Twice a week, an ambulance pulls into the parking lot of the Big Rock shopping center to hand out something not usually found in bulk quantities in small US towns: clean needles for heroin addicts.
It is just one example of a surprising - and disturbing - fact: The US area with the highest drug-mortality rate per capita isn't New York, Los Angeles, or any other major city. It is this sparse, rural county flanked by the Sangre de Cristo mountains of northern New Mexico.
The reasons for the startling statistic are as varied as they are entrenched. One is location. Rio Arriba County lies along the drug-smuggling route from Mexico to Denver. Between here and Santa Fe - where many people drive to work - there's little but 30 miles of scrub pine, adobe houses, and blacktop. With people tacking on long commutes at the end of their work days, that leaves "a lot of unsupervised kids," says Lauren Reichelt, director of the Rio Arriba County Department of Health and Human Services.
Another reason is poverty. According to the US Census, New Mexico ranks No. 1 for poverty (along with Louisiana and the District of Columbia), and Rio Arriba is hardly the richest county in the state.
Finally, there's culture - or rather, the erosion of it. "Rio Arribans have always been extremely attached to their culture," says Ms. Reichelt. Rio Arriba has a rich Hispanic tradition, that dates back more than 400 years. But many residents, including Reichelt, feel it's disappearing.
She believes the community is suffering from a sense of collective hopelessness. As a result, she says, many are using drugs to "self-medicate" their grief.
An uphill battle
But county officials are determined to shed themselves of the dubious distinction of being the county with the most deaths per capita, in the state where the greatest number of drug-related deaths occur. (There were 163 drug-related deaths in New Mexico last year.)
They face an uphill battle. While the US average for drug-related deaths is 2.5 per 100,000 people, Rio Arriba County has 35 deaths per 100,000. The county's drug of choice is black-tar heroin, leading to a higher rate of overdoses. What makes combating drug abuse here even more complicated is that, in many cases, it's become a family affair - with entire families not only using, but burglarizing houses together to support their habit.
Phillip Martinez, a former heroin addict, says drugs were an intergenerational problem in his family. His grandfather was an alcoholic, and his father was hooked on prescription drugs. Two of his brothers died of drug overdoses.
"In all the traditions that we celebrated - birthdays, weddings, funerals, matanzas - alcohol was involved," he says. But Mr. Martinez is one of Rio Arriba's success stories. He credits the treatment program Amistad, where he now works as a counselor, for helping him stay drug-free for 18 months.
In addition to being a stop on a drug-smuggling route, Rio Arriba is considered the heart of the centuries-old, northern-New-Mexico Hispanic culture. Galleries with traditional weavings, religious carvings, paintings, and other crafts stud the road from Espanola to Chimayo. Residents proudly claim their home as the birthplace of the lowrider.
Families commonly have lived in the same towns for many generations. Among themselves, they frequently speak a mix of Spanish and English, often in the same sentence - a phenomenon known as code-switching. But that's fading, as the younger generations lose the Spanish language.
"The dilemma is: Do they choose the culture they were born into or the telecommunications culture? Do they choose MTV?" asks Harry Montoya, director of a drug-prevention program called Hands Across Culture.
But Mr. Montoya acknowledges that, even within the traditional culture, heroin use has been prevalent among a minority of residents since the 1930s. "Families are dealing because of poverty," says counselor and recovered addict Betty Ross. "Some start selling it, and didn't mean to start using it - it was to feed the kids."
While no one is downplaying the severity of the problem, some residents resent being labeled a giant drug house. With a population of 41,000, Rio Arriba County had 16 drug deaths in 2000 and 18 in 1999, according to the New Mexico Department of Health.
Murray Ryan, an Espanola physician who is outspoken on the issue, has also worked in Seattle, where he says there were "horrendous pockets of 10,000 people in housing projects where the drug situation was much worse. But because it was a metropolitan area, the statistics get spread out."
Residents take action
New Mexico, whose Gov. Gary Johnson has been a champion of treating rather than punishing drug offenders, has taken several steps this year that may help Rio Arriba. Some $9.8 million was allocated for a more treatment-oriented drug policy, following the example of states like Arizona and California.
And a law was passed that, for the first time in the US, gives private physicians the right to administer Narcan, a drug used to keep alive victims of heroin overdoses. In Rio Arriba, Narcan kits have been created for families of addicts to keep on hand.
Residents have also taken matters into their own hands. In September 1999, there was a major federal raid in Chimayo, resulting from a close coordination between a citizen committee and law enforcement.
Informing on dealers in this tightknit community of 3,000 is difficult, especially with many interrelated families. However, the citizen committee used that closeness to their advantage. "About 12 people had a network of sources, and some had really good ones," says Bruce Richardson, committee president.
In one morning, 34 drug dealers were apprehended. Chimayo now has its own police substation, and Police Chief Wayne Salazar says residents are much more likely to report crime.
Mr. Richardson says there was a "big outpouring of emotion from grandmothers and mothers. They put a big poster in the post office saying things like 'Thank you to God.' "
(c) Copyright 2001. The Christian Science Monitor