HEAD NORTH on Saint Ann’s Ave. in the South Bronx and go past the AutoZone on E. 149th St. On most afternoons, students from two nearby high schools pack the sidewalks. Across the street, hidden from view, the depth of the city’s heroin epidemic is on harrowing display.

Beyond a chain-link fence a slope leads to an abandoned railroad bed. At first glance, the hill sparkles with the shiny orange caps from single-use needles.

Move closer. Something more sinister blankets the patches of weeds and dirt: discarded syringes. Hundreds of them.

There are needles scattered on the ground like twigs and needles clumped under trees like piles of leaves. Needles are staked into a mud wall. Needles are floating in the pools of standing water below. Some of the syringes’ tips are still stained with blood.

(Video by Marcus Santos and Michael Sheridan, with Rich Schapiro reporting )

On a gray and damp Friday afternoon, Leidanett (Lady) Rivera sits in front of a crudely erected shelter overlooking the railroad bed, surrounded by used needles and other trash. She fumbles with an unused syringe as she describes surviving two overdoses in the past two months.

“I was lucky to come back twice,” says the rail-thin Rivera, 38. “I might not be lucky the third time.”

A few minutes pass. Rivera takes out a bottle cap-shaped cooker and mixes a solution of heroin and cocaine. She’s wearing several layers of sweatshirts, blue jeans and construction boots. Pulling up her sleeves, she reveals arms covered in puncture marks and dark red scars.

Leidanett "Lady" Rivera is injected by her boyfriend at St. Ann's and E. 150th St. in the Bronx. (Marcus Santos / New York Daily News) 15 photos view gallery

“You see these track marks,” Rivera says. “The vein is hard for me to hit.” Her “addict partner” has just shown up. Rivera passes him the needle and tugs down her collar.

She looks straight ahead, her face blank, as the man sticks the syringe into the left side of her neck and presses the plunger.

Opioid abuse has exploded in the city and across the country in the past five years. Overdoses involving prescription painkillers and heroin are soaring in the South Shore of Staten Island just as they are in countless middle-class American communities that have never before seen drug epidemics.

In many of these communities, users first got hooked on prescription opioids such as Percocet and oxycodone. They later turned to heroin, lured by its cheaper prices and staggering high.

The South Bronx in contrast has battled rampant heroin use since the 1960s. Experts say opiate consumption in the borough leveled off in the 1980s and ’90s but has now returned with a vengeance.

Here, the users tend to be older and poorer than elsewhere. Most are black and Hispanic. Many have been hooked on heroin for years.

“It’s great the profile of this issue has been raised but the Bronx has always been experiencing a heroin problem,” said Julia DeWalt, advocacy manager for Boom!Health, a nonprofit that offers a range of services to opioid users in the South Bronx.

More than 1,370 New Yorkers died from overdoses in 2016 — twice the number of deaths from homicides and car wrecks combined. Roughly 80% of the overdoses involved opioids. Out of those, 90% were caused by heroin or fentanyl, a powerful synthetic drug.

The Mott Haven-Hunts Point area, where the shooting gallery spotlighted by The News is located, has the highest rate of heroin-involved overdose deaths in the city.

Its 2015 tally — 18.8 per 100,000 people — dwarfs the national rate of 4.1 per 100,000. If the neighborhoods were a state, it would trail only West Virginia in a ranking of those with the highest rates of all drug overdose deaths.

The South Bronx’s opiate epidemic plays out in plain view.

The neighborhood around Lincoln Hospital is the kind of place where you can see men in wheelchairs shooting up between parked cars in the middle of the afternoon, where paramedics sometimes find addicts passed out on police station steps and where the only spots that consistently draw long lines are the methadone clinics.

“This is what I was seeing when I was a kid and there’s more of it now,” said Bronx District Attorney Darcel Clark.

A photo of the South Bronx from the top of a building. (Marcus Santos / New York Daily News)

Clark grew up in the Soundview Houses where, she said, heroin was the drug of choice in the late 1960s and 1970s. “Back then, it was like no one cared about the people in the South Bronx,” Clark said. “It was an urban problem, a community-of-color problem. “There’s a sense of urgency now,” she added, “because it’s in the communities where it wasn’t before.”

Ric Curtis, a John Jay College of Criminal Justice professor who has studied the city’s heroin market for decades, agreed. “New populations are coming into the (heroin) scene – younger people, white kids, it’s in the suburbs – but this is old news in the South Bronx,” Curtis said.

EMT Paramedic Robert Kelly and EMT Lieutenant Barbara Aziz are no strangers to the impact heroin has had on the South Bronx. (Marcus Santos / New York Daily News)

FDNY paramedics Bob Kelly and Lt. Barbara Aziz-Lopez know the drug den on Saint Ann’s Ave. well. Junkies refer to it simply as “the hole.” Aziz-Lopez and Kelly know it as the final refuge for the most hardcore addicts.

“It’s the last stop before death,” Kelly said.

Both veterans of more than 20 years, Aziz-Lopez and Kelly operate on the front lines of the South Bronx’s heroin crisis. Each lost count long ago of the number of overdose victims they’ve treated.

“I could never put a number on it,” said Kelly, 48. “I’d say it’s definitely in the thousands.” Aziz-Lopez doesn’t even try to estimate anymore. “Too many to count,” she said.

All FDNY emergency workers now carry naloxone, better known by its brand name Narcan. It quickly reduces the effects of opioid overdoses. First responders from EMS station No. 14 in Mott Haven, where Aziz-Lopez and Kelly work, used it on 317 overdose victims last year — nearly one case a day.

EMTs help an apparent drug addict in the South Bronx. (Marcus Santos / New York Daily News)

There are several known heroin hot spots in Mott Haven and Hunts Point, but “the hole” is the most notorious.

Aziz-Lopez and Kelly have both been called there for overdoses, falls and other mishaps. “I’ve probably forgotten more times than I can remember,” Kelly said.

The paramedics returned there on a chilly morning last month to give a reporter and photographer from The News a window into the area’s heroin scourge. “There’s just a needle everywhere you look,” Kelly said, scanning the ground behind the fence. “It’s ridiculous.”

“I’ve been here 25 years and this place has always been like this,” he added. “A classic shooting gallery.” As if on cue, a disheveled man emerged from a makeshift hovel along the slope. He squinted in the morning light and stomped off.

“And you see that,” she said. “It’s a school.”

ADVERTISEMENT

The building actually houses two schools – University Prep Charter High School and Hostos-Lincoln Academy of Science – and the block fills with kids about 3 p.m.

The building that houses University Prep Charter High School and Hostos-Lincoln Academy of Science is just a fence away from "the hole." (Marcus Santos / New York Daily News)

A few minutes after the man left, a reporter tiptoed around an especially heavy clump of needles. Aziz-Lopez looked up and shook her head. “Welcome to the South Bronx,” she said.

The city cleared out “the hole” in September 2015 after Mayor de Blasio visited the area amid a crackdown on homeless encampments. But the addicts returned days later, drawn by its proximity to street dealers and isolated location. The site is invisible from the school. But the shooting gallery reveals itself with a stream of men walking in and out of the fenced-in area at all hours of the day.

Curtis, the John Jay professor, believes the city would be wasting its time by trying to close it down for good. “It’s like squeezing a balloon,” Curtis said. “You’re just spreading the problem to other places.”

It’s 3 p.m., and Rivera is alone inside the open-air drug den. As schoolkids pour out onto the sidewalks across the street, Rivera is rooting around a mound of trash in search of cookers with heroin or cocaine residue left inside of them.

“I’m ashamed to say that I sleep in cartons,” Rivera says, gesturing toward her shelter. “This is not a house. This is not how I want to be living.”

Leidanett "Lady" Rivera (left) is pictured near her makeshift home in "the hole." A crude shelter (right) looks down on the abandoned railroad bed. (Marcus Santos / New York Daily News)

Rivera is eager to talk about her life and her battles with addiction, though certain details don’t always match up. Her speech is slow and slurred. But she remains coherent as she delves into the past.

Rivera says she grew up in Puerto Rico and went to school to become a mechanic, but her life got derailed at age 20 when she started sniffing dope. The drug was never far away; her brother was selling it. At some point, she arrived in New York and remained clean for several years.

Rivera says she got married, had five kids and was living a normal life in the Bronx. But a badly broken thumb led to prescription pills, which eventually led her back to heroin and cocaine. She now has HIV and has been sleeping at “the hole” off and on for two years.

“I know what it is to live clean,” Rivera says. “I know what it is to have $80,000, and go have fun. Get on a plane and go have fun without drugs.”

Rivera describes her past while holding an unused needle in her right hand.

As she speaks, the man she referred to as both her boyfriend and addict partner shows up with two other guys. One of the men was toting baggies of heroin and cocaine in his backpack. As the boyfriend helps Rivera inject into her neck, the two other men prepare their own solutions. Within seconds, they’re both simultaneously shooting a heroin-cocaine mixture into their forearms.

The highly-addictive drug cocktail, known as a “speedball,” delivers the intense rush of cocaine followed by the dreamy, pain-erasing sensation of heroin. Once he gets his fix, one of the men opens up about his habit.

Julio Oquendo shoots heroin into his arm. (Marcus Santos / New York Daily News)

Julio Oquendo, 38, speaks in a soft and even voice. He’s wearing jeans, a blue hoodie and a Cleveland Cavaliers hat.

“I know we do drugs, but we don’t harm nobody,” Oquendo says.

ADVERTISEMENT

Oquendo, who also hails from Puerto Rico, says he started using 10 years ago. He relapsed six months ago after separating from his wife. He sleeps at a temporary shelter in Hunts Point and has never overdosed.

“Not yet,” Oquendo says. “Thank God.”

His voice grows even quieter. “But sometimes you feel like you want to die because you don’t have a purpose in life,” Oquendo says. “We’re tired of this life, but there are a lot of no’s,” he adds. “No jobs. No places to stay. No real help for people like us.”

“Sometimes you feel like you want to die because you don’t have a purpose in life.”

Rivera nods her head in silent agreement. The gesture reveals the glistening puncture mark on her neck.

She didn’t always bear such obvious signs of heroin addiction. Rivera’s Facebook page contains photos from as recently as three years ago that bear little resemblance to her current appearance. Her face in the Facebook pictures is round and full. Her skin is clear. She has a healthy body weight and a bright smile.

But the pictures don’t tell the full story.

Rivera’s Facebook friend Beth Soto spoke to a reporter about her old pal. The first words out of her mouth were telling. “Is she dead?”

Soto said she watched Rivera spiral downward while they were living in the same single-room occupancy residence from March 2014 to early 2015. “She was beautiful and she had a beautiful soul,” recalled Soto, 52, who lived at the W. 97th St. building with her husband because they were displaced after a fire. “We tried to save her, but she wasn’t ready.”

Soto painted a sad portrait of Rivera as a full-blown drug addict who still had a magnetic personality.

(Marcus Santos / New York Daily News)

According to Soto, Rivera would use any drug she could get her hands on. The struggling addict was living there with her then-husband as part of a program for people suffering from HIV. Soto said the husband was a terrible influence — a controlling man who sold prescription pills.

In the summer of 2014, Rivera found out that she was going to become a grandmother and vowed to change her ways. “She was trying to get clean because she didn’t want her daughter to see her like that,” Soto said. “She wanted to get clean for the baby.”

Rivera wasn’t able to pull it off.

“So she missed the birth of her grandchild,” Soto said. “She was trying so hard, but the devil is a liar.”

To reach the railroad bed, the addicts climb down a white rope that they’ve tied around a tree. Like the slope above, the ground is littered with used syringes and orange caps.

(Marcus Santos / New York Daily News)

It’s 11 days later, and Rivera and two men are standing there now, looking over a 4-foot-long black plastic case that’s being used as a table. On top of it are four bundles of 10 tiny paper envelopes containing heroin, two larger and two smaller plastic baggies of cocaine, a bottle cap-shaped cooker, a blue tube of saline, a palm-sized container of antibacterial hand gel, a light blue lighter and a $20 bill. In all, they’re staring at more than $400 worth of drugs.

Rivera is wearing magenta lipstick and a gray T-shirt that hangs loosely on her bony frame.

One of the men is the boyfriend she had described as her addict partner. He’s wearing a blue Knicks T-shirt and gray sweatpants and he has an Android smartphone. He reluctantly identifies himself as Menor, 41, and says little else. The other man, Efrain (Tanaka) Pagán, won’t stop talking. He claims to be the founder of the drug den.

“I’ve been here 20 years,” says Pagán, 48, who had a syringe nestled above his left ear. “This is our home. We feel comfortable here.”

Socket wrench, syringe and a rag on the ground in the St. Ann's "shooting gallery." (Marcus Santos / New York Daily News)

Pagán, dressed in a white T-shirt and black pants, is carrying a socket wrench and a sky blue rag. He says that he and Menor work as freelance mechanics in the neighborhood. “That’s how we support our habit,” Pagán says. “We don’t steal. We don’t sell drugs. We don’t do nothing. We just use drugs. And we would like help. Instead of the police taking us to jail, help us. Stop taking us to jail and throwing us in the slammer. Because you’re not helping us.”

(Menor would later say that he spent up to $2,000 a week on drugs. He acknowledged selling some on the side to support his and Rivera’s habit.)

Pagán says he first tried heroin when he was a 10-year-old boy in Puerto Rico. He arrived in New York in 1982 at age 14 and drugs eventually took over his life. “Look at my arms,” Pagán says after eagerly rolling up his sleeves. “I don’t have no veins.”

As Pagán speaks, Menor gets to work. He prepares a heroin-cocaine mixture large enough for the three of them to share. As Menor draws the hit into a syringe, Pagán grows more animated.

“This is an everyday thing for us,” he says. It soon becomes clear that it’s more like an every hour thing for them.

“We do drugs to function,” Pagán adds. “We do drugs to take the ache and the anxiety away from us. When we do the poison, everything goes away and we can function normally.”

Menor lifts his sleeve to reveal a nasty 5-inch scar curving around the inside of his left elbow. He carefully places the needle into the bottom tail of the wound and gently presses the plunger. As the drugs flow into his body, his expression remains unchanged.

“Instead of the police taking us to jail, help us. Stop taking us to jail and throwing us in the slammer. Because you’re not helping us.”

Menor pulls out an antibacterial wipe from a container at his feet and cleans the injection site. He raises his arm in the air and points at the scar. “Maybe one million right here,” he says.

Rivera is up next. Crouching down, she cleans the track mark on her neck with a wipe. Then she hands Menor her already-filled needle and looks straight ahead as he prepares to inject it.

The moment suddenly turns surreal – the shooting gallery’s resident rooster ambles over. “You believe that rooster is a drug addict?” Pagán says.

As Menor pumps the drugs into Rivera’s external jugular vein, the rooster walks directly into her line of sight. She smirks as the chicken heads toward some of the drug paraphernalia. “She comes for the cooker,” Rivera quips.

Pagán sits on the ground to take his hit. He first wraps a thin turquoise band around his left bicep. “I don’t have no veins, so I got to squeeze to at least make something of it,” Pagán says.

(Marcus Santos / New York Daily News)

No promising vein presents itself. So he switches over to his right arm. Pagán is successful this time, easing the speedball into his forearm.

“I shot up mansions. I shot up a lot of money in these arms,” says Pagan, who has suffered five overdoses. “I’m not happy about it but I feel like this relieves my problems.” Pagán pauses for a few seconds. Then he offers a strikingly candid reassessment.

“That’s bull----,” he says. “Because it doesn’t really relieve my problems. I just love to get high – put it that way.”

Rivera eventually changes the subject to how she spent the previous day. She says she shot up near her encampment before heading to Third Ave. to get something to eat. On the way back, she suddenly felt faint and dropped to her knees.

A female passerby called 911, and first-responders brought her to Lincoln Hospital, where she was examined and released. Rivera claimed it wasn’t an overdose. “They just gave me some bad drugs,” she says.

Rivera adds that she told nurses she wanted to go to a detox facility but no one listened to her.

“I’m tired of living like this. I’m tired of using,” says Rivera, who was still wearing a red plastic hospital bracelet on her right wrist.

Lady's clothes hang loosely on her bony frame. “I know what it is to live clean,” she says. “I know what it is to have $80,000, and go have fun." (Marcus Santos / New York Daily News)

As if out of nowhere, a baby-faced man with jet black hair appears in the old railroad bed. He shuffles towards the others but stops about 10 feet away. His eyes close and his upper body folds forward like a question mark.

He remains in that position, completely motionless, for more than 10 minutes. “He must have been smoking PCP, too,” Pagán says.

More than a dozen men trickle in and out of the site over the next half-hour. The majority stay for less than five minutes. They bend at the knees on the slope above the railroad bed to prepare their hit and take off immediately after getting high.

One of them, a man with close-cropped black hair and wearing Nike sneakers and blue jeans, looks perfectly normal from afar. A closer look reveals that he has no fingers on his right hand. He perches on the ledge, grips the needle with his left hand and shoots up in his right bicep.

Men trickle in and out of the site. Most stay for less than five minutes. They bend to prepare their hit and take off immediately after getting high. (Marcus Santos / New York Daily News)

A few minutes later, Rivera steps away from Pagán and Menor, and turns reflective.

“I could break free,” she says. “I know what I want. I know who I am. The drugs cannot put me down so much ... that I can’t leave this life.”

She and Menor pack up their things.

(Marcus Santos / New York Daily News)

Rivera explains that an addict friend was being treated at Lincoln Hospital for a drug-related infection. Earlier that day, he had reached out to them in desperation from his hospital bed. “He needs methadone, but they’re not giving it to him,” Rivera says. “They’re trying to give him Tylenol.”

So Rivera and Menor have decided to come to his rescue. The plan was to deliver heroin and needles right to his hospital bed. Rivera describes what they’re intending to do matter-of-factly, as if they’re bringing him a sandwich or toothpaste.

Rather than climb out of the railroad bed, she and Menor decide to take the easier route to the street. The railroad bed turns from dirt to grass as it continues north underneath the Westchester Ave. overpass. About 40 yards from the overpass, a low ledge leads to a hole in a chain link fence on Rae St. That’s where Rivera and Menor are heading.

The pair walk underneath the overpass at a good clip. Brilliant sunshine meets them as they come out of the other end. They march on several yards before stopping abruptly. Rivera hands Menor a syringe already filled with heroin and cocaine.

She turns her head.

Right there, in the middle of the overgrown railroad bed, bathed in sunlight, he once again jabs the needle into her neck and presses the plunger.

(Marcus Santos / New York Daily News)

Are you or a family member struggling with opioid addiction?

Find opioid addiction resources here.

This is the first in a series of stories on New York City’s opioid epidemic.

The Daily News interviewed addiction experts, recovering addicts, police and prosecutors to provide an in-depth look at the drug scourge.

The News watched as addicts injected heroin into their bodies. Reporters sat down with families grieving over relatives whose lives were cut short by opioid abuse. And the highest levels of the NYPD weighed in on the opioid crisis in the city, saying cops are taking a different approach — acknowledging police can’t arrest their way out of the problem.