Over the past month my team and I have followed the heroin corridor from colourful poppy fields in the remote mountains of southern Mexico to Martinsburg, West Virginia - one small American town ravaged by addiction and overdoses.
What we saw was that on both sides of the border, the trade has resulted in death and misery.
In Mexico that death is usually delivered at the end of a gun in regions ruled by drug gangs. More than 100,000 people have been killed or gone missing since Mexico launched its war against drug cartels in 2006.
All drug-related violence of course isn’t directly tied to heroin. But according to Antonio Mazzitelli, chief of the United Nations Office on Drugs and Crime in Mexico, cartels are growing in strength as a result of a boom in heroin sales in the US. That strength allows them to rule with even more impunity in some parts of Mexico.
Poppy farmers we spoke to told us they can’t negotiate with the middlemen who come to buy their raw opium paste. They likened any challenge to those men as suicidal.
"That would be like putting a gun to my head," one farmer told us.
Death delivered by needle
In the US, death is delivered by needle.
According to a new report from the Centers for Disease Control, more than 8,200 people in the US died from heroin overdoses in 2013 - nearly three times as many as in 2010.
For several years now, West Virginia has had the highest rate of deadly drug overdoses in the US - that’s all drugs, not just heroin. Heroin addiction took hold after a much larger wave of prescription pill addiction.
According to the United Health Foundation, in 2014 about 31 out of every 100,000 people in the state died from drug overdoses. If you were to compare that to Mexico’s homicide rate of 22 murders per 100,000 people, living in West Virginia seems riskier than life south of the border.
Berkeley county, which is home to Martinsburg, reported 36 deaths from heroin overdoses between 2007 and 2012, the highest for the whole state. We met several people in Martinsburg who knew people who had died from heroin overdoses, many more who've overdosed repeatedly and been lucky enough so far to survive. The day before we arrived a man died shooting up in a Wendy’s fast food restaurant bathroom.
Kathy Stevens-Butts, the mother of a 23-year-old woman who died from a heroin overdose in November told us heroin is a "plague".
"I don’t know what else to liken it to. People are just dropping dead left and right," she said.
Guerrero State - Mexico’s most violent
Farmers in the southwestern state of Guerrero are increasingly seeding fields of poppies to cash in on the boom in heroin consumption in the US.
Throughout its history, Guerrero has been one of Mexico’s most violent states. Now it has the highest murder rate in Mexico. And much of that killing can be tied to organised crime and the drug trade.
The case of 43 students who disappeared in the arms of local police illustrates just how lawless and violent Guerrero is. According to the government, the students were murdered by the area’s dominant gang, Guerreros Unidos, or Warriors United.
Mexico’s attorney general said members of Warriors United killed the students and incinerated their bodies because they thought they were members of a rival gang.
Whether you believe the government’s theory or not, the logic is: Protect your highly lucrative turf at any cost.
The poppy fields we visited are just a few hours drive from where the students were last seen.
Not only is Guerrero one of Mexico’s most violent states, it is also one of its poorest. According to a UN report more than half of Guerrero’s population are affected by extreme poverty.
The state relies heavily on tourism. But its former jewel of a resort, Acapulco, is now one of the world’s most violent cities, famous for bridge hangings, beheadings and shootings as well as dazzling beaches. The state’s economy is in ruins, and some of the only decently paid steady work in Guerrero is with organised crime.
In the mountains, poppy farmers tell you they would rather grow something else. Avocados, peaches - anything that could rival what they earn from poppies.
But the problem is they have no good roads to get their product to market. Heroin paste is compact and portable. It doesn’t bruise going down a bumpy dirt road. But peaches and avocado do.
For decades activists have pressured the government for services and roads. But the state remains a backwater. That neglect, they say, is what pushed them into the drug-growing business.
American public health crisis
Many also blame lack of opportunity in West Virginia for its high levels of addiction. According to the Kaiser Family Foundation in 2009 West Virginia residents filled 19 painkiller prescriptions per capita - the highest in the US. Since then the government has cracked down on illegal pill dealing.
As pill prices rose, Mexican cartels flooded the US market with cheap, high-grade heroin, to deadly effect. According to The Atlantic, painkiller overdoses have dropped slightly in West Virginia whereas heroin overdose deaths have tripled in the past five years.
The problem is so bad in West Virginia and other states that authorities we spoke to all said the problem should be addressed as a public health crisis.
One police officer who used to work on drugs and now investigates murders in West Virginia said, "I used to believe locking people up was the answer, but that has completely failed".
Heroin dealers told one recovering addict we spoke to that Martinsburg was a "goldmine". He and other former users told us if you go to certain corners in nearby Baltimore, Maryland, with West Virginia plates on your car, dealers swarm you with free samples.
The state is clearly known for its desperation and addiction.
One image particularly stands out to me from our trip to West Virginia: That of a gleaming new neo-natal intensive care unit complete with several incubators.
Helena Brady is the nursing director for the unit. It’s set up to help premature babies and other newborns struggling in their first weeks of life. Brady said usually more than half of the babies in the unit are addicted to heroin - because their mothers were heroin addicts. It can take months to wean the babies off the drug.
When we asked Brady if she expects to see more heroin-addicted babies she said, "Yes, a tidal wave is coming."
Source: Al Jazeera