PULSE CHECK Trends in Drug Abuse November 2001

Executive Office of the President Office of National Drug Control Policy Washington, DC 20503 NCJ 191248 ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS The Office of National Drug Control Policy (ONDCP) acknowledges the contributions made by the 83 Pulse Check sources who voluntarily prepared for and participated in the in-depth discussions that are the basis for this report. Their names (unless they requested anonymity) appear in an appendix. Information presented in this publication reflects the views of those sources, and not necessarily those of the Federal Government.

Marcia Meth and Rebecca Chalmers of Johnson, Bassin & Shaw, Inc., produce the Pulse Check for ONDCP, under Contract Number 282-98-0011, Task Order Number 10. Anne McDonald Pritchett, Office of Programs, Budget, Research, and Evaluation, ONDCP, serves as the project director and editor for Pulse Check.

All material in this publication is in the public domain and may be reproduced or copied without permission from ONDCP. Citation of the source is appreciated. The U.S. Government does not endorse or favor any spe- cific commercial product. Trade or proprietary names appearing in this publication are used only because they are considered essential in the context of the information reported.

This issue and previous issues of Pulse Check are available online at . CONTENTS

CONTENTS Highlights...... 1

Introduction ...... 5

Heroin ...... 7

Crack Cocaine ...... 29

Powder Cocaine ...... 43

Marijuana ...... 55

Methamphetamine ...... 67

Ecstasy and Other Club Drugs...... 75

Special Topic: Synthetic Opioids ...... 89

Appendix 1: Methodology ...... 99

Appendix 2: Population Demographics in the 21 Pulse Check Sites ...... 101

Appendix 3: National-Level Data Sources Available in the 21 Pulse Check Sites ...... 101

Appendix 4: Pulse Check Sources ...... 102

Appendix 5: List of Discussion Areas by Source Type ...... 104

EXHIBITS Highlights Exhibit 1. How serious is the perceived drug problem in the 21 Pulse Check communities? ...... 1 Exhibit 2. How has the perceived drug problem changed (fall 2000 vs spring 2001)? ...... 1 Exhibit 3. What new problems have emerged or intensified during spring 2001? ...... 2 Exhibit 4. How has the perceived drug problem changed (fall 2000 vs spring 2001)?...... 3 Exhibit 5. What are the most serious drug problems in the 21 Pulse Check sites, by type of source? ...... 4 Exhibit 6. What are the most serious drug problems in the 21 Pulse Check sites, by number of sources and sites? . . . . . 4

Heroin Exhibit 1. How available is heroin across the 21 Pulse Check cities? ...... 7 Exhibit 2. How has heroin availability changed (fall 2000 vs spring 2001)? ...... 8 Exhibit 3. How available are the different varieties of heroin? How has their availability changed (fall 2000 vs spring 2001)? ...... 9

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Exhibit 4. What are the prices and purity levels of different types of heroin in 18 Pulse Check cities? How have prices and purity changed (fall 2000 vs spring 2001)? ...... 11 Exhibit 5. How is heroin referred to, and what types of heroin predominate, in different regions of the country? . . . .12 Exhibit 6. How likely are heroin sellers to use their own drug? ...... 14 Exhibit 7. Where is street-level heroin sold and used? ...... 15 Exhibit 8. What other drugs do heroin dealers sell? ...... 16 Exhibit 9. What demographic groups predominate among heroin users, according to different Pulse Check sources? . .19 Exhibit 10. How do users administer heroin? ...... 22 Exhibit 11. How has heroin use impacted the health of users? ...... 25

Crack Cocaine Exhibit 1. How available is crack cocaine across the 21 Pulse Check cities? ...... 29 Exhibit 2. How has crack cocaine availability changed (fall 2000 vs spring 2001)? ...... 30 Exhibit 3. How much does crack cocaine cost in 19 Pulse Check cities? ...... 31 Exhibit 4. How is crack cocaine referred to across different regions of the country? ...... 31 Exhibit 5. What other drugs do crack dealers sell? ...... 33 Exhibit 6. How likely are crack sellers to use their own drug? ...... 34 Exhibit 7. Where is street-level crack sold and used? ...... 35 Exhibit 8. What age group is most likely to use crack? ...... 37 Exhibit 9. Which genders are the predominant users of specific drugs in the 21 Pulse Check cities? ...... 38 Exhibit 10. What racial/ethnic group is most likely to use crack? ...... 38

Powder Cocaine Exhibit 1. How available is powder cocaine across the 21 Pulse Check cities? ...... 43 Exhibit 2. How has powder cocaine availability changed (fall 2000 vs spring 2001)? ...... 44 Exhibit 3. How much do grams and "eight-balls" of powder cocaine cost in 17 Pulse Check cities? ...... 44 Exhibit 4. How is powder cocaine referred to across different regions of the country? ...... 45 Exhibit 5. What other drugs do powder cocaine dealers sell? ...... 46 Exhibit 6. Where is street-level powder cocaine sold and used? ...... 48 Exhibit 7. What racial/ethnic group is most likely to use specific drugs? ...... 50 Exhibit 8. What is the predominant socioeconomic status of powder cocaine users? ...... 51

Marijuana Exhibit 1. How available is marijuana across the 21 Pulse Check cities? ...... 55 Exhibit 2. What varieties of marijuana are described as “widely” or “somewhat” available across the 21 Pulse Check cities? How has availability changed (fall 2000 vs spring 2001)? ...... 56 Exhibit 3. How has marijuana availability changed (fall 2000 vs spring 2001)? ...... 57 Exhibit 4. How much does marijuana cost in 19 Pulse Check cities? ...... 58 Exhibit 5. How is marijuana referred to in different regions of the country? ...... 59 Exhibit 6. What age group is most likely to use marijuana? ...... 62 Exhibit 7. Where are drug users most likely to reside? ...... 64 page iv Pulse Check: November 2001 CONTENTS

Exhibit 8. How are different drug users referred to treatment? ...... 64 Exhibit 9. What are some slang terms for drug combinations involving marijuana? ...... 65

Methamphetamine Exhibit 1. How available is methamphetamine across the 21 Pulse Check cities? ...... 67 Exhibit 2. How has methamphetamine availability changed (fall 2000 vs spring 2001)? ...... 68 Exhibit 3. How much does methamphetamine cost in 16 Pulse Check cities? ...... 69 Exhibit 4. How is methamphetamine referred to in different regions of the country? ...... 69 Exhibit 5. In what other crimes are illicit drug sellers involved, by different drugs, across Pulse Check sites? ...... 71 Exhibit 6. Where is methamphetamine sold and used across 18 Pulse Check cities? ...... 71 Exhibit 7. What age group is most likely to use methamphetamine? ...... 73

Club Drugs Exhibit 1. Where are club drugs emerging? ...... 75 Exhibit 2. How available is club drugs across the 21 Pulse Check cities? ...... 76 Exhibit 3. Has club drug availability changed across the 21 Pulse Check cities (fall 2000 vs spring 2001)? ...... 77 Exhibit 4. How are ecstasy and ecstasy combinations referred to across Pulse Check cities? ...... 78 Exhibit 5. How are ecstasy pills labeled in reporting Pulse Check cities? ...... 79 Exhibit 6. How much does a pill (one dose) of ecstasy cost in 17 Pulse Check cities? ...... 79 Exhibit 7. What other substances might be contained in ecstasy tablets? ...... 79 Exhibit 8. Where is ecstasy sold and used across the 21 Pulse Check cities? ...... 81 Exhibit 9. Has the number of novice ecstasy users in treatment changed (fall 2000 vs spring 2001)? ...... 84 Exhibit 10. How much do GHB, ketamine and Rohypnol cost? ...... 86 Exhibit 11. What are the predominant characteristics of club drug sellers? ...... 88 Exhibit 12 What are the predominant characteristics of club drug users? ...... 88

Synthetic Opioids Exhibit 1. How much of a problem is OxyContin® diversion and abused, by U.S. Region? ...... 90 Exhibit 2. How has the perceived OxyContin® problem changed since the last reporting period, by U.S. region? . . . .90 Exhibit 3. How serious a problem is OxyContin® diversion and abuse in Pulse Check cities and how has the problem changed (fall 2000 vs spring 2001)? ...... 91 Exhibit 4. Where is OxyContin® emerging? ...... 92 Exhibit 5. How available is diverted OxyContin® in 17 Pulse Check cities, and how has availability changed (fall 2000 vs spring 2001)? ...... 92 Exhibit 6. How is diverted OxyContin® referred to in Pulse Check cities? ...... 93 Exhibit 7. What are the most commonly sold units of diverted OxyContin®? ...... 94 Exhibit 8. Where is diverted OxyContin® sold and abused across 17 Pulse Check cities? ...... 95 Exhibit 9. How has the number of novice OxyContin® treatment clients changed (fall 2000 vs spring 2001)? ...... 96 Exhibit 10. Who abuses OxyContin®, according to epidemiologic and ethnographic respondents? ...... 98 Exhibit 11. Who abuses OxyContin®, according to methadone and non-methadone treatment respondents? ...... 98

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page vi Pulse Check: November 2001 HIGHLIGHTS

PULSE CHECK HIGHLIGHTS This report is based on discussions with 83 epidemiologists, ethnographers, law enforcement officials, and methadone and non-methadone treatment providers from 21 Pulse Check sites. Telephone discussions with these individuals, conducted between May and July 2001, reveal that overall, when comparing spring 2001 with fall 2000, the majority of Pulse Check sources consider the drug problem to be very serious but stable. (Exhibits 1 and 2)

Exhibit 1. The situation is characterized by several key features: How serious is the perceived drug problem in the 21 Pulse ➤ Diversion and abuse of OxyContin®, a high-dose formulation of the pharma- Check communities? ceutical opiate oxycodone, is the latest and most rapidly emerging problem. (Exhibits 3 and 4) Percent (N=83) 100 ➤ 90 Heroin and crack are both equally associated with more serious consequences than any other illicit drugs, as reported in 14 Pulse Check sites 80 each. (Exhibits 5 and 6) 70 60 ➤ Marijuana remains the most widely abused illicit drug, as reported in 19 50 sites. (Exhibits 5 and 6) 40 30 ➤ The emerging problem of "ecstasy" (methylenedioxymethamphetamine, or 20 MDMA) and, to a lesser extent, other club drug use continues to intensify. 10 (Exhibit 4) 0 Very Somewhat Not Very ➤ Methamphetamine continues to be reported as an emerging problem in Serious Serious Serious some areas. (Exhibit 4)

Sources: Epidemiologic, ethnographic, treatment, and law enforcement respondents HIGHLIGHTS FROM THE SPECIAL SECTION TOPIC: Synthetic Opiates Pulse Check sources asked about report OxyContin® abuse specifi- Exhibit 2. synthetic opiates reported the diver- cally among adolescents who have How has the perceived drug sion and abuse of the prescription not used opiates previously. problem changed (fall 2000 vs pain reliever OxyContin® as the spring 2001)? ® emerging drug problem in their sites: OxyContin abuse and diverted sales are emerging in the rave and Percent (N=83) Nearly all law enforcement nightclub scene in Billings, Boston, 100 sources report increased avail- Miami, New Orleans, Philadelphia, 90 ability of diverted OxyContin®, and St. Louis. 80 with sources in the Northeast 70 generally reporting higher While the media often refer to 60 ® availability than elsewhere. diverted OxyContin as "hillbilly 50 heroin," its use is not isolated to 40 Although in most cities Oxy- rural areas. For example, in 30 Contin® abusers are predominant- Baltimore, Philadelphia, and 20 ly young adults (18–30 years) or Washington, DC, abusers reside 10 adults (older than 30), adolescent primarily in central city areas; in 0 Much Some- Same Less (13–17 years) users are emerging in Birmingham, Detroit, and Memphis, Worse what Serious a few cities, such as Portland (ME) they reside in rural areas and the Worse and Miami. Similarly, sources in six suburbs; and in Columbia (SC) and cities (in Billings, Boston, Detroit, Miami, they reside predominantly in Sources: Epidemiologic, ethnographic, treatment, and law enforcement respondents Miami, Portland, and St. Louis) the suburbs.

Pulse Check: November 2001 page 1 HIGHLIGHTS

Since the last reporting period, HIGHLIGHTS BY SPECIFIC injectable Mexican black tar, which OxyContin® diversion has ILLICIT DRUG predominates in the West and in intensified. For example, in The 83 discussions also yielded key some parts of the South. Portland (ME), armed robberies of findings about heroin, crack cocaine, ® Street-level prices and purity are pharmacies for OxyContin and powder cocaine, marijuana, metham- generally stable—at low and high home invasions of clients who phetamine, and club drugs: have legitimately filled prescrip- levels, respectively—with a few ex- tions have increased. In Miami, HEROIN ceptions, such as a price drop in El Paso and an increase in Baltimore. dealers recruit patients from Heroin availability remains general- substance abuse treatment ly stable at high levels, with only a Young adults (18–30 years) are facilities, drive them to doctors few increases and no declines increasingly using heroin in the who prescribe the drug, have the reported. High-purity, snortable majority of Pulse Check sites, prescriptions filled, then sell the South American (Colombian) white accor-ding to epidemiologic and pills illegally. heroin is the most commonly cited ethnographic sources. The number type, followed by lower purity, of novice heroin users (any drug Exhibit 3. treatment client who has recently What new problems have emerged or intensified during spring 2001? begun using heroin) has increased in programs across nine Pulse OxyContin® Ecstasy/Club Drugs Methamphetamine Check sites.

E,N L L Baltimore, MD Baltimore, MD Columbia, SC Heroin use is spreading to L,N L,N E Billings, MT Boston, MA Detroit, MI suburban areas surrounding five Birmingham, ALL,N,M Columbia, SCN,M El Paso, TXN Pulse Check sites: Baltimore, Boston, MAL,E,M Denver, COL,E,N Memphis, TNL Columbia, SCE Detroit, MIL St. Louis, MOE Memphis, Miami, and Washing- Denver, COM El Paso, TXE Sioux Falls, SDN ton, DC, in the South; and Seattle Detroit, MIE Honolulu, HIL,E,N Seattle, WAL in the West. Use is also spreading Miami, FLL,E,N Los Angeles, CAL,E Washington, DCL to the rural areas surrounding Honolulu, HIM Memphis, TNE,N Portland (ME) and El Paso. Philadelphia, PAL,E,N,M New York, NYE Portland, MEL,E,N Philadelphia, PAN,E Injecting remains the most New Orleans, LAL,N,M Portland, MEL common route of heroin adminis- E,M N St. Louis, MO Seattle, WA tration. Snorting, however, either E,M E Washington, DC St. Louis, MO equals or surpasses injecting in Sioux Falls, SDL,E nine Pulse Check sites, and it has increased in six sites: Columbia Other Emerging Drug Problems (SC), Denver, El Paso, Miami, ® M Clonidine (Catapres ): Chicago, IL New Orleans, Philadelphia, and "Devil's trumpet" herbal: Honolulu, HIE Washington, DC. New and Dextromethorphan (DXM): Washington, DCE younger users tend to snort ® M Diphenhydramine (Benadryl ): Portland, ME rather than inject. Hydromorphone (Dilaudid®): Memphis, TNE Marigolds, Khat: Boston, MAL "Speedballs" containing heroin Marijuana + Methamphetamine: Sioux Falls, SDN plus crack (as opposed to powder Marijuana + Cocaine or Heroin: El Paso, TXM cocaine) have increased in El Paso PCP: New York, NYN and Los Angeles. Reports of heroin "Red ferrari" (designer amphetamine): Los Angeles, CAN combined with ecstasy have White heroin: Honolulu, HIE increased in three southern Pulse

LLaw enforcement respondents EEpidemiologic/ethnographic respondents Check sites: Birmingham, Memphis, NNon-methadone treatment respondents MMethadone treatment respondents and Miami. page 2 Pulse Check: November 2001 HIGHLIGHTS

Exhibit 4. socioeconomic suburbanites— How has the perceived drug problem changed (fall 2000 vs spring 2001)? sometimes in nightclubs, bars, and private parties. Where has the drug with "the most Where has "the most commonly abused serious consequences" changed? drug" changed? Powder cocaine sellers in New York Site/Source Fall 2000 Spring 2001 Site/Source Fall 2000 Spring 2001 have recently added ecstasy to the El PasoE Heroin Crack New YorkM Crack Heroin many other drugs they sell. In Los MiamiE Heroin OxyContin® PortlandL Powder Heroin and Angeles, powder cocaine plus New OrleansM Heroin OxyContin® cocaine pharmaceu- ecstasy is a recent combination. MemphisN Crack Powder tical opiates cocaine MemphisN Powder Crack MARIJUANA PortlandL Powder Pharmaceu- cocaine Marijuana availability continues to cocaine tical opiates be wide and stable in nearly every LLaw enforcement respondents EEpidemiologic/ethnographic respondents Pulse Check site. However, NNon-methadone treatment respondents MMethadone treatment respondents hydroponically grown marijuana availability is increasing in several CRACK COCAINE While crack is nearly always cities, including Chicago, Miami, Crack remains widely available in smoked, increased crack injection St. Louis, and Washington, DC. the majority of Pulse Check sites, is reported in Baltimore and with few changes in availability or Washington, DC. Young adult (18–30 years) user price. The crack sales scene has groups are increasing in several POWDER COCAINE remained relatively stable, with cities: Detroit, Los Angeles, and only a few isolated changes, Powder cocaine remains widely Memphis. including the following: available, with few changes in price or purity. El Paso, however, Compared with heroin, crack, and ➤ Younger crack sellers are increas- is one exception: powder cocaine powder cocaine users, who tend to ingly reported in the South. and heroin are now cheaper and reside predominantly in central more abundant on the American city areas, marijuana users reside in ➤ Electronic equipment, such as side of the border than on the all areas (central, suburban, and cell phones and beepers, contin- Mexican side. rural), reflecting the pervasiveness ue to be increasingly involved in of marijuana use. sales. As a result, sales are mov- Availability and purity levels are ing indoors in some cities, and particularly high in New York. More than 80 percent of non- crack houses are becoming less methadone treatment sources prominent in others. Powder cocaine users often report that marijuana users are ➤ Gangs have recently started resemble heroin users, rather than referred to treatment by the crimi- taking over sales in New York. crack users. For example, they are nal justice system, an increase from more likely to be male, rather than the last reporting period. Criminal ➤ Sales in the Denver area are female, and White, rather than justice referrals involving heroin starting to take place in the Black. and crack have also increased dra- suburbs. matically. The next Pulse Check will Young adults and, in some cases, continue to monitor this trend. Females are equally or more likely adolescents are increasingly using than males to use crack in many powder cocaine in five sites: METHAMPHETAMINE cities, more so than any other Birmingham, Detroit, Los Angeles, Methamphetamine continues to be illicit drug except ecstasy, Sioux Falls, and Washington, DC. more widely available in the West according to epidemiologic and than in other U.S. regions. More- ethnographic sources. In some sites, such as Washington, over, half of western sources DC, powder cocaine use is report increasing availability. increasing among White middle

Pulse Check: November 2001 page 3 HIGHLIGHTS

Methamphetamine is considered Exhibit 5. the most widely used drug in two What are the most serious drug problems in the 21 Pulse Check sites, by western Pulse Check cities: Billings type of source?* and Honolulu. It is reported as Most commonly abused?* Most serious consequences? the drug contributing to the most City LEN LE N M serious consequences by 13 sources Boston, MA HCl MJ H Crack Crack H Cocaine+ in 4 cities: Billings, Denver, Hono- Alcohol lulu, and Sioux Falls. New York, NY MJ MJ Crack H Crack Crack Crack Philadelphia, PA MJ MJ H H H H+Crack H Most sources link methampheta- Northeast Portland, ME H/Pharm. MJ Crack Pharm. H H Benzos Opiates opiates mine sellers to domestic violence, Baltimore, MD H H Crack H H Crack+H NR much more so than any other Birmingham, AL Crack MJ Crack Crack Crack Crack Any IV illicit drug sellers. drugs Columbia, SC MJ Crack MJ Crack Crack Alcohol H CLUB DRUGS El Paso, TX MJ MJ Crack NR Crack H H South Memphis, TN Crack MJ MJ Crack Crack HCl NR Ecstasy continues to be the most Miami, FL Crack MJ Crack Crack Oxy Crack NR available club drug (more than 90 New Orleans, LA MJ Crack Crack Crack Crack Crack Oxy percent of law enforcement, epi- Washington, DC Crack Cocaine Crack MJ H Crack H demiologic, and ethnographic Chicago, IL Crack MJ Crack Crack Crack Crack H sources report it as widely or Detroit, MI MJ MJ Crack Crack H Crack H St. Louis, MO MJ MJ NR Crack Crack Crack H

somewhat available), followed by Midwest Sioux Falls, SD MJ MJ MJ Meth Meth Meth Meth gamma hydroxybutyrate (GHB), Billings, MT Meth MJ Alcohol Meth Meth Meth NR ketamine, and flunitrazepam Denver, CO MJ MJ Crack HCl HCl Meth MJ (Rohypnol). Ecstasy availability +HCl continues to increase in most sites, Honolulu, HI MJ Meth MJ Meth Meth Meth Benzos + while GHB, ketamine, and West Meth Los Angeles, CA Crack MJ MJ Crack H Meth H Rohypnol availability is stable. Seattle, WA MJ H MJ H H Cocaine Benzos

Ecstasy is reported as an emerging *Heroin is almost always, by definition, the most commonly used drug in methadone programs, drug of abuse in 15 sites. so methadone treatment sources are excluded from this question. Note: HCl = Powder cocaine; MJ = Marijuana; H = Heroin; Meth = Methamphetamine; ® Benzos = Benzodiazepines; Oxy = OxyContin Ecstasy seller and user populations LLaw enforcement respondents EEpidemiologic/ethnographic respondents continue to expand to include NNon-methadone treatment respondents MMethadone treatment respondents various ethnic sellers in the North- east, Black sellers in the South, Exhibit 6. adolescent users across the country, What are the most serious drug problems in the 21Pulse Check sites, by and non-White and Hispanic users number of sources and sites? in some southern and western Drug Most commonly abused?* Most serious consequences? cities. Ecstasy sale and use settings No. of sources No. of sites No. of sources No. of sites also continue to expand from Heroin 6 5 24 14 raves, concerts, nightclubs, and Crack 20 14 29 14 bars to streets, private residences, Powder cocaine 1 1 2 1 and private parties. Marijuana 30 19 1 1 Methamphetamine 3 2 13 4 Drugs sold and used with ecstasy Pharmaceutical opiates 1 1 3 3 Benzodiazepines 1 1 3 3 are expanding from marijuana and Alcohol 2 2 2 2 other club drugs to heroin and powder and crack cocaine. *Methadone treatment sources are excluded from this count. Sources: Law enforcement, epidemiologic/ethnographic, non-methadone treatment, and methadone treatment respondents page 4 Pulse Check: November 2001 INTRODUCTION

INTRODUCTION to describe the age, ethnicity, and rural and urban areas. Second, to gender of illegal drug users and those ensure regular reporting, any treat- Since 1992, the Office of National who sell drugs and any changes in ment provider who was unavailable Drug Control Policy (ONDCP) has these characteristics. The information to participate was replaced via published the Pulse Check, a source provided to Pulse Check reflects the purposeful selection, in consultation for timely information on drug abuse observations of the sources, and their with experts in the field, rather than and drug markets. The report aims to descriptions are purely for determin- the random selection that was used in describe hardcore drug-abusing popu- ing the size, scope, and diversity of the past. lations, emerging drugs, new routes the drug problem. The intent of the of administration, varying use pat- Pulse Check has been and continues Use and Interpretation of Pulse terns, changing demand for treat- to be merely to describe patterns in Check Information ment, drug-related criminal activity, illicit drug use and illicit drug markets and shifts in supply and distribution By contacting professionals from that are emerging in local communities. patterns. Pulse three different disciplines—ethnogra- Check regularly phy/epidemiology, The 21 Pulse Check Sites addresses five drugs law enforcement, of serious concern: and treatment—a cocaine, marijuana, rich picture of the heroin, metham- changing drug abuse phetamine, and—as situation emerges. of the last issue— Though this “ecstasy” (methyl- approach offers sub- enedioxymetham- stantial strengths in phetamine, or timeliness and depth, MDMA) and other Pulse Check is not a club drugs. measure of the Additionally, the prevalence of drug current issue pro- abuse or its conse- vides information quences. As an anec- on an emerging dotal source of infor- problem: diversion mation, any interpre- and abuse of Oxy- tation or conclusion Contin®, a high-dose formulation of drawn from Pulse the pharmaceutical opiate oxycodone. Enhancements to Pulse Check Check must be viewed carefully and in conjunction with other more quan- The current Pulse Check issue The Pulse Check is not designed to be tifiable direct and indirect measures includes two changes over the previ- used as a law enforcement tool but of the drug abuse problem. ous issue, reflecting ONDCP’s ongo- rather to be a research report present- ing effort to enhance the project and ing findings on drug use patterns and More specifically, several of the keep up with the changing nature of drug markets as reported by ethnog- limitations of Pulse Check are briefly the Nation’s drug abuse situation. raphers, epidemiologists, treatment discussed below. First, due to particular concerns providers, and law enforcement offi- about the drug abuse situation in Pulse Check is limited to a report cials. With regards to race and ethnic- Baltimore, MD, that city was added on the drug abuse situation in 21 ity, just as the National Household to the list of Pulse Check sites, bring- specific sites throughout the Survey on Drug Abuse and other ing the total to 21 geographically Nation. Though considerable national data sources report findings diverse cities—highlighted on the effort was made to select sites by race and ethnicity, sources con- map above—spread across the four across a broad range of geographic tributing to the Pulse Check are asked Census regions and representing both areas, including Census regions

Pulse Check: November 2001 page 5 INTRODUCTION

and divisions, urban and rural each might come in contact with (HIDTAs). The epidemiologists and States, racial/ethnic coverage, and different populations or each might ethnographers are 21 researchers high intensity drug trafficking deal with a specific geographic associated either with local health areas, Pulse Check cannot be neighborhood. departments, university-based viewed as a national study, and research groups, or other community information cannot be reasonably Information from treatment sources is health organizations. Some of those aggregated up to a national level. particularly susceptible to variance 21 individuals are qualitative because some facilities target specific researchers who employ ethnographic Of the 85 sources identified and populations. Furthermore, treatment techniques to obtain observational recruited across the three disci- providers from methadone and non- data directly from the drug user’s plines, 83 provided information methadone programs are likely to world; others are epidemiologists for this Pulse Check issue. The have very different perspectives on who access both qualitative and information presented in this their communities’ drug problems quantitative data. The treatment report is based solely on the obser- because their respective clientele sources are 41 providers from 23 vations and perceptions of those differ in the nature of their drug non-methadone programs and 18 83 individuals. These individuals problems and in their demographic methadone programs across the 21 may not be knowledgeable about characteristics. It is for this reason sites. Those providers include two every aspect of the drug abuse that two treatment sources were non-methadone sources each from situation in their sites, and they selected from each of the 21 sites— Billings and Sioux Falls because those may have biases based on their one from a methadone program, and cities do not have methadone pro- experiences and exposures. one from a non-methadone program. grams. They also include two metha- Due to the comprehensive nature Taken together, all four sources at done sources from Boston, both of of the telephone discussions, each site provide a richer picture of whom were available to contribute sources were asked to discuss only the drug problem’s nature. information. They do not include two areas in which they were thor- methadone sources from Baltimore Current Sources and Reporting oughly knowledgeable. Thus, the and Memphis, who were unable to Periods total number (N) of respondents to participate in this round of discussions. any one question might be less The current report includes informa- than 83. tion gathered during May through These sources offer a wealth of July 2001 from telephone conversa- information that, when taken together, Any contradictory reports within an tions with 83 sources, representing 21 provides a comprehensive snapshot of individual site are not necessarily a sites across the various regions of the drug abuse patterns in communities Pulse Check limitation. Just as the site country. These individuals discussed across the country. Further, these sampling methodology was designed their perceptions of the drug abuse individuals provide expertise that can to reflect the country’s geographic situation as it was during the spring alert policy makers to any short-term and population diversity, recruiting months of 2001 and in comparison changes or newly emerging problems four sources per site was incorporated to a period 6 months earlier, during concerning specific drugs, drug users, into the design to reflect diversity fall 2000. and drug sellers. within each of the 21 sites. For exam- ple, a law enforcement source in one The law enforcement sources who The appendices at the end of this site might perceive cocaine to be the provided information include 21 report provide a list of these sources, community’s most serious problem, narcotics officers from local police describe the methodology used to while an ethnographic source at that departments, field office agents of the select them, and discuss the content same site might consider the most Drug Enforcement Administration of the approximately 1-hour serious problem to be heroin. And (DEA), and representatives of High conversations held with them. they would both be right—because Intensity Drug Trafficking Areas

page 6 Pulse Check: November 2001 HEROIN

TRENDS IN DRUG USE: FALL 2000 VS SPRING 2001

HEROIN: THE PERCEPTION Exhibit 1. How do Pulse Check sources per- How available is heroin across the 21 Pulse Check cities? ceive the heroin problem in their communities? Excluding sources According to law enforcement sources (N=21)... associated with methadone programs, where heroin is by definition the most commonly used drug, only six sources in five cities consider heroin as their communities’ most commonly used illicit drug: the ethnographic and law enforcement sources in Baltimore, the non-methadone treatment sources in Boston and Philadelphia, the epidemi- ologic source in Seattle, and the law enforcement source in Portland, ME (who also lists pharmaceutical opiates as an equally serious problem).

Additionally, sources in 10 cities Widely Available Somewhat Available consider heroin the second most Not Very Available Not Available commonly used illicit drug in their communities. They span the country, ranging from the Northeast (New According to epidemiologic and ethnographic sources (N=20)...* York, Philadelphia, and Portland) to the South (Baltimore, El Paso, and Washington, DC) to the Midwest (Chicago), and the West (Honolulu, Los Angeles, and Seattle).

The numbers go up somewhat when discussing which drug has the most serious consequences—that is, med- ically, legally, societally, or otherwise. Heroin is named by 24 sources (of 82 who discussed this question) in 14 cities: all Pulse Check cities in the Northeast (Boston, New York, Phila- delphia, Portland), as well as cities in *The epidemiologic source in Columbia, SC, did not provide this information. the South (Baltimore, Columbia (SC), El Paso, and Washington, DC), the second most serious drug in terms In Seattle, for example, the epidemio- Midwest (Chicago, Detroit, and St. of consequences to 11 Pulse Check logic source considers heroin and Louis), and the West (Denver, Los communities. crack, respectively, to be the city’s first Angeles, and Seattle). In the case of and second most commonly abused Philadelphia, all Pulse Check sources In many cases, the perception of a drugs; in the surrounding rural areas, agree that heroin is the drug with the community’s drug abuse picture however, methamphetamine and most serious consequences. An addi- changes radically when distinguishing marijuana hold those distinctions. tional 22 sources name heroin as the a city from its surrounding environs.

Pulse Check: November 2001 page 7 HEROIN

Has the perception of the heroin Exhibit 2. Has heroin availability changed? problem changed between fall How has heroin availability changed (Exhibits 2 and 3) Heroin availability 2000 and spring 2001? All but (fall 2000 vs spring 2001)?* remained stable between fall 2000 and two of the Pulse Check sources who spring 2001, according to the majority name heroin as the most commonly (18 of 21) of Pulse Check law enforce- used illicit drug during the current Birmingham, ALL ment sources. Increased availability is reporting period also listed it as such Denver, COE perceived in only three sites: Portland during the previous period. The two El Paso, TXE (ME) in the Northeast; and Birming- exceptions occur in New York and Memphis, TNE ham and Washington, DC, in the Portland. According to the New York Miami, FLE South. No declines are reported. methadone treatment source, heroin New Orleans, LAE According to the 20 epidemiologic has replaced crack as the most com- Portland, MEL,E and ethnographic sources who L monly used illicit drug, while the Washington, DC discussed this question, heroin avail- Portland law enforcement source ability increased in 6 sites: El Paso, Baltimore, MDL,E Los Angeles, CAE states that it has replaced powder Memphis, Miami, and New Billings, MTL,E Memphis, TNL cocaine among hardcore users. Birmingham, ALE Miami, FLL Orleans in the South; Portland in Boston, MAL, E New Orleans, LAL the Northeast; and Denver in the Three sources perceive that Chicago, ILL,E New York, NYL,E West. The remaining 14 epi- other drugs have replaced hero- Columbia, SCL Philadelphia, PAL,E demiologic and ethnographic in as causing the most serious Denver, COL Seattle, WAL,E sources perceive stable supplies consequences. Crack has replaced Detroit, MIL,E Sioux Falls, SDL,E of heroin in general, but some of heroin in El Paso, according to that El Paso, TXL St. Louis, MOL,E those 14 report increases in specific city’s epidemiologic source. And the Honolulu, HIL,E Washington, DCE forms of heroin. In Detroit, for diversion and abuse of the pharma- example, Southeast and Southwest L Law enforcement respondents ceutical opiate oxycodone (in its E Asian heroin availability appears up. ® Epidemiologic/ethnographic respondents OxyContin formulation) has *The Columbia epidemiologic source did Los Angeles is another example, with replaced heroin in Miami and New not provide this information. an increase reported in availability of Orleans, according to those cities’ Mexican black tar and brown heroin. epidemiologic and methadone treat- Miami, New Orleans, and Washing- A third example is Honolulu, where ment sources, respectively. ton, DC, in the South; Detroit and St. the predominant Mexican black tar Louis in the Midwest; and Denver has increased in availability, but Only one Pulse Check source consid- and Seattle in the West. Similarly, the where a white powder heroin has also ers heroin to be a new or emerging majority of epidemiologic and ethno- been seized for the first time. drug problem in comparison to the graphic sources who discussed this last Pulse Check reporting period: the question (12 of 20) consider the drug Denver epidemiologic source, who widely available: New York, Philadel- Traffic in reverse? notes an increase in suburban young phia, and Portland in the Northeast; According to the El Paso epidemiologic White heroin users. Baltimore, El Paso, New Orleans, and source, heroin is now cheaper and more Washington, DC, in the South; HEROIN: THE DRUG abundant on the American side of the Chicago and Detroit in the Midwest; border than on the Mexican side–to the How available is heroin across and Denver, Honolulu, and Seattle in point where people from Mexico are the country? (Exhibit 1) the West. Heroin is cited as not very crossing over to buy heroin in El Paso. Approximately half of the Pulse available by only five sources in four These changes are attributed to compe- Check law enforcement sources (11 cities (Billings, Birmingham, Memphis, tition for the market by three different of 21) consider heroin to be widely and Sioux Falls), and only one source cartels. El Paso’s law enforcement available in their communities: New considers it not available at all (the law source, on the other hand, gives heroin York and Philadelphia in the North- enforcement source in Sioux Falls). only a “somewhat available” rating. east; Baltimore, Columbia (SC), The remaining 12 sources describe the drug as “somewhat available.” page 8 Pulse Check: November 2001 HEROIN

Exhibit 3. How available are the different varieties of heroin? How has Midwest. Since the last Pulse Check their availability changed (fall 2000 vs spring 2001)?* reporting period, black tar has All Mexican Mexican become increasingly available in City forms Colombian black tar brown SEA** SWA*** Honolulu, Los Angeles, and Portland L E L E L E L E L E L E (ME). Availability has declined in Boston, MA ↔ ↔ ↔ NR ❍ ↔ NR ❍ ↔ NR ❍ ↔ NR ❍ ↔ NR Chicago and (slightly) in El Paso. New York, NY ↔ ↔ ↔ ↔ ❍ ↔ ❍↓ ❍ ↔ ❍↓ ↔❍ ↔ ↔ ❍↓ Stable trends are reported elsewhere. Philadelphia, PA ↔ ↔ ↔ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔❍ ↔ ❍ ↔ ❍ ↔ Southeast Asian and Southwest Asian Northeast ❍ ❍❍ ❍ Portland, ME ↑ ↑ ↑ ↑ ↑ ↑ NR ↑ ↑ heroin are the least common forms, Baltimore, MD ↔ ↔ ↔ ↔ ❍ ↔ ❍ ↔ ❍ ↔ NR ❍ ↔ NR with wide availability reported in Birmingham, AL** ↑ ❍ ↔ NR NR NR NR NR NR NR NR NR NR only three cities apiece and increased Columbia, SC ↔ NR ↔ NR ↔ NR ↔ NR ↔ NR ↔ NR availability reported only in Detroit, El Paso, TX ↔ ↑ ❍ ↔ ❍ ↔ ↓ ↔ ↓ ❍ ↔ ❍❍↔ ❍ ❍ ❍ ❍ Portland, and Washington, DC. South Memphis, TN ↔ ↑ ↔ ↔ ↔ NR ↔ NR ↔ NR Miami, FL ↔ ↑ ↔ ↑ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔❍ ↔ ❍ ↔ ❍ ↔ New Orleans, LA ↔ ↑ ↔ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ↔ ❍ ↔ ↔ White heroin hits St. Louis? Washington, DC ↑ ↔ ↑ ❍ NR ❍❍↑ NR ↑ NR Chicago, IL ↔ ↔ ↑ ↔ ❍↓ ↔ ❍ ↔ ↔ ↔ ↔ ❍↓ ↔ According to the St. Louis epidemio- Detroit, MI ↔ ↔ ↔ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ↔ ↑ ↔ ↑ logic source, that city’s supply is almost St. Louis, MO ↔ ↔ ↔ ❍ ↔ ↔ ↔ ↔ NR ❍ ↔❍ ↔ ❍ ↔ ❍ ↔ exclusively Mexican black tar. How- Midwest Sioux Falls, SD ❍ ↔ ❍ ↔ ❍ ↔ NR ❍ ↔ ❍ ↔ NR ❍ ↔ NR ❍ ↔ NR ever, a recent seizure involved a white Billings, MT ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔❍ ↔ ❍ ↔ ❍ ↔ heroin whose signature has not yet been Denver, CO ↔ ↑ ↔ ❍ ↔ ↔ ↔ ↑ ❍ ↔ ❍ ↔ ❍ established but is suspected to be of Honolulu, HI ↔ ❍ ↔ NR ↑ ↔ ↑ NR ↔ NR ❍ ↔ NR Nigerian origin. West Los Angeles, CA ↔ ↔ ❍↑ ↔ ↑ ↑ ↔ ↑ ↔❍ ↔ ↔ ❍ ↔ Seattle, WA ↔ ↔ ❍ ↔ ❍ ↔ NR ❍ ↔ NR ❍ ↔ ❍❍↔ ❍ How pure is heroin across the Sources: Law enforcement (L) and epidemiologic/ethnographic (E) respondents country? (Exhibit 4) According to Widely available Somewhat available ❍ Not very available ❍ Not available * Arrows indicate up, down, or stable trends. Absence of an arrow indicates that respondent did law enforcement, epidemiologic, and not provide trend information. ethnographic sources, street-level **Southeast Asian ***Southwest Asian Colombian heroin purity ranges from What kind of heroin is available availability of Colombian heroin has as low as 7 percent in New Orleans across the country? (Exhibit 3) As increased in only five cities, spanning to as high as 95 percent in Philadelphia. in the last Pulse Check report, South all four regions: Chicago, Los Angeles, Typically, however, purity is at the American (Colombian) white heroin Miami, Portland (ME), and higher end of that range. Street-level is the most common type, cited as Washington, DC. Stable trends are Mexican black tar heroin purity widely available by sources in nine reported in all other Pulse Check cities. ranges from 14 to 58 percent, with cities across all the regions except the both extremes reported in Seattle. West and as somewhat available by Mexican black tar, a lower purity, Users often tend to complain about sources in six cities–again, spanning injectable heroin, is ranked as widely low purity despite evidence to the the Northeast, South, and Midwest available by sources in eight cities, contrary. As the New York ethno- regions. By contrast, this high-purity, mostly in the West and the South graphic source notes, “We continue to snortable heroin is described as “not (and in St. Louis in the Midwest). hear users complain about the ‘bad very available” or “not available” by Sources in five cities consider it dope,’ when everybody is saying that sources in 11 cities: Portland in the somewhat available, and sources in there has never been such ‘good Northeast; Birmingham, El Paso, and nine cities consider it not very avail- dope’ around.” That source adds, Memphis in the South; Sioux Falls able. It is described as “not available however, that in this case the users’ and St. Louis in the Midwest; and at all” by sources in seven cities: all perceptions might be accurate, Billings, Denver, Honolulu, Los four northeastern Pulse Check cities; because “high availability and low Angeles, and Seattle in the West. Since Miami and Washington, DC, in the prices are making it possible for street the last Pulse Check reporting period, South; and Sioux Falls in the dealers to dilute the heroin.”

Pulse Check: November 2001 page 9 HEROIN

Then and Now: Heroin purity (fall What are street-level heroin in price and purity. Capsules (known 2000 vs spring 2001) prices across the country? on the street as “pills”) are the most (Exhibit 4) The most commonly common street sales unit in Balti- Heroin purity remained relatively stable reported heroin street sales unit is 0.1 more, where prices increased from in the majority of Pulse Check sites, gram, which sells for as little as $4 $3–$6 to $10 for a pill of equal (but according to law enforcement, epidemi- for Colombian heroin in Boston to as unknown) size while purity remained ologic, and ethnographic sources. Levels much as $120 for Mexican black tar stable. In nearby Washington, DC, the increased in only four cities (Honolulu, Miami, New Orleans, and Washington, in Seattle. In some cities, however, milligram price increased from $1.13 DC) and declined in only one (Denver). street sales units are much larger: for to $1.36. In the Midwest, a slight None of these changes appears particu- example, the Birmingham law increase is reported in the price of a larly dramatic. enforcement source states that “no medium- to large-sized bag of heroin one wants to sell less than 1 gram” of (from $10 to $10–$20) in Chicago. What adulterants are added to heroin. Purity, sales quantity, and heroin? A wide range of heroin dealer competition all play a part in The El Paso price drop is dramatic, adulterants, some benign and some determining heroin price. Sometimes, from $10 to $3 per “hit” (amount harmful, are reported by law enforce- however, other more subtle factors— not specified), reflecting the increased ment, epidemiologic, and ethnograph- such as marketing strategies or availability and cartel competition ic sources in several cities, particularly barter—come into play. For example, described above. Also reflecting in the Northeast and South: “any according to the New York ethno- increased availability, black tar prices powder” in Portland; lactose in graphic source, “Some dealers in the in Los Angeles declined sharply at the Boston; rat poison, powdered milk, Bronx and Brooklyn have been offer- hit (0.25 gram) level (from $35–$100 baking soda, and coffee creamer in ing a $5 bag to lure customers.” to $20–$40), at the gram level (from New York; quinine and sugar in Another example is Hawaii, where $150–$300 to $100), and at the Baltimore; scopolamine and baby the epidemiologic source notes that “eightball” (1/8 ounce) level (from powder in Columbia (SC); cocaine and few people buy drugs for cash. $400–$600 to $300). The St. Louis Rather, they tend to barter goods, price drop involves “bindles” of #6 vitamin B12 in Memphis; baking soda and “any white powder” in Miami services, or other drugs. Many of the gel caps, which sold for the “low (the same adulterants as in cocaine, goods, such as stereos, cameras, and 20s” in fall 2000 and the “high teens” but one shade darker); baby laxatives jewelry, are obtained via larceny and in spring 2001. and powder in Detroit; and sugar in other forms of theft. How is heroin referred to across Los Angeles (to give black tar a tan the country? (Exhibit 5) Street appearance). names throughout the country often Then and Now: Heroin prices (fall vary by geographic region and by “Tres pesos” and “benita”... 2000 vs spring 2001) type of heroin. However, some terms, such as “horse,” “H,” and “boy” are New York, NY: According to the ethno- Heroin prices appear to be relatively common across regions. Street names graphic source, “A user in Brooklyn stat- stable, according to the majority of ed that the heroin was being mixed with law enforcement, epidemiologic, and (slang) and brand names (dealer des- ‘Tres Pesos’ (meaning ‘three steps’), ethnographic sources who provided this ignations) are often interchangeable, which is a rat poison shipped from Santo information. Prices increased in only as is the case in New York (“millenni- Domingo. (They call it three steps four cities (Baltimore, Chicago, New um 2000”) and Washington, DC because after the mice inhale it they take Orleans, and Washington, DC) and (“jerry springer” and “747” ). Many three steps and die.) The user said the declined in only three (El Paso, Los factors other than brand names, reaction is intense, the rush is quicker, Angeles, and St. Louis). however, can engender a street name. and they feel like they’re going to die.” In Washington, DC, for example, the Baltimore, MD: The ethnographic source Three of the reported price increases non-methadone source reports that a reports that “‘benita,’ a type of heroin are in the South. In New Orleans, cel- major news event, such as a hurricane cut with quinine, which has been around lophane bags containing two or three or tornado, can trigger a new street for a while, is less available than before.” doses of white heroin increased both name. page 10 Pulse Check: November 2001 HEROIN

Exhibit 4. What are the prices and purity levels of different types In some cities, different dealers use of heroin in 18 Pulse Check cities?* How have prices and purity changed different brand names or logos as a (fall 2000 vs spring 2001)? marketing strategy and for identifica- tion purposes. In other cities, brand City Source Unit Size Price/Change** Purity/Change** names and logos are nonexistent. Baltimore, E pill NR $10 ↑ NR ↔ MD Brand names and logos are frequently changed, sometimes on a daily basis. Boston, MA L “bundle” 0.1 gm $4–$6 ↔ 60–70% ↔ In Baltimore, for example, the ethno- Chicago, IL L “hit” 0.2 gm $20 ↔ NR NR graphic source states: “Labels change Columbia, L “bindle” 0.2 gm $20–$25 ↔ 62% ↔ daily. Dealers give out ‘testers,’ put a SC L “bundle” 2 gm $225 ↔ NR NR label on it, word gets out on what’s Detroit, MI L “bindle” 1 gm $125–$175 ↔ 50% ↔ ‘good’ that day and in which neighbor- L “pack” 2 dosage units $10–$20 ↔ NR NR hoods it’s available, then users go to ↔ Miami, FL E “bag” 0.1 gm $10 20% ↑ those neighborhoods to make their New Orleans, L “unit” 0.45 gm $20–$25 ↑ 7% ↔ buys.” Philadelphia is another example LA of a city where heroin brand names New York, L “hit” NR $10–$14 ↔ 80–90% ↔ proliferate: the number of brand names NY L “bundle” 10 bags $95–$107 ↔ 80–90% ↔ identified by the epidemiologic source

South American (Colombian) white L NR 1 gm$60–$74 ↔ 80–90% ↔ increased from 59 during the last L NR 1 oz $2,000 ↔ 80–90% ↔ reporting period to 86 during the cur- Philadelphia, L “baggie” NR $10–$20 ↔ 40–95% ↔ rent period—probably reflecting the PA E “hit” NR $10 ↔ NR NR dealers’ strategy to increase their L “bundle” (10–13 bags) $100 ↔ 40% ↔ market. Conversely, New York’s ethno- Denver, CO L “balloon” 0.2 gm $20 ↔ 20–30% ↓ graphic source reports that “More El Paso, TX L NR 0.1 gm $20 ↔ NR NR dealers throughout the city are relying E “hit” NR $3 ↓ NR ↔ on generic heroin ‘non-signature’ Honolulu, HI L “bindle” 0.1 gm $50–$75 ↔ NR NR brands in an effort not to be identified Los Angeles, L “hit” 0.25 gm $20–$40 ↓ 25% ↔ by law enforcement. Some dealers have CA L “eightball” 1/8 oz $300 ↓ 25% ↔ gone away from name or signature L NR 1 gm $100 ↓ 20% ↔ bags and are using bag color to identify St. Louis, E #6 gel cap- 0.25–0.5 gm “high teens” ↓ NR NR the source. Those still using brand

Mexican black tar Mexican MO “bindle” names are constantly changing the Seattle, E “bindle” NR $20 ↔ 20–25% ↔ name to avoid detection from police.” WA L NR 0.1 gm $90–$120 NR 14–58% ↔ E NR 1 gm $80 ↔ 20–25% NR How is heroin packaged? Heroin L NR 1 oz $600–$1,300 NR 14–58% ↔ is most commonly packaged in plas- Memphis, L “pack” 0.1 gm $30 ↔ 40–50% ↔ tic, cellophane, glassine, or coin bags, TN E NR 1 gm $125–$175 NR NR NR usually the “zipper” type, as reported Asian by law enforcement, epidemiologic,

Southeast E “hit” square inch bag $125–$175 NR NR NR and ethnographic sources in every Birmingham, L (powder) 1 gm $500 NR NR NR AL city except Detroit, El Paso, Billings, Chicago, IL E “bag” NR $10–$20 ↑ NR NR Denver, and Los Angeles. Other Denver, CO E NR 1 gm $100 ↔ 16–18% ↔ common packaging includes plastic or Washington, L “dime bag” 50–75 mg $10 ↔ 10–15% ↔ cellophane wrap (as reported in Unspecified DC (white powder) Baltimore, Chicago, St. Louis, E “bag” 1 mg $1.36 ↑ 23% ↑ Denver, and Honolulu), wax paper (in Boston, Portland, Baltimore, and Sources: Law enforcement (L) and epidemiologic and ethnographic (E) respondents *Respondents in Billings, Portland, and Sioux Falls did not provide this information. Memphis), and balloons (in El Paso, **Arrows indicate up, down, or stable between fall 2000 and spring 2001. Memphis, Denver, and Los Angeles).

Pulse Check: November 2001 page 11 HEROIN

Exhibit 5. and latex pellets in Denver. Two How is heroin referred to, and what types of heroin predominate, recent changes are reported: in in different regions of the country? Chicago, bags are becoming more common, while foil is becoming WEST MIDWEST NORTHEAST rarer; and balloons are no longer H, horse, smack, dope, p-dope, used in Baltimore. H, boy, horse, smack, H, boy, horse, choco-fan, milleni- dope, stuff, tar, chiva, blow, junk, hay- um 2000 (“the ron, cap, stuff, HEROIN: THE SELLERS treat, china white, best s--t around”), china white, raw, boy, Mexican tar, DK, red devil, bat- getting snotty How are street-level heroin brown tar, chiba, man, TNT, bag, (using heroin). A-house, junk, spoon. stuff, smack, E. sellers organized? Street-level heroin sellers tend to be independent Mostly Mexican of organized structures such as gangs, black tar available according to 13 of the 20 law Mostly Colombian white available enforcement sources who discussed this question. In Portland, ME, for Heroin type varies SOUTH example, most sellers are heroin addicts who go to neighboring H, boy, horse, dogfood, s--t, negro, chiva, smack, china white, monkey, big, heroin, train, foil, girl, doogie, stuff, mud, slag, dragon, mac, heron, 1-boldstep, magic, revenge, white Massachusetts to get the drug, import dragon, jerry springer, orange bag, green bag, red bag, black bag, 747, carga, black coffee, it, and sell it back home; only occa- white horse, lady, manteca, diesel, pink, doosey, black tar, bone, shake, grown man, tammy sionally does an organized group Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents from Massachusetts come in to sell the drug in Portland, but then they Some more unusual packaging is Baltimore; double plastic bags with leave. Three additional sources—in reported: lottery tickets in Detroit; uncooked rice in between (to keep Miami, New Orleans, and St. Louis— “bricks” of compressed heroin in moisture out) in New Orleans; paper report both independent and organ- New York; loose single pills or cap- wrapping inside of plastic, or in ized sellers in their cities. In Miami, sules that melt when heated in folded magazine pages, in Billings; independent sellers are found on the

What heroin brand names (and logos) are seen in different cities? Brand names (dealer designations) and logos are not used in all cities. In cities where they are, including those below, brand names are sometimes—but not always—interchangeable with street names (slang).

Baltimore, MD G-money, murder one, john hinkley, code blue; (colored packaging, spider symbols, eagle symbols) Chicago, IL Doorway, one stop; (faces printed on bags) Columbia, SC New york, new york; skull and crossbones; mercedes; plymouth; playboy Detroit, MI Danger; (skull and crossbones) Miami, FL (cartoon characters) New York, NY Tres pesos, shark, first class, america on-line, death certificate, murder, 777, dead president, millenium 2000 Philadelphia, PA 747, 911, bone collector, creeper, devil’s advocate, eagle, fatal, m & m, maggie 2, movada, old navy, one life,opium, rabbit, really hot, river, rose, samurai, scorpio, scorpion, super AT&T, super hot, super nautica, thumbs up, timberland, WCW, 7up, bad habit, bart simpson, big mac, body bag, chevrolet, cobra, cold water, colt 45, dead on arrival (DOA), dead.com, demolition, diesel, DMX, do-wop, dracula, fingers, fuega, godfather, holyfield, homicide, I’ll be back, K & A, kill over, knock out, land rover, laser, legend, life after death, lucifer, mike tyson, motorola, nautica, no joke, octopus, one and done, pacman, painkiller, poison, star, suicide, super buick, super slow, titanick TNT, tommy hilfiger, too hot to handle, soo strong, toyota, UPS, USA, V-8, viper, white control, white house Portland, ME Red devil, batman, black eagle, TNT Washington, DC Jerry springer, 747, $; (different colored bags) page 12 Pulse Check: November 2001 HEROIN

streets, while organized sellers Epidemiologic and ethnographic organized structures). According to conduct their transactions in clubs. sources paint a slightly different that city’s ethnographic source, Organized sellers predominate in only picture: they report organized sales heroin’s organized sales structure has four Pulse Check cities: Chicago, structures in 10 cities. In five of those three or four tiers between the leader Columbia (SC), Denver, and Seattle. cities, law enforcement sources, by and the individual who delivers the The Seattle organized structure con- contrast, report independent opera- drug to the customer. Similarly, the sists of two kinds of sellers: a go- tions: Baltimore, Detroit, El Paso, New Orleans epidemiologic source between who is an addict, and “the Memphis, and Washington, DC. defines that city’s organized structure guy in the car with the bags, who is These seeming discrepancies might be as a series of loose connections, not not an addict,” comments that city’s explained by differing definitions of gang-related, in which a seller has a law enforcement source. Recently, what constitutes an organized group. dealer who gets calls to arrange pick- Asian groups have starting getting In Baltimore, for example, the law ups at specified locations. involved in heroin sales in New enforcement source points out that Orleans, and individuals from Russia while young adolescent sellers are not Some cities have two kinds of and Eastern Europe have been getting in gangs, they do work in small sales structures... involved in New York. cliques (which might be construed as Honolulu, HI: The epidemiologic Then and Now: source describes most sellers of heroin, marijuana, methamphetamine, and How have street-level heroin sales changed across the country (fall cocaine as independent, with each 2000 vs spring 2001)? seller having two or three “runners” to deliver drugs to customers and return Only a few changes (none in the Midwest) are reported in the heroin sales scene and in the payments to the seller. Some sellers, the kind of people who sell the drug at the street level. however, have Mexican affiliations: youths with minimal English-speaking ➤ In the Northeast... Boston, MA: The law enforcement source describes heroin sales skills are recruited in Mexico, flown as being more underground than in the past and than other into Hawaii, given addresses via phone drug sales. identifying where they should report to begin “running” drugs, and then ➤ New York, NY: Individuals from Russia and Eastern Europe are returned to Mexico after 4–6 months. increasingly involved in heroin sales, according to the law enforcement source. Miami, FL: The law enforcement source notes that independent sellers are found ➤ Philadelphia, PA: The epidemiologic source reports that in the on the streets, while organized sellers past each dealer sold one drug; now, in addition to all the conduct their transactions in clubs. “meat and potatoes” products (that is, heroin, crack cocaine, and marijuana), dealers also sell diverted pharmaceuticals, How old are street-level heroin ® ® such as alprazolam (Xanax ) and oxycodone (Percodan , sellers? Young adults (age 18–30) ® ® Percocet , and OxyContin ). are the group most likely to sell heroin in the street, according to 11 In the South... ➤ Baltimore, MD: According to the law enforcement source, of the 19 law enforcement sources heroin sales activity appears to have increased. who discussed this question and ➤ Columbia, SC: The law enforcement source reports an increase spanning all regions of the country. in drug dealers robbing other drug dealers, with some robberies Moreover, they are just as likely as resulting in shootings. older adults (>30 years) to sell street- level heroin in an additional three ➤ New Orleans, LA: Recently, Asian groups have starting getting Pulse Check cities (El Paso, Portland, involved in heroin sales, according to the law enforcement and St. Louis). Older adults are the source. likeliest to sell heroin in five of the In the West... ➤ Billings, MT: The law enforcement source reports that heroin cities: Billings, Honolulu, Memphis, trafficking and sales appear to be down. Philadelphia, and Washington, DC.

Pulse Check: November 2001 page 13 HEROIN

Only 13 of the epidemiologic and in the South; Chicago and St. Louis in Exhibit 6. ethnographic sources provided infor- the Midwest; and Honolulu and How likely are heroin sellers to mation on this question. Again, the Seattle in the West). Prostitution is use their own drug?* majority (10) name young adults as mentioned in six cities (Boston and Boston the primary street-level sellers. Philadelphia in the Northeast; El Paso MA Birmingham and Detroit are two of and New Orleans in the South; none New York, NY the three exceptions, with older in the Midwest; and Denver and Philadelphia adults more likely to sell heroin; the Honolulu in the West). Other crimes Northeast PA Portland third exception is Chicago, where, mentioned by law enforcement sources ME most disturbingly, the epidemiologic include pharmaceutical diversion (in Baltimore source names adolescents (13–17 Portland, ME), domestic violence (in MD Birmingham years) as the most likely to sell heroin Boston), and money laundering (in AL on the street. Adolescents, while not Miami). The Columbia, SC, law Columbia, SC the primary seller group in most enforcement source reports an increase El Paso cities, do sometimes sell heroin. In in drug dealers robbing other drug TX Memphis New York, for example, the epidemio- dealers, with some robberies resulting South TN logic source reports that “Street deal- in shootings. Miami FL ers are using teenagers to sell their New Orleans drugs. These teenagers can be seen on Do heroin sellers use their own LA small bikes loitering in front of local drug? (Exhibit 6) Of the 19 law Washington DC enforcement sources who discussed grocery stores or on the corners.” Chicago this question, 7 consider heroin sell- IL ers very likely to use their own drug, Detroit MI Does sales location have anything 8 give a “somewhat likely” response,” Midwest St. Louis to do with the age of sellers? and 5 consider them not very likely MO to do so. The 15 epidemiologic and Billings The New York ethnographic source MT ethnographic sources who discussed notes that “Sellers on the street range Denver the same question are more evenly CO in age from the late teens to the late Honolulu divided, with 5 giving each of the HI thirties; dealers that sell from indoor West locations range in age from the late above-named responses. One of the Los Angeles CA teens to late fifties.” “somewhat likely” responses is given Seattle by the Boston ethnographic source, WA who comments that “Nearly all users Law enforcement

What type of crimes are heroin eventually sell to help sustain their sources Very sellers involved in? All but 1 of the habit, usually just selling because it is Epidemiologic and Not very 19 law enforcement sources who dis- a way to procure heroin.” That source ethnographic sources Somewhat cussed this question consider heroin also notes, however, that young Domi- Sources: Law enforcement, epidemiologic, and ethnologic respondents sellers as somewhat or very likely to be nican gang members, who constitute a *The law enforcement source from New York involved in criminal activity. The small proportion of heroin sellers, are and the epidemiologic sources from Billings, Columbia, Los Angeles, New York, Birmingham source, however, believes unlikely to use their own heroin. On Philadelphia, Seattle, and Sioux Falls did that sellers are not very involved in the rare occasions they do, it is with not provide this information other crimes. Specifically, the law crack. Similarly, the Baltimore the enforcement sources mention nonvio- ethnographic source, who describes a Where is street-level heroin lent crime more often than violent sales structure with three or four tiers sold? (Exhibit 7) As in the last Pulse crime in association with heroin sales between the leader and the deliverer, Check report, law enforcement (in 12 versus 8 cities, respectively). notes that those at the bottom tier are sources generally agree that most Gang-related crime is mentioned in very likely to use their own drug, heroin sales take place in central city seven cities (none in the Northeast; while the actual seller at the top is not areas. However, in New York and Baltimore, El Paso, and New Orleans likely to do so. Portland, it is also sold in rural and page 14 Pulse Check: November 2001 HEROIN

Settings for sales and use vary... suburban areas are reported as more common. Additionally, a rural border New York, NY: The ethnographic source suggests that “Young Whites prefer Staten crossing area in El Paso is seeing Island because of its close proximity to New Jersey and indoor selling locations. The much heroin sales activity. buyers prefer paying a higher price (for security and the feeling that you get ‘better dope’ indoors than on the street) at indoor locations in New Jersey than to travel to Indoor and outdoor sales are equally outdoor locations in Brooklyn and Manhattan.” common, according to the majority Miami, FL: According to the law enforcement source, “distributors find someone in (13 of 20) of responding law enforce- the central city, beep that person, then they meet. Often, they meet in the suburbs for ment sources. Indoor sales, however, delivery.” are reportedly more prominent in Boston, Detroit, Memphis, and Baltimore, MD: The ethnographic source notes that street-selling locations include Portland; while outdoor sales are open air markets. Indoor sales include some unusual settings, such as locally run fried chicken restaurants with plexiglass drive-up windows where drug transactions take more evident in Baltimore, Honolulu, place. Additionally, the law enforcement source describes slots, cut into vacant build- and Philadelphia. Most epidemiologic ings, where “money goes in and drugs go out.” and ethnographic sources (10 of 15) concur that heroin sales are equally suburban areas; in Memphis, it is also generally concur that central city likely to take place indoors and out- sold in rural areas; and in Miami, it is areas are the most common sites for doors, but indoor sales are reportedly also sold in the suburbs. Epidemio- heroin sales. Two exceptions, howev- more common in four sites (Miami, logic and ethnographic sources also er, are Miami and Sioux Falls, where New York, Portland, and Sioux Falls), while outdoor sales are more

Exhibit 7. Where is street-level heroin sold and used?*

Private Public Play- Shop- Total # Resi- Hous- Private Crack Inside grounds/ Night- College ping of Street dence ing Parties Houses Cars Parks Raves Clubs Campus Schools Malls Settings Site Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Boston, MA 26 New York, NY 912 Philadelphia, PA 34

Northeast Portland, ME 83 Baltimore, MD 10 9 Birmingham, AL 37 Columbia, SC NA 2 El Paso, TX 12 11

South Memphis, TN 99 Miami, FL 712 New Orleans, LA 310 Washington, DC 35 Chicago, IL 67 Detroit, MI 44 St. Louis, MO 48 Midwest Sioux Falls, SD 13 Billings, MT 33 Denver, CO 59 Honolulu, HI 29 West Los Angeles, CA 33 Seattle, WA 86

Sources: Law enforcement, epidemiologic, and ethnographic respondents for seller settings Epidemiologic and ethnographic respondents for user settings *The law enforcement sources in Sioux Falls, and the epidemiologic/ethnographic sources in Billings, Columbia, Los Angeles, and Seattle, did not provide seller setting information. The epidemiologic source in Columbia did not provide user setting information.

Pulse Check: November 2001 page 15 HEROIN

prominent in Washington, DC. The How is street-level heroin sold? systems that create difficulties for New York ethnographic source As in the last Pulse Check report, narcotics officers to monitor or track elaborates that heroin continues to be hand-to-hand sales remain the most person-to-person transactions. sold mostly indoors because of law common way to sell user-level heroin, enforcement initiatives aimed at street as reported by each of the 20 law Epidemiologic and ethnographic sales. Similarly, the Boston law enforcement sources who discussed sources, similarly, report that hand- enforcement source describes heroin this question. Sales involving beepers to-hand and beeper/cell phone sales sales as being more underground than or cell phones are the second most are the most common (in 12 cities in the past and than other drug sales. commonly reported (in 14 cities), fol- each), followed by acquaintance net- lowed by the home delivery method works (in 9 cities) and home delivery As the chart shows, law enforcement, (which also commonly involves beep- (in 6 cities). New York features office epidemiologic, and ethnographic ers or cell phones) (in 11 cities) and delivery service. The Honolulu epi- sources report a wide range of specific acquaintance networks (in 10 cities). demiologic source describes a typical settings for heroin sales: In the Midwest, the Detroit law high-risk scenario: a buyer tells a enforcement source describes car runner what drug he wants, the run- Private residences and public hous- “meets” with dealers by appointment, ner then finds out the cost, returns to ing developments: Mentioned in while the St. Louis source reports that collect the money, then leaves and nearly every Pulse Check city sellers are becoming more guarded comes back to “make the drop.” Private parties, crack houses (or about what they say on cell phones. What other drugs do heroin deal- “crash houses,” as the Memphis The Los Angeles law enforcement ers sell? (Exhibit 8) Heroin dealers law enforcement source terms source, however, reports that dealers, continue to sell additional drugs in them), cars, and parks or play- after being paged to call the buyer, nearly every Pulse Check city, except grounds: Common venues use sophisticated digital cell phone

Raves and nightclubs: Particularly Exhibit 8. common in the South, but not What other drugs do heroin dealers sell?* mentioned in the Midwest Powder Mari- No other Schools and college campuses: City Crack Cocaine juana Other drug sold Mentioned, respectively, in eight Boston, MA and seven cities–with both venues New York, NY Ecstasy reported in four cities representing Philadelphia, PA Alprazolam (Xanax®) four different regions: Billings, Oxycodone (all forms) Chicago, Memphis, and New York Northest Portland, ME OxyContin® Other pharmaceutical opiates Shopping malls: Mentioned in five Baltimore, MD cities Birmingham, AL Columbia, SC Other heroin sales venues, not depict- Memphis, TN ed in the chart, are also reported by South Miami, FL Ecstasy law enforcement, epidemiologic and New Orleans, LA ethnographic sources: Washington, DC Chicago, IL In or near supermarkets: In Billings, Detroit, MI

Columbia (SC), El Paso, Honolulu, Midwest St. Louis, MO New York, and New Orleans Billings, MT Denver, CO Methamphetamine Over the Internet: In El Paso,

West Honolulu, HI Honolulu, and New York Seattle, WA

Hotels and motels: In Memphis Sources: Law enforcement, epidemiologic, and ethnographic respondents *Respondents in El Paso, Los Angeles, and Sioux Falls did not provide this information. page 16 Pulse Check: November 2001 HEROIN

for Billings, Boston, Columbia (SC), Then and Now: and Honolulu, where neither law enforcement, epidemiologic, nor epi- How have heroin user demographics changed across the country demiologic sources indicated such (fall 2000 vs spring 2001)? sales. Crack and powder cocaine are According to epidemiologic and ethnographic sources... mentioned most frequently, followed by marijuana. Also mentioned are Age: ➤ Increases in the young adult (18–30 years) group are reported in the ecstasy (methylenedioxymethamphet- Numerous majority of Pulse Check cities: Boston in the Northeast; Baltimore, amine, or MDMA) (in Miami and shifts are Columbia, Memphis, Miami, and Washington, DC, in the South; New York), pharmaceutical opiates reported: Detroit, St. Louis, and Sioux Falls in the Midwest; and Denver, such as OxyContin® (in Portland), Honolulu, and Seattle in the West. and methamphetamine (in Denver). ➤ A new user group is emerging in El Paso: adolescents born into multi- The Philadelphia epidemiologic generational families of heroin addicts and sellers (but young adults source reports that in the past each age 18–30 still predominate). dealer sold one drug; now, in addi- tion to all the “meat and potatoes” ➤ More younger people (16–22 years) in Portland, ME, are initiating products (that is, heroin, crack heroin use. cocaine, and marijuana), dealers ➤ sell diverted pharmaceuticals, e.g., Race/ Denver, CO: Whites, who are the predominant heroin user group, ethnicity: continue to increase as a percentage of heroin users; however, they alprazolam and oxycodone Distributions are still underrepresented relative to the city’s general population. (Percodan®, Percocet®, and remain ® ➤ OxyContin ). In Baltimore, some generally Miami, FL: Hispanics are an emerging group (but are still under- heroin sellers also sell powder cocaine, stable except represented relative to the general population). sometimes as a “one-and-one” (both for five ➤ drugs sold together as a unit); other reported Philadelphia, PA: The proportion of Whites among heroin users has dealers, however, sell the drugs sepa- shifts: declined slightly, while Black and Hispanic representation has rately. With Memphis heroin dealers increased slightly. also selling cocaine in various mixes, ➤ Seattle, WA: Slight increases are reported in heroin use by Hispanics. that city’s epidemiologic source notes that buyers often don’t know what ➤ Washington, DC: Blacks remain the racial/ethnic group most likely to they’re getting. In St. Louis, dealers use heroin, but Whites have been increasingly using the drug. affiliated with gangs are particularly likely to run a “one-stop shop,” selling Gender: Distributions remain stable, with three exceptions: the number of female heroin heroin, crack, and marijuana. users has increased slightly in New Orleans, Philadelphia, and Portland (ME).

HEROIN: THE USERS Residence: Heroin use is spreading to the suburban areas surrounding four Pulse Check cities in the South (Baltimore, Memphis, Miami, and Washington, DC) and Seattle in the How old are heroin users? West. Use is also spreading to the rural areas surrounding Portland, ME (as suggested by (Exhibit 9) The vast majority of epi- rising hepatitis C figures), and El Paso (partly because many people are moving there). demiologic and ethnographic sources (17 of 21) in the Pulse Check sites New Orleans. In two sites—Philadel- and Portland, adolescents are agree that the people most likely to phia and St. Louis—both the younger increasingly initiating heroin use. By use heroin are generally older than and older adult groups are cited as contrast, in Boston, the ethnographic 30. However, younger adults (18–30 equally likely to use heroin. source remarks that “It’s rare to see years) sometimes comprise substantial Moreover, the younger adult groups young minority heroin users. They proportions of users in those sites. are increasing in many cities, such as often saw its effects on their parents Furthermore, in the South, younger Portland (ME) and Sioux Falls, where and tend not to use it.” adults are more likely than older the older adults still predominate. adults to use heroin in four sites: Even more disturbingly, in some The two Philadelphia treatment Baltimore, El Paso, Memphis, and cities, including Baltimore, El Paso, sources agree with that city’s

Pulse Check: November 2001 page 17 HEROIN

epidemiologic source that both the similar consensus among all source where heroin users are perceived to younger and older adult age groups categories occurs in Birmingham, be primarily older adults, and in New are equally likely to use heroin. A Boston, Detroit, and Honolulu, Orleans and St. Louis, where they are perceived to be primarily young Then and Now: adults. Overall, heroin users in methadone programs seem to be How have heroin user demographics changed across the country (fall somewhat older than those in non- 2000 vs spring 2001)? methadone treatment: 10 out of 17 According to treatment sources... (59 percent) methadone treatment sources who discussed this question The number of novice heroin users (any drug treatment client who has recently begun consider heroin users more likely to using heroin) in methadone and non-methadone treatment has increased in five be older adults, versus 8 out of 18 methadone programs (in Billings, Denver, El Paso, St. Louis, and Portland) and five (44 percent) non-methadone sources. non-methadone programs (in Boston, Chicago, Columbia, El Paso, and Miami) across Another disturbing report comes nine Pulse Check cities. Additionally, that number has increased in the teen facility of the Honolulu non-methadone program while the number adult novice users has remained from Chicago, where the methadone stable. Stable numbers are reported in all other programs where this information was program’s heroin users are primarily available: in 10 non-methadone programs (in Baltimore, Billings, Birmingham, Boston, both adolescents and young adults. Chicago, Columbia, Honolulu, Miami, New Orleans, and Philadelphia), and in 7 methadone programs (in Birmingham, Boston, Chicago, Honolulu, New Orleans, Are there gender differences in St. Louis, and Seattle). No declines are reported. who uses heroin? (Exhibit 9) All but 2 of the 21 epidemiologic and In addition to changes in the number of novice users, only a handful of Pulse Check ethnographic sources agree that males treatment sources report any demographic changes between fall 2000 and spring 2001: are more likely than females to use Non-methadone programs Methadone programs heroin, at least among the largest user groups. The exceptions are in Gender shifts: In Baltimore, more female heroin Younger clients: Heroin users Birmingham and Washington, DC, users have been entering treatment; nevertheless, coming into one of the two where males and females are equally the program’s heroin-using population remains Boston methadone programs likely to use the drug. Since the last predominantly male. In Honolulu, males and represented in Pulse Check appear Pulse Check reporting period, the females used to be evenly represented among to be younger than in the past. number of female heroin users has heroin users; now the program’s heroin users are predominantly males. Older clients: Heroin users in increased slightly in New Orleans, Columbia (SC), El Paso, and Philadelphia, and Portland (ME). Residence shifts: While clients in the El Paso non- Portland (ME) appear to be older methadone program are predominantly suburban, than in the past. Similarly, the vast majority of report- central city representation is increasing. ing non-methadone treatment sources cite males as the largest heroin-using group. In methadone treatment pro- grams, however, males and females Recent age shifts among heroin users in treatment: are equally likely to use heroin, as Some possible explanations... reported by 10 of 17 methadone Only four treatment sources report any recent changes relating to age. In one of the treatment sources who discussed this two Boston methadone programs, heroin users entering treatment appear to be a little question. The only changes reported younger than previously. The Pulse Check source speculates that this shift might be are in two non-methadone programs: occurring because younger people who have been abusing diverted oxycodone (in the increases in female heroin users enter- OxyContin® form) might be unable to sustain the costs of that drug. Conversely, ing the Baltimore program (which heroin clients coming into the Columbia (SC), El Paso, and Portland methadone pro- remains predominantly male) and in grams appear older than in the past. The Columbia source explains that users must be addicted for at least a year to be admitted. Similarly, the El Paso source speculates that male users entering the Honolulu people are taking longer to come in for treatment. program (which used to be evenly split but is now predominantly male). page 18 Pulse Check: November 2001 HEROIN

Exhibit 9. population. Similarly, in Boston, What demographic groups predominate among heroin users, according where Whites are in the majority to different Pulse Check sources?* among heroin users, Blacks are nevertheless overrepresented. City Age Gender Race/Ethnicity E N M E N M E N M Boston, MA >30 18–30; 18–30; Males Males Both Whites Whites Whites Demographic differences between >30 >30 clients in methadone and non- New York, NY >30 18-30 >30 Males Females Males Whites Whites Whites methadone programs... Philadelphia, PA 18–30; 18–30; 18–30; Males Males Males Whites Blacks, Whites According to Pulse Check treatment

Northeast >30 >30 >30 Hispa- nics sources, heroin-using clients in the two Portland, ME >30 >30 >30 Males Males Both Whites Whites Whites types of programs differ somewhat in Baltimore, MD 18–30 >30 >30 Males Males NR Blacks Blacks NR age and gender distributions: Birmingham, AL >30 >30 >30 Both Males NR Whites/ Blacks NR Blacks Age: Overall, heroin users in Columbia, SC >30 NR 18–30 Males Males Both Whites/ NR NR methadone programs seem to be Blacks somewhat older than those in El Paso, TX 18–30 NR >30 Males Males Males Hispa- Hispa- Hispa- non-methadone treatment.

South nics nics Gender: Heroin users in the Memphis, TN 18–30 NR NR Males Males NR Whites NR NR Miami, FL >30 >30 18-30 Males Males Males Whites Hispa- NR non-methadone programs are nics predominantly males. Even gender New Orleans, LA 18–30 >30 >30 Males Males Both Blacks Blacks Whites distributions are much more Washington, DC >30 18–30 >30 Both Both Males Blacks Blacks Blacks common in methadone programs. Chicago, IL >30 >30 18-30 Males Males Both Blacks Blacks Blacks Race/Ethnicity: Methadone treatment Detroit, MI >30 >30 >30 Males Males Both Whites Blacks Blacks St. Louis, MO 18–30; >30 >30 Males Males Both Blacks Blacks NR sources are more likely to report Whites as the predominant heroin Midwest >30 Sioux Falls, SD >30 18–30 NA Males Males NA Whites NR NA user group in their programs, while Billings, MT >30 18–30 NA Males Both NA Whites Whites NA non-methadone treatment sources are Denver, CO >30 >30 18–30 Males Males Both Whites Whites Whites more likely to report Blacks. Honolulu, HI >30 >30 >30 Males Both Males Whites Whites Whites/ Asians Socioeconomic status (SES): Heroin West Los Angeles, CA >30 NR >30 Males Males Both Hispa- NR Hispa- users in methadone programs are more nics nics likely than those in non-methadone Seattle, WA >30 NR >30 Males Males Both Whites NR Whites programs to be from middle SES backgrounds. Conversely, those from Sources: Epidemiologic/ethnographic (E), non-methadone treatment (N), and methadone treat- non-methadone programs are more ment (M) respondents *Shaded boxes indicate that a given heroin-using racial/ethnic group is overrepresented relative likely to be from low SES backgrounds. to that city’s general population. Not all sources, however, had this information available. Employment and education: Is any racial/ethnic or socioeco- predominant user groups in El Paso Employment rates and education nomic group more likely to use and Los Angeles. Epidemiologic and levels are higher among heroin users heroin? (Exhibit 9) According to ethnographic sources also note that in methadone programs than among epidemiologic and ethnographic some racial/ethnic groups who are those in non-methadone programs. sources, heroin users are most likely not the most likely to use heroin in Residence: Suburban representation is to be Whites in 12 Pulse Check cities their cities are, nevertheless, overrep- somewhat higher among heroin users and Blacks in five cities. Whites and resented. For example, in Denver and in methadone treatment than among Blacks are equally represented among Philadelphia, Whites predominate in those in non-methadone treatment. heroin users in Birmingham and heroin use, but Hispanics are over- Columbia (SC), and Hispanics are the represented relative to the general

Pulse Check: November 2001 page 19 HEROIN

Only a few minor changes are What is the most common methadone clients tend to be on reported by epidemiologic and ethno- socioeconomic background of long-term maintenance, so they are graphic sources. In Washington, DC, heroin users? In all but four of the less likely to be currently active drug for example, Whites, have been Pulse Check cities, the largest heroin- users and are more likely to be increasingly using heroin, but they using group reported by epidemiolog- employed and to be able to afford still reflect their distribution in the ic and ethnographic sources is in the treatment fees. general population and are still not low SES category. Heroin users are the predominant user group. In more likely to be middle SES in Employment figures from both types Denver, Whites, who are the predom- Memphis (where they have of treatment programs bear out this inant heroin user group, have been increased), Miami, and Sioux Falls, explanation to some extent. Less than increasing; however, they are still while the Detroit source reports that half of clients are employed, either underrepresented relative to the city’s all SES groups are equally likely to part-time or full-time, in 12 of 14 general population. And in Philadel- use heroin. non-methadone programs but in 8 of phia, the proportion of Whites 14 methadone programs where this among heroin users has declined Similarly, the vast majority of non- information was available. slightly, while Black and Hispanic methadone treatment sources report representation has increased slightly. that their programs’ heroin-using Heroin use by Hispanics has also clients are from low SES backgrounds. Middle socioeconomic heroin increased slightly in Seattle. Only four programs are exceptions: users: A hidden population? in Billings, where high SES clients pre- St. Louis, MO: Heroin users often Pulse Check treatment sources dominate; in Honolulu, where the come from low SES backgrounds, as in similarly report diverse racial/ethnic middle SES is named; and in Boston St. Louis. But that city’s epidemiologist distributions at their programs. Whites and Washington, DC, where heroin points out that middle SES heroin users are the predominant heroin user group clients are equally likely to be from might be a hidden population because in nine methadone programs but only either low or middle SES backgrounds. they tend to use private physicians for six non-methadone programs. Conver- treatment. sely, Blacks are the primary user group among heroin clients in eight non- methadone programs but only four Conditions that contribute to low What is the education level of methadone programs. Hispanics are socioeconomic status among non- heroin users? According to more likely than other groups to use methadone clients... responding treatment sources, heroin heroin at the El Paso and Miami non- The Washington, DC, non-methadone users in methadone treatment seem to methadone programs and at the El source explains that SES is low at the have a higher education level than Paso and Los Angeles methadone pro- program for three reasons: lack of those in non-methadone programs. grams, and they equal Blacks as the employment; lack of education; and Among the 17 methadone treatment primary heroin-using group in the lack of family support resulting from sources who provided this informa- Philadelphia non-methadone program. the addicts’ drug use. tion, only 4 report that the majority In Honolulu, heroin users at the of their programs’ clients have not methadone program are about half completed high school (in Chicago, Asians and half Whites; the non- Methadone treatment providers are Detroit, Los Angeles, and Philadel- methadone program’s teen center has the only Pulse Check sources who phia); the comparable dropout figures primarily Asian heroin clients, while name middle SES more frequently for the non-methadone are 7 out of that program’s adult center heroin than low SES as the predominant sta- 13 responding programs. El Paso clients are primarily Whites. No treat- tus of their heroin clients: of the 15 provides an example of the disparity ment sources report any major changes respondents who discussed this ques- in education levels between the two in racial/ethnic distributions since the tion, 8 name the former, 5 name the types of heroin users: the majority in last Pulse Check reporting period. latter, and 2 name both low and mid- the non-methadone program have dle SES clients as equally represented. only completed junior high, while the This finding is not surprising because majority of those in the methadone page 20 Pulse Check: November 2001 HEROIN

program are split evenly between Some heroin users reside in rural tion in Springfield, Missouri—once people who have completed high areas, as reported in Portland, El considered a rural area, but now school and those who have completed Paso, and St. Louis. In Portland, becoming more urbanized. This latter 2 years of college. In two other pro- rising hepatitis C figures suggest an case shows how the lines between grams, Pulse Check sources report increase of heroin use in those rural city, suburban, and rural areas are that heroin users have completed 2 areas, but heroin users continue to often becoming blurred. years of education beyond high reside predominantly in the central school: the methadone program in city. In El Paso, heroin users are most Pulse Check treatment sources also New York, and the non-methadone likely to reside in several barrios in name the central city more frequently program in Honolulu. the central city; however, heroin is than other areas. Among the 15 non- increasingly reported in the rural methadone sources who discussed the Where do heroin users tend to areas, partly because many people are subject, only 2 (in Denver and in El reside? Central city areas are moving into those areas. The St. Paso) report that their clients are generally cited by epidemiologic and Louis epidemiologist is watching for more likely to be suburban, and 1 (in ethnographic sources as the most like- growth in the heroin-using popula- Honolulu) reports that adult clients ly place of residence for heroin users. The suburbs, however, are the most Then and Now: likely residence area for heroin users in Sioux Falls and Los Angeles. In How have heroin use patterns changed across the country Detroit, heroin users are equally like- (fall 2000 vs spring 2001)? ly to reside in both central city and According to epidemiologic and ethnographic sources... suburban areas Additionally, many smaller heroin-using populations Sources in three regions—particularly in the South— report some slight changes in the reside in suburban areas, as men- way heroin users take their drug and in the other drugs they use. No such changes are tioned in at least two northeastern reported in the Midwest. areas (Boston and New York), four ➤ Increased snorting: While injecting still predominates, snorting has increased in southern areas (Baltimore, Memphis, Columbia (SC), Denver, El Paso, Miami, New Orleans, and Washington, DC. Miami, and Washington, DC), three western areas (Denver, Honolulu, and ➤ Increased smoking: Smoking has increased in Denver and Memphis, but injection Seattle), and one midwestern area remains the primary route of administration in both cities. (Chicago). An increasing spread of ➤ heroin use to suburban areas is Increased injecting: In Honolulu, some young adults are shifting from “chasing the dragon” to needle use. reported by several epidemiologic and ethnographic sources, including those ➤ Increased crack combinations: Speedballs containing heroin plus crack have increased in Baltimore, Memphis, Seattle, and in El Paso (where they used to include only powder cocaine, but now crack cocaine is Washington, DC. as likely to be included as powder) and in Los Angeles (where speedballs continue to contain primarily heroin plus powder cocaine).

New York, NY: The drug and the ➤ Changes in benzodiazepine use: Alprazolam use, common among Philadelphia heroin user on the move... addicts, has been increasing, while diazepam use has been declining.

According to the New York ethno- ➤ Increased ecstasy use: Heroin combined with ecstasy has recently been reported in graphic source, “Researchers report Memphis (as users move away from crack) and Miami. that young Whites, both males and females, continue to come to Brooklyn According to treatment sources... to purchase heroin and use the needle Use patterns remain relatively stable in the treatment population. Only two changes are exchange programs. The heroin and reported. In Philadelphia, the Pulse Check methadone treatment source reports a shift needles are transported back to Long from injecting to snorting due to increased heroin purity. And in Birmingham, the non- Island, where they are sold.” methadone treatment source notes a “trail mix” used by adolescents, consisting of heroin, cocaine, and ecstacy, which showed up about a year ago.

Pulse Check: November 2001 page 21 HEROIN

are most likely to be from rural areas Exhibit 10. more common), in New York (where (although clients at that program’s How do users administer heroin? snorting and injecting both predomi- teen facility are more likely to be nate), and in Denver (where snorting Injecting is most Snorting is most from the central city). The El Paso common in... common in... and smoking both predominate). In source adds that even though clients the New York program, new patients, Boston, MAE*,M,N* Boston, MAE*,M,N* are predominantly suburban, central New York, NYM* New York, NYE,M* compared to the overall heroin-using city representation is increasing. The Philadelphia, PAE,N Philadelphia, PAM population, are much more likely St. Louis source mentions that while Northest Portland, MEE, M Portland, MEN to snort than inject—about 60–70 the largest proportion of clients are percent are snorters. Similarly, in N E from central city areas, a large pro- Baltimore, MD Baltimore, MD Boston, novice users are primarily Birmingham, ALE*,N Birmingham, ALE* portion also resides in the suburbs. snorters, while the program’s overall Columbia, SCE,M New Orleans, LAM heroin-using population are primarily El Paso, TXE,M,N Washington, DCN Methadone treatment sources report E injectors. In the Philadelphia pro-

South Memphis, TN slightly higher suburban representa- Miami, FLE,M,N gram, the Pulse Check source reports tion than their non-methadone New Orleans, LAE,N a shift from injecting to snorting due counterparts: of the 15 sources who Washington, DCE,M to increased heroin purity. discussed this subject, 4 report the E ,M E,M,N suburbs as the likeliest place of resi- Detroit, MI * Chicago, IL E,M E dence (in Boston, Columbia (SC), St. Louis, MO Detroit, MI * Do route of administration and St. Louis, MOE*,N demographics interrelate? Denver, and New Orleans), and Midwest Sioux Falls, SDE,N another 2 (in Los Angeles and Seattle) Several epidemiologic and ethnographic report suburban and central city areas Billings, MTN* Billings, MTE,N* sources note a strong relationship as equally likely places of residence. Denver, COE Denver, COM,N between these two variables, as in the Honolulu, HIE,M,N following examples: How do heroin users administer West Los Angeles, CAE,M heroin? (Exhibit 10) As in the last Seattle, WAE,M New York, NY: “The younger crowd Pulse Check report, injecting remains prefer snorting,” notes the ethno- *Respondent considers injecting and graphic source, “because they feel the most common route of heroin snorting as approximately equal. administration, according to epidemi- EEpidemiologic/ethnographic respondents they can’t get addicted and they fear NNon-methadone treatment respondents contracting HIV.... Sharing of needles ologic and ethnographic sources in M Methadone treatment respondents by older drug users continues to the majority of cities. Snorting, how- NOTE: One of the two treatment sources in ever, either equals or surpasses inject- the following cities did not provide this increase as people live longer with the information: Billings, Birmingham, virus. The feeling is it’s okay to share ing in nine sites, including all four Columbia, Los Angeles, Memphis, Sioux midwestern sites. Since the last Pulse Falls, and Seattle. your works.”

Check reporting period, smoking has St. Louis, MO: Snorting has overtaken reportedly increased in Memphis, The epidemiologic source suggests, injecting for the first time in St. Louis where the heroin is smoked in combi- however, that they might switch back (although the two are nearly equal), nation with other drugs, and in to chasing the dragon if white heroin “probably,” notes the epidemiologic Denver (continuing a trend ongoing continues to become increasingly source, “because of the increase in since the early 1990s). Heroin smok- available. young adults who tend to snort.” ing is also occasionally reported in Injection, however, still predominates Pulse Check methadone treatment Miami, usually related to the in that city’s rural areas. European tourist scene. Some young sources concur that injection is the adults in Honolulu are reportedly most common route for administering Detroit, MI: Young adult heroin users shifting from “chasing the dragon” heroin, as reported in 12 out of 17 tend to snort the drug; the older user (placing heroin on aluminum foil, cities where this information was group, however, is equally likely to lighting a fire underneath it, and available. The exceptions are five snort and inject it. sniffing the resulting smoke through a programs in Chicago, New Orleans, straw or other means) to needle use. and Philadelphia (where snorting is page 22 Pulse Check: November 2001 HEROIN

Snorting is mentioned much more fre- Speedballing is also frequently holds true: according to the epidemi- quently by Pulse Check non-methadone mentioned by treatment sources. ologic source, the prescription drug sources than by their epidemiologic, Specifically, heroin plus powder hydromorphone (Dilaudid®) is ethnographic, and methadone treat- cocaine is used by clients in 15 illegally sold and and more available ment counterparts. Out of 16 sources programs, and heroin plus crack is than heroin, so heroin may be used as who provided this information, 6 cited used by clients in 16 programs. a supplement or replacement. snorting as the most common route used by their programs’ heroin users, 7 To enhance the effects of heroin, Marijuana is another drug frequently cited injecting, 1 cited both snorting heroin users also sometimes consume smoked by heroin users, as mentioned and injecting, 1 cited smoking, and 1 benzodiazepines, such as alprazolam, by epidemiologic and ethnographic cited both snorting and smoking. as noted by epidemiologic and ethno- sources in Columbia (SC), Philadel- graphic sources in Baltimore, Boston, phia, St. Louis, and Seattle. Metham- What other drugs do heroin users Philadelphia, and Seattle. The phetamine is sometimes combined with take? Cocaine is the drug most often Baltimore ethnographic source notes heroin, as mentioned in Honolulu taken along with heroin, either in that some heroin injectors purchase (where that combination is sometimes combination (“speedballing”) or alprazolam as a heroin substitute called a “speedball”) and Billings. sequentially, according to epidemio- (depending on the price of heroin) to logic and ethnographic sources in the “get out the gate”–that is, to get their The Memphis epidemiologic source majority of Pulse Check cities. first shot (“gate shot”) in the morning notes an increased tendency to mix Speedballs can involve either powder until they can “do a hustle for the heroin with other drugs, with the cocaine (often cooked) or crack (some- dopeman.” latest mixture being heroin plus times dissolved). They are generally ecstasy. The heroin-ecstasy combina- ® injected, but they can also be smoked Clonazepam (Klonopin ) is another tion is also mentioned by the Miami or snorted. In Baltimore, for example, benzodiazepine taken by Boston and epidemiologic source. In Birmingham, “bipping” refers to snorting heroin or Seattle heroin users. The Boston the non-methadone treatment source cocaine, either separately or together. ethnographic source notes that notes a “trail mix” used by adoles- Speedballing in that city usually “benzodiazepine-heroin mixers are cents, consisting of heroin, cocaine involves injecting heroin and powder generally working to middle class.” In and ecstacy, which showed up about cocaine that are cooked together; less El Paso, some users of speedballs a year ago. often it involves heroin combined with (heroin plus powder cocaine) also use crack. Similarly, in Seattle, heroin and flunitrazepam (Rohypnol) to help Where and with whom is heroin powder cocaine are injected simultane- them sleep and “soften the fall when used? (Exhibit 7) Heroin use tends ously, while heroin and crack are coming down.” Additionally, the to be an indoor activity. Only two smoked sequentially. In Miami, speed- Honolulu and Seattle methadone epidemiologic and ethnographic balls are heroin plus crack, which may treatment sources mention that hero- sources, in El Paso and Honolulu, be smoked or snorted rather than in users also take benzodiazepines. In perceive that outdoor use is more fre- injected. Sequential use of the two Honolulu, such users usually alternate quent than indoor use. An additional drugs is more common than speedball between the two drugs; however, a three, in Boston, Memphis, and use in some cities, such as Columbia few inject them simultaneously. Washington, DC, perceive indoor and (SC) and St. Louis. outdoor use to be about equal. Street When heroin is scarce or low in use does, however, take place to some Often, the choice of speedballs is purity in some cities, users sometimes extent, as reported in 12 sites. related to demographic variables. In supplement or replace it with other Similarly, parks and playgrounds are New York, for example, the ethno- opiates. Such is the case in El Paso, reported as heroin use areas in 10 graphic source notes that “in speaking where heroin users in the non- sites. The Baltimore ethnographic with many heroin addicts...older methadone treatment program some- source points out that heroin use addicts prefer speedballing because times use diverted propoxyphene tends to take place indoors due to its ® the effect is greater when heroin is (Darvon ) and other opiates. In illegal nature; but outdoor use tends mixed with cocaine.” Birmingham, however, the reverse to increase seasonally, as the weather

Pulse Check: November 2001 page 23 HEROIN

improves, especially in parks and One unusual setting, described by the Being “in the mix”... playgrounds. The Boston ethno- Honolulu methadone treatment graphic source adds that “All users source, is parties for heroin users that According to the Baltimore ethno- seek the most private available take place in the dealer’s home. graphic source, “Over the life of their setting. The homeless use a public addiction, heroin users tend to increas- ingly ‘be in the mix’: they become restroom or back alley because that is more networked, more ritualistic in the most private place they can find.” “Abandonimiums,” public bath- rooms, and other unusual heroin behavior, more involved in social activity, so they can pool resources to Pulse Check treatment sources use settings... purchase drugs or ‘do a hustle.’” concur that most heroin use takes Baltimore, MD: “Abandominiums,” place indoors, as reported by all but according to the epidemiologic source, How is heroin impacting the four respondents: in Boston (non- are abandoned row houses where users methadone and methadone), Denver shoot heroin. Users also inject heroin in health of users? (Exhibit 11) Since (non-methadone), and Honolulu the bathrooms of fast-food restaurants. the last Pulse Check reporting period, (methadone). the impact of heroin use on acquired El Paso, TX: “Addicts inject heroin in immunodeficiency syndrome (AIDS) any place immediately available,” says and human immunodeficiency virus The indoor settings most commonly the epidemiologic source, “including (HIV) seems to have stabilized in the cited (by 10 or more of the 20 epi- jails, court bathrooms, public bath- majority of non-methadone and demiologic and ethnographic sources rooms, alleys, and side roads....” who discussed this question) are methadone programs, except as listed private residences, public housing in the table. Any declines are noted in developments, private parties, cars, Heroin use tends to take place in the Northeast, while any increases are and crack houses. Raves and night- small group settings, as reported by noted in the Midwest and South. By clubs are cited in only six sites each, the majority of epidemiologic/ethno- contrast, cases of hepatitis C have schools are cited in El Paso and graphic and non-methadone treat- increased among heroin users in the Memphis, and shopping malls are ment sources. Only four epidemiolog- majority of reporting programs–in also cited in El Paso and New York. ic and ethnographic sources (in many cases because of increased In El Paso, in addition to every Chicago, Los Angeles, Memphis, and screening, awareness, and early aforementioned use setting, the epi- New York) and five non-methadone detection. Overdose cases have also demiologic source lists some unusual sources (in Birmingham, Denver, increased in numerous programs, settings, such as jails, court bath- Honolulu, New York, and Philadel- especially in the South, and often due rooms, public bathrooms, alleys, and phia) perceive that users are more to drug mixing. Cases of high-risk side roads. Indoor settings in likely to take heroin when alone. By pregnancy are generally stable, Baltimore include abandoned row contrast, heroin users in methadone except as noted. houses, otherwise known as “abando- maintenance are more likely to use HEROIN: THE COMMUNITY miniums,” as well as bathrooms in their drug while alone, as reported by fast-food restaurants. Abandoned sources in 8 out of 14 sites where this How available is methadone buildings, rarely used buildings, and information was provided. treatment in Pulse Check com- public restrooms are also mentioned munities? Methadone maintenance by the ethnographic source in Boston. Use contexts are related to demograph- is not available at all in Billings or ic variables. For example, the Detroit Sioux Falls. In the remaining Pulse Treatment sources paint a similar pic- and Miami epidemiologic sources note Check cities, about half of the epi- ture of the various indoor heroin use that older users tend to take heroin demiologic and ethnographic settings, with the top-six responses (in while alone, but younger adults tend to sources—mainly in the South— order of response frequency) being take it in groups or among friends. By consider methadone to be available private residences, crack houses, cars, contrast, in Baltimore, heroin users in selected areas only (in Baltimore, public housing, parties, and nightclubs. increase their social activity and net- Boston, Columbia, El Paso, Hono- working as they age. lulu, Memphis, Miami, New Orleans,

page 24 Pulse Check: November 2001 HEROIN

Exhibit 11. How has heroin use impacted the health of users? Pulse Check Adverse Comments Site Impact

Boston, MA ↓ Less needle use and needle sharing; more needle exchange programs, education, snorting other opiates Portland, ME ↓ Prevention activities having impact Philadelphia, PA ↓ Clients are tested in the program: 15% positive Chicago, IL ↑ More AIDS hospitalizations and deaths Detroit, MI ↑ Not necessarily up in community, but more education causes more HIV+ clients to seek treatment Baltimore, MD ↑ More criminal justice referrals; more funding sources for social and health care services HIIV/AIDS Birmingham, AL ↑ More HIV screening; some women resorting to prostitution to get drugs Miami, FL ↑ Injecting drug use Washington, DC ↑ More unprotected sex; Prostitutes don’t get tested till they reach treatment Boston, MA ↑ More screening, diagnosis, early detection; some becoming symptomatic after long time since infection New York, NY ↑ Users not tested till reach treatment; Mainly unhealthy sex practices Portland, ME ↑ More injecting drug use Baltimore, MD ↑ Increasing among criminal justice population Birmingham, AL ↑ More screening and diagnosis Columbia, SC ↑ Lack of knowledge; younger users think they are invincible, don’t take precautions El Paso, TX ↑ Long-term exposure to drugs, more body piercing and tattooing Memphis, TN ↑ Needle sharing Miami, FL ↑ Injecting drug use

Hepatitis C Washington, DC ↑ Testing started at program in November 2000 Chicago, IL ↑ More testing available this year St. Louis, MO ↑ Up especially among adolescents and 40+ users who started using in the 1970s; more physician awareness, more testing Billings, MT ↑ Increased heroin use Denver, CO ↑ More testing Seattle, WA ↑ Injecting drug use Detroit, MI ↓ Improved access to treatment on demand, so people enter treatment earlier

Health Consequences Seattle, WA ↓ Possibly because fewer juvenile clients (juveniles are most likely to OD) Boston, MA ↑ Users don’t know how pure the drug is El Paso, TX ↑ Heroin potency up, price down; detox center recently closed; not enough treatment available for increasing demand Sioux Falls, SD ↑ Increases generally in fall, when students return to college Baltimore, MD ↑ Birmingham, AL ↑ Mainly because used in combination with diverted OxyContin® Overdose Columbia, SC ↑ More drug mixing, more copycat drugs (especially ecstasy), more peer pressure Memphis, TN ↑ Due to interactions with other drugs New Orleans, LA ↑ Mainly because used in combination with diverted OxyContin® Billings, MT ↑ Honolulu, HI ↑ Increasing benzodiazepine use Los Angeles, CA ↓ Because of perinatal program Sioux Falls, SD ↑ Increase in Native American population, who are more frequently under influence of substances as well as victims of rape by perpetrators under the influence Boston, MA ↑ Predominantly Hispanics; More risk-taking teenagers, more people taking drugs Portland, ME ↑ More awareness by medical community Columbia, SC ↑ Proportion of heroin users up Washington, DC ↑ More unprotected sex and prostitution

High-Risk Pregnancy Billings, MT ↑ More pregnant females applying for treatment services Honolulu, HI ↑

Sources: Non-methadone and methadone treatment providers

Pulse Check: November 2001 page 25 HEROIN

Portland, and Washington, DC), while New Orleans, and increased starting up again imminently. (2) A the other half—mainly in the somewhat in Baltimore, Chicago, satellite of the area’s only methadone Midwest and West—consider it to be Detroit, Philadelphia, Seattle, and program (which is private–—the area available throughout their areas. Washington, DC. In private pro- has no public programs) has recently grams, capacity has remained stable in opened, easing some of that program’s Waiting lists for admission to public 12 cities, increased greatly in Portland pressure. Additionally, the local Office methadone programs are reported by (ME), and increased somewhat in of Substance Abuse is considering epidemiologic and ethnographic Detroit, Memphis, and Seattle. funding a public detox and methadone sources in 12 cities, with particularly maintenance program. large numbers reported in Boston To what extent is there a (1,000 people) and the longest wait methadone diversion problem New York, NY: The ethnographic reported in Honolulu (about 3 from programs in Pulse Check source suggests that police initia- months). Only three sources report communities? The majority of law tives aimed at street-level drug adequate capacity (in Denver, Miami, enforcement sources who discussed selling has driven most of the and New Orleans). In private pro- this question do not consider heroin dealers indoors. grams, the majority of epidemiologic methadone diversion a problem. It is and ethnographic sources report ade- considered somewhat of a problem, Philadelphia, PA: Drug-related quate capacity, with waiting lists however, by sources in Baltimore, deaths have been increasing reported only in Birmingham, Denver, Los Angeles, and Portland dramatically, particularly those Columbia, and Miami. (ME). And sources in Memphis, New involving heroin (from 236 heroin Orleans, and Washington, DC, con- toxicology reports in 1999 to 332 How have methadone treatment sider diversion to be a serious prob- in 2000). Additionally, the average availability and capacity changed lem in certain parts of their commu- number of drugs per death has (fall 2000 vs spring 2001)? Since nities. Since the last Pulse Check been increasing. the last Pulse Check reporting period, reporting period, diversion has according to epidemiologic and ethno- declined in Portland and St. Louis, In the South... graphic sources, methadone treatment increased in Columbia and Memphis, Baltimore, MD: The ethnographic in public programs has declined in and remained stable elsewhere. Boston and El Paso, become more source reports on recent develop- available in Chicago and somewhat What is the impact of and ments in medical consequences, more available in five additional cities community reaction to the heroin research efforts, law enforcement (Baltimore, Detroit, Philadelphia, problem? Recent developments in initiatives, and community Seattle, and Washington, DC), and has various Pulse Check communities are collaboration: remained stable in eight cities. Private relevant to the heroin problem and ➤ A dramatic increase in heroin treatment has declined in two cities the drug abuse situation in general in overdoses over the past 9 (Boston and New Orleans), become a variety of ways: months has prompted plans for more available in three cities (Detroit, further investigation, via focus Memphis, and Seattle), become some- In the Northeast... groups and other exploratory what more available in two cities techniques. (Portland and Birmingham), and Portland, ME: The epidemiologic source reports on two recent remained stable in nine cities. ➤ developments in the criminal jus- Similar to the aggressive law enforcement approach recently Slot capacity in public programs tice and treatment communities: used in New York, Baltimore’s has remained stable in eight cities, (1) The drug court program, new mayor and police chief have declined somewhat in El Paso and defunded about 1 year ago, will be been adopting the J.Q. Wilson “broken window” model during

page 26 Pulse Check: November 2001 HEROIN

the past year: go into a specific El Paso, TX: Its unique location, In the West... neighborhood, put more police its indigent population, and recent on the beat, engage in community developments make El Paso vulner- Seattle, WA: Current events, social relations, establish a law enforce- able to drug abuse problems, issues, legislative efforts, and drug ment presence, and prevent that according to the Pulse Check abuse are intertwined in a variety first broken window. It is still too epidemiologic source: of ways, according to the Pulse early to gauge whether this strat- Check epidemiologic source: egy has affected crime and the ➤ The only local detox center ➤ perception of crime. recently closed, leaving a large A major international conference gap in services, possibly related on heroin overdoses, held in to a recent increase in hospital Seattle in January 2000, spurred Baltimore, MD: “The first-of-the- emergencies and deaths. a variety of local public activi- month phenomenon”... ties, such as a joint mayoral/ ➤ According to the Baltimore ethnograph- A small grant for hepatitis C county executive task force that ic source, the drug scene, like the gener- testing among indigents, begun in developed recommendations for al street scene, rotates in a 30-day cycle: September 2000, has recently a variety of approaches to deal it blossoms during the first half of the yielded a 92-percent-positive rate with Seattle’s long-standing month, particularly from the first in injecting drug users (IDUs). heroin overdose problem. through the eighth day, with more sales, more people on the street, more mer- Memphis, TN: Several recent ➤ Recent legislation enables the chants restocking their shelves, and developments are relevant to the various counties to open new more business activity in general; then it local drug abuse situation, accord- methadone clinics, and many de-escalates during the second half. ing to the epidemiologic source: methadone treatment slots are Similarly, drug sales, drug-related crime, likely to open up over the next and drug-related emergency department ➤ After a major central city hospi- year. Another recently intro- visits, seem to follow this up-down tal recently closed, drug-related duced bill aims at reducing cycle. One theory to explain this phe- incidents increased in all other nomenon is its relation to the compen- mandatory sentencing and send- local emergency departments. sation cycle: items such as wages, food ing incarcerated drug abusers to stamps, welfare, and Social Security treatment before their release. ➤ Two ongoing task forces on checks, tend to be received toward the ➤ beginning of the month. mental health and substance A movement is underway to abuse have recently increased change the criteria for diverting their activities. people to drug court: currently, only users are diverted, while ➤ The Safe and Sound crime ➤ A recent diversion program both dealers and “cluckers” prevention effort, targeted at focuses on moving misdemeanor (middlemen who “facilitate” youth, brings together the teams drug abusers out of law enforce- connections between the buyers of health professionals and law ment and into appropriate health and sellers) are excluded; with enforcement officials to address care, such as local emergency the proposed change, both the immediate and specific needs departments or detox. Inpatient users and cluckers would go of both victims and assailants. service can be provided, regard- to drug court. less of ability to pay.

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page 28 Pulse Check: November 2001 CRACK COCAINE

CRACK: THE PERCEPTION Exhibit 1. How do Pulse Check sources How available is crack cocaine across the 21 Pulse Check cities? perceive the crack cocaine problem in their communities? According to law enforcement sources (N=21)... Crack is considered the most commonly used drug in Pulse Check communities by 20 law enforcement, epidemiologic, ethnographic, and non-methadone treatment sources in 14 cities. As reported in the last Pulse Check issue, more than half of those cities are in the South (all eight Pulse Check sites in that region). The rest span the remaining regions: the Northeast (New York and Portland, ME); the Midwest (Chicago and Detroit); and the West (Los Angeles, and Seattle). Additionally, the Denver Widely Available Somewhat Available non-methadone treatment source Not Very Available Not Available considers both crack and powder According to epidemiologists and ethnographers (N=20)...* cocaine as the most commonly used drugs. Further, crack is considered the second most commonly used drug by sources in Boston, Philadelphia, and St. Louis.

Crack is also named as the drug with the most serious consequences in Pulse Check communities by 29 of the 82 sources who provided this infor- mation. These sources span 14 cities, and again, more than half are in the South (all 8 Pulse Check sites). The rest span the remaining three regions: *The epidemiologic source in Columbia, SC, did not provide this information the Northeast (Boston and New York); the Midwest (Chicago, Detroit, powder cocaine in Denver and Seattle; period report a stable trend since the and St. Louis); and the West (Los heroin in Baltimore and Los Angeles; previous period. Similarly, all but two Angeles). Another two sources (in and benzodiazepines in Philadelphia. sources report a stable trend in crack Baltimore and Philadelphia) name as the drug with the most serious both crack and heroin as the most Has the perception of the crack consequences in their communities. serious drug problem, while two problem changed between fall El Paso is one exception: that city’s name cocaine without differentiating 2000 and spring 2001? One epidemiologic source believes that between the two types. Crack is source in Memphis believes that crack crack has been making inroads and is named as the drug with the second has overtaken powder cocaine as the replacing heroin in terms of serious most serious consequences by 22 most commonly abused drug among consequences. Memphis is the other additional sources in 16 cities, and it hardcore users in the community. exception, but in reverse: the non- is considered equal to other drugs However, all other sources who list methadone treatment source believes (in causing the second most serious crack as the most commonly abused that powder cocaine has overtaken consequences) in another 5 cities: drug during the current crack in this area.

Pulse Check: November 2001 page 29 CRACK COCAINE

CRACK: THE DRUG Exhibit 2. How and where is crack cocaine How has crack cocaine made? Crack continues to be How available is crack cocaine availability changed (fall 2000 vs processed locally in most Pulse Check across the country? (Exhibit 1) spring 2001)?* communities, as noted in the last More than three-quarters (32 of 42) issue. In Denver and Portland (ME), of law enforcement, epidemiologic, however, sources note that it is and ethnographic Pulse Check sources processed prior to arriving in the who discussed this question consider Seattle, WAE community, while in Washington, crack to be widely available in their Sioux Falls, SDL DC, crack may be processed community. Only six sources give locally or in New York. Baking a “somewhat available” L L,E Los Angeles, CA Baltimore, MD E soda continues to be the response: three in the West L,E Memphis, TN Billings, MT L,E standard ingredient added (Denver, Los Angeles, and Miami, FL Birmingham, ALL,E New Orleans, LAL,E to powder cocaine to Seattle); the two sources in Boston, MAL,E New York, NYL,E convert it into crack. A Portland, ME; and one Chicago, ILE Philadelphia, PAL,E few sources, however, source in Chicago. And Denver, COL Seattle, WAL mention the use of other only three sources, in three L,E Detroit, MI E L Sioux Falls, SD adulterants. In New York, different regions, consider it El Paso, TX L,E L,E St. Louis, MO for example, the ethnographic not very available: in Billings, Honolulu, HI Washington, DCL,E source reports vitamin B and El Paso, and Sioux Falls. 12 L Chicago, IL lidocaine. Vitamin B12 is also E Has crack availability changed? Denver, CO mentioned by the epidemiologic E (Exhibit 2) Crack availability El Paso, TX source in Memphis. The Baltimore Los Angeles, CAE remained stable between fall 2000 ethnographic source notes different Portland, MEL,E and spring 2001, according to the types of cooking solutions and ammo- majority of Pulse Check sources who nia as crack cocaine adulterants. discussed this question (17 of 20 law enforcement sources and 14 of 19 Do-it-yourself “chemistry”... epidemiologic and ethnographic L Law enforcement respondents E Epidemiologic/ethnographic respondents The New York ethnographic source sources). Increased availability of *The Columbia (SC) epidemiologic and the notes that “One crack user told a crack is reported by only one law Memphis law enforcement sources did not researcher that while a lot of crack is enforcement source (in Sioux Falls) provide this information. available it is better to buy your own and one epidemiologic source (in powder cocaine and cook it yourself” Seattle). Two law enforcement approximately $100, but prices are as low as $24 in New York and as high (rather than buy ready-made crack) “if sources perceive a decline in crack you want to get your money’s worth. as $250 in Honolulu. Purity levels are availability (in Chicago and in These people refer to themselves as usually not reported. Nearly all prices Portland, ME), as do four epidemio- ‘chemists.’” logic and ethnographic sources: two are stable in comparison to the last Crack by bus... in the West (Denver and Los Pulse Check reporting period. Two Angeles), one in the South (El Paso), minor changes are reported: the Los According to the El Paso epidemiologic and one in the Northeast (Portland). Angeles law enforcement source source, street outreach workers report reports some market fluctuation, that some individuals regularly travel What are crack cocaine prices resulting in a slight increase in the by bus between Los Angeles and El across the country? (Exhibit 3) price of some rocks (0.2 gram); and Paso for personal reasons and, in the Crack tends to be sold in 0.1 and 0.2 the Seattle epidemiologic source process, also transport crack. Thus, not gram rocks, which generally cost reports a price decline for “kibbles all of El Paso’s crack comes from approximately $10 and $20, respec- and bits,” a unit smaller than the across the border: some of the supply tively, according to law enforcement, standard rock size (not included in comes from California. epidemiologic, and ethnographic the chart), to $5. sources. Gram prices tend to be page 30 Pulse Check: November 2001 CRACK COCAINE

Exhibit 3. How much does crack cocaine cost in 19 Pulse Check cities?*

MOST COMMON STREET UNIT 1 GRAM City Unit Size Price Purity Price Purity Boston, MA“jum” (small rock) 0.1 gm $10 NR NR NR New York, NY bag NR $3–$10 NR $24–$30 58% “eightball” 1/8 oz $20 58% NR NR rock NR $7–10 58%

Northeast Philadelphia, PA rock 0.05–0.1 gm $5–$10 80% NR NR Portland, ME rock NR $80 75% NR NR “100-rock” 0.5 gm $100 80% Baltimore, MD vial NR $5–$10 NR NR NR Birmingham, AL rock 0.2–0.5 gm $10–$20 NR $100 NR Columbia, SC rock 0.2 gm $20 NR $100 NR “slab” 0.5 gm $100 NR El Paso, TX rock 0.25 gm $20 NR NR NR South Memphis, TN rock 0.2 gm $20 40–50% $100 40–50% Miami, FL rock 0.1 gm $5–$20 80% NR 80–90% New Orleans, LA rock 0.25 gm $10 NR $40–$50 NR Washington, DC “dimebag” 75 mg $10 30–60% $80–$100 NR Chicago, IL rock 0.2 gm $5–$20 NR $123 NR Detroit, MI rock 0.1 gm $10 90% $70–$125 90%

Midwest Sioux Falls, SD rock 0.3–0.5 gm $50 NR NR NR Denver, CO rock 0.1–0.2 gm $20 70% $100–$125 NR Honolulu, HI rock 0.25 gm $25–$35 70% $100–$250 NR Los Angeles, CA rock 0.2 gm $20 NR $80 NR West Seattle, WA “20 rock” 0.1–0.125 gm $20 NR $100 40–85% “40 rock” 0.2–0.25 gm $40 NR

Sources: Law enforcement, epidemiologic, and ethnographic respondents *Respondents in Billings and St. Louis did not provide this information.

Exhibit 4. How is crack referred to across How is crack cocaine referred to across different regions of the country? the country? (Exhibit 4) Slang names for crack seem particularly common in the South, with numerous WEST NORTHEAST MIDWEST names listed by law enforcement, epi- Rock, crack Rock, crack, jum, Rock, crack, $ sign, batman, cards, demiologic, and ethnographic sources hard stuff, clover, devils, ghost, in all eight Pulse Check sites. The bumper, bopper gold crowns, gun, nike, pacman, spotlight, stars majority of the names listed for the Northeast come from Philadelphia. Few slang names are reported by Rock, crack, ready rock, scottie, red top, bule top, hard, ball sources in the Midwest and the West. (four and eightball), 20, I wanna be a rock star, snow, primo, Ma’a (rock woody, momo, geek, joint, blooper, white stuff, big momma, How is crack packaged and in Samoan) bump, crumb, monkey nut, (a big rock), yam, (big rock), marketed? The New York ethno- twinkie, loose rock, stones graphic source reports that small SOUTH glassine bags and light plastic wrap Sources: Law enforcement, epidemiologic, and ethnographic respondents

Pulse Check: November 2001 page 31 CRACK COCAINE

knotted at both ends are replacing CRACK: THE SELLERS are organized in Chicago and (loosely) plastic colored vials as the preferred in Sioux Falls, while both independent How are crack cocaine sellers method of packaging crack cocaine. and organized structures are reported organized? According to law The Portland, ME, law enforcement in Detroit and St. Louis. Similarly, in enforcement sources, crack sellers in source mentions a similar packaging: the West, sales structures vary, from all four Pulse Check cities in the a plastic bag whose corner is knotted organized in Billings, Denver, and Northeast operate independently. in “Dominican ties.” Elsewhere, pack- Seattle to independently run opera- Recently, however, gangs have started aging remains relatively unchanged tions in Honolulu, to a mix of struc- taking over sales in New York. In the since the last Pulse Check reporting tures in Los Angeles. South, by contrast, sales structures period. The most commonly reported vary: independent operations are packaging, as in the case of heroin, By contrast, nearly all epidemiologic reported in Baltimore, El Paso, remains small plastic, cellophane, and ethnographic sources who provide Miami, and Washington, DC; both glassine, or coin bags, often the this information report that crack sell- types of sales structures—independent “zipper” type, particularly throughout ers are affiliated with organized sales and organized—are reported in the Northeast, the South, and the structures, such as gangs. As is the case Birmingham and New Orleans; and Midwest. In the West, however, that with heroin, this seeming discrepancy loosely organized structures or small packaging is reported only in might be explained by differing networks are reported in Columbia Honolulu. Other types of packaging definitions of what constitutes an (SC) and Memphis. Sales structures are more common in that region: organized group. also vary in the Midwest: operations plastic or glass vials (as reported in Denver, Los Angeles, and Seattle); foldover bindles of plastic, paper, or Then and Now: magazine pages (as reported in How have crack sellers and sales changed across the country (fall 2000 Billings, Denver, Honolulu, Los vs spring 2001)? Angeles, and Seattle); plastic wrap or cellophane (in Denver, Honolulu, and The crack sales scene has remained relatively stable since the last Pulse Check report. Los Angeles); foil (in Los Angeles and Only a handful of changes are reported, with no discernible regional trends: Seattle); plastic balloons (in Los Baltimore, MD; Birmingham, AL; ➤ Law enforcement sources note a tendency Angeles); and just loose rocks (in Columbia, SC; and Memphis, TN: toward younger crack sellers. Seattle). Loose rocks are mentioned most frequently in the South Boston, MA: ➤ Continuing a trend noted in the last issue (Birmingham, Columbia, Memphis, of Pulse Check, crack sales are increasingly Miami, New Orleans, and Washing- moving indoors, with more deliveries made via ton, DC), but are also found in the beeper orders. The Boston ethnographic source Northeast (in Boston and New York) attributes this phenomenon to increased law and the Midwest (Detroit and St. enforcement efforts and to urban renewal. Louis). Baltimore is the only Pulse Denver, CO: ➤ Sales are starting to take place in the suburbs, Check city outside of the West where according to the law enforcement source. sources report crack sold in vials. According to that city’s ethnographic Los Angeles, CA: ➤ The law enforcement source notes that elec- source, different neighborhoods use tronic equipment, such as cell phones, continues different colors on the crack vial tops to be increasingly involved in crack sales. for identification: “The vial tops are New York, NY: ➤ The law enforcement source reports that gangs red on Monroe Street, but blue on have recently started taking over sales. East Baltimore....” Elsewhere in the South, the El Paso law enforcement St. Louis, MO: ➤ According to the epidemiologic source, crack source reports balloon packaging and used to come into the area from Colombia paper diamond folds—similar to through Mexico, but now more seems to be packaging found nearby in the West. coming directly from Mexico. page 32 Pulse Check: November 2001 CRACK COCAINE

How is street-level crack sold? all three age groups are listed for primary crack sellers in Birmingham Hand-to-hand crack sales are report- Denver, while adolescents reportedly and Detroit; young adults and older ed by law enforcement sources in predominate in Seattle crack sales. In adults are equally likely in Memphis; every Pulse Check city, as noted in the comparing the fall 2000 and spring and adolescents are considered the last Pulse Check, and similar to the 20001 reporting periods, four law predominant seller group in Baltimore most common method for selling enforcement sources—all in the and Chicago. Adolescents are also heroin. Sales involving beepers or cell South—note a tendency toward noted, to a lesser extent, as sellers in phones are also quite common— younger crack sellers: in Baltimore, other cities. In New York, for exam- reported by law enforcement sources Birmingham, Columbia (SC), and ple, the ethnographic source reports in 16 cities: all four Pulse Check sites Memphis. that “some dealers in Manhattan are in the Midwest, all but one (Washing- as young as 13.” ton, DC) of the sites in the South, all Epidemiologic and ethnographic but one (Seattle) in the West, and New sources concur that young adults are What other drugs do crack deal- York in the Northeast. Acquaintance the most likely to sell crack, as report- ers sell? (Exhibit 5) As reported in networks are mentioned in 13 cities, ed in nearly every city where this previous issues of Pulse Check, crack and home delivery (which often also information was provided. Five excep- dealers are often polydrug sellers. In involves beeper or cell phone use) is tions, however, are noted in the South New York, law enforcement, epidemi- mentioned in 11. Internet sales are and the Midwest: young adults and ologic, and ethnographic sources reported in New York. adolescents are equally likely to be the report that some dealers sell as many

Epidemiologic and ethnographic sources, similarly, report that hand- Exhibit 5. to-hand sales are the most common What other drugs do crack dealers sell?* (in 14 cities), followed by beeper/cell Mari- Powder Metham- No Other phone sales (in 10 cities), then by City juana Cocaine Heroin phetamine Ecstasy Drugs Sold home delivery and acquaintance net- LE E LE E LE E LE E LE E LE E works (in 7 cities each). In El Paso, Boston, MA crack is also reportedly sold over New York, NY

the Internet. Northeast Philadelphia, PA Portland, ME How old are street-level crack Baltimore, MD sellers? As reported in the last Pulse Birmingham, AL Check issue, young adults (18–30 Columbia, SC years) continue to be the predomi- El Paso, TX nant crack sellers at the street level, South Memphis, TN according to law enforcement sources Miami, FL in nearly every city. Several excep- New Orleans, LA Washington, DC tions, however, are noteworthy. In Chicago, IL the Northeast, for example, older Detroit, MI adults are more likely to sell crack in St. Louis, MO Philadelphia. In the South, adoles- Midwest Sioux Falls, SD cents are the primary sellers in Billings, MT Baltimore, while all three age groups Denver, CO (adolescents, young adults, and older Honolulu, HI adults) are equally likely to sell crack West Los Angeles, CA in Memphis. In the Midwest, both Seattle, WA young and older adults are named as Sources: Law enforcement (LE), epidemiologic, and ethnographic (E) respondents the primary crack sellers in Sioux *Epidemiologic sources in Billings, Columbia, El Paso, Denver, Honolulu, Los Angeles, Falls and St. Louis. And in the West, Philadelphia, Portland, Seattle, Sioux Falls, and Washington, DC, did not provide this information

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as four drugs in addition to crack. Exhibit 6. eventually sell” and that “older sellers Other “one-stop shops,” where deal- How likely are crack sellers to are selling to make enough to ‘hustle’ ers sell two or three drugs in addition use their own drug?* their own crack,” but that “a few of to crack, are particularly common in the dealers are younger, in gangs, and the South (Birmingham, Columbia, Boston less likely to use.” Nearly all the MA and New Orleans) and the Midwest Philadelphia remaining epidemiologic and ethno- (Chicago, Detroit, and St. Louis); PA graphic sources who addressed this they are less commonly reported in Northeast Portland issue believe that crack sellers are not the Northeast (Portland, ME) and the ME very likely to use crack. Furthermore, Baltimore West (Billings and Seattle). Overall, MD in Baltimore, the ethnographic source marijuana is reported in 11 cities, Birmingham reports that sellers, who are predomi- followed by heroin (in 8 cities) and AL nantly adolescents, do not use crack. Columbia, powder cocaine (in 7 cities). Metham- SC phetamine is mentioned in only two El Paso What type of crimes are crack western sites, and ecstasy is named TX sellers involved in? All law Memphis

South enforcement sources consider crack only in New York. Eight law enforce- TN ment sources and three epidemiologic Miami sellers as somewhat or very likely to and ethnographic sources, however, FL be involved in other criminal activity. report that crack sellers in their New Orleans The majority name both violent and LA communities sell no other drugs. Washington nonviolent crimes (15 and 16 sources, DC respectively, out of 21). The most Chicago commonly mentioned crime is gang- IL related activity, as noted by 13 sources, One-stop shopping... Detroit MI heavily concentrated in the South (in In some cities, such as St. Louis—as Sioux Falls Baltimore, Birmingham, Columbia, noted by that city’s epidemiologic Midwest SD Memphis, New Orleans, and St. Louis source—crack dealers affiliated with MO Washington, DC) and the West (in gangs are the ones most likely to run a Billings Denver, Honolulu, Los Angeles, and “one-stop shop,” selling multiple drugs. MT Seattle), and to a lesser extent in the Denver CO Northeast (in Boston) and the Honolulu Midwest (in Chicago and St. Louis). HI

Do crack sellers use their own West Prostitution is also mentioned fre- drug? (Exhibit 6) In Miami, St. Los Angeles quently, again particularly in the South CA Louis, and Seattle, crack sellers usual- Seattle (Birmingham, Columbia, El Paso, New ly do not use the product they sell, WA Orleans, and Washington, DC), and to according to law enforcement a lesser extent elsewhere (Boston and sources. In all other Pulse Check sites, Philadelphia in the Northeast; St. Louis Very sellers are somewhat or very likely to in the Midwest; and Denver and Not very Not at all use their own drug. Epidemiologic Somewhat Honolulu in the West). Domestic and ethnographic sources, however, violence is noted in six cities (Balti- Law enforcement sources generally consider crack sellers as less more, Birmingham, Boston, Denver, likely to use their own drug. Only in Epidemiologic and ethnographic Memphis, and St. Louis). Other crimes Boston, El Paso, Memphis, New sources specified include theft and burglary (in Orleans, and St. Louis do these Sources: Law enforcement, epidemiologic, Billings and Chicago), robberies and sources describe crack dealers as and ethnologic respondents shootings involving other dealers (in *The law enforcement source from New very or somewhat likely to use crack York and the epidemiologic sources from Columbia, SC), and money laundering themselves. The Boston ethnographic Billings, Columbia, Los Angeles, New York, (in Detroit). Philadelphia, Portland, Seattle, and Sioux source adds that “nearly all users Falls did not provide this information.

page 34 Pulse Check: November 2001 CRACK COCAINE

Exhibit 6. Where is street-level crack cocaine sold and used?*

Public Private Shop- # Crack Hous- Hous- Inside ping Super- Inter- of City Street Houses ing ing Cars Parties Parks Schools Clubs College Raves Malls markets net Settings S U S U S U S U S U S U S U S U S U S U S U S U S U S S U Boston, MA 7NR New York, NY 14 6 Philadelphia, PA 56

Northeast Portland, ME 32 Baltimore, MD 10 12 Birmingham, AL 13 5 Columbia, SC 5NR El Paso, TX 13 12

South Memphis, TN 14 6 Miami, FL 11 3 New Orleans, LA 12 8 Washington, DC 48 Chicago, IL 11 6 Detroit, MI 11 6 St. Louis, MO 96 Midwest Sioux Falls, SD 42 Billings, MT 13 2 Denver, CO 96 Honolulu, HI 14 1 West Los Angeles, CA 36 Seattle, WA 610 S = Sell U = Use Sources: Law enforcement, epidemiologic, and ethnographic respondents *The epidemiologic/ethnographic sources in Billings, Boston, Columbia, Los Angeles, Seattle, and Sioux Falls did not provide seller setting information. The Columbia epidemiologic/ethnographic source did not provide user setting information. The Boston source for user setting responded, “most private setting available.”

Where is crack cocaine sold? Similarly, nearly every epidemiologic while outdoor sales predominate in (Exhibit 7) All but 6 of the 21 law and ethnographic source who provid- Washington, DC. enforcement sources agree that crack ed this information indicates that sales generally take place in central crack is sold primarily in central city The specific settings for crack sales, city areas. Five of those six excep- areas. In Birmingham and El Paso, like for heroin sales, are varied. tions are in the South. In Miami and however, it is sold both in central city Public housing developments, cars, New Orleans, crack is equally likely and rural areas. And in Detroit, crack and crack houses are mentioned by to be sold in central city and subur- is sold in central city, rural, and sub- law enforcement, epidemiologic, or ban areas. In El Paso, crack sales are urban areas. ethnographic sources in nearly every more likely to occur in the suburbs. city. Parties and schools are the next In Birmingham, Memphis, and— Both outdoor and indoor sales occur most common settings, followed by outside of the South—New York, across sites, with a few exceptions. parks, private housing, and clubs. crack is sold in a wide range of areas, According to law enforcement College campuses and raves are also including central city, suburban, and sources, outdoor sales are more com- mentioned in at least half the sites, rural areas. The locations for crack mon in Chicago and Philadelphia while sales in shopping malls, outside sales remain the same since the last while indoor sales predominate in supermarkets, and over the Internet Pulse Check reporting period, except Baltimore. According to epidemiolog- are mentioned in some cities. Overall, for Denver, where crack sales have ic and ethnographic sources, indoor several cities have a particularly wide expanded to suburban areas, accord- sources are more common in Detroit range of crack sales settings. ing to the law enforcement source.

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CRACK: THE USERS Then and Now:

How old are crack cocaine How have crack cocaine users changed across the country (fall 2000 vs users? (Exhibit 8) Epidemiologic spring 2001)? and ethnographic sources vary in According to epidemiologic and ethnographic sources... their views of which age groups are most likely to use crack. Three (in Crack use has remained relatively stable since the last Pulse Check reporting period. Only Boston, Birmingham, and Detroit) a few changes are reported among young adults, among Hispanics, among women, and in consider both young adults (18–30 where crack users reside: years) and older adults (older than ➤ 30 years) equally likely to use the Among young adults: Birmingham, AL: Crack use has declined among young drug, although in Birmingham, crack adults (18–30 years), who are now as likely to use the use among young adults has declined. drug as older adults (>30 years). Young adults are considered the pri- ➤ Washington, DC: Crack use has increased among mary user group in nine Pulse Check younger adults, but older adults remain most likely to cities: Philadelphia in the Northeast; use the drug. Baltimore, El Paso, and New Orleans in the South; St. Louis and Sioux Among Hispanics: ➤ Columbia, SC: A small increase in the number of Falls in the Midwest; and Billings, Hispanics using crack reflects a similar increase in the Honolulu, and Seattle in the West. overall population. The numbers, however, remain small. Older adults are named in eight ➤ Philadelphia, PA: Hispanics, who are overrepresented cities: Portland, ME, in the among crack users, have increased in proportion since Northeast; Columbia, Memphis, the last Pulse Check report. Miami, and Washington, DC, in the South; Chicago in the Midwest; and Among women: ➤ Columbia, SC: The percentage of females among crack Denver and Los Angeles in the West. users has been fluctuating during the past 12 months In Washington, DC, however, while (between 38 and 56 percent), with no particular pattern. older adults remain the primary user ➤ St. Louis, MO: While crack users are still predominantly group, use among younger adults is males (approximately 60 percent), the number of female increasing. These findings differ from users has been increasing over the past 5 or 6 years. those in the last Pulse Check issue, when epidemiologic and ethnograph- Where crack users reside: ➤ St. Louis, MO: With the mass exodus from the city into ic sources named older adults as the the surrounding counties over the past few years, the group likeliest to use crack in all but crack problem is becoming more concentrated among four cities (Birmingham, Honolulu, people of lower SES, who remain in the city. Los Angeles, and Sioux Falls). ➤ Washington, DC: Crack users continue to reside primarily in the central city, but increases are noted All reporting Pulse Check treatment among suburban dwellers. sources note that the age of crack users in treatment has remained sta- According to treatment sources... ble. The non-methadone treatment ➤ providers are more likely to report Crack user demographic Novice use: Recent initiation of crack use by any younger adults (18–30 years) than characteristics and use drug treatment client has increased in only four non- older adults (>30 years) as the patterns have remained methadone programs (in Billings, Memphis, Portland, stable since the last Pulse and Sioux Falls) and one methadone program (in predominant crack users. Both age Check reporting period, Columbia, SC). groups are considered equally likely with only a few ➤ to use crack in three cities: Birming- exceptions: Female use: The Washington, DC, non-methadone ham, Memphis, and Philadelphia. provider notes an increase in females smoking crack. The younger adult group is named in page 36 Pulse Check: November 2001 CRACK COCAINE

Exhibit 8. Check cities: Chicago and Sioux Falls What age group is most likely to use crack? in the Midwest; Boston and Philadelphia in the Northeast; Adolescents (<18) Young Adults (18–30) Adults (>30) Baltimore, Columbia, Miami, and E,N,M E,M Boston, MA Boston, MA Washington, DC, in the South; and Philadelphia, PAE,N,M Philadelphia, PAN Seattle in the West. The remaining 11 N E Northeast Portland, ME Portland, ME epidemiologic and ethnographic Columbia, SC N Baltimore, MDE Baltimore, MDN sources report males as the predomi- Birmingham, ALE,N Birmingham, ALE,N,M nant crack users in their respective Columbia, SC M Columbia, SCE cities. In St. Louis, while crack users El Paso, TXE,N Memphis, TNE,N are still predominantly males

N E (approximately 60 percent), the num- South Memphis, TN Miami, FL ber of female users has been increas- Miami, FLN Washington, DCE,M ing over the past 5 or 6 years. New Orleans, LAE,N,M Washington, DCN

N N E,M Sioux Falls, SD Chicago, IL Chicago, IL What drugs do female users tend Detroit, MIE,N Detroit, MIE,M to take? St. Louis, MOE St. Louis, MON Midwest The Boston ethnographic source com- E N Sioux Falls, SD Sioux Falls, SD ments that “females are more likely to Los Angeles, CAN Billings, MTE Denver, COE,N use crack than IV drugs such as heroin Honolulu, HIE,N Honolulu, HIM and powder cocaine.” Indeed, as

N E,M West Los Angeles, CA Los Angeles, CA Exhibit 9 shows, epidemiologic and ethnographic sources tend to consider Seattle, WAE,N Seattle, WAME females as equally or more likely than E Epidemiologic/ethnographic respondents N Non-methadone treatment respondents males to use crack, more so than any M Methadone treatment respondents other illicit drug except ecstasy.

11 cities: Boston and Portland in the to be in the older adult (>30 years) Northeast; El Paso, Miami, New category. This finding, similar to find- Non-methadone treatment sources, Orleans, and Washington, DC, in the ings about heroin-using clients, is not like epidemiologic and ethnographic South; Chicago and Detroit in the surprising because methadone mainte- sources, report an even gender split Midwest; and Honolulu, Los Angeles, nance tends to involve people who among crack-using clients in several and Seattle in the West. Older adults, have been treated over a long period Pulse Check cities: Philadelphia in the exclusively, are named in only two of time. The only exceptions are in Northeast; Washington, DC, in the cities: Baltimore and Denver. Most Boston, Philadelphia, Columbia (SC), South; Sioux Falls and St. Louis in disturbingly, adolescents (younger and New Orleans programs, where the Midwest; and Billings, Honolulu, than 18) are the largest crack-using the younger adults outnumber the Los Angeles, and Seattle in the West. group in the Columbia, SC, non- older adults among crack users in Males are the predominant crack methadone program, and they share methadone maintenance. users among clients in the remaining the dubious number-one spot with non-methadone treatment programs. young adults in Los Angeles, and with Are there any gender differences The only reported change is in older adults in Sioux Falls. in who uses crack? (Exhibit 9) Washington, DC, where more females According to the New York ethno- are smoking crack than ever before. By contrast, crack-using clients in the graphic source, females are the pre- methadone programs appear older dominant crack users in that city. Only four methadone treatment than those in the non-methadone Moreover, females and males are providers report males as predomi- programs: nearly all responding Pulse evenly split among crack users nant among crack users in their Check sources in this category report according to epidemiologic and programs: in Birmingham, Boston, that any clients who use crack tend ethnographic sources in nine Pulse

Pulse Check: November 2001 page 37 CRACK COCAINE

Exhibit 9. Which genders are the predominant users of specific drugs Whites, and Hispanics are about in the 21 Pulse Check cities? equally represented at three non- methadone programs: in El Paso, Los 100 Percent of respondents Angeles, and Philadelphia. No Male racial/ethnic shifts are reported by 80 any treatment sources since the last Female Pulse Check reporting period. 60 Split What is the most common evenly 40 socioeconomic background of crack users? Crack-using popula- 20 tions are predominantly in lower SES 0 categories in all but 4 of the 21 cities, Heroin Powder Marijuana Metham- Crack Ecstasy according to epidemiologic and (N=21) Cocaine (N=20) phetamine (N=21) (N=16) (N=20) (N=15) Exhibit 10. Source: Epidemiologic and ethnographic respondents What racial/ethnic group is most likely to use crack? New Orleans, and Seattle. Both males three of those cities. Only two and females are equally likely to use race/ethnicity changes are reported: City Crack crack in another five methadone pro- in Philadelphia, Hispanics, who are E N M Boston, MA Black White White grams (in Boston, Columbia, Detroit, overrepresented among crack users, New York, NY NR NR NR Los Angeles, and Washington, DC). have increased in proportion since Philadelphia, PA Black All Black Females comprise the majority of the last report; and in Columbia, SC, Northeast Portland, ME White White NR crack-using clients in the Chicago and a small increase in the number of Baltimore, MD Black Black Black Honolulu methadone programs. Eight Hispanics using crack (which remains Birmingham, AL Black/ Black Black methadone sources, however, did not small) reflects a similar increase in the White supply breakdowns of their client overall population. Columbia, SC Black White Black/ population by gender. White

South El Paso, TX Black All NR Is any racial/ethnic group more White crack users in Boston? Memphis, TN White Black NR Miami, FL Black Black NR likely to use crack? (Exhibit 10) “The majority of crack users are New Orleans, LA Black Black White According to epidemiologic and Black,” states Boston’s ethnographic Washington, DC Black Black Black ethnographic sources, Blacks account source. “White crack users tend to be Chicago, IL Black Black Black for the largest proportion of crack heroin addicts who are losing injectable Detroit, MI White Black Black users in 11 of the 21 Pulse Check surface veins.” St. Louis, MO Black Black NR cities, where they are overrepresented Midwest Sioux Falls, SD White Black N/A relative to the general population. In Billings, MT White White/ N/A Birmingham, Blacks and Whites are According to Pulse Check treatment Ameri- equally likely to use crack, reflecting sources, Blacks are the predominant can their distributions in the general pop- crack users among clients in 11 non- Indian

ulation. El Paso has two distinct methadone programs but only 5 West Denver, CO White Black Black racial/ethnic groups of crack users: methadone programs. Whites account Honolulu, HI White NR White Blacks are the predominant sole crack for the largest proportions of crack Los Angeles, CA Black All White users; but Hispanics are the most users at four non-methadone pro- Seattle, WA Black White White likely to use both crack and heroin. grams and six methadone programs. Sources: Epidemiologic/ethnographic (E), Whites are more likely than other Blacks and Whites are split approxi- non-methadone treatment (N), and methadone treatment (M) respondents racial/ethnic groups to use crack in mately evenly as the foremost crack Note: Shaded boxes indicate that a given drug- seven cities and are overrepresented users in the Columbia, SC, using population is overrepresented relative to that city’s general population. Not all sources, relative to the general population in methadone program, while Blacks, however, had this information available. page 38 Pulse Check: November 2001 CRACK COCAINE

ethnographic sources. In Honolulu Seattle is the third exception, with How do users take crack? and Sioux Falls, crack users are pri- crack users equally likely to reside in Smoking, by far, remains the predom- marily middle SES; in Birmingham, both central city and suburban loca- inant route of crack administration in they are both lower and middle SES; tions. Additionally, smaller popula- every Pulse Check city, according to and in Detroit, users cross all SES tions of crack users reside in the sub- all epidemiologic and ethnographic categories. Treatment sources concur urban and rural areas surrounding sources and nearly all treatment that crack users are generally found Honolulu and St. Louis, as reported sources. The only exceptions are in in the lower SES groups. The only by those cities’ methadone and three non-methadone treatment exceptions are in Boston, Columbia non-methadone treatment sources, programs: in Boston, injecting equals (SC), Honolulu, Los Angeles, New respectively. smoking; in Memphis, snorting pre- Orleans, and Sioux Falls, where either dominates; and in Sioux Falls, both the middle SES or both lower and How do crack cocaine users wind snorting and smoking are common. middle SES groups are cited by treat- up in treatment? Occasional crack injection is also ment providers. mentioned by epidemiologic and As reported in the last Pulse Check issue, ethnographic sources in Baltimore courts and the criminal justice system (where solid crack is sometimes remain the most common referral Crack in St. Louis: Increasingly a sources for clients entering treatment for cooked and injected), New Orleans lower SES problem... crack addiction, according to the (where crack is injected with heroin responding treatment sources. Individual in speedballs), and Washington, DC As the St. Louis epidemiologic source referrals, again, follow closely as the (where it is injected with heroin and notes, “With the mass exodus from the second most common referral source. marijuana). city into the surrounding counties over the past few years, St. Louis’ crack problem is becoming more concentrat- Then and Now: ed among people of lower SES, who remain in the city.” How have crack cocaine use patterns changed across the country (fall 2000 vs spring 2001)?

According to epidemiologic and ethnographic sources... Where do crack users tend to reside? Crack users reside primarily Increased crack injection: ➤ Baltimore, MD: Solid crack is sometimes cooked and in central city areas, as reported by injected, according to recent reports. nearly all (18 of the 21) epidemiologic ➤ and ethnographic sources. In El Paso Washington, DC: Crack is being injected with heroin and Sioux Falls, however, crack users and marijuana. are more likely to reside in the sub- More drugs: ➤ Philadelphia, PA: Crack users are taking a wider range urbs, while in Detroit users reside of other drugs than before, including heroin, marijuana, throughout the area. While Birming- ecstasy, and diverted prescription drugs such as alprazo- ham’s crack users reside primarily in lam (Xanax®), diazepam, amitriptyline (Elavil®), and, the central city, the epidemiologic most recently, oxycodone (OxyContin®). source notes that many users reside ➤ throughout small rural towns all Decline in crack houses: Denver, CO: Crack houses have become less prominent, over Alabama. but this change is long term, rather than recent. ➤ St. Louis, MO: Crack houses have become less promi- Similarly, all but three treatment nent, possibly because cell phones and beepers are sources report that the majority of increasingly used and because users know which blocks crack users reside in central city to drive down in order to make their “connections.” areas. Two exceptions are in Sioux Falls, where crack users in the two Increased public use: ➤ Seattle, WA: Public smoking of crack has increased since non-methadone Pulse Check sites are the last report. Users are now equally likely to smoke more likely to live in rural areas. the drug either in public or in private.

Pulse Check: November 2001 page 39 CRACK COCAINE

How frequently do users take The marijuana-crack combination Nearly all the remaining epidemiologic crack? The majority of non- (in a blunt) in Philadelphia is known and ethnographic sources report that methadone treatment sources (15 of as a “diablito” or a “turbo.” That sales and use occur both indoors and 21) report that crack users in their city’s epidemiologic source also lists outdoors and in both private and program tend to take the drug daily. a variety of diverted prescription public locations. But sources in six Less frequent usage is reported in six drugs abused by crack users, cities (Baltimore, Los Angeles, programs, three of which are in mid- including alprazolam and diazepam Memphis, Miami, New York, and western Pulse Check cities: Chicago (benzodiazepines); amitriptyline (an Portland) report that crack users tend (four to seven times a week), antidepressant); and oxycodone (the to use their drug while alone, rather Columbia (SC) (once to twice a opiate in Percodan®, Percocet®, and than in a group. The Baltimore month), Los Angeles (twice a month), OxyContin®). The New York ethno- ethnographic source explains that Portland (ME) (three to four times a graphic source similarly mentions the “crack users tend to smoke their drug week), St. Louis (three to four times a crack-diazepam combination, stating alone, not in groups, because of the week), and Sioux Falls (once to twice that “A woman in the Bronx told a short duration of the high.” Baltimore a month). In methadone programs, by researcher that when she cooked up is also the only city where outdoor comparison, usage frequency appears her crack she would put ‘a valium’ use is slightly more common than lower: only seven Pulse Check sources in it. She said when she smoked this indoor use, but the ethnographic report daily crack usage by clients in crack combination it felt like she was source notes a particularly wide range their programs, while another seven using heroin.” New York users also of use settings, including “abando- report less than daily use. In Philadel- combine crack with PCP, a practice miniums” (abandoned row houses) phia, for example, some clients use known as “space basing.” Further and fast-food restaurant bathrooms. crack daily, but binge use is more south, alprazolam and diazepam are Similarly, the El Paso epidemiologic typical. also commonly taken by crack users source lists a particularly wide range in Memphis, according to the epi- of use settings. El Paso is also the What other drugs do crack users demiologic source. In the West, three only city where use in public places is take? Aside from alcohol, the sub- treatment sources—in Billings, more common than use in private stances most commonly consumed Honolulu, and Los Angeles—report locations. with crack—either sequentially or in that crack users in their programs combination—are marijuana and also abuse diverted benzodiazepines, Overall, a wide variety of specific heroin. Marijuana is mentioned by such as diazepam and clonazepam. settings are reported, with private res- epidemiologic, ethnographic, and The Los Angeles methadone idences most commonly mentioned, treatment sources across the country: treatment source adds that some followed by crack houses and public Philadelphia in the Northeast; crack-using clients also abuse the housing developments. Crack houses, Baltimore, Birmingham, Columbia, diverted prescription muscle however, are becoming less prominent Miami, New Orleans, and relaxant carisoprodol (Soma®). in some areas, such as Denver and St. Washington, DC, in the South; Louis. Other venues mentioned, in Detroit and St. Louis in the Midwest; Where and with whom is crack descending order of frequency, and Denver, Honolulu, and Seattle in used? (Exhibit 7) Unlike crack sales, include parties, cars, nightclubs, the West. Heroin is also mentioned which occur both indoors and out- schools, and college campuses. The by the same source categories in all doors, crack use is more likely to take Honolulu epidemiologic source adds four regions: Boston, New York, place indoors than outdoors (accord- two other unusual crack use settings: Philadelphia, and Portland in the ing to 12 out of 20 responding epi- adult video galleries, and hotel rooms. Northeast; El Paso, Memphis, New demiologic and ethnographic Orleans, and Washington, DC, in the sources). Users also prefer to smoke Treatment sources concur that crack South; only Chicago in the Midwest; crack in private, rather than public is usually used indoors, in private, and Denver, Honolulu, and Los (13 out of 20 sources) and in small and in small groups or among friends. Angeles in the West. groups or among friends, rather than Outdoor use is more common than while alone (11 out of 20 sources). indoor use in only two programs (the Boston and Columbia [SC] page 40 Pulse Check: November 2001 CRACK COCAINE

Indoor versus outdoor crack use in Crack houses on the decline... Small-group versus private use... Boston... The St. Louis epidemiologic source notes The Baltimore ethnographic source Outdoor use in Boston, while slightly less a decline in crack houses, possibly explains that “crack users tend to smoke common than indoor use, is still wide- because cell phones and beepers are their drug alone, not in groups, because spread. As that city’s ethnographic source increasingly used and because users know of the short duration of the high.” A points out, “crack is used outdoors more which blocks to drive down in order to Honolulu treatment source points out, than other drugs because it’s easier to make their “connections.” The Denver however, that group use is more economi- ‘do’ without being seen.” By contrast, a epidemiologic source also reports a long- cal: friends can share costs and, when Boston treatment source states that “crack term decline in crack houses. availability is low, they can share the drug. can’t be used in public because of its dis- tinct odor.” non-methadone programs), public six programs (at the methadone ment source in Honolulu points out use is more common than private use programs Chicago, Detroit, New that people tend to use crack in small in only one (the Columbia non- Orleans, and Washington, DC, and at groups and among friends in order to methadone program), and solo use is the non-methadone programs in the share costs and, when availability is more common than social use in only Miami and Washington, DC). A treat- low, to share the drug.

Pulse Check: November 2001 page 41 This page intentionally left blank.

page 42 Pulse Check: November 2001 POWDER COCAINE

POWDER COCAINE: Exhibit 1. THE PERCEPTION How available is powder cocaine across the 21 Pulse Check cities? How do Pulse Check sources perceive the powder cocaine According to law enforcement sources (N=21)... problem in their communities? Boston is the only community in which a Pulse Check source (the law enforcement source) names powder cocaine as the most widely abused drug. In Denver, one source (from non-methadone treatment) considers both crack and powder cocaine as that city’s most widely abused drugs, and the other three Pulse Check sources consider powder cocaine as the second most widely abused drug (following marijuana). It is also Widely Available Somewhat Available Not Very Available considered the second most widely abused drug by sources in El Paso, According to epidemiologists and ethnographers (N=21)...* New Orleans, and New York.

Also in Denver, two sources (law enforcement and epidemiologic) name powder cocaine as the drug with the most serious consequences, whether medically, legally, societally, or other- wise. In Memphis, too, one source (non-methadone treatment) puts powder cocaine into that category.

Has the perception of the powder cocaine problem changed between fall 2000 and *The epidemiologic source in Columbia did not provide this information. spring 2001? Two sources who named powder cocaine as their the non-methadone source perceives according to nearly two-thirds (27 of communities’ most widely abused drug that powder cocaine has replaced 41) of law enforcement, epidemiolog- during the last Pulse Check reporting crack in causing the most serious ic, and ethnographic sources who period perceive a change: the consequences. No sources in any other discussed this question. Ten sources in Memphis non-methadone treatment Pulse Check cities believe powder eight cities describe it as “somewhat source believes that crack has replaced cocaine to be associated with any available”: Boston and Philadelphia powder cocaine, and the Portland new or emerging problems. in the Northeast; Baltimore and (ME) law enforcement source believes Washington, DC, in the South; St. POWDER COCAINE: THE DRUG that heroin and diverted pharmaceuti- Louis and Sioux Falls in the Midwest; cal opiates have replaced it. The How available is powder cocaine and Honolulu and Seattle in the West. Portland law enforcement source also across the country? (Exhibit 1) Only four sources consider the drug believes that diverted pharmaceutical Powder cocaine is considered widely not very available: two in the West opiates have replaced powder cocaine available in 18 of the 21 Pulse Check (Billings and Los Angeles), and two in as the drug with the most serious con- cities (the 3 exceptions are St. Louis, the Midwest (Chicago and St. Louis). sequences. By contrast, in Memphis, Sioux Falls, and Washington, DC),

Pulse Check: November 2001 page 43 POWDER COCAINE

Has powder cocaine availability Birmingham; in the Midwest, Exhibit 3. changed? (Exhibit 2) Powder availability increased in Chicago and How much do grams and “eight- cocaine availability remained stable Detroit and remained stable in Sioux balls” of powder cocaine cost in between fall 2000 and Falls and St. Louis; 17 Pulse Check cities?* spring 2001, accord- Exhibit 2. and in the West, GRAM ing to the majority How has powder cocaine availability increased City Price Purity (18 of 20) of Pulse availability changed (fall in Denver and Seattle Boston, MA $60 50–60% 2000 vs spring 2001)?* Check law enforce- and remained stable in New York, NY $28–$30 75% ment sources who dis- Billings and Los Philadelphia, cussed this question. Angeles.

Northeast PA $100–$125 60–80% Only two of those E Portland, ME $80–$100 30–70% sources perceive an Birmingham, AL What are powder Chicago, ILE Birmingham, AL $100 NR increase (in Colum- cocaine prices and Columbia, SCL Columbia, SC $100 NR bia, SC, and in purity levels across Denver, COE Memphis, TN $100 40–50% Portland, ME), and E the country? Detroit, MI Miami, FL $40–$60 80–90% (Exhibit 3) Grams South no declines are Portland, MEL New Orleans, $25–$150 NR reported. Trends are Seattle, WAE and “eightballs” more mixed, how- (1/8 ounce) are LA L,E E ever, according to Baltimore, MD Memphis, TN the sales units Washington, DC $100 20–60% L,E L the 20 epidemio- Billings, MT Miami, FL most common- Chicago, IL $125 NR Birmingham, ALL New Orleans, LAL,E logic and ethno- ly reported by Detroit, MI $70–$125 60–90% Boston, MAL New York, NYL,E graphic sources law enforce- Midwest Sioux Falls, SD $80–$100 NR Chicago, ILL Philadelphia, PAL,E ment, epi- who discussed Denver, COL Portland, MEE Denver, CO $100 20–50% demiologic, this question: Detroit, MIL Seattle, WAL Honolulu, HI $100–$120 NR L L,E and ethno- powder cocaine El Paso, TX Sioux Falls, SD West Los Angeles, CA $80 80–85% L L,E graphic availability Honolulu, HI St. Louis, MO Seattle, WA $80–$100 57–58% increased in 5 sites, Los Angeles, CAL,E Washington, DCL sources. Grams declined in 5, and E range in price Boston, MA “EIGHTBALLS” (1/8 OUNCE) remained stable in E from a low of $28 El Paso, TX City Price Purity 10. Regionally, trends E in New York to a Honolulu, HI Boston, MA $200–$250 60% are mixed: in the Miami, FLE high of $150 in New Portland, ME $250 50% Northeast, stable Washington, DCE Orleans, with $100 trends are reported in the most frequently Northeast Columbia, SC $250–$300 NR New York, reported price. L Law enforcement respondents Eightballs sell for as South Memphis, TN $350–$400 40–50% Philadelphia, and E Epidemiologic/ethnographic low as $80 in Seattle Sioux Falls, SD $275 NR Portland, while a respondents decline is reported in *The Boston and Columbia and as high as $400 in Midwest epidemiologic/ethnographic Memphis. Gram-level Boston; in the South, sources and the Memphis law Seattle, WA $80–$100 NR supply declined in El enforcement source did not purity ranges from a West Paso, Miami, and respond. low of 20 percent in Sources: Law enforcement, epidemiologic, and Washington, DC, Denver and Washing- ethnographic respondents remained stable in Memphis and New ton, DC, to a high of 90 percent in *Respondents in Baltimore, Billings, El Paso, and St. Louis did not provide this information. Orleans, and increased in Detroit and Miami.

How much powder cocaine can $10 buy? In several cities, law enforcement, epidemiologic, and ethnographic sources report units of sale, often called “dime bags,” that sell for $10 apiece:

“A little cellophane bag” in Baltimore 0.1 gram in Detroit 0.25 gram in Seattle 0.1–0.2 grams in Denver 0.5 gram in New Orleans 150–150 milligrams in Washington, DC page 44 Pulse Check: November 2001 POWDER COCAINE

ment source reports that powder several other cities as well: New York Then and Now: Powder cocaine cocaine might be mixed with other in the Northeast; Baltimore, El Paso, prices and purity, fall 2000 vs spring 2001 drugs, such as heroin. and Memphis (where folded pieces of paper are called “pony packs”) in the Powder cocaine prices and purity levels How is powder cocaine referred South; Chicago, Detroit, and St. remained relatively stable since the last to across the country? (Exhibit 4) Louis in the Midwest; and Honolulu, Pulse Check reporting period, according As in the case of crack, users in the Los Angeles (as mentioned above), to law enforcement sources, with only South refer to powder cocaine with a and Seattle in the West. Other two exceptions: the Los Angeles source wider variety of slang names than methods of packaging include tin or notes an increase in the gram price users in the other three regions. (from $70 to $80) attributable to mar- aluminum foil (in Detroit, New York, Crack and powder cocaine names are ket fluctuation, while the El Paso and Washington, DC), compressed not interchangeable in most cities. source notes a drop in the price of a bricks (in Billings and New York), “hit” (weight unknown), from $10 to balloons (in Denver and El Paso), How is powder cocaine packaged $3. The El Paso epidemiologic source vials (in Baltimore, Philadelphia, and confirms a price drop, noting that pow- and marketed? Powder cocaine is Seattle), and glue tubes (in Denver). der cocaine, like heroin, is now cheaper generally packaged in plastic bags of In Billings, the law enforcement and more abundant on the American some sort—whether cellophane, source reports that plastic bags con- side of the border than on the Mexican glassine, coin, zipper type, heat taining powder cocaine are sometimes side. Again, these changes are apparent- sealed, or even just the torn-off cor- inserted into perfume containers or ly the result of competition for the mar- ner of a sandwich bag (as is the case motor oil cans. ket by the same three different cartels in Columbia, SC)—according to law involved in the heroin trade. Similarly, enforcement, epidemiologic, and “Retro” packaging for powder in the Northeast, the New York ethno- ethnographic sources in all but one cocaine: Back to the Seventies? graphic source notes that high availabil- Pulse Check city. Los Angeles is the ity and purity levels are allowing deal- exception: that city's law enforcement One dealer in New York informed the ers to sell three separate qualities: pure source reports that the drug is sold Pulse Check ethnographic source, “I’m (the most expensive); semi-pure (medi- packaging coke in sexy magazine um priced); and compressed (the least only in “bindles.” Bindles—foldover, paper, like Playboy, like in the expensive). Also, because powder stapled, knotted, or taped packages Seventies.” He also stated that “coke cocaine is so plentiful and cheap in made of plain paper, cellophane, keeps better in the magazine paper New York, some crack users are buying glassine, magazine paper, dollar bills, than in plastic or aluminum.” powder cocaine to snort it, freebase it, or lottery tickets—are reported in or mix their own crack. Exhibit 4. What adulterants are added to How is powder cocaine referred to across different regions of the country? powder cocaine? In addition to baking soda, which is a standard NORTHEAST ingredient added to powder cocaine WEST MIDWEST to make crack, Pulse Check law Coke, blow, product, enforcement, epidemiologic, and Coke, blow, big, Coke, powder, girl, C, toot, white white, snow, shirt snow, flave ethnographic sources cite several girl, nose candy, adulterants, including crystalline product, flake stereoisomeric cyclic alcohols (such as inositol and mannitol) in Columbia Coke, powder, blow, the lady, girl, yay, snow, soft, soda, (SC), El Paso, Honolulu, and Miami. white, blanca, funk, nose candy, sugar boogers, vc, coc, Other adulterants mentioned include white powder, white ghost, white girl, white horse, Coke, geekin, tweekin, wiggin, schizo, fruit, bump, toot, lactose in Boston, “any powder” in flake Miami and Portland (ME), and baby shake, snow white, snag laxatives, vitamin B, and vitamin C in SOUTH Memphis. The Detroit law enforce- Sources: Law enforcement, treatment, epidemiologic, and ethnographic respondents

Pulse Check: November 2001 page 45 POWDER COCAINE

In some cities, dealers add logos, cocaine dealers as affiliated with some Epidemiologic and ethnographic insignias, or pictures to the packag- sort of organized structure. Indepen- sources are even more in agreement ing. Such is the case in three southern dent dealers are mentioned only in that young adults are the predomi- cities: Memphis (logos on baggies Boston, Birmingham, Memphis, and nant sellers of powder cocaine. Only sold in head shops), Miami (brand Denver. In Boston, where both types two report otherwise. In Boston, both name insignia), and New Orleans of operations are reported, those who young and older adults are likely to (pictures of horses, cats, and stars on are organized tend to be Dominican sell the drug. And, in Chicago, dis- bags). Logos in New Orleans report- people who are part of a larger distri- turbingly, the primary sellers are edly change often. In Chicago, kilo bution network. reportedly adolescents. packages sometimes have cartoon characters stamped on the wrappers, How old are street-level powder What other drugs do powder and sometimes the inner and outer cocaine sellers? All but four law cocaine dealers sell? (Exhibit 5) wrappers have different cartoon enforcement sources name young New York is the only Pulse Check site stamps. In Denver, too, wrappers adults (18–30 years) as the predomi- in the Northeast where law enforce- have various logos, such as scorpions nant sellers of powder cocaine. In El ment, epidemiologic, and ethno- and stars. Paso and Portland (ME), young adults graphic sources report polydrug sales and adults older than 30 are equally by powder cocaine dealers—some- POWDER COCAINE: THE SELLERS likely to sell the drug. In Los Angeles, times as many as four additional both young adults and adolescents are drugs (marijuana, crack cocaine, Then and Now: named as the primary sellers. And in heroin, and ecstasy). In the West, by How have powder cocaine sellers Philadelphia, older adults predominate. contrast, polydrug sales are reported and sales changed across the Exhibit 5. country (fall 2000 vs spring 2001)? What other drugs do powder cocaine dealers sell?* Only one notable change is noted since Crack Metham- No Other the previous Pulse Check reporting Marijuana Heroin Cocaine phetamine Ecstasy Drugs Sold period: in New York, powder cocaine City LE E LE E LE E LE E LE E LE E dealers have added ecstasy to the many Boston, MA other drugs they sell. Elsewhere, the New York, NY powder cocaine sales market has Philadelphia, PA

remained generally stable. Northeast Portland, ME Baltimore, MD How are powder cocaine sellers Birmingham, AL organized? In only three cities do Columbia, SC law enforcement sources report that El Paso, TX powder cocaine sales operate pre- South Memphis, TN dominantly within an organized Miami, FL New Orleans, LA structure, such as a gang: Birmingham Washington, DC in the South, and Billings and Seattle Chicago, IL in the West. Both independent and Detroit, MI organized sales structures are report- St. Louis, MO ed in Chicago, El Paso, New Orleans, Midwest Sioux Falls, SD Los Angeles, and Portland, ME (loose Billings, MT networks, not ganglike). In every other Denver, CO Pulse Check city, law enforcement Honolulu, HI West sources report that powder cocaine Los Angeles, CA dealers operate independently. By Seattle, WA contrast, as in the case of heroin and Sources: Law enforcement (LE) and epidemiologic and ethnographic (E) respondents crack, epidemiologic and ethnographic *Epidemiologic and ethnographic sources in Billings, Columbia, El Paso, Honolulu, Los Angeles, sources generally categorize powder Philadelphia, Portland, St. Louis, Seattle, and Washington, DC, did not provide this information. page 46 Pulse Check: November 2001 POWDER COCAINE

in every site. Sources in the South and What type of crimes are powder cities). Domestic violence is Midwest, however, paint a mixed cocaine sellers involved in? All mentioned in El Paso, and drug picture, with dealers in some cities but three Pulse Check law enforce- rape is mentioned in Miami. engaged in multiple drug sales and ment sources believe that cocaine sell- dealers in other cities selling only ers are very likely or somewhat likely Where is powder cocaine sold? powder cocaine. Overall, marijuana is to be involved in crime. The excep- (Exhibit 6) In many Pulse Check reported in 11 cities, followed by tions are in Columbia (SC), St. Louis, cities, street-level powder cocaine crack and heroin (in 7 cities each). and Washington, DC, where dealer sales, like heroin and crack sales, take Methamphetamine is mentioned in involvement in crime is considered place in central city areas, as reported only four cities (three in the West), as not very likely. The majority of the in the last Pulse Check. However, as is ecstasy. Additionally, the Detroit epi- responding sources (14 out of 20) also reported in the last Pulse Check, demiologic source reports that some name nonviolent crime, and half (10) suburban areas are frequently men- powder cocaine dealers also sell LSD. name violent crime (less so than for tioned as well, more so than for hero- The only change in this aspect of the crack). Specifically, gang-related activ- in or crack. Specifically, both subur- sales scene is reported in New York, ity is mentioned in nine cities (Boston ban and central city locations are where ecstasy sales by powder cocaine in the Northeast; Chicago in the named by law enforcement sources in dealers are a new phenomenon. Midwest; Baltimore, Birmingham, seven sites: Miami and New Orleans Memphis, and New Orleans in the in the South; Detroit and Sioux Falls Do powder cocaine sellers use South; and Billings, Los Angeles, and in the Midwest; and Denver, Los their own drug? Law enforcement Seattle in the West), while prostitu- Angeles, and Seattle in the West. sources in Billings, Boston, Sioux tion is mentioned in eight (Boston, Furthermore, areawide sales (span- Falls, and Washington, DC, believe Philadelphia, and Portland in the ning central city, suburban, and rural that powder cocaine sellers are very Northeast; Birmingham, Memphis, areas) are reported in the Northeast likely to use their own drug. In nearly and New Orleans in the South; and (Boston, New York, and Portland) every other Pulse Check city, they Denver and Honolulu in the West). and the South (Birmingham and describe these sellers as “somewhat The nonviolent crimes specified Memphis). In El Paso, the suburbs, likely” to use it. Only in Denver and include burglaries, auto break-ins, exclusively, are named as the likeliest Miami do law enforcement sources and shoplifting in Columbia; money location for powder cocaine sales. believe that powder cocaine dealers laundering in Miami; and aiding ille- are not very likely to use their drug. gal aliens in El Paso. According to epidemiologic and ethnographic sources who discussed Epidemiologic and ethnographic Epidemiologic and ethnographic this question, central city areas are sources in four cities, all in the South sources in the South express varied the predominant sales locations in (Baltimore, Birmingham, El Paso, and opinions on whether powder cocaine Baltimore, Memphis, New Orleans, Memphis), believe that powder sellers are involved in crime. Those in New York, and Washington, DC. cocaine sellers are very likely to use Baltimore, El Paso, and Miami believe Suburban areas are named in Detroit, their own drug. Independent dealers that very likely to be the case, while Miami, and Sioux Falls. Both types of in Boston are also very likely to use those in Memphis and New Orleans areas are named in Boston, Chicago, their own powder cocaine, but deal- consider it somewhat likely, and those Birmingham, and El Paso. In Denver, ers affiliated with an organization in in Birmingham and Washington, DC, sales occur in all three types of city that city are not likely to do so at all. consider it not very likely. The most locations (including rural areas). The Detroit source considers sellers commonly named activities are vio- somewhat likely to use their own lent crime and gang-related crimes (in Powder cocaine is sold both indoors drug. The remaining sources who dis- Detroit and in four southern cities), and outdoors, according to the major- cussed this topic believe that this nonviolent crime (in Honolulu and ity (14 of 21) of law enforcement practice is not very likely. four southern cities), and prostitution sources. However, indoor sales loca- (in Boston and in three southern tions are more frequent in Chicago, Detroit, Portland (ME), and Seattle,

Pulse Check: November 2001 page 47 POWDER COCAINE

Exhibit 6. Where is street-level powder cocaine sold and used?*

Private Public Shop- # Resi- Hous- Crack ping Inside Super- of City Street dences Clubs ing College Houses Schools Parties Malls Cars Parks Raves markets Settings Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Boston, MA 12 1 New York, NY 13 10 Philadelphia, PA 53

Northeast Portland, ME 34 Baltimore, MD 11 11 Birmingham, AL 12 4 Columbia, SC 30 El Paso, TX 13 13

South Memphis, TN 12 7 Miami, FL 11 7 New Orleans, LA 11 3 Washington, DC 94 Chicago, IL 88 Detroit, MI 56 St. Louis, MO 85 Midwest Sioux Falls, SD 52 Billings, MT 11 2 Denver, CO 10 7 Honolulu, HI 10 3 West Los Angeles, CA 33 Seattle, WA 57 Sources: Law enforcement, epidemiologic, and ethnographic respondents *The epidemiologic/ethnographic sources in Billings, Boston, Columbia, Los Angeles, Seattle, and Sioux Falls did not provide seller setting information. *The epidemiologic/ethnographic source in Columbia did not provide user setting information. The Boston source for user setting gave an overall response: “most private setting available.” while outdoor locations are more fre- settings, followed by college campus- as well as in Boston, Chicago, quent in Miami, Philadelphia, and es, schools, and raves. No rave sales Denver, and Seattle. In Detroit, both Sioux Falls. Epidemiologic and ethno- are reported in the Midwest. Crack younger and older adults are equally graphic sources similarly report both houses are mentioned in only 10 likely to use the drug. types of locations in Chicago, cities, predominantly in the Northeast Baltimore, Denver, El Paso, Memphis, and the South. Supermarket areas are Findings are even more dramatic in and New Orleans. Indoor locations, also mentioned in 10 cities, but none non-methadone treatment programs: however, are more frequent in are in the Midwest. young adults are the age group likeli- Birmingham, Detroit, Miami, New est to use powder cocaine in nearly York, and Sioux Falls, while outdoor POWDER COCAINE: THE USERS every Pulse Check city. There are only locations are more frequent in How old are powder cocaine five exceptions. Young adults and Washington, DC. users? Young adults (18–30 years) older adults alike are the predomi- are the predominant powder cocaine nant users in Philadelphia. Older The specific settings for powder users in 10 of 20 Pulse Check cities, adults are more predominant in cocaine sales are as varied as those for according to responding epidemiolog- Denver. Young adults and adolescents heroin and crack. Private residences, ic and ethnographic sources. People are equally predominant in Los public housing, and clubs are named as older than 30 are more likely to use Angeles. And adolescents are actually sales sites by law enforcement, epi- the drug in nine cities, mainly in the the most likely to use powder cocaine demiologic, and ethnographic sources South (Baltimore, Memphis, Miami, in Columbia (SC) and one of the in nearly every Pulse Check city. Cars New Orleans, and Washington, DC) Sioux Falls programs. and parties are the next most common page 48 Pulse Check: November 2001 POWDER COCAINE

Then and Now:

How have powder cocaine users changed across the country (fall 2000 vs spring 2001)?

According to epidemiologic and ethnographic sources....

In five Pulse Check cities, more ➤ Birmingham, AL: Young adults are the most likely to use powder cocaine, but the drug is younger people—sometimes becoming trendier among adolescents, who are moving away from crack. adolescents—are reportedly using powder cocaine: ➤ Detroit, MI: Young adults (18–30 years) have been increasingly using powder cocaine, so that they now equal older adults (>30 years) as the groups most likely to use the drug.

➤ Los Angeles, CA: Young adults are the most likely to use powder cocaine, reflecting a slight resurgence in use among “business person types.”

➤ Sioux Falls, SD: Young adults are the most likely to use powder cocaine, but an increase is reported among adolescents, particularly females.

➤ Washington, DC: While older adults (>30 years) remain most likely to use powder cocaine, the younger adult (18–30 years) group is increasing.

A few reported shifts reflect a spread ➤ Portland, ME: Anecdotal data suggest that powder cocaine use might be spreading from the to the suburbs and to different racial/ central city into the suburbs. ethnic and socioeconomic groups: ➤ Washington, DC: While Blacks remain the racial/ethnic group most likely to use powder cocaine, Whites have been increasingly using the drug. Likewise, powder cocaine users are predominantly lower SES central city residents, but use is reportedly increasing among mid- dle SES suburbanites.

Shifting use patterns are reported in ➤ Columbia, SC: A slight shift to injection is noted, but snorting still predominates. four cities: ➤ Los Angeles, CA: Some resurgence of injection (with no other drugs) is reported, but snort- ing still predominates. Also, a new combination is reported: powder cocaine plus ecstasy.

➤ Portland, ME: Smoking is increasing, but snorting still predominates.

➤ Washington, DC: While powder cocaine is usually injected (in speedballs), snorting has been increasing, particularly in nightclubs, bars, and private parties. Such locations are emerging settings for powder cocaine use. However, the predominant settings remain crack houses, private residences, public housing developments, and cars.

According to treatment sources… ➤ Chicago, IL (methadone)

The number of novice users of ➤ Columbia, SC (methadone and non-methadone) powder cocaine (any drug treatment client who has recently begun using ➤ El Paso, TX (methadone and non-methadone) the drug) has increased among clients in several programs in ➤ Memphis, TN (non-methadone) five cities: ➤ New York, NY (non-methadone)

Conversely, novice use has declined ➤ Denver, CO among clients in non-methadone programs in two cities: ➤ Portland, ME

Pulse Check: November 2001 page 49 POWDER COCAINE

Methadone treatment clients who use Is any racial/ethnic group more powder cocaine users: Blacks are powder cocaine tend to be older than likely to use powder cocaine? named in four cities, Whites in three, their counterparts in non-methadone (Exhibit 7) Powder cocaine users, and Hispanics in one (Miami). The treatment. People older than 30 are compared with crack users, are more other three regions seem to have pre- named as the predominant user group likely to be White, as reported by dominantly White users in every city in seven cities (Boston, Chicago, both epidemiologic and ethnographic except Chicago, where Blacks are the Detroit, Los Angeles, and Washing- sources and non-methadone treat- predominant group. Non-methadone ton, DC), while younger adults are ment sources; conversely, they are less treatment sources give slightly differ- named in five (Boston, Columbia, likely to be Black than crack users. As ent regional breakdowns: Black users Denver, El Paso, and New Orleans). reported in the last Pulse Check, their seem to be more concentrated in the racial/ethnic breakdowns are more Midwest than in the other regions, Are there any gender differences similar to those of heroin users than while Whites generally tend to be the in who uses powder cocaine? to those of crack users. predominant user group elsewhere. Epidemiologic and ethnographic Hispanics, however, are considered sources generally agree that males are Regionally, according to epidemiologic the likeliest racial/ethnic group to use more likely than females to use pow- and ethnographic sources, the South is powder cocaine in El Paso and der cocaine. In this respect, powder the only region with a mix of racial/ Miami, and they are about equal to cocaine users resemble heroin users ethnic groups as the predominant Whites and Blacks in Philadelphia (who are more likely to be males) and Los Angeles. rather than crack users (who are equally likely to be males and females Exhibit 7. in many cities). In three Pulse Check What racial/ethnic group is most likely to use specific drugs?* cities, however, males and females are City Heroin Crack Powder Cocaine equally likely to use the drug: New ENE NEN York, Portland (ME), and Sioux Falls. Boston, MA White White Black White White White Furthermore, the gender of powder New York, NY White White NR NR NR NR cocaine users is sometimes related to Philadelphia, PA White Black/ Black All White All their age. In Detroit, for example, Northeast Hispanic Portland, ME White White White White White White older (>30 years) powder cocaine Baltimore, MD Black Black Black Black Black White users are predominantly males, but Birmingham, AL Black/White Black Black/White Black Black/White White the younger adult (18–30 years) user Columbia, SC Black/White NR Black White Black White group is evenly split between the El Paso, TX Hispanic Hispanic Black All White Hispanic

genders. South Memphis, TN White NR White Black Black Black Miami, FL White Hispanic Black Black Hispanic Hispanic Treatment sources, by contrast, paint New Orleans, LA Black Black Black Black White NR a picture that includes more females. Washington, DC Black Black Black Black Black Black Women and men are equally likely to Chicago, IL Black Black Black Black Black Black use powder cocaine in nine non- Detroit, MI White Black White Black White Black methadone programs (in Chicago, St. Louis, MO Black Black Black Black White Black/White Midwest Los Angeles, Seattle, Philadelphia, Sioux Falls, SD White NR White Black White Black/White Washington, DC, and both programs Billings, MT White White White White/ White White in Billings and Sioux Falls) and six American Indian methadone programs (in Boston, Denver, CO White White White Black White Black Columbia [SC], Chicago, Detroit,

West Honolulu, HI White White White NR White White Denver, and Seattle). Moreover, in Los Angeles, CA Hispanic Hispanic Black All White All the Los Angeles methadone program, Seattle, WA White NR Black White/ White White female powder cocaine users out- Hispanic number males. Sources: Epidemiologic/ethnographic (E) and non-methadone treatment (N) respondents *Shaded boxes indicate that a given drug-using population is overrepresented relative to that city’s general population. Not all sources, however, had this information available. page 50 Pulse Check: November 2001 POWDER COCAINE

What is the most common reside predominantly in the central in the suburbs, particularly in the socioeconomic background of city, but anecdotal data suggest that South. Among 21 responding non- powder cocaine users? (Exhibit 8) use might be spreading to the suburbs. methadone treatment sources, 10 Low and middle SES backgrounds are name central city areas as the likeliest reported approximately equally by Similarly, powder cocaine users in place of residence, 7 name the sub- epidemiologic and ethnographic treatment generally tend to live in urbs (in Birmingham, Columbia, El sources in their descriptions of pow- central city areas, but many also live Paso, and Memphis in the South, and der cocaine users–unlike their descriptions of heroin and crack Exhibit 8. users, which tend to be more on the What is the predominant socioeconomic status of powder cocaine users?* “low” side. The only exceptions are in New Orleans and St. Louis, where Boston, MA** sources describe powder cocaine users Epidemiologic and as “middle to high” SES, and in New York, NY ethnographic sources Detroit, where users come from all

Northeast Philadelphia, PA backgrounds. No regional patterns Non-methadone treatment sources are evident. Similarly, methadone Portland, ME Methadone treatment sources treatment sources are split about Baltimore, MD evenly in the two responses. Non- methadone treatment sources, by Birmingham, AL contrast, tend to name low SES Columbia, SC groups more frequently (15 of 22 respondents). El Paso, TX

South Memphis, TN Where do powder cocaine users tend to reside? Suburban areas are Miami, FL named as the predominant place of New Orleans, LA residence for powder cocaine users by Washington, DC five epidemiologic and ethnographic sources (in Boston, Los Angeles, Chicago, IL Miami, St. Louis, and Sioux Falls). Detroit, MI Additionally, users are equally likely to reside in either the central city or Midwest St. Louis, MO the suburbs in New Orleans and Sioux Falls, SD** Seattle; they reside predominantly in rural areas in El Paso; and all three Billings, MT types of areas are named in Detroit. Denver, CO The remaining 12 epidemiologic and Honolulu, HI ethnographic sources, however, West believe that powder cocaine users Los Angeles, CA reside, for the most part, in central Seattle WA city areas. In Baltimore, the ethno- graphic source points out that while Low Low/ Middle Middle/ High All most powder cocaine users reside in Middle High the central city, some suburban SES Group residents purchase their drug in the *This information was not provided by the ethnographic source in New York, the non-methadone central city “because the suburbs have treatment sources in New York and one of the Billings programs, and by the methadone treatment no open air markets.” Similarly, in sources in Honolulu, Miami, New York, Philadelphia, Portland, and St. Louis. **Information was provided from two methadone programs in Boston and two non-methadone Portland, ME, users continue to programs in Sioux Falls.

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Honolulu and Seattle in the West), 2 speedball. Marijuana is frequently What motivates different age name rural areas (in both Sioux Falls smoked by powder cocaine users in groups to choose snorting over programs), and 2 name all locations injecting? many cities (sometimes sequentially, throughout the area (in Billings and sometimes laced together), as reported St. Louis). According to responding In Baltimore, where speedballing is com- in Boston, Columbia (SC), Detroit, methadone treatment sources, central mon, the ethnographic source explains Philadelphia, St. Louis, and Sioux city places of residence are more that “street-knowledgeable folks tell Falls. Diverted benzodiazepines are how inserting a needle in the skin pro- common in Boston, Birmingham, mentioned by sources in Boston, El duces abscesses, so they are more likely Chicago, Detroit, El Paso, Los Paso (alprazolam, or Xanax®), and to snort, especially with the increased Angeles, and Washington, DC, while potency. For newcomers, fear of HIV is St. Louis (diazepam). As part of the the suburbs are more common in the a deterrent to needle use.” club drug scene, powder cocaine is second Boston program and in sometimes combined with ecstasy in El Columbia (SC), Denver, and New Paso; with ecstasy and a whole gamut Non-methadone treatment sources Orleans. In Los Angeles and Seattle, of club drugs in Miami; and with concur that snorting is generally the non-methadone clients who use pow- ecstasy, GHB, or both in Birmingham. primary route of administration for der cocaine are equally likely to live powder cocaine, but, again, some in central city and suburban areas. Non-methadone treatment sources in exceptions are noteworthy. Smoking Baltimore, Birmingham, Chicago, How do powder cocaine users is the primary route at the programs Denver, and Philadelphia similarly take their drug? Snorting is the in Denver and Honolulu. Smoking report that powder cocaine is some- primary route of administration for equals snorting as the primary route times combined with heroin. powder cocaine, according to the vast in Baltimore and Los Angeles. And Marijuana is cited by non-methadone majority of epidemiologic and ethno- injecting equals snorting as the pri- treatment sources in Columbia (SC), graphic sources, with a few notable mary route in Billings. Not surpris- Denver, Detroit, Los Angeles, exceptions: injecting (as part of a ingly, injecting is mentioned as a pri- Memphis, and Sioux Falls (where the speedball) is cited as more common mary route of administration by pow- source specifies that it is laced in with in Philadelphia and Washington, DC, der cocaine users in some methadone the powder cocaine). The combina- and smoking is as common as snort- programs, as in Boston, Los Angeles, tion of powder cocaine and ecstasy is ing in Honolulu. In some cities, route and Seattle. Moreover, the El Paso mentioned in four programs: in of administration varies with age. For methadone treatment source reports Billings; in Birmingham, where this example, in Detroit, young adult that powder cocaine users are likely phenomenon first appeared around a (18–30 years) powder cocaine users to either smoke or inject the drug. year ago; in Columbia, where the tend to snort the drug, while the drugs are specified as a club drug What other drugs do powder older (>30 years) user group is combination; and in Portland, ME, cocaine users take? Epidemiologic equally likely to snort and smoke it. where the use of this combination has and ethnographic sources report that Epidemiologic and ethnographic increased. Finally, powder cocaine is powder cocaine users also consume a sources report three changes in cities sometimes combined with metham- variety of other drugs, sometimes in where snorting still predominates: a phetamine in the West, as reported by combination, and sometimes sequen- shift towards smoking in Portland non-methadone treatment sources in tially. For example, powder cocaine is (ME), some resurgence of injection in Billings and Honolulu. often taken as part of a “speedball” Los Angeles (with no other drugs), combination with heroin, as reported and a slight shift to injection in Nearly every methadone treatment in New York, Philadelphia, and Columbia (SC). Conversely, in source, again not surprisingly, reports Portland in the Northeast; Memphis Washington, DC, where injection that powder cocaine is sometimes in the South; Chicago and Sioux Falls predominates, snorting has been combined with heroin. Additionally, in the Midwest; and Denver and increasing. diverted benzodiazepines are some- Seattle in the West. In Portland, times taken either together with ® diverted OxyContin is sometimes powder cocaine or afterwards to used instead of heroin in this type of mitigate the side effects, as noted at page 52 Pulse Check: November 2001 POWDER COCAINE

programs in Boston, Columbia (SC), Similarly, among non-methadone powder cocaine is sometimes used and Seattle. The El Paso methadone treatment sources, only rare reports in abandoned row houses (abando- treatment source adds that some are given for outdoor use (only in miniums) and fast-food restaurant clients also use “roche” (pronounced Honolulu, Los Angeles, and Boston), bathrooms. ro-cha), presumably the benzodi- public use (only in Honolulu and azepine flunitrazepam (Rohypnol), Seattle, although both private and Overall, any specific setting is usually brought in from Mexico. public use are reported in Billings, Los more likely to be a sales site than a use Angeles, Memphis, and Washington, site for powder cocaine, according to Where and with whom is powder DC), or solo use (only in Boston, law enforcement, epidemiologic, and cocaine used? (Exhibit 6) Powder although both solo and group use ethnographic sources. Schools are a cocaine is usually used indoors, in is reported in Memphis and particular case in point: in 11 cities, private, and in small groups among Philadelphia). they are reported as a place where friends. Indoor use is cited by every dealers sell powder cocaine but not as epidemiologic and ethnographic Private residences, by far, are the a place where users take it. Only in source except in Washington, DC, most common settings for powder Baltimore and El Paso are schools where both indoor and outdoor use cocaine use, according to epidemio- mentioned as settings for both sales are equally common. The Baltimore logic and ethnographic sources (as and use. Similarly, public housing ethnographic source notes seasonal shown previously, in exhibit 6) as developments and the areas around increases in outdoor use as the well as non-methadone treatment supermarkets are named much more weather improves, as is the case with sources. The other most common frequently as places where sales, heroin use. Private, as opposed to settings are clubs, parties, and cars. A rather than use, occur. In a few cases, public, use is cited by all the sources few unusual use settings are noted by however, the opposite holds true. but three: in Birmingham, El Paso, epidemiologic and ethnographic For example, in Portland, ME, three and Washington, DC, powder cocaine sources. For example, in Portland, settings named as use sites (clubs, is used both in public and in private. ME, powder cocaine is sometimes public housing, and parties) are not Only three sources—in New York, used on boats (during long fishing mentioned as sales sites. Similarly, in Miami, and Los Angeles—report that trips) and in the woods. In Miami, it Chicago, Detroit, and Los Angeles, the drug is used while alone, rather is used in restaurant kitchens. And in powder cocaine is used but not sold than in small groups among friends. Baltimore, like heroin and crack, in parks.

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page 54 Pulse Check: November 2001 MARIJUANA

MARIJUANA: THE PERCEPTION quences in their communities: the The types of marijuana, compared Birmingham law enforcement source with marijuana in general, vary more How do Pulse Check sources believes that the diversion and abuse in availability as perceived by the perceive the marijuana problem of prescription drugs have replaced Pulse Check sources knowledgeable in their communities? Baltimore marijuana, the Columbia (SC) non- on the subject. The most common and Washington, DC, are the only methadone treatment source believes variety is locally produced commercial two cities where no Pulse Check that LSD has done so, and the Sioux -grade marijuana, ranked as widely source names marijuana as their com- Falls epidemiologic source believes available by 24 law enforcement, munity’s most widely abused drug. In that club drugs have done so. epidemiologic, and ethnographic the other 19 Pulse Check cities, 30 sources in all but law enforcement, 3 of the 21 Pulse epidemiologic, Exhibit 1. Check cities: ethnographic, and How available is marijuana across the 21 Pulse Check cities?* Birmingham, non-methadone According to law enforcement, epidemiologic, and ethnographic sources... Detroit, and St. treatment sources Louis. Six sources indeed name describe local marijuana as such. commercial-grade Interestingly, marijuana as some- Washington, DC, is what available, the only city where three describe it as a source (law not very available, enforcement) con- and two (in El siders marijuana to Paso and Washing- be the drug with ton, DC) consider the most serious it not available consequences. at all. However, an additional 10 Sinsemilla, or the sources in 9 Widely Available, Widely Available, according to epidemiologic seedless variety of cities (Billings, according to both and ethnographic sources; somewhat available marijuana, is the Birmingham, source types according to law enforcement sources second most com- Denver, Detroit, *The Columbia (SC) epidemiologic source did not provide this information. mon variety Los Angeles, reported in Pulse Miami, Seattle, St. Check cities, cited Louis, and Sioux Falls) name MARIJUANA: THE DRUG as widely available by 13 law enforce- marijuana as the drug related to the ment, epidemiologic, and ethno- second most serious consequences. How available is marijuana across the country and what graphic sources in 10 cities spanning all regions of the country: Boston, Has the perception of the mari- type of marijuana is available? New York, and Portland (ME) in the juana problem changed between (Exhibits 1 and 2) Similar to reports Northeast; El Paso and Miami in the fall 2000 and spring 2001? No in the last Pulse Check, nearly all (39 South; Detroit and St. Louis in the sources report any change in their of 41) epidemiologic, ethnographic, Midwest; and Billings, Honolulu, and perception of marijuana as a widely and law enforcement sources who Seattle in the West. Another 13 abused drug or as a drug related to discussed this question consider mari- sources in 10 cities describe sinsemilla serious consequences in their com- juana to be widely available in their as somewhat available, 8 sources in munities. Three sources, however, communities. The two exceptions are 7 cities report it as not very available, perceive that marijuana has been in Boston and Chicago, where one and only 1 source (in El Paso) says it replaced by another drug contributing source in each city describes the drug is not available at all. to the second most serious conse- as somewhat available.

Pulse Check: November 2001 page 55 MARIJUANA

Exhibit 2. As reported in the last Pulse Check, of What varieties of marijuana are described as “widely” or “somewhat” all the marijuana varieties discussed, available across the 21 Pulse Check cities? How has availability changed British Columbian (“BC bud”) is least (fall 2000 vs spring 2001)?* commonly considered widely avail- able, with only four sources reporting Local Mexican it as such. Two are in the Northeast City Commercial Sinsemilla Commercial Hydroponic BC Bud (New York and Philadelphia), one is LELELE L ELE in the South (El Paso), and one is in Boston, MA ↔ ↔ ❍❍↔ ↔ the West (Billings). An additional 7 New York, NY ↔ ↑ ↔ ↔ ↔ ↔ ❍↔ ↔ sources in 6 cities give it a somewhat Philadelphia, PA ↔ ❍↔ ❍↔ ❍↔ ↔ ❍↔ ↔

Northeast Portland, ME ↔ ↔ ↔ ↔ ❍↔ ❍ ↔ ❍↔ ❍↔ ❍↔ available rating, 8 sources in 7 cities Baltimore, MD ↑ ↔ ❍↔ ❍↔ ❍↔ ❍↔ consider it not very available, and it is Birmingham, AL** not available at all according to 10 Columbia, SC ↔ ↔ ❍ sources in 8 cities: Boston in the El Paso, TX ↔ ↔ ↔ ↔ ↔ Northeast; Baltimore, El Paso,

South Memphis, TN ❍❍ ❍❍Memphis, Miami, New Orleans, and Miami, FL ↔ ↔ ↑ ↑ Washington, DC, in the South; and New Orleans, LA ↔ ❍↔ ↔ ❍↔ Detroit in the Midwest. Washington, DC ↔ ❍↔ ↑ ↔ Chicago, IL ❍↔ ↔ ❍↔ ❍↔ ❍↔ ❍↔ ❍↑ It is important to note that in some Detroit, MI ❍↔ ↔ ❍↔ ❍↔ ↔ ❍↔ ❍ cases, the different varieties of St. Louis, MO ↔ ❍↔

Midwest marijuana can overlap. In Seattle, for Sioux Falls, SD ↑ example, the categories of “sinsemilla,” Billings, MT ↔ ↔ ↔ ↔ “locally grown,” and “hydroponic” are Denver, CO ↔ ↑ ❍↔ ↔ ↑ ❍↔ ❍↔ synonymous: the most common form Honolulu, HI ↑ ↔ ↑ ❍↔ ❍↓ ❍↔ ❍↔ ❍↑ West Los Angeles, CA ❍↔ ↔ ↔ ↔ ❍↔ available is locally grown hydroponic Seattle, WA ❍↔ ↔ ❍↔ ↔ ❍↔ ↔ ❍↔ ❍↔ sinsemilla.

Sources: Law enforcement (L) and epidemiologic/ethnographic (E) respondents Has marijuana availability Widely available changed? (Exhibit 3) Marijuana ❍ Somewhat available availability remained stable at high * Arrows indicate up, down, or stable trends. Absence of an arrow indicates that respondent did not provide trend information. levels between fall 2000 and spring **While both Birmingham sources noted marijuana as widely available, neither rated the 2001, according to the majority of different varieties. Pulse Check sources who discussed this question (18 of 20 law enforce- Mexican commercial-grade marijuana Hydroponically grown marijuana is ment sources and 16 of 19 epidemio- is as available as sinsemilla, with wide considered widely available by eight logic and ethnographic sources). The availability cited by 13 sources in 10 sources in seven cities, all either in two law enforcement exceptions are cities: Boston and New York in the the Northeast or the South: all four in Baltimore and Sioux Falls, where Northeast; Columbia (SC), El Paso, law enforcement sources in the increased availability appears driven and Memphis in the South; Detroit in Northeast; both sources in Washing- by increases in local commercial the Midwest; and Billings, Denver, ton, DC; and the law enforcement grades. The three exceptions among Los Angeles, and Seattle in the West. sources in Miami and New Orleans. epidemiologic and ethnographic It is described as somewhat available Another 13 sources in 11 cities sources are increases in Boston, by another 12 sources across all the describe hydroponic marijuana as Denver (where both local and regions, not very available by 6 somewhat available, 9 sources in 9 Mexican commercial grades have sources, and not available by 3 cities rate it as not very available, and increased in supply), and New sources (in New York, New Orleans, 3 law enforcement sources—in York (where an increase in local and Washington, DC). Baltimore, Billings, and El Paso— consider it not available at all. page 56 Pulse Check: November 2001 MARIJUANA

commercial-grade marijuana is Exhibit 3. tends to be more expensive, as in noted). No sources report declines in How has marijuana availability Denver, where it sells for $300 per overall marijuana availability. changed (fall 2000 vs spring ounce, although it costs as little as 2001)?* $80–$100 per ounce in Boston. BC In some sites where overall availabili- bud is even more expensive, as in ty is stable at high levels, some shifts Denver, where it sells for $500 per are reported for specific varieties. For ounce. The highest reported prices, L example, the Birmingham law Baltimore, MD however, are for hydroponic and Boston, MAE enforcement source reports declining organic marijuana, which sell for Denver, COE availability for three varieties: $700–$800 in New York. Joints New York, NYE Mexican commercial, BC bud, and Sioux Falls, SDL and bags of either domestic or hydroponic marijuana. Mexican commercial-grade Baltimore, MDE Los Angeles, CAL,E Conversely, the Honolulu law marijuana tend to sell for Billings, MTL,E Miami, FLL,E enforcement source reports Birmingham, ALL,E New Orleans, LAL,E $5–$10. Since the last increasing availability for Boston, MAL New York, NYL reporting period, prices three varieties: local com- Chicago, ILL,E Philadelphia, PAL,E have remained relatively mercial grade, sinsemilla, Columbia, SCL Portland, MEL,E stable in reporting Pulse and BC bud. Several sources Denver, COL Seattle, WAL,E Check cities, except in report increases in hydropon- Detroit, MIL,E Sioux Falls, SDE Seattle, where BC bud ic marijuana availability: the El Paso, TXL,E St. Louis, MOL,E prices declined since the last epidemiologic source in St. Louis Honolulu, HIL,E Washington, DCL,E reporting period. and the law enforcement sources L in Chicago, Miami, and Law enforcement respondents How is marijuana referred to E Epidemiologic/ethnographic respondents Washington, DC. The St. Louis epi- *The Boston and Columbia (SC) epidemiologic across the country? (Exhibit 5) demiologic source also reports peri- sources and the Memphis law enforcement Similar to reports in previous Pulse source did not provide that information. odic rumors, thus far unconfirmed, of Check issues, “grass,” “pot,” and the emergence of BC bud. And the “weed” remain common slang terms What are street-level marijuana Miami epidemiologic source reports for marijuana across Pulse Check prices across the country and that two varieties have increased in sites. Additionally, as the New York have they changed since the last supply: sinsemilla and Jamaican. ethnographic source states, “Brand reporting period? (Exhibit 4) names dominate the scene.” Such is According to law enforcement, How potent is marijuana across also the case in Philadelphia and in epidemiologic, and ethnographic the country and how has potency some southern cities, such as sources, commercial-grade marijuana changed? (Exhibit 4) Marijuana Memphis and Miami. Some of the (Mexican or domestic) ounce prices potency ranges from 1–5 percent more recent names in New York are generally in the $100–$200 tetrahydrocannabinol (THC) for include “texas tea,” “purple haze,” range, except in Memphis, where a Mexican commercial-grade marijuana “arizona,” “elo,” “hydro,” “dro,” $25 price is reported. Sinsemilla in Detroit to 15–22 percent THC for “pellet,” “beef and broccoli” (a sinsemilla in Honolulu, according to combination of hydro and pellet), and reporting law enforcement, epidemio- “Early-in-the-month” bags? “trees.” In Philadelphia, some of the logic, and ethnographic sources. Since According to the Baltimore ethno- latest names include “$ signs,” “8 the last Pulse Check, potency levels graphic source, as a new marketing ball,” “horse heads,” and “marijuana remained relatively stable in most strategy, marijuana is available in leaf.” The Miami epidemiologic reporting cities, except in Memphis, individual joints, for $2–$3 each, source gives further insight into some where potency for commercial-grade toward the latter part of the month, of the other names: for example, (domestic and Mexican) marijuana when users’ income is lower; then, “‘kryppy’ is short for ‘kryptonite’– increased, and in Portland (ME), early in the following month, it is sold because it’s THAT strong,” and where potency of marijuana in gener- in $5 and $10 bags. “killer” is so named “because it’s the al has increased. worst; it stinks.”

Pulse Check: November 2001 page 57 MARIJUANA

Exhibit 4. MARIJUANA: THE SELLERS How much does marijuana cost in 19 Pulse Check cities?* How are street-level marijuana Purity sellers organized? In most Pulse City Type UnitPrice (%THC) Check cities, independent sellers are Boston, MA Sinsemilla 1 oz $80–$100 NR the norm, according to law enforce- New York, NY NR Bag $10 NR ment respondents. Conversely, in Hydroponic 1 oz $700–$800 NR Portland (ME), where major local and organic growers organize out-of-State and Northeast Philadelphia, PA Local commercial 1 oz $150–$200 NR local distribution of the drug, most Portland, ME NR 1 oz $175 NR sellers are organized. In four cities, Baltimore, MD NR Bag $5–$10 NR independent and organized distribu- Birmingham, AL NR 1 gm (joint) $10 NR tion networks are mentioned: El Paso, Los Angeles (where organized Columbia, SC Local or 3–4 gm $10 NR Mexican commercial distributors are affiliated with Mexican cartels), St. Louis, and El Paso, TX Mexican commercial 1/4 oz $20 NR Seattle. Epidemiologic and ethno- Memphis, TN Local commercial 1 oz $25 5–6% graphic respondents report organized NR 1/4 oz $25–$30 NR distribution networks more frequently South Miami, FL Sinsemilla 1/4 oz $100 10–18% than do their law enforcement coun- Sinsemilla Bag $750–$1,200 NR terparts: most marijuana sellers are New Orleans, LA Domestic commercial Joint $5–$10 NR organized in Baltimore, Denver Washington, DC Local or 1/4 oz $25–$75 NR (where they are Mexican nationals), Mexican commercial Detroit, El Paso, Honolulu (where Local or 750 mg bag $20 NR they are loosely organized groups of Mexican commercial two to three “runners” and often Chicago, IL Local or Bag $5–$10 NR affiliated with Mexican nationals), Mexican commercial and New Orleans (where they are Detroit, MI Mexican commercial 1 oz $150–$200 1–5% Midwest organized loosely). Additionally, the Sioux Falls, SD Local commercial 1 oz $100–$150 NR epidemiologic sources in Chicago and Denver, CO Local or 1 oz $100–$200 4% St. Louis report marijuana sellers as Mexican commercial both organized and independent. Sinsemilla 1 oz $300 NR BC bud 1 oz $500 4% How is street-level marijuana Honolulu, HI Mexican commercial Joint $5 NR sold? Marijuana distribution meth- West Kona gold Joint $20 NR ods continue to vary widely. All (21) Sinsemilla 1 gm $25 15–22% law enforcement respondents report Los Angeles, CA Mexican commercial Joint $10 4–6% marijuana as sold hand-to-hand Seattle, WA BC bud 1 gm $15–$25 NR through acquaintance networks; most also report the use of beepers and Sources: Law enforcement, epidemiologic, and ethnographic respondents *Respondents in Billings and St. Louis did not provide this information. delivery-type services. Epidemiologic respondents also report hand-to-hand sales, and most report that these sales How is marijuana packaged and (ME); manilla envelopes, aluminum occur via acquaintance networks. marketed? As reported in the last foil, and plastic wrap in New York; Moreover, beeper and cell phone use Pulse Check, the most common mari- plastic coin zipper bags with logos in is also reported by epidemiologic juana packaging in Pulse Check cities Philadelphia; balloons in Denver; and sources in Chicago, El Paso, is plastic zipper or sandwich bags. blunts in Washington, DC. No new Memphis, Miami, New Orleans, New Additional packaging includes loose packaging was reported since the last York, and Sioux Falls, and delivery- joints in Baltimore and Portland Pulse Check. type methods are reported in page 58 Pulse Check: November 2001 MARIJUANA

Exhibit 5. How old are street-level How is marijuana referred to in different regions of the country? marijuana sellers? Marijuana sellers are predominantly young adults WEST MIDWEST NORTHEAST (18–30 years), according to most law Grass, loose shake, weed, dope, enforcement, epidemiologic, and Grass, ragweed, Hydro, Mary bud, smoke, texas tea, purple haze, ethnographic respondents across Pulse skunkweed, good s--t, Jane, weed, arizona, elo, hydro, dro, pellet, beef ditch weed, BC bud, green Check sites, but ages vary widely. For and broccoli (hydro + pellet), trees, ganga, dope, pot, bud, example, all age groups are equally blunt $ signs, 8 ball, hershey’s kisses, horseheads, marijuana leaf likely to sell the drug in Billings, Memphis, and Portland (ME), accord- Grass, gungie, weed, smoke, cabbage, broccoli, hay, bud, dank, ing to law enforcement sources there. herb, mota, blunt, dope, thirteen, mary jane, trees, joint, junt, green acres, kine, schwag, gree, dosier, chronic, green, red bud, The Baltimore law enforcement and bubbleberry, gold bu, hydro, teak, ink, clover, ragweed, ditch- Kona gold, ditch weed, kuai epidemiologic sources report adoles- weed, kryptonite, kryppy, crippie, regs, skunk, killer, reefer, KD, electric, Maui wowie, bud, cents (13–17 years) as the predomi- kindbud, blueberry, white widow, northern lights, mota pakalolo (crazy tobacco), nant sellers, and they are split evenly chronic, grass, weed SOUTH between adolescents and young Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents adults, according to five sources: the law enforcement sources in Then and Now: Birmingham, Los Angeles, and New How have marijuana sellers and sales changed (fall 2000 vs spring Orleans; and the epidemiologic 2001)? sources in Chicago and Detroit. As in many other cities, Memphis has a The marijuana sales scene has remained relatively stable since the last Pulse Check wide diversity in the age of sellers: report. Only a few changes are reported, with no discernible regional trends: marijuana sellers there are predomi- Baltimore, MD: ➤ Marijuana sellers are increasingly younger, according to the law nantly young adults, but some are as enforcement source. young as preadolescents (<13 years), according to the Los Angeles, CA: ➤ The use of electronic equipment, including cell phones, in marijua- epidemiologic source. na sales has increased, according to the law enforcement source. What other drugs do marijuana Honolulu, HI, and ➤ According to law enforcement sources, ecstasy sold with marijuana dealers sell? According to 11 of 21 New York, NY: is new this reporting period. law enforcement sources, marijuana Miami, FL: ➤ The law enforcement source reports that marijuana grown indoors sellers sell other drugs, most com- and hydroponically is increasing, perhaps due to drought in the monly (and as reported in the last region. Pulse Check) crack and powder cocaine (in Birmingham, Columbia ➤ New York, NY: According to the epidemiologic source, as marijuana, especially [SC], Detroit, Honolulu, Los Angeles, hydroponically grown marijuana, continues to be available, new New York, and St. Louis). Addition- brand names have appeared. ally, methamphetamine is sold with Portland, ME: ➤ The law enforcement source states that marijuana sellers are marijuana in Billings, Honolulu, and becoming more organized and the amount sold has increased. Memphis; ecstasy in Honolulu, Miami, and New York; heroin in Washington, DC: ➤ The epidemiologic source states that marijuana’s presence on the New York; and PCP in New Orleans. drug market has increased. Marijuana sellers typically do not sell other drugs in Baltimore, Boston, Birmingham, Chicago, Denver, El delivered to offices, and in Chicago, Denver, El Paso, Philadel- Paso, Miami, New York, and Philadelphia, it is sold primarily phia, Portland (ME), Seattle, Sioux Washington, DC. Additionally, in hand-to-hand on street corners. Falls, and Washington, DC. New York, marijuana is often

Pulse Check: November 2001 page 59 MARIJUANA

Similarly, according to 8 of 14 St. Louis, and Washington, DC), and MARIJUANA: THE USERS epidemiologic and ethnographic prostitution is mentioned in three How old are marijuana users? respondents, marijuana sellers (Baltimore, El Paso, and Memphis). (Exhibit 6) As reported in the last typically sell other drugs, including Pulse Check issue, adolescents (13–17 crack cocaine in five cities (Denver, Where is marijuana sold? years) outnumber the young adult Detroit, New Orleans, New York, and According to law enforcement, epi- (18–30 years) and older adult (>30 St. Louis), heroin in four cities demiologic, and ethnographic respon- years) user groups in eight Pulse (Baltimore, Denver, New York, and dents, marijuana sales are widespread. Check cities: Baltimore, Columbia St. Louis), powder cocaine in two Most (14 of 21) law enforcement (SC), Denver, El Paso, Los Angeles, cities (Denver and New York), and respondents report that marijuana is New Orleans, Portland (ME), and methamphetamine in Denver. In sold in all areas of cities (central, sub- Sioux Falls (according to epidemio- Memphis, any drug available may be urban, and rural), four (in Chicago, logic and ethnographic respondents). sold with marijuana. In St. Louis, Columbia [SC], Honolulu, and Adolescents and young adults are many dealers, especially those affiliat- Washington, DC) report that it is sold equally likely to be the predominant ed with gangs, run a “one-stop shop,” mostly in central city areas, and three user group in Seattle. Young adults, selling heroin, crack, and marijuana, (in Baltimore, Los Angeles, and New however, are named as the largest as reported in earlier sections. Orleans) report that it is sold in cen- group of marijuana users in eight tral city and suburban areas. Similarly, cities: Billings, Birmingham, Chicago, Do marijuana sellers use their four epidemiologic sources (in Memphis, Miami, Philadelphia, St. own drug? As reported in the last Birmingham, Denver, St. Louis, and Louis, and Washington, DC. Older Pulse Check, according to nearly all Washington, DC) report that marijua- adults are mentioned only in Detroit law enforcement and epidemiologic na is sold in all areas of cities, four (where they equal young adults as the respondents, marijuana sellers are (in Baltimore, Honolulu, New York, predominant user group), in Hono- very likely to use the drug. Only the and Portland [ME]) report that it is lulu (where all three groups are Denver and Honolulu epidemiologic sold primarily in the central city, and equally represented), and in Boston. sources report that marijuana sellers two (in Chicago and Detroit) report Since the last Pulse Check reporting are not very likely to use the drug. its sale in the central city and suburbs. period, the Memphis and Los Angeles Additionally, suburban areas are the sources note a slight increase among Are street-level marijuana primary sales location in Sioux Falls, young adults, and the Boston source sellers involved in other crimes? and rural areas are in El Paso, accord- notes an emerging adolescent group, Nearly all law enforcement, epidemi- ing to epidemiologic sources. ologic, and ethnographic respondents with an age of initiation typically view marijuana sellers as not very Marijuana is sold both indoors and between 14 and 16 years. A longer likely or somewhat likely to be outdoors, according to all (21) law term trend is noted in Birmingham, involved in other crimes, although enforcement sources; epidemiologic where the young adult group has law enforcement respondents general- respondents tend to agree. According been steadily increasing for the past ly report higher crime levels than to law enforcement respondents, decade, in tandem with a decrease in their epidemiologic counterparts. The marijuana is sold in a wide variety of crack use. most common type of other crime specific settings, most commonly In the majority of non-methadone associated with marijuana sellers is streets and inside cars (mentioned by programs, the clients most likely to nonviolent criminal acts, such as all sources), public housing develop- use marijuana are young adults. property damage and burglary. ments, private residences, around Preadolescents, however, are named Additionally, gang-related crimes are junior high and high schools, and as the predominant marijuana user mentioned in nine cities (Baltimore, in nightclubs. Epidemiologic and group in two non-methadone treat- Birmingham, Detroit, El Paso, ethnographic sources agree that ment programs (in Baltimore and Honolulu, Los Angeles, Memphis, St. marijuana is sold in a wide variety Portland [ME]), and adolescents are Louis, and Washington, DC), violent of settings, most commonly private named in another three programs (in crimes are mentioned in five residences and streets. Chicago, Columbia [SC], and Sioux (Baltimore, Los Angeles, Memphis, page 60 Pulse Check: November 2001 MARIJUANA

How have marijuana users changed across the country (fall 2000 vs spring 2001)?

According to epidemiologic and ethnographic sources....

Several increases are noted ➤ Boston, MA: Adolescents (13–18 years) are an emerging group. in various age groups: ➤ Detroit, MI: Young adults (18–30 years) have been increasingly using marijuana, so that they now equal older adults (>30 years) as the groups most likely to use the drug. Moreover, adolescents have been emerging as a user group.

➤ Los Angeles, CA: Adolescents constitute the largest user group, but young adults have increased slightly.

➤ Memphis, TN: Young adults (18–30 years), the predominant marijuana user group, have increased even more.

➤ Sioux Falls, SD: Adolescents constitute the largest user group, but the number of preadolescent users (<13 years) has increased.

➤ Washington, DC: Young adults (18–30 years) constitute the largest user group, but older adults (>30 years) have increased.

An increase in female marijuana ➤ New Orleans, LA users is noted in two cities: ➤ Philadelphia, PA

Racial/ethnic distributions have ➤ Memphis, TN: White marijuana users have increased. shifted in a few cities: ➤ Sioux Falls, SD: An increase in marijuana use among middle school students (sixth through eighth grades) is reported among recent immigrants from Ukraine, Russia, and various African tribes. This large new population base bears watching for other emerging drug issues, especially among those of student age.

➤ Washington, DC: Increasing use is noted among Hispanics, but that group is still underrepresented relative to the general population.

Drug use patterns have changed in ➤ Birmingham, AL: Marijuana is most commonly smoked in joints. Blunts are becoming passé. a few cities: ➤ Memphis, TN, and New Orleans, LA: While joints remain the most common vehicle for smoking marijuana, use of blunts has increased.

➤ Honolulu, HI: The combination of marijuana and PCP is a recent development.

➤ Philadelphia, PA: A new practice, still rare, is reported: crushing and sprinkling the diverted prescription drug Xanax® (alprazolam) onto marijuana. According to treatment sources...

➤ Novice use of marijuana has remained relatively stable, but increases are reported in one methadone program (in Portland, ME) and in four non-methadone programs: in Billings, MT; Boston, MA; Columbia, SC; and New Orleans, LA.

➤ Columbia, SC: The non-methadone treatment source notes an increase in Blacks and Hispanics, an increase in females, and a lower age of first use.

➤ Honolulu, HI: The methadone treatment source notes a decline in the number of marijuana/drug combinations.

Falls). In the Los Angeles and Seattle programs, and they equal both Marijuana-using clients in methadone programs, marijuana-using clients are younger groups in the St. Louis programs tend to be older than those equally likely to be adolescents and program. The Columbia (SC) non- in non-methadone programs: older young adults. Older adults are named methadone treatment source notes adults are named as the predominant as the predominant group in the that the age of first use has become marijuana users in Chicago, Honolulu, Denver program, they equal young lower since the last Pulse Check Los Angeles, and Washington, DC, as adults in the El Paso and Philadelphia reporting period. well as in one of the Boston programs.

Pulse Check: November 2001 page 61 MARIJUANA

Both young adults and older adults are Exhibit 6. Honolulu, Los Angeles, New Orleans, the predominant marijuana users in What age group is most likely to Portland [ME], and one of the Boston the El Paso and Portland (ME) use marijuana? programs) than to be primarily males programs. Only in the Birmingham (as in Birmingham, El Paso, Washing- Number of Respondents program are young adults, exclusively, 18 ton, DC, and the second Boston 17 named as the group most likely to use Preadolescents Young Adults program). marijuana. In the second Boston 16 (<13 years) (18–30 years) methadone program, marijuana users 15 Is any racial/ethnic group more are equally likely to be adolescents, 14 Adolescents Older Adults likely to use marijuana? As noted (13–17 years) (>30 years) young adults, and older adults. The 13 in the last Pulse Check issue, the Pulse Check source at that program 12 marijuana problem cuts across all 11 elaborates that methadone clients gen- racial/ethnic groups. Nine epidemio- 10 erally have been chronic marijuana logic and ethnographic respondents 9 users since their adolescence, and that (in Billings, Birmingham, Chicago, El 8 marijuana tends to be the one drug Paso, Philadelphia, Portland [ME], St. 7 they don’t give up—sometimes using it Louis, Seattle, and Sioux Falls) report 6 that racial/ethnic distributions are daily, sometimes several times a day. 5 fairly representative of their respec- 4 tive cities’ populations. White users Why do methadone clients take 3 are more prominent in the Midwest marijuana? 2 1 (in Detroit, Sioux Falls, and St. According to a Boston treatment source, 0 0 Louis), in the West (in Billings, methadone clients sometimes use mari- 0 Epidemi- Non- Methadone Denver, Los Angeles, and Seattle), juana daily, sometimes several times a ologic/ Methadone Treatment and in Memphis, Miami, and day, for several possible reasons: Ethnographic Treatment Sources Portland. The Los Angeles epidemio- To potentiate the methadone Sources Sources (N=10) (N=20) (N=19) logic source adds that Whites, who To temper their heroin cravings now trail Hispanics in Los Angeles’ As a sleep aid, to counter the impact Note: In some cities, more than one age group general population distribution, are methadone sometimes has on sleep is named. nevertheless the most likely to use In the treatment population, more marijuana. In Birmingham, Whites Are there any gender differences than in the population described by and Blacks are equally likely to use in who uses marijuana? According epidemiologic and ethnographic marijuana. Blacks are more likely to epidemiologic and ethnographic sources, both genders are equally like- than other racial/ethnic groups to use sources, males are more likely than ly to use marijuana. Such is the case marijuana in six cities: Baltimore, females to use marijuana in all but in 11 non-methadone programs: in all Chicago, Columbia (SC), New five Pulse Check cities. In Boston, five cities in the West, in both Sioux Orleans, Philadelphia, and Chicago, Portland (ME), Sioux Falls, Falls programs, and in Memphis, Washington, DC. In Honolulu, Asians and Washington, DC, males and Philadelphia, Portland (ME), and are the likeliest to use marijuana, but females are equally likely to do so. Washington, DC. Males predominate they are underrepresented relative to Further breakdowns by age, however, in the remaining nine programs the general population. While show different gender distributions. where this information was provided. Hispanics are not Philadelphia’s In Detroit, for example, older mari- In the Columbia (SC) program, where largest marijuana-using population, juana users tend to be males, but the males are the predominant marijuana they are overrepresented relative to emerging adolescent group appears users, females have increased since the general population. The only evenly split between the genders. the last Pulse Check reporting period. racial/ethnic shift reported by epi- Since the last Pulse Check reporting Similarly, in methadone treatment demiologic/ethnographic sources period, an increase in female marijua- programs, marijuana users are more since the last Pulse Check reporting na users has been noted in New likely to be evenly split between the period is an increase in White Orleans and Philadelphia. two genders (as reported in Chicago, marijuana users in Memphis. page 62 Pulse Check: November 2001 MARIJUANA

Similarly, reports from treatment likely to use marijuana in seven cities and Denver, Honolulu, and Seattle in sources show how the marijuana (Billings, Chicago, El Paso, Los the West. Suburban residences are problem touches all racial/ethnic Angeles, Memphis, Miami, and Sioux more predominant in Billings, Los groups. According to non-methadone Falls), and low SES groups are named Angeles, and Sioux Falls, and both treatment sources, marijuana users in five (Baltimore, Columbia [SC], suburban and central city residences are predominantly Whites in 9 pro- New York, Philadelphia, and are reported in Boston and Chicago. grams (in Billings, Columbia [SC], El Washington, DC). The Birmingham central city residences are more com- Paso, Los Angeles, Memphis, source names both low and high SES monly reported in the Northeast (in Philadelphia, Portland [ME], Seattle, groups as the most likely to use mari- New York, Philadelphia, and—along and Sioux Falls), Blacks in 11 pro- juana, and the Seattle source names with rural areas—in Portland [ME]) grams (in Baltimore, Birmingham, low to middle SES groups. No and the South (in Baltimore, Colum- Detroit, El Paso, Los Angeles, changes are reported since the last bia [SC], Memphis, and Washington, Memphis, Miami, New Orleans, New Pulse Check reporting period. DC). Since the last Pulse Check, the York, Philadelphia, and Washington, El Paso epidemiologic source notes an DC), Hispanics in 4 programs (in Non-methadone treatment sources, increase in marijuana users living in Chicago, El Paso, Los Angeles, and however, paint a somewhat different rural areas. That shift, however, is Philadelphia), and Asians in 2 pro- picture. The majority (in 15 cities) probably not due to new use: more grams (in Honolulu and Los Angeles). report that marijuana-using clients in likely, it is because more outreach (Sources in El Paso, Los Angeles, their programs are likely to come efforts are reaching those areas. Memphis, and Philadelphia list more from low SES backgrounds. Only two than one group as predominant.) The (in Denver and Sioux Falls) name the Marijuana users in non-methadone Columbia non-methadone treatment middle SES group, and another two treatment programs are likely to live source notes an increase in Black and (in El Paso and Los Angeles) name in central city areas, as reported in 12 Hispanic marijuana users since the both the low and middle SES groups. Pulse Check cities (New York and last Pulse Check. St. Louis is the only Pulse Check city Philadelphia in the Northeast; where marijuana-using clients are Baltimore, Birmingham, El Paso, According to methadone treatment equally likely to come from all three Miami, New Orleans, and Washing- sources, Whites are the predominant (low, middle, and high) SES groups. ton, DC, in the South; Chicago and marijuana users in four programs (in According to methadone treatment Detroit in the Midwest; and Billings, Boston, Honolulu, Los Angeles, and sources, low SES groups predominate Denver, and Los Angeles in the West). New Orleans), Blacks in three (in in five programs, middle SES groups They are likely to reside in the sub- Birmingham, Chicago, and Washing- in two, and both low and middle SES urbs in Columbia (SC), El Paso, ton, DC), Hispanics in three (in El groups in one (Boston); New Orleans Portland (ME), and Seattle, while Paso, Los Angeles, and New Orleans), is the only city where all three SES rural areas predominate in both Sioux and Asians in the Honolulu program. groups are named. Falls programs. Only in Honolulu and (The Honolulu and New Orleans St. Louis are clients likely to live in sources list more than one group.) Where do marijuana users tend all three types of locations. to reside? (Exhibit 7) As reported in Is any socioeconomic group the last Pulse Check, marijuana users, According to responding methadone more likely to use marijuana? As more so than other drug users, reside treatment sources, marijuana users in with race/ethnicity, marijuana use “everywhere”—a term used by six programs reside predominantly in knows no socioeconomic bounds. numerous sources to refer to central central city areas (in Birmingham, Epidemiologic and ethnographic city, suburban, and rural places of res- Boston, Chicago, El Paso, Portland sources report that all SES groups are idence. Specifically, epidemiologic [ME], and Washington, DC), those in represented relatively evenly among and ethnographic sources report all Los Angeles live in both central city marijuana users in six Pulse Check three locations in nine Pulse Check and suburban areas, and those in a sec- cities: Denver, Detroit, Honolulu, cities: Birmingham, El Paso, Miami, ond Boston program live in the sub- New Orleans, Portland (ME), and St. and New Orleans in the South; urbs. All three types of locations are Louis. Middle SES groups are more Detroit and St. Louis in the Midwest; named in Honolulu and New Orleans.

Pulse Check: November 2001 page 63 MARIJUANA

Exhibit 7. reporting period to more than 80 marijuana, as reported by the vast Where are drug users most likely percent during the current period. majority of epidemiologic and ethno- to reside? These percentages should be viewed graphic respondents. However, blunts with caution because the numbers (hollowed-out cigars filled with mari- Number of Respondents (N=21) 20 involved are relatively small and juana) are more common than joints 19 Rural Areas because we cannot generalize Pulse in Baltimore and Philadelphia, and 18 Check findings to the general treat- they are nearly as common as joints Suburbs 17 ment population. That said, these in Birmingham, but they are report- 16 Central City findings make sense in light of the edly becoming passé in that city. In 15 All Areas growing legislative trend toward some cities, different subgroups of 14 diverting misdemeanor drug abusers marijuana users prefer different 13 out of law enforcement and into vehicles for smoking marijuana. In 12 treatment. Boston, for example, central city 11 residents tend to use blunts, while 10 Comparatively few non-methadone suburban residents tend to use joints. 9 treatment sources list referral sources 8 Similarly, in St. Louis, Blacks who live other than courts or the criminal jus- 7 in the central city tend to use blunts. tice system. Only four list alcohol or 6 Increases in blunt use are reported in drug abuse health care providers (in 5 Memphis and New Orleans, although 4 Memphis, Philadelphia, Portland in the latter city they are not referred 3 [ME], and Washington, DC), three to by that term. Pipes and “bongs” 2 name individual referrals (in El Paso, are other vehicles for smoking 1 Memphis, and Washington, DC), marijuana, as reported in Denver, 0 0 0 0 another three name school referrals Miami, and Seattle. Mari- Powder Crack Heroin (in Baltimore, Chicago, and Columbia juana Cocaine [SC]), two name employer referrals Non-methadone treatment sources Sources: Epidemiologic and ethnographic (in Honolulu and Washington, DC), report blunts as the predominant respondents and only one (in Memphis) lists other vehicle more often than epidemio- Note: Some respondents list two areas per city. health care providers. logic and ethnographic sources. Such How do marijuana users wind up is the case in nine programs: in How do marijuana users take in treatment? (Exhibit 8) The vast Baltimore, Chicago, Columbia (SC), El marijuana? Joints seem to be the majority (17 of 21) of non-methadone Paso, Honolulu, New Orleans, Seattle, most common vehicle for smoking treatment sources report that marijua- Sioux Falls, and Washington, DC. na clients at their programs come Exhibit 8. mainly from court or criminal justice How are different drug users referred to treatment? referrals. These findings differ from those in the last Pulse Check in two 100 Percent ways. First, during the last reporting 90 period, the number of marijuana 80 Marijuana Heroin Crack clients exceeded crack and heroin 70 (N=21) (N=17) (N=20) clients in court or criminal justice 60 referrals, whereas during the current 50 period, heroin and crack clients have 40 slightly surpassed marijuana clients in 30 this type of referral. Second, the pro- 20 portions of clients with criminal justice 10 0 0 0 0 0 referrals have increased for all three Court/Crim- Alcohol/Drug Abuse Indivi- School Employer Health drugs: from less than 50 percent of inal Justice Health Care Provider dual Care Provider responding sources during the last Sources: Non-methadone treatment respondents page 64 Pulse Check: November 2001 MARIJUANA

Additionally, marijuana users in marijuana is taken with ecstasy, and Miami, New Orleans, and Birmingham, Boston, Los Angeles, in Memphis, marijuana is laced with Washington, DC) and in the Midwest Memphis, and the second Sioux Falls methamphetamine or amphetamine— (in Detroit and Sioux Falls). Unlike program are equally likely to use blunts a combination that has increased epidemiologic and ethnographic and joints. Joints are more common in since the last reporting period. PCP reports, no crack use is noted in the Billings, Detroit, Miami, New York, lacing or dipping is reported in Northeast, but two reports emanate Philadelphia, and Portland (ME). Most Boston, Chicago, Honolulu, New from the West (in Billings and clients in Denver, and some in Los Orleans, New York, Philadelphia, and Seattle). Marijuana clients in Angeles and Sioux Falls, tend to smoke Washington, DC. The PCP combina- Birmingham, Chicago, Columbia marijuana in pipes. tion in Honolulu is a recent develop- (SC), El Paso, and Los Angeles use ment. Elsewhere in the West, the only powder cocaine. The Birmingham Eight out of nine methadone treat- other drugs mentioned are embalming source notes that sometimes the deal- ment respondents report that their fluid in Seattle, and club drugs (ecsta- er laces the marijuana with cocaine, clients smoke marijuana in joints (in sy, LSD, and GHB) in Los Angeles. but with the user’s knowledge. PCP Boston, Chicago, El Paso, Honolulu, use is noted among marijuana clients Los Angeles, New Orleans, Portland in Billings, Chicago, Memphis, [ME], and Washington, DC). In a Marijuana: First drug of abuse? Miami, Portland (ME), and second Boston program, however, According to the Los Angeles epidemi- Washington, DC. In Billings and marijuana smokers are equally likely ologic source, “Marijuana is not always Chicago, embalming fluid is some- to use joints, blunts, and bongs. the precursor to other drug use: now, it times added to the marijuana-PCP sometimes follows club drug use. Some mixture. Embalming fluid is also What other drugs do marijuana ‘rave kids’ start by using GHB, then mentioned in Birmingham, where users take? (Exhibit 9) According move on to ecstasy, and subsequently some clients soak marijuana in the to epidemiologic and ethnographic end up using marijuana. Some of substance. Marijuana clients in sources, marijuana users often also these users have never even smoked Billings and Sioux Falls sometimes use use crack, sometimes sequentially and cigarettes.” methamphetamine. Heroin is men- sometimes in combination, particularly tioned only in Philadelphia and St. throughout the Northeast (in Boston, Marijuana users in several non- Louis, but the St. Louis source notes New York, and Philadelphia), the methadone treatment programs also that “Most marijuana users don’t use South (in Birmingham, Columbia [SC], take crack. Such reports, like those of anything else but alcohol. On the El Paso, Memphis, and Washington, epidemiologic and ethnographic other hand, most hardcore drug users DC), and the Midwest (in Chicago, sources, occur in the South (in also smoke marijuana.” Detroit, and St. Louis). Powder cocaine is sometimes used with marijuana in Memphis, Miami, and Philadelphia. Exhibit 9. The Boston ethnographic source hears What are some slang terms for drug combinations involving marijuana? occasional reports about marijuana being mixed with both heroin and Marijuana combined with what drug Slang Term City cocaine, but has not personally observed such cases. As that source Marijuana + crack Oolies Boston notes, “Heroin users tend not to use Coolies New York marijuana because they have to be on Diablitos or turbos Philadelphia their toes too much.” In Philadelphia, Worties Washington, DC some users occasionally crumble and Marijuana dipped in same Elo New York sprinkle the diverted prescription water used to cook crack drug alprazolam (Xanax®) onto Marijuana + powder cocaine Primos Chicago, El Paso, Los Angeles marijuana; others sometimes mix Marijuana + PCP Wets New York, Philadelphia honey into marijuana to add flavor Love boat Philadelphia and “slow the burn.” In Miami, Sources: Epidemiologic, ethnographic, and treatment provider respondents

Pulse Check: November 2001 page 65 MARIJUANA

In methadone treatment programs, divided on the question of public and grant applications are currently some marijuana clients use crack in versus private use: clients in Balti- being made to sustain them. Chicago, Los Angeles, and New more, Billings, Chicago, Columbia Orleans. The El Paso source notes (SC), Honolulu, New York, and Hawaii: After an 8-month halt, the that some dealers lace marijuana with Washington, DC, tend to smoke Big Island’s Operation Green heroin or cocaine but that the users marijuana in public; clients in Harvest marijuana eradication are not aware of this practice until Birmingham, Detroit, Memphis, effort was reinstated in April 2001. they are tested at the clinic. The Miami, New Orleans, Portland (ME), The epidemiologic source predicts Honolulu source notes a decline in St. Louis, and Sioux Falls tend to do that the amount of “local grow” the number of combinations. so in private; and clients in Denver, will go back down, but that this El Paso, Los Angeles, and Seattle are decline will affect the amount of Where and with whom is mari- equally likely to smoke marijuana in marijuana exported, not the juana used? As reported in the last public and in private. amount consumed locally. Hawaii Pulse Check, many epidemiologic and also has a “Weed and Seed” ethnographic sources use the word Marijuana users in methadone program, similar to many States’ “everywhere” to describe the settings programs, however, have much more “Drug Free Zones,” with stiff and contexts of marijuana use. Of 20 discrete use patterns than their coun- sentences for drug arrests sources who discussed this question, terparts in non-methadone treatment. around schools. 11 report that users are equally likely In the majority of reporting programs, to smoke the drug both indoors and users prefer to smoke marijuana Sioux Falls, SD: The local school outdoors, 12 assert that users tend to indoors rather than outdoors, and in district is promoting a parent edu- use it in groups or among friends, private rather than in public. These cation program that supports zero and 9 report that users are equally clients, however, still retain the social tolerance for all drugs. The effort likely to smoke marijuana both in aspect of marijuana use: no metha- includes letters to parents and bill- public and in private. Solo use and done treatment sources report that boards about communicating with group use are equally likely in eight solo use is predominant over use in their children. Anecdotal reports cities. For example, in Boston, users groups or among friends. from parents so far suggest that the report smoking marijuana while alone program is having a positive as a sleep aid or sexual stimulant. MARIJUANA: THE COMMUNITY impact. Additionally, the area has However, in no city does any source What is the impact of and recently completed its first full year report that solo use is predominant. community reaction to the mari- of a school-based drug testing The specific settings are as varied as juana problem? program partially funded by the school system. Under this program, the possibilities—from concerts in Billings, MT: A new media parents can sign up their children Philadelphia to the workplace in St. campaign, targeting both parents in advance for random testing and Louis, from festivals in Denver to and youth, focuses on marijuana and agree to have conversations with outside supermarkets and shopping alcohol. The campaign is converting them about drugs; alternatively, malls in El Paso, from before and existing ONDCP printed matter into parents can request one-time tests after raves in Miami to around junior locally relevant messages. Efforts are as they feel necessary. Students high and high schools in 10 Pulse underway to similarly access and from the first category are testing Check cities. localize ONDCP’s Media Campaign positive at significantly lower messages. Several other recent Similarly, non-methadone treatment levels than those from the second community prevention efforts sources frequently report that category. Thus, apparently, the include the following: parent semi- marijuana users are equally likely to parent-child conversations are nars; services to under-privileged, smoke the drug indoors and out- having an impact, and it is possible high-risk youth, such as mentor doors, and the majority reports that that students are using the testing programs at Boys’ and Girls’ Clubs; users tend to smoke the drug in as an excuse not to use the drug. and programs that focus on Native groups or among friends. These American youth. It is too early to sources, however, are about equally assess the impact of these efforts, page 66 Pulse Check: November 2001 METHAMPHETAMINE

METHAMPHETAMINE: and the epidemiologic and non- and Sioux Falls (the law enforcement, THE PERCEPTION methadone sources in Honolulu. epidemiologic, and methadone and How do Pulse Check sources Additionally, nine sources in five non-methadone treatment sources). perceive the methamphetamine cities (all western) consider metham- Since the last Pulse Check reporting problem in their communities, phetamine the second most widely period, no changes were reported in and have their perceptions used drug: in Billings (the epidemio- the perceptions of methamphetamine changed? Only three sources in logic and non-methadone treatment as the most or second most widely two cities (both western) consider sources), Denver (the non-methadone abused drug. methamphetamine the most widely treatment source), Honolulu (the law More sources report methamphe- used drug in their communities: the enforcement source), Los Angeles (the tamine as contributing to the most law enforcement source in Billings non-methadone treatment source), serious consequences in their commu- nities than report methamphetamine as Exhibit 1. the most widely used drug. Thirteen How available is methamphetamine across the 21 Pulse Check cities? sources in four cities (Billings, Denver, According to law enforcement sources... (N=21) Honolulu, and Sioux Falls) report methamphetamine as contributing to the most serious consequences. The Memphis law enforcement source is the only one to report methampheta- mine as the drug contributing to the second most serious consequences. Again, since the last Pulse Check, no changes were reported in the percep- tions of methamphetamine as the drug of abuse contributing to the most or second most serious consequences.

METHAMPHETAMINE: THE DRUG

Widely Available Somewhat Available How available is methamphe- tamine across the country? Not very Available Not Available (Exhibit 1) Nearly two-thirds (25 of 42) of law enforcement, epidemiolog- According to epidemiologists and ethnographers... (N=19)* ic, and ethnographic sources report methamphetamine as somewhat or widely available in their communities, and availability varies widely by region. In the West, it considered widely available by nearly every respondent (in Billings, Denver, Los Angeles, Honolulu, and Seattle); in the Midwest, it ranges from not very available (in Chicago) to widely avail- able; in the South, it ranges from not very to widely available; and in the Northeast, it is not very or not avail- able, according to nearly every *The epidemiologic and ethnographic sources in Columbia and El Paso did not provide this respondent. information.

Pulse Check: November 2001 page 67 METHAMPHETAMINE

Has methamphetamine avail- Exhibit 2. lower purity methamphetamine) is ability changed? (Exhibit 2) Since How has methamphetamine most often used. According to the law the last reporting period, metham- availability changed enforcement source in Seattle, locally phetamine availability increased or (fall 2000 vs spring 2001)?* produced methamphetamine is purer remained stable according to all law than methamphetamine produced in enforcement, epidemiologic, and Mexico. ethnographic respondents, with the Since the last reporting period, exception of the law enforcement Billings, MTL source in Philadelphia and the epi- Birmingham, ALL methamphetamine labs have increased demiologic source in Boston, who Chicago, ILL in several Pulse Check cities, including report availability declines. Similar to Columbia, SCL Detroit, Memphis, Portland (ME), St. the last Pulse Check, most increases Denver, COL Louis, and Sioux Falls. Local box labs occurred in the South, Midwest, and Detroit, MIE or local clandestine labs have L West, although the percentage of Honolulu, HI increased in Denver, Los Angeles, L western sources reporting increases Memphis, TN Memphis, Portland (ME), Sioux Falls, L this reporting period is lower than Portland, ME and Seattle. The Portland law Seattle, WAL,E the percentage reporting increases enforcement source states that an Sioux Falls, SDL last period (50 versus 86 percent). increasing number of people, Washington, DCL,E typically from the Southwest, are What type of methamphe- Baltimore, MDL Honolulu, HIE beginning to create metham- tamine is available? Locally Billings, MTE Los Angeles, CAL,E phetamine labs in that city. produced methamphetamine is Birmingham, ALE Miami, FLL,E The Denver law enforcement L L slightly more available than Boston, MA New Orleans, LA source reports that metham- E L,E methamphetamine produced in Chicago, IL New York, NY phetamine produced by the Denver, COE Philadelphia, PAE Mexico, according to law Nazi method is increasing. The Detroit, MIL Sioux Falls, SDE enforcement, epidemiologic, and Seattle law enforcement source El Paso, TXL St. Louis, MOL,E ethnographic respondents. “Ice,” states that although the number Philadelphia, PAL nearly 100 percent pure metham- of local box labs has increased, law Boston, MAE phetamine, is not very available in enforcement officials focus their most cities, except in Honolulu, efforts on the large labs. The where it is widely available according Memphis law enforcement source to both the law enforcement and states that more amphetamine is L Law enforcement respondents epidemiologic sources. E Epidemiologic/ethnographic respondents being produced than methampheta- *The Baltimore, Columbia (SC), El Paso, mine, and the Denver epidemiologist According to most law enforcement, Memphis, New Orleans, and Portland (ME) epidemiologic/ethnographic sources did not reports that dietary supplements are epidemiologic, and ethnographic provide this information. often used in the methamphetamine sources (in Billings, Columbia [SC], production process. Denver, El Paso, Memphis, Portland The manufacturing processes used to [ME], St. Louis, and Sioux Falls) most produce methamphetamine differ by What are methamphetamine available methamphetamine is pro- region. In the Midwest, the “Nazi prices and purity levels across duced in “box labs,” small, mobile, method” (involving ephedrine or the country? (Exhibit 3) Reported clandestine labs often located in rural pseudoephedrine, lithium, and anhy- gram prices (the most common unit areas. Additionally, methamphetamine drous ammonia) is most often used. In of methamphetamine sold) vary labs run by large operations in Mexico the South and West, both the “cold- widely: $100 in the Northeast and California produce some of the cooking method” (involving ephedrine, (Boston and Philadelphia reporting), methamphetamine available in Denver, red phosphorus, and iodine crystals) $80–$175 in the South, $330 in Detroit, Los Angeles, Philadelphia, and the Nazi method are used. In Chicago, and $20–$300 in the West. Seattle, and Washington, DC. Philadelphia, the “P2P (phenyl-2- propanone) method” (producing a page 68 Pulse Check: November 2001 METHAMPHETAMINE

Exhibit 3. produced methamphetamine is often How much does methamphetamine cost in 16 Pulse Check cities? of higher purity.

City Gram price Ounce price Purity (%) How is methamphetamine Boston, MA $100 NR NR referred to across the country? Philadelphia, PA $100 NR <25 (Exhibit 4) Across the country, Portland, ME NR $1,400 40 Northeast methamphetamine is often referred to Birmingham, AL $120 $1,800 NR Columbia, SC $175 NR NR as “meth,” “speed,” “crank,” and Memphis, TN $90–$110 NR 90–95 “crystal.” Other slang terms vary by region and tend to be based on the

South Miami, FL $80–$100 NR NR New Orleans, LA $100–$150 NR NR color or consistency of the available Washington, DC $140 NR NR methamphetamine, such as “clear,” Chicago, IL $330 NR NR “glass,” “yellow girl,” and “cinna- Detroit, MI NR $500–$2,000 20–25 mon.” Often terms are based on

Midwest Sioux Falls, SD NR $800–$1,000 NR production methods: “bathtub meth” Denver, CO $80–$125 NR 20–90 refers to methamphetamine Honolulu, HI $200–$300 NR NR manufactured in bathtubs, and

West Los Angeles, CA $80–$100 NR 15–35 “Christmas tree meth” refers to Seattle, WA $20–$60 $350–$650 75–95 green methamphetamine produced Sources: Law enforcement, epidemiologic, and ethnographic respondents using Drano® crystals.

Between fall 2000 and spring 2001, Exhibit 4. prices remained relatively stable, How is methamphetamine referred to in different regions of the country? except in Memphis, where prices declined slightly according to the law Ice, peanut butter, glass, anhydrous, soap, enforcement source, and in Chicago, fire, nazimeth, bathtub meth, CR, chemical, california, spackle, getgo, white crosses, where prices increased according to speckled birds, yellow jackets, christmas the law enforcement source. trees, black beauty, poppers, pink hearts, (also known by the color of the substance: Glass, baggies, red, black, brown, white, white rock, pink) Methamphetamine purity levels, window, yellow reported by only seven sources, vary girl MIDWEST WEST widely, ranging from 15–35 percent NORTHEAST in Los Angeles to 90–95 percent in Hydro, dro, Memphis. Since the last reporting 8 ball, OZs, period, purity levels changed in elbows, half several cities: according to the law elbows enforcement source in Denver and Los Angeles, purity increased, possibly because high-purity metham- phetamine produced in local labs by the Nazi method has replaced lower purity methamphetamine produced in Clear, cloud, Mexico. Similarly, the law enforce- ice, batu, SOUTH ment source in Seattle states that the shabu purity of methamphetamine produced Ice, blade, snow, christmas tree meth, holiday meth, cinnamon (pink), X’s and O’s, hugs and in Mexico decreased because it has kisses, sugar, good glass, hydro, rice krispy been diluted with methylsulfonyl methane (MSM) and that locally Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents

Pulse Check: November 2001 page 69 METHAMPHETAMINE

How is methamphetamine sellers are fairly independent with do sell other drugs, namely heroin, packaged? According to law two to three “runners,” and some are crack and powder cocaine, and enforcement, epidemiologic, and affiliated with Mexican nationals. marijuana. Additionally, methamphet- ethnographic respondents, metham- amine sellers often sell cocaine or phetamine is most commonly pack- How is street-level metham- ecstasy in Memphis, ecstasy in Miami, aged in plastic sandwich or zipper phetamine sold? According to law and powder cocaine and club drugs bags, as reported in the last Pulse enforcement, epidemiologic, and (including ecstasy, GHB, and keta- Check. Additional types of packaging ethnographic respondents, metham- mine) in Washington, DC. vary widely: it is packaged in folded phetamine is sold using a variety of paper in Detroit, El Paso, Los methods. The most common are Do street-level methampheta- Angeles, and Memphis; small coin hand-to-hand sales through acquain- mine sellers use their own drug? zipper bags in El Paso, Honolulu, and tance networks. Many sales also Most law enforcement, epidemiolog- Washington, DC; tied-off corners of involve beeper or cell phone technol- ic, and ethnographic respondents (15 plastic bags in St. Louis and Sioux ogy (as reported in 12 cities), and in of 23) report that street-level Falls; cellophane or plastic wrap with 7 cities (Billings, Birmingham, methamphetamine sellers are very duct tape in Denver and Los Angeles; Denver, Honolulu, Memphis, likely to use the drug, as reported in vials in Miami and Seattle; and bal- Philadelphia, and St. Louis), delivery- the last Pulse Check. Reported levels loons in Denver. It is sold loose in type services are used. of likeliness to use the drug are high- rock form, like crack, in Birmingham, est among western sources. According St. Louis, and Seattle. Few sources How old are street-level to the St. Louis epidemiologist, inde- in the Northeast responded to this methamphetamine sellers? Law pendent sellers are very likely to use question, in keeping with the lower enforcement, epidemiologic, and the drug, but organized sellers are not availability in that region; the widest ethnographic respondents across the very likely to use the drug. variety of packaging was reported in Nation report methamphetamine the West, corresponding to the wider sellers as predominantly young adults Are street-level methampheta- availability in that region. (18–30 years), with a few exceptions: mine sellers involved in other according to four sources (the law crimes? (Exhibit 5) According to METHAMPHETAMINE: enforcement sources in Los Angeles, most law enforcement, epidemiologic, THE SELLERS Memphis, and Sioux Falls, and the and ethnographic respondents, epidemiologic source in St. Louis), methamphetamine sellers continue to How are street-level metham- sellers are evenly split between young be somewhat involved or very likely phetamine sellers organized? adults and adults (>30 years), and to be involved in other crimes, most According to law enforcement, according six sources (the law commonly domestic violence, nonvio- epidemiologic, and ethnographic enforcement sources in Baltimore, lent crimes, and other violent crimes. respondents, methamphetamine sell- Columbia [SC], Philadelphia, Portland Furthermore, methamphetamine sell- ers are predominantly independent in [ME], and St. Louis, and the Billings ers who are organized are reported as the Midwest, mostly independent in epidemiologic source), they are more likely to be involved in other the Northeast (except in Philadelphia, mostly adults. crimes than those who are independ- where biker and organized crime ent. Methamphetamine sellers seem groups are the predominant sellers), What other drugs do street-level particularly involved in domestic vio- and both independent and organized methamphetamine sellers sell? lence: according to 34 law enforce- in the South and West. According to Similar to reports in the last Pulse ment and epidemiologic respondents, the epidemiologist in St. Louis, the Check, most (13 of 22) law methamphetamine sellers account for affiliation of methamphetamine dis- enforcement, epidemiologic, and 44 percent of the domestic violence tributors depends on the source: ethnographic respondents agree that among drug sellers, compared with independent sellers distribute locally methamphetamine sellers do not only 24 percent for crack cocaine produced methamphetamine, and typically sell other drugs, but all sellers, 20 percent for powder cocaine organized sellers distribute Mexican respondents in the West (5 of 5) sellers, and 9 percent for heroin sellers. methamphetamine. In Honolulu, report that methamphetamine sellers page 70 Pulse Check: November 2001 METHAMPHETAMINE

Exhibit 5. Where is methamphetamine In what other crimes are illicit drug sellers involved, by different drugs, sold? (Exhibit 6) The geographic across Pulse Check sites? location of methamphetamine sales varies widely by region. In the West, 44% except for Honolulu (where sales occur in the central city), respondents agree that sales occur in all areas of the city: suburban, rural, and central. Methamphetamine Domestic Nonviolent In the Midwest, respondents cite violence crimes Heroin mostly rural areas for methampheta- (N=96) (N=34) Crack mine sales, except in Chicago, where suburbs are mentioned. In the Powder cocaine Northeast, rural areas are mentioned Violent Marijana by the law enforcement sources in crimes (N=75) Boston and Portland (ME), and all areas are mentioned in Philadelphia. Gang-related Prostitution Epidemiologists in the Northeast did (N=44) crimes not respond to this question. In the (N=60) South, sales settings vary: all areas are Sources: Law enforcement, epidemiologic, and ethnographic respondents mentioned in Birmingham; suburbs are mentioned in Columbia (SC) and

Exhibit 6. Where is methamphetamine sold and used across 18 Pulse Check cities?*

Private Raves Public Play- Shop- Around Hotels/ Total Resi- Private Inside Night- Con- Hous- College grounds/ ping Crack Super- Motels # City Streets dences Parties Cars Clubs certs ing Campus Parks Malls Houses markets Settings Sell Use Sell Use Sell Use Sell UseSell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Boston, MA 61 Philadelphia, PA 43 Portland, ME 1NR Northeast Birmingham, AL 3 NR Columbia, SC 1NR El Paso, TX 19

South Memphis, TN 12 10 Miami, FL 32 Washington, DC 45 Chicago, IL 15 Detroit, MI 14 St. Louis, MO 62 Midwest Sioux Falls, SD 83 Billings, MT 12 4 Denver, CO 98 Honolulu, HI 12 2 West Los Angeles, CA 26 Seattle, WA 86

Sources: Law enforcement, epidemiologic, and ethnographic respondents *For sales settings law enforcement, epidemiologic, and ethnographic sources responded, except for the following: the law enforcement sources in Baltimore, Chicago, Detroit, New Orleans, and New York, and the epidemiologic sources in Baltimore, Billings, Birmingham, Boston, Columbia (SC), El Paso, Los Angeles, New Orleans, New York, Philadelphia, Portland (ME), and Seattle. For users settings, epidemiologic and ethnographic sources responded, except for the sources in Baltimore, Birmingham, Columbia (SC), New Orleans, New York, and Portland (ME).

Pulse Check: November 2001 page 71 METHAMPHETAMINE

El Paso; the central city is mentioned Then and Now: in Memphis and Washington, DC; How have methamphetamine user characteristics changed (fall 2000 vs and suburbs and the Miami Beach spring 2001)? area are mentioned in Miami. According to epidemiologic and ethnographic sources, methamphetamine user All law enforcement, epidemiologic, characteristics have changed in several areas: and ethnographic respondents in the West report that outdoor and indoor ➤ Billings, Detroit, and Washington, DC: Although adults (>30 years) are the sales are equally common. In the predominant users, young adults (18–30 years) are cited as emerging user groups. other three regions, indoors sales are ➤ Sioux Falls: Pre-adolescents (<13 years) are cited as an emerging user group. generally more common than out- doors sales, but several respondents ➤ Detroit and Honolulu: Most methamphetamine users are male, but female (in Birmingham, Memphis, Philadel- methamphetamine users have increased. phia, Sioux Falls, and Washington, DC) report that outdoor and indoor ➤ Los Angeles: Hispanics and Asian/Pacific Islanders are increasingly using sales are equally common. The most methamphetamine. frequently mentioned specific sales ➤ Washington, DC: Hispanics are cited as an emerging methamphetamine user settings, according to law enforce- group. ment, epidemiologic, and ethno- graphic respondents, continue to be ➤ Los Angeles and Honolulu: Methamphetamine users who reside in suburban private residences, followed by areas have increased. nightclubs and bars, private parties, ➤ and inside cars. St. Louis: Methamphetamine users who reside in central city and suburban areas are emerging groups. METHAMPHETAMINE: THE USERS ➤ Honolulu, El Paso, and St. Louis: Injecting as a route of methamphetamine How have novice methampheta- administration is increasing. mine treatment clients changed between fall 2000 and spring city, according to 15 epidemiologic Are there any gender differences 2001? Most (9 of 15) non- and ethnographic sources, with most in who uses methamphetamine? methadone treatment respondents (8) reporting young adults (18–30 According to most (11 of 15) report that the number of novice years) as the predominant users (in epidemiologic and ethnographic methamphetamine users in treatment Chicago, El Paso, Los Angeles, respondents, methamphetamine users (defined as any drug treatment client Memphis, Miami, St. Louis, Sioux are predominantly male, as reported who has recently begun using Falls, and Seattle). Additionally, four in the last Pulse Check. Only three methamphetamine) is stable, with a respondents (in Billings, Denver, sources (in Billings, Los Angeles, and few exceptions: novice users Philadelphia, and Washington, DC) Sioux Falls) report methamphetamine increased in Billings, Denver, El Paso, cite adults (>30 years) as the pre- users as split evenly between genders, and Sioux Falls; they declined in dominant methamphetamine users, and only in El Paso are methampheta- Portland (ME) and among adolescents two (in Birmingham and Detroit) cite mine users primarily females. By con- in Honolulu. Methadone treatment both young adults and adults, and the trast, most (8 of 12) non-methadone sources did not provide information Honolulu source cites adolescents and treatment respondents report that on methamphetamine users or young adults. Based on regions, no males and females are equally likely methamphetamine treatment clients. patterns in the age of methampheta- to use methamphetamine; the remain- mine users emerged. Most (8 of 12) ing sources report that users tend to How old are methamphetamine non-methadone treatment providers be males. users? (Exhibit 7) As reported in the concur that methamphetamine users last Pulse Check, the predominant age are predominantly young adults. of methamphetamine users varies by page 72 Pulse Check: November 2001 METHAMPHETAMINE

Exhibit 7. How do methamphetamine users What age group is most likely to use methamphetamine?* wind up in treatment? Adolescents (13–18) Young Adults (18–30) Adults (>30) Courts and the criminal justice system Philadelphia, PAE,N Philadelphia, PAN are the most common referral sources N Portland, ME for clients entering treatment for meth- Northeast amphetamine addiction, according to Columbia, SCN Birmingham, ALE,N Birmingham, ALE non-methadone treatment respondents. E,N E El Paso, TX Washington, DC Individual referrals follow closely as the E South Memphis, TN second most common referral source. Miami, FLE

N E E Sioux Falls, SD Chicago, IL Detroit, MI How do most methamphetamine Detroit, MIE users take the drug? Route of St. Louis, MOE,N

Midwest administration for methamphetamine Sioux Falls, SDE,N varies widely, according to epidemio- Honolulu, HIE Billings, MTN Billings, MTE logic and ethnographic sources. Most Los Angeles, CAN Denver, COE (3 of 4) responding sources in the Denver, CON West (in Denver, Los Angeles, and

E,N Honolulu) report smoking as the pre- West Honolulu, HI dominant route of administration, but Los Angeles, CAE,N the Seattle epidemiologic source Seattle, WAE,N reports oral ingestion as the predomi- E Epidemiologic/ethnographic respondents N Non-methadone treatment respondents nant route. Snorting predominates in *Notes: Epidemiologic sources did not respond in Baltimore, Columbia (SC), New Orleans, and three non-western areas (Chicago, Portland (ME); non-methadone treatment sources did not respond in Baltimore, Boston, Chicago, Detroit, Honolulu, Memphis, Miami, New Orleans, New York, Seattle, and Memphis, and Washington, DC), oral Washington, DC. If respondents cited methamphetamine users as evenly split between two age ingestion predominates in Miami, and groups, that respondent is listed under both age groups. Two non-methadone treatment sources from Sioux Falls responded. smoking is most common in Sioux Falls and New York. In Philadelphia Is any racial/ethnic or socioeco- SES backgrounds and 9 reporting and Birmingham, snorting and nomic group more likely to use them as being middle SES. All (12) injection are mentioned, in El Paso methamphetamine? As reported in non-methadone treatment respon- injection and oral ingestion are men- the last Pulse Check, methampheta- dents concur with epidemiologic tioned, and in Detroit, snorting and mine users tend to be Whites and sources that users tend to be of low oral ingestion are mentioned. overrepresented compared with the or middle SES. According to the Los Angeles and general population, according to St. Louis epidemiologic sources, nearly all (17 of 19) epidemiologic and Where do methamphetamine methamphetamine users often switch ethnographic sources. In Billings, they users tend to reside? Depending routes of administration. Most non- are split evenly between Whites and on the region, the residences of methadone treatment respondents Native Americans, and in Honolulu, methamphetamine users vary widely. agree with their epidemiologic coun- they are be split evenly between According to epidemiologic and terparts about predominant route of Whites and Asian/Pacific Islanders. ethnographic sources, most metham- administration. Most non-methadone treatment phetamine users reside in suburban What other drugs do metham- respondents agree with their epidemi- and rural areas in the Midwest; in phetamine users take? ologic and ethnographic counterparts. central city areas in the Northeast; and in rural areas, suburbs, and Methamphetamine users take a Methamphetamine users continue to central city areas in the South and variety of other drugs, according to be of low or middle SES, with 7 of 16 West. Most non-methadone treatment epidemiologic and ethnographic epidemiologic and ethnographic respondents agree with their respondents, and as reported in the sources reporting them as having low epidemiologic counterparts. last Pulse Check. The most common

Pulse Check: November 2001 page 73 METHAMPHETAMINE

drugs used in combination with mine is generally used indoors and in private parties and nightclubs. Other methamphetamine are marijuana (in private. Methamphetamine use is common use settings include inside Birmingham, Detroit, Los Angeles, most often a group activity, according cars and raves and concerts, similar to Memphis, Philadelphia, and St. Louis) to the vast majority (21 of 27) of those reported as sales settings. and ecstasy (in Miami and Washin- those respondents. Additionally, the Moreover, respondents in the South gton, DC). Non-methadone treatment Detroit and Seattle epidemiologic and West report more user settings sources agree that marijuana is often sources and the Philadelphia and than those in other regions. Non- used in combination with metham- Honolulu non-methadone treatment methadone treatment respondents phetamine, as reported in Billings, sources report that most metham- also report private residences as the Denver, Los Angeles, Philadelphia, phetamine users take the drug both most common setting for metham- St. Louis, and Sioux Falls. alone and in groups; the Miami and phetamine use, followed by private Los Angeles epidemiologic sources parties, inside cars, and parks and Where and with whom do report that most use the drug alone. playgrounds. methamphetamine users take the drug? (Exhibit 6) According to The most frequently mentioned user nearly all (17 of 27) epidemiologic, settings, according to epidemiologic ethnographic, and non-methadone and ethnographic respondents are treatment respondents, methampheta- private residences, followed by

page 74 Pulse Check: November 2001 CLUB DRUGS

ECSTASY AND OTHER CLUB DRUGS in the United States but legally that club drug users have not entered prescribed in Mexico and other treatment in large numbers. It is The last two issues of Pulse Check countries. It has been involved in important to note that the amount of addressed “club drugs” as a special numerous drug-assisted rapes, but information received from Pulse topic because of reports that these its most common abuse pattern is Check sources was much greater for drugs were increasingly available and episodic use by teenagers and ecstasy than for other club drugs. that the number of users increased. young adults as an “alcohol The continuing growth of the club extender” and disinhibitory agent. Although these drugs are categorized drug problem, particularly ecstasy, has as club drugs, the settings and contexts warranted the addition of a club Nitrous oxide is an inhalant often of their use are expanding to include drugs section to the report. referred to as laughing gas. venues other than nightclubs and raves. Moreover, Pulse Check sources This broad category of drugs includes Lysergic acid diethylamide (LSD) continue to suggest that White non- the following: (“acid”) is a hallucinogen, most Hispanics are no longer the exclusive commonly distributed on blotter Ecstasy (methylenedioxymetham- sellers and users of the drugs. An paper and taken orally. phetamine, or MDMA), a synthetic, increasing number of Pulse Check psychoactive substance with sources report that ecstasy is being The club or rave experience typically stimulant and mild hallucinogenic sold with heroin and powder and involves music, dancing, and socializ- properties, is the most widely crack cocaine and that ecstasy users ing and usually lasts through the available of club drugs and often are also using these other illicit drugs. night. Club drugs are commonly used in pill form. Just as Pulse Check continues to track combined with one another and with club drug activity due to concern other illicit drugs or alcohol. As Gamma hydroxybutyrate (GHB) is about increased availability and use, reported in the last Pulse Check, a central nervous system depressant Federal efforts to combat club treatment sources had less first-hand usually sold as an odorless, color- drugs (ecstasy in particular) include knowledge of club drug activity than less liquid in water bottles. GHB enacting new Federal sentencing the law enforcement, epidemiologic, precursors, gamma butyrolactone guidelines for ecstasy (MDMA) and and ethnographic sources, indicating (GBL) (a chemical used in many ecstasy-like substances (including industrial cleaners) and 1,4 butane- diol (1,4 BD), convert into GHB in Exhibit 1. Where are club drugs emerging? the body and have been sold as nutritional supplements in health food stores and over the Internet, often in powder or capsule form. GHB, Rohypnol, Because the effects of GHB precur- designer sors are similar to those of GHB, ampheta- many Pulse Check sources do not mines* distinguish between GHB and its GHB, ketamine* precursors. GHB* Ketamine is a prescription anesthetic with hallucinogenic and dissociative properties and market- ed for human use, but primarily for veterinary use. Ketamine can be Ecstasy reported as emerging since last reporting period used in liquid or powder form. No club drugs reported as emerging since last reporting period

Rohypnol (flunitrazepam) is a Sources: Law enforcement, epidemiologic, ethnographic, and non-methadone treatment benzodiazepine, no longer marketed respondents; methadone treatment sources did not provide information on club drugs. *Additional club drugs reported as emerging

Pulse Check: November 2001 page 75 CLUB DRUGS

methylenedioxyamphetamine [MDA] across the Nation, with no regional remains the most available of club and paramethoxyamphetamine patterns evident. Other club drugs drugs, with more than 90 percent (38 [PMA]). The new guidelines, effective mentioned as emerging include GHB of 42) of law enforcement, epidemio- November 1, 2001, will increase the in Denver, Los Angeles, and Hono- logic, and ethnographic sources prison term for the sale of 200 grams lulu; diverted ketamine in Denver; reporting it as widely or somewhat of ecstasy (about 800 pills) from 15 and Rohypnol (flunitrazepam) and available. Only three sources deem months to 5 years, and the penalty designer amphetamines distributed as ecstasy as not very available: the for sale of 8,000 pills will also rise samples at raves in Los Angeles. In epidemiologic sources in Billings and from 41 months to 120 months (simi- only six cities (Billings, Birmingham, New Orleans and the law enforce- lar to that of powder cocaine). Pulse Chicago, El Paso, New Orleans, and ment source in El Paso. Availability of Check will continue to track ecstasy Washington, DC) are club drugs not club drugs is not based on regional and club drug activity and, as new reported as emerging this reporting patterns. laws are established, will report period. In four of those cities changes, if any, in the sale and use of (Chicago, El Paso, New Orleans, and As reported in the last Pulse Check, club drugs. Washington, DC), club drugs were GHB follows ecstasy as the most reported as emerging last reporting available club drug, reported as wide- ECSTASY AND OTHER CLUB period, suggesting that these are now ly or somewhat available by 40 per- DRUGS: THE PERCEPTION established drugs of abuse in those cent (17 of 42) of respondents. GHB How do Pulse Check sources communities. is described as not available in only perceive the ecstasy problem in three cities: Denver, El Paso, and their communities? Ecstasy is not ECSTASY AND OTHER CLUB Portland (ME). As reported in the last DRUGS: AVAILABILITY, SLANG, considered the most widely abused Pulse Check, cities where wide avail- AND COMBINATIONS drug by any law enforcement, epi- ability is reported are predominantly demiologic, ethnographic, or treat- How available are club drugs in in the West or South: Billings, ment source, but it is considered the Pulse Check communities? Birmingham, Denver, Los Angeles, second most widely abused drug by (Exhibit 2) Nearly identical to reports Miami, New Orleans, and (in the sources in four cities (Billings, in the last Pulse Check, ecstasy Northeast) New York. Honolulu, Memphis, and Miami), an increase from only one source (the Memphis law enforcement source) Exhibit 2. during the last reporting period. How available are club drugs across the 21 Pulse Check cities? Additionally, the law enforcement source in Billings is the only source to Widely Available Not Available or Not Very Available report it as the drug contributing to Percent Somewhat Available No Response the second most serious consequences. 70 No other source reports ecstasy as 60 contributing to the most or second most serious consequences in their 50 communities, and no other club drugs 40 were mentioned as such. 30 What club drugs are emerging in Pulse Check communities? 20 (Exhibit 1) Although not currently 10 considered the drug contributing to 0 the most serious consequences in any Ecstasy GHB Ketamine Rohypnol city, ecstasy is reported as an emerg- (N=42) ing drug of abuse by 25 Pulse Check sources in most cities (15 of 21) Sources: Law enforcement, epidemiologic, and ethnographic respondents page 76 Pulse Check: November 2001 CLUB DRUGS

Diverted ketamine is considered ecstasy availability increased or exceptions: the law enforcement somewhat or widely available by 29 remained stable between fall 2000 sources in New Orleans and Portland percent (12 of 42) of law enforce- and spring 2001, with 64 percent (27 report increases, and declines are ment, epidemiologic, and ethno- sources) reporting increases, and 29 reported in Birmingham, El Paso, graphic sources, a lower percentage percent reporting stable trends. As Honolulu, and Miami. than that reported in the last Pulse with availability trends for other club Check. It is not available in three drugs, no regional patterns emerged. How are club drugs and their western areas (Billings, Denver, and combinations referred to across Honolulu), El Paso, and Sioux Falls. GHB availability continues to show the country ? (Exhibit 4) Slang Rohypnol remains the least available mixed trends, according to 42 law terms for ecstasy are similar across of the club drugs, with 19 percent of enforcement, epidemiologic, and the Nation. It continues to be gener- law enforcement, epidemiologic, and ethnographic sources: 24 percent ally referred to as “X,” although “E” ethnographic sources reporting it as report increases (in Birmingham, and “roll” are also used. The practice somewhat or widely available. Three Billings, Chicago, Denver, Memphis, of taking ecstasy is often referred to (in Los Angeles, New Orleans, and New Orleans, Portland [ME], Sioux as “rolling.” Ecstasy is often referred New York) report Rohypnol as widely Falls, and Washington, DC, according to by its design or the shape of the available, five report it as somewhat to both sources), 12 percent report pill: for example, it is called “sham- available (in Boston, Detroit, El Paso declines (in Columbia [SC], Detroit, rock” in St. Louis because pills may by both sources, and Seattle), and the Honolulu, Miami, and St. Louis), and be clover shaped and “Buddha” in rest report it as not or not very avail- most report availability as stable. Memphis because pills may be able. No regional patterns based on Ketamine availability increased stamped with a Buddha design. Other ketamine or Rohypnol availability according to sources in Chicago, ecstasy terms vary by locality, and are apparent. Columbia, New Orleans, New York, many terms are new this reporting Portland, and Washington, DC; period, suggesting increasing ecstasy How has club drug availability declined according to sources in availability and use. changed? (Exhibit 3) According to Honolulu and Miami; and remained all law enforcement, epidemiologic, stable according to remaining GHB continues to be referred to as and ethnographic sources who dis- respondents. Rohypnol availability “G” and ketamine as “K” or “special cussed this question (38 of 42), shows mostly stable trends, with few K.” Rohypnol is typically referred to as “roofies” and “rochas” where Exhibit 3. available. Other terms for these drugs Has club drug availability changed across the 21 Pulse Check cities (fall vary by locality, with no particular 2000 vs spring 2001)? regional patterns. Use of particular combinations of club drugs varies by Percent city and highlights that multisub- 100 stance use or “cafeteria-style use” 90 remains common among club 80 Up Stable Down No response drug users. 70 60 ECSTASY: THE DRUG 50 40 What form does ecstasy come 30 in? (Exhibit 5) According to law 20 enforcement, epidemiologic, and 10 ethnographic sources, the tablet form 0 of ecstasy remains, by far, the most Ecstasy GHB Ketamine Rohypnol available, followed by powder and (N=42) liquid forms. Powder ecstasy is widely available according to sources in Sources: Law enforcement, epidemiologic, and ethnographic respondents Boston, Memphis, and Portland

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(ME); it is somewhat available Exhibit 4. according to sources in seven other How are ecstasy and ecstasy combinations referred to across Pulse Check areas (Baltimore, Birmingham, cities? Columbia [SC], Los Angeles, Miami, Drug or drug combination Slang term City Philadelphia, and Washington, DC); Ecstasy Tabs Memphis, New Orleans, and it is not or not widely available and St. Louis elsewhere. The epidemiologic source The bean, beans Birmingham, Denver, in Sioux Falls regards liquid ecstasy as and Miami Beads, ills, and illy Denver somewhat available, and the epidemi- Candy, shamrock St. Louis ologic source in El Paso regards it as Buddha, eenie greenie, Memphis widely available. All other respon- Rolanda, and wafers dents report liquid ecstasy as not very Dice Columbia or not available. Disco biscuits Birmingham Sky Portland Tuna, X-Files Washington, DC As reported in the last Pulse Check and Two ecstasy pills Double stacks Chicago according to law enforcement, epi- Thick ecstasy pills Double stacks Memphis demiologic, and ethnographic sources, The use of more than one Stacking St. Louis ecstasy tablets are white or colored, ecstasy tablet at a time and many are pressed with designs and The use of more than one Piggybacking St. Louis logos that change periodically. The ecstasy tablet sequentially Ecstasy (adulterated Speedies Sioux Falls variety of designs or logos on ecstasy with amphetamine) tablets reported has increased dramati- Ecstasy (adulterated Snackies Sioux Falls cally since the last Pulse Check. with mescaline) Designs on ecstasy tablets common Ecstasy + LSD Candy flipping Chicago, Denver, and across the country include “E,” Philadelphia (new term “mitsubishi,” “mercedes,” “playboy,” and practice in this city) Ecstasy + LSD Trolling Miami and cartoon characters. Other designs Ecstasy +LSD or Flipping Boston differ according to city. In Columbia psilocybin mushrooms (SC), where a variety of stamped Ecstasy + GHB, keta- E sitting, sitting E St. Louis tablets are available, some are home mine, or nitrous oxide pressed. According to the law enforce- Ecstasy + ketamine Matrix Chicago Ecstasy + PCP Pikachu Washington, DC ment source in Denver, designs on (combined in a pill) (also the logo on the pill) ecstasy seized at raves vary widely, Ecstasy + psilocybin Hippie flipping Chicago but designs on ecstasy seized in large mushrooms shipments are the same. Ecstasy + Xanax® Zanybar Miami (alprazolam) How is street-level ecstasy Ecstasy + Viagra® Hammerheading Miami packaged? Overwhelmingly, law (sildenafil citrate) X's and O's enforcement, epidemiologic, and GHB Liquid X, liquid E Boston, Chicago, Denver Funk, holy water Denver ethnographic sources agree that ecsta- Gamma New Orleans sy tablets are not typically packaged, G juice St. Louis but sold as loose (or “naked”) pills. Scoop Birmingham Additionally, in Denver, El Paso, Water Sioux Falls Miami, and Portland (ME), pills are Ketamine Cat Columbia, Memphis, Washington, DC packaged in plastic bags; in Birming- Cat food, kitty, vitamin K Denver ham and Denver, they are packaged In the K-hole (use of ketamine) Boston in prescription bottles; in Billings and Thunder Columbia Honolulu, they are packaged in Sources: Law enforcement, epidemiologic, ethnographic, and treatment provider respondents Note: A term in bold face indicates that it is reported as new to the respondent's community since the last reporting period. page 78 Pulse Check: November 2001 CLUB DRUGS

Exhibit 5. enforcement source in Chicago, How are ecstasy pills labeled in reporting Pulse Check cities? prices increased. Other units of ecsta- City Label sy sold in Pulse Check cities include Boston, MA Mercedes, mitsubishi, and playboy small tablets (50–150 milligrams) for Philadelphia, PA Michelin and mitsubishi $10–$20 apiece in Seattle, one jar of 100 pills for $3,000 in Sioux Falls,

Northeast Portland, ME E, various numbers Columbia, SC Diamonds, elephants, mickey mouse, and mercedes and wholesale units at $6–$18 in El Paso, TX E New York and $7–$8 in Miami. Memphis, TN Arrowheads, cartoon characters, flintstone characters, lady- bugs, mercedes, teletubbie characters, and VW beetle What adulterants are added to South Miami, FL Cartoon characters ecstasy? (Exhibit 7) Similar to New Orleans, LA Mitsubishi, rolex the last reporting period, law Washington, DC E, animals, pikachu (contains PCP) enforcement, epidemiologic, and Chicago, IL Ferrari ethnographic sources report that Detroit, MI Butterflies, fish, and mitsubishi ecstasy may be adulterated with St. Louis, MO Clovers, mitsubishi, playboy, and statue of liberty Midwest other stimulants or may contain no Sioux Falls, SD Mitsubishi, nike, suns Denver, CO Cartoon characters, clovers, and stars MDMA. Additionally, according to the epidemiologic source in New West Honolulu, HI Happy faces, suns, pooh bear, mickey mouse York, powder cocaine has been sold Sources: Law enforcement, epidemiologic, and ethnographic respondents Note: A logo in bold face indicates that it is reported as new to the respondent's community since as powder ecstasy. last reporting period. Exhibit 7. plastic coin bags; in New Orleans, Exhibit 6. What other substances might be they are packaged in plastic logo- How much does a pill (one dose) contained in ecstasy tablets? of ecstasy cost in 17 Pulse Check emblazoned coin bags, similar to City Adulterant cities?* powder cocaine packaging; in St. Boston, MA Amphetamines, ketamine, Louis, they are packaged in cigarette City Price LSD, paramethoxyamphe- boxes; in Philadelphia, they are Boston, MA $20–$35 tamine (PMA), PCP strung on necklaces; and in Seattle, New York, NY $12.50–$38 Denver, CO Cocaine, heroin, they may be concealed in the ends of Philadelphia, PA $20–$35 strychnine glow necklaces. Northeast Portland, ME $25 Memphis, TN Depressants, heroin, Birmingham, AL $20–$35 methamphetamine What are street-level ecstasy Columbia, SC $20–$35 Miami, FL PMA prices across the country? Memphis, TN $20–$35 Philadelphia, PMA PA (Exhibit 6) The most commonly South Miami, FL $20–$50 St. Louis, PCP (sold as ecstasy and reported unit of ecstasy sold is one New Orleans, LA $25–$35 Washington, DC $18–$30 MO referred to as “space”) tablet (approximately 100–150 mil- Chicago, IL $20–$30 Sioux Falls, Amphetamine, mescaline ligrams according to the Miami law Detroit, MI $25–$30 SD enforcement source and 150–250 Midwest Sioux Falls, SD $30 Washington, Methamphetamine, PCP milligrams according to the Seattle Denver, CO $20–$25 DC (tablets with pikachu law enforcement source), selling at Honolulu, HI $25–$45 designs) $12.50–$38 in the Northeast, West Los Angeles, CA $20–$30 Sources: Law enforcement, epidemiologic, $20–$30 in the Midwest, $18–$50 in Seattle, WA $20–$30 and ethnographic respondents the South, and $20–$45 in the West. Note: An adulterant in bold face indicates Sources: Law enforcement, epidemiologic, that it is reported as new to the respondent’s Between fall 2000 and spring 2001, and ethnographic respondents community since the last reporting period. according to law enforcement, *Law enforcement, epidemiologic, and ethnographic respondents in Baltimore, epidemiologic, and ethnographic Billings, El Paso, and St. Louis did not sources, prices remained stable, with provide this information. one exception: according to the law

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Then and Now: Pulse Check sources discuss the How have street-level ecstasy sales changed between fall 2000 and wide range of MDMA purity in spring 2001? ecstasy tablets: Ecstasy seller ➤ Los Angeles, CA: The law enforcement source states that the Boston, MA: According to the law populations are number of independent ecstasy sellers has increased. enforcement source, a lot of phony expanding: ➤ ecstasy is available, and local manufac- Memphis, TN: According to the law enforcement source, ecstasy turers simply use pill molds to make sellers are expanding to include more high school students. them. The epidemiologic source ➤ St. Louis, MO: According to the epidemiologic source, more agrees and states that ecstasy purity adolescents are becoming involved with ecstasy sales, and now fluctuates wildly, though it may be about equal numbers of adolescents and young adults sell the drug. more consistent for buyers who find New seller groups ➤ Birmingham, AL regular dealers. include various ➤ ethnicities in the Columbia, SC Los Angeles, CA: Ecstasy pills Northeast and ➤ containing adulterants, referred to as Memphis, TN Blacks in the “bunk pills,” are common, but the ➤ South in five New York, NY epidemiologic source reports that they Pulse Check ➤ Philadelphia, PA are no longer seeing pills containing cities: paramethoxyamphetamine (PMA). Ecstasy sales ➤ Birmingham, AL: The law enforcement source reports that bars St. Louis: According to the epide- settings have and nightclubs are now catering to underage youth. Bars typically miologic source, ecstasy tablet dosage also expanded in have a “rave night” once a week, where no alcohol is sold, but varies greatly due to inconsistent cities across the where customers are selling marijuana and ecstasy. country: production methods. ➤ Portland, ME: Law enforcement sources report an increase in the number of local raves. Washington, DC: It is becoming harder to obtain pure MDMA tablets, ➤ St. Louis, MO: Ecstasy is now more prevalent in high schools and according to the epidemiologic source. is expanding from raves to schools and from central city areas to suburbs, according to the epidemiologic source.

➤ Washington, DC: According to the law enforcement source, ECSTASY: SALES ecstasy is increasingly sold on the street. Who sells ecstasy? Young adults are the predominant street-level Street-level ecstasy sellers tend to be “house dealers” at raves may be in ecstasy sellers, according to most (20 independent, according to most (19 charge of ecstasy sales, with their of 29) law enforcement, epidemio- of 30) law enforcement, epidemio- “runners” distributing drugs to indi- logic, and ethnographic respondents. logic and ethnographic respondents. vidual buyers; in Miami, organized Five sources (in Birmingham, Denver, Five respondents report ecstasy as sellers in clubs tend to be connected New Orleans, St. Louis, and Sioux organized, and five claim that ecstasy with drug trafficking; and in Los Falls) report ecstasy sellers as evenly sellers are evenly split between being Angeles, sellers tend to be affiliated split between young adults and independent and organized, with with organized crime. In Columbia adolescents, and four (in Baltimore, organized sellers more involved in (SC) and Denver, independent sellers Boston, Memphis, and Seattle) report raves and nightclub sales than are college students or those who sellers as primarily adolescents. A independent sellers. For example, have access to the college scene. summary of ecstasy drug market in Denver and Portland (ME), characteristics appears in exhibit 11 at the end of this section.

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Are ecstasy sellers involved in and prostitution (users prostituting crimes in Baltimore and gang-related other crimes? Most law enforce- for the drug) in Birmingham. crimes in Memphis. ment respondents (13 of 19) report that street-level ecstasy sellers are not Epidemiologic and ethnographic Do ecstasy sellers use their own typically involved in other crimes. respondents report that ecstasy deal- drug? Similar to information in the Reports of “somewhat” or “very like- ers are less involved in other crimes last Pulse Check, nearly all (25 of 27) ly” involved in other crimes are given than do the law enforcement sources. law enforcement, epidemiologic, and by six respondents (in Baltimore, Most (seven of eight) epidemiologic/ ethnographic respondents believe that Detroit, Portland (ME), Memphis, ethnographic respondents report ecstasy sellers are somewhat or very Miami, and New Orleans). Further- those selling ecstasy are “not at all” likely to use the drug. Only in more, ecstasy dealers are not typically or “not very likely” to be involved in Baltimore (by the epidemiologic involved in violence, according to 16 other crimes. Similar to the Baltimore source) and Miami (by the law en- of 17 respondents. Only the Balti- law enforcement response, according forcement source) are ecstasy more source associates violent crimes to the epidemiologic source, ecstasy sellers reported as not very likely with ecstasy sellers. Other crimes sellers are somewhat likely to be to use the drug. associated with ecstasy sellers include involved in other crimes in that city. drug-assisted rape in Baltimore, Other crimes reported by epidemio- Where is street-level ecstasy Denver, Los Angeles, and Memphis; logic and ethnographic sources are sold? (Exhibit 8) According to 20 domestic violence in Baltimore, typically nonviolent crimes, although law enforcement respondents, ecstasy gang-related activity in Honolulu; ecstasy sellers are reported to be sales take place in a wide variety of involved in prostitution and violent areas, mostly central cities and

Exhibit 8. Where is ecstasy sold and used across the 21 Pulse Check cities?*

Raves/ Night- College Private Shop- The Play- Total Con- clubs/ Cam- Residen- Private Inside Around ping Inter- Public grounds/ # City Streets certs bars puses ces Parties Cars Schools Malls net Housing Parks Settings Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Sell Use Sell Use Sell Use Boston, MA 5NR New York, NY 96 Philadelphia, PA 32

Northeast Portland, ME 43 Baltimore, MD 94 Birmingham, AL 63 Columbia, SC 43 El Paso, TX NR 7

South Memphis, TN 10 6 Miami, FL 10 3 New Orleans, LA 12 1 Washington, DC 84 Chicago, IL 55 Detroit, MI 83 St. Louis, MO 8NR Midwest Sioux Falls, SD 53 Billings, MT 9NR Denver, CO 89 Honolulu, HI 11 2 West Los Angeles, CA 35 Seattle, WA NR 4

Sources: Law enforcement, epidemiologic, and ethnographic respondents *For sales settings law enforcement, epidemiologic, and ethnographic sources responded, except for the following: the law enforcement source in El Paso and Seattle and the epidemiologic source in Billings, Columbia (SC), El Paso, Los Angeles, Honolulu, New Orleans, Philadelphia, Portland (ME), Sioux Falls, and Seattle. For users settings, epidemiologic and ethnographic sources responded, except for the sources in Billings, Boston, and St. Louis.

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suburbs. Law enforcement sources in Then and Now: six cities (Columbia [SC], Denver, New York, Philadelphia, Portland What other drugs are sold or used with club drugs (fall 2000 vs spring 2001)? [ME], and Washington, DC) report Perhaps the most disturbing changes in ecstasy and club drugs activity since the last ecstasy sales in all areas of the cities. reporting period are reports in several cities that they are sold and sometimes used with Similarly, according to epidemiologic other drugs of abuse, such as heroin and cocaine: and ethnographic respondents, the Los Angeles: ➤ locations of ecstasy sales vary widely, Club drugs are becoming the entry point for use of other drugs, such as marijuana, as noted by the epidemiologist. Many “rave occurring mostly in central city and kids” in that city start using GHB as part of the “water bottle syn- suburban areas. drome,” and then move to ecstasy use, followed by marijuana use.

➤ Raves and concerts, nightclubs and Memphis, TN: The epidemiologic source warns that ecstasy sellers are beginning to sell heroin and powder and crack cocaine. The sale of other bars, college campuses, private resi- illegal drugs by ecstasy dealers may be related to the increasing dences, private parties, and inside numbers of young ecstasy users using other drugs of abuse. cars remain the primary settings for ➤ ecstasy sales as reported by law Miami, FL: According to the law enforcement source, ecstasy sellers tend to deal in many drugs, including heroin, powder and crack cocaine, enforcement, epidemiologic, and and marijuana. As reported in the last Pulse Check, the law ethnographic sources. Reinforcing the enforcement source states that heroin and ecstasy sold and used widespread availability of ecstasy, in combination at raves may be a ploy to attract new heroin users. common sales settings also include The doses of heroin used in combination with ecstasy are small schools, streets, shopping malls, and enough to have little effect; therefore, the user may perceive heroin as harmless. the Internet. Less common settings include public housing developments New York, NY: ➤ Ecstasy is sold with other illicit drugs now because selling ecstasy in Miami, New Orleans, and Sioux can be extremely lucrative, according to the law enforcement Falls; playgrounds or parks in New source. Moreover, polydrug sales involving ecstasy are the norm, and ecstasy is actually becoming a currency of trade for Orleans and Honolulu; hotels and other drugs. motels in Columbia (SC); and many ➤ types of social gatherings, regardless Portland, ME: The law enforcement source reports an increase in polydrug sales of setting, in Baltimore. involving ecstasy. Washington, DC: ➤ Crack cocaine dealers on the street, according to the law enforcement source, are increasingly selling ecstasy. Ecstasy sales and user settings: A closer look and ethnographic respondents. sales. According to the Memphis law The numbers of different ecstasy sales Additionally, beepers or cell phones enforcement source, ecstasy transac- settings and user settings mentioned are used in 10 cities (Baltimore, tions are conducted via introductions; tend to be larger in the southern and western cities, possibly indicating wider Billings, Chicago, Detroit, Honolulu, that is, sellers are introduced to availability and use in those regions. Memphis, Miami, New Orleans, St. potential buyers by a liaison or Louis, and Washington, DC). mutual acquaintance who can vouch Ecstasy sales settings tend to overlap According to law enforcement for the seller. with user settings in most cities, but respondents, the drug is distributed typically more settings are mentioned by delivery-type services in five cities What other drugs do ecstasy for sales than for use. (Baltimore, Birmingham, Memphis, dealers sell? According to most (12 New Orleans, and St. Louis), and it is of 18) law enforcement respondents, sold via the Internet in four cities ecstasy sellers also tend to sell other How is street-level ecstasy sold? (Detroit, Honolulu, Memphis, and drugs. By contrast, according to most Ecstasy sales typically involve hand- New Orleans). Conversely, epidemio- (6 of 8) epidemiologic and ethno- to-hand sales through acquaintance logic and ethnographic respondents graphic respondents, ecstasy sellers networks, according to most (24 of do not report the use of delivery-type do not typically sell other drugs. 29) law enforcement, epidemiologic, services or the Internet for ecstasy Other drugs sold by ecstasy dealers, page 82 Pulse Check: November 2001 CLUB DRUGS

according to law enforcement, Then and Now: epidemiologic, and ethnographic How has ecstasy use changed (fall 2000 vs spring 2001)? sources, include other club drugs (especially GHB, ketamine, and LSD), Parallel to the expansion of ecstasy sales and seller populations, ecstasy use is expanding heroin, powder and crack cocaine, to new users groups and new settings in some Pulse Check areas: marijuana, methamphetamine (where Adolescent ecstasy ➤ it is available), and other diverted Columbia, SC users are increasing prescription drugs. The Philadelphia ➤ Los Angeles, CA in number, accord- ➤ law enforcement sources states that ing to epidemiologic Memphis, TN LSD is often sold as an ecstasy and ethnographic ➤ Miami, FL substitute. sources in seven ➤ St. Louis, MO sites across the ➤ Sioux Falls, SD ECSTASY: THE USERS country: ➤ Washington, DC How has the number of novice ecstasy users in treatment ➤ changed? (Exhibit 9) According to Ecstasy use is Los Angeles, CA ➤ most (9 of 15) non-methadone treat- expanding to non- Honolulu, HI White and Hispanic ➤ ment respondents, the number of Memphis, TN populations: novice ecstasy users in treatment ➤ Miami, FL (defined as any drug treatment client who has recently begun using ecstasy) Ecstasy use is ➤ Boston, MA: Settings for new ecstasy users include streets, pub- has increased since the last reporting expanding to new lic housing developments, and cars, according to the methadone treatment source. period, with the remaining respon- settings and contexts in several ➤ dents reporting stable trends. Only Denver, CO: According to the non-methadone treatment sites: source, new ecstasy user settings include supermarkets and one methadone treatment source (in nightclubs. Boston) responded to the question, ➤ Miami, FL: Ecstasy use is moving from a specific event or place reporting an increasing number of to more common daily use, and some users are beginning to use novice ecstasy users in treatment. the drug alone and in private, according to the epidemiologic source. Additionally, private residences, around schools, and Who uses ecstasy? Similar to private parties were added to the list of user settings. information in the last Pulse Check, Furthermore, according to the law enforcement source, as ecstasy users tend to be young (13–30 ecstasy activity has skyrocketed, the popularity of ecstasy use at raves has shifted to private parties. years), evenly split between genders, ➤ White, and of middle to high SES, St. Louis, MO: The epidemiologic source states that, in the past, ecstasy use was confined to raves and dance clubs in the according to epidemiologic, ethno- central city, but use has moved into the suburbs and into new graphic, and non-methadone treat- settings, paralleling increases in adolescent use. ment sources. In general, methadone ➤ Sioux Falls, SD: According to the epidemiologic source, more treatment sources did not provide indoor raves are taking place in the area, with increasing information about club drug users. advertising and promoting.

Of 17 epidemiologic and ethno- graphic respondents, most (15) report compared with the general popula- exceptions: in Baltimore, predominant that ecstasy users are predominantly tion in that city. In El Paso, Hispanics users are of low SES, and in Portland White, and of these, most (13) report are the predominant ecstasy users, at (ME), ecstasy users are distributed that Whites are overrepresented com- proportions about equal to that of the somewhat evenly among all SES cate- pared with the general population in general population. Most ecstasy gories. A summary of ecstasy users and their cities. Only in Baltimore are users range from middle to high SES, use characteristics appears in Exhibit Blacks the predominant ecstasy users, according to 18 epidemiologic 12 at the end of this section. but they are underrepresented and ethnographic sources, with 2

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Non-methadone treatment provider Exhibit 9. sources. All 18 respondents report that respondents (12) agree with epidemi- Has the number of novice ecstasy ecstasy is predominantly used in ologic and ethnographic sources and users in treatment changed (fall groups or among friends, but in report that ecstasy users in treatment 2000 vs spring 2001)?* Miami, ecstasy users are beginning tend to be adolescents and young to use the drug alone and in private. adults, with the Honolulu source reporting the emerging group of How is ecstasy used and what ecstasy users in treatment as mostly other drugs do ecstasy users preadolescents. Also similar to Billings, MT take? Predominant route of adminis- reports by epidemiologic sources, Boston, MA tration among ecstasy users remains most (8 of 13) treatment respondents Columbia, SC oral, according to epidemiologic, state that ecstasy users in treatment Denver, CO ethnographic, and non-methadone are split evenly between genders, and Honolulu, HI treatment respondents. Additionally, most (8 of 13) report ecstasy users in Memphis, TN in Miami and St. Louis, some users treatment as predominantly Whites Portland, ME are beginning to snort or inject the Seattle, WA and overrepresented or about drug; in New Orleans, it is mixed in Sioux Falls, SD proportionate to the general beverages; and in Birming-ham and Washington, DC, it is dis- population. Although most treat- Miami, FL solved in hot beverages. ment respondents (9 of 12) New York, NY state that ecstasy users in Philadelphia, PA Ecstasy continues to be used treatment are predominantly of Sioux Falls, SD in combination with other middle SES, two (in Memphis St. Louis, MO and Billings) report them as pre- drugs, including other club drugs dominantly of low SES, and the (such as LSD, psilocybin mush- Los Angeles source reports them Sources: Non-methadone treatment rooms, GHB, ketamine, and nitrous respondents oxide) across the country; marijuana as of both low and middle SES. *Sources in Baltimore, Birmingham, Additionally, in three cities (Boston, Chicago, Detroit, Los Angeles, New Orleans, in the South, West, and Philadelphia; and Washington, DC, did not provide this methamphetamine in the West, Mem- New Orleans, and Seattle), emerging information; Billings has two non-methadone ecstasy users in treatment are pre- treatment respondents. phis, Washington, DC, and Chicago dominantly of low SES. (where the practice is rare); heroin in Memphis, Miami, and St. Louis; pow- Where and in what contexts do Where do ecstasy users tend to der cocaine in Memphis and Seattle; ecstasy users tend to use the reside? According to 18 epidemio- and diverted prescription depressants drug? (Exhibit 8) Similar to settings logic and ethnographic respondents, in Miami. “Candy flipping,” the use of for ecstasy sales, settings for ecstasy locations of ecstasy users’ residences ecstasy and LSD, was mentioned in use, in descending order of the most differ by region. For example, in the several areas: Chicago, Denver, frequently mentioned by law enforce- Northeast, ecstasy users reside pre- Hono-lulu, Memphis, Miami, ment, epidemiologic, and ethno- dominantly in central cities (except in Philadelphia, and Washington, DC. graphic respondents, include raves, ® Philadelphia, where they reside in In Los Angeles and Miami, Viagra nightclubs, private parties, private both the central city and suburbs); in (sildenafil citrate) is used with ecstasy. residences, and college campuses. the West, they reside predominantly Exhibit 4 lists slang terms for club Since the last reporting period, sever- in central cities and suburbs; in the drug combinations. al new user settings have been added South, they reside in central cities, to the list, including playgrounds and rural areas, and suburbs; and in the According to non-methadone treat- parks, public housing developments, Midwest, they reside predominantly ment respondents, the most common shopping malls, streets, inside cars, in suburbs (except in Chicago, where club drug combination is ecstasy and and around schools. Ecstasy use they reside in both the central city marijuana. Emerging combinations occurs predominantly indoors, accord- and suburbs). include ecstasy and diverted Oxy- ing to epidemiologic and ethnographic Contin® (a time-release, high-dosage page 84 Pulse Check: November 2001 CLUB DRUGS

formulation of oxycodone) in Boston; orally or converted into powder for ecstasy and LSD in Columbia (SC); Ecstasy users in treatment: A snorting. Additionally, the liquid form and ecstasy and high-purity metham- closer look is injected in Boston, Detroit, and phetamine (“ice”) or cocaine in The most common treatment referral Washington, DC; the drug is available Honolulu. sources for ecstasy users in treatment, in pill form in Los Angeles and New according to 13 non-methadone treat- York; and the liquid form is poured in drinks in Boston. Ketamine is illegally In several Pulse Check cities ment respondents, are health care Viagra® has recently been report- providers (in Billings, Columbia [SC], sold primarily by the plastic bag as a ed as sold or used with ecstasy. Denver, and Miami), court or criminal powder or by the vial as a liquid. justice referrals (in Denver, Miami, St. Furthermore, according to the ® Honolulu: Viagra (sildenafil citrate) Louis, and Sioux Falls), and secondary Columbia (SC) law enforcement is sold with ecstasy or GHB at raves. school referrals (in Denver, Los Angeles, source, sellers transfer ketamine from and St. Louis). The non-methadone Miami: Viagra® used in combination prescription vials into plain vials to treatment source in St. Louis comments with ecstasy is referred to as “X’s and avoid connection with the pharmacy or that most ecstasy users in treatment who O’s” or “hammerheading.” veterinary office from which it was were referred by schools were sent to stolen. The Memphis law enforcement Los Angeles: Viagra® is often used treatment because they were caught with source states that ketamine powder is with ecstasy. marijuana on school property. Similarly, according to the Boston methadone sold in foil or in folded paper, and the treatment source, another drug besides New Orleans law enforcement source OTHER CLUB DRUGS: THE DRUGS ecstasy, typically abuse of diverted Oxy- reports that liquid ketamine is sold in Contin®, tends to be the primary reason plastic soda or sports drink bottles. What are the common forms of an ecstasy user is in treatment. Accor- Ketamine is sold in powder form if it is GHB, ketamine, and Rohypnol, ding to the non-methadone source in used in clubs and raves in Washington, and how are they packaged? The Columbia, ecstasy users in treatment ini- DC, and in liquid form if it is to be most common form of GHB available tially claim to be addicted to drugs other delivered outside of the District, than ecstasy, but clients often later reveal is liquid, typically clear, as reported according to the law enforcement that ecstasy tends to be their primary by law enforcement, epidemiologic, source. and ethnographic respondents. drug of use. Additionally, a powder form of the Six of 10 non-methadone treatment Rohypnol is available in pill form, drug is somewhat available in New respondents (in Denver, Honolulu, according to respondents in all areas Orleans and Los Angeles. GHB as a Memphis, Portland [ME], St. Louis, and where it is available, and is sold as liquid is packaged in a variety of ways Sioux Falls) report that ecstasy clients loose pills, except in New Orleans depending upon locality. Common typically use the drug one to two times (according to the law enforcement packaging includes plastic bottles per week, three respondents (in Los source), where it is packaged in plastic (typically water, sports drink, or soda Angeles, Miami, and Sioux Falls) report bowls or small plastic bags. bottles) in Birmingham, Chicago, that ecstasy clients use one to two times Columbia (SC), Detroit, Los Angeles, per month, and the source in Columbia How much are GHB, ketamine, (SC) reports that they use three to four Memphis, Miami, New Orleans, and and Rohypnol across the coun- times per week. In Honolulu, the fre- St. Louis; eyedropper bottles in try? (Exhibit 10) Where quency of ecstasy use among adolescent Chicago, Los Angeles, and Miami; clients has increased since the last available, GHB sells primarily as a and vials (glass or plastic) in Billings, reporting period. liquid by the dose, with a dose usual- Boston, Miami, Philadelphia, St. ly comprising bottle capfuls or drops. Louis, and Washington, DC. GBL and One dose (a “shot” or “swig”) costs 1,4 BD (GHB precursors) are avail- Diverted ketamine is available pre- $5–$20 in Pulse Check cities. able in some areas, including Boston, dominantly in liquid and powder Additionally, in Birmingham, dealers Los Angeles, Miami, New Orleans, forms, according to responding law are putting GHB in water guns, and and Sioux Falls. Many respondents enforcement, epidemiologic, and users are paying for it by the squirt. do not distinguish between GHB and ethnographic sources. It is typically In Miami, candy, typically lollipops, its precursors. bought and sold as a liquid and taken is dipped in GHB and sold. In

Pulse Check: November 2001 page 85 CLUB DRUGS

Columbia (SC), a product containing Exhibit 10. GHB (liquid Verve®) was given away How much do GHB, diverted ketamine, and Rohypnol cost? as a promotional item in a nutritional Most Common supplement store. In Miami, a 32 City Unit Sold Price ounce bottle of GBL or 1,4 BD sells for $40–$70. Reported prices for GHB GHB have remained stable since the Birmingham, AL 1 ounce $60 last reporting period, except in Los Boston, MA Capful $5 Angeles, where they have dropped due to increased availability. Chicago, IL Capful $15–$20 Denver, CO Capful $5–$10 The prices for diverted ketamine vary New York, NY 1 gram $30 based on the form of the drug and unit available. Prices have remained Los Angeles, CA Capful (one shot) $5–$20 stable since the last reporting period, Memphis, TN Capful $20 with two exceptions: increases due to Miami, FL One swig or hit $5–$10 decreasing availability are reported in New Orleans, LA Capful $15–$20 Los Angeles and Portland (ME). Rohypnol prices are reported in only Philadelphia, PA One vial (one dose) $10–$20 five cities (Chicago, El Paso, Los Washington, DC Thimbleful $10 Angeles, Memphis, and New Orleans) Ketamine and range widely (from $1 to $25), Boston, MA 1-ounce bottle of liquid $50 but have not changed since the last reporting period. Chicago, IL One bag of powder $10–$20 Columbia, SC ½-ounce liquid vial $125 OTHER CLUB DRUGS: THE SALES Denver, CO One dose $25 Who sells other club drugs, and Detroit, MI 100 milligrams of liquid NR how and where are they sold? Los Angeles, CA One pill NR (Exhibit 11) According to most law 0.2 grams of powder $20 enforcement, epidemiologic, and Memphis, TN 0.1 gram of powder $10 ethnographic respondents, GHB, Miami, FL One vial $40 ketamine, and Rohypnol sellers and sales characteristics are similar to New Orleans, LA 0.35-gram bag of powder $15–$20 those of ecstasy, with a few differ- New York, NY One pill $40–$50 ences, as shown in Exhibit 11. Philadelphia, PA One liquid vial $10–$20 OTHER CLUB DRUGS: THE USERS Portland, ME 0.3-gram bag $40 Who uses GHB, ketamine, and Washington, DC 1/8 gram of powder $20 Rohypnol and where are the 150-milligram bag $25 drugs used? (Exhibit 12) Regardless Rohypnol of the specific drug and similar to Chicago, IL One pill $5 seller characteristics, club drug user El Paso, TX One pill $1–$5 characteristics are similar, with a few key differences noted in Exhibit 12. Los Angeles, CA One pill $6–$10 Memphis, TN One pill $5–$10 New Orleans, LA One pill $15–$25

Sources: Law enforcement, epidemiologic, and ethnographic sources page 86 Pulse Check: November 2001 CLUB DRUGS

Then and now:

How have GHB, ketamine, and Rohypnol sales and users changed (fall 2000 vs spring 2001)?

Changes among GHB ➤ Birmingham, AL, and New Orleans, LA: More races and ethnicities are involved in selling GHB. and Rohypnol sellers are ➤ Los Angeles, CA: The number of independent GHB and Rohypnol sellers increased. reported by law enforce- ment sources in a few ➤ Washington, DC: GHB has recently been seized with methamphetamine, suggesting that they may be Pulse Check cities: produced at the same clandestine labs. ➤ Los Angeles, CA, and Memphis, TN: Adolescent users increased.

➤ Sioux Falls, SD: A group of high school boys has emerged as users.

GHB use has expanded to ➤ Los Angeles, CA: An emerging group of high SES users is reported. new user groups in several ➤ Miami, FL: Emerging groups include Blacks and central city dwellers. Emerging groups tend to be even- Pulse Check sites, accord- ly split between the genders. ing to epidemiologic and ethnographic sources: ➤ New Orleans, LA: Homosexual males are now the primary GHB users.

Ketamine and Rohypnol ➤ Boston, MA: Although ketamine is used predominantly at private residences, the emerging group of use and user characteristics users tends to use the drug in nightclubs and bars. have changed in several ➤ Miami, FL: Adolescents are an emerging ketamine user group. Pulse Check cities, accord- ing to epidemiologic and ➤ Washington, DC: Young adults are the most likely age group to use ketamine, but adolescents are a ethnographic sources: growing user population. The drug is usually snorted, but injecting has increased. ➤ Birmingham, AL, and Memphis, TN: Rohypnol use declined.

➤ Los Angeles: Rohypnol use increased.

➤ Sioux Falls, SD: Adolescents are an emerging Rohypnol user group.

With what other drugs are GHB, ketamine in Denver. Ketamine is Birmingham and Miami, LSD and ketamine, and Rohypnol used? combined with ecstasy in Chicago, ecstasy in Miami, heroin and powder Club drug combinations include GHB Miami, and Washington, DC; with cocaine in El Paso, where the speed- with alcohol across the country; with marijuana in Detroit and Miami; with ball effect (in this case, Rohypnol, a ecstasy in Chicago, Los Angeles, LSD in Chicago; and with metham- depressant, and cocaine, a stimulant) Miami, and Seattle; with marijuana phetamine in Birmingham. Rohypnol is reported to “soften the fall when in Birmingham and Miami; and with is combined with marijuana in users are coming down from the high.”

Pulse Check: November 2001 page 87 CLUB DRUGS

Exhibit 11. What are the predominant characteristics of club drug sellers?

Variable Ecstasy GHB Ketamine Rohypnol Age 18–30 years 13–30 years 13–30 years 13–30 years Organization Independent Independent NR NR Sales method Hand-to-hand through acquaintance networks NR NR Likeliness to be Not likely Not likely, with the Not likely, with the Somewhat likely especially involved with other exception of drug- exception of vet- especially drug-assisted rape crimes or violence assisted rape erinary clinic thefts and nonviolent crimes to obtain the drug Likeliness to use Somewhat or very likely Somewhat likely Somewhat or Not very likely the drug very likely Indoors or outdoors Indoors and outdoors Indoors Indoors Indoors Most common settings Raves/concerts, nightclubs, college campuses, and Private parties Raves private residences and parties, but vary widely and nightclubs Likeliness to be sold Somewhat likely, especially Somewhat likely, espe- NR NR with other drugs with other club drugs cially with other club and some major drugs drugs and marijuana Other NR Precursors sold at health NR NR food and vitamin stores or gyms

Sources: Law enforcement, epidemiologic, and ethnographic respondents

Exhibit 12. What are the predominant characteristics of club drug users?

Variable Ecstasy GHB Ketamine Rohypnol Age 13–30 years 13–30 years 13–30 years 13–30 years Gender Evenly split Male Male Male Race/ethnicity Whites and over- Whites and over- Whites and over- Whites and over- represented represented represented represented SES Middle to high Middle Middle Middle Indoors or outdoors Indoors Indoors Indoors Indoors Context In groups/among friends In groups/among friends In groups/among friends Most common settings Raves/concerts, nightclubs, and private residences and parties, but vary widely Likeliness to be Very likely, especially with other Likely, especially with combined with club drugs, heroin, powder and Likely, especially with ecstasy marijuana other dugs crack cocaine, and marijuana Other characteristic Students NR NR Around the Mexican border, users tend to be Hispanic and overrepresented

Sources: Law enforcement, epidemiologic, and ethnographic respondents

page 88 Pulse Check: November 2001 SPECIAL TOPIC: SYNTHETIC OPIOIDS

SPECIAL TOPIC: SYNTHETIC medical use by patients who use these Virginia, and in rural areas of Ohio. OPIOIDS products at the direction of their OxyContin® is often referred to by This Pulse Check’s special topic dis- physicians. the media as “hillbilly heroin” or cusses the illegal diversion and abuse “poor main’s heroin” for its heroin- OxyContin® is the trade name for a of synthetic opioids. The topic was like effects and for the initial abuse high-dose, 12-hour-time-release form selected after several respondents pro- of the drug in low SES rural areas. of oxycodone, an opoid analgesic, viding information for the last Pulse These terms, however are misnomers often prescribed for relief from Check issue expressed concern about because it is more expensive than chronic pain and taken orally. Oxyco- the diversion and abuse of synthetic heroin when bought illicitly and done is also the active ingredient in opiates, with several specifically citing because its abuse has moved from other schedule II prescription drugs, OxyContin®. The category synthetic only lower SES rural areas to include such as Percodan®, Percocet® and opioids was used for the current spe- metropolitan areas in 2001. Tylox®; however, OxyContin® cial topic as it includes a wide range contains a higher concentration of Reports of crimes committed in order of prescription pain medication, and oxycodone (currently 10-, 20-, 40-, to obtain OxyContin® (such as ONDCP was interested in learning to and 80-milligram tablets are avail- pharmaceutical burglaries, home what extent such medications were able) than similar pain relievers. invasions, and prescription fraud) being diverted and abused. However, and negative health consequences while respondents were asked about Since the drug became available in (including deaths, overdoses requiring the diversion and abuse of synthetic 1996, there have been reports on the emergency department visits, and opiods in general for this Pulse ® diversion and abuse of OxyContin , addiction requiring treatment) Check, sources who discussed this especially in rural areas of North- increased through 2000 and 2001. emerging issue specifically cited the eastern and Southeastern States, such Although the nonmedical use of diversion and abuse of one particular as Kentucky, Maine, Maryland, OxyContin® was rare in 2000, the prescription opiate, OxyContin®. As Pennsylvania, Virginia, and West most recent (2000) National a result, the bulk of this section refers specifically to OxyContin®. Pulse Check sources reflect mixed views on the accuracy of media attention: ® OxyContin (oxycodone hydrochlo- Although most responding Pulse Check sources believe that the media has portrayed the ride controlled-release) tablets are diversion of OxyContin® accurately in their communities, several sources believe that the prescribed to patients suffering from media has either underplayed or overemphasized the problem. For example, the New severe persistent pain—a legitimate Orleans law enforcement source states, “The media hasn’t given it (diverted Oxy-Contin®) medical need. However, concern has much media time, but it is a big problem.” The Baltimore non-methadone source, the increased about the diversion and Memphis epidemiologic source, and the Philadelphia non-methadone source agree that the abuse of OxyContin® and other anal- media has underplayed the problem in their communities. However, two sources in gesics in some areas of the country. Portland (ME) (law enforcement and methadone treatment) state that initially the media The manufacturer, Purdue Pharma, underplayed the problem, but that now it is addressed adequately. They also believe that media attention has helped prompt legislation to make it harder to forge prescriptions. has been working proactively with law enforcement and the medical By contrast, many sources (the law enforcement source in Birmingham and Washington, community to provide education on DC; the epidemiologic sources in Boston, New Orleans, Philadelphia, Seattle, and Sioux the appropriate use of OxyContin® Falls; and the non-methadone source in Sioux Falls) believe that the media has overem- and has recently launched a pilot phasized the problem. Several admit that the reason the media might be emphasizing the campaign in several cities to warn problem is that “such drugs are very addictive.” However, the opinion of several sources youth about the dangers of prescrip- is that not only has the media overplayed the problem of diverted synthetic opiates like ® tion drug abuse. This special topic OxyContin in their communities, but also they have helped encourage abuse. For example, the Boston epidemiologic source states, “Large amounts of media coverage section presents findings on the have probably led to increased use by alerting opiate addicts to a possible market….it diversion and illegal use or abuse of ® ® has probably increased illicit (OxyContin ) sales.” The Portland (ME) epidemiologic OxyContin as reported by Pulse source reports that the intense press coverage is accurate for the area, but that media Check sources, not on legitimate attention “may have increased the value of illicit OxyContin®; it may have increased the desire to obtain it.”

Pulse Check: November 2001 page 89 SPECIAL TOPIC: SYNTHETIC OPIOIDS

Household Survey on Drug Abuse Exhibit 1. (NHSDA) shows a significant increase How much of a problem is OxyContin® diversion and abuse, by U.S. region? (p<0.01) in the number and Percent percentage of lifetime nonmedical 40 No Response Somewhat Serious ® use of OxyContin since 1999. 35 Not a Problem Very Serious Finally, the most recent data from Not Very Serious 30 emergency department mentions of the synthetic opiate, oxycodone, which 25 includes OxyContin®, Percocet®, 20 ® ® Percodan , and Tylox , increased 68 15 percent (from 6,429 to 10,825) 10 between 1999 and 2000, according to the Drug Abuse Warning Network 5 (DAWN). 0 0 Total Northeast South West Midwest In summer 2001, increased reports of (N=83) (N=17) (N=30) (N=20) (N=16) Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone abuse of the drug and related crimes treatment repondents prompted the FDA to strengthen warnings and precautions in the Exhibit 2. ® labeling of the product. Purdue How has the perceived OxyContin problem changed since the last Pharmaceuticals undertook a number reporting period, by U.S. region? Percent of activities aimed at reducing diver- 70 sion and abuse, including issuing a No Response Stable warning in the form of a letter distrib- 60 No Longer of Concern More Serious uted widely to physicians, pharmacists, 50 Less Serious and other health care professionals, and the suspension of sales of the 40 strongest formulation of the tablet 30 (160 milligrams). 20 This Pulse Check special section 10 corroborates increased levels of 0 0 0 0 0 0 0 OxyContin® diversion and abuse and 0 Total Northeast South West Midwest finds that its diversion and abuse are (N=83) (N=17) (N=30) (N=20) (N=16) reported as highest in the Northeast Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone and eastern parts of the South and treatment respondents lowest in the Midwest. Furthermore, sources who provided demographic Northeast and Southeast), such as treatment, and non-methadone ® information about OxyContin® Baltimore, Boston, Denver, Detroit, treatment) perceive OxyContin abusers and sellers were mostly from Miami, Philadelphia, St. Louis, and diversion or abuse as a somewhat the Northeast and (to a lesser extent) Washington, DC. serious or very serious problem in the Southeast, highlighting that it is their communities, 23 percent (19) OXYCONTIN®: THE PERCEPTION not yet a large problem in the West perceive it as not a very serious and Midwest. This section also sup- How serious a problem is problem, 20 percent (17) perceive it ports reports that although Oxy- OxyContin® abuse and diversion as not a problem, and 18 percent (15) Contin® diversion and abuse occur in Pulse Check cities? (Exhibit 1) did not respond to the question. mostly in rural areas, they have also Nearly one-third (32 of 83) of Pulse Sources in the Northeast perceive ® recently emerged in metropolitan Check sources (law enforcement, epi- OxyContin diversion and abuse as a areas (especially those in the demiologic, ethnographic, methadone more serious problem than in other page 90 Pulse Check: November 2001 SPECIAL TOPIC: SYNTHETIC OPIOIDS

regions, with 35 percent of those Exhibit 3. sources reporting it as a very serious How serious a problem is OxyContin® diversion and abuse in Pulse Check problem and 24 percent reporting it cities and how has the problem changed (fall 2000 vs spring 2001?)* as a somewhat serious problem. Very serious Somewhat serious Seventeen percent of sources in the South report the problem as very serious, and 27 percent report it as Boston, MAL,M N Philadelphia, PAL Boston, MA somewhat serious. By contrast, only N Portland, MEL,E,M Portland, ME 10 percent of western sources report E Birmingham, ALN Birmingham, AL it as very serious and 25 percent as L Columbia, SCM Columbia, SC somewhat serious; and finally, no L,N Miami, FLE Miami, FL midwestern sources report it as very L,E New Orleans, LAL,E Washington, DC serious and only 13 percent report it L Billings, MTN Sioux Falls, SD as somewhat serious. Billings, MTL Honolulu, HIN Honolulu, HIL,M (adult care) How has the perceived problem Los Angeles, CAE changed between fall 2000 and Philadelphia, PAE,M spring 2001? (Exhibits 2 and 3) Not very serious Birmingham, ALM Nearly half (37 of 83) of Pulse Check E ® Memphis, TN sources perceive OxyContin St. Louis, MOM Boston, MAE,M diversion and abuse as escalating in M N Seattle, WA their communities since the last Philadelphia, PA Birmingham, ALL reporting period, and no sources Baltimore, MDE,N Not a problem report the problem as declining. As N El Paso, TX New York, NYE,N with perceived levels of seriousness, L Chicago, IL L ® Baltimore, MD increases in OxyContin diversion E Detroit, MI Columbia, SCL and abuse are largest in the North- E,N St. Louis, MO El Paso, TXL,M E east, with 65 percent of sources Billings, MT Chicago, ILM,N E,M reporting increases. Increases were Denver, CO Detroit, MIN lowest in the Midwest, with 31 per- E,N New York, NYL Sioux Falls, SD E cent of sources reporting increases. Columbia, SCN Billings, MT L,N Memphis, TNL Denver, CO N Moreover, among sources who report New Orleans, LAN Honolulu, HI the diversion and abuse of Oxy- Washington, DCM (among adolescents) ® E,N Contin as a very serious problem Detroit, MIL Seattle, WA (in Billings, Birmingham, Boston, Columbia [SC], Honolulu, Miami, LLaw enforcement respondents MMethadone treatment respondents EEpidemiologic and ethnographic respondents NNon-methadone treatment respondents New Orleans, Philadelphia, and Port- land [ME]), all report an intensification *Information was not provided by law enforcement sources in Los Angeles, St. Louis, and Seattle; epidemiologic sources in Chicago, El Paso, and Honolulu; methadone treatment sources in Detroit, of the perceived problem except in Los Angeles, Miami, New Orleans, and New York; and non-methadone treatment sources in Los Honolulu, where it remained stable Angeles, Memphis, Sioux Falls, and Washington, DC. since the last reporting period. communities than any other drug this OxyContin® was reported as the ® Where is OxyContin abuse reporting period. For example, 31 of emerging drug of abuse only by the emerging across the country? 84 sources in most (14) Pulse Check epidemiologic source in Portland (ME). ® (Exhibit 4) More sources (law enforce- cities report OxyContin as an emerg- During this reporting period, more ment, epidemiologic, ethnographic, ing drug of abuse, compared with 25 sources in northeastern and southern and methadone and non-methadone sources in 15 cities who report ecstasy (especially southeastern) cities report ® treatment) report OxyContin as the as an emerging drug of abuse. By stark OxyContin® as an emerging drug of emerging drug of abuse in their contrast, in the last Pulse Check, abuse than in cities elsewhere. Pulse Check: November 2001 page 91 SPECIAL TOPIC: SYNTHETIC OPIOIDS

Exhibit 4. report diverted the OxyContin® ® Where is the diversion and abuse of OxyContin emerging? as somewhat or widely available. Furthermore, most (17 of 23) respon- dents report increased availability of the diverted product since the last reporting period, 5 report it as stable, and only 1 (the Portland [ME] epi- demiologic source) reports declining availability. In general, sources in the Northeast report higher levels of diverted OxyContin® than those elsewhere.

How is diverted OxyContin® OxyContin® reported as emerging since last reporting period referred to across the country? ® OxyContin® not reported as emerging since last reporting period (Exhibit 6) Diverted OxyContin is most often referred to as “oxy” or LLaw enforcement respondent MMethadone treatment respondent EEpidemiologic/ethnographic respondent NNon-methadone treatment respondent “OC’s,” according to law enforce- ment, epidemiologic, ethnographic, and methadone and non-methadone OXYCONTIN®: THE DRUG and ethnographic respondents in 12 cities (Billings, Birmingham, Boston, treatment respondents. Additionally, How available is diverted Chicago, Detroit, Honolulu, Miami, the pills are referred to as “blues” in ® OxyContin ? (Exhibit 5) Across the New Orleans, Philadelphia, Portland Miami, “forties” and “horse pills” in country, more than two-thirds (18 of [ME], Seattle, and Washington, DC) Boston, and “O’s” in Philadelphia. 26) of law enforcement, epidemiologic, Exhibit 5. How available is diverted OxyContin® in 17 Pulse Check cities, and how has availability changed (fall 2000 vs spring 2001)?*

Law enforcement sources Epidemiologic and ethnographic sources No Not Not very Somewhat Widely No Not Not very Somewhat Widely City response available available available available Change response available available available available Change Boston, MA ↑ ↔ New York, NY ↔ NR Philadelphia, PA ↑ NR Northeast Portland, ME ↑ ↓ Baltimore, MD NR ↔ Birmingham, AL ↑ ↑ Memphis, TN NR NR

South Miami, FL ↑ ↑ New Orleans, LA ↑ NR Washington, DC ↑ ↑ Chicago, IL ↑ NR Detroit, MI ↔ ↔ Sioux Falls, SD ↑ NR Midwest St. Louis, MO NR ↑ Billings, MT ↑ NR Honolulu, HI ↑ ↑ West Seattle, WA ↑ NR *Sources did not provided information in Columbia (SC), Denver, El Paso, and Los Angeles. page 92 Pulse Check: November 2001 SPECIAL TOPIC: SYNTHETIC OPIOIDS

Exhibit 6. the pills obtained through the pre- Once OxyContin® is diverted, it is ® How is diverted OxyContin scriptions. Patients who obtain and sold hand-to-hand, mostly through referred to in Pulse Check cities? use the drug legitimately, as pre- acquaintance networks, according to scribed by doctors for pain, but sell law enforcement respondents. Slang some of the pills illicitly, are also fre- Additionally, beepers and delivery- Term City quently mentioned by sources (in type services are used to distribute Oxy Billings, Boston, Detroit, Birmingham, Boston, Detroit, and the drug illicitly in Billings, Boston, Honolulu, Philadelphia, Washington, DC). Pharmaceutical Honolulu, and New Orleans. Portland (ME), robberies are mentioned in Billings, Washington, DC Boston, New Orleans, and Portland What are diverted OxyContin® OC’s Birmingham, Boston, (ME). Additionally in Portland (ME), Miami, Portland (ME) prices across the country, what where armed robberies of pharmacies are the most common units sold, Oxy-cotton Memphis, Philadelphia ® Blues Miami for OxyContin have increased and how is it packaged? (Exhibit 7) ® Forties, drastically, doctors and pharmacy Diverted OxyContin costs $1 per horse pills Boston employees have been involved in milligram in most cities where law O’s Philadelphia OxyContin® theft and may help enforcement, epidemiologic, and plan the robberies. Also in that city, ethnographic sources responded (in Sources: Law enforcement, epidemiologic, home invasions of clients who have Boston, Chicago, Miami, and ethnographic, methadone treatment, and ® non-methadone treatment respondents legitimately filled OxyContin pre- Philadelphia). In Billings, prices are scriptions have been reported, with $1–$1.50 per milligram, and in the suspicion that pharmacists are Washington, DC, they are $1–$2 per DIVERTED OXYCONTIN®: SALES involved in obtaining patient informa- milligram. How is OxyContin® diverted and tion. Finally, in New Orleans, some sold illicitly? According to law shipments of the drug are thought to The most common pill unit of enforcement sources, OxyContin® is come via U.S. mail from Mexico. diverted OxyContin®, according to diverted in a variety of ways within law enforcement, epidemiologic, Pulse Check communities, including Except in Boston and Miami, epidemi- ethnographic, and treatment sources, fraudulent prescriptions, “doctor ologic and ethnographic sources did is the 40-milligram tablet, followed shopping,” legitimately obtained pills not provide information about the by the 20- and 80-milligram tablets. ® sold illicitly, and pharmaceutical rob- sources of diverted OxyContin . Interestingly, methadone and non- beries. The most common way to According to the Boston epidemiologic methadone treatment sources report divert the drug (as reported in source and in agreement with the law higher milligram units (typically 80 Billings, Boston, Honolulu, New enforcement source in that city, low milligrams) sold than their law ® Orleans, Philadelphia, Portland [ME], SES patients with legal OxyContin enforcement and epidemiologic Sioux Falls, and Washington, DC) is prescriptions sell some of the pills counterparts. through filling fraudulent prescrip- illicitly. In Miami, organized diversion tions: diverted OxyContin® sellers efforts are conducted by dealers who According to eight of nine law either make their own prescription recruit patients from substance abuse enforcement, epidemiologic, and forms or steal blank prescription pads treatment and mental health facilities. ethnographic respondents (in and write their own prescriptions to Dealers drive these patients in vans to Baltimore, Boston, Detroit, Miami, ® obtain the drug. Another frequently doctors who prescribe OxyContin . Philadelphia, Portland [ME], and reported method of diverting Oxy- After the prescriptions have been Washington, DC), diverted ® Contin® (as reported in Boston, written and filled, patients return to OxyContin is sold as loose pills. Detroit, New Orleans, Philadelphia, the vehicles, give most of the pills to Additionally, law enforcement respon- and Portland) is doctor shopping: the dealers, and keep a few pills for dents in Boston and Portland (ME) people, posing as patients, fake legiti- themselves. Dealers often target and report that it is sold in prescription mate pain to numerous doctors, and recruit methadone and other treatment bottles, and the Billings law enforce- doctors prescribe the drug. Often, clients because of their vulnerability to ment source reports that it is sold in people who doctor shop use some of addiction. small zipper coin bags.

Pulse Check: November 2001 page 93 SPECIAL TOPIC: SYNTHETIC OPIOIDS

Exhibit 7. According to law enforcement, In what types of other crimes What are the most commonly sold epidemiologic, and ethnographic are diverted OxyContin® sellers ® units of diverted OxyContin ? respondents in Billings, Honolulu, involved? According to most law Memphis, Philadelphia, and enforcement, epidemiologic, and City Most common unit Washington, DC, diverted OxyContin® ethnographic respondents (8 of 12), sold (in milligrams) sellers tend to be adults (>30 years). sellers of diverted OxyContin® are Boston, MA 10, 40 Young adults (18–30 years) predomi- somewhat or very likely to be Philadelphia, PA 20, 40, 80 nate in two cities: Birmingham involved in other crimes, including

Northeast Portland, ME 20, 40, 80, 160 and Portland (ME). Furthermore, the following: nonviolent crimes in Baltimore, MD 20, 40 according to the New Orleans law Billings, Boston, New Orleans, Birmingham, AL 80 enforcement source, participants in Portland (ME), and Washington, DC; Columbia, SC 40, 80

South the club scene are starting to become violent crimes in Honolulu and Miami, FL 20 involved with the sale and use of Portland; prostitution in Boston and Washington, DC 20, 40 ® Detroit, MI 40, 80 diverted OxyContin . Portland; and gang-related crimes in St. Louis, MO 40 Portland, where crimes involving What other drugs do diverted ® Midwest diverted OxyContin have increased ® Billings, MT 20, 40 OxyContin dealers sell? according to the law enforcement

West Honolulu, HI 20, 80 According to all law enforcement, source. Only by respondents in epidemiologic, and ethnographic Sources: Law enforcement, epidemiologic, Birmingham, Memphis, and Philadel- ethnographic, methadone treatment, and non- respondents (11 of 11), diverted phia are diverted OxyContin® sellers ® methadone treatment respondents OxyContin dealers sell other drugs, regarded as not involved in other most commonly heroin (as reported crimes. How often is diverted OxyContin® in Baltimore, Boston, Honolulu, New available? According to the Portland Orleans, Portland [ME], and Wash- Where is diverted OxyContin® (ME) law enforcement and epidemio- ington, DC) and other diverted sold? (Exhibit 8) Diverted Oxy- logic sources and the New Orleans law prescription drugs, especially other Contin® is sold in the central city enforcement source, for the past year, opiates (as reported in Honolulu, and rural areas, according to most OxyContin® has been available con- New Orleans, Philadelphia, Portland law enforcement and epidemiologic tinually on the illicit drug market. By [ME], and Washington, DC). Diver- respondents. However, suburbs are contrast, according to epidemiologic ted OxyContin® dealers also sell the predominant sales locales in sources in Birmingham and Washing- cocaine in Baltimore, and marijuana Philadelphia, and the drug is sold ton, DC, and the law enforcement and methamphetamine in Billings. throughout all areas of Boston and source in Honolulu, the drug has Portland (ME). According to the been available on the illicit drug ® Do diverted OxyContin sellers law enforcement source in Washing- market only periodically. Other use the drug? According to seven ton, DC, most sales occur in the respondents claim that the drug is so of eight law enforcement respondents central city, but the buyers reside in new to the illicit drug market that (in Birmingham, Honolulu, New the suburbs. they cannot assess whether the drug is Orleans, Philadelphia, Portland [ME], available continually or periodically. Sioux Falls, and Washington, DC), According to law enforcement, OxyContin® sellers are somewhat or epidemiologic/ethnographic, and Who sells diverted OxyContin®? very likely to use the drug. Three treatment respondents, diverted According to all (nine) responding epidemiologic sources responded to OxyContin® is sold most often in law enforcement sources, diverted the question: the Portland and private residences, followed by streets OxyContin® sellers are independent. Washington, DC, respondents agree and around methadone treatment The law enforcement sources in New with their law enforcement counter- clinics. The reported number of Orleans, Portland (ME), Seattle, and parts that OxyContin® sellers are diverted OxyContin® sales settings is Washington, DC, add that they tend very likely to use the drug, but the highest in Boston and New Orleans. to be heroin addicts or often associate Memphis respondent cites sellers as with heroin users. not very likely to use the drug. page 94 Pulse Check: November 2001 SPECIAL TOPIC: SYNTHETIC OPIOIDS

Exhibit 8. Where is diverted OxyContin® sold and abused across 17 Pulse Check cities?*

Private Meth- Night- Around Play- Con- Shop- Total Resi- Public Inside Crack Private adone clubs/ Super- College grounds/ certs/ ping # Streets dences Housing Cars Houses Parties Clinics Bars Markets Campus Parks Raves Malls Settings City Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Boston, MA 13 4 Philadelphia, PA 27 Portland, ME 32 Northeast Baltimore, MD 5 4 Birmingham, AL 12 Columbia, SC NR 1 Memphis, TN NR 2 South Miami, FL NR 3 New Orleans, LA 11 NR Washington, DC 45 Detroit, MI NR 1 St. Louis, MO NR 7 Midwest Billings, MT 210 Denver, CO NR 1

West Honolulu, HI 4NR Seattle, WA NR 5

Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone treatment respondents *For sales settings seven law enforcement sources responded (in Billings, Birmingham, Boston, Honolulu, New Orleans, Philadelphia, Portland [ME], and Washington, DC) and three epidemiologic and ethnographic sources responded (in Baltimore, Boston, Portland [ME], and Washington, DC). For users settings, nine epidemiologic and ethnographic sources responded (in Baltimore, Detroit, Memphis, Miami, Philadelphia, Portland [ME], St. Louis, and Washington, DC), seven methadone treatment sources responded (in Boston, Columbia [SE], Denver, Portland [ME], St. Louis, Seattle and Washington, DC), and eight non-methadone treatment sources responded (in Billings, Birmingham, Baltimore, El Paso, Miami, Philadelphia, Portland [ME] and St. Louis).

OXYCONTIN®: THE ABUSERS prescribed the drug for a legitimate the drug in Birmingham, Columbia medical need. Most OxyContin® (SC), Portland (ME), and Washington, How has the number of novice abusers are young adults (18–30 DC. Treatment respondents agree that ® OxyContin treatment clients years) or adults (>30 years), males are the predominant users or changed? (Exhibit 9) According to according to most epidemiologic, that they are evenly split between the most (12 of 16) methadone and non- ethnographic, and methadone and genders. Females predominate, methadone treatment respondents, non-methadone treatment respon- however, in treatment programs in the number of novice users of divert- dents. However, according to the Baltimore, St. Louis, and two Western ® ed OxyContin in treatment (defined epidemiologic and methadone treat- cities (Billings and Denver). as any drug treatment client who has ment sources in Portland (ME) and recently begun using diverted the epidemiologic source in Miami, Whites are the predominant Oxy- ® ® OxyContin ) has increased since the adolescent (13–17 years) and young Contin abusers and are overrepre- last reporting period, mainly in the adult abusers are increasing. sented compared with the general South. The remaining respondents population, according to nearly all reporting stable trends. Males are the predominant Oxy- epidemiologic and ethnographic Contin® abusers, according to most respondents. Blacks, however, are the ® Who abuses OxyContin and (5 of 9) epidemiologic and ethno- predominant abusers and overrepre- where do they reside? (Exhibits graphic respondents (in Baltimore, sented in Baltimore and Washington, 10 and 11) This section refers to Detroit, Memphis, Miami, and DC. Most treatment respondents those who abuse diverted Philadelphia). However, males and agree that Whites predominate as ® OxyContin , not those who are females are equally likely to abuse OxyContin® abusers. Additionally,

Pulse Check: November 2001 page 95 SPECIAL TOPIC: SYNTHETIC OPIOIDS

Exhibit 9. OxyContin® users in treatment: reside in the suburbs. Most treatment How has the number of novice Referral sources, education, and respondents concur with their OxyContin® treatment clients employment epidemiologic counterparts. changed (fall 2000 vs spring 2001)? The most common referral sources for Where and in what contexts do ® OxyContin treatment clients, accord- OxyContin® abusers tend to use ing to methadone and non-methadone Baltimore, MDN the drug? (Exhibit 8) Most Oxy- treatment respondents, are individual Billings, MTN,N Contin® abusers use the drug indoors referrals (in Baltimore, Birmingham, Birmingham, ALN and in private, according to all (eight Boston, Columbia [SC], Denver, Miami, Boston, MAM Philadelphia, Portland [ME], St. Louis, of eight) epidemiologic respondents Columbia, SCM Seattle, and Washington, DC), followed (in Baltimore, Birmingham, Detroit, El Paso, TXN by courts or the criminal justice system Memphis, Miami, Philadelphia, Miami, FLN (in Philadelphia, Portland [ME], and Portland (ME), and Washington, DC). Portland, MEM,N St. Louis) and health care providers (in Treatment respondents agree that St. Louis, MON Billings, El Paso, and Portland). Accor- diverted OxyContin® is primarily Washington, DCM ding to the Denver methadone source, used indoors and in private, but the doctors are a common referral source: Denver, COM Birmingham non-methadone source doctors who have been prescribing Philadelphia, PAM,N cites both indoor and outdoor use OxyContin® to their patients for pain Seattle, WAM because, “you can take a pill any- refer them to treatment when they believe where.” According to the epidemiolog- their patients may have an addiction. ic sources in Memphis, Philadelphia, MMethadone treatment respondents NNon-methadone treatment respondents Nearly all (14 of 17) treatment respon- and Washington, DC, they primarily Notes: Billings has two non-methadone dents report that most OxyContin® use the drug in groups or among treatment sources. abusers have a high school education. friends, but in Baltimore, Miami, and Only the methadone source in Seattle Whites from rural areas are increas- Portland (ME), most use the drug and the methadone and non-methadone ingly abusing the drug, according to alone. By contrast, most (8 of 12) sources in Philadelphia report that most treatment respondents (in Billings, the epidemiologic sources in OxyContin® users have less than a high Birmingham, Columbia (SC), Denver, Birmingham and Washington, DC. school education. The employment sta- Portland (ME), St. Louis, and Washing- tus of OxyContin® abusers varies widely ® ® Most OxyContin abusers are of low according to treatment respondents, with ton, DC) report that most OxyContin or middle SES, according to nearly all most reporting full-time employment or abusers take the drug alone. epidemiologic, ethnographic, and unemployment. Additionally, the non- methadone and non-methadone methadone source in El Paso reports that The most frequently mentioned treatment respondents. Additionally, most are retired or disabled, and the settings for abuse of diverted Oxy- ® according to treatment respondents, methadone treatment source in Boston Contin , according to epidemiologic, OxyContin® abusers in the Northeast reports that most are unemployed due to ethnographic, and non-methadone are more likely to be of low SES than chronic pain. and methadone treatment respon- dents, are private residences, followed those in other regions. OxyContin® abuse among health care professional and adolescents... by public housing developments, The locations of OxyContin® abusers’ inside cars, and private parties. Other residences vary by city, according to Only 5 of 23 epidemiologic, ethnograph- common settings include streets (in epidemiologic and ethnographic ic, and methadone and non-methadone Baltimore, Billings, Philadelphia, and treatment respondents (in Baltimore, respondents: in Baltimore, Philadel- Washington, DC), nightclubs and bars Billings, Portland (ME), St. Louis, and phia, and Washington, DC, they reside (in Billings, Boston, Philadelphia, and Seattle) report health care professionals as St. Louis), and concerts and raves (in in central city areas; in Detroit, involved in OxyContin® abuse. Birmingham, and Memphis, they Boston, Miami, and St. Louis). reside in rural areas and the suburbs; Seven respondents in six cities report ® and in Columbia (SC) and Miami, they OxyContin abuse among opioid-naïve adolescents (in Billings, Boston, Detroit, Miami, Portland (ME), and St. Louis). page 96 Pulse Check: November 2001 SPECIAL TOPIC: SYNTHETIC OPIOIDS

How is OxyContin® taken, and For example, benzodiazepines are How is heroin related to what other drugs do OxyContin® taken in combination with Oxy- OxyContin® abuse? ® users take? Unlike those with a Contin in Baltimore, Boston, Columbia (SC), Philadelphia, and According to many Pulse Check sources, legitimate medical need for Oxy- heroin users often abuse diverted ® Seattle. Other diverted prescription Contin who injest the pill orally by OxyContin®, mostly as a heroin swallowing it whole, OxyContin® opiates are combined with Oxy- ® ® substitute. Seven respondents (the law abusers seek to deactivate the time- Contin in Billings (Percocet , enforcement sources in New Orleans ® release formula by injecting, chewing, meperidine [Demerol ] or morphine), and Philadelphia; the epidemiologic ® ® or snorting the crushed pill or tablet Philadelphia (Percocet ), and Miami source in Miami, the methadone treat- ® to achieve rapid release and absorp- (hydrocodone [Vicodin® or Lorcet ], ment sources in Philadelphia and Seattle; ® tion of oxycodone, according to or carisoprodol [Soma ]). Heroin is and the non-methadone treatment ® epidemiologic and ethnographic used with diverted OxyContin in sources in Birmingham and St. Louis) report that heroin users often replace respondents. Injection (by crushing Boston, Billings, and St. Louis, and heroin with diverted OxyContin®, the pill, dissolving it in water or crack in Billings and Philadelphia. In ® especially when heroin is scarce. Four cooking it, and typically injecting it Boston, diverted OxyContin is some- times used with ecstasy to assuage the respondents (the Portland (ME) law through cotton balls or cotton pads— enforcement source, the Boston effects of ecstasy. hence, its street name “oxycotton”) is methadone treatment source, and the reported in seven cities (Baltimore, Billings and St. Louis non-methadone Several sources report that Oxy- Birmingham, Detroit, Portland [ME], treatment sources) state that diverted Contin® abusers have previously Philadelphia, St. Louis, and Washing- OxyContin® may be used in combina- used drugs other than opiates. ton, DC). The diverted drug is taken tion with heroin to enhance the effects According to the law enforcement orally (often chewed) in three cities of heroin. And the methadone treatment source in Billings, methamphetamine (Memphis, Miami, and Philadelphia), sources in Columbia (SC) and Washing- users who are unable to obtain and it is crushed and snorted in ton, DC, report that heroin users often methamphetamine or are looking for take illegally obtained OxyContin® to Columbia (SC) and Detroit. Unlike a more sustained high may begin “tide them over” until their next dose of epidemiologic and ethnographic using diverted OxyContin®, and heroin or methadone. respondents, treatment sources over- according to the Boston methadone whelmingly (16 of 20 respondents) By contrast, in Chicago, the diversion treatment source, OxyContin® users cite oral ingestion as the predominant and abuse of other prescription opiates tend to have already experimented mode of OxyContin® administration abuse continues to be low because with marijuana and sometimes by hardcore drug users. Injecting the heroin is readily available and less cocaine. drug is only mentioned by the Billings expensive there. Sources also point out that many OxyContin® abusers use the non-methadone treatment source, and How often do OxyContin® drug exclusively. For example, in snorting crushed pills is mentioned abusers use the drug? Most Birmingham, most OxyContin® abusers only by three sources: the methadone OxyContin® abusers take the drug at use the drug rather than heroin or other treatment source in Boston and the least daily, according to most (11 of diverted prescription drugs because they methadone and non-methadone 15) treatment respondents (in believe it is more potent. And the law sources in Portland (ME). According Birmingham, Boston, Columbia [SC], enforcement source in Boston reports to the epidemiologic source in that most Oxy-Contin® abusers do not Denver, Philadelphia, Portland [ME], Washington, DC, oral ingestion of use heroin, but that they may start to use St. Louis, and Washington, DC). The the drug is increasing. heroin if they are unable get their methadone treatment sources in OxyContin® “fix.” Boston and Philadelphia report that Few epidemiologic, ethnographic, or OxyContin® abusers begin using the treatment respondents report other drug occasionally or on weekends, drugs used in combination with but they often quickly progress to diverted OxyContin®, and most daily use. drugs mentioned are other prescrip- tion drugs that have been diverted.

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Exhibit 10. Who abuses diverted OxyContin®, according to epidemiologic and ethnographic respondents?

Race/Ethnicity; representation compared with the general Socioeconomic City Age Gender population Status Residence Philadelphia, PA Young adults (18–30) Male White; underrepresented Low Central city and adults (>30)

Northeast Portland, ME Young adults Split evenly White; equal Low All Baltimore, MD Adults Male Black; overrepresented Low Central city Birmingham, AL Adolescents (13–17) Split evenly White; overrepresented Low and middle Suburbs and rural areas Columbia, SC Young adults Split evenly White; equal Middle Suburbs

South Memphis, TN Young adults Male White; overrepresented Middle Suburbs and rural areas Miami, FL Adults Male White; overrepresented Low Suburbs Washington, DC Adults Split evenly Black; overrepresented Low Central city Detroit, MI Young adults Male White; overrepresented Middle and high Suburbs and rural and adults areas Midwest

Exhibit 11. Who abuses diverted OxyContin®, according to methadone and non-methadone treatment respondents?

Race/Ethnicity; representation Treatment compared with the Socioeconomic City source Age Gender general population Status Residence Boston, MA Methadone Adults (>30) Split evenly White; equal Low Suburbs Philadelphia, PA Methadone Young adults Split evenly White; NR Low Central city (18–30) Non-methadone Young adults Split evenly White, Black, Hispanic; equal Low Central city

Northeast Portland, ME Methadone Young adults Split evenly White; NR Low and middle Central city Non-methadone Adults Male White; NR Low Rural Baltimore, MD Non-methadone Young adults Female White; underrepresented High Central city Birmingham, AL Methadone Young adults Male White; equal Middle Suburbs Non-methadone Young adults Split evenly White; equal Low and middle Suburbs Columbia, SC Methadone Young adults Male White; equal Middle Rural El Paso, TX Non-methadone Adults Male White, Black, Hispanic; equal All Central city

South and suburbs Miami, FL Non-methadone Adults Split evenly White; overrepresented Middle Suburbs New Orleans, LA Non-methadone Adults Male White; NR Middle Central city Washington, DC Methadone Adults Male White, Black; NR Low Central city St. Louis, MO Methadone Young adults Split evenly Multi-racial; NR Middle Suburbs and central city

Midwest Non-methadone Young adults Female White; NR Middle Suburbs Billings, MT Non-methadone Young adults Female White; NR Low Suburbs Denver, CO Methadone Adults Female White; NR Middle Suburbs

West Honolulu, HI Non-methadone Adults Male Asian/Pacific Islander; NR Middle Suburbs Seattle, WA Methadone Adults Split evenly White; equal Low Central

page 98 Pulse Check: November 2001 APPENDIX 1: METHODOLOGY

APPENDIX 1: METHODOLOGY ! Region I (Northeast): Portland, Applying these criteria resulted in the ME—Of the three rural States in final selection of the following 21 How were the sites selected? the Northeast Region (including Pulse Check sites: (See map in the Introduction) A total New Hampshire and Vermont), of 21 sites were studied for this issue Baltimore, MD Maine has the only Atlantic coast- of Pulse Check, including a new site Billings, MT line and shares the longest border not studied in the last (Mid-Year 2000) Birmingham, AL with Canada. It also includes an issue: Baltimore, MD. Baltimore was Boston, MA ONDCP-designated High Intensity included at the request of the Office Chicago, IL Drug Trafficking Area (HIDTA). of National Drug Control Policy Columbia, SC Portland is Maine's most populous Denver, CO (ONDCP) because of concerns about metropolitan area. Detroit, MI its unique problems involving heroin El Paso, TX and cocaine. We selected the other 20 ! Region II (South): Columbia, SC— Honolulu, HI sites using Census Bureau regions and The three other rural States in the Los Angeles, CA divisions with a goal of achieving South census region are Kentucky, Miami, FL geographic and demographic diversi- Mississippi, and West Virginia. Memphis, TN ty. In addition, we made an effort to However, South Carolina's location New Orleans, LA select sites in areas with special drug New York City, NY along a major drug trafficking cor- abuse problems of national concern. Philadelphia, PA ridor makes that State a strategic More specifically, we applied the fol- Portland, ME choice. Recent cocaine seizures in lowing methodology in selecting sites. St. Louis, MO Columbia further highlight its Seattle, WA strategic importance. We purposely selected the most Sioux Falls, SD populous States in the four census Washington, DC ! Region III (Midwest): Sioux Falls, regions: New York in Region I SD—Sioux Falls is the most popu- How do the 21 sites vary (Northeast Region); Texas in Region lous metropolitan area within the demographically? Appendix 2 II (South Region); Illinois in Region Midwest Region's two rural States highlights the demographic diversity III (Midwest Region); and California (North Dakota and South Dakota). of these 21 sites. For example, their in Region IV (West Region). In three population density per square kilome- of these States, we selected the most ! Region IV (West): Billings, MT— ter ranges from a sparse 18.6 in populous metropolitan areas: New Montana is the only census-desig- Billings, MT, to a crowded 2,931.6 in York City, Chicago, and Los Angeles. nated rural State in the West New York City. Their unemployment In Texas, however, we selected El Region, and Billings is its most rates range from a 1.7 low in Sioux Paso—a known high trafficking area populous metropolitan area. Falls, SD, to a 9.4 high in El Paso, with particularly high levels of unem- TX. The racial/ethnic breakdowns in ployment, population growth, and The remaining 12 sites were selected the 21 sites further exemplify their poverty—because of its proximity to to ensure that the entire list included diversity: White representation ranges the United States border with Mexico. at least 2 sites from each of the 9 from 30.9 percent in Honolulu, HI, Census Bureau divisions (East North to 97.8 percent in Portland, ME; We included four rural States, one per Central, Mountain, Middle Atlantic, Black representation ranges from 0.5 census region. (Rural States are New England, Pacific, South Atlantic, percent in Billings, MT, to 42.4 per- defined by the Census Bureau as South East Central, South West cent in Memphis, TN; and Hispanic those in which 50 percent or more of Central, and West North Central). representation ranges from less than 1 the State's population reside in cen- Additional selection criteria included percent in Birmingham, AL, and sus-designated rural areas.) The four population density, representation of Portland, ME, to 75.4 percent in El rural sites selected are as follows: racial/ethnic minorities, and emphasis Paso, TX. on high drug trafficking areas.

Pulse Check: November 2001 page 99 APPENDIX 1: METHODOLOGY

What other data are available at To identify treatment sources for the Thus, a total of 85 sources were the 21 selected sites? Information previous (Mid-Year 2000) issue of identified and recruited, and we from other national-level data sources Pulse Check, we randomly selected successfully obtained information for will be useful for framing, comparing, providers from the 1998 Uniform this Pulse Check issue from 83 of corroborating, enhancing, or explain- Facility Data Set (UFDS), a listing them: a response rate of 98 percent. ing the information obtained for Pulse of Federal, State, local, and private The nonresponding participants were Check. The following data sources, facilities that offer drug abuse and the methadone treatment providers listed in Appendix 3, are available in alcoholism treatment services. For from Baltimore and Memphis. A full nearly every site: ONDCP's past Pulse this purpose, we excluded facilities list of responding sources appears in Check reports; the National Institute that reported more than 50 percent Appendix 4. on Drug Abuse (NIDA) Community of their clientele as having a primary Epidemiology Work Group (CEWG); alcohol abuse problem, served a What kind of data were collect- the Substance Abuse and Mental caseload of fewer than 100 clients, or ed, and how? For each of the 83 Health Services Administration provided only prevention or detox responding sources, we conducted a (SAMHSA) Drug Abuse Warning services. We then divided the remain- single telephone discussion lasting Network (DAWN); and the National ing facilities into two groups— about 1 hour. We asked sources to Institute of Justice (NIJ) Arrestee Drug methadone and non-methadone explore with us their perceptions of Abuse Monitoring (ADAM) program. treatment facilities—in order to the change in the drug abuse situation capture two client populations whose between spring 2000 and fall 2001. Who are the Pulse Check demographic characteristics and use We discussed a broad range topic sources, and how were they patterns often differ widely. We areas with these individuals, as selected? Consistent with previous selected one from each of these two delineated in Appendix 5. Not issues, the information sources for categories of programs for each of the surprisingly, ethnographic and Pulse Check were telephone 20 selected sites. Because Billings, epidemiologic sources seemed to be discussions with 4 knowledgeable MT, and Sioux Falls, SD, have no very knowledgeable about users and individuals in each of the 21 sites: 1 UFDS-listed methadone treatment patterns of use; they were somewhat ethnographer or epidemiologist, 1 facilities, we selected two non- knowledgeable about drug availabili- law enforcement official, and 2 treat- methadone facilities in those sites. ty; and they were less informed about ment providers. Excluding the new sellers, distribution, and trafficking Baltimore recruits, the vast majority For this issue of Pulse Check, in order patterns. Treatment providers had a of the 42 epidemiologists, ethnogra- to preserve continuity, we retained all similar range of knowledge, but they phers, and law enforcement sources available treatment sources who generally focused on the specific pop- who reported for this issue of Pulse reported for the last issue. Addition- ulations targeted by their programs. Check were the same, or associated ally, to ensure regular reporting for Some providers, however, were able with the same agencies, as those who the future, any treatment provider to provide a broader perspective reported for the previous issue. who was unavailable to participate about the communities extending Ethnographers and epidemiologists was replaced via purposeful, rather beyond their individual programs. were recruited based on several possi- than random, selection based on con- Among the three Pulse Check source ble criteria: past participation in the sultation with experts in the field. types, law enforcement officials Pulse Check program; membership in Altogether, we recruited 43 treatment appeared to be most knowledgeable NIDA's CEWG; research activities in sources: 20 methadone providers (2 about drug availability, trafficking local universities; or service in local from Boston, and 1 from each of the patterns, seller characteristics, sales community programs. We recruited other Pulse Check sites except for practices, and other associated law enforcement officials by contact- Billings and Sioux Falls), and 23 non- activities; they were, understandably, ing local police department narcotic methadone providers (1 from each less knowledgeable about user groups units, Drug Enforcement Administra- Pulse Check site plus extra sources and characteristics. tion (DEA) local offices, and HIDTA from Billings and Sioux Falls to com- directors. pensate for their lack of methadone representation). page 100 Pulse Check: November 2001 APPENDICES 2 AND 3: SITE DEMOGRAPHICS AND OTHER DATA SOURCES

APPENDIX 2: POPULATION DEMOGRAPHICS IN THE 21 PULSE CHECK SITES

Race Percenta Violent Percent Popula- *Small = <300,000 MSA American Asian Crime/ Persons Unem- tion Percent persons; Medium = 300,000–1 million Size* Indian and 100,000 Under18 ploy- Density/ Popu- persons; Large = 1 Pulse Check (S, M, Eskimo Pacific Percent Popu- Below Pov- ment Square lation million–5 million per- Site L, X) White Black Aleut. Islander Hispanica lationb erty Levelc Rate KMa Changed sons; Extra Large = >5 million persons 1 Boston, MA X 89.9 6.0 .2 3.9 5.7 505 15.2 3.1 353.3 3.8 1Includes Worcester, New York City, NY X 61.3 28.9 .4 9.3 25.6 1,037 32.9 6.2 2,931.6 1.9 Lawrence, Lowell, Philadelphia, PA-NJ L 76.5 20.1 .2 3.2 4.7 667 17.1 4.1 495.7 .6 Brockton MA-NH 2 Northeast Portland, ME S 97.8 .8 .3 2.6 2.0 730 16.6 4.0 368.7 4.6 Includes Washington, DC- Baltimore, MD L 69.1 28.0 .3 .6 .8 581 19.4 3.1 110.9 8.9 MD-VA-WVA Birmingham, AL M 70.4 28.9 .2 .6 .8 581 19.4 3.1 110.9 8.9 3Includes Los Columbia, SC M 68.7 29.6 .2 1.5 2.1 868 19.2 2.5 136.8 13.8 Angeles-Long El Paso, TX M 94.5 3.4 .5 1.5 75.4 668 38.6 9.4 267.5 18.6 Beach 4Includes Seattle,

South Memphis, TN L 56.3 42.4 .2 1.2 1.3 1,081 21.4 3.6 141.9 9.7 Bellevue-Everett, WA Miami, FL L 77.6 20.4 .3 1.8 57.4 1,532 29.6 5.8 432.0 12.3 a1999 New Orleans, LA L 62.6 34.9 .3 2.2 5.2 918 26.4 4.4 148.2 1.6 b1998 2 Washington, DC L 67.7 25.3 .3 6.7 7.6 537 12.8 2.6 281.1 12.2 c1997 Chicago, IL X 75.8 19.3 .2 4.6 14.8 NA 17.2 4.1 610.5 8.1 d1990–1999 Detroit, MI L 74.9 22.6 .4 2.0 2.5 870 19.1 3.5 433.3 4.9 Note: Shaded boxes Sioux Falls, SD S 96.9 0.8 1.5 0.8 0.9 252 11.4 1.7 45.8 18.1 indicate that selected Midwest St. Louis, MO-IL L 80.8 17.6 .2 1.3 1.5 NA 16.4 3.7 155.2 3.1 city is in a rural State. SOURCE: 2001 Billings, MT S 95.5 .5 3.3 .6 3.3 187 16.8 4.0 18.6 12.2 County and City Denver, CO L 89.8 6.2 .8 3.1 14.9 385 13.4 2.4 203.2 21.9 Extra: Annual Metro, Honolulu, HI M 30.9 3.6 .5 65.0 7.4 268 14.8 4.9 556.4 3.4 City, and County

West 3 Data Book, Tenth Los Angeles, CA X 74.8 11.2 .6 13.4 44.4 1,027 30.5 5.9 887.3 5.3 Edition. Eds: Gaquin, Seattle, WA4 L 84.7 4.7 1.3 9.3 4.3 419 11.7 3.4 203.7 14.8 D.A., and Littman, M.S. Washington, DC: Bernan Press APPENDIX 3: NATIONAL-LEVEL DATA SOURCES AVAILABLE IN THE 21 PULSE CHECK SITES Pulse Check Site HIDTA1 State CEWG2 DAWN3 ADAM4 Boston, MA !!! New York, NY !!!! Philadelphia, PA !!! Northeast Portland, ME ! Baltimore, MD !!! Birmingham, AL !! Columbia, SC El Paso, TX !!

South Memphis, TN ! Miami, FL !!!! New Orleans, LA !!!! Washington, DC !!!! 1High Intensity Drug Trafficking Area of the Chicago, IL !!!!Drug Enforcement Administration (DEA) Detroit, MI !!!!2Community Epidemiology Work Group of Sioux Falls, SD ! the National Institute on Drug Abuse (NIDA) Midwest St. Louis, MO !!! 3Drug Abuse Warning Network of the Substance Abuse and Mental Health Billings, MT Services Administration (SAMHSA) Denver, CO !!!!4Arrestee Drug Abuse Monitoring program Los Angeles, CA !!!!of the National Institute of Justice (NIJ) West Honolulu, HI !! Note: Shaded boxes indicate that selected Seattle, WA !!!!citiy is in a rural State.

Pulse Check: November 2001 page 101 APPENDIX 4: PULSE CHECK SOURCES

Pulse Check Site Epidemiology/Ethnography Law Enforcement Baltimore, MD James Peterson Richard Hite Johns Hopkins University Baltimore Police Department School of Public Health Billings, MT Ernesto Randolfi, Ph.D. Scott Forshee Montana State University at Billings City/County Special Investigations Unit Department of Health and Physical Education Birmingham, AL Foster Cook Sergeant T.E. Thrash University of Alabama Birmingham Police Department Vice and Narcotics Division Boston, MA George Arlos Lieutenant Francis W. Armstrong, Jr. Substance Abuse Treatment Boston Police Department and Prevention Services Drug Control Division Chicago, IL Larry Ouellet, Ph.D. Chicago Police Department University of Illinois at Chicago Organized Crime Division, Narcotic School of Public Health and Gang Investigations Section Columbia, SC Dennis Nalty, Ph.D. Columbia Police Department Department of Alcohol and Organized Crime and Narcotics Unit Other Drug Abuse Services Denver, CO Bruce D. Mendelson, M.P.A. Curt Williams, B.S. State Treatment Needs Assessment Contract Denver Police Department Colorado Department of Human Services Alcohol and Drug Abuse Division Detroit, MI Richard F. Calkins Southeast Michigan HIDTA Michigan Department of Community Health Division of Substance Abuse Quality and Planning El Paso, TX Tessa Hill, M.A. Jeff Cole Aliviane, Inc. El Paso Police Department, Narcotics Unit Honolulu, HI D. William Wood, Ph.D., M.P.H. Lieutenant Mike Moses University of Hawaii Narcotics, Vice Division Department of Sociology Honolulu Police Department Los Angeles, CA Richard Rawson, Ph.D. Criminal Intelligence Group University of California, Los Angeles Los Angeles Police Department Integrated Substance Abuse Programs (ISAP) Memphis, TN Randolph Dupont, Ph.D. Fred Romero Department of Psychiatry Memphis Police Department University of Tennessee Vice Narcotics Unit Miami, FL James N. Hall Prefers anonymity Up Front Drug Information Center New Orleans, LA Gail Thornton-Collins Lieutenant Commander Bruce Adams New Orleans Health Department Narcotics Major Case Section New Orleans Police Department New York, NY John A. Galea, M.A. Drug Enforcement Administration New York State Office of Alcoholism New York Division and Substance Abuse Services Street Studies Unit Philadelphia, PA Samuel J. Cutler Drug Enforcement Administration Philadelphia Behavioral Health System Philadelphia Field Division Coordinating Office for Drug Divisional Intelligence Group and Alcohol Abuse Programs Portland, ME Nate Nickerson, R.N., M.S.N. George Connick Public Health Division, Augusta Field Office/ Maine Drug Enforcement Agency Department of Health and Human Services City of Portland Seattle, WA Thomas R. Jackson, M.S.W. Steve Freng Evergreen Treatment Services High Intensity Drug Trafficking Area Sioux Falls, SD Prairie View Prevention Services Jerry Mundt & Lieutenant Doug Barthell Sioux Falls Police Department Narcotics Division St. Louis, MO James M. Topolski, Ph.D. Detective Leo Rice Missouri Institute of Mental Health St. Louis Police Department Narcotics Division Washington, DC Alfred Pach, Ph.D., M.P.H. Sergeant John Brennan National Opinion Research Center Washington, D.C. Police Department Major Narcotics page 102 Pulse Check: November 2001 APPENDIX 4: PULSE CHECK SOURCES

Pulse Check Site Non-Methadone Treatment Methadone Treatment Baltimore, MD Ruth Daiker Nonrespondent Jones Falls Community Corporation Billings , MT Mona Sumner Illegal in the State of Montana Rimrock Foundation Deena Vandersloot South Central Mental Health Center Journey Recovery Program Birmingham, AL Eleanor D. Powers Bill Garrett, M.P.H. Program prefers anonymity University of Alabama Birmingham Substance Abuse Program Boston, MA Jim Sweeney Joanne Swindell Gavin House CAB Health and Recovery Services Patrick Griswold NCIA Chicago, IL Del Larkin Terrie Matthes Association House of Chicago Cornell Interventions Columbia, SD Bryan Fox Jim Van Frank Palmetta Baptist Medical Center Columbia Metro Treatment Center Denver, CO Tim McCarthy Pamela J. Manuele, RN, BSN, ANPC, CCJS Arapahoe House Comprehensive Addiction Treatment Services Detroit, MI Renaissance West Community Health Services Octavius Sapp, C.A.C. City of Detroit, Department of Human Services Drug Treatment El Paso, TX Armando Salas Julie Renteria, L.V.N. Aliviane Men’s Residential Facility El Paso Methadone Maintenance and Detox Treatment Center Honolulu, HI Andy Anderson Lisa Cook Hina Mauka Recover Center Drug Addiction Services of Hawaii Los Angeles, CA Mari Radzik, Ph.D. Wynnell Domeniguez Substance Abuse Treatment Program West Los Angeles Treatment Program Division of Adolescent Medicine Children’s Hospital of Los Angeles Memphis, TN Sharon Davis Nonrespondent Frayser Family Counseling Center Miami, FL Michael Miller Prefers anonymity The Village South, Inc. Addiction Treatment Center New Orleans, LA Eleanor Glapion DRD Clinic New Orleans Substance Abuse Clinic Bronx, NY Narco Freedom Eugenia Curet, Ph. D. Adult Service Clinic The New York Presbyterian Hospital Philadelphia, PA C. Joseph Schultz, M.Ed. Peter A. Demaria, Jr., M.D., FASAM Northeast Treatment Department of Psychiatry and Human Behavior Jefferson Medical College Portland, ME Stephen Leary Discovery House Maine Milestone Foundation, Inc. Seattle, WA Ramona Graham Victoria Evans Center for Human Services Therapeutic Health Services Sioux Falls, SD Robin Erz, CCDCIII Turning Point Alcohol and Drug Center Illegal in the State on South Dakota

Keystone Treatment Center St. Louis, Missouri Mike Morrison Chris Johnson Bridgeway Counseling DART Washington, D.C. Prefers anonymity LaTonya Sullivan Umoja Treatment Center

Pulse Check: November 2001 page 103 APPENDIX 5: DISCUSSION AREAS

APPENDIX 5: DISCUSSION AREAS BY SOURCE TYPE*

Topic L E M N SNAPSHOT How serious is the current illegal drug problem in your community? !!!! How has the illegal drug problem changed in your community? !!!! THE PERCEPTION What is the most commonly abused drug in your community during the current reporting period? !!!! Second most commonly abused drug? What drug is related to the most serious consequences? Second most serious consequences? Is any new problem drug appearing in your community? What was the most commonly abused drug in you community during the last reporting period? !!!! Second most commonly abused drug in your community? What drug was related to the most serious consequences last reporting period? Second most serious consequences? THE DRUG** How available is the drug in your community (for each drug, asks about various forms)? !! How has availability changed? !! What are the most common and second most common units of sale and corresponding standard units of the drug? !!!! (special section only) What is the purity range for the drug during the current reporting period? During the last reporting period? !! What is the price range during the current reporting period? During the last reporting period? !! What is the source for your price and purity information? !! Why have price and purity changed or why have they remained stable? !! What are the street names, and are any of these new this reporting period? !!!! What types of packaging are used, and are any of these new this reporting period? !! Are labels or brand names used? If yes, please list and indicate if any are new this reporting period. !! Are there any adulterants? If yes, please list and indicate if any are new this reporting period. !!!! Have there been any changes in street names, packaging, labels, or adulterants since the last reporting period? !! If yes, please describe. THE SALE** How is the drug manufactured, processed, or grown? !! What is the source country or point of origin? !! What are the transshipment cities? !! What is the point of entry? !! What is the final destination city or region? !! Have there been any changes in manufacturing process or trafficking since the last reporting period? !! If yes, please describe. What is the predominant affiliation of local, street-level sellers? !! How likely are sellers to use their own drugs? !! How involved in other crimes are sellers? !! In what type of other crimes are sellers involved? !! Have there been any changes in seller characteristics since the last reporting period? If yes, please describe. !! Are there any new sellers groups this reporting period? If yes, please describe. !! What is the geographical area where most street-level sales of the drug occur? !! Is the drug sold mostly indoors, outdoors, or evenly split between both? !! In what settings is the drug sold? !! How is the drug sold? !! Are other drugs sold by this type of dealer? If yes, please list the drugs. !! Have any of the drugs sold with this drug changed since the last reporting period? If yes, please describe. !! What are any other distinctive features of the drug scene in your area? !! Have any of the drug scene characteristics changed since the last reporting period? If yes, please describe. !!

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THE USERS: Predominant characteristics** L E M N What is the predominant age range of the drug users? !!! What is the predominant gender? !!! What is the predominant racial/ethnic group? Is this group underrepresented, overrepresented, !!! or about equal compared with the general population in your area? What is the predominant socioeconomic position? !!! What is the most common geographical residence? !!! What is the predominant route of administration? !!! What are the drugs commonly taken in combination with this drug, including any street names for the !!! combination or practice? Is the drug used mostly indoors or outdoors? !!! Is the drug used mostly in public or in private? !!! Is the drug used mostly alone or in groups/among friends? !!! What are the common settings for the use of this drug? !!! What are the unusual settings or contexts for the use of this drug? !!! What is the most common referral source? !! What is the predominant education level? !! What is the most common frequency of use? !! What is the predominant employment status? !! THE USERS: New or emerging users** How did the number of new or emerging users change since the last reporting period? If increased, ! repeat the first 12 questions under “the users: predominant characteristics” for the new/emerging user group. How did the number of novice users in your program change since the last reporting period? !! If increased, repeat all questions under “the users: predominant characteristics” for the novice user group. METHADONE DIVERSION/TREATMENT To what extent is there a methadone diversion problem from treatment programs in your community? ! How has the diversion problem changed since the last reporting period? ! Is illegal methadone transported into your community from other areas? ! Who has been selling diverted methadone? ! How is it sold? ! Who has been buying diverted methadone? ! What is the availability of methadone treatment in your community? ! How has treatment availability changed since the last reporting period? ! What is the capacity of public methadone treatment? Private methadone treatment? ! How has the capacity of public methadone treatment changed since the last reporting period? ! Private methadone treatment? COMMUNITY CONTEXTS Were there substantial changes or issues involving (treatment availability or waiting time, drug-related hospital !! medical emergencies, drug-related deaths, large drug seizures, targeted law enforcement policy directives or initiatives, community policing, new sentencing practices, new joint task forces, new legislation, new community education or prevention programs, new public service campaigns, drug-related news events, other)? If yes, please describe. How did medical, political, criminal, or societal changes or issues (listed above) impact your community’’s !! overall drug abuse problem? Have drug-related consequences (HIV/AIDS, hepatitis C, liver cirrhosis, drug-related automobile accidents, !! high-risk pregnancy, drug overdoses, alcohol DTs, tuberculosis, other) increased, decreased, or remained stable since the last reporting period? If changed, explain. Have any of the psychiatric comorbidity diagnoses (conduct disorder, psychosis, mood disorders, suicidal !! thoughts/attempts, other) increased, decreased, or remained stable as a concern among your clients since last reporting period? If changed, explain. Do any potential barriers (limited slot capacity, lack of trained staff to treat comorbid clients, !! violent behavior among presenting clients, age restrictions, other) prevent your program from serving all individuals who seek treatment? If yes, explain.

Pulse Check: November 2001 page 105 APPENDIX 5: DISCUSSION AREAS

COMMUNITY CONTEXTS (continued) L E M N Have any factors (law enforcement referral patterns, waiting lists, treatment funding slot capacity, !! access to treatment at other local programs, program outreach, media attention, availability, purity, overdoses just prior to treatment, withdrawal just prior to treatment, adulterants, route of administration, other drugs used concurrently, other drugs used by clients, other) contributed to increases or decreases in your program’’s number of admissions related to any specific drug? If yes, describe. Have any legal issues (nonviolent offenses, violent offenses, gang-related activity, prostitution, !! drug-assisted rape, domestic violence, DUI/DWI, other) increased or decreased as concerns among your clients since the last reporting period? If yes, describe. TREATMENT BACKGROUND What is your program’s maximum capacity? !! What is your current enrollment? !! Does your program’s clientele reflect the population of your local community? If no, please describe. !! SPECIAL TOPIC: SYNTHETIC OPIOIDS All the above topics in “the drug,” “the sale,” and “the users: predominant characteristics” section were discussed about diverted/abused synthetic opioids (specify). In addition, the following topics were discussed: L E M N How serious is the problem in your community? !!!! How has the problem in your community changed since the last reporting period? !!!! What are the sources of illicit distribution of the drug? !! Are there a substantial number of impaired health care professionals using the drug in your community? !!! If yes, explain. Is the drug continually on the illicit drug market or does it emerge periodically? !! Is there prevalence for opioid-naive adolescents in your community? If yes, explain. !!! Are highly tolerant or experienced opioid abusers using? If yes, explain. !!! Is the drug used to replace heroin, used with heroin, or is its use not associated with heroin use? !!! Is the user population in your community new this reporting period? !!! In your opinion, has the media overemphasized, underplayed, or reflected accurately the problem !!!! in your community? Have there been any related health consequences, comorbidity/dual diagnoses, barriers to treatment, !! or legal issues related to the drug’s abuse?

LLaw enforcement EEpidemiologic/ethnographic MMethadone treatment NNon-methadone treatment *Please note that for the methadone and non-methadone treatment interviews, “community” was replaced with “program.” **Respondents were asked about heroin, crack cocaine, powder cocaine, methamphetamine, marijuana, ecstasy, GHB, ketamine, Rohypnol, hallucinogens (specify), and any other drugs (specify) for each of the discussion areas.

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