So if I had seen you on the street, what conclusions do you think I would've drawn? And compare that to who you were.

MITCHELL: Well, I was very, very thin. I used to wear a baseball cap backwards. And I'd wear multiple layers of clothes. I was pretty dirty. I would pull my pants down anywhere, sheet over my legs. I was, you know, very socially isolated. I spent a lot of time by myself or nodding out someplace on the street. So I don't - I think you probably would've walked right past me and not really thought about me at all.

GROSS: So you were one of the people with all your possessions in a shopping cart?

MITCHELL: Oh, yeah. I lived in alleyways for years.

GROSS: Yeah.

MITCHELL: I mean, I lived outside. So when I first started going to recovery meetings, it was kind of hard for me to relate to some of the people because I have never met a woman in the state that I was in. I mean, I've met people with similar sort of heavy-use stories. But, you know, living outside, completely like a feral animal, is not something that many people recover from.

GROSS: Let's talk about rehab. Some people credit 12-step programs with their recovery from drugs or alcohol. And other people find that it's not a perfect fit for them. What was your experience? Do you feel like 12-step programs helped you get sober?

MITCHELL: I would say that 12-step was part of a package. So what I tell people who contact me that are seeking recovery is try a bunch of things and see what works. The people in 12-step were good for me in that I got to see other people like myself who were clean. I think there are - for people who are highly motivated and fit into certain categories, 12-step can be helpful. But as a dominant form of treatment in the United States, it's problematic because it definitely doesn't work for everyone. So I did 12-step. There's a program called LifeRing. I worked out of their workbook. I went to support groups. I ended up having therapy. So I did a lot of different things. So can I credit one particular thing for my recovery? I would say no. But it was very, very helpful for me. But it wasn't certainly the only thing. And I took a lot of the things that people said sort of with a grain of salt.

GROSS: In order to get sober, you had to be alive, which a lot of your friends from the '90s, when you were addicted, are not. You had friends who died of overdosing, of AIDS. So let's talk about some of the things that enabled you to stay alive in spite of the fact that you spent some of your time as an addict living on the streets, that you suffered from a lot of health problems and abscesses. One of the things that you attribute with remaining alive during the AIDS era - 'cause you were addicted in the '90s before there were drugs that enabled people with HIV to stay alive - you attribute part of the fact that you are alive to needle exchange programs. So how did that work for you?

MITCHELL: Well, when I came from Cincinnati, Ohio, there was absolutely no - now there's a needle exchange. I do some work for them. But at the time there was no needle exchange at all. And so you would use the same syringe over and over again, and hopefully it didn't break off in your arm until the numbers wore off of it, and you would sharpen it on a matchbook, and it was just horrible. It was like a rusty nail sticking in your arm. And so I came to San Francisco and they had needle exchanges, which was a revelation because so many people in the country were suffering from HIV and AIDS, particularly AIDS because there was no antiretrovirals. There was - you know, they would tell you you have two years, go home and die and have - you know, try to have some kind of quality of life until that happens. So the syringe exchange people provided me education about my drug use. You know, they were very compassionate. They were a familiar face that I would come see, that I would check in with. Sometimes I would provide them information. If you don't see me and I die, please will you contact my family? They would, you know, give out condoms. I would be able to - they would give me enough supplies so I would have some to carry around and give out to other people. So it was a really - you know, it was an important part of my life - checking in with different people at the needle exchange programs. And that's why it's so unfortunate in large swaths of the country today we have rolled back some of the services that we used to have. You know, I get contacted by people all over the United States that live in areas where there is no - you can't buy syringes in a pharmacy, even though law says that you can, because the pharmacist will refuse to sell them. And we still have people, especially in places like Florida and Indiana, Texas, that are using syringes, you know, where they're worried about the needle breaking off and the numbers worn off.

GROSS: And your argument is that having people use dirty syringes or malfunctioning syringes isn't going to prevent them from using. It's just going to make them sick and perhaps kill them.

MITCHELL: Oh, it definitely doesn't prevent them from using. I know in particular, I've seen in my life so many examples of where not having a syringe never - you know, a clean syringe - never stopped anyone. I've seen people pick them up out of the gutters. I've seen them, even here in San Francisco where there's a lot of access, people break open sharp containers that they've stolen from hospitals because they need a syringe and they don't have one. People picking them up off the side of the road. It doesn't stop people. All it does is spread a public health crisis.

GROSS: My guest is Tracey Helton Mitchell. Her new memoir is called "The Big Fix." When she started shooting heroin, she lost her appetite and went from chubby to skinny. And she was validated for being thin. We'll talk about that after a break. I'm Terry Gross and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Tracy Helton Mitchell, a recovering heroin addict who's been sober for 18 years. She went back to college and became a certified addiction specialist. She works with addicts through the public health system and is part of the harm reduction movement. She's written a new memoir called "The Big Fix." When we left off, we were talking about how harm reduction services like public clinics and needle-exchange programs helped her stay alive until she was able to kick heroin. You mentioned that at the needle-exchange programs, you also had free condoms that you were able to get, which was probably also very important in saving your life because there were periods when you sold your body for money because you needed the money for drugs and that was your way of getting it. So you might have died of AIDS if it wasn't for the condoms you got for free.

MITCHELL: That is true. But one of the things I need say is that I wasn't just prostituting for drugs. I was prostituting for money to live. So engaging in sex work wasn't something I did a lot of, but it was something that I did because I - I didn't just need drugs. I needed a place to stay. It paid for my rent. Or, you know, I needed it for - and there's - to me, when I look at back on that time period of my life, you know, it's kind of hard to believe that I did that. But on the other things, you know, there was so much encouragement into that activity among people that were around me. You know, the males and the females all engaged in it. You know, I had a lot of transgender friends who engaged in it. And everyone was engaging in it for different reasons. And so, you know, taking the stigma out of the idea - you just did it for drugs - it's like no, I actually did it because I was, you know, homeless living on the streets. And, you know, it's a collaborative relationship. Think - I think about - who are these people that would come pick me up? I remember one time in particular, I'm dirty, I'm filthy. I'm out in an alleyway, and this man is trying to solicit me. I'm, like, one of the most vulnerable people in society. I'm not even looking for someone, but yet someone - people would come and try to shake me and wake me up and ask me if I wanted to turn tricks with them.

GROSS: Well, I was going to ask you that question, who are these guys?

MITCHELL: Oh, it was - you know, it was interesting - so I used to have a really young face, not so much anymore. And a lot of the men who picked me up - I used to, you know, camp out sort of by a youth center. And some people that would pick me were definitely, you know, consenting adults looking for, you know, sort of consensual activities. And some of them were, you know, predators that were looking for people that were in a very vulnerable state. And that seems to be when you're, you know, very heavily addicted to drugs, some the people that navigate towards a person like the state I was in.

GROSS: So if you hooked up with a predator, what did they want from you in addition to sex?

MITCHELL: Well, one - I mean, I - one guy picked me up, and it was clear that he wanted to rape and kill me. And that wasn't uncommon. But I was - you know, I was fortunate I wasn't - I didn't do those things for very long. And I also would tell them oh, I have a friend waiting for me or we - my friend wrote down your license plate. I had sort of resources and other people that would sort of look out for me and stuff like that. But, you know, I've had male friends that were raped. I've had trans friends that are raped and had their throat cut. I've had friends that were murdered by Johns that picked them up. One was cut up and found - you know, they found in a dumpster. That's - I mean, those are some of the real things that happened.

GROSS: Let's get back to how you managed to stay alive while you were addicted - alive long enough so that you could get into recovery and actually kick. One of the things you attribute with your ability to stay alive was public health clinics. And you point out you needed a place where you could openly discuss your addiction and the health-related problems that you had, which you felt you couldn't do in just any doctor's office.

MITCHELL: Yeah, so the public health workers really were some of the people that were kind to me. I mean, when you're homeless, you experience things like people pouring bleach out of their window on you, people throwing batteries out their window on you, pennies, bottles that you, see people stealing your shoes from under your head. I mean, there's a lot of violence that goes on in the streets between different people. And then I would come into the clinics when I would go in - a lot of times I wouldn't even go in until my leg almost fell off. But I would go in and they would still be nice to me. They would still, you know, talk to me in a way that was respectful. And that was very important because I had lost a certain sense of my humanity. You know, I was - I wasn't born a drug addict. That was just a period in my life. So some people like to use the term user. I use the term drug addict because that's how I look at myself. I was a very serious addict. But they treated me with the humanity and respect that I wasn't experiencing, and that was important to me.

GROSS: When you did finally kick heroin, you went into working with heroin addicts. You became a certified addiction specialist - do I have the lingo right?

MITCHELL: Yeah, so I'm a certified addiction specialist.

GROSS: Right, and you're a public health worker and you do harm reduction work.

MITCHELL: Yes. I get up to, you know, sometimes up to 50 messages a day either from - people watch "Black Tar Heroin" on YouTube or they find me through various sources, through social media because I'm unusual in that I'm very, very open about my past history of drug use. I make it - myself available if people have questions about addiction or recovery, harm reduction questions. And so people started contacting me about Naloxone. Do you have access to Naloxone? Do you know how to get Naloxone? And I would hook people up with programs when they were available. But at a certain point, I ended up sending out Naloxone, which I didn't - which at the time was pretty illegal because there weren't these laws and the availability in various states. But I decided to do it anyway because I thought if I can somehow hook people up with it, I absolutely know that this is going to save lives. And so...

GROSS: You need to explain what Naloxone is.

MITCHELL: OK, so Naloxone is a drug where if it's given to you will reverse the effects of an overdose. So if you've taken - and only overdoses that are from opioids. So there's - that includes heroin, that includes various kinds of prescription opioids like OxyContin, Percocets, whatever it is. So - and if you've taken multiple drugs, like you've taken a benzodiazepine like a Klonopin or an alcohol and you're having an overdose, it might help reverse the effect of an overdose because it's taking one of those drugs off-line.

GROSS: And in talking about Naloxone, we should mention that Narcan is the brand name. Naloxone is the generic form.

MITCHELL: Yes.

GROSS: So, you know, since we've been talking about harm reduction for addicts - in other words, like, if you're not ready to kick drugs, harm reduction helps you stay alive with, for instance, clean needles, condoms, anti-overdosing drugs like Naloxone. The argument against harm reduction that you hear some people make is well, you're just, like, either condoning or enabling drugs - illegal drugs. So how do you answer those people?

MITCHELL: Well, my answer is you can't get clean if you're dead, so there has to be harm reduction. So we're not encouraging people to do anything. We're taking a look at their public health behaviors and then addressing what the particular needs are. So look at the cost of one syringe versus the cost of someone getting hepatitis C and having to take care of them for a lifetime. Look at the public health costs of, you know, various other medical conditions that a person can have. I mean, from not using sterile water or alcohol pads, someone having endocarditis or some other infection. So having a - you know, safe systems for people to take care of themselves and treating addicts and, you know, users - not just addicts - there's plenty of people who use who are not necessarily considered on the spectrum of drug addicts - treating people humanely and having them have access to, you know, public health services and the things that they need --

GROSS: If you're just joining us, my guest is Tracy Helton Mitchell. She is a recovering heroin addict. She's been sober for 18 years. Her new memoir is called "The Big Fix." Let's take a short break, then we'll talk some more. This is FRESH AIR.

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GROSS: This is FRESH AIR. And if you're just joining us, my guest is Tracey Helton Mitchell. She's written a memoir called "The Big Fix" about her addiction to heroin and her recovery, and she's been sober for 18 years. You may have seen her in the documentary from 1999 called "Black Tar Heroin." She was one of five young addicts who were profiled in that film. Right now, she's a public health worker, and she's also part of the harm reduction movement. In retrospect, you believe that one of the reasons why you became a heroin addict was because you had this untreated depression. So you kick heroin, that doesn't make the depression go away. How have you dealt with depression without using addictive drugs?

MITCHELL: Well, part of the reason why I wanted to write "The Big Fix" is because I felt like there's no books - there's no, really, education on long-term recovery about what really happens over time. So dealing with topics like untreated, you know, depression and anxiety and all the other kind of things that you go through when you take the drugs away, I mean, those - and then you have new issues because before you used drugs you didn't have all these guilty, shameful things that you had to deal with, you know, that you now have to deal with if you're a person like me and you get off drugs. So its - I've had a very, you know, complicated relationship with my emotions in the past 18 years that I've been clean. I've dealt with, you know, very serious posttraumatic stress disorder, you know, being very checked out and dissociative at various points, having to deal with, you know, the constant specter of depression, you know, every once a while having suicidal thoughts. And one of the things that I try to do is really normalize those feelings when people want to know about what recovery is really like. It's like, you know, some days you feel really crappy. You really have some things that are going on with you. And I think sort of the prevalent idea is that you get clean, everything's supposed be great, like oh, now you're off drugs, your life is great. You know, you have this great life. And it's like you can have a great life, but you still - you know, still not feel all that great.

GROSS: So I'm going to ask you about an issue that I imagine a lot of people have who have given up heroin and other forms of opioids. You had a miscarriage, and then you had three C-sections when your children were delivered. And each of those times - we're talking about four times - you were told that you really needed painkillers in order to recover well, and those painkillers were opioids. You were terrified to take them for obvious reasons. The last thing you wanted to do after all you'd been through was become addicted again. So how were you able to take the opioid painkillers and not feel like you were flirting with addiction, or at least not get addicted?

MITCHELL: Well, the first thing I think any person who's had, you know, a history of addiction needs to do is sort of have an honest dialogue with themselves and the people around them about their pain. So I was very honest about with my partner, my husband, about, you know, I need to take these medicines. And in particular, when I had my miscarriage they tried to send me home with, like, 30 Vicodin or whatever and I told them, you know, I'm so depressed, I already want to kill myself, and now they're trying to give the means to kill myself, and so I need you to go back and I need you to fix this prescription. With the second piece, you know, medical advocacy, when I had one of my...

GROSS: ...Fix it so that they gave you less?

MITCHELL: Yeah, they gave me less. I had to wait, like, an extra half an hour to an hour to get - to have them give me less. And if I would've needed it, I could've called in to get them. I don't think necessarily we should give pained patients all these, you know, unnecessary barriers. But I'm talking about my own particular advocacy for myself, and so the advocacy for myself was, you know, I think I probably can manage. Let me at least try. And then when I had my daughter, my first C-section - it was an emergency C-section - I had a lot of pain and I was on pain medicines for quite a few weeks. I had to arrange my own taper schedule. No one had any discussion with me about how I was going to taper off these drugs. I was in withdrawal with a newborn - you know, a screaming newborn. But fortunately, I educated myself on what I should do, I got support around me of people that, you know, would take me out and help me cope with those - having those dual issues going on at the same time. I mean, some people don't necessarily have the experience that I've had. But I've - you know, I've been prescribed medications a few times, and I just have an honest conversation with myself. If I feel like I really need them, then I - sometimes I've had my husband hold the medications for me, but I haven't had that experience where I thought, you know, oh, I'd really like to take a lot more of those. It's more like sort of a burden having to take them. But, you know, I need - I did need them obviously. But there's no good advice out there really. I mean, that was - you know, that was something I had to construct for myself.

GROSS: There are stories in which fashion models have taken heroin as a diet plan. You know, as a way to suppress appetite and stay really skinny. There was a period when you were on heroin when you'd lost a lot of weight and that seemed like a good thing to you because you'd been a little on the chubby side, you'd been something of an overeater, and you felt, like, validated for being thin. So when you got off drugs and started to regain a normal appetite again, was weight an issue for you?

MITCHELL: Oh, weight is a huge issue. It's - I think it is for a lot of people. So there's a saying that you - and pick up the fork so you're no longer shooting heroin and you start eating. And so I, most of my life, was chubs (ph) and so I put on a lot of weight. And that's hard. I got a lot of validation - like, even today people see "Black Tar Heroin" and say oh, you were so beautiful then. It's like, did you see how I was living?

GROSS: (Laughter).

MITCHELL: I mean, they're more concerned with my personal appearance than with...

GROSS: ...With the fact that you were thin, yeah.

MITCHELL: Yes. They thought I was, like, perfect because of the way that I looked. And it's like, well, I think I'd rather be, you know, chubby or overweight than have - than live the way that I was living. And, you know, it's always been like a - food is one of my first fixes. Like, it's just something that I've used for comfort most my life, it's always been available to me. It's, you know, huge issue. And so now even eating healthy, I have to get to a place where I'm like, you know what? I can't constantly struggle with my weight, you know, stepping on a scale 15 times a day and stuff like that. I have to find a place where I am accepting of myself. And drugs were an extension of my eating disorders for sure because once I got to a certain point where I was completely skeletal, I received so much validation from other people around my appearance despite the complete dysfunction in my life.

GROSS: That's crazy, isn't it?

MITCHELL: It is. It tells you about the - you know, the value we put on personal appearance where that was - you know, that was the most important thing to some people was the way that I looked. And it's very, very hard for people when they come into recovery and they start getting clean and they start putting on those pounds because the first thing people do is come up and say oh, you're fat, or look at how fat you are now. And it's like, oh, thanks. You know what I mean? It's like, I'm clean now, but they - I've had so many clients come up and touch my stomach - are you pregnant? And - oh, girl. You know, you're working in the jails and stuff, and they have a distorted sense of what, you know, looks good to them, too, because they've been on drugs. And I just had to learn, like, you know, I have to be OK with myself. No matter what, you know, I'm a good person, I think I look good, my husband thinks I look good, and that's good enough for me.

GROSS: So you have been convicted of - was it holding or selling heroin?

MITCHELL: Sales, transport of a controlled substance.

GROSS: OK, and how much was that?

MITCHELL: A $20 bag of drugs.

GROSS: OK. So as a convicted felon, can you vote?

MITCHELL: In California I can vote. Yay, California. So I actually just passed a background check. So I've been working as a contractor for seven-and-a-half years, so my city - my job got converted to a city position and I had to go through another background check. So that's always a scary time for me to see what pops up. But because it had been over seven years, I guess the county doesn't really take that into account in the hiring process. But if I went to some other states, I wouldn't have - I'd be disenfranchised and wouldn't be able to vote. And that's - you know, that's kind of a sad thing. There's - you know, there's struggles in the state of Kentucky and lots of other places around people's right to vote, and we have this whole section of society because of the war on drugs that aren't able to freely participate in society here in the United States, and it's a shame.

GROSS: Well, Tracey, thank you so much for talking with us.

MITCHELL: Thanks for having me.

GROSS: Tracey Helton Mitchell's new memoir is called "The Big Fix." After we take a short break, Milo Miles will review a new album by a master percussionist in the Afro-Cuban tradition. This is FRESH AIR. Transcript provided by NPR, Copyright NPR.