OSAM Ohio Substance Abuse Monitoring Network Surveillance of Drug Abuse Trends

in the State of Ohio June 2017 - January 2018

Lake Ashtabula Lucas Fulton Williams Ottawa Geauga Cuyahoga Defiance Henry Wood Sandusky Erie Lorain Trumbull

Huron Portage Paulding Seneca Medina Summit Putnam Hancock Mahoning

Van Wert Crawford Ashland Wyandot Wayne Stark Allen Richland Columbiana Hardin Marion Carroll Mercer Auglaize Holmes Morrow Tuscarawas Jefferson Logan Knox Shelby Union Delaware Coshocton Harrison

Champaign Darke Licking Miami Guernsey Belmont Franklin Muskingum Clark Madison

Noble Preble Montgomery Fairfield Monroe Greene Perry Pickaway Morgan Fayette Hocking Washington Butler Warren Clinton Ross Athens Vinton Hamilton Highland Meigs Pike Clermont Jackson

Brown Adams Scioto Gallia

Lawrence Legend Akron-Canton region Columbus region

Athens region Dayton region

Cincinnati region Toledo region Ohio Department of Mental Health and Addiction Services Cleveland region Youngstown region Office of Quality, Planning and Research Ohio Substance Abuse Monitoring Network Surveillance of Drug Abuse Trends in the State of Ohio June 2017 - January 2018

Prepared by:

Ohio Department of Mental Health and Addiction Services Office of Quality, Planning and Research

Sanford Starr, Deputy Director — MSW, LISW-S R. Thomas Sherba, OSAM Principal Investigator — PhD, MPH, LPCC Kathryn Coxe, OSAM Coordinator — MSW, LSW Jessica Linley, OSAM Quantitative Data Analyst — PhD, MSW, LSW

Table of Contents OSAM-O-Gram ...... 3 Executive Summary...... 5

Drug Abuse Trends by Region Akron-Canton Region...... 29 Athens Region...... 55 Cincinnati Region...... 77 Cleveland Region...... 101 Columbus Region...... 127 Dayton Region...... 151 Toledo Region...... 181 Youngstown Region...... 203

Tracy J. Plouck, Director • John R. Kasich, Governor Contact information: R. Thomas Sherba Office of Quality, Planning and Research 30 E. Broad St., 8th Floor Columbus, OH 43215 P: 614.466.9020 Email: [email protected] Recommended citation for this report: Ohio Department of Mental Health and Addiction Services [OhioMHAS] (2018). Ohio Substance Abuse Monitoring Network: Surveillance of Drug Abuse Trends in the State of Ohio: June 2017 - January 2018. Columbus, OH: State of Ohio. OSAM-O-G OSAM-O-Gramram Ohio Substance Abuse Monitoring Network Surveillance ofOhio Drug Substance Abuse Trends Abuse in Monitoring the State of Network: Ohio OSAM OhioDrug Substance Abuse Trends Abuse Monitoringin the State Network of Ohio June 2017 - January 2018 Surveillance of Drug Abuse Trends in the State of Ohio June 2012 - January 2013 John R. Kasich, Governor Orman Hall, Director

ToledoToledo Region Region ClevelandCleveland Region Region • • Increased availability of heroin; likely increased availability of Ecstasy, • likelyFentanyl, decreased meth av ailability& illicit ofSuboxone® Ecstasy availability high-grade• Fentanyl marijuana & meth availabilityand methamphetamine; likely decreased availability of • •Illicit DEA prescriptionand BCI reported opioid increase availability in number of bath salts cases; bath salts bath• Illicit salts prescription opioid availability • chemicallyUser preference altered and for re-branded fentanyl over heroin due to tolerance •• HeroinIn Cleveland, not adulterated heroin is now withcommonly fentanyl available difficult through to anonymous obtain • Despite decreased availability of Ecstasy, Ecstasy-like substances (2CE and • in number of persons receiving Suboxone®; many sell all or • Heroin users now seek fentanyl for its potency 2CB) available • part of their “subs” • Meth availability in suburban communities • DEA report everal mobile methamphetamine labs, • in users prescribed Neurontin® • manufacture in meth usedthrough as “one-pot” cut for other and “shake-and-bake” drugs methods • Purest form of Ecstasy (aka “Molly”) becoming more available as knowledge • in heroin users switching to meth of• Kratom drug gro wsavailable from heroin dealers; produces heroin-like high; • Some doctors prescribing Neurontin® in lieu of opioids for pain used to alleviate “dope sickness” Dayton Region • Decreased availability of Ecstasy; Akron-CantonAkron-Canton Region Region Daytonlikely increased Region availability of heroin • Increased availability of and Suboxone®; likely decreased • Fentanyl, marijuana (“dabs”) & meth •av Fentanyl,ailability of methcrack cocaine & illicit opioidsavailability and Sub oxone®; likely • Neurontin® availability increased availability of crack cocaine • Heroinand heroin not adulterated with fentanyl •heroin Heroin has unadulterated reached “epidemic” with difficult to obtain fentanyl or carfentanil nearly • Methamphetamine thought to notunavailable used personally in region reported friends • have in marijuanaincreased due products to more people(“edibles”) •and Many family users who hnowave desire fromwith knowledge out-of-state of “one-pot” dispensaries or • fentanyl Free “test ers”& carfentanil of heroin remain over “shake-and-bake” method of • Regionmanufactu floodedre with crystal meth avheroinailable in Dayton which makes it from Mexico for users to avoid the drug • • Fentanyl purchased online • Users “getting clean” from heroin/ from overseas vendors & 50 percent of all drug-related deaths mailed to the region fentanylaccording toby cor switchingoner’ to meth • Increased availability of heroin and • Kratom available from heroin dealers, • in heroin/fentanyl users Youngstown Region Subillicitlyoxone®; using likely Neurontin® increased to produces heroin-like high availability of bath salts, • alleviate “dope sickness” opioids; likely increased availability of marijuana; likely decreased availability heroin, methamphetamine and of powdered cocaine SubYoungstownoxone®; likely decreased Region availability • Cincinnati Region • • Opana®, Fentanyl, Roxicet®, marijuana Ultram® (“dabs”), and meth with those as young as 12 years Please note: & powdered cocaine availability beginning use • Fentany, marijuana (“dabs”) & = Increase opioids• demand now present for infentanyl 77.8 perc asent more of all • meth Current availability availability of drug-heroinrelated users deaths exposed according to the it & methamphetamine is high in rural Columbus Region = Decrease coroner’ • Fentanyl supplanting heroin increase their tolerance for opiates in the region • Throughout the region, professionals • Fentanyl, marijuana, (“dabs”) & reported• Heroin heroin users to beswitching the primary to drug cocaine • cocaine demand among meth availability Athens Region problem& meth due to fear of opiate heroin users who seek Illicit prescription opioid availability overdose & death Columbusstimulant Region drugs to “speedball” • Athens Region • Increased availability of bath salts; likely Difficult increased av toailability obtain of heroin,heroin or • Fentanyl, marijuana & • in cocaine demand as more • Hamilton County Coroner • meth• Increased availability availability of heroin and Suboxone®; likely increased reports 39% of drug-related fentanyl without the other users treated with Vivitrol® Illicitavailability prescription of bath salts opioid and methamphetamine; likely decreased •deaths involved cocaine • Users actively seek fentanyl • • Use of “dabs” the new & hip thing to do easily obtained at the same stores that previously sold them before the law availability • Heroin users switching to • in cocaine use due to prices • • Some doctors now prescribing banningmeth to them avoid took “dope e ect sickness” • Highseeking availability treatment for of heroin use & perception that cocaine is carfentanil indicated Neurontin® in lieu of opioids for •& out of overdose fear “safer” than heroin • some pain conditions, anxiety & • Law enforcement report drug • Fentanylbath salts pressed into sleep issues popularity • in popularity of “speedballing” pill form & sold as cartels aggressively pushing • BCI reported an increase in bath salts cases; as soon as one substance is (using opiates with stimulants) prescription opioids meth on heroin market banned, another chemical analogue takes its place • in crystal meth brought to • Crystal meth as prevalent as marijuana in region the region from other states & Meth use as fear of death by opiate overdose • Ohio Department ofMexico Alcohol and Drug Addiction •Se rvices • Division of Planning, Outcomes & Research • • 30 W. Spring St., 6th Floor, Columbus, Ohio 43215 • 1-800-788-7254 • www.ada.ohio.gov OSAM Drug Trend Report January-June 2013 Ohio Department of Mental Health and Addiction Services • Office of Quality, Planning and Research Surveillance of Drug Abuse Trends in the State of Ohio

Page 4 OSAM Drug Trend Report June 2017- January 2018 Surveillance of Drug Abuse Trends in the State of Ohio Surveillance of Drug Abuse Trends in the State of Ohio OSAM Ohio Substance Abuse Monitoring Network

Surveillance of Drug Abuse Trends in the State of Ohio June 2017 - January 2018

Executive Summary

The Ohio Substance Abuse Monitoring (OSAM) Network consists of eight regional epidemiologists (REPIs) located in the following regions of the state: Akron-Canton, Athens, Cincinnati, Cleveland, Columbus, Dayton, Toledo and Youngstown. The OSAM Network conducts focus groups and individual interviews with active and recovering drug users and community professionals (treatment providers, law enforcement officials, etc.) to produce epidemiological descriptions of local substance abuse trends. Qualitative findings are supplemented with available statistical data such as coroner’s reports and crime laboratory data. Mass media sources, such as local newspapers, are also monitored for information related to substance abuse trends. Once integrated, these valuable sources provide the Ohio Department of Mental Health and Addiction Services (OhioMHAS) with a real-time method of providing accurate epidemiological descriptions that policymakers need to plan appropriate prevention and intervention strategies. This Executive Summary presents findings from the OSAM core scientific meeting held in Columbus, Ohio on January 26, 2018. It is based upon qualitative data collected from July through December 2017 via focus group interviews. Participants were 350 active and recovering drug users recruited from alcohol and other drug treatment programs in each of OSAM’s eight regions. Data triangulation was achieved through comparison of participant data to data collected from 135 community professionals via individual and focus group interviews, as well as to data surveyed from coroner and medical examiner offices, family and juvenile courts, municipal courts, common pleas and drug courts, the Ohio Bureau of Criminal Investigation (BCI), the Ohio State Highway Patrol Crime Lab, police and county crime labs, OhioMHAS’ Screening, Brief Intervention and Referral for Treatment (SBIRT) program which operates in federally qualified health centers, and the Ohio Department of Public Safety (ODPS), which logs drug task force seizures from across Ohio. Media outlets in each region were also queried for information regarding regional drug abuse for July through December 2017. OSAM research administrators in the Office of Quality, Planning and Research at OhioMHAS prepared regional reports and compiled this summary of major findings. Please refer to regional reports for more in-depth information about the drugs reported in this section.

Powdered Cocaine

Reported Change in Availability of Throughout OSAM regions participants continued to report Powdered Cocaine that powdered cocaine is just a phone call away and easily during the Past 6 Months obtained at some nightclubs and bars. Corroborating data indicated that powdered cocaine is readily available. Coroner Region Current Availability Availability Change and medical examiner offices in Cuyahoga, Hamilton and Montgomery counties reported that approximately 40% Akron-Canton High No change of all the drug-related deaths they recorded this reporting Athens Moderate to High No change period involved powdered/crack cocaine. The availability Cincinnati High Increase of the drug has likely increased in the Cincinnati and Youngstown regions. Cleveland Moderate to High No change When participants in the Cincinnati region were asked why Columbus High No change the availability of powdered cocaine has increased, several Dayton Moderate to High No change participants reported that there has been an increase in demand for the drug among heroin users. They explained Toledo High No change that heroin users seek stimulant drugs like cocaine to Youngstown High Increase

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“speedball” (concurrent or consecutive stimulant and region) with fentanyl … it’s to get you addicted to their cocaine sedative highs). Moreover, they discussed using cocaine … so in other words, you think you’re doing cocaine, but yet … with heroin to counteract “nodding out” (passing out) and it’s more fentanyl than it is cocaine; They cut everything with to increase their “stay up” (awareness). Treatment providers fentanyl; A lot of stuff is cut with fentanyl to make you crave in the Youngstown region discussed a migration from opiates.” Treatment providers also discussed fentanyl cut into heroin to cocaine as more opiate users become fearful of cocaine often unbeknownst to the user: “We’ve had several fatal overdose due to fentanyl and carfentanil. Reportedly, overdoses from putting the fentanyl in the cocaine … and users view cocaine use as “safer” than heroin/fentanyl use. In these are the die-hard cocaine [users], who are like, ‘I promise addition, participants and treatment providers throughout you, I was not doing [fentanyl]’; I had a client tell me he can tell regions explained that as more users are treated with [powdered cocaine] was mixed with fentanyl because when he Vivitrol®, the demand for cocaine has increased due in part to used it, he felt life leaving him, and he felt like he was dying … he those receiving medication assisted treatment for opiate use passed out outside and his wife found him.” disorder who still desire to get high. Crime labs throughout OSAM regions noted the following Participants throughout OSAM regions most often rated cutting agents for powdered cocaine: acetaminophen the current overall quality of powdered cocaine as ‘5-6’ on (analgesic), atropine (prescription heart medication), caffeine, a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); local anesthetics (benzocaine, lidocaine and procaine), the regional modal quality scores ranged from ‘5’ for Akron- mannitol (diuretic), and pet and livestock dewormers Canton, Cleveland, Dayton and Youngstown to ‘10’ for (levamisole and tetramisole). Toledo. Participants in Akron-Canton, Athens, Cincinnati and Current street jargon includes many names for powdered Columbus regions noted a decrease in the overall quality cocaine. Street names often refer to famous actresses or of powdered cocaine during the past six months, whereas female singers (e.g. “Christina Aguilera,” “Katy Perry” and participants from all other regions indicated that quality has “Lindsay Lohan”). Other names refer to the color and texture remained the same. of the drug (e.g. “fish scales,” “powder” and “snow”). One While participants reported the current quality of powdered participant explained the reason for the street name, fish cocaine as generally moderate, they explained that there scales: “When it was the good ether stuff, it would have a shine is a lot of inconsistency in quality between dealers due to to it like fish scales would, literally.” Participants also shared varying types and amounts of “cuts” (adulterants) added phrases used for referring to the drug: “It’s ‘snowing’ at my to the drug that affect its quality. Participants universally house (I have powdered cocaine); What’s up with that ‘girl’ (I’m indicated that powdered cocaine is often cut with other looking for powdered cocaine).” substances and reported that the top cutting agents for powdered cocaine included: aspirin (including baby aspirin Current Street Names of and BC® Powder), baby formula, baby laxatives, baby powder, Powdered Cocaine baking soda, carfentanil, creatine, fentanyl, inositol (dietary supplement), NoDoz®, prescription opioids (Vicodin® and blow, coke, fish scale, girl, powder, General Names Percocet®), Similac® and vitamin B. snow, soft, white girl Other cuts mentioned included: acetone, Benefiber®, bao, bitch, Christina Aguilera, fire benzodiazepines (Valium®), “Bolivian Rock” (a cutting agent powder, flake, flour, fluff, Katy Perry, marketed as a concentrated room and carpet deodorizer), Other Names Lindsay Lohan, nose candy, scale, brick dust, caffeine powder, calcium, Carpet Fresh®, “Close softball, sugar, summer snow, white, Enough” (reportedly a product sold in head shops to cut white stallion, yayo drugs), “energy pills,” ether, fingernail polish remover, flour, heroin, Kool-Aid®, laxatives, local anesthetics (benzocaine Participants in half of OSAM regions reported that the most and Novocain), mannitol (diuretic), MSG (monosodium common quantity of purchase for powdered cocaine is glutamate), MSM (methylsulfonylmethane, a joint generally a gram for $50-80, while participants in the Akron- supplement), niacin, omega 3, Orajel®, PCP (phencyclidine), Canton, Cincinnati and Columbus regions indicated the most powdered sugar, prescription stimulants (Adderall® and common quantity of purchase as 1/8 ounce (aka “eight ball”) Ritalin®), protein powder, Sleepinal®, teething tablets and for $150; and in the Athens region, participants identified 1/2 Tylenol®. gram for $50 as the most common purchase for powdered cocaine. Participants in the Cleveland, Columbus and Dayton Regarding the practice of cutting cocaine with fentanyl, regions reported purchasing an ounce of the drug for participants reported: “There’s cocaine down here (Cincinnati between $900-1,300.

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Participants throughout OSAM regions indicated that the feeling kind of down or sloppy, or you’re slurring [your speech] relationship between the drug dealer and the user directs a little bit, you do a couple of lines; You need to drive home the price of the drug; reportedly, if a user has an established and not get a DUI [use cocaine]; It makes you more alert … it relationship with a dealer, the price could be lower than brings you back to life. You can function; you can drink all night that for a user perceived as a one-time buyer. Participants in if you have cocaine….” Lastly, participants noted that any the Akron-Canton and Cleveland regions reported that the drug could be used with powdered cocaine. One participant overall price for powdered cocaine has decreased during remarked, “Anything that floats your boat or that fancies you, the past six months, primarily due to increased interest in you can mix them together … there’s no actual guide to it.” methamphetamine among stimulant users, thereby lowering the demand for powdered cocaine, and correspondingly decreasing its cost. Substances Most Often Combined with Powdered Cocaine The most common route of administration for powdered cocaine throughout OSAM regions is snorting. Participants • alcohol • heroin • marijuana • methamphetamine • estimated that out of 10 powdered cocaine users, 5-10 would • prescription opioids • sedative-hypnotics • snort and 1-5 would either “shoot” (intravenously inject) or smoke the drug. The majority of participants with experience using powdered cocaine reported that they would snort the drug. However, due to the high prevalence of intravenous Crack Cocaine injection for opiates, many participants shared the sentiment that if users shoot other drugs, they would shoot all drugs, including powdered cocaine. They stated: “A lot of people Crack cocaine remains highly available. Respondents have moved to the needle (intravenous injection); Everyone is throughout OSAM regions discussed cocaine (crack shooting everything; They probably do both. If you can’t find a and powdered) as going hand-in-hand with heroin. needle, you snort.” Reportedly, most heroin dealers also carry crack cocaine There was discussion that smoking powdered cocaine due to demand among users for both heroin and cocaine generally meant rocking the drug into crack cocaine. as discussed above in the powdered cocaine section. However, a few participants discussed free-basing powdered Treatment providers in the Columbus region reported cocaine, explaining that to do this a user would heat the drug an increase in demand for crack cocaine among those on aluminum foil and inhale the resulting vapor through who receive medication assisted treatment for opiate use a straw. Lastly, a few participants reported that powdered disorder (i.e. Vivitrol® and Suboxone®). cocaine may also be administered by eating it, rubbing it on the gums or lips, adding it to coffee and “parachuting” Reported Change in Availability of (wrapping the drug in tissue paper and swallowing it). Crack Cocaine Participants and community professionals most often during the Past 6 Months described typical powdered cocaine users as affluent, white people and professional, while also noting powdered Region Current Availability Availability Change cocaine use among heroin users. Akron-Canton High No change Many other substances are used in combination with Athens High No change powdered cocaine. Participants reported that powdered Cincinnati Moderate to High No change cocaine is often used in combination with heroin to “speedball” (concurrent or consecutive stimulant and Cleveland High No change sedative highs). Participants also noted that alcohol, Columbus High No consensus marijuana and sedative-hypnotics are used to bring a user down from the intense stimulant high produced by cocaine Dayton High No change use. Participants stated: “They take a downer to come off it; Toledo High No change Marijuana takes all the shakiness away….” Youngstown High No change In addition, participants discussed alcohol as balancing out cocaine, enabling a user to party longer. They said: “Alcohol and cocaine go hand-in-hand; You drink and then you do a couple of lines [of cocaine] and it balances you out … if you’re

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Participants throughout OSAM regions most often rated the current overall quality of crack cocaine as ‘7’ on a Current Street Names of scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); Crack Cocaine the regional modal quality scores ranged from ‘3-8’ for Columbus to ‘8-10’ for Cincinnati. Overall, participants General Names butter, crack, hard, melt, rock, work throughout OSAM regions reported that the quality of A1, action, Bobby Brown, caviar (cavvy), crack cocaine has remained the same during the past six crinak, Dom Pérignon, drop (straight drop), months; however, some participants in the Akron-Canton Other Names filet mignon, food, girl, hard, hard tacos, and Cincinnati regions thought that the overall quality of hardware, hot rocks, stone, yank, yay, yayo, crack cocaine has decreased. yellow, yum

Following the discussion of the current quality of often sells for $175. Participants throughout OSAM regions powdered cocaine, participants explained that there is a indicated that the price for crack cocaine has remained the lot of inconsistency in the current quality of crack cocaine same during the past six months, with the exception of as well, depending on the dealer and the varying types participants in the Cincinnati region who reported that prices and amounts of “cuts” (adulterants) added to the drug have decreased. Participants in this region also reported that affect its quality. They reported that the top cutting exchanging stolen goods, such as televisions, for crack cocaine. agents for crack cocaine included: baby laxatives, baby Participants reported that the most common route of powder, baking soda and isotol (dietary supplement). administration for crack cocaine remains smoking. Participants Other cuts mentioned included: ammonia, aspirin, baby estimated that out of 10 crack cocaine users, 5-8 would smoke formula, baby laxatives, benzodiazepines (Valium®), and 2-5 would intravenously inject (aka “shoot”) the drug. chalk, coffee creamer, creatine, ether, fentanyl, heroin, ibuprofen, mannitol (diuretic), methamphetamine, Orajel®, While many participants did not believe there is a typical prescription opioids (Percocet®), rat poison, sleeping pills, user of crack cocaine, participants often described typical soda (Seven-Up® and Sprite®), Tylenol® and Vitamin B-12. crack cocaine users as people of lower socio-economic status living in urban settings. Moreover, one participant explained Crime labs throughout OSAM regions noted the following that if users weren’t poor before using drugs, crack cocaine cutting agents for crack cocaine: acetaminophen causes people to spend all of their money and have to resort (analgesic), atropine (prescription heart medication), to committing crime to afford the drug. Some community caffeine, local anesthetics (benzocaine, lidocaine and professionals reported that crack cocaine users are more likely procaine), mannitol (diuretic), and pet and livestock from lower income areas; however, the majority of community dewormers (levamisole and tetramisole). professionals did not identify characteristics of a typical crack cocaine user. In addition, as stated previously, participants and Current street jargon includes many names for crack community professionals noted that heroin users receiving cocaine. Street names refer to a user’s favorability towards Vivitrol® as medication assisted treatment use crack cocaine. the drug (e.g. “A1,” “caviar” and “Dom Pérignon”), as well as the texture and appearance of the drug (e.g. “butter,” Several other substances are used in combination with crack “yellow” and “rocks”). Participants discussed: “It’s a hard, cocaine. Participants reported using alcohol in combination rocky substance; It looks like butter; When you smoke, when with crack cocaine to enable drinking for longer periods, to you put the flame to it, it melts down … so that’s why some come down from the intense stimulant high of crack cocaine, and because they perceived the substances to go hand-in- people call it ‘melt,’ ‘butter’ … stuff like that.” A participant hand. Participants reported using heroin in combination in the Akron-Canton region reported that the term “filet with crack cocaine to “speedball” (concurrent or consecutive mignon” is applied to crack cocaine, “especially when it is stimulant and sedative highs), and using heroin and sedative- good.” hypnotics (i.e. Xanax®) to come down from the stimulant high Participants in the Akron-Canton, Cincinnati, Cleveland, of crack cocaine. Participants in the Dayton region reported Dayton and Toledo regions reported that the most common that marijuana mixed with crack cocaine is called a “dirty quantity of purchase for crack cocaine is approximately 1/10 blunt,” and participants throughout regions reported using gram (aka “rock” or “piece”) for $10-20; in all other regions, a marijuana because it enhances the effects of crack cocaine. gram is the most common quantity of purchase. Throughout A few participants reported using methamphetamine in OSAM regions, a gram sells for $60-100; 1/16 ounce (aka combination with crack cocaine. A participant explained, “If “teener”) sells for $80-90; and 1/8 ounce (aka “eight ball”) most they are not getting the ‘speed’ (stimulant high) from crack, they will use meth.”

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With the exception of the Athens and Columbus regions Substances Most Often Combined with where participants noted black tar heroin as the most Crack Cocaine available heroin type, participants generally reported powdered heroin as most available. In regions where • alcohol • heroin • marijuana • methamphetamine • white powdered heroin is reportedly available, there • sedative-hypnotics • was discussion as to whether white powdered is “china white” (white powdered heroin thought to be the most potent and purest). One participant in the Cincinnati region stated, “It’s china white … just like a white powdery Heroin substance. You would probably think it was fentanyl because that’s how much it looks like it.” A Columbus participant Although participants and community professionals commented, “[China white is] all fentanyl-laced [heroin] throughout OSAM regions reported high current these days.” There was a general consensus that white availability of heroin, respondents across focus groups powdered heroin usually contains fentanyl and is not true discussed that heroin is generally heroin mixed with china white heroin. fentanyl. Participants explained that “just heroin,” heroin Participants in the Athens region reported not seeing unadulterated with fentanyl or carfentanil is nearly white powdered heroin at all during the past six months, unavailable. They, along with community professionals, while participants in the Youngstown region indicated that noted users now desiring fentanyl and carfentanil over gray heroin is most likely “cut” (adulterated) with fentanyl, heroin; reportedly, many users seek the synthetic opioids. and red heroin is most likely cut with carfentanil. Overall, In the Cleveland region, participants throughout focus participants reported a variety of colors for powdered groups reported the increasing difficulty in finding heroin heroin, including: brown, gray, pink, purple, red, tan and not adulterated with fentanyl or fentanyl analogues as the white. State and local crime labs reported processing: basis of their reporting that the availability of heroin has beige, brown, gray, off-white, purple, tan and white decreased during the past six months. powdered heroin, as well as black tar heroin.

Reported Change in Availability of Participants throughout OSAM regions most often rated Heroin the current overall quality of heroin as ‘7’ on a scale of ‘0’ during the Past Six Months (poor quality, “garbage”) to ‘10’ (high quality); the regional modal quality scores ranged from ‘0’ for Akron-Canton Current Availability Most Available to ‘8’ for Toledo, ‘5’ and ‘10’ for Cleveland, and ‘6-10’ for Region Availability Change Heroin Type Columbus. Akron-Canton participants surmised that Akron-Canton High No change Brown powdered since the heroin supply is so heavily adulterated with more potent substances (i.e. fentanyl/carfentanil) that the Athens High No change Black tar current quality of heroin must be very poor. Participants Cincinnati High No change White powdered in Akron-Canton, Athens, Cincinnati and Dayton regions Cleveland High Decrease Powdered noted a decrease in the overall quality of heroin during Powdered and the past six months, whereas participants from Cleveland, Columbus High No change Black tar Toledo and Youngstown regions indicated that quality has Dayton High No change Powdered remained the same. In the Columbus region, participants could not comment on a change in quality during the past Toledo High No change White powdered six months, explaining it is difficult to do so due to the Youngstown High No change Brown powdered potency of fentanyl added to heroin. Participants discussed adulterants (aka “cuts”) that affect the quality of heroin. In addition to fentanyl and carfentanil, participants also named the following as top cutting agents for heroin: brown sugar, coffee, powdered sugar, vinegar and vitamin B. Additional cuts mentioned included: artificial

OSAM Drug Trend Report January-JuneJune 2017- January 2013 2018 Page 9 Page 8 Surveillance of Drug Abuse Trends in the State of Ohio sweeteners (lactose and saccharin), aspirin, baby food, baby Contrary to the previous reporting period, where the formula, baby laxatives, baking soda, battery acid, Benadryl®, most common quantity of purchase for heroin was 1/10 Benefiber®, benzodiazepines (Xanax®), brick dust, candy gram, participants throughout the majority of OSAM (caramel and Tootsie Rolls®), chalk, chocolate powder, cinnamon, regions reported that the most common quantities of cocaine, coffee creamer, cosmetics, cough drops, creatine, dark purchase are currently 1/2 gram and a gram. Reportedly, sodas (Coca Cola® and Pepsi®), dietary supplements (inositol 1/2 gram sells for $50-70; and a gram sells for $100-120. and isotol), ether, Goody’s® Powder pain relievers, kratom A participant commented, “You gotta have your fix for the (mitragynine, a psychoactive plant substance), lactate powder, day, so I guarantee probably everybody in this room needs to laxatives, lidocaine (local anesthetic), lithium, mannitol (diuretic), buy at least a gram.” Only participants in the Dayton region maple syrup, marijuana, menthol, methamphetamine, Miralax®, reported the most common quantity of heroin purchase molasses, Neurontin® (gabapentin), niacin, Orajel™, prescription as 1/10 gram, usually in a capsule for $10-20. opioids (morphine, Percocet® and Vicodin®), rat poison, sleep aids (Sleepinal®), tea, teething tablets, toothpaste, tranquilizers, In addition, participants in the Akron-Canton and Tylenol® and vitamin D. Columbus regions reported being able to purchase the quantity that the amount of money they had on hand Crime labs throughout OSAM regions noted the following afforded. A participant stated, In“ my experience, you can cutting agents for heroin: acetaminophen (analgesic), artificial get whatever you want. If you want [to spend] $10, you sweeteners (lactose and sorbitol), caffeine, carfentanil, cocaine, can get $10 [worth of heroin].” In the Cincinnati region, diphenhydramine (antihistamine), dipyrone (banned analgesic), participants discussed that better prices for heroin are fentanyl/fentanyl analogues, lactose, mannitol (diuretic), obtained if the user has a relationship with the dealer, and methamphetamine, nicotinamide (vitamin), papaverine if the user buys larger amounts of the drug at one time. (vasodilator), prescription opioids and quinine (antimalarial). These participants also discussed driving dealers around or letting dealers use their cars in exchange for heroin. Current street jargon includes many names for heroin. Throughout OSAM regions, participants reported that the Throughout OSAM regions, participants reported that the most common street name for heroin is “dog food,” although price of heroin has generally remained the same during this term more specifically refers to brown powdered heroin. the past six months. However, many participants in the One participant shared that dealers solicit heroin customers Cincinnati and Youngstown regions noted decreased by asking prospective users, and usually at a gas station: “You pricing. Participants who reported decreased pricing cited want some dog food?” Participants also discussed that male increased dealer competition for customers as the reason names beginning with the letter ‘H’ are used to reference for the lowering of prices. In Cincinnati, participants also heroin. They named Hank, Harold and Henry as specific discussed dealers giving away “get wells” (small amounts names used for the drug. of heroin for regular customers in obvious withdrawal) and “testers” (free samples of heroin). Current Street Names of Participants continued to report that the most common Heroin routes of administration for heroin remain intravenous boy, caps (capsules containing injection (aka “shooting”), followed by snorting. heroin), dope, heron, fire, food, General Names Participants most often estimated that out of 10 heroin H, Harold, horse, man, Ron, scag, smack, stamps, packs, Uncle Henry users, nine would shoot and one would snort the drug. Participants reported that injection needles are most Other Names for balloons, berries, tar available from drug stores/retail pharmacies, drug dealers Black Tar and people with diabetes. Additionally, participants Other Names for dog, doggy, dog food, Kibble n’ Bits®, reported obtaining needles from doctors, pet stores and Brown Powdered Scooby snacks through Internet purchase; and participants in every Other Names for chime, china, china white, Incredible OSAM region noted access to and utilization of needle White Powdered Hulk, pink Peruvian, sugar, white exchange programs where a used needle is traded for a new needle. Even if a program is not operating within Other Names for gray, gray death a region, participants reported travel to an adjacent Gray Powdered region to exchange needles. For instance, participants

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in the Akron-Canton and Youngstown regions reported Fentanyl traveling to Cleveland’s needle exchange program, while some Dayton participants reported utilizing the needle exchange programs in Columbus. Participants also Throughout OSAM regions, fentanyl is extremely discussed users sharing/using someone else’s needle as available—and its availability has universally increased common, although some noted that users who inject during the past six months. Law enforcement reported drugs often clean needles with hot water or alcohol prior that drug cartels have flooded Ohio with the drug. They to use. Reportedly, the most common price for needles on also noted that fentanyl is purchased online from overseas the street is $1-2 per needle. vendors, primarily in China, and mailed to addresses throughout the state. Participants and community While participants and community professionals throughout professionals discussed the increase in availability of OSAM regions continued to describe the typical heroin user fentanyl as due to increased demand for the drug. as anybody, many respondents continued to note heroin use Participants attributed increased demand to more heroin primarily among white people. users being exposed to fentanyl and increasing their tolerance for opiates. They explained that fentanyl is Many other substances are used in combination with far more potent than heroin; thus, once a heroin user heroin. Participants throughout OSAM regions discussed experiences the high of fentanyl, it is difficult for the the popularity of using cocaine, and the increasing user to be satisfied with a heroin high. One participant popularity of using methamphetamine, with heroin to remarked, “Heroin doesn’t even get people high no more.” “speedball” (concurrent or consecutive stimulant and sedative highs). Participants discussed: “A shot of ‘meth’ Many community professionals indicated that some (methamphetamine) and heroin at the same time; Especially, clients do not know they are taking fentanyl, while others crack [is used with heroin] ‘cause you want to speed up. indicated that clients are actively seeking the drug. Speedball a little bit, and then you do another shot of heroin, Overall, community professionals shared the belief that and then you smoke a little bit of crack….” Other participants fentanyl is widely available because it is showing up in discussed using methamphetamine in combination with other substances, such as cocaine, heroin and prescription heroin to come down from the intense stimulant high opioids (reportedly, fentanyl is pressed into pills and sold of the methamphetamine or to avert an overdose. One as prescription opioids). Many participants also attributed participant stated, “I’ve used meth to pull myself out of an increased availability of fentanyl to dealers being able overdose.” to acquire the drug inexpensively, which has resulted in dealers substituting fentanyl for other drugs and in cutting Participants also discussed the combination of Neurontin® other drugs with it to increase their profits; fentanyl is (gabapentin) with heroin to help a user alleviate cheaper than heroin but sells at heroin prices. withdrawal symptoms. They said: “Gabapentin, Neurontin® … it’s kind of more of a withdrawal drug. I know people Additionally, both respondent types discussed the that use it in combination with heroin, but a lot of people higher frequency in overdoses statewide as indicative use it when they don’t have the heroin; It helps with the of a higher supply of fentanyl, while also noting the withdrawal.” Lastly, participants reported marijuana use as high number of lives saved with Narcan® (naloxone, an common with heroin. A couple of participants discussed opiate overdose reversal medication). Both participants lacing marijuana by sprinkling heroin into a blunt and law enforcement indicated naloxone as available (marijuana-filled cigar) before smoking. and accessible throughout OSAM regions. Columbus Police, BCI Bowling Green, BCI London, BCI Richfield and the Miami Valley Regional crime labs reported that Substances Most Often Combined with the number of fentanyl and fentanyl analogues cases Heroin they process have increased during the past six months. • alcohol • crack cocaine • ecstasy • marijuana • In addition, BCI London, Lake County and the Miami • methamphetamine • molly • Neurontin® • Valley Regional crime labs reported that the number of • powdered cocaine • prescription opioids • carfentanil cases they process have increased. • sedative-hypnotics •

OSAM Drug Trend Report January-JuneJune 2017- January 2013 2018 Page 11 Page 8 Surveillance of Drug Abuse Trends in the State of Ohio

Reported Change in Availability of Other participants commented: “I don’t hear names for Fentanyl fentanyl. I just hear everybody just call it ‘dope’ (heroin), but during the Past 6 Months it’s not ‘dope,’ it’s fentanyl ….” However, participants in the Dayton region reported that fentanyl is called “fetty” and Region Current Availability Availability Change “fetty wap” because of the rapper, Fetty Wap. Akron-Canton High Increase Athens High Increase Current Street Names of Cincinnati High Increase Fentanyl Cleveland High Increase Most Common Names fetty, fetty wap Columbus High Increase baby boy, carfentanil, Chinese food, Other Names Dayton High Increase dope, fennies Toledo High Increase Participants in six OSAM regions reported on prices for Youngstown High Increase fentanyl. Participants in the Athens region reported that the drug is pressed into pill form and sold as prescription Participants throughout OSAM regions most often rated opioids on the street, often as Roxicodone® 30 mg for $30- the current overall quality of fentanyl as ‘10’ on a scale 35. In the Columbus region, participants reported being of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the unable to discuss current prices for fentanyl alone since previous most common score was not reported. Although the drug is so often mixed with heroin. In all other regions, participants noted that fentanyl is very potent, many 1/10 gram of fentanyl most often sells for $20; 1/2 gram participants complained that the effect of the drug is short sells for $50; and a gram sells for $100. In the Cleveland lived. One participant explained, “The thing I liked about and Dayton regions, participants reported obtaining 1/4 fentanyl is that for $20 you can get four shots off of it. But, ounce of the drug for $600. Participants reported that it still wasn’t as good as heroin, ‘cause the fentanyl doesn’t fentanyl is sold similarly as heroin, but is cheaper for the last long enough. You’ll do it, and an hour later you’re sick drug dealer to purchase, and therefore slightly cheaper for again (in withdrawal). With heroin, you can go five, six hours the consumer. without getting sick.” The most common route of administration for fentanyl In terms of cutting agents for fentanyl, participants is intravenous injection (aka “shooting”). Participants explained that fentanyl is typically a cut for other drugs, estimated that out of 10 fentanyl users, 7-10 would shoot such as heroin and cocaine. However, many participants and the rest would likely snort the drug, although there reported that fentanyl, due to its high potency, needs were mentions of smoking and orally consuming fentanyl. to be cut with something or else users would overdose A participant remarked, “If you’ve made it up to using and potentially die. These participants reported that fentanyl, you’re shooting it.” Participants and community the top cutting agents for fentanyl included: coffee, providers throughout OSAM regions most often described heroin, powdered sugar and vitamin B. An additional cut typical fentanyl users as similar to heroin users. mentioned included MSM (methylsulfonylmethane, a joint supplement). Crime labs did not report on adulterants for Many other substances are used in combination with fentanyl. Overall, participants reported that the general fentanyl. Participants discussed using fentanyl in quality of fentanyl has remained the same during the past combination with crack cocaine, powdered cocaine and six months, with exception of the Cleveland and Dayton methamphetamine to either come up from the sedative regions where participants reported increased quality. effects of the fentanyl or to “speedball” (concurrent or consecutive stimulant and sedative highs). Participants Current street jargon includes few names for fentanyl. commented: “I like to smoke crack then shoot up In some regions, participants did not discuss any street (inject fentanyl); I always used methamphetamine with names for the drug, or reported the same names as heroin fentanyl ‘cause I was either way too up and needed to since the two are so often mixed together. One participant come down, or way too down and needed to come up.” stated, “It’s usually sold as heroin … they pass it off as heroin.” Participants throughout OSAM regions reported using

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benzodiazepines in combination with fentanyl to intensify noted doctors cutting back on prescribing opioids as the sedative effects of fentanyl even further. Participants another reason for decreased availability. Treatment remarked: “Xanax® makes [the fentanyl high] more providers also credited the Ohio Automated Rx Reporting powerful; It’s a ‘benzo’ (benzodiazepine), so it intensifies the System (OARRS) as having a positive impact on the decline drowsiness (aka ‘nod’) effect.” in street availability. However, even though many treatment providers believed that doctors have tightened their prescribing of opioids, making many opioids less available, Substances Most Often Combined with Fentanyl providers in the Toledo region continued to report that users can easily obtain these drugs for illicit use if desired. • crack cocaine • heroin • methamphetamine • Current street jargon includes many names for • powdered cocaine • sedative-hypnotics • prescription opioids. General street names for the drugs include: “beans,” “M&M’S®,” “pills,” “skittles” and “Tic Tacs®.” Participants explained that street names are generally Prescription Opioids derived from the brand name for the opioid; the brand name is either shortened or the first letter of the brand name is used to refer to it (e.g. ‘Vs’ or ‘vikes’ for Vicodin®). In the majority of OSAM regions, the availability of In addition, street names for prescription opioids often prescription opioids for illicit use has decreased during the include names based on the color (e.g. “blues”) and past six months. As a result of the increased demand for milligram doses (e.g. “5s” for 5 mg and “10s” for 10 mg) of and supply of fentanyl, participants described decreased the drugs. street availability of prescription opioids. They explained that fentanyl is a stronger and cheaper alternative to both heroin and prescription opioids. In addition, participants Current Street Names of Prescription Opioids Reported Availability Change of Dilaudid® alien heads, daddy, Ds, K8, K10 Prescription Opioids Lortab® tabs during the Past 6 Months methadone dones Current Availability Most Norco® norcs, yellows, yellow jackets Region Availability Change Available Opana® O, oranges, pans, 40 Opana® OxyContin® oxy, OC, OP Percocet® Akron-Canton Moderate Decrease Roxicodone® blues, blueberries, jerks, Ps, percolators, Vicodin® Percocet® perks, perk 5, perk 10, school buses, Dilaudid® yellow school buses Percocet® Athens Moderate Decrease Bs, blues, blueberries, perk 30, rox, roxis, OxyContin® Roxicodone® Vicodin® Roxanne, smurfs Cincinnati High No consensus Percocet® Ultram®/tramadol tram , trammies Cleveland Moderate Decrease Percocet® Vicodin® blues, Vs, vikes, vikies Oxycodone Columbus High Decrease Percocet® Participants throughout OSAM regions most often Vicodin® reported that prescription opioids sell for $1 per milligram. Oxycodone Percocet® However, participants in the Toledo region reported Dayton High No change Ultram® that in rural areas these drugs may cost more. Overall, Vicodin® participants in most regions reported that the street price Toledo High Decrease Percocet® for prescription opioids has remained the same during Roxicodone® the past six months, with the exception of the Athens and Oxycodone Dayton regions where participants reported an increase Youngstown Moderate No consensus Ultram® Vicodin in prices. Participants in the Dayton region explained

OSAM Drug Trend Report January-JuneJune 2017- January 2013 2018 Page 13 Page 8 Surveillance of Drug Abuse Trends in the State of Ohio that due to regulations targeting prescribing practices, with my girls. I feel like it would get my courage up; Right, the drugs are more difficult to find on the streets, and give me more confidence to talk to the opposite sex and therefore more expensive. Participants discussed that if everything. It made me feel like I could walk up to anybody given the choice between purchasing prescription opioids and take them home.” Regarding the use of sedative- on the street and purchasing heroin, users would choose hypnotics in combination with prescription opioids, a to purchase heroin because the drug is far less expensive participant stated, “Xanax® is a big one because it’s a downer than prescription opioids. Participants stated: “For the price so it of course is going to make for a more intense high.” you pay for two ‘perks’ (Percocet®), you can buy a bag of heroin Reportedly, marijuana is used with prescription opioids to and a pack of cigarettes; If you got the choice between buying level out one’s high. a $10 Percocet® or a $10 cap (capsule of heroin/fentanyl) that’s Participants also reported using crack cocaine, powdered gonna keep you out all day, you gonna buy a cap.” cocaine and methamphetamine in combination with Participants reported obtaining prescription opioids for prescription opioids to either “speedball” (concurrent illicit use from doctors, drug dealers, family members or consecutive stimulant and sedative highs) or to and friends with prescriptions for them, hospitals, pain counterbalance the effects of the opioids. A participant management clinics, pharmacies through fraudulent explained, “Meth and cocaine are central nervous system prescriptions, and through social media connections and stimulants; opiates are central nervous system depressants, Internet purchase. you know that stops your breathing, your heartbeat, and if you got one that counteracts that aspect, it’ll keep you alive.” While there were a few reported ways of consuming prescription opioids, and variations in methods of use were noted among types of prescription opioids, Substances Most Often Combined with generally the most common routes of administration for Prescription Opioids illicit use remain snorting, followed by oral consumption and intravenous injection (aka “shooting”). Participants • alcohol • crack cocaine • heroin • marijuana • throughout OSAM regions estimated that out of 10 illicit • powdered cocaine • sedative-hypnotics • prescription opioid users, 3-9 would snort, 2-7 would orally consume, and 1-5 would shoot the drugs. Reportedly, oral consumption includes swallowing, chewing and “parachuting” (crushing and wrapping the drug in a piece Suboxone® of tissue paper and swallowing). Participants discussed that shooting prescription opioids is not as common Suboxone® remains highly available for illicit use throughout as previously due to the reformulation of many opioids the majority of OSAM regions. The street availability for the to include abuse deterrent measures. However, some drug has increased in half of the regions during the past six participants specifically noted shooting or smoking months. Both participants and community professionals Percocet® to produce a more intense high. reported that the sublingual filmstrip form of Suboxone® (aka “strips”) is the most prevalent form of the drug throughout A profile of a typical illicit prescription opioid user did regions; in fact, there were few mentions of Suboxone® in its not emerge from the data. In addition to describing illicit pill form as available. prescription opioid users as anybody and everybody, participants most often reported factory workers and There was consensus among respondents who reported manual laborers (roofers and construction workers), increased street availability that there has been an increase younger people and people with money as typical users. in the number of persons in treatment receiving Suboxone®, Many other substances are used in combination and thus an increase in the prescribing of Suboxone®. In with prescription opioids. Participants reported that addition, respondents in the Cincinnati region noted an these drugs are most often used in combination increase in the number of prescribers within that region. Both with alcohol, marijuana and sedative-hypnotics (i.e. respondent types discussed those with prescriptions selling Xanax®). Participants described combining alcohol with all or part of their prescribed Suboxone® for other drugs (i.e. prescription opioid use to intensify their high. They stated: heroin/fentanyl). “I used to go and get a couple of pain pills and go to the bar

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The Columbus Police Crime Lab, the Lake County Crime Lab, Participants and community professionals continued to the Miami Valley Regional Crime Lab, and the BCI London describe typical illicit Suboxone® users as people addicted to and Richfield crime labs all reported that the number of opiates who use the drug to alleviate withdrawal symptoms Suboxone® cases they process have increased during the when they run out of opiates. Reportedly, many other drugs past six months. are used in combination with Suboxone®. Participants reported that Suboxone® is most often used in combination Reported Availability Change of with stimulant drugs as the medication does not block the Suboxone® effects of these drugs, allowing the user to continue to get during the Past 6 Months high. Participants commented: “[Suboxone® is] like Vivitrol® that’s [also] an opiate blocker … people [on Suboxone®] are Current Availability Region still getting high off of coke and crack and meth; I know one Availability Change girl, every day, when she gets up, she’ll do Suboxone® … she’ll Akron-Canton High No consensus do Xanax® … she’ll do meth….” However, several participants Athens High No consensus throughout OSAM regions reported not using Suboxone® in combination with any other drugs and reported using Cincinnati High Increase Suboxone® only to avoid opiate withdrawals. Participants Cleveland High No consensus reported: “Everyone uses them to not get sick, nobody is using Columbus High Increase them to get high; I have yet to meet anyone using for any other Dayton High Increase reason but to avoid getting sick.” Toledo High Increase Substances Most Often Combined with Youngstown Moderate to High No consensus Suboxone®

Current street jargon includes several names for Suboxone®. • crack cocaine • marijuana • methamphetamine • Names often refer to the color (e.g. “oranges” and “orange • powdered cocaine • sedative-hypnotics • tabs”), shape of the drug (e.g. “stop signs”) and a shortened version of the brand names (e.g. “subs” for Suboxone® and “tex” for Subutex®). Sedative-Hypnotics Current Street Names of Suboxone® Sedative-hypnotics (benzodiazepines, barbiturates and muscle relaxants) are moderately to highly available for boxes, shoe boxes, subs, General Names illicit use throughout OSAM regions. Participants and subways community professionals continued to report Xanax® as the Other Names for strips, strippers most available sedative-hypnotic in terms of widespread Filmstrips illicit use. One participant remarked, “Everyone is prescribed Other Names for oranges, orange drops, orange tabs, Xanax®.” The Ohio State Highway Patrol Crime Lab reported Tablets stop signs, tabs that alprazolam (Xanax®) is by far the most frequent benzodiazepine found in case submissions during the past six Contrary to previous reports, where street prices for months. Suboxone® were variable, participants throughout OSAM As was the case in the previous reporting period, there were regions most often reported that Suboxone® 8 mg filmstrips reports of fake Xanax® pills. Participants in a couple of focus or pills sell for $20. In addition to obtaining Suboxone® from groups within the Dayton region noted high availability of doctors, participants continued to report obtaining the pressed, or fake, Xanax®. Participants reported: “A lot of the drug for illicit use from drug dealers and other users. The “bars” (Xanax® 2 mg) nowadays are pressed … like pressed into most common routes of administration for illicit use of the pills with fentanyl and other fillers; People will take the original Suboxone® remain sublingual (under the tongue), followed prescription and crush it up and cut it with fentanyl and repress by intravenous injection (aka “shooting”) and snorting. them; You can’t tell the difference between a pressed pill and a

OSAM Drug Trend Report January-JuneJune 2017- January 2013 2018 Page 15 Page 8 Surveillance of Drug Abuse Trends in the State of Ohio regular pill … unless you had some kind of [fentanyl] tester. You In most OSAM regions, participants and community know, they look exactly the same.” In addition, the BCI London professionals were not in agreement as to a change in Crime Lab reported that it has seen an increase in the number availability of sedative-hypnotics during the past six of cases of designer benzodiazepines during the past six months. Respondents who perceived an increase in months. street availability cited increases in availability and use of methamphetamine as increasing demand for the drugs, Corroborating data indicated that sedative-hypnotics explaining that methamphetamine users seek sedative- are available for illicit use throughout OSAM regions. The hypnotics to help with coming down from the extreme Montgomery County Coroner’s Office reported that 42.6% of stimulant high produced by methamphetamine. Participants the 385 drug-related deaths it processed during the past six discussed: “When ‘speed’ (methamphetamine) started to get months involved one or more benzodiazepine. OhioMHAS’ big, people sought Xanax® to help them come down; It helps Screening, Brief Intervention and Referral for Treatment with dope sickness.” Fewer participants perceived decreased (SBIRT) program, which operates in federally qualified health street availability of sedative-hypnotics during the past six centers, reported that of the 478 individuals in the Cincinnati months. In the Cincinnati region where participants reported region who reported substance use during the past 30 days, decreased availability, they attributed the decrease to 21.8% reported illicit use of benzodiazepines on one or more doctors prescribing these medications less, resulting in those days. The Ohio Department of Public Safety (ODPS), which with prescriptions holding onto their medication for personal logs drug task force seizures from across the state, reported use, thus less is being diverted. 34 drug task force seizures of benzodiazepines in the Columbus region during the reporting period. Current street jargon includes many names for sedative- hypnotics. General street names include a shortened version Reported Availability Change of of the group classification of benzodiazepines (e.g. “benzos”) Sedative-Hypnotics and effects of the drugs (e.g. “blackout boys” and “downers”). during the Past 6 Months Additional street names refer to the color (e.g. “blues” and “peaches”) and shape (e.g. “footballs”) of the pill. Current Availability Most Widely Region Availability Change Used Current Street Names of Ativan® Sedative-Hypnotics Akron-Canton High No consensus Klonopin® Xanax® General benzos, blackout boys, downers Moderate to Klonopin® Athens No consensus Ambien® sleepers High Xanax® Ativan® addies, school buses Klonopin® Cincinnati Moderate No consensus forgetters, forgot-a-pin, green monsters, Xanax® Klonopin® kingpins, klodies, klonies, k-pins, lodies, Klonopin® Cleveland High No change pins, spinning wheels Xanax® Soma® soma coma, soma shuffle, somatose Columbus High No consensus Xanax® Valium® blues, v-cuts Ativan® Moderate to banana peels, bars, blues, blue boys, Dayton No change Klonopin® High footballs, forget-me-nots, greens, hulk bars, Xanax® Xanax® ladders, monsters, peaches, totem poles, Xs, Toledo High No consensus Xanax® xanie bars, xanies, Zs Ativan® Youngstown Moderate No change Klonopin® Current street prices for sedative-hypnotics were consistent Xanax® among participants with experience purchasing the drugs. Reportedly, Xanax® 1 mg most often sells for $2-3; Xanax® 2 mg most often sells for $5. Participants reported that these drugs are most often obtained for illicit use from doctors, people with prescriptions and through Internet purchase. The most common routes of administration for

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illicit use of sedative-hypnotics are snorting, followed by and concentrates (aka “wax” and “dabs”) have increased. oral consumption. Participants throughout OSAM regions Participants referred to dabs use as the new and “hip” thing to estimated that out of 10 illicit sedative-hypnotic users, 5-9 do. One participant remarked, “Everybody’s wanting to try it.” The would snort and 1-5 would orally consume the drugs. Ohio State Highway Patrol, Columbus Police, Lake County, BCI London and BCI Richfield crime labs reported that the number Participants and community professionals most often of marijuana extracts and concentrates cases they process described typical illicit sedative-hypnotics users as female, have increased during the past six months. white people and illicit drug users, specifically users of stimulant drugs and opiates, noting the high prevalence Reported Availability Change of of polysubstance use with these medications. Participants reported that sedative-hypnotics are most often used Marijuana in combination with stimulant drugs (i.e. cocaine and during the Past 6 Months methamphetamine) to help with coming down from the Current Availability Region intense highs produced by these other drugs. A participant Availability Change remarked: “It’s mostly like a come down for crack [or] any Akron-Canton High Increase speed (stimulant) … [it’s] mostly used with speed.” Participants Athens High also reported that sedative-hypnotics are often used with Increase alcohol and heroin to intensify the highs of these drugs, Cincinnati High Increase or with heroin/fentanyl to alleviate withdrawal symptoms. Cleveland High No change They discussed: “I was using em’ like with heroin to get that Columbus High Increase extra [high] … and for … getting you well [after heroin use]; Mix them with heroin; If you’d ran out of your heroin for the day Dayton High Increase [and] you can’t get it ‘til the morning, you’d take benzos to sleep; Toledo High No consensus If I ran out of [heroin], I would mix benzos and alcohol.” Youngstown High Increase

Substances Most Often Combined with Participants throughout OSAM regions most often rated Sedative-Hypnotics the current overall quality of marijuana as ‘9-10’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality). • alcohol • crack cocaine • heroin • marijuana • Participants attributed increased quality to a rise in THC • methamphetamine • powdered cocaine • (tetrahydrocannabinol, the psychoactive component of • prescription opioids • Suboxone® • marijuana) content, more advanced growing techniques, crossbreeding of plants to achieve more potent strains of the drug, and an increase in the availability and use of medicinal marijuana. Participants reported: “There’s more Marijuana THC in it then there’s ever been; People put a lot of research into growing it. There is a whole science behind it, and that Marijuana remains highly available throughout OSAM is resulting in better quality ‘pot’ (marijuana).” Overall, regions. Participants reported no trouble obtaining participants reported that the quality of marijuana has marijuana, whether from the streets, from other states, increased during the past six months. or through Internet purchase. Both participants and community professionals reported that recent legislative Participants in the Cincinnati, Cleveland and Dayton regions changes allowing for medicinal marijuana use in Ohio, discussed marijuana laced with other substances, whether legalization of recreational marijuana use in other states, intentionally or unintentionally, including crack and decreased stigma associated with marijuana use, and powdered cocaine, “molly” (powdered MDMA), fentanyl, intergenerational marijuana use all contribute to the formaldehyde and methamphetamine. current high availability of the drug. Note: OSAM respondents reported that they have heard Respondents in most OSAM regions reported that the of people who have used marijuana laced with fentanyl, overall availability of marijuana has increased during the though none of the participants had experienced this first past six months. In addition, participants in six OSAM hand. Some treatment providers discussed clients testing regions reported that the availability of marijuana extracts positive for fentanyl, when reportedly, “these clients only

OSAM Drug Trend Report January-JuneJune 2017- January 2013 2018 Page 17 Page 8 Surveillance of Drug Abuse Trends in the State of Ohio smoke marijuana.” However, no law enforcement agency, Participants throughout OSAM regions continued to report or crime lab, has substantiated these claims. A crime lab smoking as the most common route of administration for analyst reported that there is no evidence of fentanyl-laced both marijuana and marijuana extracts and concentrates. marijuana. The potential for fentanyl-laced marijuana will Participants estimated that out of 10 marijuana users, all 10 continue to be monitored by the OSAM Network. would smoke the drug. Participants discussed smoking the marijuana using vaporizers, bongs, glass pipes, apples, soda Current street jargon includes many names for marijuana. cans and carburetors. A participant explained the difference Street names for low-grade marijuana include negative between smoking and “vaping” the drug: “Smoking it is connotations related to its generally poor quality (e.g. different than vaporizing it because you’re only getting the “dirt weed” and “skunk”) and reference the color of the THC out of vaping it … you [also] get the carcinogens out of marijuana (e.g. “dirt” and “downtown brown”). Current street smoking it. Smoking it is using fire and vaping is like [heating names for high-grade marijuana include references to it to] 325 degrees Fahrenheit.” Participants also discussed combustibles (e.g. “fire,” “gas” and “diesel”), as well as to food orally consuming marijuana in various food products (aka (e.g. “blueberry kush,” “cookie” and “tootie fruity”). Current “edibles”), including: brownies, butter, candy and cookies. street names for marijuana extracts and concentrates often allude to the appearance of the substance (e.g. “wax” and Consistent with previous reports, respondents reported “shatter”). that marijuana users are of any age, race, gender, occupation and socio-economic status. Respondents Current Street Names of throughout OSAM regions commented: “That’s an Marijuana ‘everybody drug;’ Male, female, young, old, rich, poor, job or no job; It’s a part of the culture.” However, respondents reported bud, grass, green, Mary Jane, pot, General Names that typical marijuana extracts and concentrates users weed are most often white, young (teenagers to 20-year olds), commercial, dirt, dirt weed, downtown chronic marijuana users, and people with more income. Other Names for brown, home grown, mersh, Mexican Low Grade weed, mids, reggie, Regina, skunk, that Marijuana is used in combination with many other brown, that headache substances, although reportedly most commonly with alcohol and powdered cocaine. Participants throughout blueberry kush, bubble gum kush, cardiac OSAM regions discussed that marijuana is used with other kush, chron, chronic, cookie, cushion, drugs to either balance out or to intensify the effects dank, diesel, dro, fire, gas, gorilla, gorilla produced by other drugs. For instance, participants blue, granddaddy purple (purp), hem, reported using marijuana in combination with powdered Other Names for hydro, hydro chronic, kind bud, kush, High Grade cocaine to “come down” from the intense stimulant cocaine lemon kush, loud, loud pack, master kush, high. In addition, respondents in several OSAM regions medical kush, monkey paw, OG kush, described the process of lacing (adulterating) marijuana pineapple express, pressure, thrax, tootie with other substances, including formaldehyde (aka “wet”), fruity, white owl, Wiz Khalifa promethazine, crack and powdered cocaine to intensify their Other Names dabs, hash, live resin, moon rock, shatter, high and to augment the effects of low-grade marijuana. for Extracts & wax Concentrates Substances Most Often Combined with Current street prices for marijuana were reported by Marijuana participants with experience purchasing the drug. Participants reported that marijuana is most often • alcohol • crack cocaine • fentanyl • heroin • purchased in quantities ranging from a “blunt” (marijuana- • powdered cocaine • filled cigar) to 1/4 ounce. For low-grade marijuana, a blunt most often sells for $5; 1/4 ounce sells for $20-25 in the Dayton and Toledo regions, and for $40-50 or higher in all other regions. For high-grade marijuana, generally, a blunt most sells for $10; a gram sells for $20; 1/8 ounce sells for $40-50; 1/4 ounce sells for $100; and an ounce sells for $300.

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Methamphetamine Reported Availability Change of Methamphetamine Methamphetamine remains highly available throughout during the Past 6 Months OSAM regions; however, respondents in the Toledo Current Availability Region region continued to indicate high methamphetamine Availability Change availability in rural areas and low to moderate Akron-Canton High Increase availability in the city of Toledo. Respondents referred Athens High to methamphetamine as the “new marijuana” and “new Increase crack cocaine,” when discussing the current prevalence Cincinnati High Increase of the drug as widely available as marijuana and Cleveland High Increase cocaine. Respondents reported that the drug is both Columbus High Increase imported from other countries, particularly Mexico, and made locally. Participants noted that heroin users Dayton High Increase are turning to methamphetamine to aide in alleviating Toledo High Increase opiate withdrawal symptoms, or to avert opiate-related Youngstown High Increase overdoses. One participant remarked, “A lot of people is tryin’ to use them to get off heroin.” Participants reported Participants most often reported the current overall being able to obtain a high from methamphetamine quality of methamphetamine as ‘10’ on a scale of while on medication assisted treatment for opiate use ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); disorder, such as Vivitrol® or Suboxone®, since these the previous most common scores were ‘5’ for drugs only block for an opiate high. powdered methamphetamine and ‘7-8’ for crystal Respondents also noted that the price and quality of methamphetamine. Participants in regions who reported methamphetamine is generally better overall than for on both types of methamphetamine continued to report cocaine, thereby driving demand for the drug. Law higher quality scores for crystal methamphetamine than enforcement discussed methamphetamine as the new for powdered methamphetamine. Participants most drug of choice, and reported cartels shipping mass often described crystal methamphetamine as clear or quantities of the drug into Ohio. Law enforcement blue, resembling the appearance of glass. commented: “I’m seeing it by gallon-size baggies … crystal Participants discussed adulterants (aka “cuts”) that affect meth, and it’s cheaper than heroin … it’s very cheap, the quality of methamphetamine, and reported the that’s why we’re seeing an influx; I think it’s just the cartels following cutting agents for the drug: Adderall®, baby trucking it in, kilo after kilo.” aspirin, baby laxatives, bath salts (synthetic cathinones), Participants throughout OSAM regions reported that battery acid, butane, caffeine, dietary supplements methamphetamine is available in both powdered and (isotol and niacinamide), Drano®, Epsom® salt, fentanyl, crystal forms, but reported crystal methamphetamine fish oil, glass (fiber glass), heroin, lighter fluid, matches, as the most prevalent form of the drug. Respondents “molly” (powdered MDMA), MSG (monosodium in all OSAM regions reported that the availability of glutamate), MSM (methylsulfonylmethane, a joint methamphetamine has increased during the past six supplement), powdered cocaine, propane, rock candy, months. Corroborating data indicated an increase rock salt, sugar and vitamin B-12. The BCI London Crime in the availability of methamphetamine during the Lab reported dimethyl sulfone (dietary supplement) as a reporting period. The Ohio State Highway Patrol, cut for methamphetamine. Columbus Police, Miami Valley Regional, BCI London Current street jargon includes many names for and BCI Richfield crime labs reported that the number methamphetamine. Street names most commonly of methamphetamine cases they process have increased reference the appearance of the substance (e.g. “blue,” during the past six months. “clear crank,” “glass,” “ice,” “powder” and “shards”) and the effects of the stimulant (e.g. “go go,” “go fast” and “speed”).

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Current Street Names of intense stimulant high produced by methamphetamine. Methamphetamine Participants in the Akron-Canton and Cincinnati regions also reported methamphetamine use with Suboxone®. crank, fast, glass, go, go fast, go go, General Names A participant in the Athens region described the use of meth, speed, tweak methamphetamine with caffeine: “’Ninja coffee’ … that’s Other Names shake, shake-and-bake, Ricky Bobby when you make a coffee with the filters that you used to for Powdered cook ‘dope’ (methamphetamine).” blue, clear crank, crystal, diamonds, Other Names high speed chicken feed, ice, ice cream, for Crystal ice cubes, ice skating, jib, shards, shard Substances Most Often Combined with broccoli, skates, Tina Methamphetamine

Reports of current prices for methamphetamine were • alcohol • heroin • marijuana • consistent throughout OSAM regions. Generally, the • prescription opioids • sedative-hypnotics • most common quantity of purchase is a gram. For powdered methamphetamine, 1/2 gram most often sells for $30, and a gram sells for $70. For crystal methamphetamine, 1/2 gram most often sells for $40, and a gram sells for $60-80. Prescription Stimulants

Participants throughout OSAM regions reported Throughout most OSAM regions, prescription stimulants that the most common routes of administration for remain moderately to highly available for illicit use. methamphetamine are intravenous injection (aka In regions where respondents indicated high street “shooting”) and smoking. Participants also reported availability, reportedly, these medications are easily the following other routes of administration for the obtained through prescription from doctors, or from drug: snorting, oral consumption (consuming the drug acquaintances, friends and family members with in tea, coffee and soda), “hot railing” (a process where prescriptions, or from parents with a child who has ADHD the user places the drug in a glass pipe, heats the pipe, (attention-deficit hyperactivity disorder). Participants and inhales the vapors from the drug through the nose discussed: “If you know anyone that’s got ADHD or has ADHD and exhales through the mouth) and “parachuting” kids, then they’re gonna try and sell them; I was friends with a (wrapping the drug in a piece of tissue and swallowing). person [with ADHD] so they would give them to me. I would trade … painkillers [for ADHD medications].” Consistent with previous reports, respondents reported typical methamphetamine users as white people, Respondents in most OSAM regions reported that the aged 20-40 years, of low socio-economic status, and street availability of prescription stimulants has remained individuals who work labor intensive jobs or jobs that the same during the past six months; and although participants most often noted unchanged availability, they require long hours, such as truckers, mechanics, and indicated lessened interest in prescription stimulant use as people in the restaurant industry. Respondents also the availability of methamphetamine continues to increase. reported noticing a shift in opiate users switching to Participants commented: “It’s another one that is becoming methamphetamine, as well as noting the popularity increasingly difficult to obtain, even legally and legitimately; of the drug in the gay community. Throughout OSAM People can just do meth.” The Columbus Police, Lake County, regions, respondents noted not seeing the drug used in BCI London and BCI Richfield crime labs reported that the African-American communities. number of amphetamine (Adderall®) cases they process has increased during the past six months. Many other substances are used in combination with methamphetamine. Participants reported that methamphetamine is used with heroin to produce a “speedball” effect (concurrent or consecutive stimulant and sedative highs). Methamphetamine is used with alcohol, marijuana, heroin, prescription opioids and sedative-hypnotics to help users come down from the

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Reported Availability Change of levels. Respondents also reported opiate users illicitly using prescription stimulants to alleviate withdrawal symptoms, Prescription Stimulants and truck drivers and people in the restaurant industry during the Past 6 Months illicitly using them to stay awake for long shifts. Current Availability Most Widely Region Availability Change Used Other substances are used in combination with prescription stimulants. Participants in the Akron-Canton and Athens Adderall® Moderate to region reported use of prescription stimulants to mitigate Akron-Canton No consensus Ritalin® High the effects of coming down from methamphetamine. Vyvanse® Adderall® Athens Moderate No change Ritalin® Substances Most Often Combined with Adderall® Prescription Stimulants Cincinnati Moderate No change Vyvanse® • alcohol • heroin • marijuana • methamphetamine • Moderate to Adderall® Cleveland No change • sedative-hypnotics • High Vyvanse® Moderate to Adderall® Columbus No change High Vyvanse® Adderall® Dayton Moderate No change Ecstasy Ritalin® Moderate to Toledo No change Adderall® Ecstasy (methylenedioxymethamphetamine: MDMA, or High other derivatives containing BZP, MDA, and/or TFMPP) is Adderall® Low to moderately to highly available throughout most OSAM Youngstown No change Ritalin® Moderate regions. In addition, during the reporting period, law Vyvanse® enforcement in the Cincinnati region reported a large seizure of MDA (aka “sally,” “sass” and “sassafras”) at an Current street jargon includes several names for area hotel that was shipped from Canada. Respondents prescription stimulants. Street names commonly reference indicated that the availability of ecstasy/molly tends to the stimulant effect of the drugs. be seasonal, with availability higher during the summer months at music festivals where use of these drugs is Current Street Names of reportedly common. Generally, respondents agreed that Prescription Stimulants it is easier to obtain “molly” (powdered MDMA) than it is to obtain ecstasy tablets. poor man’s coke, poor man’s crack, General Names speed, uppers Frequently throughout OSAM regions, participants Adderall® addies and community professionals reported incongruous conclusions as to whether the availability of ecstasy Current street prices for prescription stimulants were and molly has changed during the past six months. provided by participants with experience purchasing Participants in six OSAM regions reported that the the drugs. Reportedly, Adderall® 10 mg most often sells availability of ecstasy/molly has decreased during the past for $5; and 30 mg sells for $15. Participants throughout six months, while participants in the Athens and Toledo OSAM regions reported that the most common routes of regions reported that availability has remained the same. administration for illicit use of prescription stimulants are Among the treatment providers and law enforcement who snorting, followed by oral consumption. were able to report on change in availability, all reported Respondents described typical illicit prescription stimulant that the availability of ecstasy/molly has remained the users as teenagers and college students, as well as middle- same during the past six months, except for treatment aged women. Respondents reported that the drug is often providers in the Dayton region who perceived an increase abused among students to help them study, and among in availability. The Columbus Police, Miami Valley Regional, middle-aged women for weight loss or to increase energy

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BCI Bowling Green, BCI London and BCI Richfield crime really a drug itself, it’s kind of like a mix. You don’t really know labs reported that the number of ecstasy/molly cases they what you’re getting with ecstasy, so every time you take it, process have increased during the past six months. you’re going to have a different experience; That’s also why people are avoiding it more and more.” Reported Availability Change of Current street jargon includes several names for ecstasy. Ecstasy/Molly However, for powdered MDMA, participants reported no during the Past 6 Months names other than “molly.” The most common street names Current Availability for ecstasy are abbreviated forms of its name (e.g. “E” and Region Availability Change “X”), refer to the quantity of the drug (e.g. “double stack” and “triple stack”), and reference food (e.g. “beans” and Akron-Canton Moderate No consensus “Skittles®”). As one participant in the Cincinnati region Athens Moderate No change reported, “Instead of, ‘I got ecstasy,’ say, ‘I got these beans.’” Cincinnati Moderate No consensus Cleveland Moderate to High No change Current Street Names of Columbus No consensus No consensus Ecstasy General Names E, moon rocks, rolls, X Dayton No consensus No consensus beans, doubles, double stacks, Other Names for Toledo Moderate to High No change Skittles®, stacks, triples, triple Ecstasy Youngstown No consensus No consensus stacks Reports of street prices for ecstasy and molly were Participants in the Akron-Canton, Athens, Cleveland, consistent among participants with experience purchasing Toledo and Youngstown regions reported on the current the drugs. Participants most often reported that a low quality of ecstasy/molly during the past six months. dose (aka “single stack”) of ecstasy sells for $10; a medium Depending on the region, participants reported the dose (aka “double stack”) sells for $20; and a high dose quality of ecstasy as ‘4-8’ and of molly as ‘7-10’ on a scale (aka “triple stack”) sells for $30. For molly, 1/10 gram most from ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the often sells for $10; and a gram sells for $80. In the Akron- previous most common scores were ‘3-10’ for ecstasy Canton region, participants reported purchasing molly and ‘8-10’ for molly. Participants reported that ecstasy by dollar amounts, where a user would request a ‘20’ for and molly are “cut” (adulterated) with fentanyl, heroin, $20 worth and a ‘50’ for $50 worth, while participants in ketamine (an anesthetic typically used in veterinary the Cincinnati region reported being able to purchase medicine), methamphetamine, powdered cocaine and molly in capsule form for $5. Participants in the Cincinnati Viagra®. One law enforcement officer in the Cleveland region also explained that the drug is often shared free region stated, “Molly is wanted but … a lot of kids have of charge at parties, festivals and concerts, where users complained that they are getting ‘meth’ (methamphetamine) will pass around a baggie of the substances and people instead of molly.” will either take an ecstasy tablet or lick their pinky and dip it into molly, taking as much of the substance as Participants in the Cleveland and Toledo regions noted a desired. Participants in the Youngstown region reported decrease in the overall quality of ecstasy during the past six purchasing 3.5 grams of molly for $200. months; Toledo participants also reported that the overall quality of molly has decreased, while Cleveland participants Participants reported obtaining ecstasy and molly through indicated increased quality of molly. Participants in all other drug dealers, Internet purchase, at concerts, festivals and OSAM regions could not comment on a change in quality “raves” (dance parties), or by making the drug themselves of ecstasy/molly during the past six months, explaining that by ordering supplies through the Internet. Throughout quality varies. In the Columbus region where participants OSAM regions, participants reported oral consumption were unable to report on quality, participants discussed: as the most common route of administration for both “It varies in terms of quality and purity; Ecstasy is basically not ecstasy and molly. Participants reported orally consuming the drugs by allowing them to dissolve in water (aka

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“molly water”), alcohol and Gatorade®. In addition, a Several other substances are used in combination few participants discussed snorting and “shooting” with ecstasy and molly. Participants noted that ecstasy (intravenously injecting) these drugs, although these and molly are most often used in combination with forms of administration are reportedly less common. alcohol and marijuana, as reportedly, these drugs Respondents described typical ecstasy and molly users as intensify the effects of the ecstasy/molly. A participant high school and college students, hippies, people in their in the Youngstown region reported that molly is used 20s, and people in the club scene and those who attend with mescaline (a psychedelic drug derived from the raves, concerts and festivals. One participant remarked, “It’s peyote cactus that causes similar effects as lysergic more like a fun drug than a habit drug.” Respondents in the acid diethylamide [LSD]) to intensify the effects of the Dayton and Youngstown regions described typical ecstasy hallucinogenic experience. and molly users as white people, while respondents in the Cleveland region described typical users as African- Substances Most Often Combined with American people. Respondents in the Dayton region Ecstasy/Molly also noted the drug being promoted in certain genres of music, and is therefore, more popular among certain • alcohol • hallucinogens • marijuana • powdered cocaine • music listeners.

Other Drugs in the OSAM Regions

Participants and community professionals listed a variety of other drugs as currently available, but these Reported Availability of drugs were not mentioned by the majority of people Other Drugs interviewed. Several of these other drugs were not in each of the OSAM Regions reported as present in every region. Note: no mention/ Region Other Drugs discussion of a drug does not indicate the absence of the bath salts, hallucinogens (lysergic acid drug in the region(s). Akron-Canton diethylamide [LSD] and psilocybin mushrooms), In addition, secondary data sources reported on the kratom, Neurontin®, synthetic marijuana following other drugs that were not mentioned by OSAM Athens anabolic steroids, inhalants, Neurontin®, OTCs* respondents: diphenhydramine (Benadryl®), ketamine Cincinnati synthetic marijuana (an anesthetic typically used in veterinary medicine) and hallucinogens (lysergic acid diethylamide U-47700 (a synthetic opioid). [LSD], phencyclidine [PCP] and psilocybin Cleveland The Cuyahoga County Medical Examiner’s Office reported mushrooms), kratom, Neurontin®, that 29 of the 380 drug-related deaths it recorded promethazine, synthetic marijuana this reporting period involved diphenhydramine; anabolic steroids, hallucinogens (psilocybin Columbus and of all fentanyl-related deaths, 8.4% also involved mushrooms), Neurontin®, synthetic marijuana diphenhydramine. The BCI London Crime Lab reported it bath salts, hallucinogens (dimethyltryptamine processed 21 cases of ketamine and 44 cases of U-47700 [DMT], lysergic acid diethylamide [LSD] and during the reporting period. Other data sources also Dayton psilocybin mushrooms), inhalants, ketamine*, reported having processed U-47700 cases during the Neurontin®, promethazine, Seroquel®*, reporting period: the BCI Bowling Green Crime Lab synthetic marijuana reported 11 cases, while the Lake County Crime Lab reported 12 cases; the BCI Richfield Crime Lab reported Toledo Neurontin®, promethazine hallucinogens (psilocybin mushrooms), that the number of cases it processes increased to 100, Youngstown from 11 cases in the previous reporting period; and the Neurontin®, promethazine Hamilton County Coroner’s Office reported that 14 of the *For limited information on ketamine (anesthetic typically used in veterinary medicine), over-the- 291 drug-related deaths it recorded this reporting period counter cough syrups (OTCs) and Seroquel® (antipsychotic), please see regional reports. involved U-47700.

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Anabolic Steroids Treatment providers in the Dayton region reported that the availability of bath salts has decreased during the past six months. The BCI London and BCI Richfield crime labs Respondents in the Athens and Columbus regions reported that the number of bath salts cases they process reported on the availability of anabolic steroids for illicit have increased, while the Miami Valley Regional Crime use during the past six months. Participants and law Lab reported that it has not processed any bath salts cases enforcement in the Columbus region most often reported during the past six months. Treatment providers described the current availability of these drugs as ‘8’ on a scale of ‘0’ typical bath salts users as white people, aged 18-30 years. (not available, impossible to get) to ‘10’ (highly available, extremely easy to get). In the Athens region, only a few law enforcement officers were able to discuss current availability of anabolic steroids; they most often reported Hallucinogens current availability for illicit use as ‘3-4.’ Respondents in five OSAM regions reported on the current Respondents reported popularity of these drugs among availability of hallucinogens. Generally, hallucinogens body builders, weightlifters and high-school athletes. include lysergic acid diethylamide (LSD) and psilocybin Reportedly, these drugs are most often obtained at gyms mushrooms; however, participants in the Cleveland and community centers. In the Columbus region, law region also reported phencyclidine (PCP) as highly enforcement also reported being able to obtain anabolic available, and participants in the Dayton region reported steroids at tractor supply stores. Athens regional law DMT (dimethyltryptamine) as highly available. Overall, enforcement reported that the availability of anabolic hallucinogens are moderately to highly available in steroids for illicit use has decreased during the past six the Akron-Canton and Cleveland regions; moderately months. An officer stated, “We’ve prosecuted people, that available in the Columbus and Youngstown regions; and has something to do with it … people are more scared now there was no consensus among respondents in the Dayton of purchasing it.” Law enforcement described typical illicit region as to the current level of hallucinogenic availability anabolic steroids users as males who desire to be very in that region. muscular. Participants reported needing to personally know someone who has hallucinogens in order to obtain them. Bath Salts Law enforcement in the Akron-Canton and Cleveland regions reported that these drugs are often found among people who smoke marijuana extracts and concentrates Bath salts (synthetic cathinones; compounds containing (aka “dabs”), and participants in the Columbus region methylone, mephedrone, MDPV or other chemical reported hallucinogens as popular on and around analogues, including alpha-PVP, aka “flakka”) were college campuses. In the Dayton region, participants reported as available in the Akron-Canton and Dayton reported being able to easily obtain DMT through Internet regions; however, few participants indicated personal purchase. experience with this drug during the past six months. In the Akron-Canton region, only a few respondents reported Only respondents in the Cleveland and Dayton regions the drug as available; and these respondents noted reported on change in availability for hallucinogens during that only a small group of people seek bath salts due to the past six months. In the Cleveland region, participants its reported negative effects on the mind and body. In reported that the availability of LSD, psilocybin addition, Akron-Canton participants discussed baths salts mushrooms and PCP have remained the same, while law sold as other drugs. A participant shared, “People don’t seek enforcement reported increased availability of LSD. In the it out. It’s sold as heroin or fentanyl.” One law enforcement Dayton region, participants and community professionals officer in the Akron-Canton region reported a few reported that the availability of LSD has remained the methamphetamine users now using flakka. In the Dayton same, while participants reported that the availability of region, one treatment provider reported use of baths salts psilocybin mushrooms and DMT have increased. by two of her clients during the past six months. Reports of current prices were reported by participants with experience purchasing the drugs. Reportedly, for LSD,

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a dose (aka “hit”) most often sells for $10; and 100 doses providers in the Athens region reported that the availability (aka “sheet”) sells for $250-300. For psilocybin mushrooms, of inhalants for illicit use has remained the same during the 1/8 ounce most often sells for $25-30; and 1/4 ounce sells past six months. Participants in the Dayton region reported for $50. For PCP, Cleveland participants reported that an that a can of N2O sells for $45 at an adult store, and a can of ounce most often sells for $200; a PCP dipped cigarette air duster sells for $5 at big box stores. sells for $10-20. Dayton participants did not report on pricing for DMT. Participants reported that hallucinogens are most often obtained through drug dealers, friends, Kratom Internet purchase and at concerts.

Participants reported that the most common route of Reportedly, kratom (mitragynine, a psychoactive plant administration for psilocybin mushrooms and LSD is substance that produces a heroin-like high) is available in oral consumption; for PCP, the most common route of the Akron-Canton and Cleveland regions. Participants in administration remains smoking. Participants estimated the Akron-Canton region reported being able to purchase that out of 10 psilocybin mushroom and 10 LSD users, the drug from heroin dealers and through Internet all would eat in food or consume the drugs in beverages. purchase, while community professionals indicated that Participants reported drinking the drugs in teas, or eating the drug can be purchased at head shops. Participants them by mixing with chocolate, peanut butter or putting in the Cleveland region reported being able to purchase them in sandwiches. Participants stated: “[Psilocybin the drug in powdered form and in capsules. Participants mushrooms] taste horrible so you have to put them in reported that the drug looks similar to brown powdered something, like food or a drink; I put it in a milkshake; You heroin, produces similar effects as heroin, and is primarily can put the liquid [LSD] on gummy bears, but paper (liquid used by individuals subject to drug screening and by LSD on paper blotter) is most readily available.” In addition, people addicted to heroin who use the drug to alleviate participants reported that users occasionally administer opiate withdrawal symptoms. Participants reported that liquid LSD through the eye similar to the administration the most common route of administration for kratom is of eye drops. Participants in Cleveland estimated that out intravenous injection (aka “shooting”). Participants in the of 10 PCP users, all 10 would smoke the drug. Route of Akron-Canton region estimated that out of 10 kratom administration was not reported for DMT. users, seven would shoot the drug and three would orally Participants and community professionals described consume the drug (including drinking it as a tea). typical hallucinogen users as white people, college- aged individuals, hippies, people who party, and people who attend music festivals. In the Cleveland region, Neurontin® respondents described typical PCP users as young, African-American people. Reportedly, only few other drugs Respondents in seven of eight OSAM regions reported are used in combination with hallucinogens: alcohol, high current availability of Neurontin® (gabapentin, an marijuana and powdered cocaine. anticonvulsant and nerve pain medication) for illicit use; Cincinnati was the only region not to comment on the current street availability of Neurontin® during the Inhalants past six months. Respondents reported that the drug is readily prescribed by physicians as a pain reliever in Inhalants (duster [DFE] and nitrous oxide [N2O], aka lieu of prescription opioids, and that heroin users seek “whippets”) are available for illicit use in the Athens region the drug to alleviate opiate withdrawal symptoms. according to a few treatment providers; and highly available Some respondents also noted users intentionally taking in the Dayton region according to a few participants. In the large amounts of the drug for mood altering effects. Athens region, treatment providers indicated that the drug Respondents in the Athens, Cleveland, Dayton and is used among some people in treatment who still desire to Youngstown regions reported increased street availability obtain a high. Participants in the Dayton region explained of Neurontin® during the past six months. that the high availability of these drugs is due to people being able to easily obtain them at adult stores. Treatment Reports of current street prices for Neurontin® were reported by participants with experience purchasing the

OSAM Drug Trend Report January-JuneJune 2017- January 2013 2018 Page 25 Page 8 Surveillance of Drug Abuse Trends in the State of Ohio drug. Reportedly, Neurontin® 300 mg most often sells for region; an ounce of promethazine sells for $20 in the $0.50; 600 mg sells for $0.50-0.75; and 800 mg sells for Youngstown region; and three ounces of promethazine $0.75-1. However, participants in the Cleveland region sells for $30 in the Dayton region. Participants reported reported that Neurontin® 800 mg sells for $5. Participants that promethazine is most often consumed by drinking reported obtaining Neurontin® for illicit use from drug the drug mixed in sodas. Participants in the Dayton region dealers, doctors and other users with prescriptions. discussed drinking promethazine with Pepsi® or root beer; and when red-colored promethazine is mixed with The most common route of administration for illicit Sprite®, they called it a “Sprite® remix”. One participant use of Neurontin® remains oral consumption; however, reported cutting (adulterating) promethazine with other participants in the Athens region also reported snorting prescription drugs: “You might crush up a couple Xanax®, the drug. Respondents described typical illicit Neurontin® or crush up a ‘roxi’ (Roxicodone®) [and dissolve into lean].” users as people on probation, in substance abuse Respondents described typical illicit promethazine users treatment, particularly people addicted to opiates. as high-school students, people aged 20-40 years, African- Participants discussed using Neurontin® to alleviate American people and drug dealers. opiate withdrawal symptoms, or until they were able to obtain more heroin. Reportedly, Neurontin® is used in combination with alcohol, heroin, marijuana, methamphetamine and prescription opioids. Synthetic Marijuana

Participants in five OSAM regions reported on the current Promethazine availability of synthetic marijuana (synthetic cannabinoids) during the past six months. Respondents in the Akron- Canton, Cleveland and Dayton regions reported the Participants in half of OSAM regions reported on the current availability of synthetic marijuana as moderate to current street availability of promethazine (prescription- high. Participants in the Cincinnati and Columbus regions strength cough syrup with codeine, aka “lean” when mixed reported current availability of synthetic marijuana, with soda). Participants in the Dayton and Youngstown although they were unable to provide an availability regions reported that the drug is highly available for rating. A Columbus participant commented, “‘Posh’ illicit use; participants in the Cleveland region reported (synthetic marijuana) is popular because 80% of Mansfield moderate street availability; participants in the Toledo [Richland County] is on probation, and you can’t smoke region were unable to assign a rating to the current street ‘weed’ (marijuana) on probation. You could buy posh at the availability of promethazine, although they reported that store legally….” the availability and use of the drug has increased during the past six months. Law enforcement in the Toledo region Respondents reporting on synthetic marijuana noted reported moderate availability of promethazine for illicit that the drug is easily obtained at gas stations, head use. Participants in the Dayton region reported that the shops, from friends and family, in correctional institutions, street availability of promethazine has decreased during and through Internet purchase. In the Dayton region, the past six months. participants reported that the availability of synthetic marijuana has increased during the past six months. Throughout reporting regions, participants indicated being able to obtain promethazine for illicit use through The BCI Richfield Crime Lab reported that the number prescription or Internet purchase. Respondents also of synthetic marijuana cases it processes has increased noted that glorification of the drug in rap lyrics has during the past six months, while the BCI London and contributed to the popularity of lean. Law enforcement in Miami Valley Regional crime labs reported that the the Cleveland region discussed the term “robo tripping” number of cases they process have decreased. The (getting high on Robitussin®) as referred to in rap music. Columbus Police Crime Lab reported that the number of cases it processes has remained the same, and was Reports of current street prices for promethazine were fewer than five cases. The Lake County Crime lab reported limited. However, reportedly, an ounce of lean sells for processing just eight synthetic marijuana cases during the $30 and a pint-sized bottle sells for $400 in the Cleveland past six months.

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Participants in the Columbus region reported the current Reports of current prices for synthetic marijuana were overall quality of synthetic marijuana as high. A Columbus consistent among participants with experience buying the participant commented, “Regular weed’s been good for a drug. Reportedly, a gram most often sells for $10; a 5-gram while now, but ‘posh’ has been better and better and better. bag sells for $20; an 8-gram bag sells for $30; and a 10- They keep cranking it up (increasing the potency).” However, gram bag sells for $40-45. Participants reported that the in the Cincinnati region, participants referred to the drug most common route of administration remains smoking. as potpourri and incense, and discussed the drug in Consistent with previous reports, respondents described negative terms; while participants in the Cleveland region typical synthetic marijuana users as people on probation, reported that the overall quality of synthetic marijuana parole or in prison who are subject to drug testing. has decreased during the past six months. Cleveland Participants reported that alcohol is most often used in participants commented: “It has gone down a lot; I know combination with synthetic marijuana. stores you can still get it, but all you do is get this potpourri shit and that is all it is.”

Current Street Names of Other Drugs acid, blotter, jelly, Lucy, orange sunshine, LSD paper blotter, Sid, tripping, window pane Neurontin® gabs, gabbies, new-new, rots, rontins (gabapentin

PCP water, wet, gorilla piss, sherm, woo

Psilocybin boomers, shrooms, trips mushrooms dirty Sprite®, drank, lean, liquid heroin, purple Promethazine drank, purple lean, purple rain, sizzurp, Sprite® remix, Watson Synthetic K2, posh, potpourri, spice, toochie marijuana

OSAM Drug Trend Report January-JuneJune 2017- January 2013 2018 Page 27 Page 8 Surveillance of Drug Abuse Trends in the State of Ohio

Page 28 OSAM Drug Trend Report June 2017- January 2018 Surveillance of Drug Abuse Trends in the Akron-Canton Region Surveillance of Drug Abuse Trends in the Akron-Canton Region OSAM Ohio Substance Abuse Monitoring Network

Drug Abuse Trends in the Akron-Canton Region

Data Sources for the Akron-Canton Region

This regional report was based upon qualitative data collected via focus group interviews. Participants were active and recovering drug users recruited from alcohol and other drug treatment programs in Portage, Stark, Summit and Tuscarawas counties. Data triangulation was achieved through comparison of participant data to qualitative data collected from regional community professionals (treatment providers and law enforcement) via focus group interviews, as well as to data surveyed from the Ohio Bureau of Criminal Investigation (BCI) Richfield Crime Lab, which serves the Akron-Canton, Cleveland and Youngstown areas, and the Ohio Department of Public Safety (ODPS), which logs drug task force seizures from across Ohio.

All secondary data are summary data of cases processed from January through June 2017. In addition to these data sources, Ohio media outlets were queried for information regarding regional drug abuse for July through December 2017.

Note: OSAM participants were asked to report on drug use/ knowledge pertaining to the past six months prior to the interview; thus, current secondary data correspond to the reporting period of participants.

OSAM Staff: Regional Epidemiologist: Joseph Cummins, MA, PCC-S, LICDC R. Thomas Sherba, PhD, MPH, LPCC OSAM Principal Investigator Kathryn A. Coxe, MSW, LSW OSAM Coordinator Jessica Linley, PhD, MSW, LSW OSAM Quantitative Data Analyst

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 29 Page 8 Surveillance of Drug Abuse Trends in the Akron-Canton Region

Regional Profile Indicator1 Ohio Akron-Canton Region OSAM Drug Consumers Total Population, 2016 11,614,373 1,195,922 45 Gender (female), 2016 51.0% 51.3% 55.6% Whites, 2016 82.5% 85.4% 93.0%2 African Americans, 2016 12.8% 9.9% 4.7% Hispanic or Latino Origin, 2016 3.7% 2.0% 6.7% High School Graduation Rate, 2012-16 89.5% 90.4% 86.3%3 Median Household Income, 2012-16 $50,674 $49,767 $12,000-15,9994 Persons Below Poverty Level, 2016 14.6% 13.4% 65.9%5 1Ohio and Akron-Canton region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018. 2Race was unable to be determined for 2 participants due to missing and/or invalid data. 3High school graduation status was unable to be determined for 2 participants due to missing and/or invalid data. 4Participants reported income by selecting a category that best represented their household’s approximate income for the previous year. Income was unable to be determined for 3 participants due to missing and/or invalid data. ⁵Poverty status was unable to be determined for 4 participants due to missing and/or invalid data.

Akron-Canton Regional Participant Characteristics

Consumer Characteristics N=45*

Male 20 Female 25 Gender < 20 1 20s 17 30s 10 Age 40s 11 50s 6 Less than high school graduate 6 High school graduate 24 Some college or associate's degree 12 Education Bachelor's degree or higher 1 < $12,000 20 $12,000 to $19,999 7 $20,000 to $28,999 3 $29,000 to $36,999 5

Household Income ≥ $37,000 7 Alcohol 22 Cocaine, Crack 16 Cocaine, Powdered 13 Ecstasy/Molly 1 Heroin/Fentanyl 17 Marijuana 21 Methampehtamine 23

Drugs Used** Prescription Opioids 15 Prescription Stimulants 8 Sedative-Hypnotics 17 Suboxone®/Subutex® 12 Other Drugs*** 3

0 5 10 15 20 25 30 Number of Participants

*Not all participants filled out forms completely; therefore, numbers may not equal 45. **Some respondents reported multiple drugs of use during the past six months. ***Other drugs included: lysergic acid diethylamide (LSD), Marinol®(medical marijuana pill) and synthetic marijuana.

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processes had decreased, while the number of cases of concentrated THC (tetrahydrocannabinol oils, “dabs”) had Historical Summary increased. In the previous reporting period (January - June 2017), There was consensus among participants and community crack cocaine, heroin, marijuana, methamphetamine and professionals that methamphetamine was highly Suboxone® remained highly available in the Akron-Canton available. Participants discussed methamphetamine use region. Changes in availability during the reporting as epidemic as heroin use, and also noted that, similar period included: increased availability for marijuana and to marijuana, methamphetamine use had become methamphetamine; decreased availability for prescription less stigmatizing. Community professionals reported a opioids; and likely increased availability for fentanyl. crossover from heroin to methamphetamine. Treatment providers explained that some heroin users had switched While many types of heroin were available in the region, to methamphetamine due to fear of overdosing and dying participants and community professionals reported from heroin/fentanyl. powdered heroin as most available. Participants described powdered heroin as brown, gray, pinkish or white in Participants reported that methamphetamine was color, and explained that the heroin that was pinkish or available in powdered and crystal forms throughout white was most likely adulterated with fentanyl. Many the region. However, reportedly, crystal was the most participants reported that much of what was being sold prevalent form; it was both imported and manufactured as heroin was actually fentanyl or carfentanil. Community locally. The BCI Richfield Crime Lab reported that the professionals also reported that much of the heroin in the number of methamphetamine cases it processes increased region was adulterated with fentanyl or was pure fentanyl during the reporting period; the lab reported processing or an analogue of fentanyl. crystal, off-white and white powder, and brown crystals in smoking devices. Participants reported that the availability of heroin increased during the reporting period, while community Overall, participants reported that the quality of professionals noted increased availability of fentanyl. methamphetamine decreased during the reporting Community professionals reported that the general period. They reported numerous adulterants (aka “cuts”) availability of heroin remained the same, and many for the drug, including: barbiturates, bath salts, fentanyl believed that heroin availability/use had peaked, or rather and “molly” (powdered MDMA). Reportedly, adulterating a plateaued. The BCI Richfield Crime Lab reported that the drug with other drugs was common. There was discussion number of heroin cases it processes decreased during in many participant groups regarding how ecstasy and the reporting period, while the number of fentanyl and molly were most often cut with other drugs including: fentanyl analogue cases increased. cocaine, heroin and methamphetamine. Likewise, participants discussed that crack and powdered cocaine Participants and community professionals reported that were cut with fentanyl, heroin and methamphetamine. the general availability of marijuana increased during One participant group in Tuscarawas County reported that the reporting period. Reasons for increased availability marijuana was sometimes adulterated with fentanyl. included: more people were growing marijuana; marijuana prices had gotten cheaper; more states had legalized Lastly, participants reported high availability of synthetic marijuana use; and marijuana was socially acceptable, with marijuana, and law enforcement indicated that the many respondents equating marijuana use with drinking availability of the drug increased during the reporting alcohol. Treatment providers noted that the age of first use period. Law enforcement reported that users in the region for marijuana was as young as nine or 10 years. were manufacturing the drug with chemicals purchased via the Internet from China. Participants indicated that Participants and law enforcement also indicated that the the use of the drug was common within correctional availability of marijuana concentrates and extracts (aka institutions. One officer reported that because the “wax” and “dabs”) also increased during the reporting drug produces an effect similar to methamphetamine, period. The BCI Richfield Crime Lab reported that the he suspected that the drug was popular with number of marijuana cases (including edible forms) it methamphetamine users.

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(www.ohio.com, Nov. 3, 2017). FBI agents in Canton seized 15 kilograms of cocaine, eight pounds of crystal Current Trends methamphetamine, 50 pounds of marijuana, and 10 guns during the execution of 11 search warrants in Stark and Powdered Cocaine Wayne counties; officers arrested at least two people connected to a drug trafficking ringwww.cantonrep.com ( , Powdered cocaine is highly available in the region. Nov. 9, 2017). The Summit County Drug Unit seized nine Participants most often reported the drug’s current kilograms of cocaine at a home in Akron; no arrests were availability as ‘10’ on a scale of ‘0’ (not available, impossible made (www.cleveland.com, Nov. 15, 2017). to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants Participants reported that the availability of powdered commented: “Depends on what lane you’re in … if you are cocaine has decreased during the past six months. When looking for it, you’ll find it; Dealers will walk up any time and participants were asked why the availability of powdered say, ‘What do you want?’” Treatment providers most often cocaine has decreased, several participants reported reported the current availability of powdered cocaine as lowered demand for the drug, as users typically want other ‘8,’ while law enforcement reported it as ‘8-9;’ the previous drugs, such as crack cocaine, heroin or methamphetamine. most common scores were ‘7’ for treatment providers and Participants commented: “It’s easier to find crack; I’d rather ‘5-10’ for law enforcement. Law enforcement reported: smoke crack; The heroin epidemic … people want to do more “From a law enforcement standpoint, it’s very easy; [Dealers] opiates; Now, heroin and meth are more common; Meth are really good … they can get anything….” is out there … it’s taken over cocaine; Meth became more popular. It’s cheaper than cocaine; Meth became big, it lasts Corroborating data indicated that powdered cocaine is longer [than cocaine].” available in the region. The Ohio Department of Public Safety (ODPS) reported 25 drug task force seizures of Community professionals reported that the availability of powdered cocaine in the Akron-Canton region during the powdered cocaine has remained the same during the past reporting period. six months. A law enforcement officer stated,I “ don’t see a change in powdered cocaine.” The BCI Richfield Crime Lab Media outlets reported on law enforcement seizures reported that the number of cocaine cases it processes has and arrests in the region this reporting period. A cocaine decreased during the past six months; the lab does not trafficking investigation lead by Canton Police (Stark differentiate between powdered and crack cocaine. County), the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives and the U.S. Marshals Violent Fugitive Task Reported Availability Force lead to the arrest of three women and eight men Change during the Past 6 Months during a county-wide drug sweep; eight people were charged with cocaine trafficking, one with marijuana trafficking, and three with heroin traffickingwww. ( Participants Decrease cantonrep.com, July 26, 2017). Two additional people plead guilty in the Stark County Common Pleas Court to Cocaine Law enforcement No change Powdered Powdered multiple drug charges involving the cocaine distribution Treatment providers No change ring in Stark County; both people faced 30-51 years in prison for their involvement in the cocaine ring (www. indeonline.com, Sept. 22, 2017). Federal Bureau of Participants most often rated the current overall quality Investigation (FBI) officers arrested a downtown Akron of powdered cocaine as ‘5’ on a scale of ‘0’ (poor quality, (Summit County) nightclub owner after executing a search “garbage”) to ‘10’ (high quality); the previous most warrant at one of his homes in Kenilworth (Trumbull common score was ‘8.’ Participants remarked: “It’s no good County) and seizing undisclosed amounts of suspected around here; It depends on who you are buying it from; It cocaine, methamphetamine and drug paraphernalia; FBI depends on what it smells like. If it smells like diesel fuel, then agents also seized undisclosed amounts of marijuana, it’s ‘fire’ (high quality) … if not, then I’m not buying it.” prescription drugs, guns and drug paraphernalia at the man’s other home in Cuyahoga Falls (Summit County)

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Participants further discussed adulterants (aka “cuts”) that Participants reported that the most common route of affect the quality of powdered cocaine and commented: administration for powdered cocaine is snorting and “I don’t know if I’ve ever had pure cocaine; A lot of stuff is cut intravenous injection (aka “shooting”). Participants with fentanyl to make you crave opiates; Every time I used, I estimated that out of 10 powdered cocaine users, five had to go to the bathroom (indicating presence of laxatives); would snort and five would shoot the drug. Participants Now-a-days, they’ll cut it with anything.” remarked: “A lot of people have moved to the needle (intravenous injection); Everyone is shooting everything; They Participants reported the top cutting agents for powdered probably do both. If you can’t find a needle, you snort.” cocaine as: aspirin (including baby aspirin and BC® Powder), baby laxatives, baking soda, fentanyl, inositol Participants described typical powdered cocaine users as (dietary supplement) and NoDoz®. Other adulterates of higher socio-economic status or individuals involved mentioned included: “Close Enough” (reportedly a in the adult entertainment industry. Participants stated: product sold in head shops to cut drugs), laxatives, PCP “It’s a rich man’s drug; Older, rich, white dudes; You’ve got to (phencyclidine), powdered sugar, omega 3, Tylenol®; and have money, or access to money, ‘cause you are going to burn as one participant exclaimed, “any white pill in your cabinet.” money pretty quick with coke; It’s more upscale … There’s a Overall, participants reported that the quality of powdered stigma that’s attached to crack cocaine that’s not attached to cocaine has decreased during the past six months. powdered cocaine, so the people who have money, who own Participants stated: “It’s just junk; With the drug busts, there businesses, bars, restaurants, those that don’t want to have is a decrease in the quality of ‘coke’ (powdered cocaine); So paraphernalia laying around, powdered cocaine is the way many hands, and each one cuts it; People are trying to get as to go because you don’t have to have all of that attached; much money off of it as they can, they’re stretching it out.” Business people, it’s easier to hide; I know people who do coke that are nurses and lawyers; It’s a party drug … you can do

Cutting Agents more on cocaine.” Reported by Crime Lab Treatment providers described typical powdered cocaine users as white people, while law enforcement reported l

Cocaine local anesthetics (benzocaine and lidocaine) that there is no typical user of the drug. A treatment

Powdered Powdered provider commented, “I’ve heard a lot about women involved in adult entertainment using cocaine in that setting, Reports of current prices for powdered cocaine were mostly Caucasian.” Law enforcement reported: “I think it’s variable among participants with experience buying all walks of life … it hits all social classes and races; I see it the drug. Reportedly, the most common quantity of with any age. It can cut all the way from teenagers to middle- purchase is 1/8 ounce (aka “eight ball”). Regarding pricing, aged folks.” participants commented: “It depends on who you know; It depends on how much money you’ve got; It goes for what you want … if you spend $50, you get a ‘50’ ($50 amount) Crack Cocaine … they eyeball it.” One participant group reported that the price of powdered cocaine has decreased during the Crack cocaine remains highly available in the region. past six months. A participant stated, “There’s more interest Participants most often reported the drug’s current in ‘meth’ (methamphetamine), so dealers are lowering the availability as ‘10’ on a scale of ‘0’ (not available, impossible price.” to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants

Current Prices for commented: “Real easy, easier than (powdered) cocaine [to Powdered Cocaine obtain]; It’s the easiest drug to find, by far; Equal to heroin; Dope boys (heroin dealers) sell crack … they got one, they A gram $50-100 have the other; Usually, I get it with fentanyl, hand-in-hand 1/16 ounce (aka “teener”) $75-150 … I got a dude, I buy two grams of fentanyl, they’ll throw in a Cocaine

Powdered Powdered gram of crack.” 1/8 ounce (aka “eight ball”) $150-300

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Treatment providers most often reported the current are ‘cutting’ (adulterating) it to make more money off it, and availability of crack cocaine as ‘9;’ the previous most they’re just making it more readily available.” The BCI Richfield common score was ‘8.’ One treatment provider stated, Crime Lab reported that the number of cocaine cases it “In Akron, it’s a ‘10.’ It’s more of an urban drug.” Law processes has decreased during the past six months; the enforcement most often reported current availability as lab does not differentiate between crack and powdered ‘6-7’ in Summit County and ‘10’ in Tuscarawas County;’ cocaine. the previous most common scores were ‘5’ and ‘7.’ Law enforcement in Tuscarawas County remarked: “The folks Reported Availability we have [on probation] that are testing positive for cocaine Change during the Past 6 Months are telling us they are using crack; The ones we’re dealing with, they are telling us it’s their drug of choice … that’s want Participants No change they want, and if it’s not available here, they can just go up the road to get it; It’s pretty easy. I know one area here in New Crack

Cocaine Law enforcement No consensus Philadelphia where there’s four crack houses in one block; When I’m dealing with street users, they are telling me ‘rock’ Treatment providers Increase (crack cocaine) is easier to get than ‘powder’ (powdered cocaine).” Participants most often rated the current overall quality of Corroborating data indicated that crack cocaine is crack cocaine as ‘7’ on a scale of ‘0’ (poor quality, “garbage”) available in the region. ODPS reported 12 drug task force to ‘10’ (high quality); the previous most common score seizures of crack cocaine in the Akron-Canton region was ‘3,’ ‘6’ and ‘8.’ Participants stated: “This is the drug that during the reporting period. varies the most; It depends on where you get it from … [if] when you cook the crack … you get all the impurities out; If Media outlets reported on law enforcement seizures and you buy it on the corner, it won’t be a ‘10’ … more like a ‘5’ in arrests in the region this reporting period. Akron Police quality ….’” (Summit County) arrested two men in the parking lot of a fast food restaurant after seeing drugs in plain sight in Participants reported that crack cocaine in the region is their vehicle; officers confiscated crack cocaine, powdered most often adulterated (aka “cut”) with baking soda. Other cocaine, methamphetamine, marijuana and heroin (www. cuts mentioned included: ammonia, baby laxatives and news5cleveland.com, Sept. 13, 2017). ether. A participant reported, “It’s just like ‘coke’ (powdered cocaine). Whatever you cut it with, you [cut crack cocaine Participants reported that the availability of crack cocaine with].” Overall, participants reported that the quality of has remained the same during the past six months. crack cocaine has decreased or remained the same during Participants commented: “It’s always been easy to get; It’s the past six months. Participants remarked: “Young punks always been around.” Treatment providers reported that going around trying to make a quick buck, cutting it with the availability of crack cocaine has increased during the anything they can; It’s so hard to get powder, if powder past the past six months. Treatment providers stated: “I [quality] goes down, so does crack.” think it’s increased because of the perceived safety compared to opiates, especially with the fentanyl overdoses that’s been

Cutting Agents happening; I think it increased too because of the ‘meth’ Reported by Crime Lab (methamphetamine) production. They’re concerned about some of the stuff that’s in the meth.” Law enforcement in

Summit County reported that the availability of crack Crack l

Cocaine local anesthetics (benzocaine and lidocaine) cocaine has remained the same, while law enforcement in Tuscarawas County reported that it has increased during the past six months. Law enforcement in Tuscarawas Reports of current prices for crack cocaine were consistent County commented: “I’ve been seeing a lot more crack, and among participants with experience buying the drug. a lot more crack dealers. I’ve been dealing with a lot more Reportedly, the most common quantity of purchase informants who can buy crack, so it seems to be making an is a $20 piece (aka “rock”). Participants commented: “It influx back into the area; There’s certain people in the area that

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depends on how much money you got … the more money Heroin you got, the bigger the piece; If you got $2, I’ll give you a $2 hit; You usually can get a deal, three [pieces] for $50, six for Heroin remains highly available in the region. Participants $100.” most often reported the current availability of the drug as ‘10’ on a scale of ‘0’ (not available, impossible to get) to Current Prices for ‘10’ (highly available, extremely easy to get); the previous

most common score was also ‘10.’ A participant stated,

Crack Cocaine “Every gas station, corner store, every block, you will find it.” 1/10 gram (aka “rock”) $10 However, participants throughout focus groups reported difficulty in finding heroin not adulterated with fentanyl Crack Crack A gram $60-70 Cocaine or fentanyl analogues. Participants discussed: “I don’t know 1/8 ounce $120 where there is real heroin; There’s a small, small chance you’ll find pure heroin; I had one person I could get real heroin from; I couldn’t even get heroin, only from a couple of people, it was Participants reported that the most common route all fentanyl.” of administration for crack cocaine remains smoking. Participants estimated that out of 10 crack cocaine Treatment providers most often reported the current users, seven would smoke and three would “shoot” availability of heroin as ‘10;’ the previous most common (intravenously inject) the drug. Participants commented: score was also ‘10.’ However, most treatment providers “People who shoot heroin, will shoot crack; If you’re going to also reported that, while users seek heroin, what they are shoot it, you’ll use cocaine … if you get crack, you smoke; A getting is heroin adulterated with fentanyl. Treatment lot of people do both (smoke and shoot).” providers commented: “This is hard because I think they are really talking about fentanyl when they are talking about Participants described typical crack cocaine users as heroin; You talk about the heroin epidemic, but it’s really not older, from lower socio-economic areas, and African- a heroin epidemic; I don’t know if there is pure heroin out American people. Participants discussed: “Most crack users there anymore. I think it’s all mixed with things; They think I know are older; It’s geographical. Most crack is in … lower they’re using heroin, though, recently, I’ve heard more of them class neighborhoods; People see it as a low-income drug.” actually say they prefer fentanyl; Pure heroin is hard to find However, some participants commented: “Everybody anymore. The girls I talk to in detox say they are detoxing from smokes crack; There’s as much rich people who use crack; It’s heroin, but it’s not heroin because they are testing for fentanyl; the most diverse drug … I’ve seen the richest smoking it. I’ve You don’t hear anybody talking about it, they’ll use the word seen it with the poorest of the poor.” ‘heroin,’ but when you really start talking to them, they’ll say While some community professionals reported that crack ‘fentanyl.’” cocaine users are more likely from lower income areas, Law enforcement most often reported the current the majority of community professionals did not identify availability of heroin as ‘8’ and ‘10;’ the previous most characteristics of a typical crack cocaine user. These common score was ‘10.’ A law enforcement officer stated, community professionals commented: “It’s changing. “Sometimes it can be a little harder to get. You have to travel, People you talk to who use crack … ‘You don’t look like a but it’s still readily available. We have people using heroin, crack user’ … more people than you think smoke it; It’s been and if they can’t find heroin, they’ll use other opiate pills or surprising to me lately. In the past, I’d say it was prevalent fentanyl.” with older, African-American men, but it is prevalent in other populations of all ages …. It seems like the stigma isn’t there Corroborating data indicated that heroin is available in as much as years ago; There’s more suburban kids, young the region. ODPS reported 34 drug task force seizures of adults … trying it.” Some treatment provider comments heroin and/or fentanyl in the Akron-Canton region during included: “Crack goes hand-in-hand with alcohol; It’s often the reporting period (50.0% of the seizures were made associated with sex, prostitution … sex addiction.” A law in Portage County); drug task forces did not typically enforcement officer commented,People “ with a little less differentiate between heroin and fentanyl due to the high money go for that, because you can get a cheaper high off it incidence of heroin-fentanyl mixtures. (it’s less expensive than other drugs).”

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Media outlets reported on law enforcement seizures get tar, but mostly powder. If you just tell somebody you’re and arrests in the region this reporting period. Forty-five buying heroin, you’re usually going to get powder.” Summit County residents were treated at emergency rooms for overdoses from July 28 – August 3, 2017 Participants most often reported the current availability of according to Summit County Public Health surveillance black tar heroin as ‘0’ and ‘3’ on a scale of ‘0’ (not available, reports; the report stated that people from two zip codes impossible to get) to ‘10’ (highly available, extremely in the county made up 34% of the total overdoses in easy to get); the previous most common score was ‘0.’ that county; the overdoses do not include those not Participants commented: “It’s a lot harder to find tar; I treated in emergency rooms (www.ohio.com, Aug. 4, haven’t seen tar in years; You have to go out of town for it; 2017). Authorities in Ravenna (Portage County) identified My dude will go to Akron and bring tar back here.” Treatment 22 people responsible for possessing, distributing, providers and law enforcement also indicated availability or intending to distribute, heroin, crack cocaine and of black tar heroin, most often reporting its current powdered cocaine in the Ravenna and Youngstown availability as ‘2’ and ‘3,’ and ‘6,’ respectively; the previous (Mahoning County) areas; officers identified that some most common scores were ‘3’ for treatment providers and of the drugs were purchased in Michigan and brought ‘8’ for law enforcement. Treatment providers discussed: to Ohio for distribution (www.wkyc.com, Aug. 10, 2017). “I’ve only heard one client in the past six months talk about North Canton Police (Stark County) arrested a man during tar; A few people I’ve worked with … they went to Colorado a traffic stop after finding a white and gray powdery to get tar.” A law enforcement commented, “Tar is very rare substance suspected to be heroin; one of the officers for us … we’ve seen it, but it’s rare.” became exposed to the drug while attempting to pull Participants reported that the availability of heroin the man from the vehicle, and his partner administered has decreased during the past six months. Participants Narcan® to him to revert overdose symptoms; both stated: “The heroin we think is heroin is probably not heroin, officers were treated at a nearby hospitalwww.cantonrep. ( our dealers aren’t so trustworthy; No one has it anymore, com, Oct. 4, 2017). Ohio State Highway Patrol (OSHP) everyone has fentanyl; The heroin epidemic is going down, in Summit County arrested a Connecticut man during it’s replaced with fentanyl and ‘meth’ (methamphetamine).” a traffic stop in Richfield Township after he lead police Treatment providers reported that the availability of officers on a car chase; officers in a patrol plane spotted heroin as remained the same during the past six months, the man throwing a bag into a dumpster; officers caught while law enforcement reported that it has decreased the man and seized 1,600 grams of heroin from the bag or remained the same. A treatment provider stated, “I he threw into the dumpster (www.news5cleveland.com, wonder if heroin is going down. We really don’t know what Nov. 17, 2017). Canton Police arrested a wanted man after they are getting, but with the fentanyl and carfentanil being finding him passed out from an alleged overdose in a considered as heroin [by users], maybe pure heroin is going stolen car; during a search of the vehicle, officers found a down.” Law enforcement commented: “I don’t know if the white powdered substance, an orange-brown powdered availability has decreased, but the demand has decreased substance and drug abuse instruments (www.cantonrep. a little bit; The people I talked to on the streets, a lot of them com, Nov. 30, 2017). seem to be self-medicating with methamphetamine … While many types of heroin are currently available in we’re seeing a lot more crystal meth in the area now; We put the region, participants reported brown powdered as these opiate users on the Vivitrol® shot, they don’t necessarily most available. Participants stated: “Around here, more change their behavior, so they’ll switch to cocaine or ‘powder’ (powdered heroin); I’ve seen more powder than methamphetamine.” ‘tar’ (black tar heroin).” Participants described powdered The BCI Richfield Crime Lab reported that the number of heroin as chunky to powdery in consistency, brown, gray, heroin cases it processes has decreased during the past six tan or white in color. A participant described powdered months; the lab reported processing gray and tan heroin, heroin: “Like sand, it can be rocked, with a vinegar smell to and rarely black tar heroin. it.” Community professionals also reported powdered heroin as most available. A treatment provider stated, “The only way I’ve heard it referred to is as ‘powder.’” A law enforcement officer stated,I’m “ seeing mostly powder. I can

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Reported Availability Current Prices for Change during the Past 6 Months Heroin

Participants Decrease Brown powdered: 1/10 gram (aka “point”) $20 Heroin Law enforcement No consensus

Heroin 1/2 gram $50-80 Treatment providers No change A gram $90-150

Participants most often rated the current overall quality 1/8 ounce (aka “eight ball”) $320 of heroin as ‘0’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); participants could not rate the quality of While there were a few reported ways of using heroin, heroin previously. Participants discussed: “Everyone has a generally, the most common route of administration tolerance for fentanyl and carfentanil, so when they get heroin, remains intravenous injection (aka “shooting”). Participants it doesn’t do anything; I want heroin ‘cause it lasts longer, estimated that out of 10 heroin users, nine would shoot but it’s garbage when I did find it.” Participants discussed and one would snort the drug. Participants commented: adulterants (aka “cuts”) that affect the quality of the drug “I’ve seen more needles on the streets over the last six months and reported the top cutting agents for heroin as: brown than I have in my lifetime; Some people snort for a while sugar, fentanyl, powdered sugar, vinegar and vitamins. [before progressing to shooting].” Additional cuts mentioned included: benzodiazepines, coffee, laxatives, Neurontin®, lactate, molasses and Participants reported that injection needles are most saccharin. One participant stated, “Anything that will dissolve available from drug dealers and pharmacies. Additionally, in water.” Overall, participants reported that the general participants reported obtaining needles from friends quality of heroin has decreased during the past six months. and family members who have diabetes. Regarding the purchase of needles at pharmacies, participants discussed: “I think they made it harder. You have to show I.D. [and] Cutting Agents sometimes you have to have a prescription; If you know what Reported by Crime Lab to ask for and have an I.D., you can get them; They keep track of how many times you buy [needles] … you can only buy a l acetaminophen box every so often.” Other participants reported: “Usually, l carfentanil dealers sell the needles with the drug; Dealers give a needle Heroin l cocaine to anyone who buys $40 or more in heroin; The dealer I’d go l diphenhydramine (antihistamine) to, I’d go in the morning and buy the drug, and he’d give me a l fentanyl and fentanyl analogues needle; My uncle is diabetic, I buy them from him; I stole mine from my mother.” Reports of current prices for heroin were consistent Many participants noted that there are needle exchange among participants with experience purchasing the drug. programs in Akron and in Cleveland; participants Reportedly, the most common quantities of purchase are reported individuals could receive 10 needles a week. 1/2 gram and a gram. However, participants commented: One participant reported, “You can walk into the police “Whatever you want, you can get ‘20’ ($20 amount) you can department [in Portage county] and exchange it.” The most get ‘40’ ($40 amount); Whatever they can afford; It’s hard to commonly reported price for needles on the street is come up with $40, you get a ‘20’ and hustle all day; There’d $2-7 per needle. A few participants reported buying bags be times I’d ask them to give me a ‘40’ and I’ll pay them $80 of 10 needles from dealers for $5-20 per bag. Another tomorrow, just to quit from being sick.” participant stated, “Some sell for $10 [a needle] … if you’re ‘jonesin’ (in withdrawal), you’ll pay anything.” Reportedly, sharing needles is common. A participant remarked, “Quite a few people share needles.”

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A profile for a typical heroin user did not emerge from Corroborating data indicated that fentanyl is available in the data, although some participants noted use among the region. ODPS reported 34 drug task force seizures of teenagers and individuals in their 20’s. Participants heroin and/or fentanyl in the Akron-Canton region during commented: “You die before you get old using heroin; the reporting period; drug task forces did not typically You never heard of an old junkie, ‘cause they’re dead; The differentiate between heroin and fentanyl due to the high millennials … our whole generation is dying.” However, most incidence of heroin-fentanyl mixtures. participants reported: “It’s not discriminating to any age or sex; Every walk of life; Runs the gamut, wealthy and poor.” Media outlets reported on law enforcement seizures and arrests in the region this reporting period. The Community professionals also reported that there is not Summit County Chief Epidemiologist reported at a typical heroin user. Treatment providers commented: least 57 unintentional opiate-related overdoses seen “There’s no discrimination; There may have been trends in emergency rooms in one week in early July; the before, but it doesn’t seem that there are now. We’ve had epidemiologist reported that about 43% of the individuals younger folks, older folks, different nationalities … it doesn’t were between the ages 35-64 years, and that the majority seem to make a difference.” A law enforcement officer of the overdoses in the county resulted from heroin stated, “Everybody, every age, all walks of life.” mixed with fentanyl or carfentanil (www.ohio.com, July 9, 2017). An Akron (Summit County) man plead guilty to involuntary manslaughter for providing carfentanil to a Fentanyl woman who overdosed and died in her car; the judge sentenced the man to eight years in prison (www.ohio. Fentanyl is highly available in the region. com, Aug. 28, 2017). Hospital staff in Massillon (Stark Participants most often reported the current County) treated three nurses for fentanyl exposure; availability of the drug as ‘10’ on a scale of ‘0’ the nurses were exposed while cleaning a room where (not available, impossible to get) to ‘10’ (highly they just treated a fentanyl overdose victim (www. available, extremely easy to get); the previous abc6onyourside.com, Aug. 11, 2017). An investigation most common score was not reported. Participants lead by Twinsburg Police (Summit County) and the commented: “It’s everywhere; If you’ve got feet, you’ll find Southeast Area Law Enforcement Task Force lead to the it; Fentanyl is easier to get than heroin; People are putting indictment of two men for supplying fentanyl and heroin fentanyl in ‘glass’ (methamphetamine).” to a woman who subsequently died from an overdose at a Twinsburg home (www.cleveland.com, Oct. 11, 2017). An Treatment providers most often reported the current investigation completed by Akron Police, the U.S. Postal availability of fentanyl as ‘10,’ while law enforcement most Inspection Service and Homeland Security lead to the often reported it as ‘9;’ the previous most common scores federal indictment of a man responsible for receiving an were not reported. Treatment providers commented: “It’s undisclosed number of shipments of fentanyl from China just the trend. Even if you wanted heroin, it’s all fentanyl; to an apartment in Akron (www.justice.gov, Nov. 22, 2017). You can get it over the Internet. You don’t have to deal with another person face to face. You can just sit in your living Participants reported little knowledge regarding fentanyl room and order it; Clients prefer the high.” Law enforcement analogues. While carfentanil was mentioned by a few, officers from Summit County stated:We “ have users who no participant had firsthand experience or was able to want it, specifically ask for it. They want it over heroin; We distinguish the drug from fentanyl. Law enforcement have users who want fentanyl not mixed with heroin; The reported that carfentanil is available in the region, and users don’t care if it’s fentanyl or carfentanil. They’ll take that users seek this drug. A law enforcement officer anything.” Law enforcement officers from Tuscarawas commented, “They ask for carfentanil .… We don’t mess County stated: “For me, it’s harder to buy just fentanyl. I don’t with it anymore. We just bag it, ship it to the lab … [due to see just fentanyl … it’s a cut. Actually, they’ve been using exposure risks].” fentanyl to cut anything … they’re cutting cocaine with fentanyl.” Participants and community professionals reported that the availability of fentanyl has increased during the past six months. Participants discussed: “You didn’t hear people using it six months ago; It’s cheap, more potent, you don’t

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need as much [compared to heroin]; It’s cheap, cheap, Reports of current prices for fentanyl were consistent cheap, and they’re bringing truck loads in; You can buy it off among participants with experience purchasing the drug. the Internet.” Community professionals stated: “It’s easier Reportedly, the most common quantity of purchase is a to get [than heroin]. They can get it through the mail … it’s gram. Participants reported: “It’s cheap; It’s typically sold like less risky; It’s more profitable … a bigger bang for your buck; heroin … you get a ‘20’ ($20 amount); If you give them $20 Dealers are trying to make more money … the more they or $40, you’re getting a big, big sack; You get way much more cut [heroin with fentanyl], the more money they make; It’s … triple the amount if you were to buy real heroin; If you buy easier to make, easier to synthesize.” The BCI Richfield Crime fentanyl in bulk, it’s dirt cheap.” Lab reported that the number of fentanyl and fentanyl analogue cases it processes has increased during the past Current Prices for six months, while the number of carfentanil cases has Fentanyl decreased. 1/10 gram $10-20 Reported Availability 1/2 gram $50-60 Change during the Past 6 Months Fentanyl A gram $90-150 Participants Increase

Law enforcement Increase The most common route of administration for fentanyl Fentanyl is intravenous injection (aka “shooting”). Participants Treatment providers Increase reported that out of 10 fentanyl users, all 10 would shoot the drug. A participant remarked, “If you use fentanyl, you’re Participants most often rated the current overall quality past the snorting. You’ll shoot it.” of fentanyl as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) Participants described typical fentanyl users as white to ‘10’ (high quality); the previous most common score people and young. Participants commented: “It’s a white was not reported. Participants commented: “The death people thing; It’s getting younger and younger.” Many toll explains it; I cut (adulterate/dilute) that shit and people participants and community professionals identified be still falling over; Heroin doesn’t even get people high typical fentanyl users as typical heroin users. Treatment no more; When people spray (cut) heroin with fentanyl, it providers commented: “Same as heroin, at this point; doesn’t evenly mix … you may get some very potent, some It seems if you are in the heroin, opiate field, you’ll take not potent in the same batch.” Although participants anything that you can get to not stay sick.” reported that fentanyl is very potent, many participants complained that the effect of the drug is short-lived. A participant stated, “The thing I liked about fentanyl is that for $20 you can get four shots off of it. But, it still wasn’t as Prescription Opioids good as heroin, ‘cause the fentanyl doesn’t last long enough. You’ll do it and an hour later you’re sick again (going through Prescription opioids are moderately available withdrawal). With heroin, you can go five, six hours without for illicit use in the region. Participants most getting sick.” often reported the current street availability of these drugs as ‘5’ on a scale of ‘0’ (not available, Participants discussed adulterants (aka “cuts”) that affect impossible to get) to ‘10’ (highly available, the quality of the drug and reported the top cutting extremely easy to get); the previous most common score agents for fentanyl as heroin and powdered sugar. A was ‘10.’ Participants discussed: “Pills are hard to get. Doctors participant stated, “People use sugar a lot because it don’t give them out; People are still looking for them, they’re just dissolves.” Overall, participants reported that the quality not readily available; You can find them, but they are too high of fentanyl has remained the same during the past six in price.” Treatment providers most often reported current months. Though a participant stated, “There’s a lot of people street availability as ‘6,’ while law enforcement most often dying, more today than ever, so it must be more pure.” reported it as ‘9;’ the previous most common scores were ‘6-7’ for treatment providers and ‘5’ and ‘8’ for law enforcement.

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A treatment provider stated, “Guys are talking about how months, while law enforcement reported that availability difficult it is to get them on the streets.” Law enforcement has remained the same. Treatment providers stated: “They’re commented: “I see a lot of pills. We do pill buys weekly; We see into fentanyl now; The pills are expensive; They changed the people where pills are their thing … and despite the governor’s chemical formula so that they’re not crushable, or you can’t tightening up where you can only get a seven day supply, they break it down, you can’t wash it down into a liquid, so they can’t still get their hands on it; They have their little network, and do what they want to do, which is snorting or using the syringe.” people get prescribed it for years … they sell it or trade it for Treatment providers also credited the Ohio Automated Rx what they want; People are getting them on the Internet, and Reporting System (OARRS) as having an impact in the decline getting bulk amounts of it.” of street availability of these drugs. Corroborating data indicated that prescription opioids are The BCI Richfield Crime Lab reported that the number of available for illicit use in the region. ODPS reported 13 drug oxycodone/acetaminophen (Percocet®), methadone and task force seizures of prescription opioids in the Akron- tramadol (Ultram®) cases it processes has increased during Canton region during the reporting period. the past six months, while the number of hydrocodone (Vicodin®), hydromorphone (Dilaudid®), oxymorphone Media outlets reported on law enforcement seizures and (Opana®), morphine, and oxycodone (OxyContin®) cases has arrests in the region this reporting period. Stark County decreased. Sheriff’s officers responded to a call from a home in Canton

Township and found an elderly woman unresponsive due Reported Availability to an opioid overdose; officers administered Narcan® to Change during the Past 6 Months revive her; two women, one of whom operated under a false Participants Decrease medical license, faced charges for giving the woman the drugs after she was released to their care from a care center Law enforcement No change

(www.ohio.com, July 27, 2017). Akron Police responded to an Opioids opioid overdose of a 6-month-old boy and called paramedics Prescription Treatment providers Decrease to the scene to revive the boy before taking him to a nearby hospital; officers identified three other children as victims of drug overdoses in 2017, one of whom died as a result (www. Reports of current street prices for prescription opioids were cleveland.com, Sept. 25, 2017). consistent among participants with experience buying the drugs. Reportedly, the majority of prescription opioids sell for Participants identified Opana®, Percocet®, Roxicodone® and $1 per milligram; however, a few participants reported that Vicodin® as the most available prescription opioids in terms Opana® sells for $2 per milligram. A participant stated, “For of widespread illicit use. A participant reported, “You can still the price you pay for two ‘perks’ (Percocet®), you can buy a bag find Opana® 10s (10 mg) and 20s (20 mg), but anything higher of heroin and a pack of cigarettes.” than that … I haven’t seen lately.” Community professionals identified Percocet® and Vicodin® as most available. Current Street Prices for Prescription Opioids Participants reported that the street availability of prescription opioids has decreased during the past six Dilaudid® $10-20 for 8 mg months. Participants discussed: “Heroin, fentanyl, and meth (methamphetamine) are taking over; People who were using Pharmaceutical fentanyl $100 for 100 mcg them, even if they find them, they moved to heroin and fentanyl; Opana® $80 for 40 mg You can’t melt them down, they’re not as easily abused; They changed the formulas, so they are just junk; The rules have $5-10 for 5 mg changed with doctors prescribing; They don’t prescribe until Opioids Percocet® $10-17 for 10 mg absolutely necessary; I used to go to the dentist to get them, but Prescription $17 for 15 mg they are not giving them anymore.” Roxicodone® $30 for 15 mg Treatment providers also reported that the street availability $2-5 for 5 mg Vicodin® of prescription opioids has decreased during the past six $3-7 for 7.5 mg

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Participants reported obtaining prescription opioids for Suboxone® illicit use from acquaintances who are being treated with them, drug dealers, medical providers (including dentists), Suboxone® remains highly available for illicit use in the region. and through Internet purchase. Participants discussed: “A Participants most often reported the current street availability lot of older people get them legitimately, but they need to pay of Suboxone® as ‘10’ on a scale of ‘0’ (not available, impossible bills … I’ve bought their whole ‘scripts’ (prescription); I went to to get) to ‘10’ (highly available, extremely easy to get); the the dentist and wrote on the paperwork that I’m on Vivitrol®, previous most common score was also ‘10.’ Participants and even then he tried to write me a script for Percocet®; Some commented: “A lot of people are getting it; A lot of people go to people trade their scripts to dealers; I’d take the pills [from the the clinics, get ‘scripts’ (prescriptions) and sell them; People are dentist] and take them directly to the dealer; People in the being prescribed three ‘strips’ (filmstrips) a day and selling two waiting room, they are saying, ‘I just need a couple of pills,’ that’s of them; You can get Suboxone® easier in jail than anything.” why they are there, ‘cause they know they can get them; Young Participants reported that the sublingual filmstrip form of kids on disability, they’ll go to five or six different dentists in six Suboxone® is more readily available than the pill form, but the months, just to see which one will give out Vicodin®, and then pill form can also be found in the area. A participant remarked, give out that name [of the prescribing dentist] to everyone.” “Pills are back ….” While there were a few reported ways of consuming Treatment providers most often reported the current street prescription opioids, and variations in methods of use were availability of Suboxone® as ‘10,’ while law enforcement noted among types of prescription opioids, generally the reported it as ‘9;’ the previous most commons scores were ‘9’ most common routes of administration for illicit use are and ‘3,’ respectively. Treatment providers stated: “A lot of people snorting and oral consumption. Participants estimated that sell their scripts; I hear more of them giving it to the dealers in out of 10 illicit prescription opioid users, six would snort, exchange for fentanyl; They’re using it to wean themselves off the three would orally consume (chew or “parachute,” crush and opiates, temporarily, when they are not able to get opiates; It’s wrap the drug in a piece of tissue paper to swallow), and one very big in jail.” A law enforcement officer stated,We “ get a lot of would “shoot” (intravenously inject) the drugs. A participant Suboxone® in pill buys. We have a clinic [in Tuscarawas County] remarked, “Dilaudid® you shoot, Percocet® eat, Vicodin® eat, that passes a lot of Suboxone® out, so we get a lot of guys who sell Opana® shoot.” their Suboxone® … so they can get heroin.” A probation officer reported that clients who were sent out of town for detox have A profile of a typical illicit prescription opioid user did not come back with a Suboxone® prescription, even though their emerge from the data. Participants commented: “People on drug of choice was not opiates. social security, because they have insurance; More privileged people, people who do ‘perks’ have good jobs; Most of my Participants reported that the availability of Suboxone® has customers were older, ‘cause doctors aren’t giving them out; increased or remained the same during the past six months. Middle-aged white ladies; More the conservative, working class There was also a lack of consensus among treatment providers … they won’t do heroin, even though it’s the same thing.” regarding a change in availability of Suboxone®. Treatment providers stated: “There are more addictionologists … there’s Community professionals described typical illicit prescription more prescriptions for it; It’s a money maker for the doctors, opioid users as younger people, aged late teens to early 20s. a money maker for clients; Since there’s been an increase in Treatment providers stated: “Young kids, teenagers; People Vivitrol® clinics, I don’t hear about it as often.” Law enforcement who start with a prescription. It’s really rare that I have seen a reported that the availability of Suboxone® has remained the person who did not start with a prescription … 95% of opiate same during the past six months. The BCI Richfield Crime Lab users started with a script, which got too expensive, and they reported that the number of Suboxone® cases it processes has started with heroin.” Law enforcement reported: “I see a lot of increased during the past six months. younger people, teenagers, 20s; 18-25 year olds, then it skips, and we have a group in their late 40s and 50s, who are later in life and won’t take the risk [use heroin].”

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Reported Availability Sedative-Hypnotics

® Change during the Past 6 Months Sedative-hypnotics (benzodiazepines, barbiturates and Participants No consensus muscle relaxants) are highly available for illicit use in the region. Participants most often reported the current Law enforcement No change street availability of these drugs as ‘10’ on a scale of ‘0’

Suboxone (not available, impossible to get) to ‘10’ (highly available, Treatment providers No consensus extremely easy to get); the previous most common score was also ‘10.’ A participant commented, “It’s the easiest thing to get.” Treatment providers most often reported the Reports of current street prices for Suboxone® were consistent current street availability of sedative-hypnotics as ‘10,’ while among participants with experience buying the drug. law enforcement most often reported it as ‘9;’ the previous Participants commented: “You can get them on the street for most common scores were ‘6’ and ‘5,’ respectively. Treatment cheaper than at the pharmacy. My script was $980 for 90 of them; providers remarked: “It’s rare that I have a client who hasn’t I’d sell them for up to $30 a strip, if they really need them.” used; It’s becoming more associated with opiate use; They’re so easy to get from mom’s medicine cabinet; They are so ® Current Street Prices for prevalent, people can get them anywhere .… If we didn’t ask Suboxone® about them, people wouldn’t even think about it.” Filmstrip $10-30 for 8 mg Participants identified Ativan®, Klonopin® and Xanax® as the most available sedative-hypnotics in terms of widespread

Suboxone Subutex® $20 for 8 mg illicit use. A participant remarked, “Everyone knows someone In addition to obtaining Suboxone® on the street from drug on Xanax®.” Community professionals identified Klonopin® dealers, participants also reported getting the drug through and Xanax® as most available. other people who are prescribed it. Participants remarked: Corroborating data indicated that sedative-hypnotics are “They’ll trade you Suboxone® for something else (other drugs); available for illicit use in the region. ODPS reported 12 drug People get 90 of them prescribed, they will keep 10 for themselves task force seizures of benzodiazepines in the Akron-Canton and sell the others; Whoever is getting them prescribed, they’re region during the reporting period. selling them, trading them. Many are addicts … they trade them for heroin or cocaine.” Media outlets reported on law enforcement seizures and arrests in the region this reporting period. Portage Participants reported that the most common routes of County Sheriff’s officers arrested a man in Newton Falls administration for illicit use of Suboxone® filmstrips are during a traffic stop when they found an abducted sublingual consumption, followed by intravenous injection woman in the vehicle and the man in possession of 23 (aka “shooting”); the most common routes of administration lorazepam (Ativan®) pills, 11 carisoprodol (Soma®) pills, for illicit use of Suboxone® pill form are shooting and oral six Adderall® pills, 3.5 buprenorphine pills, 15 units of consumption. Some participants commented: “In prison … lysergic acid diethylamide (LSD) and a container holding they snort them, they put a strip in a spoon, dissolve them in methamphetamine; officers confirmed the man did not water, and snort them; The older crowd shoots them; You can put have a prescription for any of the prescription drugs (www. a strip right in your nose … stick it there ….” record-courier.com, Nov. 3, 2017). Massillon Police (Stark County) arrested a Canton man after finding him asleep in Participants did not provide a profile description for a typical the driver’s seat of a vehicle on Route 21 with a loaded gun, illicit Suboxone® user. Community professionals described as well as with two unidentified pills; the man admitted typical illicit users as younger (20s) and opiate users who to taking seven sleeping pills and drinking alcohol, and cannot use other opiate drugs due to involvement in the officers learned the gun was stolenwww.cantonrep.com ( , criminal justice system. A law enforcement officer stated,I “ Nov. 22, 2017). don’t see a purist … ‘I want to be a Suboxone® user.’ It’s more to fill a gap … ‘I can get this to keep me from getting sick’ …. The men Participants did not reach consensus regarding the change going out on a social pass [from jail], they try to bring in other in availability of sedative-hypnotics during the past six things, but Suboxone® strips are easy to conceal.” months. Participants discussed: “It’s what people are doing

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now-a-days; When ‘speed’ (methamphetamine) started to get Current Street Prices for big, people sought Xanax® to help them come down; It helps with dope sickness; Not as many people want them, they want Sedative-Hypnotics the hard drugs; It’s always been popular.” Treatment providers Ativan® $2-3 for 1 mg reported that the availability of sedative-hypnotics has $2 for 1 mg increased or remained the same during the past six months. Klonopin® Treatment providers commented: “We’re hearing more about $4-5 for 2 mg Sedative- Hypnotics them. The last six months I’ve seen quite a few people that had $1-2 for 1 mg Xanax® a secondary diagnosis with the ‘benzos’ (benzodiazepines), $2-10 for 2 mg and I hadn’t seen that much up here before that; They treat the anxiety [with sedative-hypnotics], which is really heroin Generally, the most common routes of administration withdrawal.” Law enforcement reported the availability of for illicit use of sedative-hypnotics are snorting and oral sedative-hypnotics has remained the same during the past consumption. Participants estimated that out of 10 illicit six months. sedative-hypnotic users, six would snort and four would The BCI Richfield Crime Lab reported that the number orally consume the drugs (including dissolving the pill in of lorazepam (Ativan®) and carisoprodol (Soma®) cases one’s mouth or dissolving the pill in water). A participant it processes has increased during the past six months, stated, “I put them under my tongue.” while the number of alprazolam (Xanax®), clonazepam A profile for a typical illicit sedative-hypnotic user did (Klonopin®), zolpidem (Ambien®) and diazepam (Valium®) not emerge from the data. Participants and community cases has decreased. professionals discussed a wide range of descriptors for illicit sedative-hypnotics users. Participants commented: “In Reported Availability high school, Xanax® is really common; The older generation;

Change during the Past 6 Months People with mental health issues; People who self-medicate for anxiety; People ‘on papers’ (involved in the justice system), Participants No consensus they can’t smoke weed, so they take pills … they get out of your system in a few days; It’s an accepted drug among middle, Law enforcement No change upper class [people]; Everybody.” Treatment providers stated: Sedative- Hypnotics “Everyone, it’s pretty much non-discriminatory; More older Treatment providers No consensus than younger.” A law enforcement officer commented, “Mostly guys, late 20s to 30s that are testing positive for it.” Participants reported obtaining these drugs for illicit use from doctors, drug dealers, acquaintances who are Marijuana prescribed the medications, and through Internet purchase. Participants reported: “Doctors prescribe these like candy; Marijuana remains highly available in Some dealers have them; Find a friendly old person; People the region. Participants and community who are prescribed them sell them; People who sell these drugs professionals most often reported the current are usually addicted to something else, so they need to get availability of the drugs as ‘10’ on a scale of rid of these, so they can get their drug of choice; If you order ‘0’ (not available, impossible to get) to ‘10’ [online] just for yourself, it doesn’t red-flag anybody; The ‘dark (highly available, extremely easy to get); the previous web’ makes it difficult for law enforcement to trace.” Reports of most common scores were also ‘10.’ Participants observed: current street prices for sedative-hypnotics were consistent “You can get it anywhere around here; Everybody is using among participants with experience buying the drugs. marijuana.” Community professional comments included: “That’s the staple, everybody wants that; Every client interviewed [reports marijuana use]; For drug testing … it’s the drug we have the most positive tests for; It’s the go to thing for our people …. ‘To deal with my problems, I’ll just smoke some pot;’ It’s legal in other states; It’ll never go away.”

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Corroborating data indicated that marijuana is available Police (Stark County) arrested a man in his home during a in the region. ODPS reported 52 drug task force seizures summons to check on his children; officers found a large of marijuana in the Akron-Canton region during the unspecified amount of marijuana growing in the home reporting period. (www.cantonrep.com, Dec. 6, 2018). Warren Township Police (Trumbull County) arrested a couple after responding Media outlets reported on law enforcement seizures and to a call regarding a dispute between the couple and arrests in the region this reporting period. The Portage the landlord of a home where the couple rented a room; County Drug Task Force and the U.S. Drug Enforcement officers found two pipes used to smoke marijuana in plain Agency (DEA) in Youngstown (Mahoning County) sight and removed two young children from the home due confiscated over 400 pounds of marijuana from a Ford to neglectful conditions (www.nbc4i.com, Dec. 13, 2017). dealership in Portage County; staff members reported finding an unidentified package in the trunk of a new Ford Participants and community professionals also discussed vehicle that arrived to the dealership; officers discovered current availability of high-grade marijuana extracts and pressed marijuana in the package, and an additional five concentrates, often appearing as oil and waxy forms of packages containing marijuana in several other new cars; the drug (aka “dabs”). Participants most often reported the officers confiscated nine additional packages in new Ford current availability of marijuana extracts and concentrates vehicles in Portage, Stark and Columbiana counties, all of as ‘10;’ the previous most common score was also ‘10.’ A which were shipped from Mexico to the U.S. (www.fox8. participant stated, “Who smokes weed anymore? Everybody com, July 14, 2017). Ohio State Highway Patrol (OSHP) in smokes dabs.” However, participants from Portage and Summit County arrested a man during a traffic stop on Tuscarawas counties reported higher availability for dabs the Ohio Turnpike after smelling marijuana emitting from than participants from Summit and Stark counties. his vehicle; officers searched the car and found 22 pounds of marijuana and an unspecified number of prescription Community professionals most often reported the current drugs (www.clevescene.com, Aug. 29, 2017). A Portage availability of marijuana extracts and concentrates as County drug task force seized 30 large marijuana plants ‘10;’ the previous most common score was ‘5’ for law and six pounds of harvested marijuana from a home- enforcement and not reported for treatment providers. growing operation in Hiram Township; officers reported Law enforcement commented: “Pretty much anyone we get the marijuana was being made into marijuana edibles in with weed, they’re selling dabs; Sometimes it is packaged in the form of brownies and butter (www.news5cleveland. a lip-balm-like container, sometimes it is folded up in a little com, Oct. 10, 2017). OSHP in Summit County arrested a piece of wax paper.” California man during a traffic stop after criminal indicators Participants reported that the general availability of prompted a vehicle search; officers seized 143 pounds of marijuana has remained the same during the past six marijuana and 300 grams of hashish (marijuana extract) months. Participants commented: “It’s always been easy to (www.statepatrol.ohio.gov, Aug. 31, 2017). OSHP in find, since the beginning of time; More people are okay with it Summit County arrested a man during a traffic stop when ‘cause they know it’s going to be legal; It’s more acceptable in he admitted to having marijuana; officers searched the society.” Participants indicated that marijuana concentrates vehicle and found 29 vacuum-sealed bags containing and extracts in the form of oils, dabs or wax have increased marijuana and one pound of marijuana in a suitcase during the past six months. Participants stated: “It’s kind (www.wfmj.com, Nov. 3, 2017). OSHP in Summit County of a trendy thing; A lot more people are making it; People arrested a Colorado man during a traffic stop on Interstate get high [on dabs] quicker than weed; It only takes a couple 80 after smelling marijuana coming from his vehicle and of hits of that versus smoking a joint [to get high]; I’d rather conducting a probable cause search; officers seized 32 have that than weed, any day; The best nectar around.” While pounds of marijuana and placed the man in the Summit participants most often reported that both low-grade and County Jail (www.statepatrol.ohio.gov, Nov. 21, 2017). A high-grade marijuana are highly available in the region, a man was shot in the neck while sitting as a passenger in few participants in Tuscarawas County commented that a car in Akron; the man who shot the gun was smoking low-grade marijuana is becoming more difficult to find. marijuana, drinking alcohol and playing around with the These participants stated: “You have a hard time getting gun when he unintentionally fired a shot at the passenger anything but ‘dro’ (hydroponic, high-grade marijuana); There (www.news5cleveland.com, Nov. 16, 2017). Canal Fulton

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was a day when I could go and get some ‘dirt shit’ (low-grade dabs is a gram. Regarding the cost of dabs, participants marijuana) … pay $10 and get some.” stated: “It’s expensive, but it’s well worth it; It comes in a little bottle, like your contact [lens] kit, for $50; $20 a dab, the Community professionals reported that the general size of your pinky nail.” Overall, participants reported that availability of marijuana has increased or remained the same the price of marijuana has decreased during the past six during the past six months. Professional comments included: months. “It’s crossing state lines much easier; People are going up to states where it’s legal, buying tons of it, and bringing it back. They are also bringing a lot of ‘edibles’ (food products containing marijuana), Current Prices for and there are a lot of people learning how to make edibles; There’s Marijuana a shift in the mindset that it’s already legal; [The fine for marijuana Low grade: possession is] less than a speeding ticket [fine], so it’s not a big deal; A blunt (cigar) $5 I’d say it’s increasing significantly because you have the probability that it’s going to be legalized … already decriminalized ….” A gram $20 Community professionals also reported that marijuana extracts 1/8 ounce $40-50 and concentrates, often referring to hash oil, have increased 1/4 ounce $120 during the past six months. One law enforcement officer commented, “We are seeing a pretty decent increase, especially for An ounce $370 dabs.” High grade:

Marijuana A blunt (cigar) $10-15 The BCI Richfield Crime Lab reported that the number of marijuana cases (including “edibles”) that it processes has A gram $50-60 remained the same during the past six months, while the 1/4 ounce $70-135 number of cases of extracts and concentrates (oils, “dabs”) An ounce $300-325 has increased. Extracts and concentrates: Reported Availability A dab (unspecified dose) $20 Change during the Past 6 Months A gram $50-60

Participants Increase While there were a few reported ways of consuming marijuana, generally the most common route of Law enforcement Increase administration remains smoking. Participants estimated Marijuana that out of 10 marijuana users, all 10 would smoke Treatment providers Increase the drug. Reportedly, the most common route of administration for marijuana extracts and concentrates Participant most often rated the current overall quality of remains vaporizing. Participants estimated that out of 10 marijuana as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) marijuana extract users, all 10 would vaporize the drug, to ‘10’ (high quality); the previous most common score utilizing a “dab rig” or “dabbing pipe.” One participant was also ‘10.’ Participants stated: “Quality is excellent; People reported, “It looks like a meth pipe.” Other participants can just go to Michigan and get medical weed.” Overall, commented: “I took it in a pill one time; People are shooting participants indicated that the quality of both low-grade (intravenously injecting) dabs.” and high-grade marijuana have increased during the past six months. Participants remarked: “The [advancement A profile for a typical marijuana user did not emerge in] technology of botany [is a reason for the increase]; The from the data. Participants and community professionals lower grade is better now.” described typical marijuana users as everyone. Participants commented: “That’s an ‘everybody drug;’ My grandad Reports of current prices for marijuana were provided by smokes marijuana; It’s a lot in restaurants … 25% in the participants with experience buying the drug. Reportedly, house (working in the restaurant at a given time) is using the most common quantity of purchase is between 1/8 every day. ‘Pot’s’ (marijuana) in the back of the house (cooks, – 1/4 ounce; the most common quantity of purchase for dishwashers), amphetamines is in the front of the house (wait

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 45 Page 8 Surveillance of Drug Abuse Trends in the Akron-Canton Region staff, managers). That’s what I saw.” Participants reported soda bottle. By using common household chemicals that users of marijuana extracts and concentrates tend along with ammonium nitrate (found in cold packs) and to be young (teens to early 20s) and white people. A pseudoephedrine (found in some allergy medications), participant remarked, “It’s a college kid thing.” people who make methamphetamine can produce the drug in approximately 30 minutes in nearly any location. Treatment providers commented: “Everybody, police officers However, participants indicated: “People don’t make shake- do it, counselors do it, it just seems to be anybody; Any group, and-bake anymore; Since they cut down on the Sudafed® any generation … every group uses it.” Law enforcement (limited the sale of pseudophedrine) ….” Law enforcement stated: “Everybody likes it; The regular marijuana users are commented: “We used to have a problem with the ‘one-pot’ going to be the older population, people in their late 30s to 50s, (aka ‘shake-and-bake’) meth labs, we don’t see too many of the younger generation is starting to use more concentrates or those. What we see now is a lot of crystal meth being brought vapes (dabs), liquid marijuana, and … a lot of edibles.” in; A lot of the guys who were doing the one-pot are now doing crystal meth.” Methamphetamine Corroborating data indicated that methamphetamine is available in the region. ODPS reported 53 drug task force Methamphetamine remains highly available seizures of methamphetamine in the Akron-Canton region in the region. Participants most often reported during the reporting period (49.1% of the seizures were the current availability of methamphetamine made in Portage County). in both crystal and powdered forms as ‘10’ on a scale of ‘0’ (not available, impossible to Media outlets reported on law enforcement seizures get) to ‘10’ (highly available, extremely easy to get); the and arrests in the region this reporting period. Law previous most common scores were also ‘10.’ Participants enforcement in Carroll County arrested a man during remarked: “It’s everywhere; It’s all over the place; I can get it a traffic stop after a K-9 officer alerted to the presence whenever I want it; Every other week you hear of a new ‘meth’ of drugs in his vehicle; officers confiscated 17 grams of (methamphetamine) lab in New Philadelphia [Tuscarawas crystal methamphetamine packaged for sale (www.wtov9. County]; Someone who has no history [connections com, July 11, 2017). OSHP in Summit County arrested two for purchasing methamphetamine] can find crystal men during a traffic stop after a K-9 officer alerted to the [methamphetamine] within one day, within a couple hours; presence of drugs in their vehicle; officers confiscated The meth epidemic is coming back; Meth is the new ‘weed’ approximately 500 grams of crystal methamphetamine (marijuana).” (www.justice.gov, July 20, 2017). Two men plead guilty to methamphetamine possession in Portage County Community professionals reported the current overall Common Pleas Court; OSHP in Portage County arrested availability of methamphetamine as ‘10;’ the previous the men during a traffic stop on Interstate 76 when officers most common score was also ‘10.’ Law enforcement noticed the driver intoxicated and searched the vehicle, commented: “It’s skyrocketing in our area. We used to have finding 20 grams of methamphetamine packaged for a lot of meth labs … [now] it’s crystal meth coming in from sale, drug paraphernalia and a handgun (www.recordpub. Mexico … our area is flooded with it; The availability is a little com, July 27, 2017). Massillon Police (Stark County) arrested more prevalent than cocaine. It’s half the price of cocaine and a Louisville, Kentucky woman during a traffic stop after the purity is like 99%.” finding a crystalline substance and drug paraphernalia on the woman; medical staff later discovered crystal Participants reported that crystal methamphetamine is methamphetamine hidden in one of her body cavities; in a the most prevalent form of methamphetamine in the separate incident, corrections officers at the Stark County region. Participants remarked: “These days, ‘shards’ (crystal Jail found a crystalline substance on an female inmate methamphetamine) is easier to find; In my neighborhood, initially in jail for drug possession; the woman was charged it’s just crystal; I’d say it’s coming in from other places, by for bringing illegal substances into the jail (www.cantonrep. the truck load; It’s imported from Arizona and Mexico.” The com, Aug. 3, 2017). Canton Police (Stark County) arrested a powdered form of methamphetamine is typically referred Tuscarawas County man during a traffic stop after finding to as “shake-and-bake,” which means users produce the several bags of methamphetamine, cocaine and marijuana drug in a single-sealed container, such as a two-liter

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packaged for sale in his vehicle (www.timesreporter. a high-speed chase through Akron; the man refused to pull com, Aug. 18, 2017). Law enforcement in Portage County over for police and told the police dispatcher on the phone arrested nine people at various hotels in Brimsfield for their that he was high on methamphetamine, was diagnosed involvement in a crystal methamphetamine trafficking with paranoid schizophrenia, and threatened to shoot the ring; a burglary in Shalersville (also Portage County), passenger in his car; officers finally caught the man when he involving a stolen handgun and a safe with cash, prompted pulled into the lot of an abandoned home (www.ohio.com, the investigation; officers identified several suspects Dec. 12, 2017). with prior illegal drug trafficking history and obtained warrants for them; two of the suspects lead officers on a Participants reported that the availability of crystal high-speed chase on Interstate 76, which ended in officers methamphetamine has increased during the past seizing 35 grams of crystal methamphetamine hidden six months, while the availability of powdered in a compartment of their vehicle (www.record-courier. methamphetamine has decreased. Participants stated: “It’s com, Sept. 20, 2017). Canton Police arrested a man wanted really cheap; A lot of people are getting clean from heroin on multiple warrants, including methamphetamine and fentanyl. They are changing to meth … they can get high manufacturing, domestic violence and harassment; officers while on Vivitrol®; It kind of distracts you from your sickness found the man hiding in a garage in Canton with materials (opiate withdrawal), so your body does not know you’re sick used to manufacture methamphetamine (www.cantonrep. ‘cause you’re drawn off to another place; It was a Western or com, Oct. 5, 2017). A Portage County drug task force arrested Southern thing, but now it’s a Midwestern thing.” four people after executing a search warrant at a rental Treatment providers reported that the availability of home in Kent and finding methamphetamine, prescription methamphetamine has increased during the past six anti-anxiety medications and counterfeit prescription drugs months. Treatment providers commented: “It seems that in the home (www.record-courier.com, Oct. 18, 2018). the clients are using meth more now ‘cause they are getting Alliance Police (Stark County) arrested a man after he sold away from the heroin ‘cause they’re worried about the 1.5 grams of crystal methamphetamine to an informant; fentanyl and carfentanil in it, and so they’re using meth, or police seized 4.5 grams of methamphetamine prepared for they are ‘speedballing’ (using methamphetamine and heroin/ distribution near a local university, as well as approximately fentanyl concurrently); You can get high on it even if you’re 100 grams of marijuana and drug paraphernalia; in a on Vivitrol®; I always hear of using meth to get off heroin … it separate incident, Alliance Police arrested a women and helps with the withdrawal; A lot of people are using to try to a homeless man after seizing over eight grams of crystal get off heroin .”… methamphetamine and approximately 100 grams of marijuana from the couple’s vehicle; the couple also sold Law enforcement reported that the availability of one gram of methamphetamine to police (www.cantonrep. crystal methamphetamine has increased during the com, Oct. 20, 2017). A U.S. District Judge in Portage County past six months, while the availability of powdered sentenced a man to seven years in prison for manufacturing methamphetamine has decreased. Law enforcement and selling methamphetamine from a home in Streetsboro; discussed: “I’m seeing it by gallon-size baggies … crystal the U.S. Marshall’s Services Northern Ohio Violent Fugitive meth, and it’s’ cheaper than heroin … it’s very cheap, that’s Task Force and the Streetsboro Police collaborated to raid why we’re seeing an influx; Meth is a quarter of what heroin the farm where the drugs were manufactured and arrested is, price-wise. It’s so cheap; The demand in Akron [for crystal another man and his girlfriend; officers confiscated 141 meth] is so high. We used to have so many meth labs and so amphetamine pills, four large marijuana plants, 109 Xanax® many people liked meth, the cartels are smart; I think a lot of (alprazolam) pills, drug paraphernalia and multiple guns people who use heroin … heroin is a depressant … they take (www.record-courier.com, Oct. 23, 2017). The final suspect meth as well to feel normal, to get them just right. Maybe in a methamphetamine investigation lead by the Portage that’s why some of the overdoses went down; They don’t like County Drug Task Force plead guilty in Portage County to get sick, so they probably take the heroin or fentanyl, and Common Pleas Court; the man, along with two other at the same time, they’ll take a little meth just to get them people, sold methamphetamine and other drugs near an where they need to be, to get them through the day.” elementary school in Kent (www.record-courier.com, Nov. 21, 2017). Akron Police arrested a man after he lead them on The BCI Richfield Crime Lab reported that the number of methamphetamine cases it processes has increased

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 47 Page 8 Surveillance of Drug Abuse Trends in the Akron-Canton Region during the past six months; the lab reported processing brown and clear crystal methamphetamine as well as off- Current Prices for white powdered methamphetamine. Methamphetamine

Reported Availability Powdered and crystal: Change during the Past 6 Months 1/10 gram $7-10 Participants Increase 1/2 gram $30-50 A gram $50-125 Methamphetamine Law enforcement Increase 1/8 ounce $75-150

Treatment providers Increase Participants reported the routes of administration Methamphetamine for methamphetamine as intravenous injection (aka “shooting”), smoking and snorting. Participants estimated Participants most often rated the current overall quality that out of 10 methamphetamine users, 3-4 would of methamphetamine as ‘10’ on a scale of ‘0’ (poor shoot, 3-4 would smoke, and 3-4 would snort the drug. quality, “garbage”) to ‘10’ (high quality); the previous Participants stated: “It depends on the group you are with; I most common score was ‘7.’ Participants discussed shoot it, then snort it, then smoke it, all within an hour ….” adulterants (aka “cuts”) that affect the quality of the drug and reported the following as cutting agent for Participants described typical methamphetamine users as methamphetamine: Epsom® salt, fentanyl, fish oil, “molly” white people of lower to middle socio-economic status, blue- (powdered MDMA), MSM (methylsulfonylmethane, a collar workers and young people. Participants commented: joint supplement), sugar and vitamin B-12. A participant “Poor, white people; A lot of the younger generation; I know shared, “I did ‘shards’ (crystal methamphetamine) just 14-year olds, their parents are doing it, and like, they give before I went to jail a couple months ago, and it looked just it to them. A lot of parent and kid activity going on with like glass. Then I went to jail and they made me take a drug methamphetamines; In my experience, it’s in the restaurants; A test and I failed (tested positive) for MDMA … it was in the lot of truck drivers; People trying to get off heroin.” shards.” Overall, participants reported that the quality of methamphetamine has varied during the past six months. Community professionals described typical Participants stated: “Every day, every dealer is different; It methamphetamine users as white people, opiate users depends on how people make it; Every day is different … it’s and young people. Treatment providers commented: hit or miss.” “I rarely hear about meth among the African-American community; A lot of young, Caucasian females, ages 20-24 Reports of current prices for methamphetamine were years.” Law enforcement reported: “Anybody … 20s, 30s … variable among participants with experience buying if they live long enough to be in their 40s, they’re using it; The the drug. Reportedly, the most common amount of same groups that are using heroin. In detox, most report they purchase ranges from 2/10 gram to 1/8 ounce. Participants are using heroin and meth.” described the overall price of methamphetamine as “cheap.” Participants did not differentiate the price of crystal from powdered methamphetamine, with some Prescription Stimulants participants stating the price is the same. Prescription stimulants are moderately to highly available for illicit use in the region. Participants most often reported the current street availability of these drugs as ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants commented: “Super easy to find; Everyone has Adderall®; It’s really big in schools; They’re easy, especially if you know people who

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have kids.” Treatment providers most often reported the give it. Parents will say, ‘My kid won’t chill,’ and they’ll write current street availability of prescription stimulants as ‘3,’ a ‘script’ (prescription); People are getting it off the internet.” while law enforcement most often reported it as ‘8;’ the Reports of current street prices for prescription stimulants previous most common scores were ‘1’ and ‘3,’ respectively. were consistent among participants with experience A treatment provider remarked, “It’s similar to the ‘benzos’ buying the drugs. (benzodiazepines) … they eat them but don’t really talk

about it.” Law enforcement commented: “Adderall® is pretty Current Street Prices for common … it’s kind of expensive … to buy on the street; A lot Prescription Stimulants of folks we have here on probation, they are just able to go out to the doctor, get diagnosed with ADHD (attention-deficit $5 for 10 mg hyperactivity disorder), and … get it legally.” Adderall® $5-10 for 20 mg Stimulants Participants identified Adderall®, Ritalin® and Vyvanse® Prescription $10-15 for 30 mg as the most available prescription stimulants in terms of widespread illicit use, while community professionals Participants reported that the most common routes of identified Adderall® as most available. A treatment administration for illicit use of prescription stimulants provider stated, “Adderall® is the one most frequently heard remain snorting, followed by oral consumption. about.” Participants estimated that out of 10 illicit prescription Participants reported that the general availability of stimulant users, six would snort and four would orally prescription stimulants has decreased during the past consume the drugs. six months. Participants stated: “They used to prescribe Participants described typical illicit prescription stimulant them a lot; At one point, a lot of people were prescribed users as high school and college students. A participant them, selling them for other drugs; They make Adderall® also reported opiate users use Adderall® to help alleviate harder [to obtain]. They know people snort them.” withdrawal symptoms. Community professionals described Treatment providers reported that the street availability typical illicit prescription stimulant users as young people of prescription stimulants has remained the same during and students. In addition, a treatment provider reported the past six months, while law enforcement reported girls as more likely to illicitly use the drugs than boys, increased availability. One treatment provider remarked, stating, “It’s a weight [control] thing.” A law enforcement “Why bother when there is meth around?” Law enforcement officer stated,Our “ folks are younger than 30 [years] … most reported: “It’s easily prescribed; I see a lot of the younger of them.” generation. They can get Adderall® … and get the same effect of methamphetamine ….” The BCI Richfield Crime Lab reported that the number of Adderall® cases it processes Ecstasy has increased during the past six months, while the number of Ritalin® cases has decreased. Ecstasy (methylenedioxymethamphetamine: MDMA, or other derivatives containing BZP, MDA, and/or TFMPP) is moderately available in the region. Participants most Reported Availability Change during the Past 6 Months often reported the current availability of both the pressed tablet form of ecstasy and of “molly” (powdered MDMA) as Participants Decrease ‘5’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most Law enforcement Increase common score was ‘8.’ Participants discussed ecstasy: “It’s Stimulants Prescription a party and ‘rave’ (dance party) type drug; It’s more common Treatment providers No change in summer at parties and festivals.” Regarding molly, a participant commented, “Molly is easier to get than ecstasy.” Participants reported obtaining prescription stimulants for illicit use from acquaintances who have prescriptions Treatment providers most often reported the current for them and through Internet purchase. Participants availability of both ecstasy and molly as ‘5-6,’ while law remarked: “People who are prescribed it … give it away or sell enforcement most often reported it as ‘4-5;’ the previous most it; Parents take their kids’ meds and sell them; Any doctor will common scores were ‘1’ and ‘2,’ respectively. Law enforcement

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 49 Page 8 Surveillance of Drug Abuse Trends in the Akron-Canton Region commented: “I guess it’s in certain areas … college campuses, Current Prices for night clubs; If you ask for it, you can get it. I don’t see … a demand Ecstasy/Molly for it, or [people] who are looking for ecstasy or molly.” Ecstasy: Participants reported that the availability of ecstasy and $8-20 per tablet molly has decreased during the past six months. Participant (dependent on dose) commented: “There’s less raves; Everyone is on other things; Molly: People are on strong drugs, they’re not messing with party drugs; People who are doing molly have moved to crystal Ecstasy/Molly 2/10 gram $20 meth, it’s cheaper.” Community professionals reported A gram $60-80 not having enough knowledge of the drugs to report on change in availability. The BCI Richfield Crime Lab Participants reported that the most common route of reported that the number of MDMA (ecstasy/molly) cases it administration for ecstasy is oral consumption. Participants processes has increased during the past six months. estimated that out of 10 ecstasy users, all 10 would orally consume the drug. Participants reported that the most Reported Availability common routes of administration for molly are snorting Change during the Past 6 Months and oral consumption. Participants estimated that out of 10 Ecstasy/Molly molly users, five would snort, four would orally consume, and one would “shoot” (intravenously inject) the drug. Participants Decrease Participants reported that oral consumption of molly Law enforcement No comment includes dissolving the drug in water or alcohol.

Ecstasy/Molly Treatment providers No comment Participants described typical ecstasy and molly users as individuals who participate in the “club scene” (aka “ravers”), as well as festival goers and hippies. Community Participants discussed the quality of ecstasy and molly and professionals reported little contact with users of the drug rated the current quality of ecstasy as ‘8’ and of molly as ‘10’ on and thus were not able to describe a typical user of ecstasy a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the and molly. previous most common scores were not reported. Reportedly, ecstasy is often cut with other substances including cocaine, heroin and fentanyl. Participants stated: “They mix everything Synthetic Marijuana with ecstasy: cocaine, heroin, fentanyl; You can say anything is ecstasy. Mix a bunch of shit, press it [and] say it’s ecstasy.” Another Synthetic marijuana (synthetic cannabinoids) is participant shared, “I used to sell meth and say it was molly … moderately to highly available in the region. Participants you can easily pass meth as molly.” Participants did not report most often reported the drug’s current availability as ‘10’ on change in quality of ecstasy or molly during the past six on a scale of ‘0’ (not available, impossible to get) to ‘10’ months. (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participant commented: “It’s Reports of current prices for ecstasy and molly were everywhere; I know people who make it … get the chemical, consistent among participants with experience buying spray it on … ‘smokeable;’ You find it easier at[a treatment the drugs. Participants reported that molly is typically center] than you find it on the street.” Treatment providers sold by weight, where users generally ask for a ‘20’ ($20 most often reported the current availability of synthetic amount) or a ‘50’ ($50 amount). In terms of ecstasy pricing, marijuana as ‘7-8;’ the previous most common score was most groups did not distinguish between a single dose ‘3.’ Treatment providers commented: “It’s not as desired as (aka “single stack”) and a triple dose (aka “triple stack”). other drugs, but you can still get it. They got it in gas stations; Thus, the reported current price for ecstasy is a range, with I heard about one client who left here about four months ago presumably higher dosed tablets selling for higher prices. and came [back] here with an addiction to ‘spice’ and ‘K2’ (synthetic marijuana brand names); It’s in institutions.”

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Law enforcement from Summit County most often reported the current availability of synthetic marijuana Current Prices for Synthetic Marijuana

as ‘5,’ while law enforcement from Tuscarawas reported it as ‘10;’the previous most common scores were ‘1’ and ‘10,’ respectively. A law enforcement officer from Summit A joint (cigarette, aka “stick”) $2-3 County stated, “We see quite a bit of it come through the mail.” A Summit County law enforcement officer reported A gram $8-10 Synthetic Synthetic that the drug is also packaged in a vial that connects to Marijuana 5-gram bag $20-25 e-cigarettes. This officer stated,They “ make it now that it’s in a little glass vial, and you screw it in your e-cigarette and 10-gram bag $40-45 smoke it. It’s got different smells so that it does not smell like marijuana … it’s 99% synthetic THC (tetrahydrocannabinol, Despite legislation enacted in October 2011, participants the psychoactive component of marijuana).” A law reported that synthetic marijuana continues to be enforcement officer in Tuscarawas County reported that available from dealers, in certain retail shops (head synthetic marijuana is being made and sold in the area, shops, gas stations) and from on-line purchase of the and explained, “We see spice … we’re seeing a lot of the necessary chemicals to make the drug. Participants chemical being shipped from China. There are guys that reported acquiring synthetic marijuana from friends and get on the Internet and spend $400 for the chemical, have it family members, through Internet purchase and from shipped here …. There’s a company that sends it right to their various retailers, though it was reported that the retailer house … they will sell it on the streets …. They’re making a had to know a person before selling the drug to them. lot of money off of it. They mix the chemical with acetone Participants reported: “Most stores discontinued it. There’s (finger-nail polish remover). Some spray the green (synthetic just a few places you can get it from and none are around marijuana) with Raid® … we’ve had several cases of that.” here. They’re all in Canton [Stark County], that’s where I get Media outlets reported on law enforcement seizures and it; People are making it; Everybody is selling spice.” arrests in the region this reporting period. Canton Police arrested two men for selling synthetic marijuana at a Participants reported that the most common route of beverage drive-thru in Jackson Township (Stark County); administration for synthetic marijuana remains smoking. the business faced possible fines, suspensions and liquor- Participants estimated that out of 10 synthetic marijuana permit revocation (www.indeonline.com, Oct. 12, 2017). users, all 10 would smoke the drug. Participants and community professionals did not report Participants indicated that the use of the drug is most on the change of availability of synthetic marijuana during common within institutions or among individuals who the past six months. The BCI Richfield Crime Lab reported are on probation. However, one participant group in that the number of synthetic marijuana cases it processes Tuscarawas County reported that the use of synthetic has increased during the past six months. marijuana is common among all groups of people. One participant stated, “Everybody is using it.” Another Reports of current prices for synthetic marijuana were participant said, “I know a lot of people who turn it down, consistent among participants with experience buying the out of fear, because of the stories [about adverse effects of drug. One participant reported that the prices were similar using the drug].” Law enforcement reported that synthetic to prices for marijuana. marijuana users cut across all groups. They commented: “People who like weed [use synthetic marijuana]; Cuts across all ages … I’ve had 50-year olds and 20-year olds … it can be anybody.”

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Hallucinogens Other Drugs in the Akron-Canton Region Hallucinogens are moderately to highly available in the region. Participants most often reported the current Participants and community professionals listed a variety availability of LSD as ‘10’ and did not report on the current of other drugs as being present in the region, but these availability of psilocybin mushrooms on a scale of ‘0’ drugs were not mentioned by the majority of people (not available, impossible to get) to ‘10’ (highly available, interviewed: bath salts (synthetic cathinones, including extremely easy to get); the previous most common scores “flakka”), hallucinogens (lysergic acid diethylamide [LSD] were ‘7’ for LSD and ‘3’ for psilocybin mushrooms. Participant and psilocybin mushrooms), kratom (mitragynine) and comments included: “In Akron, [LSD is] everywhere; You can Neurontin® (gabapentin). find it all year long; I know one guy who has it all the time.” In addition, secondary data sources reported on other A few treatment providers reported on the current general drugs not mentioned by respondents. The BCI Richfield Crime Lab reported that the number of U-47700 (synthetic availability of hallucinogens, most often reporting it as ‘1-2;’ opioid) cases it processes has increased to 100 cases the previous most common score was ‘4-6’ for LSD. One during the past six months, from 11 cases for the six treatment provider commented, “You get the occasional months previous. ‘tripper’ (hallucinogen user).” Law enforcement most often reported the current availability of LSD as ‘5-6;’ the previous most common score was ‘1.’ Law enforcement commented: Bath Salts “I’ve seen a little more of it, mostly with marijuana people and dabs users. When they use concentrated marijuana (dabs), a lot Bath salts (synthetic cathinones; compounds containing of them will use ‘mushrooms’ (psilocybin mushrooms) or ‘acid’ methylone, mephedrone, MDPV or other chemical (LSD) ‘cause it’s almost the same type high for them; We’ve had analogues, including alpha-PVP, aka “flakka”) remain a couple of cases of young females caught with mushrooms; available in the region. However, only one participant We get little bags of mushrooms every so often, during search group in Portage County reported having knowledge of warrants ….” bath salts during the past six months. These participants most often reported the current availability of bath salts as The BCI Richfield Crime Lab reported that the number of ‘4’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ LSD, PCP (phencyclidine), psilocybin mushrooms and DMT (highly available, extremely easy to get); the previous most (dimethyltryptamine) cases it processes has decreased common score was ‘7-8.’ One participant commented, “Only during the past six months. Reports of current prices for a small group of people seek it out.” None of the community hallucinogens were consistent among participants with professional groups reported any current knowledge experience buying the drugs. Participants described typical of bath salts. A law enforcement officer stated,I “ haven’t hallucinogen users as festival goers; reportedly, these drugs heard about that in a long time … it came and went.” The BCI are primarily used at music festivals. Richfield Crime Lab reported that the number of bath salts cases it processes has increased during the past six months. Current Prices for In addition, one participant group in Summit Hallucinogens County reported on availability of flakka LSD: (pyrrolidinopentiophenone) in the region. Participants discussed: “People don’t seek it out, it’s sold as heroin or A liquid drop or a single dose (aka “hit”) $5-10 fentanyl; There’s some synthetic shit, it’s sold as heroin, and 100 hits (aka “sheet”) $275 you do a shot … you can’t tell what happened. You can A vile of liquid LSD (unspecified amount) $200 barely speak … I was trapped inside my own body; It makes you comatose.” One law enforcement group in Tuscarawas Psilocybin mushrooms: County discussed current availability of flakka. An officer Hallucinogens 1/8 ounce $25 commented, “I’ve had a group, I’ve know them to be meth 1/4 ounce $40-50 users … now using flakka.”

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Kratom Reportedly, kratom (mitragynine, a psychoactive plant Conclusion substance that produces a heroin-like high) is available in the Akron-Canton region. Participants reported obtaining Crack cocaine, heroin, marijuana, methamphetamine and the drug from heroin dealers and through Internet Suboxone® remain highly available in the Akron-Canton purchase. Both treatment providers and law enforcement region; also highly available are fentanyl, Neurontin® reported that the drug can be purchased at a head shop in (gabapentin), powdered cocaine and sedative-hypnotics. the area. Participants reported that the drug looks similar Changes in availability during the past six months to brown powdered heroin, produces similar effects as heroin, and is primarily used by individuals subject to include: increased availability for fentanyl, marijuana and drug screening and to take away ‘dope sickness’ (opiate methamphetamine; and likely decreased availability for withdrawal). Participants reported that the most common prescription opioids. route of administration is intravenous injection (aka Participants throughout focus groups reported difficulty “shooting”). Participants estimated that out of 10 kratom in finding heroin not adulterated with fentanyl or fentanyl users, seven would shoot the drug and three would orally analogues. Most treatment providers also reported that, consume the drug (including drinking it as a tea). while users seek heroin, what they are getting is heroin adulterated with fentanyl. Participants reported that Neurontin® the availability of heroin has decreased during the past Neurontin® (gabapentin, an anticonvulsant and nerve six months. Participants stated: “No one has it anymore, pain medication) is highly available for illicit use in the everyone has fentanyl; The heroin epidemic is going down, region. Participants most often reported the current [heroin has been] replaced with fentanyl and meth.” street availability of Neurontin® as ‘10;’ on a scale of ‘0’ Participants reported little knowledge regarding fentanyl (not available, impossible to get) to ‘10’ (highly available, analogues. While carfentanil was mentioned by a few, extremely easy to get); the previous most common score was not reported. Participants reported: “Everyone’s getting no participant had firsthand experience or was able to a prescription; People try to buy people’s prescriptions; I’d take distinguish the drug from fentanyl. Law enforcement 12 at a time when I get ‘dope sick’ (opiate withdrawal). It eases reported that carfentanil is available in the region and that the withdrawal a little bit; I used those for withdrawing from users seek this drug. Both participants and community heroin, they were great for that.” professionals reported that the availability of fentanyl has increased during the past six months. There was consensus A few treatment providers reported on the current street that fentanyl is cheaper, more potent and easier to obtain availability of Neurontin®, most often reporting it as ‘10;’ the than heroin. previous most common score was not reported. Treatment providers stated: “Neurontin® is being prescribed left and Participants and community professionals reported high right; It’s being prescribed big time, in large doses; [Clients] current availability of marijuana extracts and concentrates, are using it as that ‘excuse prescription,’ saying, ‘I have a often appearing as oil and waxy forms of the drug (aka prescription, so it’s okay;’ It’s the new ‘non-addicting opiate;’ “dabs”). Both types of respondents also indicated that Clients will tell you that there is street value; We are now testing these alternative forms of marijuana have increased in for it when clients are here because of the problems it’s causing availability during the past six months. Reportedly, there … we know it’s mood altering.” has been an increase in marijuana products crossing state lines into the region. Community professionals discussed Reports of current street prices for Neurontin® were an increase in popularity and use of food products consistent among participants with experience buying containing marijuana (aka “edibles,” e.g. brownies and the drug. Participants reported the drug is inexpensive on candies). Overall, participants indicated that the quality the street. Reportedly, 300 mg sells for $0.50. A participant of low-grade and high-grade marijuana has increased stated, “It’s like free.” during the past six months. And, while Participants and community professionals described typical marijuana users

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 53 Page 8 Surveillance of Drug Abuse Trends in the Akron-Canton Region as everyone, participants reported that users of marijuana Kratom (mitragynine, a psychoactive plant substance that extracts and concentrates tend to be young (teens to early produces a heroin-like high) is available in the Akron- 20s) and white people. Canton region. Participants reported obtaining the drug from heroin dealers and through Internet purchase. Both Participants and community professionals reported treatment providers and law enforcement reported that that the availability of methamphetamine has increased the drug can be purchased at a head shop in the area. during the past six months. Participants stated: “The Participants reported that the drug looks similar to brown meth epidemic is coming back; Meth is the new ‘weed’ powdered heroin, produces similar effects as heroin, and (marijuana).” Reportedly, crystal methamphetamine is the is primarily used by individuals subject to drug screening most prevalent form of methamphetamine in the region. and to take away dope sickness. Participants reported that Law enforcement indicated that this form of the drug is the most common route of administration is intravenous coming primarily from Mexico and described the region as injection (aka “shooting”). “flooded” with it. They discussed that methamphetamine is higher in availability than cocaine; its price is half that of Lastly, the BCI Richfield Crime Lab reported that the cocaine; and its “purity” (potency) is considerably higher number of U-47700 (synthetic opioid) cases it processes than that of cocaine as well. has increased to 100 cases during the past six months, from 11 cases for the six months previous. Participants and treatment providers also noted the “cheap” price of methamphetamine as a driver of its increased availability and use, while also reporting that heroin users are “getting clean” from heroin and fentanyl, often due to fear of overdose and death, by switching from opiate use to methamphetamine use. They also cited that some users receiving Vivitrol® (medication assisted treatment for opiate use disorder) continue illicit drug use with methamphetamine. All respondent groups discussed an increase in popularity of using both heroin/fentanyl and methamphetamine (aka “speedball”). Reportedly, some heroin users use methamphetamine to pick themselves up after heroin use and to not experience “dope sickness” (opiate withdrawal).

Page 54 OSAM Drug Trend Report June 2017 - January 2018 Surveillance of Drug Abuse Trends in the Athens Region Surveillance of Drug Abuse Trends in the Athens Region OSAM Ohio Substance Abuse Monitoring Network Drug Abuse Trends in the Athens Region

Regional Epidemiologist: Alycia Taylor, MPA

Data Sources for the Athens Region

This regional report was based upon qualitative data collected via focus group interviews. Participants were active and recovering drug users recruited from alcohol and other drug treatment programs in Athens, Coshocton, Hocking and Perry counties. Data triangulation was achieved through comparison of participant data to qualitative data collected from regionalr community professionals (treatment providers and law enforcement) via focus group interviews, as well as to data surveyed from the Ohio Bureau of Criminal Investigation (BCI) London Crime Lab, which serves central and southern Ohio and includes data from BCI’s Athens and Cambridge offices, and the Ohio Department of Public Safety (ODPS), which logs drug task force seizures OSAM Staff: from across Ohio. All secondary data are summary data of cases processed from January through June 2017. In addition to these R. Thomas Sherba, PhD, MPH, LPCC data sources, Ohio media outlets were queried for information OSAM Principal Investigator regarding regional drug abuse for July through December 2017.

Kathryn A. Coxe, MSW, LSW Note: OSAM participants were asked to report on drug use/ OSAM Coordinator knowledge pertaining to the past six months prior to the interview; thus, current secondary data correspond to the Jessica Linley, PhD, MSW, LSW reporting period of participants. OSAM Quantitative Data Analyst

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Regional Profile Indicator1 Ohio Athens Region OSAM Drug Consumers Total Population, 2016 11,614,373 578,650 44 Gender (female), 2016 51.0% 50.2% 45.5% Whites, 2016 82.5% 94.9% 88.6% African Americans, 2016 12.8% 2.3% 0.0% Hispanic or Latino Origin, 2016 3.7% 1.1% 6.8% High School Graduation Rate, 2012-16 89.5% 86.77% 72.7% Median Household Income, 2012-16 $50,674 $41,522 Less than $12,0002 Persons Below Poverty Level, 2016 14.6% 17.7% 70.5% ¹Ohio and Athens region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018 2 Participants reported income by selecting a category that best represented their household’s approximate income for the previous year.

Athens Regional Participant Characteristics Athens Regional Participant Characteristics Consumer Characteristics N=44*

Male 24 Female

Gender 20 < 20 1 20s 18 30s 15 Age 40s 5 50s 5 Less than high school graduate 12 High school graduate 24 Some college or associate's degree 7 Education Bachelor's degree or higher 1 < $12,000 25 $12,000 to $19,999 7 $20,000 to $28,999 5 $29,000 to $36,999 1

Household Income ≥ $37,000 6 Alcohol 19 Cocaine, Crack 8 Cocaine, Powdered 10 Ecstasy/Molly 3 Heroin/Fentanyl 12 Marijuana 21 Methampehtamine 19

Drugs Used** Prescription Opioids 15 Prescription Stimulants 9 Sedative-Hypnotics 13 Suboxone®/Subutex®3 14 Other Drugs*** 1

0 5 10 15 20 25 30 Number of Participants *Not all participants filled out forms completely; therefore, numbers may not equal 44. **Some respondents reported multiple drugs of use during the past six months. ***Neurontin® (gabapentin).

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Lastly, participants and treatment providers reported that the street availability of Neurontin® increased during the Historical Summary reporting period. Both types of respondents indicated that there was an increase in the number of prescriptions In the previous reporting period (January - June 2017), crack written. Participants described the drug as easy to obtain cocaine, heroin, marijuana, methamphetamine, Neurontin® from a doctor and desired by heroin users to alleviate (gabapentin), prescription opioids, sedative-hypnotics and withdrawal symptoms when out of heroin. A treatment Suboxone® remained highly available in the Athens region. provider stated, “We’re just waking up to the fact that that’s Changes in availability during the reporting period included: something they’re abusing.” increased availability for methamphetamine; likely increased availability for fentanyl and Neurontin®; and likely decreased availability for ecstasy and heroin. While it remained highly available, participants and law enforcement reported that heroin decreased in availability during the reporting period. They attributed decreased Current Trends availability to an increase in fentanyl as a substitution for heroin, as well as an increase in the number of heroin users receiving Vivitrol® who switched to other drugs, such as Powdered Cocaine cocaine and methamphetamine. Participants overwhelmingly reported that white powdered Powdered cocaine remains moderately to highly available heroin was heavily cut with fentanyl or was straight in the region. Participants most often reported the drug’s fentanyl. Treatment providers also reported on the high current availability as ‘10’ on a scale of ‘0’ (not available, prevalence of fentanyl used as a cutting agent for heroin impossible to get) to ‘10’ (highly available, extremely easy in the region. The BCI London Crime Lab reported that the to get); the previous most common score was also ‘10.’ number of heroin cases it processes decreased during the Participants discussed: “On campus and in the bar scene you reporting period, while the number of fentanyl, fentanyl can [get powdered cocaine] pretty easily; I know at least 20 analogue and carfentanil cases increased. people that, off the top of my head, have it and I know at least another 50 that can get it, and it is easily found on campus as Reportedly, methamphetamine replaced heroin as the most well; Our little town is flooded with it.” available drug in the region. Participants and community professionals reported that the drug was extremely Treatment providers most often reported the current available, particularly in crystal form. They discussed the availability of powdered cocaine as ‘7’ and ‘10,’ while law increase in court-mandated Vivitrol® programs as a driver enforcement most often reported it as ‘7;’ the previous for increased methamphetamine use; they also noted most common scores were ‘2’ and ’6-7’ for treatment that “crystal meth” was less expensive (“cheap”), and providers and ‘6’ for law enforcement. Treatment providers provided a longer high than cocaine. Law enforcement commented: “It’s just prevalent in this area … it comes right reported that drug cartels had flooded the region with in and gets dropped off at the door; It’s high demand … crystal methamphetamine. One law enforcement officer people demand it; It’s a big business ….” A law enforcement relayed hearing users attributing their switch from heroin officer remarked, “Cocaine is more the one that college to methamphetamine to fear of fentanyl overdose and students tend to use, or if they (non-college students) cannot death, and to the belief that the chance for overdose with get the other (heroin or methamphetamine) then they use methamphetamine was considerably lower. [cocaine].” Corroborating data indicated that methamphetamine Corroborating data indicated that powdered cocaine is was available in the region. A query of the National available in the region. The Ohio Department of Public Forensic Laboratory Information System (NFLIS) for the Safety (ODPS) reported 12 drug task force seizures of counties which comprise the Athens region returned 418 powdered cocaine in the Athens region during the methamphetamine cases reported during the reporting reporting period. period (an increase from 334 cases during the previous reporting period).

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Media outlets reported on law enforcement seizures and Overall, participants reported that the quality of powdered arrests in the region this reporting period. Washington- cocaine has decreased during the past six months. Morgan-Noble Major Crimes Task Force officers took 11 Participants stated: “It gets stomped the heck out of. It’s not people into custody after executing 15 search warrants worth it; You do not hear about people doing cocaine as at residences in Washington, Morgan, Muskingum and much as ‘meth’ (methamphetamine) anymore; Most people I Athens counties, seizing heroin and large amounts of know have graduated to methamphetamine and they do not cocaine and prescription opioids (www.nbc4i.com, Sept. do it anymore; Cocaine is for kindergartners.” 16, 2017).

Participants and community professionals reported that Cutting Agents the availability of powdered cocaine has remained the Reported by Crime Lab same during the past six months. Participants commented: “It’s always around … we will never get rid of it; I know l levamisole (livestock dewormer) a couple of dealers who still sell it. I’ve known the same Cocaine l local anesthetics (benzocaine, lidocaine Powdered Powdered people for 10 years, it never changes.” A treatment provider and procaine) commented, “Cocaine has been a mainstay in this county. I have never seen the use go down, and I have been working Reports of current prices for powdered cocaine were here 16 years.” The BCI London Crime Lab reported that consistent among participants with experience buying the the number of cocaine cases it processes has increased drug. Reportedly, the most common quantity of purchase during the past six months; the lab does not differentiate is 1/2 gram for $50. Overall, participants reported that the between powdered and crack cocaine. price of powdered cocaine has remained the same during the past six months. Reported Availability

Change during the Past 6 Months Current Prices for Powdered Cocaine Participants No change 1/2 gram $50 A gram $100-120

Cocaine Law enforcement No change Powdered Powdered Cocaine

Powdered Powdered 1/16 ounce (aka “teener”) $140 Treatment providers No change 1/8 ounce (aka “eight ball”) $300-350 Participants most often rated the current overall quality of powdered cocaine as ‘7’ on a scale of ‘0’ (poor quality, Participants reported that the most common routes of “garbage”) to ‘10’ (high quality); the previous most administration for powdered cocaine are snorting and common score was ‘8.’ Participants discussed: “It’s not super, smoking. Participants estimated that out of 10 powdered not bad … it’s good; I try not to buy drugs here because cocaine users, four would snort, four would smoke and they suck … they are ‘stomped on’ (adulterated) too much.” two would intravenously inject (aka “shoot”) the drug. A Participants reported the top cutting agents (adulterants) participant responded, “Generally, you hang out with people for powdered cocaine as: baby laxatives, baby powder who do the same as you. If you snort it, you hang out with and baking soda. Other adulterants mentioned included: people who snort ….” aspirin, baby formula, benzodiazepines (Valium®), fentanyl, Participants described typical powdered cocaine users flour, Orajel™, prescription opioids (Percocet®, Vicodin®), prescription stimulants (Ritalin®) and teething tablets. as of higher socio-economic status, white and Hispanic Participants commented: “I’ve even seen people try to use people, college students, government officials, business like crushed up pills. They’ll crush it down and make it look owners and people in certain occupations (military, like it’s powder and try to sell it like it’s cocaine; It just depends construction, landscaping, adult entertainment). where you get it from. If you get it when it comes off the brick Participants reported: “People who you do not think would (packaged kilogram) then it comes in 80 - 85% pure so it is use; People of all different incomes and households … it pretty good .… If you get it off the street, then it is probably varies from young to old and middle age; I was in the military, down around 20% pure.” most all the people in the military did ‘coke’ (powdered

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cocaine) because it gets out of your system really fast … we search warrants at different residences in Zanesville; would have ‘pop up’ (random) drug tests … you could do officersseized crack cocaine, methamphetamine, coke and two days later pass one (a drug test).” marijuana, pills, and an unknown substance, as well as drug paraphernalia (www.zanesvilletimesrecorder.com, Community professionals described typical powdered Oct. 26, 2017). The Meigs County Sheriff’s Office and the cocaine users as young factory workers, younger white Major Crimes Task Force of Gallia-Meigs County arrested males (18-28 years of age) and white females (30-40 years two women while executing a search warrant of a home in of age). Treatment providers stated, “Because they got these Salisbury Township after seizing crack cocaine, powdered family problems, or all this stress, they go to powder cocaine; cocaine, methamphetamine, heroin, pills, marijuana, cash It’s generally the pipeliners that come through that are using, and firearms www.newsandsentinel.com( , Dec. 5, 2017). to stay up, and I’ve heard that they can do some things at work that couldn’t otherwise … risk wise ….” A law enforcement Participants and treatment providers reported that the officer remarked,It’s “ more available towards people with availability of crack cocaine has remained the same more money … which typically goes towards the college during the past six months, while law enforcement students and not Athens County residents.” reported decreased availability. A law enforcement officer remarked, “I don’t think it is as easy to get in Athens as it used to be. People are having to travel to get it.” The BCI London Crack Cocaine Crime Lab reported that the number of cocaine cases it processes has increased during the past six months; the Crack cocaine remains highly available in the region. lab does not differentiate between crack and powdered Participants most often reported the drug’s current cocaine. availability as ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the Reported Availability previous most common score was also ‘10.’ Participants Change during the Past 6 Months

commented: “Our little town is flooded with it all over; If you want it, you can find it; I’ve been all over, you can get it Participants No change anywhere; It is easy to get … but if you have transportation,

it’s absolutely easy to get.” Crack

Cocaine Law enforcement Decrease Treatment providers most often reported the current Treatment providers No change availability of crack cocaine as ‘9’ and ‘10,’ while law enforcement most often reported it as ‘4;’ the previous most common scores were ‘2,’ and ‘3’ and ‘6,’ respectively. A Participants most often rated the current overall quality treatment provider commented, “It’s quick to pick that up of crack cocaine as ‘5’ and ‘7’ on a scale of ‘0’ (poor quality, if there are runners (people who travel and bring drugs into “garbage”) to ‘10’ (high quality); the previous most the region), and you know runners are running to Cleveland common score was ‘5.’ A participant commented, “It’s pretty [to get crack cocaine].” A law enforcement officer noted,If “ much a hit or miss … I can go get it now and then tonight, they can’t find ‘meth’ (methamphetamine), then the next step and it would be two totally different things.” Participants would be to go find some crack.” reported that crack cocaine in the region is most often adulterated (aka “cut”) with baby laxatives, baby powder Corroborating data indicated that crack cocaine is and baking soda. Other cuts mentioned included: baby available in the region. ODPS reported 10 drug task force formula, benzodiazepines (Valium®), isotol (dietary seizures of crack cocaine in the Athens region during the supplement), methamphetamine, Orajel™, prescription reporting period. opioids (Percocet®) and Tylenol®. Participants commented, “[It is] cut with whatever they can get; When they use the Media outlets reported on law enforcement seizures and Orajel™, you get the numbing sensation; The only thing arrests in the region this reporting period. Zanesville Police I know anyone’s ever cut crack or cocaine with is baking (Muskingum County), along with the Muskingum County soda.” Overall, participants reported that the quality of Sheriff’s Office, the Central Ohio Drug Enforcement Task crack cocaine has remained the same during the past six Force and the Ohio State Highway Patrol (OSHP) arrested months. six people after 13 traffic stops and the execution of three

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Heroin

Cutting Agents Reported by Crime Lab Heroin remains highly available in the region. Participants l levamisole (livestock dewormer) most often reported the current availability of the drug as ‘10’ Crack Crack

Cocaine l local anesthetics (benzocaine, lidocaine on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly and procaine) available, extremely easy to get); the previous most common score was also ‘10.’ Participants commented: “It’s an epidemic Current prices for crack cocaine were reported by in this area. I actually moved because it was in my housing participants with experience buying the drug. Reportedly, complex; I am about 20 months sober from that, but I know I the most common quantity of purchase is a gram. Overall, could get it.” participants reported that the price for crack cocaine has remained the same during the past six months. Treatment providers most often reported current availability as ‘10,’ while law enforcement most often reported it as ‘4’ and ‘5;’ the previous most common scores were ‘8’ and ‘9,’ and ‘10,’

Current Prices for respectively. Treatment providers commented: “If someone Crack Cocaine goes looking for it, it’s there; My clients talk about [how] they do not have to go far. They do not have to leave this block to get 1/10 gram (aka “rock”) $10-20 Crack Crack heroin, and that is anywhere in the county; Our people … boy, Cocaine A gram $100 they are learning quick ways to Cleveland, Columbus and Akron (cities where heroin availability is high); Freely available … Participants reported that the most common routes people have drug dealers [numbers] on their phone.” of administration for crack cocaine are smoking and Corroborating data indicated that heroin is available in the intravenous injection (aka “shooting”). Participants region. ODPS reported 16 drug task force seizures of heroin estimated that out of 10 crack cocaine users, five would and/or fentanyl in the Athens region during the reporting smoke and five would shoot the drug. Participants stated: period; drug task forces did not typically differentiate “Depends on what your crowd does … if you inject, you hang between heroin and fentanyl due to the high incidence of out with people who inject. Then you have people who do heroin-fentanyl mixtures. all three (smoke, inject and snort); It seems like people who smoke do not like to hang out with people who shoot; People Media outlets reported on law enforcement seizures and who snort do not care for people who smoke ….” arrests in the region this reporting period. The Athens Participants described typical crack cocaine users as County Major Crimes Unit, Athens County Prosecutor’s younger, aged 20s. Participants stated: “They are not like Office and several other law enforcement agencies arrested people living on the street or anything, they are just like four people as part of a warrant sweep for various crimes, everyone one else; Can’t really describe that … I know people including heroin traffickingwww.thenewscenter.tv ( , July who are bums, then there are people with jobs like me who 20, 2017). Coshocton County Sheriff’s officers arrested three make $50k-60K a year.” Community professionals described additional individuals connected to an earlier raid where typical crack cocaine users as aged 20-30 years, white officers arrested eight people; officers confiscated one gram people, with some college education, and individuals of heroin, drug paraphernalia and cash from a Coshocton of lower socio-economic status. A treatment provider home (www.coshoctontribune.com, July 24, 2017). The commented, “Same age [as powdered cocaine], 20s, 30s … Athens County Major Crimes Unit arrested two people at you can see older long-term crack users, but typically they’re a home in Athens County after a yearlong investigation; retired, dead or in jail.” Law enforcement commented: “I officers seized heroin, crack cocaine, digital scales and cash think they are also for the most part generally heroin addicts. (www.abc6onyourside.com, July 26, 2017). The Guernsey They are mixing or ‘speedballing’ (using crack cocaine with County Sheriff’s Office Special Response Team, Cambridge heroin) .… And so, if someone is addicted, and if someone SWAT, Monroe County Special Response Team, assisted by is using crack … they are using heroin and using them several other law enforcement agencies, executed search combined; The typical people I’ve seen are lower income.” warrants at five different residences in Cambridge, Quaker City and Old Washington (all Guernsey County), arresting five

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people and confiscating heroin, methamphetamine, crack The BCI London Crime Lab reported that the number of cocaine, marijuana, pills, drug paraphernalia, weapons and heroin cases it processes has decreased during the past six cash (www.usatoday.com, Aug. 3, 2017). Coshocton County months; the lab reported processing beige, brown, tan and Sheriff’s officers, assisted by the Coshocton County Special white powdered heroin along with black tar heroin. However, Response Team and the Coshocton Prosecutor’s Office, the lab noted that it does not typically differentiate between arrested three people during the execution of search warrant black tar and powdered heroin. at a Coshocton home; officers seized heroin, firearms, drug paraphernalia and cash (www.timesreporter.com, Aug. 8, Reported Availability 2017). OSHP in Jackson County arrested two men during a Change during the Past 6 Months

traffic stop on US 35 after smelling marijuana coming from the vehicle which prompted a probable cause search; officers Participants No change found 56 grams of heroin in the car (www.wdtn.com, Aug. 9, 2017). The Zanesville-Muskingum County Joint Drug Unit Heroin Law enforcement Decrease and the Central Ohio Drug Enforcement Task Force arrested a woman after executing a search warrant of a residence Treatment providers No change in Zanesville and seizing heroin, heroin-fentanyl mixtures, methamphetamine, cocaine, drug paraphernalia, a handgun and cash; as a result of this arrest, three other individuals Participants most often rated the current overall quality connected to the woman were arrested, including an Ohio of heroin as ‘4’ on a scale of ‘0’ (poor quality, “garbage”) to man arrested in New Jersey after being found with 15 bags of ‘10’ (high quality); the previous most common score was ‘5.’ heroin (www.zanesvilletimesrecorder.com, Sept. 18, 2017). Participants stated: “It doesn’t get you high; Around here people sell a lot of fake stuff; It sucks … it didn’t get you well or high.” While many types of heroin are currently available in the Participants discussed adulterants (aka “cuts”) that affect the region, participants and community professionals reported quality of the drug and reported the top cutting agents for black tar heroin as most available. Law enforcement heroin as coffee and fentanyl. Additional cuts mentioned commented: “[Black tar heroin is] definitely what Athens included: benzodiazepines, brown sugar, candy, carfentanil, County prefers. I don’t know that we had that many cases of caramel, chocolate powder, coffee creamer, cough drops, powder (powdered heroin) … people say they use it and have it, dark sodas, maple syrup, Sleepinal®, tea, teething tablets, but most of our cases and search warrants are for black tar.” toothpaste and Tootsie Rolls®. Participants commented: “They cut it with everything; Anything under the kitchen sink; I’ve seen Reportedly, brown powdered heroin is also widely available someone scrape a marijuana pipe and use it (resin); They mixed in the region. Participants most often reported its current it with fentanyl and I had a buddy die off of it.” availability as ‘10.’ Although participants discussed high availability of powdered heroin, they reported black tar Overall, participants reported that the quality of heroin heroin as more prevalent. A participant commented, “Usually, has decreased during the past six months. A participant people just get ‘tar’ (black tar heroin).” commented, “The only way I know if you are going to get pure heroin is when it comes in a big block (aka “brick”).” Participants reported that the availability of heroin has remained the same during the past six months. A participant stated, “When they get low on it, they send people to go [to Columbus, Akron or Cleveland] and bring it back.” Treatment providers reported that the general availability of heroin has remained the same during the past six months, while law enforcement reported decreased availability. Law enforcement discussed: “Enforcement out of this office … have gone and arrested dealers in Columbus …. This office has gone to Detroit twice … we’ve gone to South Carolina. We followed things back to their sources, and I think that has eliminated some of the people wanting to deal here.”

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Cutting Agents Participants described typical heroin users as people of Reported by Crime Lab low socio-economic status. Participants commented: “An individual who does not have a lot of money; They feel like they get more bang for their buck going with heroin. They l acetaminophen

get a bigger high for $25 bucks then they would if they went l artificial sweeteners (sorbitol and lactose) and bought ‘coke’ (cocaine) or a couple of pills.” Community l caffeine professionals described typical heroin users as aged 14-65 l cocaine years and of low socio-economic status. Law enforcement Heroin l diphenhydramine (antihistamine) stated: “Then we have the people who transition from pills to l dipyrone (banned analgesic) heroin because pills are harder to get; We do find [heroin] with l fentanyl/fentanyl analogues low-income people … the high school athlete who had her life l mannitol (diuretic) planned out and kind of fell apart.” l quinine (antimalarial)

Reports of current prices for heroin were consistent Fentanyl among participants with experience purchasing the drug. Reportedly, the most common quantity of purchase is a 1/2 Fentanyl is highly available in the region. gram. Overall, participants indicated that the price of heroin Participants most often reported the current has remained the same during the past six months. availability of the drug as ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly Current Prices for available, extremely easy to get); the previous Heroin most common score was not reported. Participants stated: “Everyone has it; Everybody is putting fentanyl in everything.” Black tar and brown powdered: Community professionals most often reported the current 1/10 gram $20-25 availability of fentanyl as ‘10;’ the previous most common

Heroin scores were no reported. A treatment provider stated, “It’s 1/2 gram $60-70 being cut into heroin.” In addition to high availability of A gram $100-120 fentanyl, participants and community professionals also indicated high availability of carfentanil. While there were a few reported ways of using heroin, generally, the most common route of administration remains Corroborating data indicated that fentanyl is available intravenous injection (aka “shooting”). Participants estimated in the region. ODPS reported 16 drug task force seizures that out of 10 heroin users, nine would shoot and one would of heroin and/or fentanyl in the Athens region during snort the drug. A participant reported, “When I started doing the reporting period; drug task forces did not typically heroin, I snorted it. That did not last very long … a couple of differentiate between heroin and fentanyl due to the high months … the buzz wears off then you need something else incidence of heroin-fentanyl mixtures. (move to injection).” Media outlets reported on law enforcement seizures and Participants reported that injection needles are most arrests in the region this reporting period. The Belmont available from friends and family members who have County Sheriff’s Office issued a warning to first responders diabetes. Additionally, participants reported obtaining using Facebook after finding a bag of heroin mixed needles from needle exchange programs, pharmacies, local with carfentanil confirmed by the Bureau of Criminal retail stores and through Internet purchase. One participant Investigation (www.wtov9.com, Sept. 22, 2017). remarked, “Some people have fake diabetes cards to get Participants reported that the availability of fentanyl them.” Reportedly, injection needles most often sell for $2 has increased during the past six months. However, a per needle on the street, and sharing needles is common. participant noted, “No one sells fentanyl on the street. It’s Participants commented: “I would give people mine, but I added into something else … usually, it’s the pressed pills.” would not use theirs; My wife and I shared needles.” Treatment providers reported that the general availability of fentanyl has increased during the past six months, while

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law enforcement reported it has remained the same or stated: “They thought it was heroin, or thought it was decreased. A treatment provider stated, “Drug traffickers Percocet® [because they] are pressing it to make it look like target this area.” Law enforcement indicated increased Percocet® … [clients] are testing positive [for fentanyl] and law enforcement in the region has lead to decreased not [for] Percocet®; They call them ‘fake perks’.” availability. The BCI London Crime Lab reported that the number of fentanyl and fentanyl analogue cases it Although participants were not able to report current processes has increased during the past six months; the prices for fentanyl, participants discussed the prevalence lab also reported an increase in the number of carfentanil of selling fentanyl as prescription opioids on the street. cases. Participants reported that Roxicodone® 30 mg lookalikes pressed with fentanyl sell for $30-35. Participants stated: Reported Availability “You can make a pill for $0.50 and sell them on the street; You Change during the Past 6 Months can get 100 grams of fentanyl for $100 [reportedly, through Internet purchase].” Participants Increase While there were a few reported ways of using fentanyl, generally, the most common route of administration Law enforcement No consensus is intravenous injection (aka “shooting”). Participants Fentanyl reported that out of 10 fentanyl users, nine would shoot Treatment providers Increase and one would orally consume the drug. A participant stated, “You can shoot it like powdered (heroin) ….” Participants most often rated the current overall quality Participants and community professionals described of fentanyl as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) typical fentanyl users as heroin or prescription opioid to ‘10’ (high quality); a previous most common score was users. Treatment providers reported: “They were using not reported. Participants and community professionals some type of opioid and had advanced to fentanyl use or discussed fentanyl as a top cutting agent (adulterant) for carfentanil; A long-term prescription opioid addict or the heroin and other drugs. A participant shared, “You do not mistake person who just ends up with it.” know it’s fentanyl until it is too late. I almost ‘OD’ (overdosed) on my parent’s kitchen floor.” Treatment providers stated: “With any drug, they can tell you it’s one thing, when it’s Prescription Opioids something completely different … or scarier, something that will really mess them up; You never know how much someone is putting in.” Prescription opioids are moderately available for illicit use in the region. Participants most Participants discussed adulterants (aka “cuts”) that affect often reported the current street availability of the quality of the drug and reported the top cutting these drugs as ‘5’ on a scale of ‘0’ (not available, agents for fentanyl as coffee and heroin. Participants impossible to get) to ‘10’ (highly available, commented: “A lot of times they use the same things they extremely easy to get); the previous most common score was cut heroin with to make it look like heroin; The only thing you ‘10.’ Participants stated: “They are like non-existent; They are can tell that has fentanyl in it is heroin because [fentanyl] more and more harder to get. These doctors are cracking down; changes the color of [heroin].” Overall, participants reported Doctors are doing it (not prescribing opioids) to save themselves; that the quality of fentanyl has remained the same during Pills aren’t really, I mean I don’t want to say they’re not ‘in’ the past six months. anymore, but that’s kind of the only way to explain it; They’re out of fashion.” Regarding pressing fentanyl into pill form and feigning the drug as prescription opioids, participants reported: Treatment providers most often reported the current “No one knows what to look for. They just don’t taste right; street availability of prescription opioids as ‘6,’ while law They look identical; When we pressed fentanyl into the pills, enforcement most often reported it as ‘4;’ the previous most we didn’t want people to overdose; Crush up a leaf to make it common scores were ‘10’ and ‘7,’ respectively. A treatment into a blue color, and then take out the OxyContin® and use provider stated, “I think that it’s available because it’s a legally fentanyl to make ‘perks’ (Percocet®).” Treatment providers produced medication and all kinds of people have it for all

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 63 Page 8 Surveillance of Drug Abuse Trends in the Athens Region kinds of reasons.” Law enforcement commented: “There are (Percocet®), oxymorphone (Opana®), hydrocodone continuous thefts of them via friends or burglary; When it is (Vicodin®), methadone and morphine cases it processes has available, it is coming from doctors.” increased during the past six months, while hydromorphone (Dilaudid®) and tramadol (Ultram®) cases have decreased or Corroborating data indicated that prescription opioids are remained the same. available for illicit use in the region. ODPS reported 11 drug task force seizures of prescription opioids in the Athens Reported Availability region during the reporting period. Change during the Past 6 Months Media outlets reported on law enforcement seizures and arrests in the region this reporting period. Coshocton County Participants Decrease Sheriff’s officers took 18 people into custody after completing Law enforcement Decrease a raid of a home in Coshocton and seizing large amounts Opioids

of prescription and illicit drugs (www.whiznews.com, July Prescription 20, 2017). Guernsey County Sheriff’s officers arrested a child Treatment providers Decrease daycare worker for selling illegal narcotics out of the facility in Cambridge where she worked while looking after children Reports of current street prices for prescription opioids were (www.nbc4i.com, Oct. 20, 2017). A former nurse at a Zanesville consistent among participants with experience buying the hospital faced up to 18 months in prison after pleading guilty drug. Reportedly, the majority of prescription opioids sell for in Muskingum County Common Pleas Court to stealing $1-2 per milligram. Overall, participants indicated that the fentanyl, an IV bag and a 20-ounce syringe from a patient’s price of prescription opioids has increased during the past hospital room (www.zanesvilletimesrecorder.com, Nov. 16, six months. A participant stated, “It’s a very expensive habit 2017). to have.” In addition a treatment provider discussed users Participants identified Dilaudid®, Percocet® and Vicodin® as trading prescription opioids for other drugs: “There’s a big the most available prescription opioids in terms of widespread market for a lot of trading … ‘Hey, you have this, and I need that, illicit use. Both treatment providers and law enforcement let’s trade,’ or ‘Hey, I’m getting this, I don’t really need it or use it, identified OxyContin® and Percocet® as most available. A but I know I can sell it and make money.’” treatment provider stated, “Percocet® and OxyContin® … those are your good ones, is what a user would say.” Current Street Prices for Prescription Opioids Participants and community professionals reported that

the street availability of prescription opioids has decreased Dilaudid® $25 for 8 mg during the past six months. Participants stated: “You can’t get prescriptions of narcotics anymore … it is kind of hard, you have to go take a trip (go outside the region to purchase); They’re Opana® $120 for 40 mg so hard to get prescribed anymore because of people abusing $7-8 for 5 mg

Opioids Percocet® them … I can’t even get them prescribed; The people I know $13-14 for 10 mg who were actually selling their medication are now taking their Prescription medication, they’re not selling it; The fake pills are going around Roxicodone® $40 for 30 mg [instead].” A treatment provider noted, “The doctors in this area … most of them have changed the way they prescribe, how Vicodin® $4-7 for 5 mg often and how many they prescribe … that’s cut down on the availability quite a bit.” A law enforcement officer reported, “I think when there was a crackdown on the pill mills there Participants reported obtaining these drugs for illicit use was an awareness … I think we are going back the other way from drug dealers, clinics, deceased people, family, friends (prescribing less).” and pill mills. Participants stated: “I’ve heard of someone who has died and they had a stock of pain pills … [users] found them The BCI London Crime Lab reported that the number of … also, older people realizing that their pills are worth money, oxycodone (OxyContin®), oxycodone/acetaminophen they usually sell them; The ‘street doctor’ (drug dealer) … if you

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don’t get them from the street, [then you get them from] a $350 and go to [a Suboxone® clinic] … five minutes and prescription. I know people that will bounce from hospital to then you have your prescription; This is one that we struggle hospital to get pills.” with the most here in rural Southeast Ohio. I think Suboxone® has become a kind of currency. You go in and get your While there were a few reported ways of consuming prescription, you take half of it to take care of your own needs prescription opioids, and variations in methods of use … the other half becomes currency to pay for other things.” were noted among types of prescription opioids, generally Law enforcement stated: “They are very easy to find on the most common route of administration for illicit use the street; I think it is misused; We have had one individual is snorting. Participants estimated that out of 10 illicit [smuggle] three strips of Suboxone® within the jail; It’s prescription opioid users, eight would snort and two considered a money maker by most doctors; I would agree would orally consume the drugs. A participant stated, “One [that] anyone [who] would like to buy it can absolutely buy it would smoke, one shoot and the rest would snort it ….” A without any problem.” few participants also discussed specifically intravenously injecting (aka “shooting”) Roxicodone 30® mg. Participants reported that the street availability of Suboxone® has increased during the past six months. Participants described typical illicit prescription opioid users A participant commented, “It’s what everyone has went as aged 20 years to elderly, construction workers, military to since they quit taking the pills (prescription opioids).” personnel and “soccer moms.” Participants stated: “It has been Community professionals reported that street availability my experience that people who are addicted to opiates are has remained the same. Treatment providers commented: people who are self-employed, like contractors who work on “It’s been steady, that’s what the people are wanting and houses, get odd jobs, because they can live their lifestyle where using; Abuse it or sell it … we see both.” The BCI London they can just show up when they need; Concrete workers … if Crime Lab reported that the number of Suboxone® and you do concrete for 5 to 10 years you would be in pain; Stay at Subutex® cases it processes has increased during the past home moms … because they do not want to go to the street to six months. buy [drugs]. Plus, it does not look as bad if they get a prescription for it.” Community professionals described typical illicit Reported Availability prescription opioid users as anyone. A treatment provider Change during the Past 6 Months remarked, “I don’t think that the availability has changed, use has changed … it’s anyone and everyone … young, old, male, Participants Increase and female.” Law enforcement No change Suboxone® Suboxone® Treatment providers No change

Suboxone® remains highly available for illicit use in the Reports of current street prices for Suboxone® were region. Participants most often reported the current consistent among participants with experience buying street availability of Suboxone® as ‘10’ on a scale of ‘0’ the drug. (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common score Current Street Prices for

was also ‘10.’ A participant stated, “It is more available than Suboxone® Percocet® and other opiates. I know a bunch of people with a ‘script’ (prescription for Suboxone®) … it is easy to get, all Filmstrip $20 for 8 mg you have to do is piss dirty (fail a drug urinalysis screen) for opiates and you get a script ….” $7-8 for 2 mg Both treatment providers and law enforcement reported Suboxone® Pill $10-15 for 4 mg the current street availability of Suboxone® as ‘10;’ $20-25 for 8 mg the previous most common scores were ‘10’ and ‘7,’ respectively. Treatment providers stated: “Just have your

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In addition to obtaining Suboxone® on the street from scale of ‘0’ (not available, impossible to get) to ‘10’ (highly drug dealers, participants also reported getting the available, extremely easy to get); the previous most common drug for illicit use through clinics and people who have score was ‘10.’ Participants reported: “They’re pretty easy prescriptions for the drug. A participant stated, “It all to find. They’re easier to find than pain pills; I could go to the comes down to a prescription … everyone has a prescription, doctor today and get three of those off the list[of commonly and everyone who has a prescription sells that; It is easier to prescribed opioids].” get [Suboxone®] than opiates and people … don’t need their Both treatment providers and law enforcement most often whole script … and a lot of people who are on [Suboxone®] reported the current street availability of sedative-hypnotics are low-income based people, and so they sell their script as ‘8;’ the previous most common scores were ‘8’ and ‘10’ by to make (pay for) their doctor’s appointment.” A treatment treatment providers and ‘5’ and ‘7’ by law enforcement. A provider stated, “I think they divert it for a lot of reasons … treatment provider stated, “It kind of comes in spurts … we they need money, they need to pay the bills. It’s their hustle, see a whole lot then it dips a little.” A law enforcement officer not necessarily for using purposes but to survive. I could drive stated, “It seems like if someone knows where to get them, they through (visit a clinic), give them $250, turn around and all go.” make double that.” Law enforcement reported: “We have clinics that prescribe Suboxone® and then we have people go Corroborating data indicated that sedative-hypnotics are and sell their Suboxone®.” available for illicit use in the region. ODPS reported five drug task force seizures of benzodiazepines in the Athens region Participants reported that the most common routes of during the reporting period. administration for illicit use of Suboxone® are intravenous injection (aka “shooting”) and snorting. Participants Participants identified Klonopin®, Valium® and Xanax® as the estimated that out of 10 illicit Suboxone® users, five would most available sedative-hypnotics in terms of widespread shoot and five would snort the drug. A participant stated, illicit use. A participant stated, “Everyone is prescribed Xanax®.” “I’ve seen people put the strips in water to snort it.” Community professionals identified Klonopin® and Xanax® as most available. A treatment provider stated, “Xanax® and Participants described typical illicit Suboxone® users as Klonopin® … these are the big ones.” prescription opioid users and people aged 22-40 years. Treatment providers described typical illicit users also Participants reported that the general availability of sedative- as people addicted to opiates. A treatment provider hypnotics has remained the same during the past six months. commented, “Someone who has struggled with opiate Participants discussed: “Most of the people that I know sell them; abuse disorder … maybe they have been dropped from a My mom has been on Valium® for 25 years and she doesn’t sell program … they are using it.” them. The only time she sells them is if she really needs money for something.” Treatment providers reported that availability of Law enforcement could not describe a typical illicit sedative-hypnotics has increased during the past six months, Suboxone® user. One law enforcement officer remarked, while law enforcement reported that availability has remained “Individuals who are waiting for the next high ….” Law the same. A treatment provider commented, “It’s based on enforcement discussed an increase in the number of the increased ‘meth’ (methamphetamine) use.” Reportedly, parents who purchase Suboxone® on the street for their methamphetamine users use sedative-hypnotics to come children. Law enforcement stated: “We have heard of parents down from the extreme stimulant high of methamphetamine. who have bought Suboxone® for their kids, so it’s more they think like they’re helping; I think they think it is better to have a The BCI London Crime Lab reported that the number of known drug in their system than the unknown drug.’” clonazepam (Klonopin®), diazepam (Valium®), alprazolam (Xanax®), carisoprodol (Soma®) and lorazepam (Ativan®) cases it processes have increased, while the number of zolpidem Sedative-Hypnotics (Ambien®) cases has decreased during the past six months. In addition, the lab reported that it has seen an increase in cases Sedative-hypnotics (benzodiazepines, barbiturates and of designer benzodiazepines during the past six months. muscle relaxants) are moderately to highly available for illicit use in the region. Participants most often reported the current street availability of these drugs as ‘5’ and ‘10’ on a

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Reported Availability common score was also ‘10.’ Participants commented: “It’s so available … I can get it on a daily basis; Marijuana is

Change during the Past 6 Months everywhere.” A treatment provider stated, “It’s kind of like (as available as) alcohol … ten people looking for marijuana, Participants No change everybody and anybody at the end of the night is gonna have what they needed.” A law enforcement officer stated, Law enforcement No change Sedative-

Hypnotics “I believe it’s almost easier to get than alcohol, especially for Treatment providers Increase teens. Parents have it … it’s a part of their upbringing.” Corroborating data indicated that marijuana is available in Reports of current street prices for sedative-hypnotics were the region. ODPS reported 13 drug task force seizures of consistent among participants with experience buying the marijuana in the Athens region during the reporting period. drugs. Media outlets reported on law enforcement seizures and arrests in the region this reporting period. The Ohio Current Prices for Sedative-Hypnotics University Police Department (Athens County) reported 58 marijuana incidents occurring in a two-week period at the beginning of the school year; students were cited Xanax® $2-5 for 1 mg for using marijuana in dormatories, and on golf courses Sedative- Hypnotics and bike paths (www.athensnews.com, Sept. 10, 2017). The Central Ohio Drug Enforcement (CODE) Task Force and the Perry County Sheriff’s Office executed a search Participants reported obtaining these drugs for illicit use warrant at a residence in Somerset after receiving tips from drug dealers, prescription and Internet purchase (“the of marijuana trafficking from the home; officers found dark web”). In addition, a participated stated, “You can buy the a large-scale marijuana grow operation; results from powder and then you can press them into pills ….” Generally, this investigation lead officers to conduct an additional the most common route of administration for illicit use of search of a residence in Roseville (Muskingum and Perry sedative-hypnotics is snorting. Participants estimated that out of 10 illicit sedative-hypnotic users, six would snort, two would counties), where officers seized 52 pounds of marijuana, shoot (intravenously inject) and two would swallow the drugs. as well as packages for sale containing butane hash oil (aka ”dabs”); in an unrelated investigation, CODE Task A profile for a typical illicit sedative-hypnotic user did Force officers arrested four people after executing a search not emerge from the data. Participants and treatment warrant at two residences in Corning (Perry County) after providers described typical illicit users as anyone, while law seizing 58.4 pounds of marijuana and firearms www.( enforcement described typical illicit users as college students zanesvilletimesrecorder.com, Sept. 27, 2017). Perry County and individuals in their late 20s to 30s. A law enforcement Sheriff’s Office, Muskingum County Sheriff’s Office, officer stated,It’s “ the young 18-25 [year old] college kid that Muskingum County Prosecutor’s Office and Zanesville is going out to drink [alcohol], and then it’s like the 35-year-old Police arrested two individuals after executing a search multi-[drug] addict just trying to spice up their addiction.” warrant at a home in Zanesville and seizing 30-40 pounds of marijuana, THC (tetrahydrocannabinol, the psychoactive component of marijuana) candies, vape oils, hash oil and Marijuana drug paraphernalia (www.zanesvilletimesrecorder.com, Nov. 3, 2017). Marijuana remains highly available in Participants and community professionals also discussed the region. Participants and community current availability of marijuana extracts and concentrates, professionals most often reported the current often appearing as oil and waxy forms of the drug (aka availability of the drug as ‘10’ on a scale of “dabs”). Participants most often reported the current ‘0’ (not available, impossible to get) to ‘10’ availability of marijuana extracts and concentrates as ‘10;’ (highly available, extremely easy to get); the previous most the previous most common score was ‘5-6.’ Participants

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 67 Page 8 Surveillance of Drug Abuse Trends in the Athens Region stated: “It lasts longer [than regular marijuana]; Lots of cigarette) the size of that pen and sit there and drool on people tried it and it really took off; You are allowed to have yourself … and the poor [quality] stuff, you can sit there and it if you have a medical card … you’re allowed to have smoke a joint about the size of that pop can and not even oil.” Treatment providers most often reported current get a buzz (high).” Participants indicated that the quality availability of marijuana extracts and concentrates as of high-grade marijuana has increased during the past six ‘5,’ while law enforcement most often reported it as months. Participants stated: “Everybody likes that good high, ‘10;’ previous most common scores among community that mellow, dramatic weed; I think it is increased, because professionals were not reported. … people wanted something better; Everybody’s wanting the better weed … you can’t find ‘mids’ (middle grade, aka Participants reported that the availability of marijuana ‘regular’ marijuana) … there’s only certain [dealers] that has increased during the past six months. One participant still sell the ‘mids’ because of the higher-grade weed [is in remarked, “Is it harvest time?” Community professionals demand].” reported that the availability of marijuana has remained the same during the past six months. A law enforcement Reports of current prices for marijuana were provided by officer stated,We “ just took out 110 pounds of marijuana … participants with experience buying the drug. Reportedly, all that’s going to do is have more flown in … the U.S. Postal the most common quantities of purchase are a gram and Service is used specifically to transport … marijuana and it 1/8 ounce. Overall, participants reported that the price happens all the time ….” of marijuana has remained the same during the past six months. Participants and law enforcement reported that the availability of marijuana extracts and concentrates, often Current Prices for referring to hash oil, has increased during the past six Marijuana months, while treatment providers reported that the availability of marijuana extracts and concentrates has Low grade: remained the same. A treatment provider remarked, A blunt (cigar) $5 “Not as available as plant based marijuana … haven’t seen it as much.” The BCI London Crime Lab reported that A gram $20 the number of marijuana and marijuana extracts and concentrates (oils, “dabs”) cases it processes have increased 1/8 ounce $25 during the past six months. 1/4 ounce $40-50

Reported Availability An ounce $100-120 Change during the Past 6 Months High grade:

Participants Increase A blunt (cigar) $10

Marijuana A gram $10-20 Law enforcement Increase Marijuana 1/8 ounce $40-50 Treatment providers No change 1/4 ounce $100 Participants most often rated the current overall quality of 1/2 ounce $150-200 marijuana as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) An ounce $300 to ‘10’ (high quality); the previous most common score was also ‘10.’ Extracts and concentrates: Regarding the difference in quality between grades of A hit $5 marijuana, a participant commented, “The ‘dank’ (high- grade marijuana), you could smoke a joint (marijuana-filled A gram $50

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While there were a few reported ways of consuming (methamphetamine) is the new crack (as available as crack marijuana and marijuana extracts and concentrates, cocaine); You can walk out the door and get meth; Meth is generally the most common route of administration for the new marijuana in town … everyone uses it; It’s cheap and all forms of marijuana remains smoking. Participants easy to get … and it lasts a lot longer [the high produced estimated that out of 10 users, all 10 would smoke the is longer in duration than the highs of other drugs]; The drug. Participants stated: “Yeah, dabs smoke; Dabs is biggest epidemic is meth; So many people around here have smoking.” Participants also reported orally consuming become so addicted to it … I’m serious … it’s absolutely marijuana in food products (aka “edibles”). Participants ridiculous. I am sick of seeing ‘meth heads’ (users addicted to stated: “We would all smoke it. Maybe one would eat it; I’ve methamphetamine) around here.” seen people eat it and smoke it. Not like eat it out of the bag, but bake it in cookies; You can bake it … make candy or Treatment providers most often reported the current butter.” overall availability of methamphetamine as ‘10,’ while law enforcement most often reported it as ‘7;’ the previous A profile for a typical marijuana user did not emerge most common scores were ‘10’ and ‘8,’ respectively. from the data. Participants and community professionals Treatment providers stated: “[Users] are hearing that this described typical marijuana users as anyone. Participants will not kill you; ‘I can get a lot done, I can work more hours’ commented: “It’s hard to tell now-a-days; My grandma is [say users] … some have lost their job while using meth; It is almost 80 [years old] and she smokes [marijuana] and I have brought in from Mexico, and then we have it made here.” a cousin who is 13 [years old] who smokes … there is a big age range; The college group is the group who typically uses Corroborating data indicated that methamphetamine higher-grade marijuana; I would say younger kids with the is available in the region. ODPS reported 23 drug task ‘mids’ because it’s cheaper and it’s easier to get.” Treatment force seizures of methamphetamine in the Athens region providers stated: “Male, female, young, old, rich, poor, job during the reporting period (26.1% of the seizures were or no job; It’s a part of the culture.” Law enforcement stated: made in Coshocton County). “[Anyone] breathing … anyone 18 to 85 years of age; We Media outlets reported on law enforcement seizures and were told that there were high school students smoking arrests in the region this reporting period. New Castle [marijuana] in their cars before they walked into school every Police (Coshocton County) arrested a couple whom they morning.” called the “modern day Bonnie and Clyde” after capturing Regarding typical marijuana extracts and concentrate the couple in Cadiz (Harrison County); the couple users, a participant specified,“I would say like teenagers and committed a series of heinous and violent crimes over the people into their 30s or more like vaporizing and dabbing it.” course of several days while high on methamphetamine, Treatment providers described typical marijuana extracts including severely beating an elderly man and his son, and concentrate users as people in their 20s, while law breaking into and robbing various locations, and holding enforcement described typical marijuana extracts and a young girl for ransom; police were able to locate the girl concentrate users as anyone. and bring her to safety (www.sharonherald.com, July 5, 2017). Central Ohio Drug Enforcement (CODE) Task Force officers arrested a man during a traffic stop in Licking Methamphetamine County after seeing marijuana in plain sight; a probable cause search of the vehicle also found methamphetamine; Methamphetamine remains highly available during this time, Muskingum County CODE agents in the region. Participants most often reported searched a hotel room in Zanesville where two men, who the current availability of methamphetamine were connected to the first man arrested, were staying, in crystal form as ‘8’ and in powdered and arrested the two men after finding 12 pounds of form as ‘10’ on a scale of ‘0’ (not available, methamphetamine (www.zanesvilletimesrecorder. impossible to get) to ‘10’ (highly available, extremely com, July 26, 2017). An investigation led by the Athens easy to get); the previous most common overall score for Police (Athens County) lead to the arrest of 13 people methamphetamine was ‘10.’ Participants discussed: “‘Meth’ responsible for trafficking methamphetamine in the

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 69 Page 8 Surveillance of Drug Abuse Trends in the Athens Region area; one man purchased crystal methamphetamine in for his involvement with a methamphetamine ring, as Zanesville and sold it to Athens County residents; during well as possessing heroin among other crimes (www. a search of one residence, officers seized 12 ounces of athensnews.com, Nov. 12, 2017). OSHP in Jackson County methamphetamine, 14 firearms and other weapons (www. arrested four people during a traffic stop after the raw zanesvilletimesrecorder.com, Aug. 15, 2017). Belmont smell of marijuana prompted a search of their vehicle; County Drug Task Force officers arrested a man after an officers seized 453 grams of methamphetamine and three investigation lead to the seizure of 28 grams of crystal grams of marijuana (www.statepatrol.ohio.gov, Nov. 25, methamphetamine in Bellaire (www.wtov9.com, Aug. 2017). Gallia County Sheriff’s officers arrested two people 23, 2017). Marietta Police (Washington County) arrested after the Gallia County Probation Department asked for a man after receiving a tip that he was manufacturing assistance in locating one of the individuals on parole; methamphetamine in his vehicle at a local campground officers located the man, and arrested him and a woman and finding methamphetamine, as well as several after finding methamphetamine, drug paraphernalia and different chemicals in his vehicle www.thenewscenter.tv( , cash in their home (www.wowktv.com, Dec. 16, 2017). Aug. 30, 2017). The Ohio Organized Crimes Investigations Cambridge Police arrested a babysitter after the mother Commission and the Washington-Morgan-Noble of an infant girl and 2-year-old boy informed police Major Crimes Task Force arrested six people in Belpre that her two children were missing; officers located the (Washington County) after officers searched a residence woman at a local business and returned the children to and confiscated 68.9 grams of methamphetamine, the mother, who found the infant breathing erratically and 10.8 grams of heroin, and drug paraphernalia (www. having seizures; physicians reported that the child had mariettatimes.com, Sept. 23, 2017). The Washington- methamphetamine in her system (www.nbc4i.com, Dec. Morgan-Noble Major Crimes Task Force arrested four 26, 2017). people after executing a search warrant at a home in Marietta and finding methamphetamine was trafficked Participants reported that methamphetamine is available out of the home; officers also removed two children from in both powdered and crystal forms throughout the the home living in unsafe, unsanitary conditions (www. region. The powdered form of methamphetamine is thenewscenter.tv, Sept. 25, 2017). Athens Police arrested typically referred to as “shake-and-bake,” which means two people after responding to a call of a disturbance users produce the drug in a single-sealed container, such at a hotel and finding the two people in possession as a two-liter soda bottle. By using common household of methamphetamine and drug paraphernalia (www. chemicals along with ammonium nitrate (found in cold athensreview.com, Oct. 5, 2017). The Noble County packs) and pseudoephedrine (found in some allergy Sheriff’s Office and the Washington-Morgan-Noble medications), people who make methamphetamine Major Crimes Task Force executed a search warrant at a can produce the drug in approximately 30 minutes in home in Belle Valley (Noble County) and arrested a man nearly any location. Participants reported that crystal for possessing a large amount of methamphetamine methamphetamine is more prevalent throughout the (www.daily-jeff.com, Oct. 5, 2017). Cambridge Police region. Participants stated: “You don’t really hear about (Guernsey County) arrested three people while ‘shake-and-bake’ anymore; People want the ‘rocks’ (crystal investigating calls regarding individuals attempting to methamphetamine); They have taken everyone who break into a vehicle in a Walmart parking lot; officers made ‘shake-and-bake’ to prison.” Treatment providers found crystal methamphetamine, 20 unidentified pills, and law enforcement did not identify a specific form of methamphetamine pipes and hypodermic needles methamphetamine as more prevalent in their area. (www.daily-jeff.com, Oct. 25, 2017). Law enforcement Participants and community professionals reported that in Hocking County arrested four people during a traffic the overall availability of methamphetamine has increased stop on State Route 93 near the Hocking and Perry during the past six months. Participants commented: “It’s County line after a search of the vehicle unveiled 32 all about the money, to make fast money … that’s where they grams of methamphetamine, drug paraphernalia and see it’s at [dealers have found methamphetamine sales to cash (www.nbc4i.com, Oct. 30, 2017). An Athens County be lucrative]; It’s gotten so available that it’s people’s next door Common Pleas Court judge sentenced a man to 10 years neighbors. I mean, to the point in which you’re sitting in your in prison after he found the man guilty of assault and

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living room and you’re smelling the chemicals coming through matches, MSG (monosodium glutamate) and propane. your window … it’s like, ‘Whoa, it’s about time to leave this Participants commented: “Instead of using Sudafed®, whole entire block and call the police’ … it’s scary.” you can use Adderall®; It’s all about wanting to be more (the most) potent.” The BCI London Crime Lab reported Treatment providers discussed: “It’s available. It’s cheap, dimethyl sulfone (dietary supplement) as a cut for quick, easy to make, boom … go sell; There are a lot of methamphetamine. ideal places to make it out here, out in the hills or in your [vehicle’s] trunk; We have gone from this home-grown Reports of current prices for methamphetamine were model to the bigger drug dealers.” Law enforcement stated: consistent among participants with experience buying the “Our elimination of opiate addicts and supply [of opiates] drug. Reportedly, the most common amount of purchase [are reasons for the increase in methamphetamine]; is 1/2 gram. However, a participant shared, “The bigger “Breaking Bad” (a movie that fantasizes the manufacture quantity you buy, the more discounts you’re gonna get.” of crystal methamphetamine) has made it kind of like this cool thing to go out and do.” The BCI London Crime Lab Current Prices for reported that the number of methamphetamine cases Methamphetamine it processes has increased during the past six months; the lab reported processing blue, clear, pink and white 1/2 gram $35-50 crystal methamphetamine as well as white powdered methamphetamine. A gram $70-80 Reported Availability Change during the Past 6 Months 1/16 ounce $90-120 Methamphetamine

Participants Increase Participants reported that the most common routes of administration for methamphetamine are smoking Law enforcement Increase and intravenous injection (aka “shooting”). Participants estimated that out of 10 methamphetamine users, five Treatment providers Increase would smoke and five would shoot the drug. A participant Methamphetamine stated, “There’s different ways of smoking it. You can put it on a foil, in a white bulb … each one of those [methods] has a Participants most often rated the current overall quality different reaction and a different feel.” of methamphetamine as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the previous most Participants described typical methamphetamine users common score was ‘2’ for powdered methamphetamine as anyone. A participant stated, “It’s one of the cheapest and ‘8’ for crystal methamphetamine. Participants stated: drugs [so it appeals to everyone].” Treatment providers “You can always tell how the quality is … if it turns brown, described typical methamphetamine users as aged 20 it’s crappy … and if it stays white or clear, it’s an excellent years and older, and users addicted to opiates, while law product; I used to make it, so I know types …. Nowadays, yes, enforcement reported typical users as rural individuals, the quality has come up ….” of low socio-economic status, and aged 20 years and older. Treatment providers stated: “We see a lot of clients Participants discussed adulterants (aka “cuts”) that switching [from opiates]. They may be on Vivitrol® and want affect the quality of the drug and reported the top to get high and then they switch over to meth; What I am cutting agents for methamphetamine as: battery acid, seeing is a lot of our meth users have that past opioid use.” MSM (methylsulfonylmethane, a joint supplement) Law enforcement commented: “Most of the people I see and rock salt. Additional cuts mentioned included: are low-income; We don’t see a lot of college students using Adderall®, bath salts (synthetic cathinones), butane, meth. It’s more like our rural residents.” caffeine, Drano®, MDMA (ecstasy/molly), lighter fluid,

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Prescription Stimulants Reported Availability Change during the Past 6 Months Prescription stimulants are moderately available for illicit use in the region. Participants most often reported the Participants No change current street availability of these drugs as ‘7’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, Law enforcement Decrease

extremely easy to get); the previous most common score Stimulants Prescription Prescription was ‘10.’ Treatment providers most often reported the Treatment providers No change current street availability of prescription stimulants as ‘8,’ while law enforcement most often reported it as ‘3;’ the previous most common scores were ‘7’ and ‘4,’ respectively. Reports of current street prices for prescription stimulants A treatment provider stated, “Kids get them, and they are were consistent among participants with experience able to sell them and trade them.” A law enforcement officer buying these drugs. Overall, participants reported that the discussed, “I think it’s readily used and abused, and they don’t price of prescription stimulants has increased during the think it’s a crime [to share prescription stimulants] … they past six months. A participant stated, “No one wants them give it to each other … it happens all the time.” anymore because they are too expensive.”

Participants identified Adderall® and Ritalin® as the most Current Street Prices for available prescription stimulants in terms of widespread Prescription Stimulants illicit use. Both treatment providers and law enforcement identified Adderall® as most available. Treatment providers stated: “Everybody wants Adderall®; A lot of people try to go $5 for 10 mg Adderall® doctor shopping for Adderall®.” A law enforcement officer $15 for 30 mg Stimulants remarked, “It is crazy the amount of high school kids that are Prescription taking Adderall® … crazy.” Participants reported obtaining prescription stimulants Participants reported that the street availability of for illicit use from people with prescriptions, drug dealers prescription stimulants has remained the same during and physicians. A law enforcement officer stated,Parents “ the past six months. Although participants most often go to the doctor and say [their child] can’t concentrate … it indicated unchanged availability, they indicated higher is getting prescribed at a pretty high amount.” Participants street prices for these drugs and lessened interest in their reported that the most common route of administration use as the availability of methamphetamine continues to for illicit use of prescription stimulants remains snorting. increase. Participants commented: “It’s another one that Participants estimated that out of 10 illicit prescription is becoming increasingly difficult to obtain, even legally stimulant users, eight would snort and two would orally and legitimately; People can just do meth; People [are] consume the drugs. going straight to meth.” Treatment providers reported that the street availability of prescription stimulants has Participants described typical illicit prescription stimulant remained the same during the past six months, while law users as college students, teenagers and “soccer moms.” A enforcement reported decreased availability. participant reported, “Anybody takes it, but it’s more like a younger person’s drug.” Community professionals described The BCI London Crime Lab reported that the number typical illicit users as high school and college students. A of amphetamine (Adderall®) cases it processes has law enforcement officer reported,This “ is definitely more increased during the past six months, while the number of of a younger generational thing … you don’t go above 35 methylphenidate (Ritalin®) cases has decreased. [years of age] … after this [age], people go to meth.”

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Ecstasy Reports of current prices for ecstasy and molly were reported by participants with experience buying the drug. Ecstasy (methylenedioxymethamphetamine: MDMA, or other derivatives containing BZP, MDA, and/or TFMPP) Current Prices for

remains moderately available in the region. Participants most Ecstasy/Molly often reported the current availability of the pressed tablet form of ecstasy as ‘5’ and of “molly” (powdered MDMA) as ‘7’ Ecstasy: on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly Low dose (aka “single stack”) $15-20 available, extremely easy to get); the previous most common scores were ‘2-3’ and ‘5,’ respectively. Treatment providers Molly:

most often reported the current availability of both ecstasy Ecstasy/Molly and molly as ‘5,’ while law enforcement most often reported 1/10 gram $10 the current availability of both drugs as ‘1-2;’ the previous most common scores from both treatment providers and law Participants indicated that molly is obtained through drug enforcement were ‘5’ for both ecstasy and molly. Treatment dealers or through Internet purchase. A participant stated, providers stated: “It’s available if you want it; There is just not “It’s called like the dark web … it’s where everyone gets their much of a demand for it; It’s very much a, ‘let’s go party’ seasonal [drugs] …. The kids will go on the Internet and order them.” drug.” Participants reported that the most common route of administration for both ecstasy and molly remains oral Participants and community professionals reported that consumption. Participants estimated that out of 10 ecstasy the availability of ecstasy and molly has remained the same and molly users, all 10 would orally consume the drugs. A during the past six months. A treatment provider stated, participant stated, “Most people I know would eat it because it “It’s not an everyday type of drug.” The BCI London Crime Lab burns too much [to snort].” reported that the number of MDMA (ecstasy/molly) cases it processes has increased during the past six months. Participants described typical ecstasy and molly users as individuals aged 15-30 years and college students. Reported Availability of Ecstasy Community professionals described typical ecstasy and molly Change during the Past 6 Months users as teenagers and college students. A law enforcement officer stated,I “ would say we have a lot of music festivals and Participants No change amongst the high school students whose parents are a little bit more trusting … [teenagers] are starting to use at the festivals Law enforcement No change … mixing with the college students.”

Ecstasy/Molly Treatment providers No change Other Drugs in the Athens Region Participants discussed the quality of ecstasy and molly and most often rated the current quality of ecstasy as ‘4,’ ‘5’ and Participants and community professionals listed a variety ‘7,’ and of molly as ‘7’ on a scale of ‘0’ (poor quality, “garbage”) of other drugs as being present in the region, but these to ‘10’ (high quality); the previous most common scores were drugs were not mentioned by the majority of people ‘1’ for ecstasy and ‘9’ for molly. Overall, participants reported interviewed: Anabolic steroids, inhalants, Neurontin® that the quality of ecstasy and molly has remained the same (gabapentin) and over-the counter (OTC) cough syrups. during the past six months. In addition, secondary data sources reported on other drugs not mentioned by respondents. The BCI London Crime Lab reported that the number of bath salts cases (synthetic cathinones; compounds containing methylone, mephedrone, MDPV or other chemical analogues, including alpha-PVP, aka “flakka”) and the number of psilocybin mushroom cases it processes have increased

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 73 Page 8 Surveillance of Drug Abuse Trends in the Athens Region during the past six months, while the number of DMT Neurontin® (dimethyltryptamine) and LSD (lysergic acid diethylamide) cases have decreased or remained the same. The lab also Neurontin® (gabapentin, an anticonvulsant reported it processed 21 cases of ketamine (an anesthetic and nerve pain medication) remains typically used in veterinary medicine) and 44 cases of highly available for illicit use in the region. U-47700 (synthetic opioid) during the past six months. Participants most often reported the current street availability of the drug as ‘10’ on a scale of ‘0’ (not available, impossible to get) Anabolic Steroids to ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants Reportedly, anabolic steroids are available for illicit use in commented: “Everyone’s getting prescribed them; Easy to the region. However, only a few law enforcement officers get a prescription.” Although law enforcement could not were able to discuss current availability, most often comment on the current street availability of Neurontin® reporting current availability of anabolic steroids for illicit in the region, treatment providers most often reported use as ‘3-4’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the current street availability as ‘10;’ the previous most previous most common score was not reported. A law common score was ‘7-8.’ Treatment providers remarked: enforcement officer commented,It’s “ mostly the gym crowd “We cannot really pinpoint when it got bad here because we [who use anabolic steroids]. We have a community center weren’t testing for it; They share [the drug].” [and] there are people selling it there and we have some high school athletes that have been alleged to be on it ….” Participants and treatment providers reported that the street availability of Neurontin® has increased during These law enforcement officers reported that the the past six months. Participants commented: “It’s not a availability of anabolic steroids for illicit use has decreased controlled substance yet; You normally get like a script of 30 during the past six months. An officer stated,We’ve “ [pills].” A treatment provider commented, “A lot of them prosecuted people, that has something to do with it, and have a prescription.” some more people are more scared now of purchasing it.” Law enforcement described typical anabolic steroids users as males who desire to be very muscular. Reported Availability ® Change during the Past 6 Months

Participants Increase Inhalants Inhalants (duster [DFE] and nitrous oxide [N2O], aka Law enforcement No comment

“whippets”) remain available for illicit use in the region. Neurontin However, participants were not able to rate the current Treatment providers Increase availability of inhalants for illicit use. Treatment providers most often reported the current availability of inhalants as Reports of current street prices for Neurontin® were ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ consistent among participants with experience buying the (highly available, extremely easy to get); the previous most drug. Reportedly, 600 mg sells for $0.50; and 800 mg sells common score was not reported. Treatment providers for $0.75-1. Participants reported that the most common commented: “It’s high availability; People who come to treatment have something to fall back on.” Law enforcement routes of administration for illicit use of Neurontin® are was not able to rate the current availability of inhalants for oral consumption and snorting. Participants estimated illicit use in the region. Treatment providers reported that that out of 10 illicit Neurontin® users, five would orally the availability of inhalants for illicit use has remained the consume and five would snort the drug. Treatment same during the past six months. providers described typical illicit Neurontin® users as aged 20-30 years, and more often female.

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OTCs for marijuana remains smoking, participants also reported orally consuming the drug in food products (aka “edibles”). Over-the counter (OTC) cough syrups remain available for illicit use in the region. A few treatment providers Participants and community professionals reported high reported the current street availability of cough syrups as current availability of methamphetamine. Participants ‘8’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ described the use of the drug to be as prevalent as (highly available, extremely easy to get); the previous most marijuana use: “Meth is the new marijuana in town, everyone common score was not reported. Treatment providers uses it; It’s cheap and easy to get … and it lasts a lot longer commented: “Always an issue; Usually if someone tests [the high produced is longer in duration than the highs positive for alcohol they say, ‘I took some Nyquil™;’ It’s not of other drugs]; The biggest epidemic is meth.” Treatment really considered [by users] as a drug of abuse. It’s something providers discussed that the increase in methamphetamine that is in the medicine cabinet.” consumption in the region is due to greater fear of death by heroin/fentanyl overdose. Law enforcement attributed increased availability of methamphetamine to their efforts to eliminate the opiate supply. Reportedly, methamphetamine is available in both Conclusion powdered and crystal forms throughout the region; however, participants reported that imported crystal Crack cocaine, heroin, marijuana, methamphetamine, methamphetamine is the most prevalent form of Neurontin® (gabapentin) and Suboxone® remain highly the drug. And, while participants described typical available in the Athens region; also highly available is methamphetamine users as anyone, community fentanyl. Changes in availability during the past six months professionals described typical users as rural individuals, include: increased availability for fentanyl, marijuana of low socio-economic status, aged 20 years and older, and methamphetamine; likely increased availability for and users addicted to opiates. Treatment providers also Neurontin®; and likely decreased availability for prescription discussed that some users receiving Vivitrol® (medication opioids. assisted treatment for opiate use disorder) continue illicit drug use with methamphetamine. There was consensus among participants and community professionals that fentanyl is highly available in the region. Lastly, Neurontin® remains highly available for illicit use in Participants stated: “Everyone has it; Everybody is putting the region. Participants and treatment providers reported fentanyl in everything.” In addition to high availability of that the street availability of Neurontin® has increased fentanyl, participants and community professionals also during the past six months. Treatment providers described indicated high availability of carfentanil. Participants typical illicit Neurontin® users as aged 20-30 years, and and treatment providers reported that the availability of more often female. fentanyl has increased during the past six months. However, according to participants, fentanyl is not generally sold in its powdered form or by itself; it is generally cut into other substances, or it is pressed into pill form and sold as prescription opioids. Participants reported that Roxicodone® 30 mg lookalikes pressed with fentanyl sell for $30-35. Participants and law enforcement reported that the availability of marijuana extracts and concentrates, often appearing as oil and waxy forms of the drug (aka “dabs”), has increased during the past six months. Regarding typical marijuana extracts and concentrates users, participants and treatment providers described them as people in their 20s. And, while the most common route of administration

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Page 76 OSAM Drug Trend Report June 2017 - January 2018 Surveillance of Drug Abuse Trends in the Cincinnati Region Surveillance of Drug Abuse Trends in the Cincinnati Region OSAM Ohio Substance Abuse Monitoring Network Drug Abuse Trends in the Cincinnati Region

Data Sources for the Cincinnati Region

This regional report was based upon qualitative data collected via focus group interviews. Participants were active and recovering drug users recruited from alcohol and other drug treatment programs in Butler, Hamilton, Lawrence and Ross counties. Data triangulation was achieved through comparison of participant data to qualitative data collected from regional community professionals (law enforcement) via focus group interviews, as well as to data surveyed from the Hamilton County Coroner’s Office, the Scioto County Coroner’s Office, OhioMHAS’ Screening, Brief Intervention and Referral for Treatment Regional Epidemiologist: (SBIRT) program which operates in federally qualified health centers in the region, and the Ohio Bureau of Criminal Investigation (BCI) London Kathryn A. Coxe, MSW, LSW Crime Lab, which serves central and southern Ohio, and the Ohio Department of Public Safety (ODPS), which logs drug task force seizures OSAM Staff: from across the state. All secondary data are summary data of cases processed from January through June 2017. In addition to these data R. Thomas Sherba, PhD, MPH, LPCC sources, Ohio media outlets were queried for information regarding OSAM Principal Investigator regional drug abuse for July through December 2017. Kathryn A. Coxe, MSW, LSW OSAM Coordinator Note: OSAM participants were asked to report on drug use/ knowledge pertaining to the past six months prior to the interview; Jessica Linley, PhD, MSW, LSW thus, current secondary data correspond to the reporting period of OSAM Quantitative Data Analyst participants.

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Regional Profile Indicator1 Ohio Cincinnati Region OSAM Drug Consumers Total Population, 2016 11,614,373 2,044,114 272 Gender (female), 2016 51.0% 51.0% 29.6% Whites, 2016 82.5% 82.1% 55.6% African Americans, 2016 12.8% 13.1% 25.9% Hispanic or Latino Origin, 2016 3.7% 2.8% 3.7% High School Graduation Rate, 2012-16 89.5% 89.1% 88.5%3 Median Household Income, 2012-16 $50,674 $48,412 Less than $12,0004 Persons Below Poverty Level, 2016 14.6% 14.2% 65.4%5

1 Ohio and Cincinnati region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018. 2 Statistics reflect the 27 participants who completed surveys. 3 High school graduation status was unable to be determined for 1 participant due to missing and/or invalid data. 4 Participants reported income by selecting a category that best represented their household’s approximate income for the previous year. 5 Poverty status was unable to be determined for 1 participant due to missing and/or invalid data.

Cincinnati Regional Participant Characteristics Consumer Characteristics N=27*

Male 19 Female 8 20s 7 30s 8

Gender 40s 4 50s 4 ≥60 4 Less than high school graduate 3 High school graduate 13 Some college or associate's degree 9 Education Bachelor's degree or higher 1 < $12,000 15 $12,000 to $19,999 5 $20,000 to $28,999 2 $29,000 to $36,999 2

Household Income ≥ $37,000 3 Alcohol 16 Cocaine, Crack 11 Cocaine, Powdered 9 Ecstasy/Molly 5 Heroin/Fentanyl 12 Marijuana 15 Methampehtamine 6

Drugs Used** Prescription Opioids 8 Prescription Stimulants 2 Sedative-Hypnotics 6 Suboxone®/Subutex® 3 Other Drugs*** 1

0 2 4 6 8 10 12 14 16 18 20 Number of Participants

* Not all participants filled out forms completely; therefore, numbers may not equal 27. **Some respondents reported multiple drugs of use during the past six months. ***Inhalants.

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Participants and law enforcement reported that the availability of methamphetamine increased during the Historical Summary reporting period. Participants explained that crystal methamphetamine (aka “ice”) was more available in In the previous reporting period (January - June cities while powdered methamphetamine (aka “shake- 2017), crack cocaine, fentanyl, heroin, marijuana, and-bake”) was more available in rural areas. Law methamphetamine, powdered cocaine, prescription enforcement reported crystal methamphetamine as the stimulants and sedative-hypnotics remained highly most prevalent form of the drug throughout the region. available in the Cincinnati region; also highly available The BCI London Crime Lab reported that the number of were prescription opioids and Suboxone®. Changes methamphetamine cases it processes increased during the in availability during the reporting period included: previous six months; the lab reported processing crystal increased availability for heroin, fentanyl, marijuana and methamphetamine as well as white and brown powdered methamphetamine; and decreased availability for bath methamphetamine. salts and prescription opioids. Reportedly, crystal methamphetamine was produced While participants and community professionals in “super labs” by drug cartels in Mexico and imported reported both heroin and fentanyl as highly available into the region, while powdered methamphetamine and increasing in availability during the reporting period, was produced locally by users. Participants mentioned they indicated that for many users, fentanyl was more purchasing pseudoephedrine (found in some allergy desirable. Reportedly, many users sought straight fentanyl medications) from pharmacies as often as legally allowed due to its known high potency. The Hamilton County in one month or paying individuals to purchase these Coroner’s Office reported that nearly half of the 219 drug- drugs for them in order to make methamphetamine: a box related deaths it recorded during the previous six months of pseudoephedrine typically sold for $50. involved fentanyl and fentanyl analogues, while 21% involved carfentanil. The most common route of administration for methamphetamine remained intravenous injection (aka The BCI London Crime Lab reported that the number of “shooting”). Participants and community professionals heroin cases it processes decreased during the reporting described typical methamphetamine users as white period, while the number of fentanyl/fentanyl analogue people, aged 20-40 years; participants also noted drug and carfentanil cases increased. In addition, the crime lab dealers and individuals in the gay community as typical and law enforcement reported the presence of U-47700, users. a synthetic opioid, in the region’s heroin/fentanyl market. Law enforcement discussed that synthetic opioids came Lastly, participants reported Neurontin® (gabapentin) as into the region via Internet shipments, primarily from highly available for illicit use in the region. Reportedly, China. Neurontin® 8 mg sold for $1 on the street. Participants described typical illicit Neurontin® users as opiate users The availability of high-grade marijuana, including who used the drug to help alleviate withdrawal symptoms. marijuana extracts and concentrates (aka “dabs”), increased during the reporting period. Law enforcement noted high-grade forms of marijuana in the region as originating from the legal dispensaries of other states, particularly Colorado. The Screening, Brief Intervention and Referral for Treatment (SBIRT) program reported that of the 385 individuals in the Cincinnati region who reported substance use during the previous 30 days, 74.3% reported using marijuana on one or more days. Participants reported that marijuana was sometimes laced with crack and powdered cocaine, fentanyl and heroin.

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and other regional roadways to intercept drugs in an effort to promote safer roadways; in total, officers seized 23.4 Current Trends grams of powdered cocaine, three grams of crack cocaine, 0.3 grams of heroin, 58.8 grams of fentanyl, 3.2 grams of methamphetamine, 1.6 grams of marijuana, 0.5 grams of Powdered Cocaine psilocybin mushrooms, and 405 grams of an unidentified brown powdered substance (www.recordherald.com, Dec. Powdered cocaine remains highly available in 6, 2017). the region. Participants most often reported the drug’s current availability as ‘10’ on a scale Participants reported that the availability of powdered of ‘0’ (not available, impossible to get) to ‘10’ cocaine has increased during the past six months. When (highly available, extremely easy to get); the participants were asked why the availability of powdered previous most common score was also ‘10.’ Participants cocaine has increased, several participants reported that commented: “I know a couple of people that have it all there’s been an increase in demand for the drug among the time; You can just make a phone call and it’s dropped heroin users. Participants discussed: “I have already had off (delivered to you);[Drug dealers] I knew had it all the about three people ask me in the past three weeks if I wanted time. They had both heroin and cocaine powder. Some of some; Cocaine used to be super expensive and super ‘cut’ them preferred powder cocaine … I think they could make (adulterated) … like 10 years ago it was bullshit, and it’s back more money off of that than heroin; Nowadays [powdered to being good … so we all want it again … we mix it [with cocaine] goes hand-in-hand with heroin.” Community heroin] and make ‘speedballs’ (concurrent or consecutive use professionals most often reported the current availability of cocaine and heroin) … people that do heroin also like to of powdered cocaine as ‘9;’ the previous most common get cocaine; [Heroin users] like to have that extra to ‘stay up’ score was ‘10.’ A law enforcement officer stated,You “ (increased awareness), so it’s pretty much goin’ hand-in-hand might not be able to walk down the street and pick it up like with [heroin].” heroin or fentanyl, but it wouldn’t take long for you to find Law enforcement reported that the availability of somebody that could [sell you powdered cocaine].” powdered cocaine has remained the same during the Corroborating data indicated that powdered cocaine is past six months. Law enforcement commented: “It’s available in the region. The Screening, Brief Intervention probably not as prevalent as heroin, but it’s up there; It’s never and Referral for Treatment (SBIRT) program reported gone away; It’s still prevalent.” The BCI London Crime Lab that of the 478 individuals in the Cincinnati region who reported that the number of cocaine cases it processes reported substance use during the past 30 days, 19.5% has increased during the past six months; the lab does not reported using cocaine on one or more days (SBIRT does differentiate between powdered and crack cocaine. not distinguish between powdered and crack cocaine). Reported Availability

The Hamilton County Coroner’s Office reported that 39.2% of the 291 drug-related deaths it recorded this reporting Change during the Past 6 Months period involved powdered and/or crack cocaine. In addition, the Ohio Department of Public Safety (ODPS) Participants Increase reported 28 drug task force seizures of powdered cocaine Law enforcement No change in the Cincinnati region during the reporting period. Cocaine Powdered Powdered Media outlets reported on law enforcement seizures Treatment providers No comment and arrests in the region this reporting period. Law enforcement in Hamilton County arrested a man after Participants most often rated the current overall quality executing a search of the man’s house, his business and of powdered cocaine as ‘6’ on a scale of ‘0’ (poor quality, his girlfriend’s home, finding 1.3 kilograms of cocaine, an “garbage”) to ‘10’ (high quality); the previous most unspecified amount of methamphetamine and firearms common score was ‘7.’ While participants reported the (www.wcpo.com, Sept. 13, 2017). Multiple state, county current quality of powdered cocaine as moderate, they and local law enforcement agencies conducted a three- explained that there is a lot of inconsistency in quality day collaborative drug interdiction effort on Interstate 71 among dealers. Participants discussed: “It’s different

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between people; Right … not every dealer the same … it’s stated, “It depends on the quality. You could buy like 60 coming from a chain and once it gets down to that bottom bucks a gram for regular or if you want to get what some call person they already put something in it to ‘cut’ (adulterate) the ‘pure’ … $100 dollars a gram….” Another participant it; You never know, this person might have pure stuff one day, shared, “When I was bar tending, it was just given to me.” and the next day it’s completely cut.” Participants could not agree whether prices for powdered cocaine have changed during the past six months. Participants discussed adulterants (aka “cuts”) that affect the quality of powdered cocaine and reported the top Current Prices for cutting agents as: baby formula, baby laxatives, baking Powdered Cocaine soda, fentanyl and carfentanil. Participants stated: “They’ll buy an ounce of the good stuff and mix it with three ounces 1/10 gram $10 of freaking baby [formula]; There’s cocaine down here with fentanyl … it’s to get you addicted to their cocaine … so in 1/2 gram $20-50 Cocaine

other words, you think you’re doing cocaine, but yet … it’s Powdered A gram $60-100 more fentanyl than it is cocaine; They cut everything with 1/8 ounce (aka “eight ball”) $100-350 fentanyl.” Other adulterants mentioned included: brick dust, ether, Participants reported that the most common routes of fingernail polish remover, heroin, Kool-Aid®, Orajel™, administration for powdered cocaine remain intravenous powdered sugar, prescription opioids, Tylenol® and injection (aka “shooting”), followed by snorting and then vitamin B-12. Participants commented: “There’s all kinds of smoking. Participants estimated that out of 10 powdered shit they cut it with; Anything that they can find inside their cocaine users, 5-6 would shoot and 4-5 would either snort medicine cabinet; I’ve seen them cut it with Orajel™ just to or smoke the drug. One participant commented, “If they make it seem more numbing like it’s the real stuff; I’ve seen are a heroin addict, they probably just going to inject it. If them put brick dust in it. Yeah, damn brick dust … you never they want to just be a cocaine addict, then they might just heard of that?” Overall, participants reported that the snort it, unless their nose is messed up.” There was discussion quality of powdered cocaine has decreased during the that smoking powdered cocaine generally meant rocking past six months, primarily due to dealers adulterating the the drug into crack cocaine. However, a few participants drug to increase their profits. They said: Yeah,“ I’m dead discussed free-basing powdered cocaine, explaining serious … anything to stretch it out and make more money. that to do this a user would heat the drug on aluminum They don’t care about the addicts … they care about their foil and inhale the resulting vapors through a straw. In pockets; You don’t even get that numbing … it’s supposed to addition, one participant shared, “Every once in a while make your feet tingle if it’s good; It ain’t what it used to be.” somebody might lace a ‘joint’ (marijuana cigarette) … like sprinkle [powdered cocaine in] one [to smoke].”

Cutting Agents A profile for a typical powdered cocaine user did not Reported by Crime Lab emerge from the data. Participants described typical l levamisole (livestock dewormer) powdered cocaine users as anyone; however, several l local anesthetics (benzocaine, lidocaine participants noted that a user would have to have the Cocaine

Powdered Powdered and procaine) financial means to afford the drug. They commented:It’s “ a rich man’s drug; I mean you’re not going to have teachers shooting up [cocaine] on their lunch breaks; There’s a lot of Current prices for powdered cocaine were reported by people that own companies and businesses that you know participants with experience buying the drug. Reportedly, sniff cocaine at the job; In this town you got lawyers and the most common quantities of purchase are a gram and doctors [using powdered cocaine]; That’s the word on the 1/8 ounce (aka “eight ball”). Participants discussed that street that all the lawyers and judges are on it in this town; It’s pricing varies depending upon the dealer and the amount easier to be a functioning addict on cocaine.” of purchase. Some participants noted that the more one buys, the better the price. Others explained that pricing is Community professionals also described typical powdered dependent upon the quality of the drug. One participant cocaine users as anyone, while noting more male than

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 81 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region female users. They stated: “It’s across the board. I don’t know Drug Enforcement Agency (DEA) officers collaborated to if you can peg it to one specific age group or ethnicity. We’re execute a search warrant at a home in Chillicothe (Ross finding it on everybody; It’s mostly male, but I wouldn’t say County), arresting three men after finding 43 grams of crack that you can nail it down to a race; We’re seeing … white, cocaine, 21 grams of powdered cocaine and cash; during black, Hispanic.” separate investigations, Chillicothe Police, Circleville Police, OSHP and U.S. DEA officers confiscated 10 grams of crack cocaine, 100 grams of heroin and 30 grams of marijuana Crack Cocaine during traffic stops; in yet another investigation, officers arrested four people during the execution of a search Crack cocaine is moderately to highly available in the warrant at a residence in Chillicothe after seizing seven region. Participants most often reported the drug’s current grams of crack cocaine, 80 grams of heroin and cash (www. availability as ‘10’ on a scale of ‘0’ (not available, impossible chillicothegazette.com, Dec. 6, 2017). to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants Participants reported that the availability of crack cocaine discussed: “It is everywhere; All you got to do is go to a corner has remained the same during the past six months. However, … and bam [you will find crack cocaine];There’s quite a few a couple of participants perceived a slight decrease in the dealers and there’s a lot of people using it; The projects … you availability, and stated: “A lot of people are selling it … I think just drive up in there and [crack cocaine dealers] flock to your it’s less people using it now though; A lot of people switched over car; I’ll tell you how available it is. If you step into Hamilton or to heroin.” Law enforcement reported that the availability Middletown [Butler County], either one, and throw a rock in any of crack cocaine has increased during the past six months. direction you’re going to hit a crack house. That’s how available They discussed: “We have seen more crack lately than we it is; You can get it probably damn near everywhere.” have in a long time; There’s more availability there, I’d say, now than I remember. It used to be you could walk down the Community professionals most often reported the current street and find somebody with crack on them, and then it like availability of crack cocaine as ‘5;’ the previous most common disappeared … and now it’s definitely coming back; There’s a score was ‘9-10.’ Law enforcement commented: “Lower theory that people are trying to use [crack cocaine] and ‘meth’ [availability] than (powdered) cocaine; I think we have to look (methamphetamine) … to detox and try to get off of heroin….” for it to find it.” However, a couple of law enforcement officers The BCI London Crime Lab reported that the number of discussed that with the current high availability of powdered cocaine cases it processes has increased during the past six cocaine in the region, it would be easy for those desiring months; the lab does not differentiate between crack and crack cocaine to manufacture the drug themselves. They said: powdered cocaine. “It’s not rocket science how to convert [powdered cocaine to crack]. … If you want crack, you can just buy coke and make it Reported Availability yourself; YouTube is very powerful [you can find how-to videos Change during the Past 6 Months online]; Google [how to make crack cocaine].” Corroborating data indicated that crack cocaine is available Participants No change in the region. The SBIRT program reported that of the 478 individuals in the Cincinnati region who reported substance Crack Law enforcement Increase Cocaine use during the past 30 days, 19.5% reported using cocaine on one or more days (SBIRT does not distinguish between crack Treatment providers No comment and powdered cocaine). The Hamilton County Coroner’s Office reported that 39.2% of the 291 drug-related deaths Participants most often rated the current overall quality it recorded this reporting period involved crack and/or of crack cocaine as ‘8-10’ on a scale of ‘0’ (poor quality, powdered cocaine. In addition, the ODPS reported 17 drug “garbage”) to ‘10’ (high quality); the previous most common task force seizures of crack cocaine in the Cincinnati region score was ‘6.’ While the majority of participants reported during the reporting period. high current quality of the drug, most discussed that crack Media outlets reported on law enforcement seizures and cocaine requires recooking in order to remove impurities arrests in the region this reporting period. Circleville Police (adulterants). Comments included: “You have to cook it down (Pickaway County), Ross County Sheriff’s officers and U.S. … to make it more pure … it’s not like it used to be back when

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they started crack; They are trying to find more stuff that they Current Prices for can add to it to make it look like it’s more, and to make you think Crack Cocaine

you’re getting some kind of cocaine affect … their doing all kinds of stuff to it to make it less cocaine and more of something 1/10 gram $20 else … to trick you.” A gram $40-120 Crack Crack

Participants discussed adulterants (aka “cuts”) that affect the Cocaine quality of crack cocaine and reported that the top cutting 1/16 ounce (aka “teener”) $80-90 agent for the drug remains baking soda. Other adulterants 1/8 ounce (aka “eight ball”) $150-200 mentioned included: aspirin, baby formula, baby laxatives, baby powder, chalk, coffee creamer, fentanyl, ibuprofen, isotol (dietary supplement), Orajel™, rat poison, Seven-Up®, Participants reported that the most common route sleeping pills and vitamin B-12. Participants commented: of administration for crack cocaine remains smoking. “Orajel™! Stuff like that they add to it to make you get the Participants estimated that out of 10 crack cocaine users, numbness of the cocaine; Any kind of medication that numbs 6-9 would smoke and 1-4 would intravenously inject (aka your mouth; Anything white and powdery that they have on “shoot”) the drug. However, one participant remarked, hand at the time.” In addition, a participant shared, “Sometimes “I snorted just because I love to snort.” Many participants they’ll try to sell you fake crack … they’ll have you wanting to discussed intravenous injection: “I always preferred to shoot kill somebody. But then you remember you don’t want to go [crack cocaine] when I did it. Of course, once you get hooked on to jail, so you don’t kill them.” Participants reported that the the needle, you prefer to shoot anything you can if you can; You overall quality of crack cocaine has either remained the same can melt it back down but … you got to have something to keep or decreased during the past six months. One participant it liquid; Crack by itself isn’t injectable unless you put … vinegar remarked, “They ‘stepping on’ (adulterating) it with all kinds of on it; They mix it with Kool-Aid® to make it injectable.” shit.” A profile for a typical crack cocaine user did not emerge from the data. Participants and community professionals

Cutting Agents described typical users as anybody. A participant Reported by Crime Lab commented, “It could be your son, daughter, doctor, or judge, policeman, anybody … drugs do not discriminate.” A law l levamisole (livestock dewormer) enforcement officer stated, “It’s kind of a problem across Crack Crack l local anesthetics (benzocaine, lidocaine Cocaine the board …. We have seen a mix of all kinds of people that and procaine) have had it.” Lastly, participants indicated that heroin users receiving Vivitrol® as medication assisted treatment use crack Reports of current prices for crack cocaine were consistent cocaine. They said: “A lot of people that do the Vivitrol® shot among participants with experience buying the drug. are using [crack cocaine]; [Vivitrol®] don’t block crack; You can Reportedly, the most common quantites of purchase are get high on other drugs just not opiates when you’re taking the a $20 piece (aka “rock”) and a gram. Participants discussed Vivitrol® shot; [Vivitrol®] only blocks opiates.” that often users will exchange stolen items for the drug. A participant commented, “If you got [crack cocaine] and somebody wants it bad enough … they will give you a 50-inch TV for a ‘20’ ($20 rock).” Overall, participants reported that Heroin the price of crack cocaine has decreased during the past six months. Heroin remains highly available in the region. Participants most often reported the current availability of the drug as ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants commented: “It’s available at every stoplight, street corner … anywhere you wanna pull over, it’s there; It’s the going drug now, so it’s poppin;’ It’s easier to get than ‘pot’ (marijuana); Guarantee

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 83 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region there’s somebody here right now with probably some of it seat with the truck running; officers found heroin, pills in the pocket of their pants.” In addition, one participant and drug paraphernalia in the truck, but reported that remarked, “In my opinion, heroin is easier to get than it is to the man did not need Narcan® to be revived (www.wtol. get medicine for your child.” Participants who reported low com, July 13, 2017). Cincinnati public health officials current availability of heroin noted fentanyl as supplanting issued a warning regarding fentanyl after 22 overdoses heroin in the region. They said: “Now it’s all fentanyl; I don’t were reported in a 24-hour period in Cincinnati; the know how much luck you’ll have going to find heroin [that’s Hamilton County Coroner reported a total of 313 overdose not adulterated with fentanyl].” deaths this year to date in the county (www.nbc4i.com, Aug. 9, 2017). Scioto County detectives arrested a couple Community professionals most often reported the current responsible for trafficking heroin in Ohio, Kentucky, West availability of heroin as ‘10;’ the previous most common Virginia and Michigan; officers located the couple after score was also ‘10.’ However, there was agreement among tracking their stolen cellphones and found them at a law enforcement officers that much of the heroin supply is fast food restaurant in West Virginia (www.dispatch.com, fentanyl or adulterated with fentanyl. An officer remarked, Aug. 29, 2017). Law enforcement in Hamilton County “Yeah 99% of the time it’s mixed [with fentanyl] … but heroin arrested two men during a traffic stop on Interstate 74 in is ‘10’ (highly available) everywhere.” Whitewater Township after seizing 6.6 pounds of heroin Corroborating data indicated that heroin is available from their vehicle; officers learned the men were part of in the region. The SBIRT program reported that of the an organization where heroin was shipped from Chicago 478 individuals in the Cincinnati region who reported to Cincinnati for distribution (www.local12.com, Sept. 1, substance use during the past 30 days, 32.8% reported 2017). Law enforcement in Warren County responded to using heroin on one or more days. The Hamilton County a call from an 11-year-old girl reporting she thought her Coroner’s Office reported that 47.1% of the 291 drug- mother had a seizure as her mother was unresponsive; related deaths it recorded this reporting period involved officers arrived at the residence and found the woman heroin; of these heroin-related deaths, 74.5% also involved overdosed from opiates and administered Narcan® to fentanyl. The Scioto County Coroner’s Office reported revive her before taking her to a nearby hospital (www. that 19.4% of the 31 drug-related deaths it recorded wkbn.com, Sept. 29, 2017). Middletown Police responded this reporting period involved heroin. In addition, ODPS to a call regarding a suspicious vehicle sitting in the reported 62 drug task force seizures of heroin and/or driveway of a residence and found a woman overdosed fentanyl in the Cincinnati region during the reporting in the vehicle; officers searched the home and found two period; drug task forces did not typically differentiate additional people overdosed; the three individuals, a between heroin and fentanyl due to the high incidence of mother, daughter and son, all refused medical treatment heroin-fentanyl mixtures. and told police they took their medications and had not overdosed; officers reported they visited the home Media outlets reported on law enforcement seizures and over 40 times in the last few months and hoped to arrests in the region this reporting period. Ohio State resolve the situation using a nuisance ordinance (www. Highway Patrol (OSHP) arrested a woman after responding daytondailynews.com, Oct. 6, 2017). A Warren County to a call that she crashed her car into five parked cars in prosecutor charged two inmates of the Lebanon Middletown (Butler County) and finding that the woman Correctional Institute with drug trafficking after prison and her two passengers were unresponsive due to heroin guards witnessed one inmate give heroin to another overdose; officers called emergency crews to the scene, inmate; the prosecutor charged the other inmate with who administered Narcan® (naloxone, opiate overdose drug possession after the man needed to be revived with reversal medication) to revive the three individuals (www. Narcan® after overdosing and prison staff found fentanyl whio.com, July 1, 2017). OSHP in Butler County arrested a and cocaine in his possession (www.daytondailynews. man after responding to a crash on Interstate 75 in West com, Oct. 9, 2017). Scioto County Sheriff’s Office, Chester Township and finding a man unresponsive in the Portsmouth Police (Scioto County), the Federal Bureau of driver’s seat of his car due to a heroin overdose (www. Investigation (FBI) and the Southern Ohio Drug Task Force whio.com, July 1, 2017). Law enforcement in Hamilton arrested four people after executing a search warrant at County responded to a call at a gas station in Cleves and two residences in Otway (Scioto County) and seizing 44 found the driver of a fuel truck overdosed in the driver’s grams of heroin, 14 grams of crystal methamphetamine,

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an unspecified amount of marijuana, oxycodone pills, cash people (heroin dealers) all the time, so I’d say it’s probably and firearms www.portsmouth-dailytimes.com( , Oct. 13, the same [high availability] or increased.” Participants who 2017). Middletown Police located and arrested a father/ reported increased availability said: “Increased … easy for son duo responsible for providing heroin to a woman me to get; That shit goin’ up every day; I could get it every who overdosed and died in her home in front of her nine single day, anytime between 6 am and 10 pm; It’s more children; the men also overdosed, but woke up and stole socially acceptable to use heroin [than previously].” money and other items from the woman’s purse while Law enforcement indicated that the high availability of arguing with her children, and leaving a loaded needle heroin has remained the same during the past six months. within reach of the children (www.nbc4i.com, Dec. 14, Officers commented:There’s “ hot spots all over the city 2017). Portsmouth Police responded to a call regarding a (Cincinnati) … just drive around and somebody will come juvenile runaway and searched the apartment where the up to your car [and offer heroin for sale];‘Over -the- Rhine’ juvenile lived after receiving consent from a woman that (an inner-city neighborhood of Cincinnati) still has a ton of only herself and her 2-year-old were in the home; however, it.” The BCI London Crime Lab reported that the number officers found two other adults and confiscated 375 grams of heroin cases it processes has decreased during the past of heroin found inside a bedroom closet, arresting all three six months; the lab reported processing beige, brown, adults (www.portsmouth-dailytimes.com, Dec. 18, 2017). tan and white powdered heroin along with black tar While many types of heroin are currently available in heroin. However, the lab noted that it does not typically the region, participants continued to report powdered differentiate between black tar and powdered heroin. heroin as most available. Colors for powdered heroin mentioned included: brown, gray, off-white, pink, purple, Reported Availability tan and white (aka “china white”). Participants indicated Change during the Past 6 Months that white powdered heroin is perhaps most available. They commented: “I’ve gotten brown a couple of few times, Participants No consensus but mostly it was white; It’s china white … just like a white

powdery substance. You would probably think it was fentanyl Heroin Law enforcement No change because that’s how much it looks like it; Carfentanil usually has like a tan color to it; But there’s regular heroin … straight Treatment providers No comment heroin that also has a tan color to it, too.” Community professionals also reported powdered Participants most often rated the current overall quality heroin as the most available heroin type in the region. of heroin as ‘7’ on a scale of ‘0’ (poor quality, “garbage”) to Law enforcement commented: “We’re not seeing black tar ‘10’ (high quality); the previous most common score was [heroin]; We have not seen black tar in a long time. It’s all ‘10.’ However, participants discussed that the quality of powder; Brown and gray … it’s all kinds of different colors.” heroin varies dependent upon the dealer and the location of purchase. They said: “Quality of it? It varies. It depends Similar to law enforcement, participants also reported on who you get it from; I always got the great stuff, but I had black tar heroin as difficult to obtain. They discussed: to go out of town [to Dayton] for it … I got it out of town “[Black tar heroin is] very difficult to get; It’s hard to find black because you couldn’t get the good stuff here; I mean even tar in this town; You can get it a lot in Columbus but not down costing another 30-40 bucks in gas … it was still worth going here … I don’t know why; Yeah, I have lived here for 3 ½ years and spending that much extra to get something that wasn’t and I have never found black tar in this town, but I found it a ‘cut’ (adulterated) to hell … really you’re only buying a half a lot in Columbus; It used to be that’s all that was around here gram if you’re buying a gram around here … it’s cut at least and then it all went to powder. I guess ‘cause it’s easier to cut that much.” (adulterate powdered heroin).” Participants discussed adulterants (aka “cuts”) that affect Participants were not in agreement as to whether the the quality of the drug and reported the top cutting availability of heroin has increased or remained the same agents for heroin as fentanyl and carfentanil. Participants during the past six months. One participant stated, “You remarked: “The majority of it’s cut with fentanyl; You would know I haven’t used in a while but I still get approached by be surprised by how many people, especially in this area,

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 85 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region overdose on heroin and their blood be tested and they have everything … it could be expensive or it can be cheap; If no heroin in their system; Fentanyl’s killing everybody.” you a return customer, they give you a deal; You get 2 for 1; I would get like a $20 discount to buy a gram instead of a half Other adulterants mentioned included: baby formula, gram; If you buy more quantity, you’re gonna get a cheaper baby laxatives, battery acid, benzodiazepines, brick dust, price.” Participants also discussed driving dealers around or chalk, crack/powdered cocaine, cosmetics, Goody’s® letting dealers use their cars in exchange for heroin. Powder pain relievers, inositol (dietary supplement), instant coffee, kratom (mitragynine, a psychoactive plant Participants were not in agreement as to whether the substance), lactate powder, lactose, laxatives, lithium, price of heroin has decreased or increased during the past mannitol (diuretic), marijuana, methamphetamine, six months. Participants who reported decreased pricing Orajel™, powdered sugar, prescription opioids, rat poison, cited increased dealer competition for customers as the sleeping pills and vitamin B-12. Participant comments reason for the lowering of prices. They discussed dealers included: “You can cut it with morphine; Pain killers; If the giving away “get wells” (small amounts of the drug given to heroin is no good, they will cut it with Xanax® to make it feel regular customers in obvious withdrawal) and “testers” (free like it’s giving you that numb; I’ve seen people cut it with brick samples).” dust. I’ve seen people cut it with rat poison; Literally, cutting it with rat poison … I’ve seen it done.” Current Prices for

Heroin Overall, participants reported that the quality of heroin has decreased during the past six months. One participant Powdered: stated, “It don’t even seem like there’s real heroin. I’ve heard 1/10 gram $10-20 so many people say like when they tested it to see what they Heroin 1/2 gram $50-100 had in it, it didn’t even have ‘dope’ (heroin) in it most of the time … they’ve been using garbage.” A gram $90-150 The most common route of administration for heroin Cutting Agents remains intravenous injection (aka “shooting”). Participants Reported by Crime Lab estimated that out of 10 heroin users, 7-8 would shoot and 2-3 would snort the drug. Participants commented: “I l acetaminophen enjoyed shooting it; I snorted it for years before I shot it; Not l artificial sweeteners (sorbitol and lactose) me, I went straight to the needle.” Participants reported that l caffeine injection needles (aka “points”) sell two for $5-10 on the l cocaine street. They also noted use of needle exchange programs Heroin l diphenhydramine (antihistamine) where a used needle is traded for a new needle. In l dipyrone (banned analgesic) addition, participants discussed smoking heroin, albeit this l fentanyl/fentanyl analogues route of administration was thought to be uncommon. l mannitol (diuretic) They said: “I heard people actually smoke it, too; It’s gotta be l quinine (antimalarial) real, real good for you to get high off it [by smoking]; You’re wasting your money if you smoke it; I’ve seen people smoke it Current prices for heroin were reported by participants … not a lot; They shoot it, but once their veins collapse, they with experience purchasing the drug. Reportedly, the smoke it….” most common quantities of purchase are 1/2 gram and a gram. Participants noted that heroin comes in folded Participants described typical heroin users most often as lottery tickets, plastic bags and capsules. They reported anybody. They said: “It doesn’t discriminate; Every human that capsules filled with heroin typically sell for $10. being; Oh my God, I have hung out with teenagers to old Participants discussed that better prices for heroin are … like 70-year-old people [using heroin]; It’s all walks of obtained if the user has a relationship with the dealer, and life … professional people and even college students using if the user buys larger amounts of the drug at one time. it; Professionals … nurses, doctors, lawyers, judges.” One Participants said: “[Heroin is] kind of like crack … [pricing] participant remarked, “I don’t think there’s any one way to depends on who you go to and whether they know you and describe someone who uses heroin.”

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While participants described anybody as a heroin user, carfentanil. In addition, ODPS reported 62 drug task force they continued to note use primarily among white people. seizures of heroin and/or fentanyl in the Cincinnati region They commented: “More white people, but I know a couple during the reporting period; drug task forces did not of black people. I know some Hispanic people [who use typically differentiate between heroin and fentanyl due to heroin]; It does not discriminate, but it does seem like there’s the high incidence of heroin-fentanyl mixtures. more Caucasian people using it; More Caucasian users, but you got a heck of a lot of African-American [heroin] Media outlets reported on law enforcement seizures dealers; Most of the dealers are African American but not and arrests in the region this reporting period. A federal users though.” Community professionals described typical grand jury in Cincinnati (Hamilton County) indicted 16 heroin users as primarily white males. Law enforcement people for their involvement in a fentanyl trafficking discussed: “We see male, whites; About 60% of the overdoses ring, and for money laundering and firearm offenses; in Hamilton County are male, whites.” the group distributed over 400 grams of fentanyl from September 2016 to June 2017 (www.wcpo.com, July 20, 2017). A Clermont County judge sentenced a man Fentanyl to six years in prison for providing carfentanil to two people that resulted in their overdoses at a residence in Fentanyl is highly available in the region. Union Township; emergency crews revived both people Participants most often reported the current using Narcan® before taking them to a local hospital for availability of the drug as ‘10’ on a scale of medical care (www.local12.com, July 20, 2017). A Brown ‘0’ (not available, impossible to get) to ‘10’ County grand jury indicted four people responsible (highly available, extremely easy to get); for providing fentanyl to a man who overdosed and the previous most common score was not reported. died from taking the drug in Mount Orab; two of the Participants commented: “There’s a lot, a lot of fentanyl people were also charged with heroin trafficking as a out there; Fentanyl is more available than regular heroin is result of the incident (www.wcpo.com, July 28, 2017). anymore; Probably the easiest thing to get out of everything A man plead guilty in federal court in Cincinnati after I would imagine right now; I knew what house to go to [to admitting to distributing heroin laced with carfentanil obtain fentanyl] … and that’s exclusively what he sold; I live that resulted in a rash of overdoses, several of which in Clermont County … it’s out there; All I had to do was walk were fatal; the man also admitted to attempting to like next door pretty much [to get fentanyl]; I can be walking murder a key witness in the case (www.cincinnati. to the store in one neighborhood … it’s on every corner.” com, Sept. 8, 2017). Middletown Police (Butler County) arrested five people, one of whom was a juvenile, after Community professionals also most often reported the responding to a shooting at a residence in Middletown; current availability of fentanyl as ‘10;’ the previous most officers conducted a search of a nearby home and found common score was not reported. Law enforcement unspecified amounts of fentanyl, marijuana and cash discussed: “It’s the same availability as heroin; The problem (www.wlwt.com, Sept. 29, 2017). A man was sentenced is [that] even when you’re buying heroin, almost every in federal court in Cincinnati to approximately 20 years single time now it’s mixed with fentanyl or carfentanil or in prison for providing fentanyl to another man that a synthetic fentanyl of some kind. So, heroin is usually not resulted in the man’s overdose death (www.fox19.com, straight heroin; We’ve had 12 different varieties of fentanyl in Oct. 5, 2017). Cincinnati Police Violent Crimes Squad, Hamilton County.” U.S. DEA, OSHP and United States Attorney’s Office for the Southern District of Ohio executed multiple search Corroborating data indicated that fentanyl is available in warrants across Cincinnati, arresting three people after the region. The Hamilton County Coroner’s Office reported seizing 21 pounds of heroin-fentanyl mixtures (www. that 58.1% of the 291 drug-related deaths it recorded this fox19.com, Nov. 22, 2017). A federal judge sentenced a reporting period involved fentanyl/fentanyl analogues, Cincinnati man to approximately 17 years in prison and while 20.6% involved carfentanil. The Scioto County ordered him to pay funeral costs for providing fentanyl Coroner’s Office reported that 48.4% of the 31 drug- that resulted in the unintentional overdose death of related deaths it recorded this reporting period involved a 17-year-old youth; during the investigation, officers fentanyl/fentanyl analogues, while 19.4% involved seized large quantities of fentanyl, cocaine, a firearm and

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 87 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region ammunition from the defendant (www.nypost.com, Nov. Reported Availability 24, 2017). Norwood Police (Hamilton County) found a Change during the Past 6 Months woman dead in her home after a federal pretrial services officer requested a check on the woman since her tracking Participants Increase device indicated she had not left her home in three days; officers placed the device on the woman after she was Law enforcement Increase arrested in June for buying weekly shipments of at least Fentanyl two grams of fentanyl from the Internet to sell in the area; Treatment providers No comment although the woman used the drug daily, the cause of her death was undetermined (www.wcpo.com, Dec. 8, 2017). The Southern Ohio Drug Task Force, along with the Participants most often rated the current overall quality of Scioto County Sheriff’s Office, Portsmouth Police (Scioto fentanyl as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to County) and the FBI conducted investigations in Scioto ‘10’ (high quality); the previous most common score was County that lead to the arrest of 33 individuals responsible not reported. Participants stated: “Strong and short lived; for trafficking fentanyl, carfentanil, heroin and crystal A lot of people when they go buy heroin, they use too much methamphetamine in Scioto County; during the course of … and then they turn around and buy it with the fentanyl, the investigation, officers seized 500 grams of suspected the carfentanil, thinking they can use that same amount heroin, 100 grams of suspected methamphetamine, and that’s what kills them….” In terms, of cutting agents for firearms and large quantities of cash www.wowktv.com( , fentanyl, participants explained that fentanyl is typically Dec. 13, 2017). a cut for other drugs, such as heroin and cocaine. One participant shared, “When I first starting coming here (to Participants and law enforcement reported that the treatment) this time, my first week worth of drug tests … availability of fentanyl has increased during the past six heroin should have been in my system … there was no heroin months. Participants and law enforcement attributed the in my system because it was pure fentanyl that I was buying increased availability of fentanyl to the ease with which that I thought was heroin.” Overall, participants reported the drug can be purchased, increased supply and demand, that the quality of fentanyl has remained the same during as well as the higher profitability of selling fentanyl over the past six months. heroin. Participants discussed: “You can buy it anywhere. You can buy it online; A lot of it’s getting shipped [to Ohio]; Participants and community professionals noted high You can buy a lot, ‘cut it down’ (adulterate it) a lot, and make numbers of overdoses in the region and lives saved with way more money [selling fentanyl] than [selling] heroin. It’s Narcan®. One participant shared, “When I was bartending, cheap; It’s cheap … and it’s a good replacement for heroin.” a girl came in and was doing cocaine, she went out (passed Law enforcement commented: “It’s just a lot more of it; They out) in the bathroom, and she needed to be revived. Her can acquire it cheaper and it’s obviously more powerful than friends were like, ‘She OD’d (overdosed) on cocaine!’ And, heroin; Plus, you can get a little bit and cut it and you got a it’s like, really? And then they ‘narcaned her’ (administered kilo (kilogram).” Narcan® to her) and she came back … she had never done heroin in her life, so there was fentanyl in her cocaine; [I know The BCI London Crime Lab reported that the number of a woman] she actually carries Narcan® on her because she’s fentanyl and fentanyl analogue cases it processes has such an active user. She’s 21-years old and she has OD’d at increased during the past six months; the lab also reported least 10 times since she was 14 [years old].” Law enforcement an increase in the number of carfentanil cases. discussed: “They say carfentanil is 10,000 times more potent than heroin … I think that’s the most powerful fentanyl out there so far; Our numbers [of overdose deaths] are up about 65% this year; We had two fatals (overdose deaths) this morning; We have a dependent population … there’s a certain market [for fentanyl] here. Either 1 of 2 things happen: they either get into treatment or they die.”

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Both participants and law enforcement indicated Narcan® Prescription Opioids as available and accessible in the region. Participants reported: “My daughter’s brother said … some dealer’s will Prescription opioids remain highly available for illicit use sell heroin and Narcan®; Yeah, they been doing it that way. in the region. Participants most often reported the current Just in case they OD, they have the Narcan® … so, people street availability of these drugs as ‘8-10’ on a scale of ‘0’ are buying not just the heroin, they are buying the Narcan®, (not available, impossible to get) to ‘10’ (highly available, too; They’re putting them in Walgreens … they’re putting extremely easy to get); the previous most common score them on the shelves to sell as an over-the-counter medicine; was ‘10.’ Participants commented: “They’re real popular And at least in Middletown [Butler County] … if you are around here; I think they be a ‘10’ because you can get them admitted for an overdose, they will send you home with a on the street or legally; I think it was in just a year they wrote Narcan®; They’ll always send you home with a prescription 5 million [opioid] prescriptions [in Huntington, WV, across or they’ll just go ahead and get it out of their pharmacy.” the Ohio River from Lawrence County, Ohio]; You can get Law enforcement reported: “You can go to Kroger’s and get it anywhere, on any corner just like you can heroin; You can one [Narcan®]; It’s free here in Hamilton County. There was get it in the store or the street. So, it’s unlimited … ain’t it?” a grant … I don’t know what the dollar amount was, but it’s Participants identified Percocet® as the most available everywhere; They flooded the market in Hamilton County prescription opioid in terms of widespread illicit use. … where the [naloxone] projects are, anybody that wants a Narcan® that has been addicted, they can get it. So, you’re While participants reported high current availability of seeing a lot of saves where the cops and the fire men are prescription opioids, the consensus among participants called. So, yes, I’m sure it’s helping, but those people that are was that heroin is more available and easier to obtain using, a lot are dying still.” than doctor prescribed opioids. Community professionals did not assign a rating for the current street availability Reports of current prices for fentanyl were consistent among of these drugs on a scale of ‘0’ (not available, impossible participants with experience purchasing the drug. Participants to get) to ‘10’ (highly available, extremely easy to get); indicated that fentanyl is generally priced similarly to heroin. the previous most common availability score was ‘10.’ Reportedly, the most common quantities of purchase are 1/2 However, one law enforcement officer reported,We “ don’t gram and a gram. Overall, participants reported that the price see the prescription pills nearly as much [as heroin].” of fentanyl has remained the same during the past six months. Corroborating data indicated that prescription opioids are Current Prices for available for illicit use in the region. The SBIRT program Fentanyl reported that of the 478 individuals in the Cincinnati region who reported substance use during the past 30 1/2 gram $50-60 days, 14.6% reported illicit use of prescription opioids on one or more days. The Hamilton County Coroner’s Fentanyl A gram $80-100 Office reported that 17.5% of the 291 drug-related deaths it recorded this reporting period involved prescription The most common route of administration for fentanyl opioids. The Scioto County Coroner’s Office reported is intravenous injection (aka “shooting”). Participants that 16.1% of the 31 drug-related deaths it recorded this estimated that out of 10 fentanyl users, seven would reporting period involved prescription opioids. In addition, shoot and three would snort the drug. Participants and ODPS reported 28 drug task force seizures of prescription community providers described typical fentanyl users as opioids in the Cincinnati region during the reporting similar to heroin users. Participants commented: “Younger period (21.4% of the seizures were made in Lawrence white people; Yeah, a lot of younger white people; There’s not County). really a certain type of person … I’ve seen all kinds; Everybody in this city from any demographic; I live in a suburb Media outlets reported on law enforcement seizures neighborhood, and there’s people out by my home who use it; and arrests in the region this reporting period. A Trenton Middle class.” (Butler County) man was charged with involuntary manslaughter for the death of his 1-year-old son who died of an overdose involving oxycodone and an anti- anxiety medication; the man called police after finding

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 89 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region his son not breathing, and officers took the child to a local hospital where he was pronounced dead (www. Current Street Prices for abc6onyourside.com, Aug. 17, 2017). A Lawrence County Prescription Opioids Common Pleas judge sentenced a man to four years in $20 for 60 mg Morphine prison for trafficking oxycodonewww.herald-dispatch. ( $50 for 100 mg com, Aug. 26, 2017). Middletown Special Investigative Unit $2 for 5 mg (Butler County) executed a search warrant at a residence Norco® $4-6 for 7.5 mg

in Middletown and arrested a man who owned the home Opioids $5-7 for 10 mg after confiscating approximately 900 Percocet® pills and an Prescription unspecified amount of cocaine www.fox19.com( , Oct. 31, Opana® $100 for 40 mg 2017). Vicodin® $7-10 for 10 mg Participants reported that the street availability of prescription opioids has decreased during the past six Participants reported obtaining these drugs for illicit use months. Participants discussed: “That’s getting a little harder from doctors, drug dealers, hospitals, pain management now because doctors are cracking down (not prescribing as clinics, pharmacies through fraudulent prescriptions, many opioids as previously); As far as buying pain pills on the and from family members and friends with prescriptions street now, they’re so much harder to get because nobody for them. Participants commented: “I got them from my wants to get rid of them anymore ‘cause the doctors and DEA baby’s mother. Her dad had some [and] my daughter’s are coming down so hard; That’s what started heroin so big, grandpa would give them to me; I’d go to a bar and it’s like is prescription pills started getting harder to find; The prices … instant connection; My whole pill thing started when I increased … people started charging a $1 per milligram….” messed up my knee … I was getting them from my doctor … I’ve been getting them from the street ever since; I had The BCI London Crime Lab reported that the number of my doctor wrapped around my finger … I was getting a oxycodone (OxyContin®), oxycodone/acetaminophen ‘script’ (prescription for opioids) like three times a month; My (Percocet®), oxymorphone (Opana®), hydrocodone grandmother … I used to sell her pills … to get money for like (Vicodin®), methadone and morphine cases it processes me and her to live on before I first started using ‘dope’ (heroin) have increased during the past six months, while … she used to get Lortab® and methadone and that’s when I hydromorphone (Dilaudid®) and tramadol (Ultram®) cases first started using them.” have decreased or remained the same. While there were a few reported ways of consuming prescription opioids, and variations in methods of use Reported Availability Change during the Past 6 Months were noted among types of prescription opioids, generally the most common route of administration for illicit use Participants Decrease is snorting. Participants estimated that out of 10 illicit prescription opioid users, five would snort and five would either orally consume (swallow) or “shoot” (intravenously Opioids Law enforcement No comment inject) the drugs. Participants commented: “They last Prescription Prescription Treatment providers No comment longer and it’s a better buzz if you snort it; I think it will last longer if you swallow it … it may not be as a bigger buzz Reports of current street prices for prescription opioids though; Mostly for me, I would snort if it didn’t have Tylenol® were consistent among participants with experience in it; Me and the people I would hang around with, we would buying the drugs. Reportedly, the majority of prescription get together and … the first thing we would do is get a couple opioids sell for $1-1.50 per milligram. However, one of pain pills out, line it up, snort it, you know … about 45 participant stated, “The guy downstairs [from my minutes later do it again, and 45 minutes later do it again ….” apartment] used to sell [opioids] to me … he got prescribed Additionally, a couple of participants discussed smoking them. So, it just depends on who you know … if you know prescription opioids. They said: “If you can crush it down somebody who’s prescribed them and you can supply them and shoot it, you can smoke it; If you can crush anything with a bunch of money at once, they might give them to you down to a powder, you can smoke it.” for cheaper.”

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A profile of a typical illicit prescription opioid user did Reported Availability not emerge from the data. In addition to describing illicit Change during the Past 6 Months prescription opioid users as anybody and everybody, participants reported factory workers and manual laborers Participants Increase (roofers and construction workers), younger people and people with money as typical users. They commented: “A lot of the male factory workers were big buyers; Anything Law enforcement No comment manual labor; ‘Youngins;’ I see a lot of young people hooked Suboxone® Treatment providers No comment on pills, too; For pain pills, I’m going to say now a higher class [user] because they cost more [than heroin]…. So, if somebody is still doing pain pills, it’s because they got Reports of current street prices for Suboxone® were money.” consistent among participants with experience buying the drug. Suboxone® ® Current Street Prices for Suboxone® remains highly available for Suboxone® illicit use in the region. Participants most Filmstrip $10-20 for 8 mg often reported the current street available

of Suboxone® as ‘10’ on a scale of ‘0’ (not Suboxone Subutex® $25-30 per 8 mg available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most In addition to obtaining Suboxone® on the street from common score was also ‘10.’ Participants discussed: drug dealers, participants also reported getting the drug “Everywhere … Suboxone® is everywhere; I mean it’s easy for illicit use through prescription from doctors and to go to the doctor’s now and get prescribed it; Suboxone® clinics, and from other users. Participants reported that is easier than other medications [to get prescribed]; They the most common route of administration for illicit use want to help people get off heroin so they give them the of Suboxone® remains oral consumption (sublingual, Suboxone®. I know a lot of people go just to get Suboxone® to dissolving under the tongue). In addition, a few sell, so that they can get their heroin. I mean a lot of people participants discussed “shooting” (intravenously injecting) do that, so it makes it pretty available.” and snorting Suboxone®. They said: “I tried shooting a Community professionals did not assign a rating for the Suboxone® ‘strip’ (filmstrip) one time. It works; I have seen the current street availability of Suboxone® on a scale of ‘0’ people in jail put a little strip in some water and let it dissolve (not available, impossible to get) to ‘10’ (highly available, and then they’ll snort the water.” extremely easy to get); the previous most common score Participants described typical illicit Suboxone® users as was ‘10.’ However, one law enforcement officer reported, heroin users who use the drug to keep from “getting “Seem like half the people that are on Suboxone® for treatment dope sick” (going into withdrawal) when they do not have sell the Suboxone® to somebody else … to get heroin.” heroin. A participant shared, “I’ve thought, ‘oh, there’s no Participants reported that the street availability of way I’m going to get money today [to buy heroin] … I guess Suboxone® has increased during the past six months. They I’m going to have to get a damn Suboxone®.’ So, I would attributed increased street availability to an increase in get a Suboxone® and half an hour later I would get money the number of prescriptions in the region generally, both somehow … and I would be like, ‘well hell, I’m going to go get more prescribers and more users seeking prescriptions. high, too’ … it always worked out.” One participant remarked, “Suboxone® is probably more abused than OxyContin® … really.” The BCI London Crime Sedative-Hypnotics Lab reported that the number of Suboxone® and Subutex® cases it processes has increased during the past six months. Sedative-hypnotics (benzodiazepines, barbiturates and muscle relaxants) are moderately available for illicit use in the region. Participants most often reported the current

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 91 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region street availability of these drugs as ‘7’ on a scale of ‘0’ (Ambien®) cases has decreased during the past six months. (not available, impossible to get) to ‘10’ (highly available, In addition, the lab reported that it has seen an increase in extremely easy to get); the previous most common designer benzodiazepine cases during the past six months. score was ‘10.’ One participant remarked, “You can go to the doctor and get them pretty easy with very little effort.” Reported Availability

Participants identified Klonopin® and Xanax® as the most Change during the Past 6 Months available sedative-hypnotics in terms of widespread illicit use. Participants commented: “I think all of em’s pretty Participants Decrease [available]; I don’t see Valium® very much; They’re harder to get; I prefer Xanax®.” Law enforcement No comment Sedative- Hypnotics Community professionals had little knowledge regarding Treatment providers No comment illicit use of sedative-hypnotics in the region; in the previous reporting period, a treatment provider reported street availability as ‘8.’ Law enforcement officers interviewed Reports of current street prices for sedative-hypnotics this reporting period stated: “There’s still ‘benzos’ were consistent among participants with experience (benzodiazepines); There’s ‘xanie bars’ (Xanax® 2 mg), but people buying the drugs. Generally, sedative-hypnotics sell for just seem to go more straight to heroin now and pills less.” $0.50-2 per milligram. Corroborating data indicated that sedative-hypnotics are Current Street Prices for available for illicit use in the region. The SBIRT program Sedative-Hypnotics reported that of the 478 individuals in the Cincinnati $0.50-1 for 0.5 mg region who reported substance use during the past Klonopin® 30 days, 21.8% reported illicit use of benzodiazepines $2 for 2 mg Sedative- on one or more days. The Hamilton County Coroner’s Hypnotics $2 for 1 mg Xanax® Office reported that 10.0% of the 291 drug-related $5 for 2 mg deaths it recorded this reporting period involved one or more benzodiazepine. The Scioto County Coroner’s Participants reported obtaining sedative-hypnotics for Office reported that 9.7% of the 31 drug-related deaths illicit use from drug dealers, physicians and other people it recorded this reporting period involved one or more with prescriptions. They stated: “People with prescriptions benzodiazepine. In addition, ODPS reported 13 drug task still sell them; They’re cracking down, but doctors [continue force seizures of benzodiazepines in the Cincinnati region to prescribe benzodiazepines].” The most common routes during the reporting period. of administration for illicit use of sedative-hypnotics are snorting, followed by oral consumption. Participants Participants reported that the street availability of sedative- estimated that out of 10 illicit sedative-hypnotic users, six hypnotics has decreased during the past six months. would snort and four would orally consume the drugs. They attributed decreased street availability to doctors Participants discussed: “Mostly snorted; I’d say snort em’, prescribing these medications less, resulting in those with swallow em’, or chew em’ up; I don’t like to eat em’ because they prescriptions holding onto their medication for personal taste so horrible. Xanax® got a horrible taste. Klonopin® are like use; thus, less is being diverted. Participants commented: a minty type taste; A lot of people still snort em’.” “Pills are getting harder to buy because doctors are not over prescribing them; If you do get Klonopin®, [doctors] only A profile for a typical illicit sedative-hypnotic user did not give you enough for like one a day or two a day … nobody emerge from the data. However, participants discussed that ever has enough to spare; Nobody’s really getting rid of their users of illicit drugs, specifically stimulant drugs (cocaine medication anymore; They’re just harder to find.” and methamphetamine), use sedative-hypnotics to help The BCI London Crime Lab reported that the number of with coming down from the intense highs produced by clonazepam (Klonopin®), diazepam (Valium®), alprazolam these other drugs. Participants stated: “That will help bring (Xanax®), carisoprodol (Soma®) and lorazepam (Ativan®) cases you down; Yeah, when you’re too high to go to sleep.” it processes have increased, while the number of zolpidem

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Marijuana individuals in the Cincinnati region who reported substance use during the past 30 days, 73.4% reported using marijuana Marijuana remains highly available in the region. on one or more days. In addition, ODPS reported 31 drug Participants and community professionals task force seizures of marijuana in the Cincinnati region most often reported the current availability of during the reporting period. the drug as ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, Media outlets reported on law enforcement seizures extremely easy to get); the previous most common scores and arrests in the region this reporting period. Lawrence were also ‘10.’ Participants commented: “You can grow it County Sheriff’s officers arrested a man after responding everywhere; I’m offered it two or three times a day just walking to a call from a retail store in Ironton regarding a shoplifter; downtown [in Cincinnati]; Regardless [if you are] somebody officers found the man in possession of marijuana and that uses heroin, somebody that smokes crack, somebody that drug paraphernalia (www.herald-dispatch.com, July 20, snorts ‘powder’ (powdered cocaine) … everybody will smoke a 2017). Law enforcement in Warren County arrested two men ‘joint’ (marijuana cigarette).” Participants also discussed that after responding to a call that an unconscious woman was the legalization of marijuana in other states, as well as the being dragged into a home in Deerfield Township; officers drug being used for medicinal purposes, contributes to the confiscated undisclosed amounts of hashish, marijuana and social acceptability of marijuana use. Participants explained: cocaine, as well as drug paraphernalia, guns, and cash from “Marijuana is about to be legalized … you got your medical the residence (www.daytondailynews.com, Aug. 21, 2017). marijuana. You get a prescription, you go to the dispensary; It’s Pike County Sheriff’s Office collaborated with the Ohio Bureau natural; I think that all my friends know that I grew up smoking of Criminal Investigation to conduct a three-day investigation it and they know that I haven’t changed … it’s easy to get that lead to the seizure of 760 marijuana plants from various and … [users] think it’s safer than any other drug out there.” locations across Pike County (www.chillicothegazette.com, Law enforcement remarked: “It’s everywhere; You can get it Sept. 13, 2017). Hanover Township Police (Butler County) anywhere.” arrested several people during the Farm Aid concert, one of whom was caught smoking marijuana in his van; officers Participants and community professionals also reported arrested two women with the man after finding cocaine, availability of high-grade marijuana extracts and methadone, heroin, prescription bottles with improper concentrates, often appearing as oil and waxy forms of labels and methamphetamine; officers arrested another man the drug (aka “dabs”). Participants most often reported the after finding him with marijuana and another individual for current availability of marijuana extracts and concentrates as possession of lysergic acid diethylamide (LSD) (www.observer- ‘5-6’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ reporter.com, Sept. 19, 2017). Cincinnati Police confiscated 44 (highly available, extremely easy to get); the previous most pounds of marijuana from a home in the city’s Over-the-Rhine common score was ‘8.’ A participant explained, “[A dab] it’s a neighborhood after receiving tips from community members little ball of wax … you put it in this little tube … you take a torch of drug activity in and around the home (www.cincinnati.com, and you light it up … it lets off smoke kind of like ‘meth’ (similar Nov. 13, 2017). Middletown Police (Butler County) arrested a to smoking methamphetamine).” 16-year-old male responsible for shooting and killing a man during a drug deal after police found him hiding in a home a Although community professionals could not rate the few days after the incident; the 16-year-old met the man to current overall availability of marijuana extracts and purchase marijuana and Xanax®, but shot the man when he concentrates, law enforcement reported: “It’s a form of put up a fight while the 16-year-old attempted to rob him THC (tetrahydrocannabinol, the psychoactive component of (www.local12.com, Dec. 11, 2017). marijuana) that they extract from marijuana; It’s considered concentrated cannabis, meaning there’s a process to extract the Participants reported that the availability of marijuana has THC like to make it where it’s a higher potency … like hash or increased during the past six months. Participants reasoned: hash oil, but they found a way to do it simpler … anybody can “It’s legal in Ohio now; The social acceptance of it … most do it ….” A participant remarked, “Butanes are a really good people really don’t consider ‘weed’ (marijuana) to be a drug.” way to extract [THC] … to get it all out.” Law enforcement reported that the availability of marijuana has remained the same during the past six months, while Corroborating data indicated that marijuana is available the availability of marijuana extracts and concentrates, often in the region. The SBIRT program reported that of the 478 referring to hash oil, has increased. Participants did not report

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 93 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region on availability change for marijuana extracts and concentrates. a lot better; There’s more people devoting their life to it. Taking A law enforcement officer remarked,Big “ increase in wax, pride in their business. That’s where dispensaries are coming in….” dabs and that type of stuff. I haven’t seen nearly as much as I Regarding the quality of marijuana extracts and concentrates, have recently….” The BCI London Crime Lab reported that the participants commented: “It depends … you can get stuff that’s number of marijuana and marijuana extracts and concentrates weaker that’s like 30 or 40% [THC]. Or, you can get to where it’s (oils, “dabs”) cases it processes have increased in the past six like 80 to 90% THC … it’s almost pure THC; One hit of dab is like months. smoking one ‘blunt’ (marijuana-filled cigar)….”

Reported Availability Reports of current prices for marijuana were provided by Change during the Past 6 Months participants with experience buying the drug. Reportedly, the most common quantity of purchase is a gram. Participants Increase Current Prices for Law enforcement Increase Marijuana Marijuana Treatment providers No comment Low grade: A blunt (cigar) or a gram $10 Participant most often rated the current overall quality of 1/4 ounce $40-50 marijuana as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ An ounce $140 (high quality); the previous most common score was ‘5’ for low- grade marijuana and ‘10’ for high-grade marijuana. Participants High grade: discussed: “There ain’t no overall quality, there’s so many different Marijuana A blunt (cigar) or a gram $20 kinds out there. They will actually tell you, ‘Do you want regular 1/4 ounce $100 weed or do you want ‘loud’ (high-grade) weed?’ There’s different kinds … you pay more for better weed. These days weed ain’t just Extracts and concentrates: weed no more like it used to be.” A gram $30-40

Participants further discussed different types of marijuana. The most common route of administration for marijuana They said: “Oh, they got different types of weeds; They are remains smoking. A participant remarked, “It’s all smoking.” learning how to cross breed these plants into hybrids; It depends Participants discussed smoking the drug through bongs on what chemicals you use and what soil; They got a weed called (water pipes), pop cans, apples and carburetors. Participants ‘speed’ and it makes people hallucinate. It looks like weed, but remarked: “It depends on the heat you use, too. If you are it’s not straight grown out the ground weed. It makes you do smoking a joint or a bowl (pipe) you can get anywhere from 10 things that you wouldn’t normally do when you smoke a regular to 20% [THC]. Now, if you use something like a torch lighter or joint.” Law enforcement stated: “I wonder if you can find shitty a vaporizer, you can get more of that THC out of it … anywhere marijuana anymore; You can’t find ‘ditch weed’ (low-grade to like 30 to 40%; Or you could put the dabs on top of your weed marijuana) … most of it is pretty concentrated, good stuff and and smoke it in a blunt.” Participants also discussed vaporizing it’s coming from states that have either made it legal or have and orally consuming the drug in the form of “edibles” (food dispensaries for medical marijuana. I mean they’re allowing it to products containing THC). Participants discussed the drug flow in … all of our bigger marijuana seizures in this past year infused into candy and brownies. Participants commented: have all been straight from [these] states.” “In the future it’s going to be all edibles and that’s going to be A few participants reported that marijuana is laced the posh way to do it. Dabs is already the posh way to do weed; (adulterated) with other drugs, including: powdered cocaine, You have to cook with the oil, you can’t just put weed in your crack cocaine, ecstasy and formaldehyde (aka “wet”). Overall, brownies; You have to put it in the butter.” participants indicated that the quality of marijuana has A profile for a typical marijuana user did not emerge increased during the past six months. Participants stated: “It’s from the data. Participants and community professionals a whole lot better than what it used to be; I think with technology described typical marijuana users as everyone. Participants [advancements] … people know how to grow it and process it commented: “It’s all races, it’s all ages … all incomes, all classes;

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Young, old, white, black, Chinese, 30 [year olds], old [people]; laced with fentanyl in Pike County, all lead by an inmate in Male, female, transgender.” Law enforcement stated: “That’s an Ohio prison; officers conducted searches at six locations universal; It’s across the board.” in Pike County, and seized 26 pounds of methamphetamine, large amounts of cash, 70 prepaid credit cards and several vehicles; officers reported that many of the individuals Methamphetamine arrested have gang ties to MS-13, Good Fellas and Konvicted Family (www.portsmouth-dailytimes.com, July 6, 2017). Ross Methamphetamine remains highly available in County Sheriff’s officers, U.S. Marshals and the U.S. 23 Major the region. Participants most often reported the Crimes Task Force executed a search warrant of a home in current availability of the drug as ‘10’ on a scale of Chillicothe and arrested a man after seizing 235 grams of ‘0’ (not available, impossible to get) to ‘10’ (highly methamphetamine, two grams of heroin, prescription drugs available, extremely easy to get); the previous and cash (www.nbc4i.com, July 29, 2017). A male inmate at most common score was also ‘10.’ Participants discussed: the Warren County Correctional Institution was accused of “Hell, where I live at there’s a ‘meth’ (methamphetamine) dealer methamphetamine transference after his wife brought 12 a block away; I wouldn’t even describe [current availability] balloons containing the drug into a visiting room, where the as a ‘10.’ I’d describe that as a ‘100;’ It’s become more and more man swallowed four of the balloons before officers caught popular than anything; It’s everywhere … just like heroin; them; officers placed the man in a room to pass the drugs to [Methamphetamine is] easy to make, and I think a lot of people, intercept them; however, the man immediately swallowed from what I heard, are switching addictions to not have [opiate] the balloons again after passing them; officers waited withdrawal symptoms. They are using methamphetamine, so another four days until the man passed the drugs again and they don’t have the withdrawals.” then confiscated them www.fox19.com( , Sept. 18, 2017). Community professionals also reported high current Adams County Sheriff’s officers arrested three people after availability of methamphetamine, although they did not responding to a fire at an apartment in West Union, which provide an availability score; the previous most common later lead to an investigation where officers uncovered a availability score was ‘10.’ Law enforcement discussed: “It’s methamphetamine laboratory at a nearby hotel; one of the pretty high; If we’re talking to an informant and they’re looking individuals confessed that the fire began at the apartment to buy, the first word out of their mouth is usually meth; Along because he was handling chemicals to manufacture the Indiana boarder … there’s plenty out there to be had [and] methamphetamine (www.wisconsinrapidstribune. along the northern border of Hamilton County more so than com, Sept. 26, 2017). A federal grand jury in Chillicothe in the city (Cincinnati) … it’s been more on the outer edges of charged seven people, one of whom was a corrections the county; As far as like cases go, we had the biggest meth officer at the Chillicothe Correctional Institute where three case recently in Warren County; They got super labs in Mexico of the individuals were inmates, for trafficking crystal sending up just bulk [amounts of methamphetamine].” methamphetamine; the three other individuals purchased the drug in Dayton and used the correctional officer and Corroborating data indicated that methamphetamine is the three prisoners to distribute the drug in the jail in June available in the region. The SBIRT program reported that of and July 2017 (www.nbc4i.com, Oct. 5, 2017). A Washington the 478 individuals in the Cincinnati region who reported Court House (Fayette County) man plead guilty to drug substance use during the past 30 days, 17.4% reported using trafficking in the Fayette County Court of Common Pleas for methamphetamine on one or more days. The Hamilton trafficking methamphetamine in the area; Washington Court County Coroner’s Office reported that 8.6% of the 291 drug- House Police executed a search warrant at the man’s home in related deaths it recorded this reporting period involved September 2017 and confiscated four bags of the substance methamphetamine. In addition, ODPS reported 45 drug task and cash (www.recordherald.com, Dec. 4, 2017). force seizures of methamphetamine in the Cincinnati region during the reporting period. Participants reported that methamphetamine is available in powdered and crystal forms throughout the region. Media outlets reported on law enforcement seizures and However, they indicated crystal methamphetamine as most arrests in the region this reporting period. The Pike County prevalent. Participants commented: “Mostly ‘shards’ (crystal Drug and Major Crimes Task Force arrested 23 individuals methamphetamine) are starting to come around big. A lot of responsible for trafficking methamphetamine and heroin people is tryin’ to use them to get off heroin; Yeah, I even heard

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 95 Page 8 Surveillance of Drug Abuse Trends in the Cincinnati Region when [drug trafficers] go to pick up the heroin or ‘fent’ (fentanyl) heroin obviously was scaring them; By and large if you were [drug cartels] always send [methamphetamine] back with to total [drug seizures] all up, there would be twice as much them for free, so it gets out there; There has been a change from methamphetamine seized at the boarder than there was the ‘shake-and-bake’ (powdered methamphetamine) stuff that cocaine, and then twice as much cocaine as there was heroin.” people used to use … now, it’s actually like real ‘crystal’ (crystal methamphetamine) … everybody’s interested in it because The BCI London Crime Lab reported that the number of it’s the real thing….” Law enforcement stated: “Crystal’s the methamphetamine cases it processes has increased during majority of what we are seeing. I don’t know if I have seen the past six months; the lab reported processing blue, clear, powder in a while; It’s really all the same, it’s just the purity of pink and white crystal methamphetamine as well as white [crystal methamphetamine is higher] … and it has a cleaner powdered methamphetamine.

look. The federal government calls it ‘ice’ when it’s 80% [pure] or better; [Drug cartels] got super labs where they’re making a ton Reported Availability of it and you have to create a market. If you want to buy heroin, Change during the Past 6 Months they make you take meth as well, so they’re forcing the meth if you want heroin.” Participants Increase

The powdered form of methamphetamine is typically Law enforcement Increase referred to as “shake-and-bake,” which means users produce the drug in a single-sealed container, such as a two-liter Treatment providers No comment soda bottle. By using common household chemicals Methamphetamine along with ammonium nitrate (found in cold packs) and pseudoephedrine (found in some allergy medications), Participants most often rated the current overall quality people who make methamphetamine can produce the of methamphetamine as ‘10’ on a scale of ‘0’ (poor quality, drug in approximately 30 minutes in nearly any location. “garbage”) to ‘10’ (high quality); the previous most common Participants remarked: “That’s bottle dope, phosphorus dope; score was also ‘10.’ Participants stated: “I was getting it They make it in a bath tub.” Law enforcement commented: “Labs out of California …. It was so pure [that] it put me in the … are like the anhydrous. The ‘one-pot meth’ (shake-and-bake), it’s hospital; Mine was coming from a connection with MS-13 the dirty meth …. We’re just not seeing it.” (an international gang originating out of Los Angeles, with members living in Ohio). I had a buddy that ran with a crowd Participants and community professionals reported that the and they did business through MS-13 and every time he would availability of methamphetamine has increased during the get a bag … it would literally just be shards … and that stuff is past six months. Participants stated: “It’s been going up; Shit, [strong]. If you don’t do it and you wanna try it, I suggest you do [methamphetamine dealers] kind of just popped up and stuck the tiniest amount or your heart will explode.” around; I would say they’re getting more prevalent … it seems like when I was getting out of the game here (getting sober) … Participants discussed adulterants (aka “cuts”) that affect they were starting to move in on all the turf around here.” the quality of the drug and reported the following as cutting agents for methamphetamine: baby laxatives and Law enforcement commented: “I think we’re the main MSM (methylsulfonylmethane, a joint supplement). The reason [cartels are] pushing meth so hard … you see they got BCI London Crime Lab reported dimethyl sulfone (dietary heroin coalitions and task forces and stuff all over the country. supplement) as a cut for methamphetamine. Overall, Everybody is paying attention to the opiate crisis and those participants reported that the quality of methamphetamine cartels aren’t stupid, they have a nice business model. They has increased during the past six months. say, ‘Well, while they’re paying attention to that, we’ll work on this;’ We have interviewed some heroin users that have said Reports of current prices for methamphetamine were that they … especially when it was huge in the news more with consistent among participants with experience buying the all the deaths last year with fentanyl-heroin deaths, that they drug. Reportedly, the most common quantity of purchase is were trying to switch to a different drug … they were scared of a gram. A participant remarked, “You make a lot of money off dying … we were finding people with both heroin and meth of it.” on them … addicts were trying to switch over to meth because they never heard of anybody dying of a meth overdose …

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Current Prices for the previous most common street availability score was Methamphetamine ‘9-10’ among the one treatment provider with knowledge of illicit use of these drugs. Participants identified Adderall® and Vyvanse® as the most 1/2 gram $35-40 popular prescription stimulants in terms of widespread illicit use. A participant remarked, “It’s Adderall® [and] Vyvanse® … people are definitely getting into that.” A gram $60-80 Participants reported that the general availability of Methamphetamine prescription stimulants has remained the same during the past six months. The BCI London Crime Lab reported that Participants reported that the routes of administration for the number of amphetamine (Adderall®) cases it processes methamphetamine include: smoking, intravenous injection has increased during the past six months, while the (aka “shooting”), snorting and “hot railing.” A participant number of methylphenidate (Ritalin®) cases has decreased. described hot railing the drug: “It’s where you get a tube, and you get it really … hot … to where a little bit of smoke’s going Reported Availability and you have the whole tube filled up with smoke and then you Change during the Past 6 Months put some [methamphetamine] down the line and you snort it up the tube … I was bouncing like a ball. Literally, [my friend] Participants No change was remodeling the inside of her house, and we got the living room done that day. And then I went home and cleaned my house.” Other participants remarked: “Actually meth, you can Law enforcement No comment Stimulants do it all kind of ways. You can put it under your tongue, you can Prescription eat it, you can mix it up with a cup of tea and drink it; They use Treatment providers No comment coffee filters to filter[meth] through and you can take those coffee filters and stick it down a bottle of Mountain Dew® and Reports of current street prices for prescription stimulants shake it and drink it … you got yourself a pow-wow drink … were consistent among participants with experience pass it around like a liquor bottle and everybody’s bouncing; But, buying these drugs. most of the people just shoot the stuff.”

Participants described typical methamphetamine users as Current Street Prices for white and rural people. Participants commented: “White; Prescription Stimulants Growing up when I would hear about meth, I would just always hear about ‘hillbillies;’ Have you ever seen black people $5 for 5 mg Adderall® that do meth?” Community professionals described typical $10 for 7.5 mg Stimulants methamphetamine users as heroin users and white people. Prescription

Participants reported obtaining prescription stimulants for Prescription Stimulants illicit use from doctors and friends. Participants reported that the most common routes of administration for illicit Prescription stimulants are moderately available for use of prescription stimulants are oral consumption illicit use in the region. Participants most often reported and snorting. Participants estimated that out of 10 illicit the current street availability of these drugs as ‘4-7’ on a prescription stimulant users, five would orally consume scale of ‘0’ (not available, impossible to get) to ‘10’ (highly and five would snort the drugs. Participants described available, extremely easy to get); the previous most typical illicit prescription stimulant users as truck drivers. common score was ‘8.’ Participants discussed: “If you want A participant stated, “I know a lot of truck drivers that love it, you can get it; I think it depends on the part of town you Adderall®.” live. I know it’s easy to get prescribed … legally prescribed. It’s pretty easy.” Community professionals did not report on the current street availability of prescription stimulants;

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Ecstasy Participants did not rate the current overall quality of ecstasy or molly on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high Ecstasy (methylenedioxymethamphetamine: MDMA, or quality); the previous most common score was ‘10’ for both other derivatives containing BZP, MDA, and/or TFMPP) is ecstasy and molly. Regarding quality of ecstasy, participants moderately to highly available in the region. Participants stated: “It all depends on where you stay (live); Yeah, I mean most often reported the current availability of the pressed there are strong ones and there’s weak ones; I know the ‘purple tablet form of ecstasy as ‘6-8’ and of “molly” (powdered Obama’s’ (ecstasy tablets imprinted with an image of President MDMA) as ‘8’ on a scale of ‘0’ (not available, impossible to get) Obama) that was out was good.” to ‘10’ (highly available, extremely easy to get); the previous Participants discussed adulterants (aka “cuts”) that affect the most common scores were ‘10’ for both ecstasy and molly. quality of the drugs and reported the following as cutting Regarding ecstasy, participants reported: “I can get it any time agents for ecstasy: cocaine, fentanyl, heroin, ketamine … just pick up the phone and call [your dealer]; People like (an anesthetic typically used in veterinary medicine) and to get it for sex.” Regarding molly, participants stated: “I can methamphetamine. Participants explained: “You’re able pick up the phone and get molly right now; Well that varies, it to tell if it’s an upper or a downer [cut] … ecstasy already depends on the season really. It’s really available in the summer.” automatically makes your senses go, but if it has heroin in it, it’s Community professionals did not rate the current availability gonna be more of a relaxed feel; Sometimes you can taste the of ecstasy or molly; the previous most common scores for main ingredient [of the cut].” Participants mentioned that the both ecstasy and molly were ‘5-6’ among one treatment other substances used to cut molly included: cocaine, heroin, provider with knowledge on the drug. However, law methamphetamine and Viagra®. enforcement reported recently seizing MDA (aka “sally,” “sass,” Current prices for ecstasy and molly were reported by and “sassafras”) in the Cincinnati region during the past six participants with experience buying the drugs. A few months. Law enforcement discussed: “It was MDA … that participants discussed that the price for low-dose tablets (aka seizure that we got at the hotel; It was like a pound of MDA from “single stack”) and medium-dose tablets (aka “double stack”) Toronto and it looked like some chopped up bricks or something of ecstasy are often the same. A participant stated, “They’re … brown and nasty. So, I did a little research because I had never the same, you know someone pulls out of bag and someone seen it before and somewhere like Northern Ohio … Toledo or might be like, ‘Give me the ‘Superman,’ or ‘give me the Smurf’ Cleveland … they had some and it’s ecstasy. It’s a Schedule I [and the prices are the same, regardless of purity].” [drug]; I’m assuming it has the same effects [as ecstasy] … the defendant that we arrested said he moves ecstasy, and then Participants reported that molly is typically sold in capsules. A when it came back from the lab it was MDA.” participant stated, “I only find molly in capsules now.” However, another participant stated, “A lot of molly is being turned Participants reported that the availability of ecstasy and (pressed) into pills now.” Other participants discussed that molly has decreased during the past six months. Participants ecstasy and molly are often given away: “I was always handed discussed: “It’s not a common drug; You might hear about it them, I never paid anything for them; For instance, someone more if they have a ‘rave’ (dance party).” The BCI London Crime might have a zip lock baggie of them and they go around and Lab reported that the number of MDMA (ecstasy/molly) start passing them out, and sometimes they’re free; It’s a party cases it processes has increased during the past six months. drug; At concerts or like in parking lots when you’re going to go see or hear music some people pass around a sandwich bag Reported Availability [containing molly] … you dip your pinky in it and then you lick Change during the Past 6 Months it, so if you want a big one (dose), you take what you want.”

Participants Decrease

Law enforcement No comment

Ecstasy/Molly Treatment providers No comment

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Current Prices for In addition, secondary data sources reported on other drugs not mentioned by respondents. The BCI London Ecstasy/Molly Crime Lab reported that the number of bath salts cases Ecstasy: (synthetic cathinones; compounds containing methylone, mephedrone, MDPV or other chemical analogues, Low dose (aka “single stack”) $5-10 including alpha-PVP, aka “flakka”) and the number of psilocybin mushroom cases it processes have increased Medium dose (aka “double stack”) $7-15 during the past six months, while the number of DMT High dose (aka “triple stack”) $20-40 (dimethyltryptamine) and LSD (lysergic acid diethylamide) cases have decreased or remained the same. The lab also Molly: reported it processed 21 cases of ketamine (an anesthetic

Ecstasy/Molly typically used in veterinary medicine) and 44 cases of A capsule $5 U-47700 (synthetic opioid) during the past six months; The 1/10 gram $20-30 Hamilton County Coroner’s Office reported that 14 of the 291 drug-related deaths it recorded this reporting period A gram $50 involved U-47700.

Participants indicated that ecstasy and molly are obtained Synthetic Marijuana through drug dealers, at concerts, raves, parties and music festivals. Participants commented: “You might hear about it Reportedly, synthetic marijuana (synthetic cannabinoids) more if they have a rave party; Lots of festivals; It’s more like a remains available in the region. However, participants fun drug than a habit drug.” and community professionals were not able to rate the current availability of the drug. Participants commented: Participants reported that the most common route of “You used to be able to buy it at gas stations; Now you can administration for ecstasy and molly is oral consumption. buy it online and make it your own self.” Participants referred A participant stated, “He (the drug dealer) told me to eat it to the drug as potpourri and incense, and discussed the (molly), do not snort it, do not shoot it, and don’t try to smoke drug in negative terms. Participants stated: “Garbage … it.” Participants also discussed other routes of administration garbage; Yeah, that shit weak ….” The BCI London Crime for ecstasy, including, anal and vaginal insertion, ocular Lab reported that the number of synthetic marijuana cases absorption and snorting. Participants commented: “Most it processes has decreased during the past six months. common would be eat it, or put it up in your anus; It goes straight to your bloodstream; Your liver can’t process the toxins, so that’s why a lot of people overdose and die on ecstasy because your body can’t fight it off that way.” Conclusion Participants described typical ecstasy and molly users as younger people who attend raves and music festivals. Heroin, marijuana, methamphetamine, powdered Participants remarked: “Early 20s; ‘Cause it’s a party drug; Like cocaine, prescription opioids and Suboxone® remain a club drug, if you will; That’s mostly like people that like music highly available in the Cincinnati region; also highly festivals ….” available is fentanyl. Changes in availability during the past six months include: increased availability for fentanyl, marijuana and methamphetamine; likely increased availability for powdered cocaine; and possible increased Other Drugs in the Cincinnati Region availability for Suboxone®. Participants and community professionals discussed While participants and community professionals synthetic marijuana (synthetic cannabinoids) as being continued to report current high availability of heroin, present in the region, but this drug was not mentioned by there was agreement that much of the heroin supply is the majority of people interviewed. adulterated with fentanyl. Corroborating data confirmed that heroin is often adulterated with fentanyl. The

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Hamilton County Coroner’s Office reported that 47.1% to “speedball” (use of cocaine/meth and heroin/fentanyl of the 291 drug-related deaths it recorded this reporting together for an up and down effect). Moreover, they period involved heroin; of these heroin-related deaths, discussed using cocaine with heroin to counteract 74.5% also involved fentanyl. “nodding out” (passing out) and to increase their “stay up” (awareness). In addition, participants indicated that heroin In discussing the increasingly high availability of fentanyl, users receiving Vivitrol® as medication assisted treatment participants noted fentanyl as supplanting heroin in the use powdered/crack cocaine and/or methamphetamine to region. Participants and law enforcement attributed the get high. increased availability of fentanyl to the ease in which the drug can be purchased, increased supply and demand, Participants and community professionals reported as well as the higher profitability of selling fentanyl over that the availability of methamphetamine has increased heroin. The BCI London Crime Lab reported that the number during the past six months. Participants reported that of fentanyl and fentanyl analogue cases it processes has methamphetamine is available in powdered and crystal increased during the past six months; the lab also reported forms throughout the region. However, they indicated an increase in the number of carfentanil cases. crystal methamphetamine as most prevalent. They also discussed heroin users switching to methamphetamine Participants explained that fentanyl is typically a cut for to not experience the withdrawal symptoms associated other drugs, such as heroin and cocaine. Participants with opiate use. Law enforcement attributed the increased and community professionals noted high numbers of availability of methamphetamine to drug cartels overdoses in the region and lives saved with Narcan® aggressively pushing the drug on the heroin market. They (naloxone, opiate overdose reversal medication). Both also noted heroin users switching to methamphetamine participants and law enforcement indicated Narcan® as use due to fear of dying via an opiate overdose with so available and accessible in the region. much fentanyl in the heroin supply. Participants reported that the street availability of Lastly, of particular note this reporting cycle, the BCI Suboxone® has increased during the past six months. They London Crime Lab reported it processed 21 cases of attributed increased street availability to an increase in the ketamine (an anesthetic typically used in veterinary number of prescriptions in the region generally, both more medicine) and 44 cases of U-47700 (synthetic opioid) prescribers and more users seeking prescriptions. One law during the past six months; the Hamilton County Coroner’s enforcement officer reported,Seem “ like half the people Office reported that 14 of the 291 drug-related deaths it that are on Suboxone® for treatment sell the Suboxone® to recorded this reporting period involved U-47700. somebody else … to get heroin.” The BCI London Crime Lab reported that the number of Suboxone® and Subutex® cases it processes has increased during the past six months. Participants continued to describe typical illicit Suboxone® users as heroin users who use Suboxone® to keep from “getting dope sick” (going into withdrawal) when they do not have heroin. Corroborating data indicated that powdered cocaine is highly available in the region. The Hamilton County Coroner’s Office reported that 39.2% of the 291 drug- related deaths it recorded this reporting period involved powdered/crack cocaine. The BCI London Crime Lab reported that the number of cocaine cases it processes has increased during the past six months. When participants were asked why the availability of powdered cocaine has increased, several participants reported that there’s been an increase in demand for the drug among heroin users. They explained that heroin users seek stimulant drugs like cocaine and methamphetamine

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Drug Abuse Trends in the Cleveland Region

Regional Epidemiologist: Jennifer Tulli, MSW, LISW-S, LCDC III

Data Sources for the Cleveland Region

This regional report was based upon qualitative data collected via focus group interviews. Participants were active and recovering drug users recruited from alcohol and other drug treatment programs in Cuyahoga, Lake and Geauga counties. Data triangulation was achieved through comparison of participant data to qualitative data collected from regional community professionals (treatment providers and law enforcement) via focus group interviews, as well as to data surveyed from the Cuyahoga County Medical Examiner’s Office, the Lake County Crime Lab, the Ohio Bureau of Criminal Investigation (BCI) Richfield Crime Lab, which serves the Cleveland, Akron-Canton and Youngstown areas, and the Ohio Department of Public Safety (ODPS), which logs drug task force seizures from across the Ohio. All secondary data are summary data of cases processed from OSAM Staff: January through June 2017. In addition to these data sources, R. Thomas Sherba, PhD, MPH, LPCC Ohio media outlets were queried for information regarding OSAM Principal Investigator regional drug abuse for July through December 2017. Kathryn A. Coxe, MSW, LSW Note: OSAM participants were asked to report on drug use/ OSAM Coordinator knowledge pertaining to the past six months prior to the interview; thus, current secondary data correspond to the Jessica Linley, PhD, MSW, LSW reporting period of participants. OSAM Quantitative Data Analyst

OSAM Page 101Drug Trend Report January-June 2013 OSAM Drug Trend Report June 2017 - January Page 2018 101 Page 8 Surveillance of Drug Abuse Trends in the Cleveland Region

Regional Profile

Indicator1 Ohio Cleveland Region OSAM Drug Consumers Total Population, 2016 11,614,373 2,269,670 41 Gender (female), 2016 51.0% 51.6% 27.5%2 Whites, 2016 82.5% 76.8% 68.3% African Americans, 2016 12.8% 18.7% 26.8% Hispanic or Latino Origin, 2016 3.7% 5.2% 0.0%3 High School Graduation Rate, 2012-16 89.5% 88.7% 84.6%4 Median Household Income, 2012-16 $50,674 $56,960 $20,000 to $24,9995 Persons Below Poverty Level, 2016 14.6% 14.5% 42.1%6 1 Ohio and Cleveland region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018. ² Gender was unable to be determined for 1 participant due to missing and/or invalid data. 3 Hispanic or Latino origin was unable to be determined for 3 participants due to missing and/or invalid data. 4 High school graduation status was unable to be determined for 2 participants due to missing and/or invalid data. 5 Participants reported income by selecting a category that best represented their household’s approximate income for the previous year. Income was unable to be determined for 2 participants due to missing and/or invalid data. 6 Poverty status was unable to be determined for 3 participants due to missing and/or invalid data.

Cleveland Regional Participant Characteristics Cleveland Regional Participant Characteristics Consumer Characteristics N=41* Male 29 Female 11 20s 10 30s 10

Gender 40s 7 50s 9 60s 3 Less than high school graduate 6 High school graduate 21 Some college or associate's degree 9 Education Bachelor's degree or higher 3 < $12,000 13 $12,000 to $19,999 5 $20,000 to $28,999 7 $29,000 to $36,999 2 ≥ $37,000 12 Household Income Alcohol 24 Cocaine, Crack 19 Cocaine, Powdered 7 Ecstasy/Molly 1 Heroin/Fentanyl 9 Marijuana 17 Methampehtamine 5 Drugs Used** Prescription Opioids 5 Prescription Stimulants 3 Sedative-Hypnotics 6 Other Drugs*** 5

0 5 10 15 20 25 30 35 Number of Participants

*Not all participants filled out forms completely; therefore, numbers may not equal 41. **Some respondents reported multiple drugs of use during the past six months. ***Other drugs included: lysergic acid diethylamide (LSD), phencyclidine (PCP) and synthetic marijuana.

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easy source for medical-grade marijuana. The BCI Richfield Crime Lab reported that the number of marijuana extract Historical Summary and concentrate cases it processes increased during the reporting period. In the previous reporting period (January - June 2017), crack cocaine, heroin, marijuana, methamphetamine, Participants reported that the availability of crystal powdered cocaine, prescription opioids, prescription methamphetamine increased during the reporting period. stimulants and sedative-hypnotics remained highly Participants and law enforcement noted a steady increase available in the Cleveland region; also highly available was in “ice” (crystal methamphetamine) flowing into the region, Neurontin® (gabapentin). Changes in availability during the moved by drug cartels in Mexico. One law enforcement past six months included: increased availability for heroin, officer estimated that 60-70% of the methamphetamine fentanyl and marijuana; likely increased availability for cases his agency processed during the previous six months methamphetamine; and decreased availability for ecstasy were crystal methamphetamine cases. A few participants and prescription opioids. predicted that the price of methamphetamine would decrease due to the increasing number of dealers selling Participants and treatment providers reported that the the drug. availability of powdered heroin increased during the past six months. Participants discussed that powdered heroin, The Lake County and the BCI Richfield crime labs reported particularly white powdered, was often adulterated with that the number of methamphetamine cases they process fentanyl. Community professionals explained that much of increased during the reporting period; the labs reported the heroin supply was fentanyl. Moreover, a few treatment having processed crystal, brown, off-white and white providers believed fentanyl was as highly available as powdered methamphetamine. heroin, while some participants expressed that fentanyl was easier to find than heroin. Regarding fentanyl specifically, Lastly, participants reported that fentanyl, heroin and participants and community professionals reported an prescription opioids were used as “cuts” (adulterates) for increase in its availability during the reporting period; many powdered and crack cocaine. Participants also noted “molly” respondent groups referenced an increase in overdoses as (powdered MDMA) as a cut for crystal methamphetamine. an indication of increased fentanyl availability. Corroborating data indicated that fentanyl was available in the region. A query of the National Forensic Laboratory Information System (NFLIS) for the counties which comprise the Cleveland region returned 1,551 fentanyl and fentanyl Current Trends analogue cases (an increase from 956 cases during the previous reporting period) and 168 carfentanil cases Powdered Cocaine reported during the reporting period. Regional crime labs reported that the number of fentanyl, fentanyl analogue Powdered cocaine is moderately to highly available in the and carfentanil cases they processed increased during the region. Participants most often reported the drug’s current reporting period. availability as ‘10’ on a scale of ‘0’ (not available, impossible While participants and community professionals reported to get) to ‘10’ (highly available, extremely easy to get); the that the general availability of marijuana remained the previous most common score was also ‘10.’ Participants same during the reporting period, both respondent groups stated: “It’s like ordering a pizza … I can get it all day long; reported that the availability of marijuana extracts and I can go literally call someone now [and place an order for concentrates (aka “dabs”) increased. Participants discussed powdered cocaine]; If you go to the gas station, especially if “edibles” (marijuana-infused food products) as becoming you are white and in the hood, they come up to you and ask popular. Both respondent groups attributed the increased you if you ‘party’ (use drugs and need anything) … if you’re a availability of high-grade marijuana to the expansion of dealer, you can just spot who is looking; My neighbors sell it. I “legal pot” in other states. Reportedly, products from legal can walk out of my apartment and they all have it; My friends dispensaries were diverted to Ohio. One law enforcement sell it, so it is easy for me to get it.” officer indicated the neighboring state of Michigan as an

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Community professionals most often reported the current and federal charges in a large-scale case after purchasing availability of powdered cocaine as ‘7;’ the previous most and selling large amounts of cocaine in Medina County; an common score was ‘8.’ Treatment providers discussed: 18-month investigation lead by DEA and state authorities “Clients I have had in the last six months … say it has been comprised of undercover purchases and subsequent search easy for them to get it; I hear about ‘powder’ (powdered warrants lead to the arrests (www.cleveland.com, Sep. 6, cocaine) frequently, and that people use it … with opiates 2017). After receiving a tip from a citizen regarding drug- because the opiates bring them down and cocaine brings related activity at a residence, Lorain Police arrested three them back up.” Law enforcement commented: “Most of people for trafficking drugs and possession of cocaine, the DUIs (driving under the influence of drugs or alcohol fentanyl and marijuana (www.morningjournal.com, Sep. 22, arrests) that we do the testing on, we are seeing some kind 2017). Lorain Police charged two individuals with trafficking of stimulant in their system; We are seeing cocaine residue, and possession of cocaine, marijuana and criminal tools after whether that is crack form or powder I am not really sure, but executing a search warrant at an apartment, seizing 60 grams it is mixed in typically with an opioid.” of cocaine, 120 grams of marijuana and various criminal tools (www.morningjournal.com, Sep. 22, 2017). Corroborating data indicated that powdered cocaine is available in the region. The Cuyahoga County Medical Participants reported that the availability of powdered Examiner’s Office reported that 38.4% of the 380 drug cocaine has decreased during the past six months. When overdose deaths it processed during the past six months participants were asked why the availability of powdered involved cocaine (powdered and/or crack cocaine). In cocaine has decreased, several participants reported: addition, the Ohio Department of Public Safety (ODPS) “Crack is where the demand is, so you can hardly find reported 23 drug task force seizures of powdered cocaine powder anymore; Crack dealers usually have [the powdered in the Cleveland region during the reporting period. cocaine] because that is what they use ‘to rock it’ (to make crack cocaine).” Community professionals reported that Media outlets reported on law enforcement seizures the availability of powdered cocaine has remained the and arrests in the region this reporting period. U.S. Drug same during the past six months. One treatment provider Enforcement Administration (DEA) officers in Cuyahoga stated, “Based on what my clients say … they are still able to County arrested two presumed drug traffickers in get it ….” Cleveland’s eastern suburbs after agents searched three apartments in Beachwood and a house in Highland The Lake County Crime Lab reported that the number of Heights and found more than four pounds of cocaine cocaine cases it processes has increased during the past hidden in a secret compartment under the floorboards of six months, while the BCI Richfield Crime Lab reported that a car parked at the house, as well as marijuana, scales, face the number of cocaine cases it processes has decreased. masks and HAZMAT suits in the house and apartments The labs do not differentiate between powdered and crack (www.cleveland.com, July 18, 2017). Elyria Police (Lorain cocaine. County) arrested 18 individuals during an investigation called “Operation Firecracker” when narcotics detectives Reported Availability conducted a warrant sweep for 10 days in July to focus Change during the Past 6 Months on street-level drug dealers; officers seized 48 grams of cocaine and 53 grams of fentanyl/heroin (www. Participants Decrease morningjounral.com, July 21, 2017). Approximately three dozen people died from unintentional drug overdoses

Cocaine Law enforcement No change from cocaine and cocaine-fentanyl mixtures in the first six Powdered months of 2017 in Lorain County (www.news5cleveland. Treatment providers No change com, July 24, 2017). In Elyria, a 16-year-old boy faced criminal charges for attempting to rob a known drug Participants most often rated the current overall quality dealer’s home; the drug dealer was charged with of powdered cocaine as ‘5’ on a scale of ‘0’ (poor quality, trafficking cocaine, possession of cocaine, and possession “garbage”) to ‘10’ (high quality); the previous most of a schedule II controlled substance (www.cleveland.com, common score was also ‘5.’ Participants reported: “Some Aug. 9, 2017). Twenty-nine people in Cleveland faced state people might sell you good stuff one day or even the same

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day, and then later … couple hours it may be pure garbage; Current Street Prices for Every once and a while I’d get a good hit , but I’m gonna give Powdered Cocaine

it a ‘5’ because I know there are people who are using the

better product; It’s pretty shitty because dealers are ‘cutting’ A gram $50 (adulterating) it a lot; The good shit is getting cooked into crack; What I was getting, it made me quit [using powdered 1/16 ounce (aka “teener”) $100 cocaine] … was that bad.” 1/8 ounce (aka “eight ball”) $150-200 Cocaine Participants discussed adulterants (aka “cuts”) that affect Powdered 1/2 ounce $650-700 the quality of powdered cocaine and reported the top cutting agents for the drug as baking soda and vitamin An ounce $1,100-1,200 B. Other adulterates mentioned included: acetone, baby laxatives, “Bolivian Rock” (a cutting agent marketed as Participants reported that the most common route of a concentrated room and carpet deodorizer), caffeine, administration for powdered cocaine remains snorting. energy pills, fentanyl, mannitol (diuretic), Novocaine Participants estimated that out of 10 powdered cocaine (local anesthetic) and vitamin B. A participant discussed, users, all 10 would snort the drug. Participants discussed: “Vitamin B-12 … acetone is used for the smell. Novocaine “Everyone snorts coke; If you just do coke, you are probably is used for the numbing. Baby laxatives … people who snorting … but if you are already ‘shooting’ (intravenously use [powdered cocaine] with this cut in it think it is better injecting) [other] drugs, you would be shooting it.” coke because they have to use the bathroom.” A treatment provider discussed, “I had a client tell me that he could tell Participants described typical powdered cocaine users as it was mixed with fentanyl because when he used it, he felt wealthy and people who to go to nightclubs. Participants life leaving him, and he felt like he was dying … he passed stated: “College kids, rich kids and white older dudes; out outside and his wife found him.” Overall, participants Cocaine is associated with higher class citizens; Professionals, reported that the quality of powdered cocaine has especially white middle-aged people; People who drink and remained the same during the past six months. go to bars because it more socially acceptable than, say, some of the harder drugs like heroin; In the suburbs because Cutting Agents it is more of a nighttime party scene and more socially

acceptable than crack is; Strippers, prostitutes … it is big in Reported by Crime Lab the dance club because is easier to use coke in the club versus l acetaminophen (analgesic) crack … you don’t need a pipe, plus coke keeps you fueled l atropine (prescription heart medication) and also powder does not make you as paranoid as crack, so l levamisole (livestock dewormers) it’s just better in clubs; It is found all over, but in the suburbs, Cocaine l local anesthetics (benzocaine and Powdered yuppies use coke and not crack.” lidocaine) l mannitol (diuretic) Treatment providers described typical powdered cocaine users as of higher socio-economic status, white people Reports of current prices for powdered cocaine were and people who have higher energy jobs, while law consistent among participants with experience buying the enforcement reported people teenaged through 30s, as drug. Reportedly, the most common quantity of purchase well as opiate users as typical users. Treatment providers is a gram. Participants commented: “You are not gonna get commented: “Car dealers, and I also have heard people in anything [for] less than $30; Normally, it is $200 for an ‘eight the restaurant industry because they have to be on it to stay ball’ (1/8 ounce), but I pay $90 because I have known the awake; People in the adult [entertainment] industry; I would guy (dealer) my whole life; Price varies dealer to dealer and say powder cocaine is used more with white people … 20s whether you can go to them or they need to deliver.” Overall, to 50s; I see some African Americans a little bit more than in participants reported that the price of powdered cocaine the past, but not more than Caucasians.” Law enforcement has decreased during the past six months. stated, “18-30-year olds; We see cocaine residue on paraphernalia in the cars of people we pull over or from an opiate overdose.”

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Crack Cocaine methamphetamine, drug paraphernalia and guns (www. news-herald.com, Nov. 16, 2017). Crack cocaine remains highly available in the region. Participants and community professionals reported that Participants most often reported the drug’s current the availability of crack cocaine has remained the same availability as ‘10’ on a scale of ‘0’ (not available, impossible during the past six months. Although one participant to get) to ‘10’ (highly available, extremely easy to get); the reported, “Crack is making a comeback and any ‘dope boy’ previous most common score was also ‘10.’ Participants (heroin dealer) has crack because people are trying to get discussed: “I live in an apartment complex where nine out of off the dope because it is killing everyone.” The Lake County 10 people sell it and use it; I can’t walk down the street without Crime Lab reported that the number of cocaine cases it tripping over it; It is pretty abundant and police are not even processes has increased during the past six months, while focusing on it … they have their hands full with heroin; People the BCI Richfield Crime Lab reported that the number of standing around on the east side, like at gas stations and at cocaine cases it processes has decreased. The labs do not the street corners and at bus stops, you know they are dealing; differentiate between powdered and crack cocaine. In Lake County they will come to you from Cuyahoga County …. They literally drive it to you.” Reported Availability Community professionals most often reported the current Change during the Past 6 Months

availability of crack cocaine as ‘7;’ the previous most common score was ‘10’ for treatment providers and ‘6’ for Participants No change law enforcement. Treatment providers commented: “There Crack

is a house right around here where they can get it … there is Cocaine Law enforcement No change a dealer practically right across the street; It is probably tied with marijuana in terms of availability for this area.” Law Treatment providers No change enforcement officer remarked,It “ is a ‘10’ for availability in Cleveland … it seems more prevalent in the city than in the Participants most often rated the current overall quality of suburbs ….” crack cocaine as ‘6’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the previous most common score was Corroborating data indicated that crack cocaine is available ‘8.’ Participants discussed: “If you take a hit and you puke, you in the region. The Cuyahoga County Medical Examiner’s know it is good; It depends on who is cooking it … some of it Office reported that 38.4% of the 380 drug overdose hypes you up and other stuff don’t even melt right … you can deaths it processed during the past six months involved taste it ain’t right; It depends because sometimes your dude has cocaine (crack and/or powdered cocaine). In addition, good stuff, and then … it’s shit; Quality really depends on the ODPS reported 15 drug task force seizures of crack cocaine dealer but each dealer says his is quality stuff even if they know in the Cleveland region during the reporting period. they are giving you crappier stuff. They are only concerned Media outlets reported on law enforcement seizures about money; If it is three in the morning, it could be garbage, and arrests in the region this reporting period. An literally not even real.” investigation lead by the Medina County Drug Task Force, Participants discussed adulterants (aka “cuts”) that affect the assisted by the U.S. DEA, lead to the indictment of 17 quality of crack cocaine and reported that the top cutting individuals for conspiring to purchase large amounts of agent for the drug is baking soda. Other cuts mentioned powdered cocaine, cook it into crack cocaine, and then included: fentanyl and vitamin B-12. Participants stated: sell it in Medina County and surrounding areas (www. “Mostly baking soda and you can tell by the way it sticks thepostnewspapers.com, Oct. 14, 2017). After receiving to your stem [of the crack pipe]; It is cut with fentanyl and multiple complaints of drug-related activity in Painesville you know because you test dirty (positive for opiates on a (Lake County), the Painesville, Mentor, Lake County drug screen) and all you know is you smoke crack.” Overall, Narcotics Agency and officers from other county agencies participants reported that the quality of crack cocaine has conducted a search warrant at a Painesville residence and remained the same during the past six months. arrested a man after finding between 27-100 grams of crack cocaine, 50-100 grams of cocaine, 50-100 grams of

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Cutting Agents socio-economic status. Treatment providers stated, “Low Reported by Crime Lab socio-economic status; There are a few folks that are 40 to

60 years old and African American who are using; It is not

gender specific but more African Americans and an older l acetaminophen (analgesic) demographic.” In addition, treatment providers noted l atropine (prescription heart medication)

Crack Crack crack cocaine use among opiate users: “We are seeing l

Cocaine local anesthetics (benzocaine and lidocaine) more combination of crack and heroin use; Our clients are on l mannitol (diuretic) l levamisole (livestock dewormer) Vivitrol® and when they relapse, it is always on crack … they know they can’t get high on opiates.”

Reports of current prices for crack cocaine were consistent among participants with experience buying the drug. Heroin Reportedly, the most common quantity of purchase is 1/10 gram (aka “rock”). Participants stated: “A piece the Heroin remains highly available in the region. size of a nerd candy is about $5, a peanut M&M® [sized rock] Participants and community professionals is $40, pencil eraser size is $15; An eight ball (1/8 ounce) most often reported the current availability of goes for $180 and that is like the size of a golf ball.” Overall, the drug as ‘10’ on a scale of ‘0’ (not available, participants reported that the price of crack cocaine has impossible to get) to ‘10’ (highly available, remained the same during the past six months. extremely easy to get); the previous most common scores were also ‘10.’ Participants commented: “I have so many numbers [phone numbers for heroin dealers]; I can Current Street Prices for get it anytime; It is pretty easy because there is such a high Crack Cocaine demand for it now; It is all that is out there, really.” Treatment

providers stated: “It is absolutely everywhere; The overdoses 1/10 gram (aka “rock”) $10 keep going up and up, so it is obviously around and very, very A gram $50-70 easy to get for our clients.” Crack Crack Cocaine 1/16 ounce (aka “teener”) $80 Corroborating data indicated that heroin is available in the region. The Cuyahoga County Medical Examiner’s Office 1/8 ounce (aka “eight ball”) $180 reported that 33.7% of the 380 drug overdose deaths it processed during the past six months involved heroin; Participants reported that the most common route 89.8% of these heroin cases also involved fentanyl. In of administration for crack cocaine remains smoking. addition, ODPS reported 44 drug task force seizures of Participants estimated that out of 10 crack cocaine users, heroin and/or fentanyl in the Cleveland region during eight would smoke and two would intravenously inject the reporting period; drug task forces did not typically (aka “shoot”) the drug. Participants stated: “I don’t like to differentiate between heroin and fentanyl due to the high shoot it because the vinegar [used to break down the crack incidence of heroin-fentanyl mixtures. cocaine] ruins your veins; It’s too much work to shoot.” Media outlets reported on law enforcement seizures Participants described typical crack cocaine users as and arrests in the region this reporting period. Cleveland Police (Cuyahoga County) arrested a woman after she people of lower socio-economic status living in urban attacked and robbed a 71-year-old for heroin money settings. Participants reported: “Impoverished because it is outside of the Cleveland’s City Council president’s office cheaper [than other drugs] … it’s in the hood; It is way more (www.cleveland.com, July 17, 2017). Westlake Police urban and city than rural; More Hispanic and lower-class (Cuyahoga County) investigated whether heroin may whites are doing crack because you can get it on any inner- have played a role in an SUV crash on Interstate 90, city street; Older white and black guys and younger Puerto which left the drivers of both vehicles injured; the driver Ricans; Prostitutes … working class women.” responsible for the crash later admitted to using heroin Community professionals described typical crack and Adderall® (www.patch.com, Aug. 4, 2017). Wickliffe cocaine users as African-American people with a lower Police (Lake County) charged a man with a drug-related

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OVI (operating a vehicle while impaired) after receiving in the region, while participants reported not seeing black a report of a man passed out behind the wheel of a car tar heroin during the past six months. One participant on a highway exit ramp; officers arrived at the scene and observed, “You get ‘tar’ (black tar heroin) on the west coast or administered two doses of Narcan® (naloxone, an opiate sometimes on the west side of Cleveland, but not like how you overdose reversal medication) to revive the man (www. can get powder.” Law enforcement stated: “We are seeing news-herald.com, Oct. 13, 2017). Ohio State Highway black tar; I’ve seen black tar but it is not prevalent … [black Patrol (OSHP) in Medina County arrested a Texas man tar heroin was found in a vehicle after] a traffic chase out in during a traffic stop after criminal indicators prompted Cleveland [recently], but I am not seeing it on the street.” a search of the vehicle; officers subsequently discovered a total of 3,996 grams of heroin packed into four bricks Participants and treatment providers reported that the (www.justice.gov, Oct. 16, 2017). Parma Police (Cuyahoga general availability of heroin has decreased during the County) charged an alleged drug dealer with involuntary past six months, while law enforcement reported that manslaughter, corrupting another with drugs, and availability has remained the same. A participant stated, “It multiple counts of drug trafficking for providing fentanyl is all fentanyl, so for me it would be harder to find straight up to a woman that lead to her overdose death in March heroin.” Treatment providers commented: “I would say less 2017; the Cuyahoga County Medical Examiner also because the heroin from what the patients are telling me is reported methadone, hydroxyzine and promethazine in not really heroin; Pure heroin has decreased because they are the woman’s toxicity report along with the fentanyl; Parma mixing it with other things.” police officers raided the man’s home and found a plastic The Lake County and the BCI Richfield crime labs reported container with a mixture of heroin and fentanyl, a baggie that the number of heroin cases they process have decreased of fentanyl, a baggie of crack cocaine, a digital scale and during the past six months. The labs report processing drug packaging materials (www.cleveland.com, Oct. 20, brown, gray, purple, tan and white heroin; the labs do not 2017). A Wayne County judge sentenced a Cleveland drug differentiate between black tar and powdered heroin. dealer to eight years in prison after finding him guilty on multiple drug charges, including trafficking heroin; officers Reported Availability arrested the man and three other people at a hotel after Change during the Past 6 Months seizing approximately 30 grams of opiates, crack cocaine, marijuana and drug paraphernalia (www.otfca.com, Oct. Participants Decrease 25, 2017). A U.S. Attorney sentenced a Cleveland man

to 17 years in prison after he sold heroin that resulted in Heroin Law enforcement No change three overdoses in Wooster (Wayne County) (www.justice. gov, Nov. 29, 2017). The Ohio Opiate Task Force reported Treatment providers Decrease to a local news source that 656 drug-related overdose deaths due to heroin, fentanyl and other synthetic Participants most often rated the current quality of opioids occurred in Cuyahoga County as of December black tar and white powdered heroin as ‘10’ and of 1, 2017, which was an increase from the same time the brown powdered heroin as ‘5’ on a scale of ‘0’ (poor previous year; officials projected a 25% increase by the quality, “garbage”) to ‘10’ (high quality); the previous end of 2017 (www.wkyc.com, Dec. 1, 2017). Beachwood most common scores were ‘7’ for black tar heroin and ‘8’ Police (Cuyahoga County) responded to a call that a man for powdered heroin. Participants discussed: “Depends. overdosed at a residence in Beachwood and rushed him to I have had really good and really bad, it has to do with the hospital (www.patch.com, Dec. 8, 2017). the ‘cut’ (adulterants) and how many people ‘stepped on’ (adulterated) it before you get it, so you never know what While many types of heroin are currently available in you are getting; I have never had shitty tar … it is always the region, participants and community professionals amazing. [Black tar heroin] is usually better and cheaper continued to report powdered heroin as most available. [than powdered heroin]; If it is cut with fentanyl, quality is a A law enforcement officer stated:It “ seems like there is lot better.” a mixture of brown and white powder, kind of looks like Nesquik® and that is more prevalent than anything ….” Law Participants discussed adulterants (aka “cuts”) that affect enforcement also reported availability of black tar heroin the quality of heroin and reported the top cutting agents

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for the drug as fentanyl and vitamin B. Additional cuts While there were a few reported ways of using heroin, mentioned included: baby laxatives, Benefiber®, Coca generally, the most common route of administration Cola®, lidocaine (local anesthetic), Sleepinal® and vitamin remains intravenous injection (aka “shooting”). Participants D. Participants stated: “Vitamin D … because it breaks estimated that out of 10 heroin users, eight would shoot down and you can ‘shoot’ (inject) it, so nobody can tell the and two would snort the drug. Participants stated: “With difference and they think they are getting better shit; I only powder, most people shoot; If you are using ‘dope’ (heroin), know of Coca Cola® for tar.” Overall, participants reported you’re shooting it; Some people still snort. I know people that the general quality of heroin has remained the who are always tootin’ (snorting) it; For tar, you can sniff it by same during the past six months. Participants stated: mixing it with water in like a Gatorade® cap to dissolve it, but “I overdosed on it last month, so I’d say it was still pretty it is not that common.” good; Just as strong as it ever was, if not more so, because of Participants reported that injection needles are most fentanyl.” available from the needle exchange programs and from people with diabetes. Participants stated, “I get them from Cutting Agents the needle exchange; You can go to [a retail store] … some Reported by Crime Lab pharmacies will [sell users needles] but [some] started not to, so it depends.” Reportedly, needles on the street most

l acetaminophen l carfentanil often sell for $1 per needle. Participants commented: “If l cocaine you are ‘dope sick’ (experiencing withdrawal), you are gonna l diphenhydramine (antihistamine) use any needle you can get your hands on. You ain’t thinking Heroin l fentanyl/fentanyl analogues about anything but not being sick; Sharing needles is not l mannitol (diuretic) preferred but happens.” l papaverine (vasodilator) Participants described typical heroin users as everyone. l quinine (antimalarial) A participants stated, “It started with white people in the suburbs, but now it is everyone, and everywhere.” Reports of current prices for heroin were consistent Community professionals described typical heroin users among participants with experience purchasing the drug. as white people. Treatment providers commented: “It is Reportedly, the most common quantity of purchase is a more geographically based. I think one time in four years I gram. Participants discussed: “You buy them by the ‘points’ had one African-American client [who used heroin]; We only (1/10 gram amounts) and I can get 16 ‘balloons’ (1/10 gram had a handful of African Americans in treatment [for heroin amounts of black tar heroin) for $100; A half a point is the use]; When I worked in Cleveland it was mostly Caucasians; smallest you can buy and it is $10; I can get five ‘bundles’ (one Primarily white people but age is across the gamut; I have seen gram amounts) … for $500.” Overall, participants indicated 18-year olds and then one person started using heroin at 68 that the price of heroin has remained the same during the and came into treatment at age 72.” One law enforcement past six months. officer remarked,Usually “ white people from the suburbs.” However, a few treatment providers noted heroin use as Current Street Prices for increasing among non-whites. They said: “It seems like it is Heroin increasing among the Latino and minority populations; I can’t particularly say why, but heroin is not just suburban … it is 1/10 gram $20 making its way into the city.” 1/2 gram $50-80 Heroin A gram $100-120 Fentanyl 1/4 ounce $600-700 An ounce $1,800 Fentanyl is highly available in the region. Participants and community professionals most often reported the current availability of the drug as ‘10’ on a scale of ‘0’ (not available,

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 109 Page 8 Surveillance of Drug Abuse Trends in the Cleveland Region impossible to get) to ‘10’ (highly available, extremely guns; the Cuyahoga County Medical Examiner reported easy to get); the previous most common scores were not that the man had both fentanyl and cocaine in his body reported. Participants stated: “Order it off the ‘dark web’ and at the time of his death (www.cleveland.com, Sep. 29, get it at your front door; It’s the only thing people are selling 2017). A federal judge in Cleveland sentenced a Highland here; It is just too easy to get heroin and fentanyl.” Treatment Heights (Cuyahoga County) man to 12 years in prison for providers discussed: “It’s everywhere; If they are going out providing a 19-year-old with fentanyl which resulted in her with hopes of getting heroin … they have a 90% chance of overdose death; the man allegedly purchased the drug getting fentanyl; Clients tell me they look for fentanyl and through the dark web from China and shipped the drug carfentanil.” Law enforcement stated: “Based on what we to Northeast Ohio (www.cleveland.com, Oct. 31, 2017). A are seeing it is ‘10’; I don’t know if people buying it know it Geauga County Common Pleas Court judge sentenced is fentanyl or if they think it is just strong heroin, but we are a Cleveland man to 11 years in prison for selling fentanyl seeing more results [indicating fentanyl] from the lab; The to a man, which resulted in his overdose death in a home last couple of addicts I interviewed in jail weren’t looking for in Auburn Township (Geauga County) (www.cleveland. heroin, they were looking for fentanyl. They … can’t wait to com, Nov. 17, 2017). Cleveland Police and the FBI arrested use it again … they are pissed when they are ‘narcanned’ 26 people for participating a large-scale drug ring where (receive Narcan® to reverse an overdose).” drug dealers bought fentanyl, heroin and cocaine from China and Puerto Rico and shipped the drugs through Corroborating data indicated that fentanyl is available the U.S. Postal Service, FedEx and UPS to Northeast Ohio; in the region. The Cuyahoga County Medical Examiner’s three men are responsible for arranging the shipments and Office reported that 71.8% of the 380 drug overdose bringing in a kilogram of fentanyl, a kilogram of heroin and deaths it processed during the past six months involved five kilograms of cocaine and storing them at auto body fentanyl/fentanyl analogues, while 25.0% involved service locations and private residences in Cleveland, Parma carfentanil (an increase from the previous six months, and Euclid; the men sold the drugs to other traffickers in when 14.2% of deaths had involved carfentanil). In the area; one man also shipped in large amount of N-ethyl addition, ODPS reported 44 drug task force seizures of pentylone (a cathinone derivative with psychostimulant heroin and/or fentanyl in the Cleveland region during effects) and another man shipped in over 100 kilograms of the reporting period; drug task forces did not typically marijuana (www.patch.com, Dec. 7, 2017). differentiate between heroin and fentanyl due to the high incidence of heroin-fentanyl mixtures. Participants and community professionals reported that the availability of fentanyl has increased during the past Media outlets reported on law enforcement seizures and six months. Treatment providers stated: “I think it is supply arrests in the region this reporting period. A federal judge and demand; It has become part of the norm … they just in Cleveland sentenced an Akron drug dealer to 16 years accept that if they are getting heroin, they know they will in prison for selling fentanyl to a truck driver that resulted get fentanyl.” Law enforcement commented: “I think it has in his overdose death (www.cleveland.com, July 13. 2017). increased because it is a little cheaper [than heroin] from A Cleveland police officer was hospitalized after being what I understand … so availability is just there; It was just exposed to fentanyl while conducting a raid of home heroin in the past, but now it seems like [heroin] is mixed a lot (www.cleveland.com, July 19, 2017). The Cuyahoga County with fentanyl.” Medical Examiner issued a public health warning after Cleveland Police discovered carfentanil in pills disguised as The Lake County Crime Lab reported that the number OxyContin® (www.usnews.com, July 27, 2017). The Lorain of fentanyl and fentanyl analogue cases it processes Police Narcotics Bureau (Lorain County) arrested a man has decreased during the past six months, while the BCI during a raid of a home in Lorain after finding 20 grams of Richfield Crime Lab reported that the number of fentanyl suspected carfentanil, cash and drug paraphernalia (www. and fentanyl analogue cases it processes has increased. cleveland.com, Aug. 22, 2017). U.S. Marshalls in Cleveland In addition, the Lake County Crime Lab reported that the arrested two people responsible for providing fentanyl to number of carfentanil cases it processes has increased a man that resulted in his overdose death; officers raided during the past six months, while the BCI Richfield Crime a home in Cleveland during the investigation and found Lab reported that the number of carfentanil cases it five grams of heroin packaged for sale, marijuana and processes has decreased.

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Reported Availability Participants and community professionals described

Change during the Past 6 Months typical fentanyl users as similar to heroin users. Participants stated: “Whatever we answered for a heroin Participants Increase addict, is the same thing here … it is the same group of people; Fentanyl is usually a cut to heroin, so you’d have to Law enforcement Increase say heroin addicts use it the most.” Treatment providers Fentanyl commented: “Opioid users; Caucasian, raised in a middle- Treatment providers Increase class background; Tied to heroin users.”

Participants most often rated the current overall quality of Prescription Opioids fentanyl as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the previous most common score was not Prescription opioids are moderately available reported. One participant stated, “It is the strongest shit you for illicit use in the region. Participants most can get.” Participants discussed adulterants (aka “cuts”) that often reported the current street availability of affect the quality of fentanyl and reported the top cutting these drugs as ‘5’ on a scale of ‘0’ (not available, agents for the drug as heroin and vitamin B. An additional impossible to get) to ‘10’ (highly available, cut mentioned included MSM (methylsulfonylmethane, a extremely easy to get); the previous most common score joint supplement). Overall, participants reported that the was ‘10.’ A participant reported, “Overall, they are harder to general quality of fentanyl has increased during the past six get.” Treatment providers most often reported current street months. One participant stated, “With all the overdoses, one availability as ‘4,’ while law enforcement most often reported would have to assume, even if you don’t use it, that it is only it as ‘5;’ the previous most common scores were ‘8’ and ’10,’ getting stronger and stronger.” respectively. Reports of current prices for fentanyl were consistent Corroborating data indicated that prescription opioids are among participants with experience purchasing the available for illicit use in the region. The Cuyahoga County drug. A participant remarked, “It is cheaper than heroin for Medical Examiner’s Office reported that 16.7% of the 380 the dealers.” Reportedly, the most common quantity of drug overdose deaths it processed during the past six purchase is a gram. Overall, participants indicated that the months involved prescription opioids. In addition, ODPS price of fentanyl has remained the same during the past reported 23 drug task force seizures of prescription opioids in six months. the Cleveland region during the reporting period. Media outlets reported on law enforcement seizures and

Current Street Prices for arrests in the region this reporting period. A man was Fentanyl charged in Mentor Municipal Court (Lake County) with 1/10 gram $20 aggravated robbery after he robbed a local pharmacy of prescription medication; after entering the store armed with

Fentanyl 1/2 gram $50 a screwdriver, the man jumped over the front counter and A gram $100 demanded Percocet® from a female employee before fleeing the store with the drug (www.cleveland.com, July 19, 2017). While there were a few reported ways of using fentanyl, After a car accident that resulted in the death of an OSHP generally, the most common route of administration Trooper on Interstate 90, prosecutors charged a man with is intravenous injection (aka “shooting”). Participants multiple charges, including aggravated vehicular homicide estimated that out of 10 fentanyl users, eight would shoot from driving under the influence of methadone www.fox8.( and two would snort the drug. Participants stated: “Most com, Aug. 9, 2017). The Elyria Police Narcotics Unit (Lorain people are shooting because by the time you [use] fentanyl, County) arrested a man at a gas station for his connection you are an ‘IV’ (intravenous) user; A lot of people are shooting with the overdose death of another man; police seized 71 ‘dope’ (heroin) … so I guess you can say that most people are doses of Roxicet®, 2.2 grams of fentanyl and a digital scale shooting it.” from the man’s vehicle (www.chroniclet.com, Aug. 31, 2017). Two people in Mentor Municipal Court were charged with

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 111 Page 8 Surveillance of Drug Abuse Trends in the Cleveland Region fifth-degree felony aggravated drug possession involving oxymorphone (Opana®) and tramadol (Ultram®) during an unspecified amount of oxycodone; the two faced up to the past six months, while the number of methadone and five years in prison www.news-herald.com( , Sep. 22, 2017). morphine cases has decreased. The BCI Richfield Crime A Parma (Cuyahoga County) woman and a Cleveland man Lab reported that the number of methadone, oxycodone/ were arrested after a retail store security officer observed acetaminophen and tramadol cases it processes have the couple shoplifting; officers searched the couple and increased during the past six months, while the number found two opioids and marijuana (www.cleveland.com, Sep. of hydrocodone (Vicodin®), hydromorphone, morphine, 28, 2017). A Lake County Common Pleas Judge sentenced oxycodone and oxymorphone cases have decreased. a Euclid (Cuyahoga County) man to 12 years in prison for beating a man in the head with an aluminum baseball bat Reported Availability to steal prescription drugs (www.news-herald.com, Oct. 18, Change during the Past 6 Months 2017). According to the U.S. Attorney’s Office of the Northern District of Ohio in Cleveland, 35,000 pounds of prescription Participants Decrease medications were collected during a Drug Take Back Day (www.cleveland.com, Oct. 28, 2017). Opioids Law enforcement Decrease

Participants and community professionals identified Prescription Percocet® as the most available prescription opioid in Treatment providers Decrease terms of widespread illicit use. Participants stated: “I can get Percocet® for you right now; Nobody uses Vicodin® anymore, Reports of current street prices for prescription opioids were well, maybe people who … get them [prescribed], but people consistent among participants with experience buying the are not selling them on the streets.” Treatment providers stated: drugs. Reportedly, the majority of prescription opioids sell “Definitely Percocet® would be number one; Vicodin® does for $1 per milligram. Overall, participants indicated that the not seem readily available, but it is not entirely impossible to street price of prescription opioids has remained the same get; Percocet® is still widely distributed by dentists … I think during the past six months. However, they indicated that the their heads are in the sand more than a general practitioner; price of Percocet® on the street has increased. A participant Percocet® seems pretty readily available. They are expensive, but shared: “It has gotten so ridiculous. I know someone selling ‘perk they are available.” 10’ (Percocet® 10 mg) for $15 .… It depends on where you live. If there is more money in the area, the higher [the price].” Participants and community professionals continued to report that the street availability of prescription opioids Current Street Prices for has decreased during the past six months. Participants Prescription Opioids discussed: “There was a time the doctors would give them out, but with everyone dying of heroin the doctors are cutting down Demerol® $12-13 for 10 mg on prescriptions or the amount they are giving … people are saying they are hard to get now; Even my dealer was looking Pharmaceutical fentanyl $50-60 for 50 mcg for [prescription opioids] but he couldn’t get them.” Treatment providers commented: “If they are on the streets, they are Methadone $5 for 10 mg probably costing sky high; It seems like less [available] … I Morphine $30 for 60 mg know there are still doctors you can go to [for prescriptions] Opana® $40 per 80 mg

but not as many anymore; Doctors are testing to make sure Opioids the prescribed pills are in the urines and doing pill counts … Prescription $3-8 for 5 mg they are much more aware and cautious … you can’t get them Percocet® $5 for 7.5 mg easily; The doctors limit the amount of the pills, too. I see a lot of $8-15 for 10 mg people being discharged [from the hospital] with only 10 pills $10-15 for 15 mg as opposed to 30.” Roxicodone® $20-45 for 30 mg The Lake County Crime Lab reported an increased number Vicodin® $2 for 5 mg of cases of hydromorphone (Dilaudid®), oxycodone (OxyContin®), oxycodone/acetaminophen (Percocet®),

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Participants reported obtaining these drugs for illicit use while the availability in pill form has remained the same. from drug dealers, doctors and people with prescriptions. Participants commented: “People are wanting to get off While there were a few reported ways of consuming heroin and they use Suboxone® ‘strips’ (filmstrips) for that, prescription opioids, and variations in methods of use were so there are more prescriptions out there to be mishandled; noted among types of prescription opioids, generally the The pills seem to be the same but a real increase in the strips.” most common routes of administration for illicit use are Community professionals reported that the availability snorting and oral consumption. Participants estimated that of Suboxone® has remained the same during the past six out of 10 illicit prescription opioid users, five would snort and months. A treatment provider stated, “I think there were a five would orally consume the drugs. Participants stated: It“ lot of primary care docs giving it out in the past … in the last depends on the drug, so like for example, Demerol®, everyone six months there hasn’t been a real change.” The Lake County eats it because it burns your nose. Nobody snorts Vicodin® either and the BCI Richfield crime labs reported that the number because it is too much powder and also the effect is so much of Suboxone® cases they process have increased during the less effective, so they just eat them; Vicodin® won’t be easily past six months. snorted because it burns; With Norco®, people snort it because it is not as much aspirin; If you are using Dilaudid® or Percocet®, Reported Availability

eight out of 10 people are sniffing because they are stronger … ® Change during the Past 6 Months the other two are eating them; You snort Dilaudid® because it is stronger that way; For fentanyl patches, you heat and ‘shoot’ Participants Increase (intravenously inject) the gel.” Law enforcement No change Participants described typical illicit prescription opioid users Suboxone as younger white people. A participant stated, “A lot of high Treatment providers No change school kids … they haven’t used heroin yet and may think they are better than heroin users … that is, until they become one.” Reports of current street prices for Suboxone® were Community professionals described typical illicit users as consistent among participants with experience buying similar to heroin users. Law enforcement stated, “Of course, it the drug. Participants discussed: “The 12 mgs are $30, but is the opioid addict but they are in the high schools, too.” the ‘12s’ (12 mgs) are harder to find unless you go to rehab; 8 mgs are about $10-20 unless you are buying the whole Suboxone® script and then you can get 28 days’ worth for $170.” Overall, participants reported that the street price of Suboxone® has Suboxone® is highly available for illicit use in the region. remained the same during the past six months. Participants most often reported the current street

availability of Suboxone® in sublingual filmstrip and in ® Current Street Prices for pill form as ‘10’ on a scale of ‘0’ (not available, impossible Suboxone® to get) to ‘10’ (highly available, extremely easy to get); the $10-20 for 8 mg previous most common scores were ‘7’ for the filmstrip Filmstrip $30 for 12 mg form and ‘3’ for the pill form. A participant remarked, “They

are really easy to get.” Community professionals most often Suboxone Pill $10-20 for 8 mg reported the current availability of Suboxone® generally as ‘10;’ the previous most common score was ‘7’ for treatment In addition to obtaining Suboxone® on the street from drug providers and ‘10’ for law enforcement. Treatment providers dealers, participants also reported getting the drug for illicit commented: “I think they are pretty available on the streets; use through people who are prescribed them. A participant I know it is out there; They are getting it on the streets … we shared, “People don’t want to be ‘dope sick’ (experience hear a lot of people who start treatment and tell us they will withdrawal) and the dealers know this, so they usually have have Suboxone® in their system.” them … it’s super common.” One treatment provider stated, “One of the things we are seeing is that they are getting them Participants reported that the availability of Suboxone® in on the streets and we want them to come in [for treatment] filmstrip form has increased during the past six months, and get them….”

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Participants reported that the most common route of Participants identified Klonopin® and Xanax® as the most administration for illicit use of Suboxone® is intravenous available sedative-hypnotics in terms of widespread injection (aka “shooting”). Participants estimated that out of illicit use. Participants stated: “Klonopin® and Xanax® are 10 illicit users of Suboxone® filmstrips, seven would shoot definitely easy to find for me; ‘Xanies’ (Xanax®) for sure are and three would orally consume the drug. In addition, the easiest to get, well that and Klonopin®… they are just participants discussed ocular absorption and snorting of popular and very easily available.” Community professionals Suboxone®. Participants stated: “Most people are putting identified Xanax® as most available. Treatment providers them under their tongue, but if you shoot, you are going to discussed: “I hear about Xanax® .… Ativan® is not widely shoot everything, even ‘subs’ (Suboxone®); Most people using abused, or at least not that I hear; Soma® has peaked Suboxone® just put the strips under the tongue, but I know and then died off. I don’t hear about Ambien®.” A law people who put them in their eyes, too.” enforcement officer shared,Xanax® “ always stands out. We see Soma®, too, it is up there … I’ve seen Klonopin® quite a bit … Valium®, there is still some … Ativan® … we have seen it Sedative-Hypnotics but not that much.” Sedative-hypnotics (benzodiazepines, barbiturates and Participants and community professionals reported muscle relaxants) ) remain highly available for illicit use in that the general availability of sedative-hypnotics has the region. Participants most often reported the current remained the same during the past six months. Both the street availability of these drugs as ‘8’ on a scale of ‘0’ Lake County and the BCI Richfield crime labs reported (not available, impossible to get) to ‘10’ (highly available, that the number of lorazepam (Ativan®) cases they extremely easy to get); the previous most common score process have increased during the past six months, was ‘10.’ Participants reported: “I would walk into the while the number of clonazepam (Klonopin®), diazepam doctor and just tell him I needed [Xanax®] and show him (Valium®) and zolpidem (Ambien®) cases have decreased. the old ‘script’ (prescription) bottle and he’d give it to me. It In addition, the Lake County Crime Lab reported that was that simple; A lot of ‘dope boys’ (heroin dealers) have the number of alprazolam (Xanax®) cases it processes ‘pills’ (benzodiazepines), too, so that is why it is so easy. has increased, while the number of carisoprodol (Soma®) People like using them together [with heroin].” Community cases has decreased. The BCI Richfield Crime Lab reported professionals most often reported current street that the number of carisoprodol cases it processes has availability of sedative-hypnotics as ‘10;’ the previous most increased, while the number of alprazolam has decreased. common score was ‘8.’ Treatment providers commented: “I hear about Xanax® and Klonopin® … primary care doctors Reported Availability give it out easily; The abuse rate even among those prescribed Change during the Past 6 Months is very high.” Corroborating data indicated that sedative-hypnotics Participants No change are available for illicit use in the region. The Cuyahoga Law enforcement No change

County Medical Examiner’s Office reported that 13.9% Sedative- Hypnotics of the 380 drug overdose deaths it processed during the past six months involved one or more benzodiazepine. Treatment providers No change In addition, ODPS reported 11 drug task force seizures of benzodiazepines in the Cleveland region during the Reports of current street prices for sedative-hypnotics reporting period. were consistent among participants with experience buying the drugs. Reportedly, sedative-hypnotics most Media outlets reported on law enforcement seizures and often sell for $1-1.50 per milligram. Overall, participants arrests in the region this reporting period. Cleveland Police reported that the price of sedative-hypnotics has arrested a Brook Park (Cuyahoga County) woman after remained the same during the past six months. A finding a bag of marijuana, a marijuana pipe, marijuana participant stated, “Prices haven’t changed much. But with grinders, and a digital scale in her hotel room when she any drug, the more you buy, the better the deal. And the more was found unresponsive after overdosing on alcohol and you know the dealer, the better the price, too.” Xanax® (www.cleveland.com, July 7, 2017).

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Current Street Prices for enforcement discussed: “Everybody seems to have marijuana Sedative-Hypnotics these days; It is easier to find marijuana than alcohol; They think, ‘It is practically legal so why you bothering me’ … and their $3-4 for 0.5 mg Klonopin® parents are doing it.” $7 for 1 mg Participants and community professionals also discussed Valium® $1 for 1 mg current availability of high-grade marijuana extracts and Sedative- Hypnotics $3 for 1 mg concentrates, often appearing as oil and waxy forms of Xanax® $5 for 2 mg the drug (aka “dabs”). Participants most often reported the $9 for 3 mg current availability of marijuana extracts and concentrates as ‘10,’ while community professionals most often reported it as ‘7;’ the previous scores were ‘10’ for both participants and Participants reported obtaining these drugs for illicit community professionals. Participants stated: “Availability of use from drug dealers, other users, doctors and through high grade is the same if not more [than regular marijuana]; Internet purchase. They discussed: “You can get them on It is kind of socially acceptable to smoke and everyone wants the streets but the Internet may be more [common] … if you the best; Because of the legalization everyone is growing it know what website to go to, you can get them all day; Xanax® and bringing the good stuff in.” A treatment provider noted, … only certain pill dealers who’d have them, so you would “We hear them talk about it and it seems like [extracts and have to know somebody.” concentrates] are around, just not as much as ‘smokable’ Participants reported that the most common routes of marijuana.” administration for illicit use of sedative-hypnotics are Corroborating data indicated that marijuana is available in the intravenous injection (aka “shooting”) and snorting. region. ODPS reported 25 drug task force seizures of marijuana Participants estimated that out of 10 illicit sedative- in the Cleveland region during the reporting period. hypnotic users, five would shoot and five would snort the drugs. Participants commented: “Most people snort; If you Media outlets reported on law enforcement seizures and are smart, you are eating Ativan®.” arrests in the region this reporting period. Police arrested three Garfield Heights (Cuyahoga County) residents after Participants and community professionals described stopping their vehicle for a traffic violation; the two passengers typical illicit sedative-hypnotics users as white people. A admitted to smoking marijuana and drinking alcohol; during participant commented, “It is definitely mostly white people.” the arrest, one of the individuals also handed officers a bottle A treatment provider stated, “Every person I have seen is of alcohol and a marijuana pipe from underneath his seat; Caucasian and age … 20 to 50-year olds … so I’d say all ages.” it was later discovered that all three were wanted for crimes Another treatment provider remarked, “I have seen women in various communities (www.cleveland.com, July 6, 2017). prescribed it more.” Law enforcement said: “White kids and Avon Lake Police (Lorain County) investigated a father after those in their 20s; Kids are getting them from their parents and the mother picked up her daughter from the man and noticed it’s these same kids that end up going into heroin.” she smelled like burnt marijuana (www.patch.com, Aug. 4, 2017). Mayfield Heights Police (Cuyahoga County) arrested a man during a traffic stop on US 422 after finding him driving Marijuana intoxicated and in possession of marijuana (www.patch.com, Aug. 30, 2017). In Bentleyville (Cuyahoga County), after being Marijuana remains highly available in the region. Participants stopped for a traffic violation, police discovered approximately and community professionals most often reported the five grams of marijuana and a pipe with residue in the center current availability of the drug as ‘10’ on a scale of ‘0’ console of a Cleveland man’s vehicle (www.cleveland.com, (not available, impossible to get) to ‘10’ (highly available, Sep. 1, 2017). In Cleveland, after stopping a vehicle for a traffic extremely easy to get); the previous most common scores violation, a police officer cited the driver for possession of drug were also ‘10.’ Participants stated: “Everyone can get it. It is all paraphernalia when he smelled marijuana coming from the over; It is easily a ‘20’ [on the availability scale].” Treatment car and found two glass pipes in the man’s car (www.cleveland. providers commented: “It is cheap and not that difficult to com, Sep. 22, 2017). When a police officer stopped a vehicle obtain and sell; People have a mindset that it is an herb … the for a traffic violation, he noticed that the Cleveland driver benefits vastly outweigh the consequences to them….” Law smelled like marijuana and saw a “joint” (marijuana cigarette)

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 115 Page 8 Surveillance of Drug Abuse Trends in the Cleveland Region in the door’s pocket; the man also admitted to having a bag of Reported Availability marijuana in his backpack, and while searching the car, police Change during the Past 6 Months found an additional bag of marijuana (www.cleveland.com, Sep. 28, 2017). In Solon (Cuyahoga County), after a routine Participants Increase traffic stop for speeding, a police officer arrested two men for possession of marijuana; when the officer approached the Law enforcement No change

vehicle, he noticed the smell of marijuana coming from the car Marijuana and a burnt marijuana “blunt” (cigar) in the center ashtray; the Treatment providers No change officer also found a small bag of marijuana hidden between the rear seat and trunk area (www.patch.com, Oct. 13, 2017). Participant most often rated the current overall quality of In Bay Village (Cuyahoga County), police cited an Olmstead marijuana as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ Falls (Cuyahoga County) resident after pulling his vehicle over (high quality); the previous most common score was also ‘10.’ for a traffic violation, noticing the smell of marijuana and Participants observed: “Because of legalization there is better ‘pot’ finding marijuana and drug paraphernalia in his vehicle www.( (marijuana); Everyone wants the best type of ‘weed’ (marijuana); cleveland.com, Oct. 28, 2017). A Seven Hills (Cuyahoga County) There is some good ‘bud’ (marijuana) up here; For dabs, it depends on police officer cited a driver for drug abuse and possession of the source because you need to know how to make it….” drug paraphernalia after stopping the speeding motorcyclist and noticing the smell of marijuana; the officer found a pill Overall, participants reported that the quality of marijuana has bottle containing marijuana and a pipe (www.cleveland.com, increased during the past six months. Participant commented: Nov. 1, 2017). Bedford Police (Cuyahoga County) arrested “Because everyone is growing it now, they are perfecting it; People the assistant basketball coach from a local high school after put a lot of research into growing it. There is a whole science the coach crashed his car and a search of his vehicle revealed behind it, and that is resulting in better quality pot.” In addition, baggies of marijuana, a scale and a gun (www.fox8.com, participants and treatment providers indicated that fentanyl Nov. 1, 2017). A North Olmstead (Cuyahoga County) police is cut into marijuana to make it more potent. Participants said: officer cited a driver for possession of drug paraphernalia after “I know they have put fentanyl in with weed to make it stronger; stopping a vehicle for a traffic violation, and noticing the smell I know two people who smoked pot and overdosed and it was of marijuana coming from the car; the driver admitted to drug fentanyl that came up in the screen.” A treatment provider paraphernalia in the center console (www.cleveland.com, Nov. remarked, “What people are lacing it with has changed, and that 3, 2017). Olmstead Township Police (Cuyahoga County) cited includes fentanyl….” a driver for possession of marijuana and related paraphernalia Reports of current prices for marijuana were provided by after finding the items in the vehicle during a traffic stop participants with experience buying the drug. Reportedly, (www.cleveland.com, Nov. 4, 2017). The Geauga County the most common quantities of purchase are 1/8 ounce for Sheriff’s Office and the U.S. Drug Enforcement Administration low-grade marijuana and a blunt and a gram for high-grade (DEA) arrested three people in Thompson Township as a marijuana. Participants stated: “You can’t buy a ‘joint’ (marijuana result of an investigation of a large marijuana grow operation; cigarette) … it is a blunt; Usually, a 1/8 [ounce] is what you buy. officers seized about 1,500 plantswww.fox8.com ( , Nov. 7, If you buy a large amount, it is to move (sell) it; The smallest 2017). [amount available for purchase] is a ‘5 dollar holla’ … a blunt [selling for $5]; $50 a gram for extracts. You don’t need much Participants and community professionals reported that more than a gram. You take one hit and that is all you need; For the general availability of marijuana has remained the same edibles (food products containing marijuana), a candy bar is like during the past six months. However, participants indicated $10.” Overall, participants reported that the price of marijuana that the availability of marijuana extracts and concentrates in has remained the same during the past six months. the form of oils or wax (aka “dabs”) has increased during the past six months. They stated: “Dabs, it is not that new, but since the general public is more aware of it now, I’d have to say it has increased; They have skyrocketed; I know more people who smoke dabs, more than anything else now.” The Lake County and the BCI Richfield crime labs reported that the number of marijuana cases they process have decreased or remained the same during the past six months, while the number of marijuana extracts and concentrates (oils, “dabs”) cases have increased.

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Current Street Prices for abuse we see; Chronic pot smokers are using oils; Extracts are used by pot smokers who are a little more serious about their use Marijuana and have better connections ….” Low grade: A blunt (cigar) or gram $5 Methamphetamine 1/4 ounce $45 Methamphetamine remains highly available An ounce $60 in the region. Participants most often reported A pound $900 the current availability of the drug as ‘10’ on a High grade: scale of ‘0’ (not available, impossible to get) to A blunt (cigar) or gram $10-20 ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants Marijuana 1/8 ounce $40 stated: “It is easy for me [to obtain methamphetamine] 1/4 ounce $60-100 because I live next to the ‘meth capital of the world,’ Ashtabula; It ain’t coming past (west of) Painesville [Lake An ounce $200 County]; Just give me 10 minutes [to obtain it]; Someone just A pound $2,200 called me the other day and asked if I wanted it. They asked Extracts and concentrates: if I ‘still cooled down with ice in the summer’ (still used crystal methamphetamine).’” A gram $50 Treatment providers most often reported the current While there were a few reported ways of consuming availability of methamphetamine as ‘5,’ while law marijuana, generally the most common route of enforcement most often reported it as ‘8;’ the previous administration remains smoking. Participants estimated that most common scores were ‘10’ for both treatment out of 10 marijuana users, nine would smoke and one would providers and law enforcement. However, one treatment “vape” (vaporize by heating) the drug. Participants discussed: provider stated, “It does not seem very available in Cleveland “Everyone smokes it; If you want an edible, the weed man as I think there are other substances people flock to rather usually has them. They are about $5 a brownie and they get than ‘meth’ (methamphetamine).” you ridiculously high … if you eat a ‘loud’ (high-grade) brownie, don’t plan on doing anything for a while; I know a guy getting Corroborating data indicated that methamphetamine medical marijuana from California and it is oil and he puts it in is available in the region. The Cuyahoga County Medical his pipe and smokes it.” Examiner’s Office reported that eight of the 380 drug overdose deaths it processed during the past six months A profile for a typical marijuana user did not emerge from the involved methamphetamine. In addition, ODPS reported data. Participants and community professionals described 43 drug task force seizures of methamphetamine in the typical marijuana users as everyone. Participants stated: “It Cleveland region during the reporting period (46.5% of is everyone, really I don’t know anyone who hasn’t smoked; the seizures were made in Wayne County). Low [grade marijuana] is usually only smoked by hippies, or when you are low on money because it is cheaper; For extracts, Media outlets reported on law enforcement seizures it is daily pot smokers, the younger crowd … experienced and arrests in the region this reporting period. Law pot smoker from the younger generation is using it more.” enforcement in Lake County arrested a man during Treatment providers commented: “My Mexican population a routine traffic stop after a K-9 officer alerted to the for sure; I primarily see African Americans, but age group runs presence of drugs; officers found six pounds of crystal the gamut … I see young and older. There is no specific age methamphetamine hidden in a suitcase in the trunk impacted more than the rest; I say all ages and a lot in the of the vehicle (www.pressdemocrat.com, July 3, 2017). younger demographic, like teens through 30s; The demographic Cleveland Police (Cuyahoga County) arrested two people of marijuana abuse is all races but in treatment there are more after a three-month long investigation when officers African Americans….” Law enforcement stated: “It is across the executed a search warrant of a home in Cleveland; board, but teenagers 15-22 [years of age] is the highest rate of officers learned the pair distributed between two to three

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 117 Page 8 Surveillance of Drug Abuse Trends in the Cleveland Region ounces of methamphetamine each week (www.wrwh. that the availability of both powdered and crystal com, July 5, 2017). Law enforcement in Holmes County methamphetamine has remained the same during the arrested three people after responding to a tip that they past six months. However, one treatment provider who were in possession of drugs; officers found a couple and felt that availability has increased stated, “I am noticing a backseat passenger parked in a high school parking a lot more people are testing positive for it. I remember lot, upon searching the vehicle, they found 2.1 grams of when it was hitting in the early 2000s and then it went methamphetamine (www.the-daily-record.com, July 19, down … now with this heroin it has gone up again.” Law 2017). Wooster Police (Wayne County) and the Medway enforcement reported that the general availability of Drug Enforcement Agency responded to several reports methamphetamine has increased during the past six of drug activity and arrested five people at a home in months. They discussed: “I don’t know why it has increased Wooster after executing a search warrant and seizing but it seems to have … just had a case of crystal the other various items related to methamphetamine use (www.the- day; We just had a house one day ago [where an individual] daily-record.com, Sep. 11, 2017). Wayne County Sheriff’s was cooking it … a family member called and police went Department and the U.S. Drug Enforcement Agency right to the house.” (DEA) arrested two people after searching a residence in Wayne County and discovering various drugs, including The Lake County Crime Lab reported that the number nearly 70 grams of methamphetamine and 74 grams of of methamphetamine cases it processes has decreased heroin (www.yourohiovalley.com, Oct. 3, 2017). The Wayne during the past six months, while the BCI Richfield Crime County Drug Enforcement Unit along with other local law Lab reported that the number of methamphetamine cases enforcement agencies arrested two people responsible it processes has increased. The labs reported processing for trafficking large amounts of crystal methamphetamine blue, brown, clear and white crystal methamphetamine into Wayne County; during an undercover investigation, as well as brown, off-white and white powdered officers seized crystal methamphetamine, pills, marijuana methamphetamine.

and cash (www.herald-dispatch.com, Oct. 12, 2017). Ashland Police (Ashland County) arrested two people Reported Availability in a Walmart parking lot; officers found the two people Change during the Past 6 Months in a mobile methamphetamine laboratory (www. richlandsource.com, Oct. 27, 2017). Participants Increase

Participants reported that methamphetamine is available Law enforcement Increase in powdered and crystal forms throughout the region. However, they identified crystal methamphetamine as Treatment providers No change most prevalent in the region. Participants commented: Methamphetamine “Everyone wants the crystal form. It is just better; Crystal is more pure, or so they say.” The powdered form of Participants most often rated the current overall quality methamphetamine is typically referred to as “shake-and- of methamphetamine as ‘8’ on a scale of ‘0’ (poor quality, bake,” which means users produce the drug in a single- “garbage”) to ‘10’ (high quality); the previous most sealed container, such as a two-liter soda bottle. By using common score was ‘5-7.’ Participants discussed adulterants common household chemicals along with ammonium (aka “cuts”) that affect the quality of methamphetamine nitrate (found in cold packs) and pseudoephedrine and reported MSM (methylsulfonylmethane, a joint (found in some allergy medications), people who supplement) as the top cutting agent for the drug. Overall, make methamphetamine can produce the drug in participants reported that the quality of powdered and approximately 30 minutes in nearly any location. crystal methamphetamine has remained the same during the past six months. Participants reported that the availability of powdered methamphetamine has remained the same during Reports of current prices for methamphetamine were the past six months, while the availability of crystal consistent among participants with experience buying the methamphetamine has increased. Participants stated: drug. Reportedly, the most common amount of purchase “Powder is still hard to get in this area; Crystal seems to be is a gram. Participants agreed that a user can trade a box more the talk in the town.” Treatment providers reported of pseudoephedrine for methamphetamine. A participant

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stated, “Just go out to Ashtabula with a pseudoephedrine get them from any dealer on the street corner … there are box and they will give you 3/4 gram of meth or $50.” Overall, certain pill dealers you can easily find, just takes a few calls.” participants reported that the price of powdered and Community professionals most often reported current crystal methamphetamine has remained the same during street availability as ‘5;’ the previous most common score the past six months. was ‘8.’ Treatment providers stated, “I get a sense they are fairly easy to get; I hear the clients talking about medication Current Prices for used for ADHD (attention-deficit hyperactivity disorder) being Methamphetamine abused so it seems out there.” Powdered: Participants identified Adderall® and Vyvanse® as the most available prescription stimulants in terms of 1/2 gram $30 widespread illicit use. Participants commented: “I always A gram $40-50 knew somebody to get Adderall® from; Nobody takes Ritalin® Crystal: anymore.” Community professionals identified Adderall® as most available. A treatment provider remarked, “I see a 1/2 gram $60 lot of patients prescribed it, but they are not working and not Methamphetamine A gram $100 going to school, so I don’t know why they are getting it.” A law enforcement officer shared,I’ve “ seen Vyvanse® a couple Participants reported that the most common route of times … this one lady had a ‘script’ (prescription) for of administration for methamphetamine remains Vyvanse® but had two Ritalin® tabs (tablets) with her, too.” smoking. Participants estimated that out of 10 crystal methamphetamine users, all 10 would smoke Participants and community professionals reported the drug. They estimated that out of 10 powdered that the street availability of prescription stimulants has remained the same during the past six months. A methamphetamine users, seven would “hot rail” and three participant said, “I can get them as easily as before … no would “shoot” (intravenously inject) the drug. Hot railing change really.” A treatment provider stated, “We still hear methamphetamine is a process where the user places the about it, but it isn’t any more or less….” The Lake County drug in a glass pipe, heats the end of the pipe and inhales and the BCI Richfield crime labs reported that the number the vapors from the drug through their nose and exhales of amphetamine (Adderall®) cases they process have through their mouth. increased during the past six months. In addition, the Participants and community professionals described Lake County Crime Lab reported that the number of typical methamphetamine users as living in rural areas. methylphenidate (Ritalin®) cases it processes has increased A treatment provider discussed, “A lot of the people I’ve during the past six months, while the BCI Richfield Crime Lab reported that the number of methylphenidate cases it seen have gotten in trouble for manufacturing and they are processes has decreased. stockpiling the residue in trailers because they can’t just throw it out in the garbage every week.” Other providers noted: “I

Reported Availability see it coming more to the suburbs in Lake County; I hear it more in the younger gay population.” Change during the Past 6 Months Participants No change Prescription Stimulants Law enforcement No change Stimulants

Prescription stimulants are moderately to highly available Prescription Treatment providers No change for illicit use in the region. Participants most often reported the current street availability of these drugs as ‘10’ on a scale of ‘0’ (not available, impossible to get) to Reports of current street prices for prescription stimulants ‘10’ (highly available, extremely easy to get); the previous were consistent among participants with experience most common score was ‘8.’ Participants discussed: “A lot buying these drugs. Overall, participants reported that the of doctors will prescribe them; You have to know where to price of prescription stimulants has remained the same get them … but if you do, they are easy to get; You can’t just during the past six months.

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Current Street Prices for of molly has remained the same. Participants commented: Prescription Stimulants “Nobody takes the time to make it into a pill anymore; Ecstasy has gone out the window because people like molly better.” Community professionals reported that the availability of $1 for 10 mg ecstasy and molly has remained the same during the past Adderall® $5 for 30 mg six months. The BCI Richfield Crime Lab reported that the

Stimulants number of MDMA (ecstasy/molly) cases it processes has Prescription Prescription increased during the past six months; the Lake County Crime Lab reported having processed only two cases of Participants continued to report obtaining prescription ecstasy during the past six months. stimulants for illicit use most often from someone who is prescribed them. One participant stated, “You just buy a script off someone usually.” Participants reported Reported Availability that the most common route of administration for illicit Change during the Past 6 Months use of prescription stimulants is snorting. Participants Participants Decrease estimated that out of 10 illicit prescription stimulant users, eight would snort and two would orally take the Ecstasy Law enforcement No change drugs. Participants stated, “For ‘addies’ (Adderall®), I’d crush and snort them … but if I was going to the bar, I’d eat Treatment providers No change them; The high is instant if you snort them.” Participants and community professionals described typical illicit Reported Availability prescription stimulant users as high school and college Change during the Past 6 Months students. Treatment providers stated, “A lot of students use it; It is all over college campuses.” Participants No change

Molly Law enforcement No change

Ecstasy Treatment providers No change

Ecstasy (methylenedioxymethamphetamine: MDMA, or Participants discussed the quality of ecstasy and molly other derivatives containing BZP, MDA, and/or TFMPP) ) is and rated the overall quality of ecstasy as ‘1’ and of molly moderately to highly available in the region. Participants as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high most often reported the current availability of “molly” quality); the previous most common scores were ‘3’ and ‘8,’ (powdered MDMA) as ‘10’ on a scale of ‘0’ (not available, respectively. Reportedly, ecstasy and molly are thought not impossible to get) to ‘10’ (highly available, extremely to be typically “cut” (adulterated) with other substances. easy to get); the previous most common score was also However, one law enforcement officer stated,Molly “ is ‘10.’ Participants reported no knowledge of the current wanted but … a lot of kids have complained that they are availability of ecstasy tablets; the previous most common getting ‘meth’ (methamphetamine) instead of molly.” Overall, availability score was ‘4.’ One participant remarked, “I can get participants reported that the quality of ecstasy has molly any time of day.” decreased during the past six months, while the quality of Treatment providers most often reported the current molly has increased. availability of molly and of ecstasy as ‘5,’ while law Reports of current prices for ecstasy and molly were enforcement most often reported the current availability of consistent among participants with experience buying the molly as ‘3’ but could not report on the current availability drugs. Reportedly, molly is typically sold by the gram. One of ecstasy; the previous most common scores among participant stated, “A gram of molly can be … $100 … [price] treatment providers were ‘7’ for molly and ‘8’ for ecstasy, depends on who you know.” Overall, participants reported while the most common scores among law enforcement that the price of ecstasy and molly has remained the same were ‘7’ and ‘5,’ respectively. during the past six months. Participants reported that the availability of ecstasy has decreased during the past six months, while the availability

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Current Prices for Synthetic Marijuana Ecstasy/Molly Synthetic marijuana (synthetic cannabinoids) is available Ecstasy: in the region. Participants most often reported the drug’s Low dose (aka “single stack”) $10 current availability as ‘10,’ while community professionals most often reported it as ‘3’ on a scale of ‘0’ (not available, Medium dose (aka “double stack”) $20 impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common scores were not High dose (aka “triple stack”) $30 reported. Participants stated: “In Lorain [Lorain County], you can get it if you know where to go [or] if you know people

Ecstasy/Molly Molly: who smoke [synthetic marijuana]; If you go 50 feet, you can 1/2 gram $50 find it. It is in convenience stores and people are selling it in pipe stores (head shops) or you can buy from a dealer who A gram $80-100 has ‘K2’ (synthetic marijuana brand) … they wrap it in lottery ticket.” Participants indicated that ecstasy and molly are most Participants and treatment providers reported that the often obtained from drug dealers. One participant stated, availability of synthetic marijuana has remained the “I can get it for you all day. You just have to know who to same during the past six months, while law enforcement ask.” Participants reported that the most common route reported decreased availability. One treatment provider of administration for ecstasy and molly remains oral stated, “In last six months, I was seeing it a lot … because consumption (“parachuting,” placing molly or crushed [treatment programs] were not testing for it regularly and ecstasy in tissue and swallowing). Participants estimated it was easy to get.” One law enforcement officer remarked, that out of 10 ecstasy and molly users, six would parachute, “We haven’t seen it in the last six months.” The BCI Richfield three would snort and one would “shoot” (intravenously Crime Lab reported that the number of synthetic inject) the drugs. One participant stated, “With molly, when marijuana cases it processes has increased during the past you snort, you peak early … so [to make the high last longer] six months; the Lake County Crime Lab reported having you parachute … and eat it.” processed eight cases of synthetic marijuana during the Participants described typical ecstasy and molly users past six months. as younger and people into the club scene. Participants commented: “Younger groups use molly because is a party Reported Availability

drug; Black dudes are starting to get into ecstasy, but it is Change during the Past 6 Months mostly the young college scene and also with people at clubs.” Community professionals described typical ecstasy and Participants No change molly users as younger. A treatment provider stated, “Pill form (ecstasy) is used as a party drug [and by those] in their Law enforcement Decrease Synthetic Synthetic 20s … taken in addition to other drugs.” A law enforcement Marijuana officer stated,Molly “ is used with high-school aged kids and a Treatment providers No change little beyond that, like 19-21 [year olds].” Reportedly, the overall quality of synthetic marijuana has decreased during the past six months. Participants commented: “It has gone down a lot; I know stores you can still get it, but all you do is get this potpourri shit and that is all it is.” Current prices for synthetic marijuana were reported by participants with experience buying the drug. They stated: “$10 per gram; $50 for a jar; Smaller bags were $20 and you’d get 3 or 4 blunts (an amount to roll 3-4 cigars).” Overall,

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 121 Page 8 Surveillance of Drug Abuse Trends in the Cleveland Region participants indicated that the price of synthetic marijuana Lastly, the Cuyahoga County Medical Examiner’s Office has remained the same during the past six months. reported that 29 of the 380 drug-related deaths it However, one participant noted, “Prices are the same as recorded this reporting period involved diphenhydramine ‘pot’ (marijuana), but they seem to be giving you less than (Benadryl®); and of all fentanyl-related deaths, 8.4% also before (previously).” involved diphenhydramine. Participants reported that the most common route of administration for synthetic marijuana remains smoking. Hallucinogens Participants estimated that out of 10 synthetic marijuana users, all 10 would smoke the drug. Hallucinogens are moderately to highly available in the region. Participants most often reported the current Participants and community professionals described availability of hallucinogens as ‘10’ for psilocybin typical synthetic marijuana users as someone on mushrooms, ‘10’ for LSD and ‘9’ for PCP on a scale of ‘0’ probation, as reportedly, regular drug screens don’t often (not available, impossible to get) to ‘10’ (highly available, test for synthetic marijuana. Participants stated: “People on extremely easy to get); the previous most common scores probation, athletes, anyone who does not want to test ‘dirty’ were ‘8’ for LSD, ‘7’ for PCP and not reported for psilocybin (positive for drug use); Only time they smoke that is when mushrooms. Participants agreed that psilocybin they ‘on paper’ (on probation).” One participant added, mushrooms are seasonal and more available in warmer “People who like hallucinogens.” Law enforcement observed seasons. One participant stated, “They are only in season that users are typically white males. However, a treatment in Spring.” In discussing the current availability of LSD, provider stated, “It’s African Americans in their 20s and 30s, not so much older though.” participants said: “You have to know somebody to get it. You aren’t just gonna have someone walk up to you and ask you if you want LSD; I can get it all day, every day at Nelson Ledges (state park in Portage County where concerts and music festivals are held).” Other Drugs in the Cleveland Region Community professionals most often reported the current Participants and community professionals listed a variety availability of hallucinogens as ‘4’ and ‘8’ for psilocybin of other drugs as being present in the region, but these mushrooms, ‘7’ for LSD and ‘4’ for PCP on a scale of ‘0’ drugs were not mentioned by the majority of people (not available, impossible to get) to ‘10’ (highly available, interviewed: hallucinogens (lysergic acid diethylamide extremely easy to get); the previous most common scores [LSD], phencyclidine [PCP] and psilocybin mushrooms), were ‘5’ for LSD, ‘4’ for PCP and not reported for psilocybin kratom (mitragynine), Neurontin® (gabapentin) and mushrooms. One law enforcement officer said of LSD, promethazine (prescription-strength cough syrup). “’Blotter’ (aka, LSD which is dropped on paper blotter for oral consumption) is pretty popular with that sect that likes In addition, secondary data sources reported on other ‘weed’ (marijuana) and wants to do psychedelics, too.” drugs that were not mentioned by respondents. The BCI Richfield Crime Lab reported that the number of bath salts Media outlets reported on law enforcement seizures and (synthetic cathinones; compounds containing methylone, arrests in the region this reporting period. An off-duty mephedrone, MDPV or other chemical analogues, Cuyahoga County Sheriff’s deputy along with Cleveland including alpha-PVP, aka “flakka”) cases it processes has Police arrested a man after he crashed his van at a high increased during the past six months; the Lake County speed and continuously fired a gun at passing vehicles Crime Lab reported having processed two bath salts cases on the Interstate 90; the man was high on PCP (www. during the past six months. The BCI Richfield Crime Lab cleveland.com, Aug. 14, 2017). reported that the number of U-47700 (synthetic opioid) cases it processes increased to 100 during the past six Participants reported that the availability of psilocybin months, from 11 cases for the six months previous, while mushrooms, LSD and PCP have remained the same the Lake County Crime Lab reported having processed during the past six months. Law enforcement reported 12 cases of U-47700 cases during in the past six months. that the availability of LSD has increased, while

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community professionals did not comment on a change addition, participants reported that users occasionally of availability during the past six months for psilocybin administer liquid LSD through the eye similar to an eye mushrooms and PCP. Regarding LSD, a law enforcement drop. Participants estimated that out of 10 PCP users, all officer stated, “Within last couple of months we have seen 10 would smoke the drug. increase.” The BCI Richfield Crime Lab reported that the number of LSD, PCP, psilocybin mushrooms and DMT Participants described typical psilocybin mushroom users (dimethyltryptamine) cases it processes have decreased as college aged and typical LSD users as white people and during the past six months; the Lake County Crime Lab hippies. Law enforcement agreed that college students reported having processed five cases of hallucinogens are typical psilocybin mushroom and LSD users but added during the past six months. that “high schoolers” also use these drugs frequently. A law enforcement officer stated, “It is used in high school and Reports of current prices for hallucinogens were into the 20s, but nobody after 26 [years of age]. I have never consistent among participants with experience buying seen that.” In terms of PCP, participants and community the drugs. Overall, participants reported that the price of professionals described typical users as African-American psilocybin mushrooms is similar to the price of marijuana people living in inner-city Cleveland. Treatment providers and has remained the same during the past six months. commented: “PCP is more common in the African-American population; Black people from the [inner city], 23 [years of Current Prices for age] and up, primarily on the east side [of Cleveland].” Hallucinogens Psilocybin mushrooms: Kratom 1/8 ounce $25 Reportedly, kratom (mitragynine, a psychoactive plant 1/4 ounce $50 substance that produces a heroin-like high) is available in the region. Participants most often reported the drug’s LSD: current availability as ‘10’ on a scale of ‘0’ (not available, A liquid drop or a single dose (aka “hit”) $10-15 impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was 10 hits (aka “strip”) $80-100 not reported. Participants reported that kratom comes in powdered form and is also put into capsules. They

Hallucinogens 100 doses (aka “a sheet”) $250-450 described the typical kratom user as people addicted to An eyedropper full of liquid LSD $100 heroin who use the drug to alleviate symptoms of opiate PCP: withdrawal. Dipped cigarette $10-20 An ounce $200 Neurontin® Neurontin® (gabapentin, an anticonvulsant Participants reported that the most common route of and nerve pain medication) remains highly administration for psilocybin mushrooms and LSD is available for illicit use in the region. oral consumption; for PCP the most common route of Participants most often reported the drug’s administration remains smoking. Participants estimated current street availability as ‘10’ on a scale of ‘0’ (not that out of 10 psilocybin mushroom and 10 LSD users, available, impossible to get) to ‘10’ (highly available, all would use the drugs orally. Participants stated: extremely easy to get); the previous most common score “[Psilocybin mushrooms] taste horrible so you have to put was also ‘10.’ One participant stated, “A lot of people being them in something, like food or a drink; I put it in a milkshake; prescribed it are also selling and abusing it.” Treatment You can put the liquid [LSD] on gummy bears, but paper providers most often reported current street availability as (liquid LSD on blotter paper) is most readily available.” In ‘10,’ while law enforcement most often reported it as ‘8’;’ the previous most common scores were not reported. A

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 123 Page 8 Surveillance of Drug Abuse Trends in the Cleveland Region law enforcement officer commented, “[Availability]is an ‘8’ high.” Participants reported an ounce of lean most often with kids because they know they can take it with something sells for $30. One participant remarked, “I would buy the else … it will get them where they want (high).” pint-sized bottle for $400.”

Participants reported that the street availability of Neurontin® has remained the same during the past six months, while community professionals reported that street availability has increased. Treatment providers Conclusion commented: “It is prescribed more; They are addicts, they experiment [with what is available].” Crack cocaine, heroin, marijuana, methamphetamine, Neurontin® (gabapentin) and sedative-hypnotics remain Reported Availability highly available in the Cleveland region; also highly Change during the Past 6 Months available are fentanyl and Suboxone®. Changes in availability during the past six months include: increased Participants No change availability for fentanyl; likely increased availability for methamphetamine and Neurontin®; decreased availability Law enforcement Increase for prescription opioids; and possible decreased

Neurontin® availability for heroin. Treatment providers Increase While heroin remains highly available in the region, Reports of current street prices for Neurontin® were participants and treatment providers reported that the consistent among participants with experience buying the general availability of heroin has decreased during the drug. Participants reported purchasing 800 mg for $5. In past six months. They cited an increase is fentanyl as a addition, a participant shared, “In jail it goes for about four substitution and adulterant for heroin as the reason for candy bars.” decreased availability. One participant stated, “It is all fentanyl … it would be harder to find straight up heroin.” Participants reported that the most common route There was consensus across focus groups that fentanyl of administration for illicit use of Neurontin® is oral is highly available. Treatment providers and law consumption. Participants estimated that out of 10 enforcement shared that many heroin users now seek illicit Neurontin® users, all 10 would take the drug fentanyl for its potency. Overall, participants reported orally. Participants described typical illicit users as that the general quality of fentanyl has increased during people addicted to heroin who use the drug to alleviate the past six months. One participant stated, “With all the symptoms of opiate withdrawal. overdoses, one would have to assume, even if you don’t use it, that it is only getting stronger and stronger.” Promethazine Participants reported that methamphetamine is available Promethazine (prescription-strength cough syrup with in powdered and crystal forms throughout the region. codeine, aka “lean” when mixed with soda) is available for However, they identified crystal methamphetamine as illicit use in the region. Participants most often reported most prevalent. And, while methamphetamine is highly the current street availability of the drug as ‘7’ on a scale available, respondents continued to report greater of ‘0’ (not available, impossible to get) to ‘10’ (highly presence of the drug in rural communities. Treatment available, extremely easy to get); the previous most providers discussed more limited methamphetamine common score was not reported. Participants discussed: availability in the city of Cleveland and increased “’Dope boys’ (drug dealers) love that stuff; Rappers use it availability for the drug in suburban communities of and they want to be cool so they glorify it [in their lyrics].” the region. One provider noted, “I see it coming more to Law enforcement commented: “It is easy to get; If you listen the suburbs in Lake County.” Another provider indicated to rap, you will hear the ‘robo tripping’ (getting high on methamphetamine as popular among the younger gay Robitussin®) they are doing; Those using it are using it to get population.

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Neurontin® remains highly available for illicit use in the region. Treatment providers reported an increase in the number of users prescribed the drug during the past six months. Participants noted that many users have prescriptions for Neurontin® which they abuse or sell. Reportedly, Neurontin® 800 mg sells for $5. Participants described typical illicit users of the drug as people addicted to heroin who use it to alleviate symptoms of opiate withdrawal.

Participants reported kratom (mitragynine, a psychoactive plant substance that produces a heroin-like high) as highly available in the region. Participants noted that kratom comes in powdered form and is also put into capsules. They described the typical kratom user as people addicted to heroin who use the drug to alleviate symptoms of opiate withdrawal.

Lastly, the BCI Richfield Crime Lab reported that the number of U-47700 (synthetic opioid) cases it processes increased to 100 during the past six months, from 11 cases for the six months previous, while the Lake County Crime Lab reported having processed 12 cases of U-47700 cases during in the past six months.

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Page 126 OSAM Drug Trend Report June 2017 - January 2018 Surveillance of Drug Abuse Trends in the Columbus Region Surveillance of Drug Abuse Trends in the Columbus Region OSAM Ohio Substance Abuse Monitoring Network

Drug Abuse Trends in the Columbus Region

Regional Epidemiologist: Jennifer Olejownik, PhD

OSAM Staff: R. Thomas Sherba, PhD, MPH, LPCC OSAM Principal Investigator Kathryn A. Coxe, MSW, LSW OSAM Coordinator Jessica Linley, PhD, MSW, LSW OSAM Quantitative Data Analyst

Data Sources for the Columbus Region This regional report was based upon qualitative data collected from across the state. All secondary data are summary data via focus group interviews. Participants were active and of cases processed from January through June 2017. In recovering drug users recruited from alcohol and other drug addition to these data sources, Ohio media outlets were treatment programs in Delaware, Fairfield, Franklin and queried for information regarding regional drug abuse for Richland counties. Data triangulation was achieved through July through December 2017. comparison of participant data to qualitative data collected from regional community professionals (treatment providers Note: OSAM participants were asked to report on drug use/ and law enforcement) via focus group interviews, as well as to knowledge pertaining to the past six months prior to the data surveyed from the Columbus Police Crime Lab, the Ohio interview; thus, current secondary data correspond to the Bureau of Criminal Investigation (BCI) London Crime Lab, which reporting period of participants. serves central and southern Ohio, and the Ohio Department of Public Safety (ODPS), which logs drug task force seizures

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Regional Profile Indicator1 Ohio Columbus Region OSAM Drug Consumers Total Population, 2016 11,614,373 2,696,353 41 Gender (female), 2016 51.0% 50.6% 63.4% Whites, 2016 82.5% 78.4% 85.4% African Americans, 2016 12.8% 14.9% 4.9% Hispanic or Latino Origin, 2016 3.7% 3.8% 2.4% High School Graduation Rate, 2012-16 89.5% 90.5% 75.0%2 Median Household Income, 2012-16 $50,674 $57,021 $16,000-$19,9993 Persons Below Poverty Level, 2016 14.6% 14.0% 51.3%4 1 Ohio and Columbus region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018. 2 High school graduation status was unable to be determined for 1 participant due to missing and/or invalid data. 3 Participants reported income by selecting a category that best represented their household’s approximate income for the previous year. Income was unable to be determined for 2 participants due to missing and/or invalid data. 4 Poverty status was unable to be determined for 2 participants due to missing and/or invalid data.

Columbus Regional Participant Characteristics Columbus Regional Participant Characteristics Consumer Characteristics N=41*

Male 15 Female 26 20s 14 30s 9

Gender 40s 11 50s 6 60s 1 Less than high school graduate 10 High school graduate 12 Some college or associate's degree 17 Education Bachelor's degree or higher 1 < $12,000 12 $12,000 to $19,999 9 $20,000 to $28,999 6 $29,000 to $36,999 2 ≥ $37,000 10 Household Income Alcohol 18 Cocaine, Crack 13 Cocaine, Powdered 10 Ecstasy/Molly 1 Heroin/Fentanyl 15 Marijuana 17 Methampehtamine 5

Drugs Used** Prescription Opioids 14 Prescription Stimulants 4 Sedative-Hypnotics 8 Suboxone®/Subutex® 7 Other Drugs*** 3

0 5 10 15 20 25 30 Number of Participants

*Not all participants filled out forms completely; therefore, numbers may not equal 41. **Some respondents reported multiple drugs of use during the past six months. ***Other drugs included: bath salts, Neurontin® (gabapentin) and synthetic marijuana.

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A query of the National Forensic Laboratory Information System (NFLIS) for the counties which comprise the Historical Summary Columbus region returned 637 methamphetamine cases reported during the reporting period (an increase from 492 In the previous reporting period (January - June 2017), cases during the previous reporting period). Participants crack cocaine, heroin, marijuana, methamphetamine, and community professionals continued to describe Neurontin® (gabapentin), sedative-hypnotics and typical methamphetamine users as young, white people. In Suboxone® remained highly available in the Columbus addition, law enforcement indicated that many heroin users region; also highly available were prescription opioids. also used methamphetamine. Changes in availability during the reporting period included: increased availability for heroin, fentanyl, Lastly, Neurontin® remained highly available for illicit use in marijuana and methamphetamine; likely increased the region. Participants and treatment providers discussed availability for crack cocaine and Suboxone®; and the drug as often prescribed to people in recovery for decreased availability for ecstasy. opiate addiction. Participants reported obtaining the drug from doctors or from people in treatment who had While many types of heroin were available in the region, a prescription. They described typical illicit Neurontin® participants and community professionals agreed that users as people addicted to heroin who misused the drug black tar and white powdered heroin were equally because, reportedly, the drug was not usually screened for by available. Participants reported that the top cutting agents treatment providers and drug courts. (adulterants) for heroin included: fentanyl and carfentanil. Law enforcement also discussed these substances as commonly used to cut heroin or as substitutions for heroin. Overall, participants reported that the general quality of heroin increased during the reporting period due to an increase in carfentanil and fentanyl as cuts. Several participants reported that fentanyl could be purchased via Current Trends the Internet and shipped to one’s home. The Columbus Police and the BCI London crime labs reported that the Powdered Cocaine number of carfentanil, fentanyl and fentanyl analogue cases they process increased during the reporting period. Powdered cocaine is highly available in the region. Participants most often reported the drug’s current The most common route of administration for heroin availability as ‘10’ on a scale of ‘0’ (not available, impossible remained intravenous injection. Participants discussed the to get) to ‘10’ (highly available, extremely easy to get); high prevalence of Hepatitis C among intravenous drug the previous most common score was ‘6.’ Participants users, and acknowledged that sharing injection needles commented: “You can pretty much get it any time; If you was a common practice. Participants described typical know one drug dealer, you’re gonna be able to get whatever; heroin users as white people, both males and females, I know people who sell it … and they can’t keep it; I know although they reported an increase in heroin use among people who will do it as though they were smoking a young African-American people. cigarette … it’s an everyday thing ….” Participants and law enforcement reported that the Treatment providers most often reported the current availability of crystal methamphetamine increased availability of powdered cocaine as ‘8,’while law during the reporting period. The Columbus Police and enforcement most often reported it as ‘5;’ the previous the BCI London crime labs reported that the number most common scores were ‘8’ and ‘7,’ respectively. of methamphetamine cases they process increased Treatment providers remarked: “It is available as ever … during the reporting period; the BCI London Crime Lab they are doing it with opioids to wake them up or bring them reported processing crystal methamphetamine, as well down; My clients who get it are on Vivitrol®, which stops them as brown and white powdered methamphetamine. from using the opioids … they are using [cocaine]; We have Participants mentioned bath salts and fentanyl as cuts for a lot of people taking Vivitrol® now, and when they relapse, methamphetamine.

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 129 Page 8 Surveillance of Drug Abuse Trends in the Columbus Region a lot of times it is with cocaine.” Law enforcement stated: “If steady demand for the substance. Participants shared: “It’s somebody wants it, they can get it. We just don’t see a lot of coming from lots of different sources, so there’s no shortage; it; I haven’t seen much lately. Doesn’t mean it’s not out there. There’s a high demand for it. It is always around. It’s always It’s just not the drug of choice now, but I am pretty sure … it been a constant ….” is available.” Although law enforcement reported overall moderate availability of the drug in the Columbus region, Treatment providers reported that the availability of a few law enforcement officers discussed the drug as powdered cocaine has increased during the past six highly available in more affluent suburbs near Columbus. months, while law enforcement indicated that availability A law enforcement officer remarked,You “ can use cocaine has remained the same. Treatment providers stated recreationally … [but] it’s really expensive ….” that the increase is likely due to decreasing prices and the perception that cocaine is safer compared to other Corroborating data indicated that powdered cocaine is substances. Treatment providers discussed: “[Powdered available in the region. The Ohio Department of Public cocaine is] … increasing because … of the move toward Safety (ODPS) reported 32 drug task force seizures of Vivitrol® and the way that the courts have placed so much powdered cocaine in the Columbus region during the emphasis on [opiate use]; It’s more in demand because of reporting period (31.3% of the seizures were made in Vivitrol®. Their drugs of choice are gone, so the dealers are Richland County). going to provide them with something else.” Media outlets reported on law enforcement seizures The perception that cocaine is safer than heroin was also and arrests in the region this reporting period. Federal cited as a reason for increased availability. One treatment prosecutors in Franklin County charged four Ecuadorian provided explained, “There’s a rash of overdose deaths men with the intent to distribute cocaine after the U.S. recently and I’ve seen people turn to ‘coke’ (powdered Coast Guard and the U.S. Drug Enforcement Agency cocaine) because they say it is safer. Not to mention, three of (DEA) intercepted 1,584 pounds of cocaine and arrested my clients in the last month relapsed on cocaine. They didn’t the men on a speedboat in the Pacific Ocean; the case is use heroin, they used cocaine.” being tried in Ohio since the prosecutor reported the high likelihood that the cocaine seized could have ended in The Columbus Police Crime Lab reported that the number distribution in Columbus (www.10tv.com, Sept. 20, 2017). of cocaine cases it processes has decreased during The Mansfield Police Chief (Richland County) addressed the past six months, while the BCI London Crime Lab law enforcement agents at a luncheon and reported that reported that the number of cocaine cases it processes has powdered cocaine and methamphetamine were on the increased; the labs do not differentiate between powdered rise, while heroin was on the decline; the crime lab director and crack cocaine. for the Mansfield Police Department also spoke and reported a recent trend in cocaine mixed with fentanyl Reported Availability

(www.mansfieldnewsjournal.com, Oct. 10, 2017). An Change during the Past 6 Months investigation lead by the Federal Bureau of Investigation (FBI), U.S. DEA, Gahanna Police, Westerville Police (Franklin Participants No change County) and an Assistant United States Attorney lead to the arrest and indictment of two people for conspiracy Cocaine Law enforcement No change to kidnap a man for not paying them after he received Powdered cocaine; the two people told the main supplier in Mexico Treatment providers Increase of the situation, who told the couple to kidnap the man until ransom money was paid; after the two drove the Participants most often rated the current overall kidnapped man to the specified location in Columbus, quality of powdered cocaine as ‘6’ on a scale of ‘0’ (poor they were met by police who arrested them (www.justice. quality, “garbage”) to ‘10’ (high quality); the previous gov, Oct. 19, 2017). most common score was ‘3.’ Participants discussed that Participants reported that the availability of powdered the quality of powdered cocaine in the region varies cocaine has remained the same during the past six dependent on where and from whom one purchases the months. Several participants explained that there is a drug. They commented: “It can vary. It just depends on who

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you get it from. It could be garbage or be, ‘This is the best stuff Participants reported that the most common route of I’ve ever had;’ I think it depends on where you’re getting it administration for powdered cocaine remains snorting. from. If you’re getting it in the ‘hood’ (inner city) it’s probably Participants estimated that out of 10 powdered cocaine better than the suburbs where it’s ‘stepped on’ (adulterated) users, eight would snort and two would smoke or too much; It’s all about who you get it from; They can make it intravenously inject (aka “shoot”) the drug. A few potent, or if they bought a smaller package and they want to participants reported that powdered cocaine may also be make more money off it … they’re gonna ‘cut’ (adulterate) it administered by eating it, rubbing it on the mouth or lips, more ….” adding it to coffee and “parachuting” (wrapping the drug in tissue paper and swallowing it). A participant explained Participants reported the top cutting agents for why some users prefer different routes of administration: powdered cocaine as baby formula and creatine. Other “People feel like they’re better if they snort it instead of smoke adulterants mentioned included: Adderall®, baby aspirin, it … people with no money like to smoke it.” baby powder, Carpet Fresh® and NoDoz®. In addition, a participant explained that there are cutting agents Participants described typical powdered cocaine users manufactured for the purpose of cutting drugs readily as professional, wealthy, middle to upper class, and aged available on the Internet: “There’s literally something you 25-50 years. Participants commented: “I’ve seen plethora’s can purchase online, and it’s basically meant to cut cocaine. [of users], but the majority of people who use it … make a lot I don’t know what it is called, but it’s a tiny bottle. It’s a white of money because it is an expensive habit. So, when they can’t powder and it looks just like coke. It’s got crystals in it and afford that, they go to crack; White people use coke more everything.” Overall, participants reported that the quality … lawyers, doctors … people with decent jobs. It’s a rich of powdered cocaine has decreased during the past six person’s drug.” Community professionals described typical months. A participant explained, “It’s gone down because powdered cocaine users as affluent, white people and there’s a higher demand for it, and so when people don’t get professional. A treatment provider commented, “They are as much, and people want it, [dealers] have to cut it more to similar to opioid users [but] maybe a little younger and more get it out to all the customers.” Caucasian, more affluent.” Another provider also noted powdered cocaine use among heroin users: “Heroin users

will sometimes use it as a pick-me-up … so someone that’s

Cutting Agents Reported by Crime Labs opiate dependent may have co-occurring cocaine abuse.”

l caffeine l Crack Cocaine

Cocaine local anesthetics (benzocaine, lidocaine, Powdered and procaine) Crack cocaine remains highly available in the region. Participants most often reported the drug’s current Reports of current prices for powdered cocaine were availability as ‘10’ on a scale of ‘0’ (not available, impossible consistent among participants with experience buying the to get) to ‘10’ (highly available, extremely easy to get); drug. Reportedly, the most common quantity of purchase the previous most common score was ‘9.’ Participants is 1/8 ounce. commented: “It’s ridiculously available; It’s everywhere … just like heroin. It goes hand-in-hand with heroin …. Nine out of Current Prices for 10 heroin dealers sell ‘crack’ (crack cocaine), too.” Treatment

Powdered Cocaine

providers most often reported the current availability of crack cocaine as ‘8,’ while law enforcement most often A gram $60-100 reported it as ‘9;’ the previous most common scores were 1/8 ounce (aka “eight ball”) $150-200 ‘10’ and ‘9,’ respectively. Treatment providers commented:

Cocaine “In alcoholics, it is the next most abused substance [after Powdered 1/2 ounce $450-700 alcohol]; Where I work is close to a homeless shelter … I have An ounce $650-1,300 seen the sale of crack just by walking across the parking lot … if someone wants it, there’s no worries on trying to get it.”

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Corroborating data indicated that crack cocaine is available crack [as they are of overdose with opiates]. It’s not as scary in the region. ODPS reported 40 drug task force seizures of … and you can still party and use your Suboxone®.” crack cocaine in the Columbus region during the reporting period (35.0% of the seizures were made in Marion County). The Columbus Police Crime Lab reported that the number of cocaine cases it processes has decreased during the past Media outlets reported on law enforcement seizures and six months, while the BCI London Crime Lab reported that arrests in the region this reporting period. Columbus the number of cocaine cases it processes has increased; Police (Franklin County) arrested a man after observing the labs do not differentiate between crack and powdered him leave a known drug house in the city run by ‘Fetti cocaine. Nation’ gang members; upon searching him, police found crack cocaine, methamphetamine, heroin and fentanyl in Reported Availability the man’s underwear (www.abc6onyourside.com, Aug. Change during the Past 6 Months

9, 2017). A school superintendent plead guilty in Franklin County Drug Court for drug possession after Columbus Participants Increase Police saw him stopped in his vehicle in an alley and asked what he was doing; officers searched his car, found crack Crack

Cocaine Law enforcement Decrease cocaine and arrested him (www.nbc4i.com, Oct. 5, 2017). Circleville Police (Pickaway County), Chillicothe SWAT (Ross Treatment providers Increase County), and Ohio State Highway Patrol (OSHP) arrested three individuals while executing a search warrant at an apartment complex in Circleville; law enforcement had Participants most often rated the current overall quality received numerous reports from people who overdosed of crack cocaine as ‘3-8’ on a scale of ‘0’ (poor quality, that they had purchased drugs at that complex; officers “garbage”) to ‘10’ (high quality); the previous most common seized unspecified quantities of crack cocaine, heroin score was ‘7.’ Participants commented: “It just depends on and drug paraphernalia during the search (www. where you get it. It could be really crappy and be a ‘3,’ or it circlevilleherald.com, Oct. 6, 2017). could be really good and be a ‘9’; There’s ‘drop dope’ and there’s ‘whipped.’ ‘Whipped dope’ is lesser quality because of how it’s Participants reported that the availability of crack cocaine made [with more adulterants]. Then, there’s ‘drop dope’ which has increased during the past six months. Participants is like the purest, most potent, least cut.” Participants reported commented: “I’ve seen it more often. More people that that crack cocaine in the region is most often adulterated I didn’t know (wouldn’t have thought to be using crack (aka “cut”) with baking soda. Other cuts mentioned cocaine) are using it; Most heroin dealers, or any drug dealers included: baby laxatives, fentanyl and heroin. Overall, … are selling some type of ‘speed’ (stimulant) with heroin. participants reported that the quality of crack cocaine has It just goes hand-in-hand; Everyone sees the money in it, so varied during the past six months. A participant remarked, everybody’s selling crack.” “It’s up and down.” Treatment providers reported that the availability of crack cocaine has increased during the past six months, while Cutting Agents law enforcement reported decreased availability. Treatment Reported by Crime Labs providers discussed: “It’s making a comeback because you l caffeine can use it while you’re on Suboxone® and still get high. You Crack l

Cocaine local anesthetics (benzocaine, lidocaine, can get off heroin and still have fun smoking crack; I think and procaine) drug dealers are basically good salesmen. ‘I have this product, but I also happen to have this. This would go well with this … why not try this?’; I had a client yesterday who said her drug Reports of current prices for crack cocaine were consistent dealer … how he remembered her birthday, I don’t know … among participants with experience buying the drug. but literally called her and said, ‘I’ve got some crack for your Reportedly, the most common quantity of purchase is a birthday if you want some;’ I think some people really are gram. Participants stated: “Most crack is [sold] in smaller trying to get off heroin [and] … I don’t think they’re as afraid of quantities; You can get a ‘fifty rock’ ($50 amount of crack cocaine).”

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Current Prices for hundreds of people selling it. They can go right to Columbus, the source city, to get it.”

Crack Cocaine Corroborating data indicated that heroin is available in 1/10 gram (aka “rock”) $10 the region. ODPS reported 69 drug task force seizures of

Crack Crack A gram $70-100 heroin and/or fentanyl in the Columbus region during Cocaine the reporting period (24.6% of the seizures were made 1/16 ounce $125-150 in Marion County); drug task forces did not typically differentiate between heroin and fentanyl due to the high Participants reported that the most common route of incidence of heroin-fentanyl mixtures. administration for crack cocaine remains smoking. However, participants reported that some people also intravenously Media outlets reported on law enforcement seizures inject (aka “shoot”) the drug. Participants commented: “I’ve and arrests in the region this reporting period. Delaware only seen people smoke it; I’d say the majority of people smoke Police (Delaware County) detained two people after it, but you’d be surprised, a lot of people shoot, too.” responding to an overdose call, where emergency crews found on person overdosed face down in water and A profile for a typical crack cocaine user did not emerge used Narcan® (naloxone, an opiate overdose reversal from the data. Participants described typical crack cocaine medication) to revive him; the other person attempted users as anyone, while community professionals described to swim away, but crews used a rope to capture him; typical users as older, African-American and white people, officers took both people to the hospital before arresting and of lower socio-economic status. Treatment providers them (www.nbc4i.com, July 9, 2017). Undercover officers commented: “Poor African-Americans, low education; I don’t in Knox County arrested a woman after United State think we see it with young kids … it’s more 20s and up; Mostly Postal Service (USPS) workers noticed a strange package it’s Caucasian … some Hispanic [people].” Law enforcement and alerted police, who worked undercover to direct reported: “We don’t really have a lot of young people [who the woman to pick up the package at a USPS location in use crack cocaine]; I know the people we see going in and out Gambier; officers arrested the woman after she arrived to of our crack houses seem to be 30s and 40s or older. If they do collect the package containing heroin (www.nbc4i.com, work, they work day labor … construction, roofers, painters.” July 18, 2017). Columbus Police Criminal Investigations Unit (Franklin County) executed a search warrant at two residences in Columbus and arrested six people for their Heroin involvement in drug trafficking; officers seized heroin, pills, marijuana and firearms www.nbc4i.com( , July 28, 2017). The Columbus City Attorney’s Office planned to Heroin remains highly available in the region. Participants shut down a known drug house after Columbus Police and community professionals most often reported the investigated the residence and made several covert drug current availability of the drug as ‘10’ on a scale of ‘0’ buys; in January 2017, officers executed a search warrant (not available, impossible to get) to ‘10’ (highly available, at the residence and seized 8.5 grams of heroin, 500 extremely easy to get); the previous most common scores pills, 47 grams of marijuana, Suboxone®, cash, several were also ‘10.’ Participants commented: “You can get it really firearms and ammunition; in February 2017, detectives anywhere. It’s everywhere. My ‘weed’ (marijuana) dealer went executed another search warrant and seized 28 grams of from selling that to selling heroin because there was such crack cocaine; 20 grams of marijuana, pills, cash, firearms a high demand. That’s what people wanted; Right off the and ammunition (www.nbc4i.com, Aug. 4, 2017). A top of my head, [there are] several places you could walk to Columbus special agent worked with the Heroin Overdose right now [to buy heroin]. It’s very available.” A treatment Prevention and Education Task Force to arrest a man provider remarked, “Anyone can get heroin … there’s a lot responsible for supplying a heroin-fentanyl mixture that of it.” Law enforcement commented: “It is very available … resulted in the overdose death of two people; the man very easy to get. Almost up there with marijuana; If you know was sentenced to 20 years in prison for these deaths one person who has it, you know 10; Fifteen years ago …15- (www.abc6onyourside.com, Aug. 10, 2017). Columbus 20 people in Fairfield County were dealers … now there are Police and The Ohio State University Police rescued a

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three-year-old child from a running vehicle parked near the shit that kills you; I’ve seen tar, white china, the brown an alley after noticing a small hand under a pile of broken stuff that’s laced with fentanyl; When I was getting it, it was glass and debris; officers found the child’s father in the tar or that gray stuff, which was carfentanil.” nearby alley and arrested him for heroin possession and child endangerment (www.nbc4i.com, Aug. 15, 2017). Treatment providers discussed: “There are more people Columbus Police responded to three heroin overdoses that talking about ‘china,’ so white powder … secondarily, black occurred at a restaurant in Whitehall (Franklin County), tar; I hear them talking about the ‘gray death’ (gray powdered one of which resulted in a death (www.abc6onyourside. heroin) and the white china; It seems like the synthetics are com, Sept. 20, 2017). Mansfield Police, Richland County easier to get than the real heroin … they’ll say there’s heroin Sheriff’s Office, Federal Bureau of Investigations (FBI) and … it’s all fentanyl or carfentanil; I don’t know that I hear U.S. DEA agents arrested 39 people for trafficking heroin about one being more available than the other … I don’t hear during a drug sweep in Mansfield (Richland County); in a about the black versus white or brown.” A law enforcement separate case, Richland County prosecutors indicted 21 officer remarked, “We see tar, we see brown powder. The people in Mansfield for trafficking heroin, crack cocaine, brown powder usually comes from Mexican sources … same powdered cocaine and marijuana (www.fox8.com, Oct. with tar … and any white powder is usually a mixture of 25, 2017). Franklin County Prosecutors indicted a man on many different variables.” multiple felonious drug trafficking charges after Columbus Participants reported that the availability of heroin Police searched his home and six other residences, seizing has increased during the past six months. Participants undisclosed amounts of heroin, cocaine, four cars and commented: “I personally have friends who are dealers three firearms; the man and four accomplices smuggled and they can’t ‘re-up’ (obtain more batches of the drug) fast drugs from Mexico to Columbus (www.abc6onyourside. enough. They run around all day long because within two com, Oct. 18, 2017). Safe Point Needle Exchange Program hours they could be completely sold out; I’ve seen situations administered by a treatment program in Columbus where people supplying it are pushing their dealers to reported providing 1.5 million free needles to intravenous move it faster and faster and faster. It’s crazy.” Community drug users since its opening in January 2016; consumers professionals reported that the availability of heroin of the program are offered health assessments, Narcan® has remained the same during the past six months. A and drug treatment referrals (www.nbc4i.com, Nov. 20, treatment provider stated, “It’s been readily available for a 2017). Columbus Police arrested a man during a traffic while now.” stop after discovering black tar heroin, fentanyl and cocaine in his vehicle; officers linked the vehicle back to an The Columbus Police and the BCI London crime labs apartment, where they seized additional drugs, totaling reported that the numbers of heroin cases they process 66 pounds of black tar heroin, fentanyl and cocaine (www. have decreased during the past six months; they reported newsjammedup.com, Nov. 23, 2017). OSHP and the U.S. processing beige, brown, tan and white powdered heroin DEA conducted an investigation of a Connecticut man that along with black tar heroin. lead to his indictment in federal court for attempting to distribute over 1,000 grams of heroin in Ohio (www.justice. gov, Dec. 14, 2017). A Columbus police officer reported Reported Availability to a local news source that he administers Narcan® nearly Change during the Past 6 Months as often as he writes tickets, and never leaves for patrol in the Hilltop area (neighborhood of Columbus) without the Participants Increase medication; the officer reported he has saved 25 lives with Narcan® (www.10tv.com, Dec. 15, 2017). Heroin Law enforcement No change

While many types of heroin are currently available in Treatment providers No change the region, participants and community professionals reported powdered and black tar heroin as equally Participants most often rated the current overall quality of available in the region. Participants stated: “I can get ‘china heroin as ‘6-8’ on a scale of ‘0’ (poor quality, “garbage”) to white’ (white powdered heroin) or black tar easily. Tar and ‘10’ (high quality); the previous most common score was ‘8.’ china white … and it’s all fentanyl-laced these days. So, it’s

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A participant shared, “I don’t think it is that good. I know Current Prices for in recent days when I went to ‘shoot it up’ (intravenously Heroin inject the drug) … my arm will get all puffy and blown up from whatever they’re cutting it with … it’s reacting badly.” Black tar or brown powdered: Participants discussed adulterants (aka “cuts”) that affect the quality of the drug and reported the top cutting 1/10 gram $10 agents for heroin as fentanyl and carfentanil. Participants 1/2 gram $30-50 discussed: “The heroin itself is not that great at all, but they A gram $70-100

get the heroin and they cut it with fentanyl and that’s what’s Heroin 1/4 ounce $350-400 dropping (overdosing) everybody; The dealers are actually putting [fentanyl] in. They’ll make 20 ‘balloons’ (1/10 gram An ounce $1,500 amounts packed in balloons) and put [fentanyl] in two White powdered: balloons so two people ‘OD’ (overdose) so that way everyone will come down and buy it … so, they’re trying to kill off 1/10 gram $20 somebody ‘cause that’s the ‘fire’ (potent drug). That’s what everybody wants to get.” Participants reported that the most common routes of administration for heroin are intravenous injection (aka Additional cuts for heroin mentioned included: baby food, “shooting”) and smoking. Participants estimated that baby formula, brown sugar and dark sodas (Coca Cola®, out of 10 heroin users, five would shoot and five would Pepsi®). Overall, participants indicated that it was difficult smoke the drug. Participants’ comments revealed that to comment on a change in quality during the past six users’ routes of administration tend to evolve over time. months due to the potency of fentanyl added to heroin. A Participants stated: “It’ll range from snorting, smoking, participant remarked, “I don’t think the purity’s increased. I shooting. If you got a heavy user, they’ll shoot it … that’s just think they’re putting other stuff in it.” how you get the best high; If we’re at a party and people are doing heroin, they’re going to be snorting it because real Cutting Agents people who shoot heroin aren’t going to be going to parties Reported by Crime Labs … they’re going to be shooting heroin; You use it a few times and as your tolerance builds … a seasoned user, they’re l acetaminophen gonna be shooting.” l artificial sweeteners (lactose and sorbitol) l caffeine Participants reported that injection needles are most l cocaine available from pharmacies and drug dealers. Additionally,

Heroin l diphenhydramine (antihistamine) participants reported obtaining needles from needle l dipyrone (banned analgesic) exchange programs and family members who have l fentanyl/fentanyl analogues diabetes. Participants discussed: “People get needles from l mannitol (diuretic) the streets. I usually got them from my dealer, but as I was l quinine (antimalarial) quitting heroin, a new clinic opened up where [you] could go [to exchange needles]; When I first started, you could go to Current prices for heroin were reported by participants [a retail store] and buy boxes [of needles], but they passed a with experience purchasing the drug. Reportedly, law so most people are trying to find people that are diabetic the most common quantity of purchase is 1/2 gram. so they can buy them off of them; I used to get them at work Participants commented: “[Price varies] with who you mess because I worked in the medical field; I went to the clinic to get with. A half a gram will range anywhere from $30-50; It just them. I even went so far as to take a diabetes test after eating depends on who you’ve been going through and how long candy so I could be diagnosed with diabetes …. Whatever I you’ve been going through them; The more you buy, the had to do to get them, I got them.” Reportedly, needles on cheaper it gets; In my experience, you can get whatever you the street sell for $1-2 per needle. A participant added, want. If you want [to spend] $10, you can get $10 [worth of “Sometimes [dealers will] just give it to you ‘cause they want heroin]; Up in Columbus it’s cheaper … they bring it down you to shoot it.” here (Fairfield County) and it’s more expensive….”

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A profile for a typical heroin user did not emerge from the remarked difficulty in obtaining fentanyl alone:It’s “ very data. Participants described typical heroin users as anyone. hard to get because they’re mixing it … a lot of people are Participants commented: “I know lawyers around here accidentally doing fentanyl because it’s mixed with the who do heroin, housewives, it varies; You got professionals heroin.” … doctors, lawyers. There’s really no way to tell; I’ve seen pretty much everyone … people of all races, all ages; It could Treatment providers most often reported the current be anybody. Top dog lawyers to bottom down in slums … availability of fentanyl as ‘9,’ while law enforcement most it doesn’t matter.” Some participants also described how often reported it as ‘4’; the previous most common scores using pain medication leads to heroin use. A participant were not reported. The lower availability score assigned by added, “You can’t look at anybody and say, ‘Oh, yeah, they law enforcement echoes the above participant sentiment fit the description.’ It’s just a build up to how they get there. that unadulterated fentanyl is somewhat difficult to Some people just start off with heroin but some people … obtain. An officer said,I “ don’t think people are going to their pain management ended, and they needed something seek fentanyl. But I think they’re going to seek who has that because they were addicted to pills, so they go with what’s strong ‘dope’ (heroin) … knowing it probably has fentanyl cheap.” in it. But, they’re not seeking fentanyl.” Many community professionals indicated that some clients do not know Community professionals described typical heroin users they are taking fentanyl, while others indicated that clients as white people. Treatment providers commented: are actively seeking it. Treatment providers explained: “They tend to be white; I don’t think it discriminates across “Many people do not know they have it in their system; socio-economic status ... and they may be the ones who A lot of the blood (drug) tests come back with fentanyl in start with pills and then progress to the heroin; It really is them .… Most of the time if they test positive for heroin, it’s across the board. [I have seen] 50, 60, 70-year-old heroin coming back with fentanyl as well; None of my clients ask for addicts … there’s been an overall increase, there’s no group fentanyl, it’s just there. It’s something they stumble into, and that stands out … I would say that if it were increasing in hopefully they survive.” any group … I would say it’s … 40 to 60-year-olds who started on prescription meds and moved on to heroin.” Law Community professionals shared that they believe enforcement added: “Primarily we see people in their 20s fentanyl is widely available because it is showing up in and 30s; Evenly split between men and women; I can’t think other substances, such as prescription opioids. Treatment of one black or Hispanic [heroin user] we’ve run into. It’s providers commented: “It’s showing up in deaths. It’s showing predominately Caucasian; I guess if I am going to generalize, up in a lot of different forms, in pills. There’s marijuana laced it would be someone after high school. Maybe 19 to 50 years with it. It’s gotta be readily available if they’re using it in old … I don’t know that it has any other definers other than all those ways; I have heard about some of the marijuana that.” having fentanyl in it … I don’t know if that’s because of the [low quality of marijuana], or if they have another reason … people who overdose are supposedly smoking marijuana, but they’re really smoking fentanyl.” A law enforcement Fentanyl officer stated, “[Clients say], ‘You know that’s the good stuff, it must have fentanyl in it.’ I had one client tell me that Fentanyl is highly available in the region. marijuana is being laced with it now.” Participants most often reported the current availability of the drug as ‘10’ on a scale of ‘0’ Other community professionals looked to death statistics (not available, impossible to get) to ‘10’ (highly to explain the high availability of fentanyl. They reported: available, extremely easy to get); the previous “I think out of the 12 overdose deaths we’ve had in Delaware most common score was not reported. Participants [County] this year, seven of them were fentanyl; A trend I’m reported: “It’s ‘10,’ but no one goes out there like, ‘I’m gonna starting to see [is] when people describe to me how many buy some fentanyl. You go to buy heroin; For me, I can’t find overdoses they’ve had, I hear people almost starting to brag heroin … I couldn’t. It’s always been that carfentanil stuff, about how many Narcan® [administrations] they had to and to be honest, the first time I tried it I didn’t even get have done. That’s really incredible. That tells me the tolerance two-thirds of it in … and I passed out. If I had gotten all of is getting way up there.” it in, I probably wouldn’t have woken up.” One participant

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Corroborating data indicated that fentanyl is available in Police seized five kilograms of fentanyl and cash while the region. ODPS reported 69 drug task force seizures of responding to a domestic violence call after the victim heroin and/or fentanyl in the Columbus region during agreed to let officers search her home; officers arrested the the reporting period (24.6% of the seizures were made perpetrator following the seizure (www.nbc4i.com, Dec. in Marion County); drug task forces did not typically 26, 2017). differentiate between heroin and fentanyl due to the high incidence of heroin-fentanyl mixtures. Participants reported that the availability of fentanyl has increased during the past six months. Participants Media outlets reported on law enforcement seizures and attributed increased availability to dealers being able arrests in the region this reporting period. A Franklin to acquire the drug inexpensively, which has resulted County grand jury indicted a man for involuntary in dealers substituting fentanyl for other drugs and in manslaughter and drug trafficking for providing fentanyl cutting other drugs in addition to heroin with fentanyl. to a man in a nursing home which resulted in his overdose Participants commented: “It’s so much cheaper than real death (www.nbc4i.com, July 7, 2017). A Union County heroin. [Dealers] are gonna make more money off of that; grand jury indicted 16 people responsible for trafficking Some people out there selling heroin add the fentanyl to try fentanyl, heroin and prescription drugs in Union County to make their [heroin] better than the next person; With the following a 10-month investigation completed by Union dark web and stuff it’s just easier to get. China’s got a surplus County Multi-Agency Drug Enforcement officers; in one of this shit, and it’s dirt cheap to get online. You can literally case, a woman did not call emergency medical crews get it sent to your house in a box.” after seeing her roommate overdosing on fentanyl, heroin and alprazolam (Xanax®); in another case, a woman stole Treatment providers reported that the general availability hydrocodone pills from her husband while he was under of fentanyl has increased, while law enforcement reported medical care for a fentanyl and diazepam (Valium®) that it has remained the same during the past six months. overdose; both overdose victims died from their overdoses Treatment providers discussed: “I think the more you can (www.abc6onyourside.com, July 31, 2017). Franklin mix it with [other drugs] … to make them stronger … people County prosecutors in Columbus charged a woman with will keep coming back; From a business aspect, it’s the next involuntary manslaughter in the death of a 12-year-old new thing. It’s bringing in new people. The people using boy, who overdosed due to fentanyl while at a sleepover heroin now want the next new thing. I’m sure after fentanyl for his cousin’s birthday party; the woman had left five it will be something else as well. People are drawn to it and children at home unsupervised when the boy overdosed prefer to have something laced with fentanyl now; It’s more on the drugs (www.nbc4i.com, Oct. 14, 2017). A Franklin available based on seeing it more in the drug screening; I County grand jury indicted three California men after drug think it’s more available because they can purchase it on task force officers arrested the men in a hotel parking lot in the Internet. It can get sent to them. It’s cheaper … and it’s Columbus after finding 4.5 pounds of fentanyl in the trunk higher quality [than heroin] … so, they’re mixing it with of their car (www.abc6onyourside.com, Nov. 3, 2017). other things.” Law enforcement commented: “We started A Bucyrus (Crawford County) woman was sentenced seeing it about a year ago, so in that time it hasn’t changed; to 59 months in prison for providing heroin laced with A lot of the fentanyl we hear about … usually comes through fentanyl that resulted in four non-fatal overdoses; the toxicology [reports] after the fact.” woman’s boyfriend also plead guilty for his involvement The Columbus Police and the BCI London crime labs and was sentenced to 30 months in prison (www. reported that the number of fentanyl and fentanyl bucyrustelegraphforum.com, Dec. 6, 2017). A Franklin analogues cases they process have increased during the County Common Pleas Court judge sentenced a man past six months. In addition, the Columbus Police Crime to 10 years in prison after he plead guilty to involuntary Lab reported that the number of carfentanil cases it manslaughter for selling fentanyl that resulted in a fatal processes has decreased during the past six months, while overdose of a man in Bexley and a near-fatal overdose the BCI London Crime Lab reported that the number of of the man’s girlfriend; the man will serve this sentence carfentanil cases it processes has increased. immediately following a four-year sentence for providing drugs to a Baltimore man that resulted in his fatal overdose (www.dispatch.com, Dec. 18, 2017). Columbus

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Reported Availability get) to ‘10’ (highly available, extremely easy to get); the Change during the Past 6 Months previous most common score was also ‘8.’ Participants commented: “They’re available but people are losing interest … heroin is cheaper and easier [to obtain]; I could get it Participants Increase delivered to my house right now.” Treatment providers most often reported the current street availability of Law enforcement No change Fentanyl prescription opioids as ‘7,’ while law enforcement most often reported it as ‘5;’ the previous most common scores Treatment providers Increase were ‘10’ and ‘8,’ respectively. A treatment provider stated, “They’re still obtainable, but I see less people coming in [for In terms of current overall quality, participants found it treatment] with that … more have moved on to heroin.” Law difficult to speak directly about fentanyl’s quality as it is most enforcement shared: “The availability is less than heroin; frequently combined with heroin. Thus, participants were It’s available, but we’re ten times more likely to see needles unclear about whether the general quality of fentanyl has (evidence of heroin use) in a car.” changed during the past six months. A participant remarked, “I’ve never bought fentanyl by itself. It’s always been with heroin Corroborating data indicated that prescription opioids and usually it’s not advertised as fentanyl. You don’t even really are available for illicit use in the region. ODPS reported know you’re doing it.” Another participant shared, “The purity 69 drug task force seizures of prescription opioids in the Columbus region during the reporting period (44.9% of of fentanyl’s not really gonna change because it is a synthetic the seizures were made in Marion County). opiate anyway. So, just like morphine, there’s only one grade of morphine. With fentanyl, there’s only one grade of it. [Quality] Media outlets reported on law enforcement seizures and just depends on how much you are doing.” arrests in the region this reporting period. A man was sentenced in Franklin County to 22 years in prison for Participants were unable to report on the current pricing operating a multi-state oxycodone trafficking ring; the of fentanyl because, as indicated above, their experience man organized and paid for trips for people to travel to with the drug has been in its combination with heroin. Florida to obtain prescriptions for oxycodone to later sell No participant reported having made purchases of in Columbus (www.nbc4i.com, Aug. 13, 2017). A Fairfield unadulterated fentanyl. County prosecutor indicted a pharmacist and his son after the Ohio Board of Pharmacy received an anonymous While there were a few reported ways of using fentanyl, tip that the pharmacist’s son stole oxycodone from the generally, the most common route of administration pharmacy in Lancaster where his father worked; the is intravenous injection (aka “shooting”). A profile for pharmacist was accused of attempting to conceal his son’s a typical fentanyl user did not emerge from the data. theft since he did not report it (www.abc6onyourside. Community professionals described typical fentanyl com, Sept. 26, 2017). A Franklin County grand jury in users as people addicted to opiates. Law enforcement Columbus indicted the parents of two young children commented: “[Fentanyl users are typically] white, aged for involuntary manslaughter on two separate occasions; 25-45 [years], and socio-economically challenged. Same the couple’s three-year-old son died by gun wound as opiate demographic; People who use fentanyl … they’re after unintentionally shooting himself with their gun in long-term addicts. If you have the tolerance with heroin to go September in Madison Township (Franklin County), and to fentanyl, you’ve been doing [opiates] for a while.” the couple’s newborn daughter died by unintentional overdose from a combination of methadone and cocaine intoxication in April (www.vindy.com, Dec. 7, 2017). Prescription Opioids Participants and community professionals identified Prescription opioids are moderately to Oxycodone®, Percocet® and Vicodin® as the most available highly available for illicit use in the region. prescription opioids in terms of widespread illicit use. Participants most often reported the current Participants remarked: “I could get those right now; Honestly, street availability of these drugs as ‘8’ on I could get any of them … my family messes with them.” A a scale of ‘0’ (not available, impossible to treatment provider commented, “Patients use Oxycodone®

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and Percocet® interchangeably. ‘Perk 30s’ (Roxicodone® 30 Current Street Prices for mg) are the most valued. It is not really Percocet® but rapid Prescription Opioids

release oxycodone.” $30-40 for 30 mg OxyContin® OP Participants and community professionals reported that $50-90 for 80 mg the street availability of prescription opioids has decreased during the past six months. Participants explained: $2-7 for 5 mg Percocet® $5-10 for 7.5 mg

“They’re trying to cut people off, so I would say less because Opioids $7-10 for 10 mg

the law changed so it is a little harder [to get a prescription Prescription for opioids]; Slightly less … I had three dealers [who dealt $5-8 for 5 mg prescription opioids], now I have two.” A law enforcement Vicodin® $10-13 for 10 mg officer stated, “They are less available because heroin and $25-40 for 30 mg other opioids are more available and affordable.” Participants reported obtaining these drugs for illicit Both the Columbus Police and the BCI London crime labs use from drug dealers, doctors, family members, other reported that the number of hydrocodone (Vicodin®), people with prescriptions and through Internet purchase. oxycodone (OxyContin®) and oxycodone/acetaminophen Participants commented: “I used to go to the pharmacies (Percocet®) cases they process have increased during the and sit outside and wait for people to come outside and try to past six months, while the number of hydromorphone buy their pills off of them; A lot of people are buying them online (Dilaudid®) and tramadol (Ultram®) cases have decreased from other countries; I got them from my doctor, but once the or remained the same. In addition, the BCI London doctor stopped giving them to me, I got them from my mother- Crime Lab reported that the number of methadone, in-law.” morphine and oxymorphone (Opana®) cases it processes has increased during the past six months, while the While there were a few reported ways of consuming Columbus Police Crime Lab reported the number of prescription opioids, generally the most common route cases it processes for these medications has decreased or of administration for illicit use is snorting. Participants remained the same during the past six months. estimated that out of 10 illicit prescription opioid users, five would snort, three would smoke, and two would orally Reported Availability consume the drugs. Participants remarked: “Smoking is

newer within the past three years; The people I party with, I Change during the Past 6 Months would see more smoking.” Participants Decrease A profile of a typical illicit prescription opioid user did not emerge from the data. Participants described typical

Opioids Law enforcement Decrease illicit prescription opioid users as anyone. Participants

Prescription Prescription commented: “I don’t think it really matters what you do for a Treatment providers Decrease living, or your race or age. I think it’s everywhere from 20s all the way up; There’s no classification on that at all .”… Reports of current street prices for prescription opioids Treatment providers described typical illicit users as were consistent among participants with experience aged late teens and 40-50 year olds, white people, buying the drugs. Reportedly, the majority of prescription restaurant workers, construction workers, landscapers and opioids sell for $1 per milligram. Overall, participants professionals. A treatment provider reported: “A lot of times indicated that the price of prescription opioids has varied I see a bimodal peak: late teens to early 20s and another during the past six months. peak in the 40s and 50s who had an injury. Pretty even male/ female, majority Caucasian … most common occupations include the restaurant industry, construction, landscaping … jobs where you are paid in cash.” Law enforcement described typical illicit prescription opioid users as 20-45 years old and white people. A law enforcement officer added, “[They are] similar to heroin users. Typically, 20-30 years old … predominately white ….”

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Suboxone® Reported Availability Change during the Past 6 Months Suboxone® remains highly available for illicit use in the region. Participants and community Participants No change professionals most often reported the current street availability of Suboxone® as ‘10’ on a Law enforcement Increase scale of ‘0’ (not available, impossible to get) to Suboxone® ‘10’ (highly available, extremely easy to get); the previous Treatment providers No consensus most common scores were also ‘10.’ Participants stated: “It’s easy to get your hands on; It’s very available. It’s everywhere; It’s the go-to-drug for people to get off other stuff; Anybody Reports of current street prices for Suboxone® were consistent can go to the doctor and get it … most people get it off the among participants with experience buying the drug. street because you have to pass drug tests if you go to a doctor; The Suboxone® that’s available is from people not Current Street Prices for

doing their program … they sell it and get their fix (drug of Suboxone® choice).” A treatment provider remarked, “It’s readily available. It has a good street value to it. Sometimes they’ll Filmstrip $15-20 for 8 mg sell Suboxone®, so they can get heroin.” Law enforcement commented: “All heroin arrests have Suboxone®; Suboxone® is common. We usually find it on arrestees. They usually have Pill $15-20 for 8 mg ‘strips’ (Suboxone® filmstrip form) in their wallet .”… Suboxone® $30-35 Subutex® Participants reported that the street availability of (unspecified dose) Suboxone® has remained the same during the past six months, while law enforcement reported increased In addition to obtaining Suboxone® on the street from availability. Treatment providers were not able to agree drug dealers, participants also reported getting the drug whether street availability of Suboxone® has remained the for illicit use through doctors. Participants reported: same or increased during the past six months. Treatment “People go to treatment to get them and instead of using providers commented: “Same or more … I’ve seen more them, they sell them. Some may trade them; I’d say fifty-fifty clinics pop up around there … just little hole-in-the-wall between street and doctor; The people who are going to the clinics … I don’t know if that means there’s more prescribers doctor are selling them.” Law enforcement shared: “[Users out there or what, but I’d say it’s gotta be increasing; Probably are] getting it from whoever they get heroin from now [since] the same or more because there are more prescribers, or more a lot of clinics require patients to take it on site; It is prescribed advertising.” a lot, too, and then abused or sold on the street; You find it in prisons.” Law enforcement reported: “I would say we’re seeing more and more Suboxone®, but the majority of them have a prescription Participants reported that the most common routes of for it, so there’s nothing you can do about it .… It can be traded administration for illicit use of Suboxone® are snorting for other drugs; More people are trying to get into medically and intravenous injection (aka “shooting”). A participant assisted treatment programs and it’s available to them.” The commented, “Most people I know shoot them or snort them. Columbus Police and the BCI London crime labs reported The strips you have to put under the tongue, or shoot them.” that the number of Suboxone® and Subutex® cases they Participants and community professionals described process have increased during the past six months. typical illicit Suboxone® users as people addicted to opiates. Participants commented: “Someone who claims to be a recovering addict; People who aren’t using them to get clean. They’re selling it to buy other drugs. They are not trying to do their program.” A treatment provider commented, “They’re obviously heroin users for the most part … that aren’t just doing Suboxone®.” A law enforcement officer reported, “The majority of Suboxone® [illicit users] you run

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into are heroin addicts. And the reason we come into contact Both the Columbus Police and the BCI London crime labs with them is they’re stealing to go buy heroin, and they have reported that the number of clonazepam (Klonopin®) and Suboxone® on them until they can buy the heroin.” diazepam (Valium®) cases they process have increased, while the number of zolpidem (Ambien®) cases has decreased during the past six months. In addition, the Sedative-Hypnotics BCI London Crime Lab reported that the number of alprazolam (Xanax®), carisoprodol (Soma®), and lorazepam Sedative-hypnotics (benzodiazepines, barbiturates (Ativan®) cases it processes have increased, while the and muscle relaxants) remain highly available for illicit Columbus Police Crime Lab reported that the number of use in the region. Participants most often reported the cases for these medications has decreased or remained current street availability of these drugs as ‘10’ on a scale the same. In addition, the BCI London Crime Lab reported of ‘0’ (not available, impossible to get) to ‘10’ (highly that it has seen an increase of designer benzodiazepine available, extremely easy to get); the previous most cases during the past six months. common score was also ‘10.’ Treatment providers and law enforcement most often reported current street Reported Availability availability as ‘8;’ the previous most common scores were

Change during the Past 6 Months ‘8’ and ‘10,’ respectively. Law enforcement stated: “Usually that’s something we’ll get out of a traffic stop … they’re out Participants No change there; You see that a lot with marijuana … you see it a lot.” Participants and community professionals continued to Law enforcement No change

identify Xanax® as the most available sedative-hypnotic in Sedative- Hypnotics terms of widespread illicit use. Treatment providers No consensus Corroborating data indicated that sedative-hypnotics are available for illicit use in the region. ODPS reported Participants were unable to provide current street prices 34 drug task force seizures of benzodiazepines in the for sedative-hypnotics. However, a law enforcement officer Columbus region during the reporting period (38.2% of reported, “You can get a ‘xanie’ bar (Xanax® 2 mg) for five the seizures were made in Marion County). bucks.” Participants reported that these drugs are obtained Media outlets reported on law enforcement seizures and for illicit use from physicians, people with prescriptions arrests in the region this reporting period. Columbus and through Internet purchase. Participants discussed: Police responded to a call regarding a woman passed “The people who I know who are abusing them have a out behind the wheel of her vehicle with her 19-month- prescription; It’s who you know, you have to know somebody old daughter with her; the woman admitted to snorting [who has a prescription]; You can order legal ‘benzos’ Xanax® and heroin immediately prior to overdosing in (benzodiazepines) off the Internet .”… the car; during the woman’s arrest, officers observed her Generally, the most common routes of administration immediately swallow 2.5 Xanax® bars (Xanax® 2 mg) to for illicit use of sedative-hypnotics are oral consumption avoid officers finding the drugswww.nbc4i.com ( , Dec. 5, and snorting. Participants estimated that out of 10 illicit 2017). sedative-hypnotic users, five would orally consume and Participants and law enforcement reported that the street five would snort the drugs. availability of sedative-hypnotics has remained the same Participants described typical illicit sedative-hypnotics during the past six months, while treatment providers users as anyone and people addicted to opiates. A were not able to agree on whether street availability of participant reported, “All over the board … 25 to 50 years sedative-hypnotics has remained the same or increased old. Occupation isn’t a factor. Xanax® users are people during the past six months. Treatment providers stated: trying to get off heroin by replacing it with something not as “Availability hasn’t changed for any of them; None of them deadly.” Community professionals described typical illicit have decreased in availability; Xanax® and Klonopin® are sedative-hypnotic users as young people, white people going up.” and female. A treatment provider commented, “Female

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… many are currently or previously prescribed and have Corroborating data indicated that marijuana is available higher mental health co-morbidity … higher percentage of in the region. ODPS reported 70 drug task force seizures Caucasian; Young white girls in their 20s; Women use benzos of marijuana in the Columbus region during the reporting more than men.” Law enforcement reported: “Prescription period (24.3% of the seizures were made in Marion County). users, heroin users; We find them with younger people more Media outlets reported on law enforcement seizures than anything.” and arrests in the region this reporting period. A state senator is urging lawmakers to change the Schedule I drug classification of marijuana to a Schedule II or III substance Marijuana to allow for additional research, prescribing rights, and patient use than what is currently allowed under Schedule Marijuana remains highly available in the region. I drugs; the senator hopes that this will, in turn, help for Participants most often reported the current scientific advancements of the drug since researchers will availability of the drug as ‘10’ on a scale of ‘0’ be better able to study it under the different drug schedule (not available, impossible to get) to ‘10’ (highly laws and not be confined to laboratory grown marijuana, available, extremely easy to get); the previous which often differs from street marijuana www.cleveland.( most common score was also ‘10.’ Participants provided com, July 20, 2017). OSHP in Richland County arrested many reasons why marijuana is highly available including: two individuals during a traffic stop on Interstate 71 after proximity to other states that have legalized medical finding the driver had a suspended license; during the marijuana, a lack of recreational activities available in the towing of the vehicle, officers learned the car had over 100 area, and the fact that marijuana is more socially acceptable pounds of marijuana in it (www.nbc4i.com, July 21, 2017). and “safer” when compared to other substances. Participants OSHP in Somerford Township (Madison County) arrested reported: “It is highly available. I can get it anywhere, any time a California man during a traffic stop after officers smelled of day. It’s nothing for me to get a hold of some really high-grade raw marijuana coming from his vehicle and conducted a stuff … I know people who grow it; I think it is high because probable cause search; officers confiscated 198 pounds there are bordering states that are carrying it medicinally, and I of marijuana edibles (www.statepatrol.ohio.gov, Aug. know for a fact that it’s coming across the borders because a lot 28, 2017). An investigation by the Ohio High Intensity of what I’ve been able to get are things that are only medicinal Drug Trafficking Area (HIDTA) lead to the indictment of such as the THC (tetrahydrocannabinol, the psychoactive five individuals responsible for trafficking marijuana in component of marijuana) pens and things of that nature; Pickerington (Fairfield County); during these arrests, officers There’s nothing else to do … the skating rink closed down … seized several hundred pounds of marijuana and thousands ain’t nothing to do, so everybody turns to drugs.” of dollars in cash (www.lancasterreaglegazette.com, Oct. 6, 2017). A Franklin County judge sentenced a man to 36 Community professionals most often reported the current months in prison, which the judge offered out of pity for availability of marijuana as ‘10’ on a scale of ‘0’ (not available, the man’s three children and sick wife, for his involvement in impossible to get) to ‘10’ (highly available, extremely easy trafficking 3,000 pounds of marijuana each trip from Arizona to get); the previous most common score was also ‘10.’ to Columbus using his semi-truck; the man first transported Treatment providers reported: “It’s probably Ohio’s number the drug after he purchased his semi-truck and realized one cash crop; You can probably go to that coffee shop right what was inside; he claimed he wanted to leave the gang there and buy some; It’s socially acceptable. It’s really down forcing him to transport the drugs, but he was coerced into played. No one overdoses on marijuana. You can buy magazines two additional transports before he found a replacement about marijuana in the store. Technology … you can just text driver; the group transported thousands of pounds of the and say, ‘Hey, I need some marijuana,’ and they’ll come to your drug each trip (www.dispatch.com, Oct. 17, 2017). The U.S. door; I think social norms are changing … [marijuana use 23 Major Crimes Task Force, and officers from Pickaway, Ross is depicted] in the movies [and] it’s in TV shows now. It’s just and Fayette counties arrested a man during a traffic stop in widely more acceptable.” Law enforcement commented: “[It Pickaway County during an “Interdiction Ride Training” after is] widely available … less commercial-grade marijuana from criminal indicators and a K-9 officer alerted officers to search cartels, and more high-quality, medical-grade marijuana from the man’s vehicle; officers found six pounds of marijuana other states, like Colorado; A lot of people are growing their own packaged in vacuum-sealed bags and a white powdery ‘pot’ (marijuana) right now.”

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substance weighing one ounce (www.circlevilleherald. always been accessible … nobody thinks it’s bad. It’s all natural.” com, Oct. 28, 2017). OSHP in Madison County arrested a Law enforcement discussed: “There’s such an abundance [of man during a traffic stop on Interstate 70 in Deer Creek high-grade marijuana]. Michigan has dispensaries, Colorado Township after noticing the smell of marijuana coming [does also]. It seems a lot of their excess ‘weed’ (marijuana) is from the vehicle and conducting a subsequent search; shipped to Ohio; A lot of it is already clipped buds, high-grade officers seized 92 pounds of marijuanawww.nbc4i.com ( , that’s being shipped in the mail, coming out the back door of a Dec. 8, 2017). Portland Police in Oregon arrested a Portland dispensary. We see a lot of that ….” man for attempting to smuggle more than five pounds of Participants and community professionals indicated that marijuana through the airport to Ohio; the man admitted to the availability of marijuana extracts and concentrates frequently shipping the drug to other states to sell, including have increased during the past six months. A participant Ohio (www.koin.com, Dec. 11, 2017). Whitehall Narcotics remarked, “Way more available. There’s been times when I Detectives (Franklin County) recovered a package containing can’t even find regular weed, but I can find edibles.” Treatment eight pounds of marijuana left at an apartment leasing office providers commented: “Most pot has stayed the same [in after apartment staff alerted police to a suspicious package availability], but I’m hearing more about the dabs and the oils they received wrapped in Christmas paper (www.10tv.com, and stuff like that; We’ve had an increase in dabs because six Dec. 20, 2017). months ago I didn’t even know what that was, and now we have Participants and community professionals also discussed several people using [dabs]; We’re starting to see more of the oils current availability of high-grade marijuana extracts and and dabs.” Law enforcement shared, “I’ve seen more marijuana concentrates, often appearing as oil and waxy forms of in edible form … suckers, candies … those kinds of things.” the drug (aka “dabs”). Participants most often reported the The Columbus Police and the BCI London crime labs current availability of these alternative forms of marijuana reported that the number of marijuana and marijuana as ‘8;’ the previous most common score was ‘10.’ Participants extracts and concentrates (oils, “dabs”) cases they process reported: “For people who don’t like to smoke, and they want have increased during the past six months. to know what it’s like to do marijuana, they will definitely do the ‘edibles’ (food products made with marijuana extracts and concentrates); People that kind of want to hide [their marijuana Reported Availability use] turn to edibles.” Law enforcement most often reported Change during the Past 6 Months current availability of marijuana extracts and concentrates also as ‘10;’ the previous most common score was not Participants Increase reported. Law enforcement Increase

Participants reported that the availability of marijuana has Marijuana increased during the past six months. Participants largely Treatment providers Increase attributed increased availability to greater social acceptability for the drug, and the expansion of medicinal marijuana into other states. Participants reported: “People are just more Participants most often rated the current overall quality of relaxed anymore since it’s legal in so many more states; I’ve marijuana as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to noticed it’s increased. I think just because a lot of what I’m seeing ‘10’ (high quality); the previous most common score was also is coming from Michigan, medicinal; I think a lot is coming ‘10.’ Participants commented: “It’s a bit surprising how good it available with all these laws and stuff they’re putting in place is nowadays … regular weed’s been good for a while now, but [legalizing marijuana use] and people across the country [high-grade marijuana] has been better and better. They keep are thinking, ‘Oh yeah, it’s ok,’ even though it might not be cranking it up; I think a lot of people are getting medicinal stuff legal in their state. They feel that it is coming … it’s going that that they don’t even know is medicinal … it used to be hit or way. I think it makes them more prone to grow it and makes it miss, but lately I’ve noticed that everyone is getting a hold of top attainable for a lot of people.” quality.” Law enforcement reported: “It is not your grandma’s weed anymore … it’s good stuff; Back in the day, you were Community professionals reported that the current high looking at 6% THC, now you’re looking at 24% THC.” availability of marijuana has remained the same during the past six months. A treatment provider commented, “I think it’s

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Overall, participants indicated that the quality of marijuana, tried it every possible way ….” In terms of eating marijuana, a as well as that of marijuana extracts and concentrates, participant stated, “Nowadays, a lot of kids under 20 [years of has increased during the past six months. Participants age] are getting into edibles more than smoking. I’ve seen a lot commented: “In the last six months it has gotten so of that and it’s growing and growing [in popularity].” unbelievably good …. You’ll have a seizure; It seems like it’s A profile for a typical marijuana user did not emerge from definitely kicked up in the last six months. It’s gotten stronger; the data. Participants described typical marijuana users as You would think after years of smoking it, it wouldn’t have that anyone. Participants commented: “I’ve smoked with any race, big an effect, but it’s so potent now .”… different financial classes. Nowadays, it doesn’t have a face; I Reports of current prices for marijuana were provided by was kind of surprised by all the people that smoke weed. There’s participants with experience buying the drug. Overall, not a specific … like I know people my dad’s age who smoke. I participants reported that the price of marijuana has know people super young in middle school who smoke. There’s remained the same during the past six months. really not a specific face anymore.” Community professionals described typical marijuana users Current Prices for as teens to elderly. Treatment providers discussed: “Pretty Marijuana much across the board … high and low socio-economic status. Old and young; I don’t think it is a specific kind of person. It’s Low grade: male and female, Caucasian, African American, Hispanic, Latino A blunt (cigar) $5 … it doesn’t matter. I don’t feel it has a very specific profile; 12 to 40 [years of age], sometimes as young as 8 years old … all A gram $10-15 socio-economic levels.” Law enforcement added: “It’s all the 1/4 ounce $75-100 way across the board; 14 to 65 years old and all over the place; Everybody’s smokes weed. You can walk down the street and

1/2 ounce $70-150 smell people smoking weed. It’s everywhere. It doesn’t matter age, race, sex. It’s all over; We still get plenty of 40 plus (40-year An ounce $300 olds and older) users, but the highest number (most prevalent) High grade: would probably be kids, 15-30s.”

Marijuana A gram $10-50 1/4 pound $1,000-1,200 Methamphetamine

Extracts and concentrates: Methamphetamine remains highly available in the region. Participants most often reported Brownies, cookies, suckers $5 each the current availability of the drug as ‘10’ on Gummy bears $20 for 10 a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to THC pills $20 for 3 get); the previous most common score was also ‘10.’ One THC pen $50 participant remarked: “It’s about an ‘11’ on a scale of ‘1’ to ‘10’ for me … Super available. It’s everywhere.” Treatment providers most often reported current availability as ‘6,’ While there were a few reported ways of consuming while law enforcement most often reported it as ‘2’ and marijuana, generally the most common route of ‘10;’ the previous most common score for both treatment administration remains smoking. Participants estimated providers and law enforcement was ‘6.’ A treatment that out of 10 marijuana users, nine would smoke and one provider commented, “Historically, it was confined to would eat the drug. In addition, participants described certain regions, like southeast Ohio had a ton of ‘meth’ other methods for using marijuana: “People are putting the (methamphetamine), but now, I’m seeing more in Columbus.” oils on their finger and putting it on their mucus membranes Law enforcement reported conflicting accounts of the and it’s being absorbed; I’ve ingested it … I’ve done all kinds of availability of methamphetamine in the Columbus region. stuff. I’ve done a hookah of it. I’ve smoked it out of an apple. I’ve

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Some law enforcement indicated that methamphetamine Sept. 28, 2017). OSHP reported to a local news source that is highly available, while others stated it is less available. they made 12,802 drug-related arrests in Ohio between Law enforcement stated: “Methamphetamines are widely January-September 2017, which is a 25% increase from available; Apparently, it’s very available because it’s the 2016; officers reported making major arrests on highways number one drug submitted to Ohio [crime] labs. But I in New Albany, Gahanna and Worthington (all Franklin can tell you outside of traffic stops in Delaware County, we County); officers specifically reported that, compared to haven’t seen it in a while.” 2016, officers saw an 82% increase in methamphetamine, 39% increase in crack cocaine, and a 54% increase in Corroborating data indicated that methamphetamine is marijuana seizures (www.10tv.com, Oct. 20, 2017). OSHP in available in the region. ODPS reported 45 drug task force Madison County arrested a man during a traffic stop after seizures of methamphetamine in the Columbus region a K-9 officer alerted to the presence of drugs in the man’s during the reporting period (35.6% of the seizures were vehicle; officers seized two pounds of methamphetamine made in Knox County). and a stolen firearm www.nbc4i.com( , Dec. 8, 2018). Media outlets reported on law enforcement seizures Participants reported that methamphetamine is available and arrests in the region this reporting period. Licking in crystal and powdered forms throughout the region; County Sheriff’s officers arrested a man during a traffic however, they noted crystal methamphetamine as stop on Interstate 70 in Harrison Township when the man most prevalent. A participant commented, “There’s more was found to be in the country without documentation of it [generally] … less ‘shake-and-bake’ and more ‘ice’ and his vehicle’s tire had a hidden compartment; the (crystal methamphetamine.)” The powdered form of man agreed to allow officers to search his hotel room, methamphetamine is typically referred to as “shake-and- where they found 13 gallon-sized baggies containing bake,” which means users produce the drug in a single- methamphetamine; officers arrested two other men with sealed container, such as a two-liter soda bottle. By using him responsible for trafficking drugswww.nbc4i.com ( , July common household chemicals along with ammonium 12, 2017). An investigation by the Madison County Drug nitrate (found in cold packs) and pseudoephedrine Task Force lead to the arrest of four individuals after officers (found in some allergy medications), people who executed search warrants at two residences and seized make methamphetamine can produce the drug in 14 grams of methamphetamine, 1.6 pounds of heroin, approximately 30 minutes in nearly any location. 3.8 ounces of marijuana and eight ecstasy tablets (www. richmondregister.com, Aug. 9, 2017). Hilliard Police (Franklin Participants reported that the availability of County) arrested a woman after executing a search warrant methamphetamine has increased during the past six at her home and finding methamphetamine, injection months. Participants expressed that there is an increase needles and other drug paraphernalia; officers visited the because more of the drug is coming from other places home 16 times previously for drug-related incidents (www. such as California and West Virginia. One participant myfox28columbus.com, Aug. 25, 2017). The Columbus remarked, “It’s more available. Bikers and everybody are bomb squad, fire crews and police responded to a call bringing it ….” Ease of obtaining ingredients is another at a motel after fire alarms went off and staff members reason why participants thought methamphetamine to evacuated patrons; officers arrested a man at the scene be increasing in the region. A participant explained, “You after he admitted to manufacturing methamphetamine can get the ingredients off the Internet. They’re making it in a in a room, which set off the fire alarmswww.nbc4i. ( bottle in their house … in 10 minutes.” com, Sept. 20, 2017). Grove City Police (Franklin County) arrested a man after the Jackson Township Fire Marshal Treatment providers indicated that the availability of called officers to assist at the scene of a hotel where the methamphetamine has increased during the past six fire marshal was completing routine fire code inspections; months, while law enforcement reported that availability upon entering the room of the man, the fire marshal has increased in some areas while it decreased in others. found a loaded firearm and cash in plain site; officers Treatment providers commented: “I believe it’s increasing. later searched the room and confiscated 442 grams of What I’ve seen is more positive drug screens for it. If I had methamphetamine, 61 grams of cocaine and 24 grams of to guess, it would be because the fentanyl being laced in heroin ready for distribution (www.abc6onyourside.com, the heroin … maybe people are … moving on to other

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 145 Page 8 Surveillance of Drug Abuse Trends in the Columbus Region substances because of their fear of overdosing and dying; Overall, participants reported that the quality of I’ve seen an increase. I’ve had more people present [for methamphetamine has been variable during the past six treatment] that are using meth; I think it’s been on an months. Participant stated: “It varies … you’ve got people increase. I see a lot of it in people’s systems.” who will mix (adulterate) it, and then it’s junk … then you’ve got high quality; I would think that across the board, if you A law enforcement officer who reported that took the good and the bad and put together, the potency methamphetamine has decreased in availability said, “You has gotten stronger over the last six months, but it is not can drive to Newark [Licking County] and get all the meth consistent.” you want, but in our area, I’d have to [say] it’s low.” A law enforcement officer who reported increased availability Current prices for methamphetamine were reported by stated, “Methamphetamines are increasing because the participants with experience buying the drug. Reportedly, Mexican cartel is bringing in ‘ice.’” the most common amount of purchase is 1/10 gram. However, a participant shared, “Whatever money you got, The Columbus Police and the BCI London crime labs they’ll sell you meth.” Other comments focused on trading reported that the number of methamphetamine cases material goods for methamphetamine. Participants added: they process have increased during the past six months; “We used to go boost (shoplift) from stores and bring [stolen the labs reported processing blue, clear, pink and white merchandise] to the dope boys … from clothes to shoes to crystal methamphetamine as well as white powdered jewelry to flashlights to TVs. People trade huge TVs for a gram methamphetamine. [of methamphetamine]; People just going out and stealing stuff and bringing it to [drug dealers] … tools, household Reported Availability items, guns, knives, lawn ornaments. I know people who Change during the Past 6 Months would trade their kids to get stuff (methamphetamine); It’s a whole bartering system out here. We don’t have $20 to give, Participants Increase but I’ve got these really cool bracelets, you know?”

Law enforcement No consensus Current Prices for Methamphetamine Treatment providers Increase

Methamphetamine Crystal:

1/2 gram $10-25 Participants most often rated the current overall quality of methamphetamine as ‘2-10’ on a scale of ‘0’ (poor A gram $20-60 quality, “garbage”) to ‘10’ (high quality); the previous An ounce $500-700 most common score was ‘7.’ Participants discussed the Methamphetamine inconsistency of methamphetamine quality in the region. One participant reported, “There’s so many factors involved Participants reported that the most common route of … where it comes from … you can get meth from somebody administration for methamphetamine remains snorting. A one day and it’s a ‘10,’ and the next day, get the same meth, participant remarked, “10 out of 10 would be snorting lines.” from the same guy, and it’s a ‘2.’” Participants also reported smoking and intravenously injecting (aka “shooting”) methamphetamine. Participants Participants discussed adulterants (aka “cuts”) that affect shared: “I started off snorting it, then I started smoking the quality of the drug and reported the following cutting it, then everybody I ran with ‘IV’ (intravenously) used agents for methamphetamine: baby aspirin, Epsom® [methamphetamine]; I’ve literally never snorted it. I’ve salt, “molly” (powdered MDMA) and powdered cocaine. always shot or smoked it.” Participants described a few In addition, a participant commented, “The ‘dope boys’ novel ways to administer methamphetamine including: (drug dealers), some of them will take a half gram [of “parachuting” (wrapping the drug in a piece of tissue methamphetamine] and throw half a gram of salt in there.” paper and swallowing) and drinking it in coffee. The BCI London Crime Lab reported dimethyl sulfone (dietary supplement) as a cut for methamphetamine. A profile for a typical methamphetamine user did not emerge from the data. Participants described typical

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methamphetamine users as anyone. Participants illicit use. Participants stated: “Adderall® is big, but Ritalin® commented: “It’s anybody; I know 70-year olds that use, that is not anymore; I’d say Vyvanse® is more available than are shooting up now; I think it doesn’t discriminate; There’s Adderall®, but everyone’s prescribed Adderall® now because no certain type of person who does it, but you can tell once everyone has ADHD (attention-deficit hyperactivity disorder). they’re on it.” That’s what they’re giving to the kids. And then, when they don’t take them, they sell them to other people and pass them Community professionals described typical along in school.” methamphetamine users as aged 20-30 years, and working-class males. Treatment providers explained: “Just Participants and community professionals reported based on the ones I’m working with now, [I see] men in the that the street availability of prescription stimulants range of late 20s to mid-30s that have a long history of legal has remained the same during the past six months. A issues, and drug-related legal issues … for dealing [drugs] participant commented, “It’s always been pretty easy to get and all that; [Methamphetamine] users tend to be younger, Adderall®.” Treatment providers commented: “[It’s] pretty more Caucasian, male, often homosexual.” A member from steady. There will always be prescriptions to people’s children. the law enforcement community added, “25-45 [years I haven’t seen an uptick or a down tick; If people want it, they of age], sometimes 50s … white, poor people … not much can get it. I know they’re out there, but people aren’t using a difference between males and females … seeing more who ton.” were opiate users.” The Columbus Police and the BCI London crime labs reported that the number of amphetamine (Adderall®) cases they process have increased during the past six Prescription Stimulants months. In addition, the Columbus Police Crime Lab reported that the number of methylphenidate (Ritalin®) Prescription stimulants are moderately to highly available cases it processes has increased during the past six for illicit use in the region. Participants most often months, while the BCI London Crime Lab reported that reported the current street availability of these drugs as ‘5’ the number of methylphenidate cases it processes has and ‘10’ on a scale of ‘0’ (not available, impossible to get) to decreased. ‘10’ (highly available, extremely easy to get); the previous most common score was ‘10.’ A participant remarked, “I can

Reported Availability get it if I tried.” Treatment providers most often reported Change during the Past 6 Months the current street availability of prescription stimulants as ‘8-10,’ while law enforcement most often reported it as Participants No change ‘6-7;’ the previous most common score for both treatment providers and law enforcement was ‘2.’ A law enforcement Law enforcement No change

officer stated, “We don’t see too much of it. People might use Stimulants Prescription Prescription it, but we just don’t know unless you take too much of it. We Treatment providers No change don’t see Adderall® in overdoses.” Media outlets reported on law enforcement seizures Participants were unable to provide current street prices and arrests in the region this reporting period. The U.S. for prescription stimulants, other than to say Adderall® Attorney for the Southern District of Ohio voiced his sells for $7 per pill (unspecified dose). Participants concerns over the rise in prescription stimulant abuse; he commented: “Honestly, I don’t really know people who sell reported concerns that people who abuse prescription Adderall® .… They just give it away for free. It’s not a very stimulants will eventually move to stimulant street expensive drug to begin with. They usually get it covered by drugs (i.e. cocaine and methamphetamine), which have their insurance. They’re not selling it for a profit. They’re just increased in availability, particularly in Columbus (www. like, ‘Here, have these;’ Hook your friends up.” myfox28columbus.com, Oct. 25, 2017). Participants reported obtaining prescription stimulants Participants identified Adderall® and Vyvanse® as the most for illicit use from physicians, friends and family members. available prescription stimulants in terms of widespread The most common route of administration for illicit use

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 147 Page 8 Surveillance of Drug Abuse Trends in the Columbus Region of prescription stimulants remains snorting. Participants reported that the availability of ecstasy and molly has estimated that out of 10 illicit prescription stimulant users, remained the same during the past six months. The eight would snort and two would “eat” (orally consume) Columbus Police and the BCI London crime labs reported the drugs. that the number of MDMA (ecstasy/molly) cases they process have increased during the past six months. Participants described typical illicit prescription stimulant users as college students, people aged 18-24 years, and those who use these drugs for weight loss. Participants Reported Availability reported: “College-age students use it to study; Used for Change during the Past 6 Months weight loss … to get skinny.” Community professionals Participants Decrease described typical illicit users as college students, people

aged 18-24 years, and women. A treatment provider Ecstasy Law enforcement No change shared, “Usually college-aged kids … it just takes hold of them.” A law enforcement official remarked,It “ is mostly Treatment providers No change women.” Reported Availability Change during the Past 6 Months

Ecstasy

Participants No comment

Ecstasy (methylenedioxymethamphetamine: MDMA, or Molly Law enforcement No change other derivatives containing BZP, MDA, and/or TFMPP) remains available in the region; however, only a few Treatment providers No change participants reported availability of the drug. Participants most often reported the current availability of the Participants were not able to report on the quality of pressed tablet form of ecstasy as ‘9-10’ on a scale of ‘0’ ecstasy or molly during the past six months. Participants (not available, impossible to get) to ‘10’ (highly available, stated: “It varies in terms of quality and purity; Ecstasy is extremely easy to get); the previous most common score basically not really a drug itself, it’s kind of like a mix. You was ‘5-6.’ A participant shared, “There’s been a lot of ‘rolls’ don’t really know what you’re getting with ecstasy, so every (ecstasy) lately.” Participants did not report the current time you take it, you’re going to have a different experience; availability of “molly” (powdered MDMA);’ the previous That’s also why people are avoiding it more and more.” most common score was ‘1-3.’ Reportedly, ecstasy sells for $15-20 per high-dose pill (aka “triple stack”). Community professionals described typical Community professionals most often reported the current ecstasy and molly users as high school students and availability of ecstasy and molly as ‘3;’ the previous most young people. common scores for both ecstasy and molly were ‘2.’ A treatment provider shared, “[Users of ecstasy and molly] aren’t normally coming into treatment. They’re out with the marijuana users, using club drugs. I haven’t really talked to a Other Drugs in the Columbus Region patient about [molly] in about six months.” Law enforcement reported: “We see it occasionally; You hear about molly. That’s popular with schools (with students); It’s somewhat Participants and community professionals listed a variety available, but I don’t think it’s easy to get; We haven’t seen of other drugs as being present in the region, but these MDMA in quite a long time.” drugs were not mentioned by the majority of people interviewed: Anabolic steroids, hallucinogens (psilocybin Participants reported that the availability of ecstasy has mushrooms), Neurontin® (gabapentin) and synthetic decreased during the past six months. A participant marijuana (synthetic cannabinoids). commented, “[Ecstasy is available] around … festival season [during the summer months]. It was more common, In addition, secondary data sources reported other drugs not mentioned by respondents. The BCI London but less so now … it’s expensive.” Community professionals Crime Lab reported that the number of bath salts cases

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(synthetic cathinones; compounds containing methylone, increased during the past six months, while the number of mephedrone, MDPV or other chemical analogues, LSD and DMT cases have decreased or remained the same. including alpha-PVP, aka “flakka”) cases it processes has increased during the past six months, while the Columbus Police Crime Lab reported that the number of bath salts Neurontin® cases it processes has decreased to fewer than 10 cases. The BCI London Crime Lab also reported it processed Neurontin® (gabapentin, an anticonvulsant and nerve 21 cases of ketamine (an anesthetic typically used in pain medication) remains available for illicit use in the veterinary medicine) and 44 cases of U-47700 (synthetic region. While participants did not report on the availability opioid) during the past six months. of Neurontin®, treatment providers most often reported the drug’s current street availability as ‘8’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, Anabolic Steroids extremely easy to get); the previous most common score was not reported. A treatment provider reported, “I am Reportedly, anabolic steroids are available for illicit use in seeing it in about one third of all drug screens.” the region. Participants and law enforcement most often reported the current street availability of these drugs as ‘8’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ Synthetic Marijuana (highly available, extremely easy to get); the previous most common scores were not reported. Law enforcement Synthetic marijuana (synthetic cannabinoids) remains commented: “My uncle is a legit professional body builder, available in the region. Although participants did not and he can get steroids anywhere. I can go to [a tractor store] rate the current availability of the drug, a participant … and go buy steroids if you want; Steroids are huge. You can commented, “‘Posh’ (synthetic marijuana) is popular because do steroids anywhere you want. I could walk you down to any 80% of Mansfield [Richland County] is on probation, and you gym here [and obtain anabolic steroids] ….” can’t smoke ‘weed’ (marijuana) on probation. You could buy posh at the store legally ….” Treatment providers most often reported the current availability of synthetic marijuana as Hallucinogens ‘2’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most Psilocybin mushrooms remain moderately available in common score was not reported. A treatment provider the region. Participants most often reported the current commented, “‘Posh’ [is] used more because it doesn’t show availability of psilocybin mushrooms as ‘7’ on a scale of ‘0’ up on drug tests.” (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common The BCI London Crime Lab reported that the number score for hallucinogens generally was ‘6.’ A participant of synthetic marijuana cases it processes has decreased commented, “They come around once in a while at a party.” during the past six months. The Columbus Police Crime Law enforcement most often reported current availability Lab reported that the number of synthetic marijuana cases of psilocybin mushrooms as ‘2’ and ‘7;’ the previous most it processes has remained the same during the past six common score for hallucinogens generally was ‘6.’ Law months, and was fewer than five cases. enforcement reported: “Mushrooms and LSD (lysergic acid Participants most often rated the current overall quality diethylamide) are kind of big on our [college] campus up of synthetic marijuana as ‘10’ on a scale of ‘0’ (poor quality, here; You can order [psilocybin mushrooms] spores online.” “garbage”) to ‘10’ (high quality). Participants added: “You The Columbus Police Crime Lab reported that the number can either smoke a joint of ‘loud’ (high-grade marijuana) or of LSD and psilocybin mushrooms cases it processes have take one hit of ‘posh’ and feel like you’re completely gone; increased during the past six months, while the number Regular weed’s been good for a while now, but ‘posh’ has of PCP (phencyclidine) and DMT (dimethyltryptamine) been better and better and better. They keep cranking it up cases have remained the same or decreased to fewer than (increasing the potency).” Reportedly, a gram of synthetic three cases. The BCI London Crime Lab reported that the marijuana sells for $10. number of psilocybin mushroom cases it processes has

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Many community professionals indicated that some clients do not know they are taking fentanyl, while others Conclusion indicated that clients are actively seeking it. Overall, community professionals shared the belief that fentanyl Crack cocaine, heroin, marijuana, methamphetamine, is widely available because it is showing up in other sedative-hypnotics and Suboxone® remain highly substances, such as prescription opioids (reportedly, available in the Columbus region; also highly available are fentanyl is pressed into pills and sold as prescription fentanyl and powdered cocaine. Changes in availability opioids). In terms of its current overall quality, participants during the past six months include: increased availability found it difficult to speak directly about fentanyl quality for fentanyl, marijuana and methamphetamine; possible as it is most frequently combined with heroin. Thus, increased availability for Suboxone®; and decreased participants were unclear about whether the general availability for prescription opioids. quality of fentanyl has changed during the past six months. Treatment providers reported that the availability of crack and powdered cocaine has increased during the past six Participants reported that the availability of marijuana months, while participants reported increased availability has increased during the past six months. Participants for crack cocaine only. Treatment providers stated that largely attributed increased availability to greater social the increases are likely due to decreasing prices and the acceptability for the drug, and the expansion of medicinal perception that cocaine is safer when compared to other marijuana into other states. In addition, participants and substances (i.e. heroin and fentanyl). They also cited that community professionals indicated that the availability of some users receiving medication assisted treatment marijuana extracts and concentrates in the form of oils or for opiate use disorder (i.e. Suboxone® and Vivitrol®) wax (aka “dabs”) has increased, with law enforcement also continue illicit drug use with cocaine. All respondent noting an increase in marijuana “edibles” (food products groups discussed an increase in popularity of using made with marijuana extracts and concentrates). both heroin/fentanyl with stimulant drugs (i.e. cocaine Participants reported that the availability and methamphetamine) to “speedball” (concurrent or of methamphetamine, specifically crystal consecutive use of depressant and stimulant drugs for methamphetamine, has increased during the past an up and down effect). Reportedly, some heroin users six months. They expressed that there is an increase use cocaine to alleviate opiate withdrawal. Participants because more of the drug (originating in Mexico) is reported that cocaine in the region is most often coming from other places such as California and West adulterated (aka “cut”) with other substances, including Virginia. One participant stated, “Bikers and everybody fentanyl. are bringing it in.” Community professionals described While heroin and fentanyl are both highly available, typical methamphetamine users as aged 20-30 years, and participants discussed difficulty in obtaining just one of working-class males. the drugs without the other. Participants reported the top Lastly, the BCI London Crime Lab reported it processed cutting agents for heroin as fentanyl and carfentanil. Both 21 cases of ketamine (an anesthetic typically used in participants and treatment providers reported the current veterinary medicine) and 44 cases of U-47700 (synthetic availability of fentanyl as high; law enforcement described opioid) during the past six months. current availability of fentanyl as moderate. The lower availability score assigned by law enforcement echoes the above participant sentiment that unadulterated fentanyl is difficult to obtain. Participants attributed increased availability of fentanyl to dealers being able to acquire the drug inexpensively, which has resulted in dealers substituting fentanyl for other drugs and in cutting other drugs with it.

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Drug Abuse Trends in the Dayton Region

Regional Epidemiologist: Kathryn Coxe, MSW, LSW

Data Sources for the Dayton Region This regional report was based upon qualitative data collected via focus group interviews. Participants were active and recovering drug users recruited from alcohol and other drug treatment programs in Champaign, Darke, Logan and Montgomery counties. Data triangulation was achieved through comparison of participant data to qualitative data collected from regional community professionals (treatment providers and law enforcement) via focus group interviews, as well as to data surveyed from the Miami Valley Regional Crime Lab, the Ohio Bureau of Criminal Investigation (BCI) London Crime Lab, which serves central and southern Ohio, the Montgomery County Coroner’s Office, Logan County Family Court, and the Ohio Department of OSAM Staff: Public Safety (ODPS), which logs drug task force seizures from across the Ohio. All secondary data R. Thomas Sherba, PhD, MPH, LPCC are summary data of cases processed from January OSAM Principal Investigator through June 2017. In addition to these data sources, Ohio media outlets were queried for information Kathryn A. Coxe, MSW, LSW regarding regional drug abuse for July through OSAM Coordinator December 2017. Jessica Linley, PhD, MSW, LSW Note: OSAM participants were asked to report on drug use/knowledge pertaining to the past OSAM Quantitative Data Analyst six months prior to the interview; thus, current secondary data correspond to the reporting period of participants.

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Regional Profile Indicator1 Ohio Dayton Region OSAM Drug Consumers Total Population, 2016 11,614,373 1,342,139 39 Gender (female), 2016 51.0% 51.1% 15.4% Whites, 2016 82.5% 83.9% 59.0% African Americans, 2016 12.8% 11.7% 30.8% Hispanic or Latino Origin, 2016 3.7% 2.5% 7.9%2 High School Graduation Rate, 2012-16 89.5% 89.7% 87.2% Median Household Income, 2012-16 $50,674 $50,817 $20,000-$24,9993 Persons Below Poverty Level, 2016 14.6% 14.7% 39.5%4

1 Ohio and Dayton region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018. ² Hispanic or Latino origin was unable to be determined for 1 participant due to missing and/or invalid data. ³ Participants reported income by selecting a category that best represented their household’s approximate income for the previous year. Income was unable to be determined for 1 participant due to missing and/or invalid data. 4 Poverty status was unable to be determined for 1 participant due to missing and/or invalid data.

DaytonDayton Regional Regional Participant Participant Characteristics Characteristics Consumer Characteristics N=39*

Male 33 Female 6 Gender < 20 1 20s 10 30s 15

Age 40s 7 50s 5 60s 1 Less than high school graduate 5 High school graduate 19 Some college or associate's degree 14 Education Bachelor's degree or higher 1 < $12,000 9 $12,000 to $19,999 8 $20,000 to $28,999 7 $29,000 to $36,999 4 ≥ $37,000 Household Income 10 Alcohol 27 Cocaine, Crack 13 Cocaine, Powdered 11 Heroin/Fentanyl 14 Marijuana 22 Methampehtamine 11 Prescription Opioids 16 Drugs Used** Prescription Stimulants 4 Sedative-Hypnotics 14 Suboxone®/Subutex® 10 Other Drugs*** 1

0 5 10 15 20 25 30 35 Number of Participants

*Not all participants filled out forms completely; therefore, numbers may not equal 39. **Some respondents reported multiple drugs of use during the past six months. ***Over-the-counter (OTC) cough syrup.

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needles for $5 each. Additionally, participants reported Historical Summary obtaining needles from needle exchange programs. While participants reported that powdered In the previous reporting period (January - June 2017), methamphetamine remained the most prevalent crack cocaine, heroin, marijuana, powdered cocaine form of methamphetamine in the region, the Miami and sedative-hypnotics remained highly available Valley Regional Crime Lab noted that 99.0% of the in the Dayton region; also highly available was methamphetamine cases it processed were the crystal methamphetamine. Changes in availability during the form of the drug. Law enforcement indicated that crystal reporting period included: increased availability for heroin; methamphetamine was coming from Mexico. Participants and likely increased availability for methamphetamine. reported that the high availability of methamphetamine as increasing. They attributed increased availability to While participants and treatment providers reported that increased demand and reported that heroin users were the availability of heroin remained high and had increased transitioning to methamphetamine either out of fear during the reporting period, law enforcement reported of overdosing, or because they were being treated with low heroin availability. Participants indicated that users Vivitrol® and could no longer use opiates. traveled to Dayton to purchase heroin/fentanyl due to the plentiful supply of the drugs in that city. The low Lastly, participants reported high availability of LSD availability rating of heroin by law enforcement reflected (lysergic acid diethylamide) in the region. The BCI London their reports that fentanyl had replaced much of the and the Miami Valley Regional crime labs reported that the heroin in the region. The Montgomery County Coroner’s number of LSD cases they process increased during the Office found fentanyl present in 77.4% of the 168 drug- reporting period. Reportedly, the most common quantity related deaths it processed during the reporting period; of purchase for LSD was a strip (10 doses) for $60-80. the lab reported heroin present in 19.0% of the 168 drug- related deaths. Reportedly, brown and white powdered heroin were the most available types of heroin in the region. Participants discussed adulterants (aka “cuts”) that affected the quality Current Trends of heroin and reported that the top cutting agents included: carfentanil and fentanyl. Participants also reported that fentanyl was used as a cut for cocaine and Powdered Cocaine acknowledged that the potency of carfentanil and fentanyl had led to many of the overdose deaths in the region. Powdered cocaine is moderately to highly available in the region. Participants most often reported the drug’s current The BCI London and the Miami Valley Regional crime labs availability as ‘7-8’ on a scale of ‘0’ (not available, impossible reported that the number of carfentanil, fentanyl and to get) to ‘10’ (highly available, extremely easy to get); fentanyl analogue cases they process increased during the previous most common score was ‘9-10.’ Participants the reporting period; the BCI lab also reported U-47700 remarked: “I can make a phone call and I can get it … I’ve (synthetic opioid) as a heroin adulterant. Moreover, got several options to pick from; It’s so easy for me to find … the BCI lab noted that heroin, fentanyl, cocaine and I worked in a bar, so I could get it any time of the day; A lot of methamphetamine were seen in various combinations people who are on or are using heroin have ‘girl’ (powdered with each other. cocaine) to go with their heroin.” Treatment providers The most common route of administration for heroin/ most often reported the current availability of powdered fentanyl remained intravenous injection (aka “shooting”). cocaine as ‘7,’ while law enforcement most often reported Participants estimated that out of 10 users, eight would it as ‘7-8;’ the previous most common scores were ‘6-7’ shoot and two would snort the drugs. Participants for treatment providers and ‘9’ for law enforcement. One reported that injection needles were most available at treatment provider commented, “I hear how they’re using retail drug stores and from drug dealers who typically sold the cocaine with the opiates to level themselves out … they’re

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 153 Page 8 Surveillance of Drug Abuse Trends in the Dayton Region using cocaine to bring them back up.” A law enforcement Reported Availability officer stated, “It typically goes hand-in-hand [with heroin]. Change during the Past 6 Months Some users will order cocaine along with their heroin.” Corroborating data indicated that powdered cocaine is Participants No change available in the region. The Logan County Family Court

reported that of the 206 positive adult drug test results it Cocaine Law enforcement No change recorded during the past six months, 25.2% were positive Powdered for powdered and/or crack cocaine. The Montgomery Treatment providers No change County Coroner’s Office found powdered and/or crack cocaine present in 40.5% of the 385 drug-related deaths Participants most often rated the current overall quality it processed during the past six months. In addition, of powdered cocaine as ‘5-6’ on a scale of ‘0’ (poor the Ohio Department of Public Safety (ODPS) reported quality, “garbage”) to ‘10’ (high quality); the previous 22 drug task force seizures of powdered cocaine in the most common score was ‘8.’ Participants reported the Dayton region during the reporting period (59.1% of the top cutting agents (adulterates) for powdered cocaine seizures were made in Allen County). as baking powder, baking soda and prescription opioids Media outlets reported on law enforcement seizures and (Vicodin® and Percocet®). Other adulterants mentioned arrests in the region this reporting period. Homeland included: baby formula, fentanyl, flour, laxatives, teething Security Investigations obtained clearance to place a GPS tablets and Tylenol®. Participants commented: “I think a tracking device on a vehicle after Ohio State Highway lot of people are discovering different things to cut it with to Patrol (OSHP) in Butler County found marijuana during a make more money off of it; Everybody is robbin’ nowadays traffic stop; special agents tracked the vehicle traveling and trying to rip you off … ‘cause they’ve got drug problems in Dayton, Chillicothe, Indianapolis and Detroit; officers too and they’re trying to feed their habit.” searched a hotel room in Butler Township where two Overall, participants reported that the quality of men operating the vehicle stayed and reported the men powdered cocaine has remained the same during the past had 30.8 pounds of powdered cocaine allegedly brought six months. A participant remarked, “I’ve done it numerous from Texas to Ohio (www.daytondailynews.com, Sept. times in the last six months and every time it’s been about the 22, 2017). West Central Ohio Task Force in Allen County same.” seized multiple drugs during an ongoing investigation after a survey of a home in Lima lead officers to believe Treatment providers discussed fentanyl as a cut for drugs were present; officers obtained a search warrant powdered cocaine. One provider said, “I know in this and confiscated 45 grams of cocaine and one pound of community we’ve had several overdoses from putting marijuana (www.hometownstations.com, Oct. 16, 2017). the fentanyl in the cocaine … and these are the die-hard cocaine [users], who are like, ‘I promise you, I was not doing Participants and community professionals reported that [fentanyl].’” Another provider commented on cocaine as a the availability of powdered cocaine has remained the cut for other drugs: “They’re lacing [the drugs]. I had a lot same during the past six months. A treatment provider of people who thought they were using the opiates and then reported, “It’s been around a long time … it’s not just heroin they’ll test positive for cocaine … they didn’t realize there was or fentanyl ….” The BCI London and the Miami Valley cocaine in it.” Regional crime labs reported that the number of cocaine

cases they process have increased during the past six months; the labs do not differentiate between powdered Cutting Agents and crack cocaine. Reported by Crime Lab l caffeine l levamisole (livestock dewormer) Cocaine Powdered Powdered l local anesthetics (lidocaine and procaine)

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Reports of current prices for powdered cocaine were can’t find cocaine or find something else to use’ … and we see consistent among participants with experience buying lots of people failing for cocaine once they’re on the Vivitrol® the drug. However, participants in Montgomery County shot.” reported higher prices for 1/8 ounce and 1/2 ounce of In addition, law enforcement described typical powdered the drug than did participants in Champaign County. cocaine users as people who also use heroin. A law Reportedly, the most common quantity of purchase is enforcement officer reported,What “ you’ll find are people a gram. Overall, participants reported that the price of will use heroin and then they’ll use cocaine in between uses powdered cocaine has remained the same during the past of heroin to keep themselves level [and] coherent … and six months. A participant commented, “It’s been the same some users will use cocaine to wean themselves off of heroin, for the last 10 years.” believe it or not.” Current Prices for Powdered Cocaine Crack Cocaine

1/10 gram $10 Crack cocaine remains highly available in the region. Participants most often reported the drug’s current 1/2 gram $20-30 availability as ‘10’ on a scale of ‘0’ (not available, impossible A gram $80-100 to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was also ‘10.’ Participants

Cocaine 1/16 ounce (aka “teener”) $150-200 commented: “It’s everywhere around here; It’s relatively cheap Powdered Powdered and people use it to counteract the effects of heroin; I would say 1/8 ounce (aka “eight ball”) $180-300 just about anybody who sells ‘dope’ (heroin) sells ‘crack’ (crack 1/2 ounce $400-500 cocaine) with it.” An ounce $900 Treatment providers most often reported the current availability of crack cocaine as ‘10,’ while law enforcement Participants reported that the most common route of most often reported it as ‘7-8;’ the previous most common administration for powdered cocaine remains snorting. scores were ‘10’ and ‘9,’ respectively. Treatment providers Participants estimated that out of 10 powdered cocaine reported: “It’s a common drug … a popular drug; There’s still users, all 10 would snort the drug. However, participants a lot of people who are dependent on it, who are comfortable also reported that powdered cocaine users will smoke or in using it; If [drug dealers] have cocaine, they have crack intravenously inject (aka “shoot”) the drug. A participant … if they have crack, they have heroin. I mean most of these commented, “A lot of the smokers of it that I’ve known will people have the whole [assortment of drugs] ….” A law put it on the end of a cigarette and call it [a] ‘primo’.” enforcement officer commented:It’s “ still readily available. You just have to know where to go to get it.” Participants described typical powdered cocaine users as rap artists, people in the legal field, white people, and Corroborating data indicated that crack cocaine is people 20-30 years of age. Treatment providers described available in the region. The Logan County Family Court typical powdered cocaine users as businessmen, reported that of the 206 positive adult drug test results it construction works, white people and people 20-50 years recorded during the past six months, 25.2% were positive of age. Regarding businessmen using the drug, treatment for crack and/or powdered cocaine. The Montgomery providers commented: “It kind of seems to be more of County Coroner’s Office found crack and/or powdered an expensive high; Business men tend to use it more, even cocaine present in 40.5% of the 385 drug-related deaths it though it’s a drug, they think it’s more of a sexier, classier type processed during the past six months. In addition, ODPS of drug.” reported 15 drug task force seizures of crack cocaine in the Dayton region during the reporting period. Treatment providers discussed that some opiate users receiving medication assisted treatment use powdered Media outlets reported on law enforcement seizures and cocaine. One provider shared, “I hear lots of people saying, arrests in the region this reporting period. The Logan ‘You can give me the Vivitrol® shot, but that doesn’t mean I County Joint Drug Task Force arrested a man wanted

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 155 Page 8 Surveillance of Drug Abuse Trends in the Dayton Region on prior felony warrants for cocaine possession after One participant group discussed that when the crack conducting a search of a residence in Bellefontaine and cocaine is cut by someone, then cut again by another finding the man cooking crack cocaine www.wpko.com( , before selling it, the second person is called a “re- Aug. 7, 2017). Miami County Sheriff’s officers arrested chef.” Participants in this group also discussed “water- three people after executing search warrants at four whipping” the drug to increase its volume before selling different residences in Piqua and seizing crack cocaine, it. Participants explained: “They whip it up and put some firearms, stolen property and cash www.wdtn.com( , Oct. air bubbles in it; If it’s good cocaine, it’ll take the water and 13, 2017). the water will blow it up, so you get double [the amount of] what you get for a ‘straight drop’ (pure cocaine).” Overall, Participants and community professionals reported participants reported that the quality of crack cocaine that the availability of crack cocaine has remained the has remained the same during the past six months. A same during the past six months. A participant reported, participant remarked, “It’s always been crap.” “It’s been high for 30 years … crack cocaine has always been there.” A law enforcement officer stated,In “ the last Cutting Agents six months, I’d say it’s been pretty even keel. I don’t think Reported by Crime Lab we’ve seen it come in any more or any less ….” A treatment provider reported, “I don’t know that it’s ever left.” l caffeine l levamisole (livestock dewormer) Crack Crack

The BCI London and the Miami Valley Regional crime labs Cocaine l local anesthetics (benzocaine, lidocaine reported that the number of cocaine cases they process and procaine) have increased during the past six months; the labs do not differentiate between crack and powdered cocaine. Reports of current prices for crack cocaine were consistent among participants with experience buying the drug. Reported Availability Reportedly, the most common quantity of purchase is Change during the Past 6 Months 2/10 gram (aka “rock”) for $20. However, a participant

reported, “The guy I got it from, he didn’t even weigh it. He’d Participants No change break me a piece off and usually it was a pretty good-sized piece of crack for 20 bucks.” Overall, participants reported

Crack Law enforcement No change that the price of crack cocaine has remained the same Cocaine during the past six months. Treatment providers No change Current Prices for Participants most often rated the current overall quality of Crack Cocaine crack cocaine as ‘6’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the previous most common score 1/10 - 2/10 gram (aka “rock”) $10-20

was ‘2-3.’ Participants remarked: “They’re cutting it more A gram $60-80 to make their money; The cocaine that they cook the crack with ain’t good. Like the cocaine they use is so cut up already 1/16 ounce (aka “teener”) $90 Crack Crack

and then they add more cut to it pretty much. It’s like a Cocaine waste of money anymore; It’s not really even crack anymore.” 1/8 ounce (aka “eight ball”) $125-175 Participants reported that crack cocaine in the region is 1/2 ounce $350-400 most often adulterated (aka “cut”) with baking soda. Other cuts mentioned included: aspirin, baby laxatives, creatine, An ounce $800-1,200 isotol (dietary supplement), mannitol (diuretic), Orajel™, Sprite® and vitamin B-12. A participant commented, Participants reported that the most common route “There’s a lot of stuff you can use … you’ll never know what of administration for crack cocaine remains smoking. they put in it anymore … people are doing some pretty Participants estimated that out of 10 crack cocaine users, messed up things.” eight would smoke and a two would intravenously inject (aka “shoot”) the drug.

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Participants described typical crack cocaine users as older buying white fentanyl, I was buying heroin; [Heroin is] not people, laborers (those who work in construction, roofing in Montgomery County. Fentanyl is in Montgomery County; and trucking) and people of low socio-economic status. People prefer to do fentanyl or carfentanil.” Treatment Participants stated: “It’s usually in the poor neighborhoods; providers observed: “I mean [clients] think they’re getting Most people who smoke crack are in their 40s, 50s and 60s, heroin, but then when they test for it [it is fentanyl]; It’s really ‘cause when crack hit the streets in ‘83, ‘84 … they were 15 to confusing because when you think about it, the heroin is not 20 years old and now thirty to 40 years later [it’s the same heroin anymore.” person].” Community professionals described typical crack cocaine users as older people, predominantly blue-collar Corroborating data indicated that heroin is available in workers, and white and African-American people. One the region. The Logan County Family Court reported that law enforcement officer stated,Older “ folks … I don’t see of the 206 positive adult drug test results it recorded too many younger folks rockin’ crack. I think it’s an older during the past six months, 7.3% were positive for generation.” A treatment provider commented, “For the heroin. The Montgomery County Coroner’s Office found most part, the ones that we’ve had [as clients] have been heroin present in 4.7% of the 385 drug-related deaths it functioning users and a lot of them have jobs, construction, processed during the past six months. In addition, ODPS trade-type jobs ….” reported 28 drug task force seizures of heroin and/or fentanyl in the Dayton region during the reporting period (46.4% of the seizures were made in Allen County); drug Heroin task forces did not typically differentiate between heroin and fentanyl due to the high incidence of heroin-fentanyl Heroin remains highly available in the region. Participants mixtures. most often reported the current availability of the drug as ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ Media outlets reported on law enforcement seizures and (highly available, extremely easy to get); the previous most arrests in the region this reporting period. The Logan common score was also ‘10.’ Participants stated: “There’s County Joint Drug Task Force arrested a couple after more and more people every day that are getting addicted Bellefontaine Police stopped the couple and searched to heroin; It’s what everybody is selling it seems like; There’s a their car; officers found heroin and fentanylwww. ( bunch of them, too … different people [who sell heroin].” examiner.org, July 1, 2017). Eaton Police (Preble County) arrested two people during an investigation where one Treatment providers most often reported the current individual sold heroin to undercover agents within 1,000 availability of heroin as ‘10,’ while law enforcement most feet of a school; a Preble County grand jury indicted a often reported it as ‘5;’ the previous most common total of four people as a result of the investigation (www. scores were ‘10’ for treatment providers and ‘2-3’ for wdtn.com, Aug. 14, 2017). Security officers at a Dayton law enforcement. One treatment provider reported, (Montgomery County) library called police to assist “Montgomery County specifically is number one in the U.S. after finding a man unconscious in a bathroom; EMS when it comes to the heroin epidemic, so obviously it’s very administered Narcan® (naloxone, an opiate overdose easy [to obtain heroin]. We have more overdoses than reversal medication) to revive the man (www.nbc4i.com, anywhere right now.” Law enforcement discussed: “In the Aug. 24, 2017). Greenville Police (Darke County) responded last six months, heroin and fentanyl are by far the most to an emergency call at a residence where a woman was heavily used drugs that we were dealing with; Everyone passed out in a bathroom; EMS administered three doses wants the fentanyl; Users aren’t wanting heroin.” of Narcan® to the woman to revive her before transporting her to a local hospital for additional treatment (www. Although participants and community professionals earlybirdpaper.com, Sept. 1, 2017). reported high current availability of heroin, respondents across focus groups discussed that heroin is not “straight While many types of heroin are currently available in heroin,” but heroin mixed with fentanyl. Participants the region, participants reported powdered heroin commented: “It’s not really heroin though. It’s fentanyl more (specifically, brown, gray and white) as most available, than anything; The thing is, there’s no such thing as heroin although participants discussed that white powdered anymore that don’t have fentanyl in it … I came here and heroin (aka “china white” heroin) is often fentanyl. Some tested positive for heroin and also fentanyl, but I wasn’t community professionals reported powdered heroin as

OSAM Drug Trend Report January-JuneJune 2017 - January 2013 2018 Page 157 Page 8 Surveillance of Drug Abuse Trends in the Dayton Region most available, while others reported black tar heroin as The BCI London and the Miami Valley Regional crime labs most available. Treatment providers reported: “Probably reported that the number of heroin cases they process the brown and the tan color [are most available] because have decreased during the past six months; the labs the white is pure and it’s harder to come by. Most of it is reported processing beige, brown, off-white, tan and adulterated with something that gives it the off color; I don’t white powdered heroin along with black tar heroin. hear them talk about tar much anymore.” Law enforcement in Darke County reported only seeing black tar heroin Reported Availability in the area. A law enforcement officer in this county Change during the Past 6 Months stated, “Mostly black tar … I haven’t heard anything else.” Conversely, law enforcement in Montgomery County Participants Increase reported brown powdered heroin as most common and reported not seeing black tar heroin during the past six Heroin Law enforcement Decrease months. A law enforcement officer reported,I “ mean there’s talk of black tar heroin, but I think I’ve seen it twice in Treatment providers No change 23 years.”

Reportedly, black tar heroin is available in the region Participants most often rated the current overall quality of according to a few participants. Among participants with heroin as ‘7’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ knowledge of black tar heroin, participants rated the (high quality); the previous most common score was ‘10.’ current availability of this type of heroin as ‘10;’ a previous A participant remarked, “There’s heroin out there, but it’s not most common score was not reported. A participant as potent as it used to be … it’s mostly fentanyl.” Participants commented, “I go straight to the source and get it.” One discussed the potency of fentanyl related to heroin. One participant group discussed “black finger” heroin as participant explained, “Fentanyl raises your tolerance up, so available in the region, which participants described as even when you try to do good heroin, it won’t give you the a mixture of both brown powdered and black tar heroin. [same high]. Fentanyl’s got more of a punch to it, that’s why Participants reported: “It looks like asphalt; It’s brown with people are dying. It’s a lot stronger.” black specks in it; It was black tar and then they cut it with powder and then, therefore, the powder’s black.” Regarding Participants discussed adulterants (aka “cuts”) that affect availability of black tar heroin in the region, a treatment the quality of the drug and reported the top cutting agent provider commented, “I still hear of black tar. The people for heroin as fentanyl. Participants discussed: “When you that are really afraid of fentanyl are using black tar.” come in here [for treatment] and they test your urine, a lot of people don’t even test positive for opiates (heroin). They’ll just Participants reported that the availability of heroin has test positive for fentanyl; When I thought I was getting ‘dope’ increased during the past six months. A participant stated, (heroin) I was actually getting cocaine or fentanyl. They were just “The availability of pain pills has gone down a lot, so a lot of mixed together.” Additional cuts mentioned included: aspirin, people just switched over to heroin.” Treatment providers baking soda, Benadryl®, cinnamon, coffee grounds, Coca reported that the general availability of heroin has Cola®, creatine, isotol (dietary supplement), lactose, laxatives, remained the same, while law enforcement reported that mannitol (diuretic), menthol, Miralax®, niacin, prescription it has decreased during the past six months. Treatment opioids (Percocet® and Vicodin®), sedative-hypnotics providers commented: “I just think that it’s been a steady (Xanax®), sleep aides, tranquilizers, Tylenol® and vitamin B-12. thing. I don’t think it’s increased or decreased; I think the A participant commented, “They’re putting Xanax® in [heroin] availability has stayed the same. I think what is being pushed … they’re tryin’ to make you tired, make you feel like your in the community has changed a little bit.” Law enforcement high off of heroin but really you’re not.” Overall, participants discussed lower availability: “Customer demand. They don’t reported that the general quality of heroin has decreased want it; Fentanyl’s a longer high, a harder high; For one during the past six months. Participants stated: “It’s trash now; reason or another, whether they’re afraid that they’re going It’s junk … ‘cause everybody’s cutting it up; Most of the time it to die [of overdose] … heroin usage [has slowed down] and wasn’t as good as I wanted it to be.” we’re seeing a lot more ‘meth’ (methamphetamine) users and a lot of people are abusing their Suboxone® and stuff like that ….”

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Cutting Agents While there were a few reported ways of using heroin, Reported by Crime Lab generally, the most common route of administration remains intravenous injection (aka “shooting”). Participants l acetaminophen estimated that out of 10 heroin users, nine would shoot l artificial sweeteners (lactose and sorbitol) and one would snort or smoke the drug. Participants

l caffeine commented: “I know a lot of people that are smoking it now l cocaine … quicker effects … because the fentanyl’s in it; It’s stronger l diphenydramine (antihistamine) now, so you can snort it or smoke it and you still get the l dipyrone (banned analgesic) effects.” Heroin l fentanyl/fentanyl analogues l mannitol (diuretic) Participants reported that injection needles are most l methamphetamine available from drug dealers and retail stores. Participants l nicotinamide (vitamin) also reported obtaining needles for free at needle l prescription opioids exchange programs in Columbus. Participants shared: “It’s l quinine (antimalarial) usually a hustle … you can get it from a drug dealer; There are [needle exchange programs], but they want you to use Reports of current prices for heroin were consistent one needle, one time. You can only get however many you among participants with experience purchasing the drug. got … so if you trade them one needle, what do you expect Reportedly, the most common quantity of purchase is us to shoot dope with one needle, one time?” Reportedly, a capsule (aka “cap”) for $10, containing approximately needles sell on the street for $2-5 per needle. In addition, 1/10 gram amount of heroin. A participant in Champaign a participant reported, “A lot people share needles. Anybody County reported, “In Dayton it’s caps. In Columbus they do else who says they haven’t, they’re lying. Nine out of 10 balloons [filled with heroin], and around here [heroin is] just people got hepatitis, shoot dope.” Participants reported bagged up in sandwich bags or foil.” Overall, participants people who inject drugs often clean needles with hot indicated that the price of heroin has remained the same water or alcohol prior to use. during the past six months. A participant remarked, “[Price] A profile for a typical heroin user did not emerge from depends …. If you got it in Dayton, you’re gonna get it for the data. Participants most often described typical heroin cheaper ….” users as anybody. However, participants distinguished the drug as used commonly among white people, aged 20-40 Current Prices for years and people who work in construction. Participants Heroin remarked: “Everybody does opiates now. If it isn’t heroin, it’s Powdered: something else, like pain killers …. Any age, race, or gender … it’s crazy; A lot of people got back problems, pain issues, 1/10 gram $10 you know, and heroin definitely helps with that; I don’t want 1/2 gram $40 to sound racist, but I think a lot more white people use it than black people; I know a lot of old cats that use, too … maybe A gram $80-100 40s, 50 [years old].”

1/8 ounce (aka “eight ball”) $350 Community professionals described typical heroin users 1/4 ounce $300-350 also as anyone. Treatment providers reported: “We get Heroin 1/2 ounce $1,200 [heroin users] from all ages, races, different neighborhoods; It’s all over the place. There’s no particular community; I’ve $2,200- An ounce had elderly gentlemen [as clients who use heroin], I’ve had 2,800 young children [as clients who use heroin]; It’s all races … Black tar: not just one race.” A law enforcement officer stated, “[Heroin use] transcends. We’ve got Centerville pilots dying off of 1/10 gram (aka “balloon”) $20 heroin in this area.” 1/2 gram $50 A gram $100

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Fentanyl Corroborating data indicated that fentanyl is available in the region. The Montgomery County Coroner’s Office Fentanyl is highly available in the region. reported that 68.1% of the 385 drug overdose deaths it Participants most often reported the current processed during the past six months involved fentanyl/ availability of the drug as ‘10’ on a scale of ‘0’ fentanyl analogues, while 46.2% involved carfentanil (not available, impossible to get) to ‘10’ (highly (an increase from the previous six months, when only available, extremely easy to get); the previous two deaths had involved carfentanil). In addition, ODPS most common score was not reported. Participants reported 28 drug task force seizures of heroin and/or commented: “It’s easier to get fentanyl than it is to get a Big fentanyl in the Dayton region during the reporting period Mac®; The highways intersect. [Interstates] 70 and 75 is like (46.4% of the seizures were made in Allen County); drug right here in Dayton. It’s like a hub for drug transportation; It’s task forces did not typically differentiate between heroin pretty easy to get … it’s all fentanyl pretty much; I could pull and fentanyl due to the high incidence of heroin-fentanyl up to a gas station right now and be served ‘dope’ (heroin/ mixtures. fentanyl) … people walk up to your window trying to sell you what they say is dope but it’s fentanyl; My brother-in-law is Media outlets reported on law enforcement seizures and a cop here in [Champaign County] and he said there was a arrests in the region this reporting period. A pediatrician least two overdoses on fentanyl every day ….” at Dayton Children’s Hospital (Montgomery County) reported to a local news source that the hospital treats up Community professionals also most often reported the to two children per week due to unintentional exposure current availability of fentanyl as ‘10;’ the previous most to opiates; hospital blood tests cannot screen for whether common score was not reported. Treatment providers the drug is fentanyl or a fentanyl analogue (www.sent-trib. reported: “There’s no shortage. I mean look at the number com, July 8, 2017). The Montgomery County Coroner’s of overdoses; What they’re getting now … it’s [fentanyl] in Office reported to a local news source that a 13-month the pills. It’s in the heroin … I’ve even heard of cases that it’s old baby died from unintentional fentanyl and carfentanil been mixed in with marijuana …. I’d say it’s very available; intoxication after being exposed to the drugs while under They always think they’re getting heroin, and it comes back the care of her grandmother; the grandmother was found [on drug screens as fentanyl]; I’ve got some [clients] that dead several days later at a motel, and officers suspected that’s what they want is fentanyl now.” Law enforcement her death was due to a drug overdose (www.nbc4i.com, remarked: “Off the scale. Off the charts; Did you get some July 7, 2017). Law enforcement in Darke County conducted thrown into your car on your way in here?; Supply and a county-wide drug sweep and arrested 14 people, one of demand, cartels are just flooding this area with it; Our supply whom was a woman who faced felonious drug charges for here is so great that people come from other counties [to trafficking fentanyl and heroinwww.dailyadvocate.com ( , purchase fentanyl]; Our potency is way up; You’re getting July 10, 2017). A man plead guilty to drug trafficking in pure fentanyl here; Straight from the cartels … straight from the federal court in Dayton for intending to distribute 178 China through the mail … shipping it right here.” capsules containing fentanyl, packaged as oxycodone; in one incident, the man approached an undercover officer In addition to fentanyl, participants also reported with a free sample (www.daytondailynews.com, July 17, current high availability of carfentanil and other fentanyl 2017). Lima Police (Allen County) on bicycle patrol arrested analogues in the region. Participants reported gray, pink, two people in a fast food parking lot after finding them white and yellow colored fentanyl. Treatment providers passed out in their car; concerned that the two men had were not able to discuss the different fentanyl analogues overdosed, officers woke them and found 57 grams of available in the region. A treatment provider remarked, carfentanil in the car (www.thenewscenter.tv, July 21, “I don’t believe that our clients particularly know what 2017). Ohio Bureau of Criminal Investigation and Wood they’re getting. They’re just doing what they feel is powerful.” County Sheriff’s Office investigated a shooting where Law enforcement also reported current availability SWAT officers shot a man during a search of a home in of carfentanil and other fentanyl analogues. Law Lima; officers found suspected fentanyl, heroin, synthetic enforcement reported pink, off-white and white fentanyl marijuana and multiple firearms www.usnews.com( , Aug. as available in the region. 4, 2017). OSHP in Montgomery County arrested a man responsible for causing a two-vehicle crash on Interstate

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70 in Clayton after he admitted to using fentanyl earlier in Reported Availability the night, and after officers found an unidentified opiate Change during the Past 6 Months at the scene, which they sent to the Montgomery County Crime Lab for testing (www.daytondailynews.com, Aug. 11, 2017). Dayton Police Street Crimes Unit and the U.S. Participants Increase DEA arrested two people after executing a search warrant Law enforcement Increase

at a Dayton home and seizing 100 doses of fentanyl, Fentanyl crack cocaine and drug paraphernalia (www.wohio.com, Aug. 23, 2017). OSHP in Montgomery County arrested a Treatment providers Increase Texas man on Interstate 70 during a traffic stop after a K-9 officer alerted to the presence of drugs in the man’s Participants most often rated the current overall quality vehicle; officers found 8.8 pounds of fentanyl hidden in of fentanyl as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) a backpack and in two purses (www.kfor.com, Aug. 25, 2017). A Miami County grand jury indicted two men for to ‘10’ (high quality); a previous most common score was involuntary manslaughter and drug trafficking for selling not reported. Participants reported: “Fentanyl is so much fentanyl to a Concord Township man who subsequently stronger than heroin, and people are tending to use it a lot died from an overdose after taking the drug; a woman more often because it wears off five times as fast, too. So they at the same residence also overdosed, but did not die use it and use it and use it; There’s only one of two levels … (www.daytondailynews.com, Oct. 4, 2017). Urbana Police either it’s [very good], or you gonna die. You either overdose (Champaign County) arrested two people after raiding or not; Yeah, there’s no middle; Every time I’ve shot fentanyl, a home and seizing suspected fentanyl, lysergic acid almost every time, I’ve blacked out for an hour or two and diethylamide (LSD), morphine, prescription pills, hashish not realized what I did … I woke up in the woods and I don’t (marijuana extract), guns, and finding a large marijuana know what happened.” grow operation (www.fox45now.com, Dec. 8, 2017). Participants discussed fentanyl as an adulterant (aka Participants and community professionals reported that “cut”) for other drugs. They reported that fentanyl is most the availability of fentanyl has increased during the past often mixed with other drugs; thus, for those seeking six months. Participants commented: “It’s cheaper than fentanyl, they often get it in combination with other drugs. heroin; I think before a lot of people were scared of fentanyl, A participant commented, “I ‘dropped dirty’ (screened and now it’s just becoming normal.” Treatment providers positive on a urinalysis drug test) for methadone, benzos reported: “It’s shifting from heroin to fentanyl … people (benzodiazepines), meth (methamphetamine) … I didn’t do actually wanting to buy the fentanyl … it’s a lesser [cost] any of those. It was just the fentanyl, just before I ‘dropped’ … for a better high; From what the clients say, it’s cheaper I didn’t know about any of that (other substances combined than heroin.” Law enforcement stated: “We don’t see heroin with the fentanyl).” Overall, participants reported that anymore … we see fentanyl and carfentanil; It’s increased … the quality of fentanyl has increased during the past six six months ago, we were just starting to hear stories about months. Participants reported: “It takes you straight up out of it in bordering counties and the bigger cities. Now … it’s here; They make sure they’re making it so you die.” here; We’ve had people OD (overdose) from it … we know it’s Reports of current prices for fentanyl were consistent increased; It’s just kind of become a normal thing.” among participants with experience purchasing the drug. Reportedly, the most common quantity of purchase is a The BCI London and the Miami Valley Regional crime labs 1/10 gram in a capsule (aka a “cap”) for $5-10. A participant reported that the number of fentanyl, fentanyl analogues commented, “[Price varies] because the color. If it’s white or and carfentanil cases they process have increased during gray … some people try to differentiate … the gray is better, the past six months. so they’ll put a bigger price on it ….” Overall, participants indicated that the price of fentanyl has remained the same during the past six months.

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Current Street Prices for support your habit, then it’s easy to get. If you don’t got a lot Fentanyl of money, then you’ll be on fentanyl and heroin; It’s one of the top drugs of choice, and everybody knows if you can get them 1/10 gram $5-10 prescribed, and your insurance pays for them, then you have a bottle of money sitting in front of you … so you’re gonna 1/2 gram $50 get rid of (sell) them.” Fentanyl A gram $100 Treatment providers most often reported the current street availability of prescription opioids as ‘10,’ while law While there were a few reported ways of using fentanyl, enforcement most often reported it as ‘6;’the previous generally, the most common route of administration most common scores were ‘10’ and ‘5-7,’ respectively. is intravenous injection (aka “shooting”). Participants Treatment providers remarked: “I think pain management estimated that out of 10 fentanyl users, seven would shoot is one of the biggest causes (source of diversion), honestly and three would smoke or snort the drug. .… They’re giving them out in excessive amounts and people aren’t taking them like they’re supposed to, they’re selling Participants described typical fentanyl users as heroin them; We still have a lot of pain doctors and pain clinics and users, aged teens to 30s and white people. Participants they go and get their monthly ‘scripts’ (prescriptions); You commented: “People that have died, the demographics are have it in your parent’s medicine cabinet, or for high school mainly white people; The reason you’re here is because white, injuries they’re given that, and they share; I will say too, on suburban kids are strung out on fentanyl ….” Community the availability of the pills, is they aren’t always getting them professionals described typical fentanyl users as heroin prescribed because they’re pill pressing them now … that’s users. One treatment provider remarked, “[My clients] are why we’re seeing the increase in the fentanyl and the cocaine usually the same as the heroin.” In addition, other providers in them because they’re literally making [fake prescription observed: “We’ve had several individuals over 60 [years of opioids with other drugs] look exactly like a prescription pill age] overdose in our community; With my females (female ….” clients), it goes into the 30s … for some of them, it was that they’ve always been prescribed pain medications, and then Corroborating data indicated that prescription opioids with the changing cultures, doctors are no longer prescribing are available for illicit use in the region. The Montgomery them a handful of ‘perks’ (Percocet®) and a handful of ‘vikes’ County Coroner’s Office reported that 21.0% of the 385 (Vicodin®) every day, and then they get cut off .”… drug overdose deaths it processed during the past six months involved prescription opioids. In addition, ODPS Law enforcement reported: “Same as the heroin; What used reported four drug task force seizures of prescription to be heroin users are now fentanyl users. Just take that same opioids in the Dayton region during the reporting period. demographic and substitute that word heroin for fentanyl; A lot of the users call it interchangeable. They ask the dealer Media outlets reported on law enforcement seizures for ‘boy’ (heroin) and before you got heroin or maybe a little and arrests in the region this reporting period. Dayton mixture of it, and now it’s just straight fentanyl; Some of the Police (Montgomery County) responded to a call of a people know that what they’re buying is fentanyl half of the child unconscious in a home due to an opioid overdose; time … chasing that high … they’re just buying whatever officers called EMS to revive the childwww.ohio.com ( , July they can get their hands on ….” 26, 2017). Clark County Sheriff’s officers arrested a man in Springfield for attempting to smuggle 70 hydrocodone tablets hidden in a Play-Doh set that he attempted to send Prescription Opioids by mail using a fake return label to a location in North Carolina; a shipping store identified the suspicious package Prescription opioids are highly available for illicit use in and notified police; officers in North Carolina also arrested the region. Participants most often reported the current a suspect possibly connected to the crime (www.cleveland. street availability of these drugs as ‘10’ on a scale of ‘0’ com, Sept. 9, 2017). (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was ‘7-8.’ Participants reported: “If you’ve got money to

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Participants identified Percocet® and Vicodin® as the most get a Percocet® 10 (10 mg) for $3-4, now they’re a dollar per available prescription opioids in terms of widespread illicit milligram … that makes them harder to get (too expensive). use. A participant commented, “Vicodin® is probably one of If you got the choice between buying a $10 Percocet® or a $10 the easiest one’s to get … it’s as strong as oxycodone and the cap [of heroin/fentanyl] that’s gonna keep you out all day, detox is not as bad as other opiates.” Community professionals you gonna buy a cap.” Overall, participants indicated that identified oxycodone, Percocet®, Ultram® and Vicodin® as the price of prescription opioids has increased during the most available in terms of widespread illicit use. Treatment past six months. providers reported: “Percocet® seems to be the easiest ones to get on the streets; Tramadol (Ultram®) you can order from out of Current Street Prices for the country rather cheaply [reportedly from Canada] … and it Prescription Opioids comes rather quickly.” A law enforcement officer stated,They “ $8 for 4 mg use tramadol a lot to cut with fentanyl.” Dilaudid® $12-30 for 8 mg Participants and community professionals reported that the street availability of prescription opioids has remained the $10 for 25 mcg same during the past six months. A participant remarked, Pharmaceutical $30 for 50 mcg “It’s always been there … it still is.” Treatment providers fentanyl $55-75 for 75 mcg commented: “It hasn’t changed; I think they know that heroin $70-80 for $100 mcg could kill them and the pills are not going to kill them, well, it’s $5 for 5 mg $10 for 10 mg not real likely, so it seems safer I think in their mind.” Methadone $30 for 25 mg

The Miami Valley Regional Crime Lab reported that $40 for 40 mg the number of hydromorphone (Dilaudid®), morphine,

and tramadol cases it processes has increased, while $10 for 5 mg $15 for 7.5 mg the number of hydrocodone (Vicodin®), methadone, Opana® oxycodone (OxyContin®), oxycodone/acetaminophen $20 for 10 mg $50-60 for 30 mg (Percocet®) and oxymorphone (Opana®) cases it Opioids

processes has decreased or remained the same Prescription $10 for 20 mg during the past six months. The BCI London Crime Lab $15 for 30 mg OxyContin® OP reported that the number of hydrocodone, methadone, $20-25 for 40 mg morphine, oxycodone, oxycodone/acetaminophen and $40 for 80 mg oxymorphone cases it processes have increased; the $5-7 for 5 mg number of cases for hydromorphone and tramadol have Percocet® $7-8 for 7.5 mg decreased or remained the same. $10-15 for 10 mg Roxicodone® $40 for 30 mg Reported Availability

Change during the Past 6 Months Ultram® $ 0.50-2 for 50 mg $1 for 5 mg Participants No change Vicodin® $3-4 for 7.5 mg $7 for 10 mg

Opioids Law enforcement No change

Prescription Prescription Participants reported obtaining these drugs for illicit Treatment providers No change use from drug dealers, doctors, family members, friends, and through social media sites and Internet purchase. Reports of current street prices for prescription opioids Participants commented: “A lot of people like to take their were consistent among participants with experience scripts as needed. So, the extras they will sell to other people buying the drugs. Reportedly, the majority of prescription who are users; It’s mostly older people who get those meds opioids sell for $1-2 per milligram. One participant prescribed … they sell their meds; You can be on ‘the book’ commented, “When I first started taking Percocet®, I could (Facebook) and people advertising on there, ‘I got perks

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(Percocet®), I got vikes (Vicodin®) right now’ … you look at the Treatment providers most often reported current street comments and you got the little hand emoji … and then the availability of Suboxone® also as ‘10,’ while law enforcement next thing you know you got a line [of people wanting to most often reported it as ‘4-5;’ the previous most common buy]; You can get it anywhere. Once you foolin’ around with scores were ‘10’ and ‘5,’ respectively. Treatment providers pills and poppin’ pills you could be in a conversation … ‘Oh commented: “Right there at the clinics, right in the parking my cousin has a bunch of ‘perks.’” lot [users sell their Suboxone®], as sad as that is; They have this extra amount … somebody hits them up and says, While there were a few reported ways of consuming ‘Hey, I’ll give you 10 bucks for one of your Suboxone®’.” A law prescription opioids, and variations in methods of use enforcement officer remarked,People “ are selling their were noted among types of prescription opioids, generally Suboxone® strips.” the most common route of administration for illicit use is snorting. Participants estimated that out of 10 illicit Media outlets reported on law enforcement seizures and prescription opioid users, nine would snort and one would arrests in the region this reporting period. Bellefontaine intravenously inject (aka “shoot”) or smoke the drugs. Police (Logan County) arrested two men during a traffic Some participants specifically discussed shooting and stop after the driver gave consent for officers to search smoking Percocet® to produce a more intense high. his vehicle; officers found a bag of cocaine and drug paraphernalia; while checking the man into the Logan Participants described typical illicit prescription opioid County Jail, officers also found three 8 mg Suboxone® users as younger, female, white people, and people who filmstrips hidden in the man’s pants www.peakofohio.com( , work labor intensive jobs. Participants commented: “I think July 31, 2017). people who work factory jobs … there’s more people who use it in factories … I think ‘cause their bodies are tore down; Participants reported that the street availability of Suboxone® Same thing with construction. I don’t think I’ve ever met a has increased during the past six months. Participants man in construction that doesn’t do some kind of drugs, or commented: “Because of the fentanyl, carfentanil epidemic, drink [alcohol].” there’s more Suboxone® clinics … more people are going to treatment [and] more medically assisted treatment is available Community professionals most often described typical now; I’d say it’s increased because a lot of people … get them illicit prescription opioid users as anyone. However, several prescribed and sell them so they can go get some other kind of treatment providers described typical users as young, drug.” Treatment providers reported that street availability people in pain, and people who work in labor intensive has remained the same, while law enforcement reported jobs or jobs that require long hours. A treatment provider it has remained the same or increased during the past six observed, “I think we’re seeing an uptick in young, females months. A law enforcement officer who indicated increased … teen years.” A law enforcement officer stated,I’d “ say by availability stated, “I can only speak to the prisons … but I think far the abusers of them can pretty much be anybody … these it’s higher because it’s gotten so much easier to conceal … they people can be high functioning … very educated and very come up with some pretty creative ways [to get Suboxone® well-known individuals in the community.” while incarcerated] ….” The BCI London and the Miami Valley Regional crime labs reported that the number of Suboxone® Suboxone® and Subutex® cases they process have increased during the past six months. Suboxone® is highly available for illicit use in the region. Participants most often reported Reported Availability

the current street availability of Suboxone® as ® Change during the Past 6 Months ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely Participants Increase easy to get); the previous most common score was ‘7.’ Participants reported Suboxone® as available in both Law enforcement No consensus sublingual filmstrip (aka “strip”) and pill forms. Participants Suboxone commented: “They’re doing away with the strips because Treatment providers No change people’s insurance won’t cover them anymore and we’re getting the orange tablets; We’re seeing a lot of pills now.”

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Reports of current street prices for Suboxone® varied extremely easy to get); the previous most common score was among participants with experience buying the drug. ‘8.’ Participants stated: “They’re so easily prescribed, and a lot of Participants in rural areas reported higher prices for the people don’t really need them … they just get them prescribed, drug. Regarding selling the strips on the street or in prisons, that way they can sell them and make some money; I feel like a participant commented, “They take the ‘eights’ (8 mg strips) they’re prescribed in mass amounts … I know somebody who and just split them and make them 2 mg a piece or whatever. gets them prescribed and he’s only supposed to take one a day In prison they split them in tenths, and one [8 mg strip] goes but he gets 90 [Klonopin®].” for $100. But they will cut them into ten pieces and sell them $10 a tenth.” Overall, participants reported that the street Treatment providers most often reported the current street price of Suboxone® has remained the same during the past availability of sedative-hypnotics as ‘5,’ ‘7’ and ‘10,’ while law six months. enforcement most often reported it as ‘7;’ the previous most common scores were ‘5-6’ for treatment providers and ‘8’ Current Street Prices for for law enforcement. Treatment providers who reported

® moderate available explained: “You gotta know somebody to Suboxone® get it; They’re overdosing off those mixed with alcohol, so they’re cutting back (doctors aren’t writing as many prescriptions as $6-7 for 4 mg Filmstrip previously).” One treatment provider who reported high $20 for 8 mg current street availability stated, “They’re easy to obtain, people

Suboxone are getting prescribed them … it’s popular right now.” A law Pill $10-20 for 8 mg enforcement officer remarked, “I think it’s there more than we know.” In addition to obtaining Suboxone® on the street from drug dealers, participants also reported getting the drug for Corroborating data indicated that sedative-hypnotics are illicit use through Suboxone® clinics and from other users. available for illicit use in the region. The Montgomery County A participant reported, “You can go to a treatment center Coroner’s Office reported that 42.6% of the 385 drug-related yourself and get them.” A treatment provider stated, “There deaths it processed during the past six months involved one are a lot of shady clinics, and people know where they are, and or more benzodiazepine. In addition, ODPS reported one they know how to get it … they know who to sell it to.” drug task force seizure of benzodiazepines in the Dayton region during the reporting period. Participants reported that the most common route of administration for illicit use of Suboxone® filmstrip form Participants identified Xanax® as the most available sedative- remains oral consumption (sublingual) followed by hypnotic in terms of widespread illicit use. Participants snorting. Participants commented: “Put it in water and sniff commented: “I can get Xanax® anywhere. I mean I can get the water; There’s always people that do shoot (inject), but it’s Xanax® any time of the day, all day; Xanax® are a ‘10’ (highly rare.” The most common route of administration for illicit available) for sure but some of those are harder to come by, use of the pill form is snorting. but Xanax® and Valium® I can get like all the time; [Xanax® is] the best … it’s the strongest benzo; It’s the most commonly Participants and community professionals described typical prescribed.” Participants in a couple groups reported high illicit Suboxone® users as aged 20-30 years, and people who availability of pressed “fake” Xanax®. Participants reported: are still using heroin and/or fentanyl or who are trying to “A lot of the “bars” (Xanax® 2 mg) nowadays are pressed … come off of these drugs. like pressed into pills with fentanyl and other fillers; People will take the original prescription and crush it up and like cut it with fentanyl and repress them; You can’t tell the difference between Sedative-Hypnotics a pressed pill and a regular pill. You can’t tell the difference unless you had some kind of tester [for fentanyl]. You know, they Sedative-hypnotics (benzodiazepines, barbiturates and look exactly the same.” muscle relaxants) are moderately to highly available for illicit use in the region. Participants most often reported the Treatment providers identified Ativan®, Klonopin® and current street availability of these drugs as ‘10’ on a scale of Xanax® as the most available sedative-hypnotics in terms ‘0’ (not available, impossible to get) to ‘10’ (highly available, of widespread illicit use, while law enforcement identified

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Xanax® as most available. Treatment providers commented: Current Street Prices for “They’re very highly prescribed; I had a woman on them for 20 Sedative-Hypnotics years, four milligrams a day. A neurologist was prescribing that for depression.” Law enforcement reported, “[Xanax® is] probably $0.50 for 0.5 mg one of the most prescribed drugs by doctors … people are selling Ativan® $0.50 for 1 mg those out on the street or giving them away ….” $2 for 2 mg $0.50-1 for 0.5 mg Participants and community professionals reported that the Klonopin® $2 for 2 mg general availability of sedative-hypnotics has remained the same during the past six months. Participants remarked: “I $1-2 for 2 mg don’t think anything’s changed. I can get a script of Xanax® … any

Sedative- Valium® $0.50-1 for 5 mg day of the week if I wanted to; People are buying it faster than you Hypnotics $3 for $10 mg can get them … and they buy them as soon as [prescriptions] get filled .”… $0.50 for 0.25 mg $1 for 0.5 mg The BCI London Crime Lab reported that the number of Xanax® alprazolam (Xanax®), carisoprodol (Soma®), clonazepam $2-3 for 1 mg (Klonopin®), diazepam (Valium®) and lorazepam (Ativan®) $4-5 for 2 mg cases it processes has increased during the past six months, while the number of zolpidem (Ambien®) Participants reported obtaining sedative-hypnotics for illicit cases has decreased. The opposite was reported by the use from drug dealers, physicians, by robbing pharmacies Miami Valley Regional Crime Lab, where the number of and through purchasing supplies and substances through various benzodiazepine cases it processes has decreased the Internet to press the pills. A participant remarked, “You or remained the same, while the number of zolpidem can get it in powder form if you go online … from Canada and (Ambien®) cases has increased. In addition, the BCI London press it into whatever form you want.” Crime Lab reported that it has seen an increase in cases of The most common route of administration for illicit use of designer benzodiazepines during the past six months. sedative-hypnotics is snorting. Participants estimated that out of 10 illicit sedative-hypnotic users, nine would snort Reported Availability and one would orally consume the drugs. A participant Change during the Past 6 Months commented, “Me and my people used to get ‘pop’ (soda) … ‘roxi’ (Roxicodone®), Xanax® … crush them up … [and mix] with Participants No change some codeine.”

Law enforcement No change Participants described typical illicit sedative-hypnotics Sedative-

Hypnotics users as millennials, and people in their 40s. A participant Treatment providers No change commented, “The younger generation likes that type of buzz (high) .… People don’t really look at it as a hard drug.” Community professionals described typical illicit sedative- Reports of current street prices for sedative-hypnotics were hypnotic users as teens to 40-year olds and females. consistent among participants with experience buying the A treatment provider remarked, “Usually women.” Law drugs. Reportedly, sedative-hypnotics most often sell for enforcement stated, “18 to 24 [year of age] … the ones I can $1-2 per milligram. However, a participant noted, “If you buy remember off the top of my head have all been females, younger a whole bunch [of Valium®], you get a discount … if you’re a females ….” loyal customer.” Overall, participants reported that the price of sedative-hypnotics has remained the same during the past six months.

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Marijuana search a residence in Columbus (Franklin County), where officers seized an additional 300 pounds of the drug Marijuana remains highly available in (www.cleveland.com, July 21, 2017). Officers with the the region. Participants and community Montgomery County Sheriff’s Office and the Miami Valley professionals most often reported the current Bulk Smuggling Task Force arrested three people after availability of the drug as ‘10’ on a scale of seizing 200 pounds of marijuana from a car during a traffic ‘0’ (not available, impossible to get) to ‘10’ stop in Dayton and observing two men attempting to get (highly available, extremely easy to get); the previous most rid of crystal methamphetamine (www.wdtn.com, Aug. 11, common scores were also ‘10.’ Participants commented: 2017). Law enforcement in Preble County arrested a man “It’s very easy to get; It’s everywhere; It’s like (as available as) who rolled his vehicle over on US 127 in Eaton; officers alcohol; It doesn’t get you sick like everything else does, so, found 14 pounds of marijuana in vacuum-sealed bags in more people are prone to smoke ‘weed’ (marijuana) instead the overturned vehicle; the man admitted to driving to of something hard; I just think it’s what a lot of people have Michigan to obtain medical marijuana to bring back to grown up seeing their parents do … it’s just really common in Ohio (www.pal-item.com, Aug. 24, 2017). Law enforcement their household.” in Montgomery County arrested a man after executing Treatment providers discussed: “Everybody smokes it; They a search warrant at his home in Trotwood and seizing think it’s not as bad … it’s not a drug; We seem to have a 20 pounds of marijuana, a gun and cash (www.wdtn. pipeline from Michigan [bringing marijuana to Ohio]; It com Sept. 22, 2017). Ohio State Highway Patrol (OSHP) seems really socially acceptable; Parents are providing it. in Preble County arrested a man during a traffic stop on It’s birthday presents, it’s Christmas presents … their parent Interstate 70 after a K-9 officer alerted to the presence smokes, so they’re smoking with them … smoking the higher of drugs in his vehicle; officers confiscated 157 pounds quality stuff together.” of marijuana; a day prior to this, OSHP in Preble County arrested another man during a traffic stop on Interstate Law enforcement reported: “One, it’s more socially acceptable 70 after finding 190 ecstasy pills, 67 grams of marijuana, now than it was before, and two, the supply … I mean there’s a and a loaded gun in a U-Haul trailer he was driving (www. huge supply we have here; It’s a recreational party drug. People daytondailynews.com, Oct. 18, 2017). OSHP in Miami use it for that. People use it to calm down. People use it because County arrested a Michigan man during a traffic stop after they think it’s some medical thing based on what’s being told to seeing marijuana residue on the driver-side door handle them on the news; There’s just a lot of it.” and finding 29 grams of hashish (marijuana extract) and three pounds of hydroponic marijuana in the car’s trunk Corroborating data indicated that marijuana is available (www.wdnt.com, Nov. 15, 2017). OSHP in Preble County in the region. The Logan County Family Court reported arrested a California man during a traffic stop in Interstate that of the 206 positive adult drug tests it recorded 70 after criminal indicators prompted a search of the man’s during the past six months, 59.7% were positive for THC vehicle; officers seized over 76 pounds of hydroponic (tetrahydrocannabinol, the psychoactive component of marijuana (www.statepatrol.ohio.gov, Nov. 16, 2017). marijuana); the court also reported that 96.6% of the 118 OSHP in Xenia (Greene County) reported that a teenage positive juvenile drug tests it recorded during the past six male was charged with vehicular homicide in Greene months were positive for THC. In addition, ODPS reported 31 County Common Pleas Court for causing a crash while drug task force seizures of marijuana in the Dayton region under the influence of marijuana that killed two other during the reporting period. teenagers (www.nbc4i.com, Dec. 4, 2017). Clarke County Sheriff’s officers arrested four people during a traffic stop Media outlets reported on law enforcement seizures in Springfield after discovering they were transporting and arrests in the region this reporting period. A grand over 50 pounds of marijuana from the West Coast to be jury in Allen County indicted a former Miss Kentucky sold in the Miami Valley and Central Ohio (www.fox45now. USA for smuggling marijuana into the Allen Correctional com, Dec. 11, 2017). OSHP in Preble County arrested a Institution in May while visiting an inmate (www.wtol. California man during a traffic stop on Interstate 70 after com, July 20, 2017). The Miami Valley Bulk Smuggling a K-9 officer alerted to the presence of drugs in the car; Task Force arrested two people during a traffic stop in officers confiscated 120 pounds of hydroponic marijuana Dayton (Montgomery County) after discovering 100 (www.nbc4i.com, Dec. 18, 2017). pounds of marijuana in their vehicle; this lead officers to

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Participants and community professionals also discussed Treatment providers reported that the availability of current availability of high-grade marijuana extracts marijuana extracts and concentrates, often referring and concentrates, often appearing as oil and waxy to hash oil, has increased during the past six months, forms of the drug (aka “dabs”). Participants most often while law enforcement reported unchanged availability. reported the current availability of marijuana extracts and Treatment providers stated: “There’s a lot of Internet buyers concentrates as ‘5;’ the previous most common score was and you can gain access to it through a lot of different head ‘10.’ Participants remarked: “That’s not a big thing here; Yeah, shops; It’s like the new thing … and so people are trying you gotta kinda look for it, but if you really wanna find it, it and experimenting with it to see what kind of high it you’ll find it; In the last six months, that’s still ‘privy’ (privilege), brings them.” Law enforcement remarked, “There’s a lot we don’t even get into dabs to be knowing were the dab at … of out of state resources you can go to now to get all of the that’s still in the suburbs.” different food products [containing marijuana extracts and concentrates] … and there’s how many different videos on Treatment provides most often reported the current YouTube that shows you how to make it and different ways availability of marijuana extracts and concentrates as ‘2,’ to make it? Plus, you’ve got out of state facilities that are while law enforcement most often reported it as ‘7-8’; the professionally making it now so that stuff is reaching out into previous most common score among both treatment other states.” providers and law enforcement was ‘10.’ Treatment providers reported: “You don’t hear about that too often; The Miami Valley Regional Crime Lab reported that I just haven’t heard it as being as common as regular the number of marijuana and marijuana extracts and marijuana. I’ve heard people say that they ‘dab’ and things concentrates (oils, “dabs”) cases it processes has decreased like that, but it’s not as common as smoking [marijuana].” during the past six months, while the BCI London Crime Law enforcement stated: “It’s pretty high. A lot of the times Lab reported that the number of marijuana and marijuana what we find is people who are cultivating marijuana are extracts and concentrates cases it processes has increased. making the hash oils and dabs themselves. So, I think it’s readily available; We’ve had a couple [arrests in Darke Reported Availability County] … it’s fairly new to this area. Now, I do know in Change during the Past 6 Months Montgomery County they’ve had a little bit more of it, and recently, they just had a big bust … I think a guy was passing Participants Increase through and they found a lot.” Participants reported that the availability of marijuana Law enforcement No change has increased during the past six months. Participants Marijuana discussed: “‘Cause of all the shops (marijuana dispensaries); Treatment providers Increase Many people who’s never done ‘pot’ (marijuana) do it now since it’s legal; It’s less frowned upon than it used to be; They Participant most often rated the current overall quality of decriminalized it and people don’t care so much as they used marijuana as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to.” Participants indicated that the availability of marijuana to ‘10’ (high quality); the previous most common score was extracts and concentrates has remained the same during also ‘10.’ Participants commented: “Nobody likes the taste of the past six months. Participants remarked: “It’s always bad weed; Don’t nobody want ‘reggie’ (low-grade marijuana) available where I be at; Everybody in my circle smokes it.” no more unless you’re an older person or you are a younger kid who really ain’t got no money.” Community professionals reported that the availability of marijuana has remained the same during the past six Participants and community professionals discussed the months. Treatment providers commented: “I think it’s the prevalence of different strains of marijuana in the region. same. There’s never really been a problem [obtaining] that. I Treatment providers stated: “There are so many different think it’s always been available; I would say it’s at least stayed types of marijuana now; They want the ‘loud’ (high-grade the same, if not increased … it just seems like here lately, marijuana) … they can [find a way to] afford it … there everybody that I’ve had coming in [to treatment] … smokes are people who only smoke ‘loud.’ They don’t want regular; marijuana ….”Law enforcement stated, “Probably stayed Definitely higher THC content. I have this one [younger the same … it’s been pretty high for a while now.”

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client] who educates me every time I see him on the mixed Current Prices for breeds … one for attention and focus, and there’s one for Marijuana relaxation, and there’s another color or flavor for this. So, there’s definitely a higher quality.” Low grade: Overall, participants indicated that the quality of A blunt (cigar) or a gram $5-10 marijuana has increased during the past six months. Participants commented: “It’s increased! There’s more THC 1/4 ounce $25 in it then there’s ever been; That’s why they call it ‘loud.’” 1/2 ounce $50 Participants also discussed the prevalence of lacing marijuana with other substances. Participants discussed: An ounce $100 “I’ve noticed that some people are putting meth and other stuff with marijuana … I just know if you smoke a joint and A pound $800 take a pee test (urinalysis drug screen) you fail for all kinds of High grade: stuff; I dropped (took a urinalysis) and got told I had cocaine in my system, and I ain’t touched that shit; I know that when A blunt (cigar) or a gram $20 I tried to go off of opiates and I went to a Suboxone® clinic, I

Marijuana 1/8 ounce $40-50 had dropped dirty (screened positive) for meth and the only thing I had done was smoke weed. I’ve never even done meth 1/4 ounce $80 before; I’ve heard that they’re lacing it with fentanyl right now. I’ve heard that that’s a big thing; I’ve heard that, too. 1/2 ounce $125 I’ve heard that they do it just to get people addicted and have An ounce $240-300 them coming back.” One participant reported that because drug dealers often handle many different drugs without A pound $3,000 washing their hands, the drugs contaminate each other, causing marijuana to be unintentionally mixed with other Extracts and concentrates: substances. 1/2 gram $20-25 Participants also discussed the high quality of marijuana 1/8 ounce $120-150 extracts and concentrates. Participants reported: “You take one hit of it and you feel like you’ve smoked a whole ‘blunt’ (marijuana-filled cigar) of weed; I don’t know why everybody While there were a few reported ways of consuming don’t smoke dabs. I mean it’s smarter. They say it’s the best. If marijuana, generally the most common route of you’re gonna do it, do it right! Smoke the good shit.” administration remains smoking. Participants estimated that out of 10 marijuana users, all 10 would smoke the Reports of current prices for marijuana were provided by drug. Participants discussed smoking the drug includes participants with experience buying the drug. Reportedly, vaporizing it or using a water bong. Regarding marijuana the most common quantities of purchase are a gram and extracts and concentrates, a participant reported, “The oil 1/4 ounce. Overall, participants reported that the price of pens was pretty good ‘cause you can smoke them in public, marijuana has decreased during the past six months. A like at a concert, you can smoke them at a club.” Another participant stated, “I say it decreased because you can buy participant discussed, “Right now, blunts are probably … the ‘loud’ like you buy (for the same price as) ‘reggie’ now because majority … but there’s people doing the dabs, there’s edibles, the demand. So many people got it, the price has dropped there’s vaporizers, there’s all kinds of ways of doing weed. But dramatically.” the majority is probably smoking blunts.” A few participants also discussed eating the drug. Participants shared: “They got candy [made with marijuana]; Some people are boiling the THC out of it and putting it in edibles; Yeah, edibles are really big right now.”

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A profile for a typical marijuana user did not emerge fentanyl and heroin laced with fentanyl … but meth has from the data. Participants described typical marijuana really been a drug of everybody’s choice lately ….” users as everyone; however, they reported that low-grade marijuana is more often used among younger people Corroborating data indicated that methamphetamine is due to the lower price. Participants discussed: “I’d say available in the region. The Montgomery County Coroner’s everybody. I don’t think there is any age range or race. It’s Office reported that 17.1% of the 385 drug-related everybody; From nine [years of age] all the way up to 99 deaths it processed during the past six months involved [years of age].” Community professionals also described methamphetamine. In addition, ODPS reported 19 drug typical marijuana users as anyone. Treatment providers task force seizures of methamphetamine in the Dayton remarked: “It’s just everybody …. They all smoke; I’ve got a region during the reporting period. guy who’s 67 years old that’s doing it, and swears he’s not ever Media outlets reported on law enforcement seizures going to stop doing it … I mean it just ranges the whole entire and arrests in the region this reporting period. Law age groups, and the older they are, the harder it is to get them enforcement in Montgomery County reported to a local to stop ….” Law enforcement commented: “12 to 112 [years news source that methamphetamine was increasing in the of age]; It’s pretty much everybody across the board … you region, amidst the current opioid epidemic; reportedly, can’t really stereotype the marijuana users ….” drug cartels are pushing the drug into the region by the kilogram and using Dayton to push the drug to other parts of the country; a task force in Montgomery County Methamphetamine seized over 20 pounds of crystal methamphetamine Methamphetamine remains highly available in February and 20 pounds in March, among other in the region. Participants most often reported methamphetamine seizures (www.fox45now.com, July the current availability of the drug as ‘10’ on a 20, 2017). The Darke County Sheriff’s Office Narcotics Unit, scale of ‘0’ (not available, impossible to get) to assisted by the Greenville Police, the Darke and Miami ‘10’ (highly available, extremely easy to get); County Special Response Teams arrested two people the previous most common score was ‘8-9.’ Participants after raiding an apartment in Gettysburg (Darke County) reported: “Pretty much everybody’s kinda switching from and finding methamphetamine, drug paraphernalia and heroin over to ‘meth’ (methamphetamine) … you can get off a handgun (www.daytondailynews.com, July 24, 2017). heroin with the ‘meth’ …. The detox won’t be as bad; Heroin Law enforcement in Clark County sent crews to dismantle goes away and meth’s taken over; Meth’s been a life saver an active methamphetamine laboratory at a park in for me … I mix it with my heroin and I won’t OD (overdose); Springfield after receiving reports from nearby campers The last time I got out of rehab … I was on Suboxone®, and of suspicious activity; officers raided the campsite to because it has a blocker in it, I couldn’t use heroin. So, I started safely neutralize the scene, and evacuated two nearby doing ‘speed’ (methamphetamine) and it don’t block speed, campsites, arresting one person (www.wohio.com, July so I could get high on it; My buddy said that because a lot of 30, 2017). U.S. DEA officers arrested a man in July after people are on Vivitrol® and you can’t get high off of the heroin a GPS trafficking device placed on the man’s car lead [people use methamphetamine].” officers to seize 26 pounds of crystal methamphetamine and a kilogram of heroin when they stopped the man for Treatment providers most often reported the current a traffic violation in Preble County; the man was driving availability of methamphetamine as ‘8,’ while law to pick up heroin/fentanyl; a task force officer also wrote enforcement most often reported it as ‘9;’ the previous in the affidavit that the man transported large amounts most common scores were ‘3’ and ‘10,’ respectively. A of U.S. currency from Ohio to California, and that he also treatment provider stated, “A lot of people are using it to possessed a firearm with a felonious conviction from a come up [after heroin use] … they aren’t using one without prior drug case (www.daytondailynews.com, Aug. 16, the other.” Law enforcement discussed: “We’ve never not 2017). A man was sentenced to 18 months in prison been able to get it; I’d say this area is probably flooded by in Darke County Common Pleas Court for attempting the cartel with large amounts of meth … instead of people to cook methamphetamine; the man was arrested for having to make it, now it’s just getting supplied in mass methamphetamine and heroin possession previously quantities; Meth has really become the drug of choice (www.earlybirdpaper.com, Oct. 16, 2017). A man was again … I don’t know if it’s because people are scared of the sentenced to five years in prison in Darke County Common

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Pleas Court for methamphetamine possession; a video Participants reported that methamphetamine is available showed a police informant purchasing methamphetamine in crystal and powdered forms throughout the region. at the defendant’s home; Darke County Sheriff’s officers However, they noted crystal methamphetamine as the also seized the drug from the man’s home (www. most prevalent form of the drug. The powdered form of dailyadvocate.com, Oct. 18, 2017). Clarke County methamphetamine is typically referred to as “shake-and- Sheriff’s officers arrested a man after noticing a fire at a bake,” which means users produce the drug in a single- residence in Medway and seeing evidence consistent with sealed container, such as a two-liter soda bottle. By using methamphetamine manufacturing; officers found a trailer common household chemicals along with ammonium in the back of the residence with a methamphetamine nitrate (found in cold packs) and pseudoephedrine laboratory in it, as well as an infant child in the home, (found in some allergy medications), people who who had been exposed to the chemicals during the make methamphetamine can produce the drug in manufacturing process (www.nbc4i.com, Nov. 15, approximately 30 minutes in nearly any location. 2017). An Allen County Court of Common Pleas judge sentenced a man to five years in prison on felonious Community professionals also reported crystal charges of trafficking methamphetamine and ordered methamphetamine as the most prevalent form of the him to pay a fine to the West Central Ohio Drug Task drug in the region. Treatment providers commented: “You Force (www.limaohio.com, Nov. 15, 2017). An undercover [used to have] a lot of private makers around. I don’t think agent with the Delaware County Sheriff’s office arrested they’re doing that anymore. They busted a lot of them; They a teenager after she admitted to making regular trips describe it as the ‘good shit’ … the ‘Mexican shit’ (imported from Muncie, Indiana to Dayton, Ohio to purchase crystal methamphetamine).” Law enforcement stated: “It’s crystal methamphetamine to sell in Indiana; the officer all crystal; Crystal meth most likely coming across the border; reported to the news source that methamphetamine We have a lot of people attempting to make their own or are was becoming easier to find and more cases involved making their own, but in the last six months, it’s all coming methamphetamine than heroin (www.fox59.com, Nov. from Mexico through to us via Dayton … same avenue as 16, 2017). The Logan County Joint Task Force and the heroin … they’re going to Dayton and buying a stronger Champaign County Sheriff’s Office collaborated to arrest meth that originated in Mexico.” two men after a K-9 officer alerted to the presence of Participants and community professionals reported that drugs in their vehicle at a business in Urbana; officers the availability of methamphetamine has increased during found a large amount of methamphetamine in the the past six months. Participants reported: “It’s getting vehicle, and inside the business, the K-9 officer alerted to real big; I’ve seen more of that around than probably ‘dope’ additional methamphetamine; officers believed the men (heroin) or anything.” Treatment providers stated: “Meth delivered methamphetamine to the store clerk (www. is becoming more prevalent … people are experimenting oeakofohio.com, Nov. 17, 2017). The Auglaize and Mercer more with it; We know from the task forces from the other County Grand Lake Drug Task Force arrested five people communities that the cartels are bringing it up and almost responsible for trafficking methamphetamine in Auglaize doing like a Black Friday special on it … [giving] a real County (www.hometownstations.com, Nov. 22, 2017). A cheap discount on it.” Law enforcement discussed: “It’s woman was sentenced to 60 months of probation, 100 progressively increasing … we’re coming across it a lot more; hours of community services and charged a fine in Darke I think it’s just the cartels trucking it in, kilo after kilo; Also, I County Common Pleas Court for methamphetamine think the users keep seeing their friends dropping dead over trafficking and child endangermentwww.earlybirdpaper. ( fentanyl or carfentanil, and meth is … I guess in their mind, a com, Dec. 4, 2017). Springfield Police responded to a call of better substance to use. Also, the Vivitrol® shot is designed for a man passed out in his vehicle; officers found 136 grams heroin … with fentanyl they get sick if they use it … they use of crystal methamphetamine and other drugs in the man’s meth, they still get a high; The overdose rate I think has gone vehicle; the man was charged with drug trafficking in down a little bit. When we get the report, we used to have 13 Clarke County Municipal Court (www.wohio.com, Dec. 12, to 14 people overdose a day, and now we’re getting five … it’s 2017). just gone way down because they’re switching over to meth.”

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The BCI London and the Miami Valley Regional crime labs reported that the number of methamphetamine cases Current Prices for they process have increased during the past six months; Methamphetamine the labs reported processing blue, clear, pink and white Powdered: crystal methamphetamine as well as brown, tan and white powdered methamphetamine. 1/8 ounce $60 Reported Availability Crystal: Change during the Past 6 Months 1/10 gram $10-20 Participants Increase 1/2 gram $20-40

Law enforcement Increase Methamphetamine A gram $60-80 Treatment providers Increase Methamphetamine An ounce $400-600 Participants most often rated the quality of crystal methamphetamine as ‘7-10’ and of powdered Participants reported that the most common route methamphetamine as ‘3-4’ on a scale of ‘0’ (poor of administration for methamphetamine is smoking. quality, “garbage”) to ‘10’ (high quality); the previous Participants estimated that out of 10 methamphetamine most common scores were ‘8-9’ and ‘5-6,’ respectively. users, eight would smoke and two would snort or Participants discussed adulterants (aka “cuts”) that affect intravenously inject (aka “shoot”) the drug. Participants the quality of the drug and reported the following as commented: “I can tell you that people start off smoking it, cutting agents for methamphetamine: glass (fiber glass), and then end up shooting it … ‘cause they get the most out of isotol (dietary supplement), MSM (methylsulfonylmethane, it; It burns like hell if you snort it.” a joint supplement), rock candy, Epsom® salt and sugar. The BCI London Crime Lab reported dimethyl sulfone Participants and community professionals described (dietary supplement) as a cut for methamphetamine. typical methamphetamine users as white people, aged 20-40 years, as well as people who work labor intensive Overall, participants reported that the quality of jobs. In addition, law enforcement noted members methamphetamine has remained the same during the of motorcycle gangs as typical users. Participants past six months. However, a few participants discussed commented: “Probably white … 20-40 [years of age] really quality as decreasing. A participant stated, “A lot of people … and definitely probably work construction jobs and a lot get their hands on it … cut (adulterate) it up to make more of truckers and mechanics and stuff … truckers have to stay money and stretch it out … like the quality went down.” up longer and drive long distances and stuff; You see whites Current prices for methamphetamine were reported by more than black [using methamphetamine]; I would say participants with experience buying the drug. Participants more white than it is any [other group] … most black people in Montgomery County reported that the most common are still doing the crack … I think more white people do it amount of purchase for methamphetamine is between a around here. They say more Mexicans, but I haven’t been gram and 1/4 ounce, whereas participants in Champaign around enough Mexicans to do a study on it; With strippers it and Logan counties reported the most common amount used to be ‘coke’ (cocaine) and now its meth.” of purchase as 1/10 gram. Overall, participants reported Treatment providers stated: “It’s typically the younger that the price of methamphetamine has decreased during generation …18-25 [years of age]; I see more parents and the past six months. A participant remarked: “There’s a lot children doing meth together; I have yet to encounter a black more people figuring out how to make it and also there’s person use it.” Law enforcement reported: “It’s really popular a lot more competition.” However, another participant among your motorcycle gangs, and there’s several in this remarked, “It depends on where you are. If you’re in Dayton, area; Suppliers run the gamut from white, motorcycle gangs it’s really, really cheap, but if you’re in Greene County, it’s almost like $100 a gram ….”

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to black males and everything probably in between. White of methylphenidate (Ritalin®) cases has increased. The females are also supplying and dealing.” BCI London Crime Lab reported the opposite: increased number of amphetamine cases and decreased number of methylphenidate cases. Prescription Stimulants Reported Availability

Prescription stimulants remain moderately available for Change during the Past 6 Months illicit use in the region. Participants most often reported the current street availability of these drugs as ‘5’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly Participants No change available, extremely easy to get); the previous most common score was ‘4-5.’ A participant commented, “I Law enforcement No change Stimulants don’t think a lot of people are that much interested in them Prescription anymore.” Treatment providers No change

Treatment providers most often reported current street Reports of current street prices for prescription stimulants availability as ‘2’ and ‘8-10,’ while law enforcement most were consistent among participants with experience often reported it as ‘6;’ the previous most common buying these drugs. Reportedly, prescription stimulants scores were ‘4-5’ for treatment providers and ‘4’ for law typically sell for less than $1 per milligram. enforcement. Treatment providers who reported low

availability stated: “I think a lot of doctors are up on that and they’re not wanting to prescribe it; If they want the ‘speedy’ Current Street Prices for (stimulant) effect they’re either going to do crack, cocaine or Prescription Stimulants meth.” A treatment provider who reported high availability Adderall® $3 for 10 mg explained, “They’ll get it from their friends … and if they have siblings that have it, they will take it.” Law enforcement Stimulants Concerta®/Daytrana® $0.50 per milligram reported, “That’s usually popping up in drug screens along Prescription with other stuff … for a while it was heroin and some of that stuff, now it’s meth and [some prescription stimulants].” Participants reported obtaining prescription stimulants for illicit use from doctors, family members and friends. Participants identified Adderall® and Ritalin® as the most A participant stated, “If you know anyone that’s got ADHD available prescription stimulants in terms of widespread (attention-deficit hyperactivity disorder) or has ADHD kids, illicit use. A participant commented, “I see people selling then they’re gonna try and sell them.” The most common their Ritalin®, and most of them are for their kids … and route of administration for illicit use of prescription they’re selling them.” Community professionals identified stimulants are snorting and oral consumption. Participants Adderall® as most available. Treatment providers estimated that out of 10 illicit prescription stimulant users, discussed: “College students, they use it as a recreational five would snort and five would orally consume the drugs. [drug]; They also say it helps them to concentrate more while they study, and I think they tend to abuse it.” Participants described typical illicit prescription stimulant users as people who work third shift (factory workers and Participants and community professionals reported that nurses) and teens and college students. A participant the general street availability of prescription stimulants remarked, “People that worked third shift and stuff … they has remained the same during the past six months. A always wanted them to stay up.” A few law enforcement treatment provider reported, “I think coming into an officers described typical illicit users as younger people institution, they try to get prescribed it, but they’re not (late teens to early 20s). One law enforcement officer chasing it out there.” commented, “The clientele we’re seeing with this are 18- 22/23 [years of age] … they received a DUI or something, The Miami Valley Regional Crime Lab reported that the they get sent to us, and they’re testing positive for this.” number of amphetamine (Adderall®) cases it processes has decreased during the past six months, while the number

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Ecstasy The BCI London and the Miami Valley Regional crime labs reported that the number of MDMA (ecstasy/molly) cases Ecstasy (methylenedioxymethamphetamine: MDMA, or they process have increased during the past six months. other derivatives containing BZP, MDA, and/or TFMPP) remains available in the region. Participants most often Reported Availability reported the current availability of the pressed tablet Change during the Past 6 Months form of ecstasy as ‘4’ and of “molly” (powdered MDMA) as ‘1-2’on a scale of ‘0’ (not available, impossible to get) to Participants Decrease ‘10’ (highly available, extremely easy to get); the previous

most common scores were ‘5-6’ and ‘1-3,’ respectively. Ecstasy Law enforcement No change Participants reported: “I ain’t heard nobody say I’ve got an ‘X’ (ecstasy) pill in six months, or I ain’t heard no wild and Treatment providers No change crazy stories, like ‘Oh man, we had a rock star night and took ‘X;’ I think a lot of the other drugs are taking over. Nobody Reported Availability really does it anymore; It’s not really a drug of choice.” Change during the Past 6 Months Treatment providers most often reported the current Participants Decrease availability of ecstasy as ‘10,’ while law enforcement most often reported it as ‘3-4;’ the previous most common Molly Law enforcement Increase scores were ‘0-1’ and ‘5-6,’ respectively. Law enforcement did not assign a current availability rating for molly, while Treatment providers No change treatment providers most often reported the current availability of molly as ‘5-8;’ previous most common Participants did not have knowledge of the current quality scores were not reported for molly. Regarding ecstasy, a of ecstasy and molly during the past six months; the treatment provider stated, “It’s a party drug and it’s just easy previous most common quality scores were ‘10’ for both to get.” Regarding molly, treatment providers commented: ecstasy and molly on a scale of ‘0’ (poor quality, “garbage”) “I think that’s on top of the list for certain populations; ‘Cause to ‘10’ (high quality). However, a few participants in one they came out with that song [referencing the rap song, focus group discussed molly “cut” (adulterated) with ‘Molly’].” Law enforcement stated: “I’d say ‘X’ here lately has powdered cocaine and heroin. A participant stated, “Just been with the ‘weed guys’ (marijuana users) … it’s a niche … after you use it, you kinda figure out [what was in it].” We’ve had a bunch of them come through the mail; The thing is, people aren’t ‘knocking over’ (robbing) drug stores to fund Reports of current prices for ecstasy and molly were their habit for MDMA. They’re doing it for heroin or fentanyl consistent among participants with experience buying … that’s what our concentration is.” the drugs. Overall, participants reported that the prices of ecstasy and molly have remained the same during the Participants reported that the availability of ecstasy past six months. and molly has decreased during the past six months. A participant commented, “I think ‘X’ has dropped off Current Prices for … molly, too.” Treatment providers reported that the Ecstasy/Molly availability of ecstasy and molly has remained the same during the past six months. A treatment provider Ecstasy: stated, “I think that it’s just been out there … there’s other Low dose (aka “single stack”) $10 things that people have been doing ….” Law enforcement reported that the availability of ecstasy has remained Medium dose (aka “double stack”) $20 the same, while the availability of molly has increased. High dose (aka “triple stack”) $25-30 Regarding ecstasy, a law enforcement officer commented, Molly: “I would guess stayed the same. It’s not something we run Ecstasy/Molly into a lot.” Regarding molly, law enforcement reported: 1/10 gram $10 “We’ve see more of it … but that’s because we’ve started A gram $80-100 doing (searching and seizing) packages more; Mostly that is shipped in through the mail … and we’ve just recently started to see them a little more.”

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Participants indicated that ecstasy and molly are obtained Reported Availability through drug dealers, at “raves” (dance parties) and by

Change during the Past 6 Months making the drugs themselves by ordering supplies through the Internet. Participants reported that the most common route of administration for ecstasy and molly remains oral Participants Increase consumption. Participants estimated that out of 10 ecstasy and molly users, all 10 would orally consume the drugs. Law enforcement No comment Synthetic Marijuana Participants described typical ecstasy and molly users as Treatment providers No change teens to 30-year olds who are involved in the party scene. A participant remarked, “It’s like a party drug.” Community professionals described typical ecstasy and molly users as Reports of current prices for synthetic marijuana were teens to 20-year olds, white people and people involved consistent among participants with experience buying the in the party scene. Treatment providers commented: “It’s drug. being promoted in music, on TV, in the streets; I think when it

comes to the psychedelics, there’s more of a demand for it in Current Prices for the white population.” A law enforcement officer observed, Synthetic Marijuana “Young, white, party crowd.” A blunt (cigar) $2 Synthetic Synthetic Marijuana Marijuana An 8-gram bag $30

Synthetic marijuana (synthetic cannabinoids) remains Despite legislation enacted in October 2011, participants available in the region. Participants most often reported the and treatment providers reported obtaining synthetic current availability of synthetic marijuana as ‘8’ on a scale of marijuana at gas stations, head shops and through Internet ‘0’ (not available, impossible to get) to ‘10’ (highly available, purchase. Participants reported that the most common extremely easy to get); a previous most common score route of administration for synthetic marijuana is smoking. was not reported. Participants commented: “People want it, Participants estimated that out of 10 synthetic marijuana so people find a way to get it … supply and demand. There’s users, all 10 would smoke the drug. Participants described a market there; It’s in [Hardin County] real bad.” Treatment typical synthetic marijuana users as people on probation, providers most often reported current availability as ‘3’ parole, or in prison, and people aged 20-30 years. Both and ‘10;’ a previous most common score was not reported. participants and treatment providers reported users often A treatment provider who reported high availability report use of the drug because of their belief that its use is stated, “You can go to the store and buy it because it’s on the legal. end of the register.” A treatment provider who reported low availability commented, “I think it’s [low] because of marijuana being so easy to obtain.”

Participants reported that the availability of synthetic Other Drugs in the Dayton Region marijuana has increased during the past six months, while treatment providers reported that it has remained the same. A participant stated, “It’s still here, and they still sell it … Participants and community professionals listed a variety of you just gotta know [the drug dealers].” A treatment provider other drugs as being present in the region, but these drugs remarked: “There are still shops that sell it … it’s pretty easy were not mentioned by the majority of people interviewed: for people to get … and [users are] ordering it online.” The BCI bath salts (synthetic cathinones), hallucinogens London and the Miami Valley Regional crime labs reported (dimethyltryptamine [DMT], lysergic acid diethylamide that the number of synthetic marijuana cases they process [LSD] and psilocybin mushrooms), inhalants, ketamine, have decreased during the past six months. Neurontin® (gabapentin), promethazine (prescription- strength cough syrup) and Seroquel® (antipsychotic).

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In addition, secondary data sources reported other drugs too difficult for them to find.” One law enforcement officer not mentioned by respondents. The BCI London Crime Lab remarked, “On some of our controlled [buys] we’ve had LSD, reported it processed 21 cases of ketamine (an anesthetic too.” Treatment providers most often reported the current typically used in veterinary medicine) and 44 cases of availability of psilocybin mushrooms as ‘0’ and ‘8,’ while law U-47700 (synthetic opioid) during the past six months. enforcement most often reported it as ‘5;’ the previous most common scores were not reported among community professionals for psilocybin mushrooms or for DMT. Bath Salts Media outlets reported on law enforcement seizures and Bath salts (synthetic cathinones; compounds containing arrests in the region this reporting period. Union City Police methylone, mephedrone, MDPV or other chemical (Darke County) arrested a Columbus woman in October analogues, including alpha-PVP, aka “flakka”) remain after finding her with LSD; the woman was charged with available in the region. However, only a few treatment felonious drug traffickingwww.dailyadvocate.com ( , Oct. 31, providers reported on bath salts. These treatment providers 2017). most often reported the drug’s current availability as ‘2,’ ‘3’ and ‘5’ on a scale of ‘0’ (not available, impossible to get) Participants and community professionals reported the to ‘10’ (highly available, extremely easy to get); a previous availability of LSD has remained the same during the past most common score was not reported. A treatment six months. Participants reported that the availability of provider stated, “I’ve only had two people report doing DMT and psilocybin mushrooms has increased during the it, and only one said she was actively doing it.” Treatment past six months, while community professionals reported providers reported that the availability of bath salts has that the availability of psilocybin mushrooms has remained decreased during the past six months. Treatment providers the same; they had no comment on a change of availability described typical bath salts users as aged 18-30 years and for DMT. A participant commented, “More people are figuring white people. The BCI London Crime Lab reported that out how to grow them (psilocybin mushrooms).” the number of bath salts cases it processes has increased The Miami Valley Regional Crime Lab reported that the during the past six months; the Miami Valley Regional number of LSD cases it processes has increased during the Crime Lab reported that it did not process any bath salts past six months, while the number of psilocybin mushroom cases during the past six months. and DMT cases it processes have decreased or remained the same, with very few cases of each. The BCI London Crime Lab reported that the number of psilocybin mushroom Hallucinogens cases it processes has increased, while the number of LSD and DMT cases have decreased or remained the same. Hallucinogens remain available in the region. Participants most often reported current availability as ‘4’ and ‘8’ for Reports of current prices for hallucinogens varied among DMT, ‘3’ and ‘8’ for LSD, and ‘2-3’ for psilocybin mushrooms participants with experience buying the drugs. Regarding on a scale of ‘0’ (not available, impossible to get) to ‘10’ LSD, a participant commented, “If you buy in bulk, you get (highly available, extremely easy to get); the previous deals.” most common score was ‘10’ for LSD, with no previous most common scores reported for DMT and psilocybin mushrooms. Regarding DMT, participants discussed: “You can get all that stuff off the Internet; I mean if you want it, you can get it!” Regarding LSD, participants stated: “You don’t just buy it from anybody; I don’t hear about it much.” Regarding psilocybin mushrooms, a participant remarked, “I haven’t heard about mushrooms since I was a teenager.” Treatment providers most often reported the current availability of LSD as ‘9,’ while law enforcement most often reported it as ‘5;’ the previous most common scores among community professionals were not reported. A treatment provider stated, “My youth [clients] are using it, so it can’t be

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Current Prices for Inhalants Hallucinogens Inhalants (duster [DFE] and nitrous oxide [N2O], aka “whippets”) are available in the region. Participants Psilocybin mushrooms: reported the current availability of whippets as ‘10’ on a 1/8 ounce $30-35 scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); a previous most common 1/4 ounce $50-70 score was not reported. A participant stated, “You could always get that! They have it everywhere. I mean they sell them LSD: at the sex shop (adult store). You buy little things (canisters) … A liquid drop or a single dose (aka “hit”) $5-10 like they sell a whole entire kit.” Reportedly, a can of N2O sells for $45 at adult stores, and a can of air duster sells for $5 at Hallucinogens 10 hits (aka “strip”) $50-75 big box stores. 100 doses (aka “sheet”) $300-500 Ketamine A vile of liquid LSD (unspecified dose) $500 Ketamine (an anesthetic typically used in veterinary Participants reported obtaining hallucinogens through medicine) is available for illicit use in the region. However, drug dealers, friends, at concerts or by producing the drugs only a few treatment providers reported on the current themselves. Regarding psilocybin mushrooms, participants availability of the drug for illicit use. They reported it as ‘2’ on stated: “They’re lab grown; You can buy kits off the Internet a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly nowadays [to grow them].” available, extremely easy to get); a previous most common score was not reported. A treatment provider stated, “I Participants reported that the most common route would say [availability is] pretty low because we don’t hear of administration for psilocybin mushrooms is oral about it too often.” Treatment providers reported typical consumption. Participants indicated that out of 10 ketamine users as young males. psilocybin users, all 10 would eat or consume the substance in beverages. Participants reported drinking psilocybin Neurontin® mushrooms by mixing them into teas, or eating them by mixing them with chocolate, peanut butter or putting them Neurontin® (gabapentin, an anticonvulsant and in sandwiches. A participant commented, “I put them on a nerve pain medication) is highly available for peanut butter sandwich or something to take that nasty taste illicit use in the region. Participants most often out of them.” reported the current street availability of the Participants described typical hallucinogen users as high- drug as ‘10’ on a scale of ‘0’ (not available, school aged to 25 years and “partiers.” Participants stated: impossible to get) to ‘10’ (highly available, extremely easy to “The psychedelics (hallucinogens) are more like an experience get); a previous most common score was not reported. type of drug; It’s more of a party-goer scene.” Community Participants stated: “They’re easily prescribed; Doctors haven’t professionals described typical hallucinogen users as been prescribing some narcotics as much and they’re white people, hippies and college students. A treatment prescribing those instead; I go to this outpatient program and provider stated, “My kids (clients) talk about wanting to everybody tries to get it prescribed … and justify their ‘trip’ (experience the hallucinogenic high) because they hear addiction by saying it’s not heroin or whatever. They say they’re such great things about the trip .… It’s also in the marijuana sober, but they eat like 20 of them things a day.” at times, so they’re trying it without realizing they’re trying Treatment providers most often reported the current street it … I have several [clients], early 20s, who talk about using availability of Neurontin® as ‘8,’ while law enforcement most it because they want that spiritual experience ….” Law often reported it as ‘2;’ no previous most common scores enforcement stated, “The white, hippy group … the same were reported. Treatment providers discussed: “You can ones who use the ‘dabs’ (concentrated marijuana).” easily get a prescription … anybody can; It’s a drug addict’s drug; A lot of people start taking it to get off heroin because it really helps with the withdrawals … when you take too much, you get the high feeling ….”

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Participants and community professionals reported that Promethazine the street availability of Neurontin® has increased during the past six months. A participant remarked, “People found Promethazine (prescription-strength cough syrup with out that it helps with withdrawals so more people take it.” A codeine, aka “lean” when mixed with soda) is highly treatment provider stated, “It’s increased from what I’ve seen available for illicit use in the region. Participants and … a lot of our clients here in residential treatment are not treatment providers most often reported the current abusing it, but a lot of mental health clients are abusing it.” A street availability of promethazine as ‘10’ on a scale of ‘0’ law enforcement officer explained,It “ went from nothing (‘0’ (not available, impossible to get) to ‘10’ (highly available, on the availability scale) to ‘2’ because I hadn’t really heard extremely easy to get); a previous most common score about it until a few months back ….” was not reported. A participant reported, “I say a ‘10’ for me because when I was doing my thing, I always knew people Reported Availability who had ‘scripts’ (prescriptions for promethazine) … so, I

® Change during the Past 6 Months bought stuff in bulk … I could get it every day ….” However, participants generally reported that the current street Participants Increase availability of promethazine has decreased during the past six months, while treatment providers reported that Law enforcement Increase it has remained the same. A participant commented, “Here recently, I think it’s went down … before I could find it all the Neurontin Treatment providers Increase time ….” Prices for promethazine varied among participants with Reports of current street prices were consistent among experience purchasing the drug. Reportedly, three ounces participants with experience buying the drug. of promethazine sells for $30. Overall, participants indicated that the price of promethazine has remained the same Current Street Prices for during the past six months. ® Neurontin® Participants reported that promethazine is most often 300 mg $0.25-0.50 consumed by drinking the drug mixed in sodas. A participant remarked, “You gotta mix it with Pepsi® or root 600 mg $0.50-0.75 beer.” Participants reported that when the red-colored promethazine is mixed with Sprite®, it is called a “Sprite® Neurontin 800 mg $0.75 remix.” One participant reported cutting (adulterating) the drug with other prescription drugs: “You might crush up a Participants reported obtaining Neurontin® for illicit use couple Xanax® or crush up a ‘roxi’ (Roxicodone®).” from drug dealers and doctors. A participant commented, Participants described typical illicit promethazine users “Usually a doctor. Any doctor will give you Neurontin®.” as aged 20-40 years. A participant remarked, “‘Cause at 40 Participants reported that the most common route [years of age] your heart might not be able to take it. It might of administration for illicit use of Neurontin® is oral slow down.” Treatment providers reported typical illicit users consumption. Participants estimated that out of 10 illicit as younger and African-American people. Neurontin® users, all 10 would orally consume the drug. A few participants also commented on snorting the drug. A participant stated, “You could actually snort them if you Seroquel® wanted to.” Seroquel® (antipsychotic) is available for illicit use in the Participants described typical illicit Neurontin® users as region. However, only a few treatment providers reported people addicted to opiates. A participant stated, “Usually, on the current street availability of the drug during the recovering heroin addicts try to replace one thing with past six months. These providers most often reported the another.” Treatment providers described typical illicit users current street availability of Seroquel® as ‘8’ on a scale of ‘0’ as white people, aged 20-50 years, people addicted to (not available, impossible to get) to ‘10’ (highly available, opiates and alcoholics. extremely easy to get); a previous most common score was

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not reported. Treatment providers stated: “Oh, it’s candy Participants reported gray, pink, white and yellow colored here; It’s prescribed a lot; You can get your psychiatrist to fentanyl. Participants discussed fentanyl as an adulterant (aka prescribe it, you can get your MD (medical doctor) to prescribe “cut”) for other drugs (e.g. cocaine). In fact, they reported that it … ER (emergency room) will prescribe it.” fentanyl is most often mixed with other drugs; thus, for those seeking fentanyl, they often get it in combination with other Treatment providers reported that the street availability drugs. Participants described typical fentanyl users as heroin of Seroquel® has remained the same during the past six users, aged teens to 30 years and white people. In addition to months. Treatment providers described a typical illicit Seroquel® user as cocaine users and people in jail. A fentanyl, participants also reported current high availability treatment provider stated, “I know a few of the guys … doing of carfentanil and fentanyl analogues. it … they don’t have anything (other drugs), so they’re stealing Participants and community professionals reported that their girlfriend’s [medication] ….” the high availability of methamphetamine has increased during the past six months. Participants discussed heroin users switching to methamphetamine as a way to detox from heroin as methamphetamine is believed to be “safer” than opiates. Likewise, law enforcement indicated some heroin Conclusion users have switched to methamphetamine use possibly out of fear of opiate overdose. Additionally, some users discussed coupling their heroin use with methamphetamine use. One Crack cocaine, heroin, marijuana and methamphetamine participant stated, “Meth’s been a life saver for me … I mix it remain highly available in the Dayton region; also highly with my heroin and I won’t ‘OD’ (overdose).” Participants and available are fentanyl, Neurontin® (gabapentin), prescription treatment providers also discussed users receiving Vivitrol® opioids and Suboxone®. Changes in availability during the as medication assisted treatment for opioid use disorder past six months include: increased availability for fentanyl, continuing to get high with methamphetamine. methamphetamine and Neurontin®; likely increased availability for marijuana; and possible increased availability Participants reported that methamphetamine is available for Suboxone®. in crystal and powdered forms throughout the region. However, they noted crystal methamphetamine as the Although participants and community professionals most prevalent form of the drug. In addition to heroin users, reported high current availability of heroin, respondents participants and community professionals described typical across focus groups discussed that heroin is not “heroin,” but methamphetamine users as white people, aged 20-40 years rather heroin mixed with fentanyl. Participants explained and people who work labor intensive jobs. Law enforcement heroin unadulterated with fentanyl or carfentanil is nearly also noted members of motorcycle gangs as typical users. unavailable in the region. They, along with community professionals, noted users now desiring fentanyl and Neurontin® is highly available for illicit use in the region, and carfentanil over heroin; many seek the synthetic opioids. participants and community professionals reported that its street availability has increased during the past six months. Fentanyl is extremely available in the region. Law Reportedly, typical illicit Neurontin® users are those addicted enforcement reported that drug cartels have flooded to opiates who use the drug to alleviate opiate withdrawal the region with the drug. They also noted that fentanyl symptoms. is purchased online from overseas vendors, primarily in China, and mailed to addresses in the region. Participants Lastly, the BCI London Crime Lab reported it processed 21 and community professionals attributed the increase cases of ketamine (an anesthetic typically used in veterinary in availability of fentanyl during the past six months to medicine) and 44 cases of U-47700 (synthetic opioid) during increased demand for the drug. They discussed that fentanyl the past six months. provides a “better” (more potent) high than heroin and at a cheaper price. Both respondent types also discussed a higher frequency in overdose in the region as indicative of a higher supply of fentanyl.

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Drug Abuse Trends in the Toledo Region

Data Sources for the Toledo Region

This regional report was based upon qualitative data collected via focus group interviews. Participants were active and recovering drug users recruited from alcohol and other drug treatment programs in Fulton and Lucas counties. Data triangulation was achieved through comparison of participant data to qualitative data collected from regional community Regional Epidemiologist: professionals (treatment providers and law enforcement) via focus group interviews, as well as to data surveyed from the Ohio Bureau of Criminal Celia Williamson, PhD Investigation (BCI) Bowling Green Crime Lab, the Hancock County Probate and Juvenile Court, OhioMHAS’ Screening, Brief Intervention and Referral for Treatment (SBIRT) program which operates in federally qualified health OSAM Staff: centers in the region, and the Ohio Department of Public Safety (ODPS), R. Thomas Sherba, PhD, MPH, LPCC which logs drug task force seizures from across the Ohio. All secondary data are summary data of cases processed from January through June OSAM Principal Investigator 2017. In addition to these data sources, Ohio media outlets were queried for information regarding regional drug abuse for July through December Kathryn A. Coxe, MSW, LSW 2017. OSAM Coordinator Note: OSAM participants were asked to report on drug use/knowledge Jessica Linley, PhD, MSW, LSW pertaining to the past six months prior to the interview; thus, current OSAM Quantitative Data Analyst secondary data correspond to the reporting period of participants.

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Regional Profile Indicator1 Ohio Toledo Region OSAM Drug Consumers Total Population, 2016 11,614,373 1,217,072 40 Gender (female), 2016 51.0% 50.9% 62.5% Whites, 2016 82.5% 87.6% 84.6% 2 African Americans, 2016 12.8% 8.7% 2.6% Hispanic or Latino Origin, 2016 3.7% 6.2% 12.5% High School Graduation Rate, 2012-16 89.5% 90.4% 89.4%3 Median Household Income, 2012-16 $50,674 $51,238 $20,000-$24,9994 Persons Below Poverty Level, 2016 14.6% 13.9% 47.4%5

1 Ohio and Toledo region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018. 2 Race was unable to be determined for 1 participant due to missing and/or invalid data. 3 High school graduation status was unable to be determined for 1 participant due to missing and/or invalid data 4 Participants reported income by selecting a category that best represented their household’s approximate income for the previous year. Income was unable to be determined for 2 participants due to missing and/or invalid data. 5 Poverty status was unable to be determined for 2 participants due to missing and/or invalid data

Toledo Regional Participant Characteristics

Consumer Characteristics N=40* Male 15 Female 25 Gender < 20 2 20s 21

Age 30s 12 40s 5 Less than high school graduate 4 High school graduate 16

Education Some college or associate's degree 19 < $12,000 12 $12,000 to $19,999 7 $20,000 to $28,999 2 $29,000 to $36,999 4 ≥ $37,000 13 Household Income Alcohol 26 Cocaine, Crack 23 Cocaine, Powdered 21 Ecstasy/Molly 4 Heroin/Fentanyl 22 Marijuana 28 Methampehtamine 16

Drugs Used** Prescription Opioids 16 Prescription Stimulants 10 Sedative-Hypnotics 20 Suboxone®/Subutex® 15 Other Drugs*** 6

0 5 10 15 20 25 30 Number of Participants

*Not all participants filled out forms completely; therefore, numbers may not equal 40. **Some respondents reported multiple drugs of use during the past six months. ***Other drugs included: ketamine, Lyrica® (pregabalin), lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), psilocybin mushrooms and synthetic marijuana.

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the region, although they reported powdered methamphetamine (aka “shake-and-bake”) as the most Historical Summary prevalent form of the drug. Community professionals reported that the availability In the previous reporting period (January - June 2018), of methamphetamine increased during the reporting crack cocaine, heroin, marijuana, methamphetamine, period. The BCI Bowling Green Crime Lab reported that powdered cocaine, sedative-hypnotics and Suboxone® the number of methamphetamine cases it processes remained highly available in the Toledo region. Changes in increased; the lab reported having processed crystal as availability during the past six months included: possible well as brown and white powdered methamphetamine. increased availability for methamphetamine and synthetic Participants described typical methamphetamine users marijuana; and decreased availability for prescription as white people, people of lower socio-economic status opioids. and people who use stimulants. Community professionals described typical users as rural white people and people While many types of heroin were available in the living in poverty. region, both participants and community professionals reported white powdered heroin (aka “china white”) as Lastly, participants reported that the availability of most available. Reportedly, brown, gray, purple and tan synthetic marijuana increased during the reporting period. powdered heroin were also available in the region. The Several participants suggested that this increase was BCI Bowling Green Crime Lab reported it processed beige, due to a surge in availability and use of the drug in north brown and tan powdered, as well as black tar heroin Toledo. The BCI Bowling Green Crime Lab reported that during the reporting period. In addition, the lab reported the number of synthetic marijuana cases it processes had that the number of carfentanil, fentanyl and fentanyl increased during the past six months. analogue cases it processes increased during the reporting Participants with experience using synthetic marijuana period. reported fear of adverse effects from the drug. Participants Participants discussed adulterants (aka “cuts”) that affect and law enforcement discussed several overdoses in the the quality of heroin and reported that the top cutting region during the reporting period which they attributed agent was fentanyl. Participants explained that fentanyl to synthetic marijuana. In addition, media outlets reported gave heroin potency, and without fentanyl, heroin would that two inmates of a correctional facility in Williams be “garbage.” Regarding fentanyl as a cutting agent, County overdosed after smoking synthetic marijuana in participants reported that fentanyl was also used to cut a bathroom. Participants described typical users of the cocaine, relaying that cocaine users were overdosing drug as high-school students, African-American males, due to fentanyl. A few participants shared that they had individuals who were drug tested and individuals on overdosed on fentanyl, while community professionals probation. noted a dramatic increase in overdoses during the reporting period. While there were a few reported ways of using heroin, generally, the most common route of administration remained intravenous injection (aka “shooting”). Current Trends Participants reported that injection needles were most available from people with diabetes, drug dealers, pharmacies and big box stores. Reportedly, needles on the street sold for $2-5 per needle. Participants indicated that Powdered Cocaine sharing needles for injection was a common practice. Methamphetamine remained highly available in the Powdered cocaine remains highly available in the region. region; however, participants continued to report high Participants most often reported the drug’s current availability in rural areas and low availability in urban availability as ‘8’ on a scale of ‘0’ (not available, impossible areas. Participants indicated that methamphetamine to get) to ‘10’ (highly available, extremely easy to get); the was available in powdered and crystal forms throughout previous most common score was ‘10.’ A participant stated,

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“You can find it … druggies like to network.” Community Participants and community professionals reported that professionals most often reported current availability the availability of powdered cocaine has remained the as ‘10;’ the previous most common scores were ‘8-10’ same during the past six months. One law enforcement for treatment providers and ‘5’ for law enforcement. A officer responded,There “ haven’t been any trends around treatment provider commented, “The availability is really here of people doing it any more or less.” The BCI Bowling high.” A law enforcement officer shared,They “ can get it Green Crime Lab reported that the number of cocaine fairly easily.” cases it processes has decreased during the past six months; the lab does not differentiate between powdered Corroborating data indicated that powdered cocaine is and crack cocaine. available in the region. The Screening, Brief Intervention and Referral for Treatment (SBIRT) program reported that Reported Availability

of the 200 individuals in the Toledo region who reported Change during the Past 6 Months substance use during the past 30 days, 8.5% reported using cocaine on one or more days (SBIRT does not Participants No change distinguish between powdered and crack cocaine). The Hancock County Probate Court reported that of the 70 adult drug screenings it completed during the past six Cocaine Law enforcement No change Powdered months, 48.1% were positive for powdered and/or crack Treatment providers No change cocaine. In addition, the Ohio Department of Public Safety (ODPS) reported 39 drug task force seizures of powdered cocaine in the Toledo region during the reporting period. Participants most often rated the current overall quality of powdered cocaine as ‘10’ on a scale of ‘0’ (poor quality, Media outlets reported on law enforcement seizures “garbage”) to ‘10’ (high quality); the previous most and arrests in the region this reporting period. Sandusky common score was ‘5.’ However, participants reported County Sheriff’s officers arrested a man while executing that the quality of powdered cocaine varies depending a search warrant at a hotel in Fremont and seizing 18 on the dealer of the drug. One participant reported, “It grams of suspected cocaine (www.thenews-messenger. just depends. Sometimes it’s good quality, sometimes it’s com, Sept. 11, 2017). Ohio State Highway Patrol (OSHP) really ‘cut’ (adulterated) and it’s awful. It varies by who you’re in Sandusky County arrested two people from Michigan getting it from.” Participants reported that the top cutting during a traffic stop on the Ohio Turnpike after the smell agents (adulterants) for powdered cocaine are baby of marijuana prompted officers to search their vehicle; laxatives and baking soda. Other adulterates mentioned officers confiscated 60 grams of powdered cocaine included: baby aspirin, Benefiber®, calcium, creatine, MSG compressed into a baseball sized bundle and 11 grams of (monosodium glutamate), MSM (methylsulfonylmethane, crack cocaine (www.statepatrol.ohio.gov, Sept. 12, 2017). a joint supplement), protein powder and Similac®. Overall, Erie County Sheriff’s officers arrested two people after participants reported that the quality of powdered cocaine executing a search warrant at a residence in Sandusky and has remained the same during the past six months. seizing 25 grams of cocaine; the investigation stemmed from one of the men reporting to police that two of his Cutting Agents firearms were missing, and police obtained warrants to Reported by Crime Lab search the home; in addition to drug possession, the man was also charged with having weapons under disability l local anesthetics (benzocaine, lidocaine (www.sanduskyregister.com, Sept. 22, 2017). The U.S. Drug and procaine) Enforcement Agency (DEA) in Toledo, the Ohio Bureau Cocaine l pet and livestock dewormers (levamisole Powdered Powdered of Criminal Investigation and Identification (BCI) and the and tetramisole) Sandusky County Sheriff’s Office collaborated to arrest a Fremont woman for trafficking cocaine; the woman was sentenced to three years in prison (www.thenews- messenger.com, Nov. 22, 2017).

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Reports of current prices for powdered cocaine were get); the previous most common score was also ‘10’. consistent among participants with experience buying the One participant remarked, “It’s very get-able.” Another drug. Reportedly, the most common quantity of purchase participant commented, “Crack is everywhere.” Community is a gram. When asked about purchasing less than a gram professionals most often reported the current availability amount, one participant reported, “They don’t really sell of crack cocaine as ‘10’; the previous most common scores it in [smaller amounts] … usually, it’s half grams, grams.” were ‘9’ for treatment providers and ‘7’ for law enforcement. Another participant remarked: “It’s really expensive … One law enforcement officer stated,If “ you can get powder especially if you’re getting anything good … crack [cocaine cocaine, you can get crack.” is] way cheaper, so people usually go that route.” Although, Corroborating data indicated that crack cocaine is available a participant shared, “Sometimes the more you buy, the in the region. The SBIRT program reported that of the 200 cheaper they cost … because you’re buying in bulk.” Overall, individuals in the Toledo region who reported substance participants reported that the price of powdered cocaine use during the past 30 days, 8.5% reported using has remained the same during the past six months. cocaine on one or more days (SBIRT does not distinguish between crack and powdered cocaine). The Hancock

Current Prices for County Probate Court reported that of the 70 adult drug Powdered Cocaine screenings it completed during the past six months, 48.1% were positive for crack and/or powdered cocaine. 1/2 gram $35 In addition, ODPS reported 26 drug task force seizures of A gram $60 crack cocaine in the Toledo region during the reporting Cocaine

Powdered Powdered period. 1/8 ounce (aka “eight ball”) $200 Media outlets reported on law enforcement seizures and arrests in the region this reporting period. Drug task forces Participants reported that the most common route of in Hancock and Wood counties collaborated in executing administration for powdered cocaine remains snorting. a search warrant at a residence in McComb (Hancock Participants estimated that out of 10 powdered County) and arrested a man after seizing unspecified cocaine users, eight would snort and two would “shoot” amounts of crack cocaine and drug paraphernalia (www. (intravenously inject) the drug. A participant remarked, thecourier.com, Aug. 25, 2017). Drug task forces in “I’d shoot mine.” However, the majority of those with Sandusky and Ottawa counties collaborated in executing experience using powdered cocaine reported that they a search warrant at a residence in Fremont (Sandusky would snort the drug. County) and arrested a man after seizing two ounces Participants described typical powdered cocaine users as of crack cocaine, 200 ecstasy tablets, two ounces of people of high socio-economic status. They commented: marijuana, cash and drug paraphernalia (www.thenews- “Upper-class; You probably have to have a job to be able to messenger.com, Sept. 15, 2017). An investigation lead afford a good amount of cocaine … unless you’re a drug by Toledo Police (Lucas County) and the Federal Bureau dealer ….” In addition, a participant observed typical users of Investigations (FBI) resulted in the indictment of two as: “white people with money.” Community professionals individuals for possessing and intending to distribute 10 described typical powdered cocaine users as across the grams of crack cocaine; during the arrests, officers also board, meaning all types of people. One law enforcement confiscated over 14 firearmswww.13abc.com ( , Sept. 29, officer remarked,It “ is everyone.” 2017). Tiffin Police (Seneca County) arrested three people while investigating a report of a home invasion in Tiffin; officers searched the residence and found crack cocaine, Crack Cocaine marijuana and drug paraphernalia (www.wtol.com, Nov. 29, 2017). Crack cocaine remains highly available in the region. Both participants and community professionals reported Participants most often reported the drug’s current that the availability of crack cocaine has remained the availability as ‘10’ on a scale of ‘0’ (not available, impossible same during the past six months. Participants explained to get) to ‘10’ (highly available, extremely easy to that availability of crack cocaine remains high: “It’s cheap.

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You need it … once you’re on it, you feel the need for it; The deal when you buy more, you know, so I always prefer to buy high doesn’t last long … you always want more.” The BCI by the gram or more.” Overall, participants reported that the Bowling Green Crime Lab reported that the number of price of crack cocaine has remained the same during the cocaine cases it processes has decreased during the past past six months. six months; the lab does not differentiate between crack and powdered cocaine. Current Prices for

Crack Cocaine Reported Availability Change during the Past 6 Months 1/10 gram (aka “rock”) $10-20

Crack Crack

Cocaine A gram $70 Participants No change 1/8 ounce (aka “eight ball”) $120 Crack

Cocaine Law enforcement No change Participants reported that the most common route of Treatment providers No change administration for crack cocaine is smoking. Participants estimated that out of 10 crack cocaine users, eight would smoke and two would “shoot” (intravenously inject) the drug. Participants most often rated the current overall quality of One participant reported, “Depends on your choice. I mean crack cocaine as ‘7’ on a scale of ‘0’ (poor quality, “garbage”) sometimes they’ll shoot ….” In order to intravenously inject to ‘10’ (high quality); the previous most common score the drug, one participant explained, “You break it down with was also ‘7.’ However, one participant reported, “You know anything acidic.” it’s varied. And it depends on how much they cook it … how much baking soda they throw in there with it.” Most A profile of a typical crack cocaine user did not emerge participants with experience with the drug supported from the data. Participants described typical users as every the sentiment that the current quality of crack cocaine race, both male and female. Additionally, one participant is generally “really good.” Participants reported that crack explained that if users weren’t poor before using crack cocaine in the region is most often adulterated (aka “cut”) cocaine, crack cocaine use will cause people to spend all with baking soda. In addition, a participant reported, “I of their money and have to resort to committing crime. think there might have been amphetamines in some of the He remarked, “They’ve spent all their money, so now they’re crack I’ve gotten ….” Overall, participants reported that the out robbing people.” Community professionals described quality of crack cocaine has remained the same during the typical crack cocaine users as from all walks of life. past six months. Heroin Cutting Agents

Reported by Crime Lab Heroin remains highly available in the region. Participants l local anesthetics (benzocaine, lidocaine and community professionals most often reported the current availability of the drug as ‘10’ on a scale of ‘0’ Crack Crack and procaine) Cocaine l pet and livestock dewormers (levamisole (not available, impossible to get) to ‘10’ (highly available, and tetramisole) extremely easy to get); the previous most common scores were also ‘10.’ One law enforcement officer remarked,It’s “ Reports of current prices for crack cocaine were consistent around here everywhere…. It’s easily available no matter among participants with experience buying the drug. where you go.” Reportedly, the most common quantity of purchase is Corroborating data indicated that heroin is available in a $10-20 “rock” (piece of crack cocaine). One participant the region. The SBIRT program reported that of the 200 commented, “It just depends on where you buy it. Like this individuals in the Toledo region who reported substance area, they’ll sell ‘dimes’ ($10 amounts) a lot, but on the east use during the past 30 days, 10.0% reported using heroin side, you usually can’t get less than a ‘twenty’ ($20 amount).” on one or more days. In addition, ODPS reported 61 drug However, another participant commented, “You get a better task force seizures of heroin and/or fentanyl in the Toledo

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region during the reporting period; drug task forces did later found additional marijuana, cash, drug paraphernalia not typically differentiate between heroin and fentanyl and criminal tools in another residence, arresting two due to the high incidence of heroin-fentanyl mixtures. woman (www.wtol.com, Sept. 7, 2017). OSHP in Wood County arrested two Chicago men during a traffic stop on Media outlets reported on law enforcement seizures Interstate 80 after criminal indicators prompted a search and arrests in the region this reporting period. In federal of their vehicle; officers found a can of WD40 with a fake court in Toledo, a drug ring leader was sentenced to 17.5 bottom, revealing 45 grams of heroin hidden in the can years in prison for his involvement in trafficking heroin, (www.fox45now.com, Oct. 3, 2017). Willard Police (Huron cocaine and marijuana (www.toledoblade.com, July 8, County) arrested a man after executing a search warrant 2017). Toledo Police responded to a call of an overdose of at a residence in the city and seizing unspecified amounts a woman at a residence in Toledo; officers used Narcan® of heroin (www.norwalkreflector.com, Oct. 6, 2017). (naloxone, an opiate overdose reversal medication) to Toledo Police and Lucas County Children’s Services were revive the woman and charged her with drug abuse called after emergency workers at a hospital used three (www.wtol.com, July 17, 2018). A federal grand jury in doses of Narcan® to revive an 18-month-old child after he Nashville, Tennessee indicted a Toledo man responsible for overdosed from heroin; the boy’s 11-year-old brother said operating a multi-state drug trafficking ring and intending that while they were at the park, the toddler put a bag of to distribute over one kilogram of heroin, powdered an unknown substance in his mouth; the boy’s mother cocaine and crack cocaine; in addition to the drug seizures reported that later she could not wake him from a nap in Tennessee, Toledo Police, along with U.S. DEA and FBI and immediately took him to the emergency room (www. agents, executed several federal search warrants at four cleveland.com, Oct. 12, 2017). locations in Toledo related to the man, which resulted in the additional seizures of heroin, crack cocaine, powdered While many types of heroin are currently available cocaine, marijuana, Suboxone®, cash and eight firearms in the region, both participants and community (www.13abc.com, July 24, 2017). Findlay Police (Hancock professionals continued to report white powdered heroin County) arrested a man after executing a search warrant at (aka “china white”) as most available. One treatment his home and confiscating unspecified amounts of heroin, provider remarked, “They like china white.” Reportedly, crack cocaine, drug paraphernalia and cash (www.13abc. brown powdered heroin is also available in the region. com, July 25, 2017). The Grand Lake Drug Task Force, Participants most often rated the current availability of consisting of law enforcement from both Mercer and this type of heroin as ‘4.’ Community professionals did Auglaize counties, collaborated to arrest a couple after not mention brown or black tar heroin, but reported Coldwater Police (Mercer County) stopped them for a that white powdered heroin is in abundance in the traffic violation and a K-9 officer alerted to the presence of region. Participants reported that the black tar heroin is drugs; officers found four capsules containing suspected rarely available, rating its current availability as ‘2‘. One heroin and learned the man had concealed heroin in his participant commented, “I’ve never seen black tar heroin in rectum; officers took the man to a local hospital where a the area.” Another participant stated, “It’s pretty rare.” physician confirmed the presence of three bags of heroin and methamphetamine hidden in the man’s rectum (www. Participants reported that the availability of heroin has wane.com, July 29, 2017). Toledo Police arrested a woman increased during the past six months. One participant after responding to a call at a residence and finding the stated, “It’s gone up.” Community professionals reported woman unconscious from a heroin overdose; officers used that the availability of heroin has remained the same Narcan® to revive the woman; the woman was referred to a during the past six months. The BCI Bowling Green drug treatment program (www.toledoblade.com, Aug. 28, Crime Lab reported that the number of heroin cases it 2017). The Seneca County Drug Task Force, Seneca County processes has decreased during the past six months; the Sheriff’s Office and Tiffin and Fostoria Police collaborated lab reported having processed brown, tan and white to execute multiple search warrants throughout Seneca powdered as well as black tar heroin during the past six County, arresting a man responsible for multiple fatal months. overdoses; officers caught the man after he attempted to flee apprehension and crashed his car into a pole; officers seized heroin, marijuana, cash and criminal tools; officers

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Reported Availability gotta have your fix for the day, so … I guarantee probably Change during the Past 6 Months everybody in this room needs to buy at least a gram.” Overall, participants reported that the price of heroin has Participants Increase remained the same during the past six months.

Heroin Law enforcement No change Current Prices for Treatment providers No change Heroin White powdered:

Participants most often rated the current overall quality Heroin 1/10 gram (aka “fold”) $10 of heroin as ‘8’ on a scale of ‘0’ (poor quality, “garbage”) to A gram $100-200 ‘10’ (high quality); the previous most common score was ‘10.’ A law enforcement officer discussed,There “ have been While there were a few reported ways of using heroin, a heck of a lot more overdoses …. You would hear one every generally, the most common route of administration now and then, and there for a while, it was daily.” Participants remains intravenous injection (aka “shooting”). Participants discussed adulterants (aka “cuts”) that affect the quality estimated that out of 10 heroin users, nine would shoot of the drug and reported that the top cutting agent for and one would snort the drug. One participant reported heroin remains fentanyl. Participants reported that most on using a heroin rinse. He said, “After you’ve already done heroin users desired to have fentanyl-cut heroin; and most the shot and everything, the residue that’s left in the spoon, participants agreed with the sentiment of one participant you put more water on it and [shoot it also] … it’s called who spoke of the potency of fentanyl. He said, “It’s killing ‘a rinse.’” He went on to say, “You [also] use a little piece of people.” cotton for a filter. So, you still have ‘dope’ (heroin) left in that Additional cuts mentioned for heroin included: Benefiber®, cotton. You add a little water and suck it back up. It’s a rinse. Benadryl®, carfentanil, lactose, Miralax®, morphine, You’ve basically got all the dope out of it, so it’s just a little bit Sleepinal® and Xanax®. A treatment provider commented, of dope left….” “They’re kind of shocked too when there’s been ‘benzos’ Participants reported that injection needles are most (benzodiazepines) in their system. They’re like, ‘well, ya know, available from drug stores. Additionally, participants they’re cutting [heroin] with it.”’ Another treatment provider reported obtaining needles from drug dealers, doctors, reported that dealers are cutting heroin with, “Cocaine, needle exchange programs and pet stores. One multiple things, and fentanyl. You see a little mixture of participant shared, “I got mine from a pet store in Monroe amphetamines sometimes.” One law enforcement officer [Michigan].” Another participant stated, “Walmart sells them commented, “I don’t think [users] are caring what they are all day long.” Reportedly, needles on the street sell for $1-3 getting anymore.” Overall, participants reported that the per needle. One participant noted, “I would buy mine from quality of heroin has remained the same during the past the drug dealer for a dollar. They sell them at the pet store for six months. a dollar a piece. And, I’ve gotten them from the pharmacy, a bag of ten for $3.95, and then I have also gotten them from Cutting Agents Detroit.” Participants also discussed that sharing needles is Reported by Crime Lab very common.

l cocaine A profile for a typical heroin user did not emerge from the data. Participants described typical heroin users as Heroin l diphenhydramine (antihistamine) l fentanyl teenagers to old people and everyone. One participant reported, “It’s pretty much across the board.” Another participant commented, “Heroin is so mainstream now.” Reports of current prices for heroin were consistent Community professionals described typical heroin users among participants with experience purchasing the as all ages, races and socio-economic status. A treatment drug. Reportedly, the most common quantity of purchase provider remarked, “It’s all across the board, from 18-80 is a gram. However, one participant commented, “You [years of age].” One treatment provider discussed her

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oldest client who is an 81-year-old heroin user. She agreed officers responded to a call regarding a drug overdose in however, that, “20s and 30s are probably the majority.” One Norwalk and found a person dead upon arrival; officers law enforcement officer described typical heroin users as, attributed the overdose to carfentanil-laced heroin “White people, probably mid-20s. Male, female; it doesn’t (www.norwalkreflector.com, Oct. 2, 2017). Toledo Police matter.” Another officer commented,The “ stories I’ve heard Vice and Narcotics detectives, along with Toledo Field from people I talked to is they hurt their back, they had Operations and SWAT, seized large amounts of fentanyl, surgery, they got hooked on Percocet® or whatever the case heroin, methamphetamine, OxyContin®, cocaine, cash and may be … couldn’t afford it anymore … lost the prescription a firearm during an investigation resulting from a traffic and switched to heroin.” stop (www.wtol.com, Oct. 9, 2017). A man plead guilty to fentanyl trafficking in Wood County Common Pleas Court after U.S. DEA agents observed the man transfer a duffle bag containing six kilograms of the drug to the trunk of a Fentanyl vehicle; officers followed the man, intercepted the drugs and arrested him on Interstate 75; prosecutors also charged Fentanyl is highly available in the region. another individual in the case for his involvement in Participants most often reported the current fentanyl traffickingwww.toledoblade.com ( , Oct. 20, 2017). availability of the drug as ‘10’ on a scale of An investigation lead by the West Central Ohio Crime Task ‘0’ (not available, impossible to get) to ‘10’ Force and the FBI resulted in the indictment of a man in (highly available, extremely easy to get); Toledo for trafficking fentanyl, methyl fentanyl, U-47700, the previous most common score was not reported. heroin and cocaine from February – August 2017; the man Participants discussed that most users seek out heroin sold U-47700 to another individual in Lima (Allen County) with the knowledge that it would likely be adulterated which resulted in an overdose for which the man faced an with fentanyl. One participant commented, “Rarely are additional 20 years of prison time (www.limaohio.com, Nov. you going to find a dealer that’s like, ‘here’s some fentanyl.’” 3, 2017). Another participant stated, “They can order that online.” Community professionals were unable to provide a rating Both participants and community professionals reported as to the current availability of fentanyl in the region; the that the availability of fentanyl has increased during previous most common score was not reported. However, the past six months. One participant commented, treatment providers shared: “I would say it’s very available; “Everybody wants fentanyl now. Once you do fentanyl, the We’re getting a list of patients that are testing negative for gray [heroin] or the tar (black tar heroin), don’t work for everything except for fentanyl.” you.” One treatment provider reported, “They’re saying it’s better. I have heard them say that it is better, stronger Corroborating data indicated that fentanyl is available in [than heroin].” The BCI Bowling Green Crime Lab reported the region. The Hancock County Probate Court reported that the number of fentanyl and fentanyl analogue cases that of the 73 fentanyl-specific adult drug screenings it processes has increased during the past six months, it completed during the past six months, 16.4% were while the number of carfentanil cases it processes has positive for fentanyl. In addition, ODPS reported 61 drug decreased. task force seizures of heroin and/or fentanyl in the Toledo region during the reporting period; drug task forces did Reported Availability not typically differentiate between heroin and fentanyl Change during the Past 6 Months due to the high incidence of heroin-fentanyl mixtures. Media outlets reported on law enforcement seizures and Participants Increase arrests in the region this reporting period. In Hancock Law enforcement Increase County, a woman was sentenced to five years in prison Fentanyl for involuntary manslaughter; the woman provided her fiancé with the carfentanil and U-47700 (synthetic Treatment providers Increase opioid) that resulted in his overdose death (www. thecourier.com, Sept. 22, 2017). Huron County Sheriff’s

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Participants most often rated the current overall quality of or the ‘perc 30s’ (Roxicodone® 30 mg) or whatever, you know, fentanyl as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) to they can’t get them, so what do you expect them to do? They ‘10’ (high quality); the previous most common score was turn to the black market drugs (illicit prescription opioids).” not reported. One participant remarked, “[Fentanyl] that’s the shit that people are coming back from [overdose] with Community professionals most often reported the current the Narcan® (naloxone, antidote for opiate overdose). They’re street availability of prescription opioids as ‘10;’ the mixing [fentanyl in heroin] and the Narcan® will bring them previous most common score was ‘8.’ Even though many back.” One treatment provider commented, “It’s definitely treatment providers believed that doctors have tightened stronger [than heroin].” Overall, participants reported that their prescribing of opioids, making many opioids less the quality of fentanyl has remained the same during the available, they continued to report that users can easily past six months. obtain these drugs for illicit use. One treatment provider commented, “It’s still [readily] available. People will tell me, Reports of current prices for fentanyl were consistent they will take someone to the drug store [to fill a prescription among participants with experience purchasing the drug. for opioids] and buy them from that person.” Reportedly, the most common quantity of purchase is 1/10 gram. Overall, participants reported that the price Corroborating data indicated that prescription opioids of fentanyl has remained the same during the past six are available for illicit use in the region. ODPS reported months. 63 drug task force seizures of prescription opioids in the Toledo region during the reporting period (19.0% of the seizures were made in Wyandot County). Current Street Prices for Fentanyl Media outlets reported on law enforcement seizures and arrests in the region this reporting period. OSHP in 1/10 gram $20 Wood County arrested two people during a traffic stop 1/2 gram $45-70 after smelling raw marijuana coming from their vehicle Fentanyl and conducting a search that lead to the seizure of 90 A gram $90-120 oxycodone pills, 112 Xanax® pills, fraudulent credit cards and a firearm www.sent-trib.com( , Dec. 2017). While there were a few reported ways of using fentanyl, generally, the most common route of administration Participants identified Roxicodone® 30 mg as the most is intravenous injection (aka “shooting”). Participants available prescription opioid in terms of widespread illicit estimated that out of 10 fentanyl users, all 10 would use; community professionals identified Percocet® as most shoot the drug. Participants described typical fentanyl available. users as white people, aged mid-20s. However, a couple Participants and treatment providers reported that the of participants indicated fentanyl users as: “All kinds; No street availability of prescription opioids has decreased longer [just] white middle class.” Community professionals during the past six months. One participant stated, “People described typical fentanyl users as the same as typical don’t want them as much [as heroin/fentanyl].” Other heroin users. participants discussed doctors cutting back on prescribing the drugs as a reason for decreased availability: “It’s harder Prescription Opioids to get them now; You know the way they crack down on the prescriptions, it’s hard to get pills. That’s why it’s become such Prescription opioids are highly available for a big heroin epidemic; I used to be in pain management and illicit use in the region. Participants most often now they’re not giving you anything. It’s so hard; I was on them reported the current street availability of for five years, you know, and then you’re just gonna try to pull these drugs as ‘8’ on a scale of ‘0’ (not available, ‘em out from under me?” impossible to get) to ‘10’ (highly available, Treatment providers commented: “I feel like it has decreased extremely easy to get); the previous most common score with the heroin increase. Like they don’t even want to bother was ‘7.’ A participant shared, “People who deserve to get with the pills; I think the doctors are afraid and are more (have a legitimate need for) the ‘perc 10s’ (Percocet® 10 mg)

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selective … they are being very cautious on who they are While there were a few reported ways of consuming prescribing to, so they (prescription opioid users) are turning prescription opioids, and variations in methods of to heroin.” Law enforcement reported that the general use were noted among types of prescription opioids, availability of prescription opioids has remained the same generally, the most common route of administration for during the past six months. One law enforcement officer illicit use remains snorting. Participants estimated that reported, “If you want it, you can get it.” out of 10 illicit prescription opioid users, nine would snort and one would “shoot” (intravenously inject) the drugs. The BCI Bowling Green Crime Lab reported that Reportedly, shooting prescription opioids isn’t as common the number of morphine and tramadol (Ultram®) as previously due to the reformulation of many opioids cases it processes have increased during the past six to include abuse deterrent measures. One participant months, while the number of hydrocodone (Vicodin®), commented, “I don’t know many people that inject it because hydromorphone (Dilaudid®), methadone, oxycodone of the fillers in the pills … they swallow them or snort them.” (OxyContin®), oxycodone/acetaminophen (Percocet®) and oxymorphone (Opana®) cases it processes have A profile of a typical illicit prescription opioid user did not decreased. emerge from the data. Participants described typical illicit prescription opioid users most often as people with a lot of Reported Availability money, white people and drug dealers. A few participants Change during the Past 6 Months noted that illicit users often started using opioids through a legitimate prescription. Another participant observed Participants Decrease that illicit prescription opioid use is easier to hide than other illicit drug use. He said, “It’s going to be used more by the upper class because I mean doing heroin is not as discreet

Opioids Law enforcement No change as taking a pill.” Additionally, another participant remarked, Prescription Treatment providers Decrease “Like you have to have a steady job; steady income to be a pill user ….” Community professionals described typical illicit prescription opioid users as anyone, particularly as one Reports of current street prices for prescription opioids provider commented, “If they have a chronic condition, or were consistent among participants with experience pain-related condition, they seek those out more … we do buying the drugs. Reportedly, the majority of prescription have some people that just use pills….” opioids sell for $1 per milligram. However, one participant noted, “Some people charge a little bit more.” Participants reported that in rural areas prescription opioids may cost Suboxone® more. One participant explained, “If I was to take percs and go to … my little hometown [in Wood County], I could make Suboxone® remains highly available for illicit at least anywhere from $3 to $5 over the milligrams.” Overall, use in the region. Participants most often the majority of participants indicated that the street price reported the current street availability of of prescription opioids has remained the same during the Suboxone® sublingual filmstrip (aka “strip”) as past six months. ‘7’ and Suboxone® pill form as ‘1’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, Participants reported obtaining these drugs for illicit extremely easy to get); the previous most common scores use from drug dealers, doctors and family members and were ‘8’ and ‘2,’ respectively. One participant reported, others with prescriptions. One participant reported, “I “People go in and out of treatment and get like a supply and either stole them from my parents or I would buy them from sell them on the street. I know I did that myself.” Another dealers, or trade [other drugs for them].” One participant participant believed, “It depends on what facility you go to. reported, “[Doctors] would give (prescribe) me 80 perc 10s a Sometimes you can only get a small supply, and sometimes week before I came here, like that’s $800 in … heroin and … you can get a whole month’s supply, depending on your crack ….” Another participant claimed, “I know a lady in her insurance.” Community professionals most often reported late 70s and she’s selling her pills just to pay her bills.” the current street availability of Suboxone® generally as

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‘10;’ the previous most common score was also ‘10.’ One Current Street Prices for treatment provider commented, “They can get it, and they ® Suboxone® do.” Media outlets reported on law enforcement seizures and Filmstrip $20-40 for 8 mg arrests in the region this reporting period. An addiction medicine physician in Lucas County was indicted for Suboxone Pill $25-40 for 8 mg trading sexual acts for Suboxone® with three woman, two of whom were his patients and one was an office employee; a judge did not sentence the man to prison, In addition to obtaining Suboxone® from doctors, but permanently revoked his medical license, and required participants also reported getting the drug from dealers him to complete 2,000 hours of community service, and other users. One participant reported, “I get mine complete a sex offender treatment program and mental from a dealer.” Another participant claimed, “Mine are from health assessment, and be electronically monitored for six prescriptions or from people selling their prescriptions like to months; the three woman agreed to this sentence, so long obtain heroin and stuff. “Another participant stated, “I would as the physician could no longer abuse his medical degree sell my Suboxone® to get ‘dope’ (heroin).” to exert power over people in recovery (www.toledoblade. com, Aug. 24, 2017). Participants reported that the most common route of administration for illicit use of Suboxone® filmstrips Both participants and community professionals reported remains oral consumption (sublingual), while the most that the street availability of the Suboxone® filmstrip common routes of administration for illicit use of the form has increased during the past six months, while the pill form are intravenous injection (aka “shooting”) and street availability of the pill form has remained the same. snorting. Participants described illicit use of the pill Participants commented: “I think more people are getting form. One participant stated, “If it was in pill form, some it; People are getting a lot of them; Doctors definitely over people would snort them or shoot them.” In order to inject prescribe them.” One participant shared, “I’ll do like a quarter Suboxone®, reportedly, the user must: “Melt it; Mix it in of a strip … keep some and then sell [the rest].” Another water; It’s annoying and tedious.” participant stated, “They give you 8 milligrams a day when in reality you only need 4 milligrams a day … it’s crazy.” The Participants described typical illicit Suboxone® users as BCI Bowling Green Crime Lab reported that the number people addicted to opiates. One participant explained, of Suboxone® cases it processes has decreased during the “I think people that are trying to get off drugs, like when I past six months. was getting Suboxone®, my buddies would hit me up (ask for my Suboxone®) …. They would take a ‘sub’ (Suboxone®), so they didn’t do ‘perc’s’ (Percocet®) that day.” Community Reported Availability professionals described typical illicit users as heroin

® Change during the Past 6 Months addicts. A treatment provider indicated, “They are using just to not be sick (to not experience withdrawal).” Participants Increase

Law enforcement Increase Sedative-Hypnotics Suboxone Treatment providers Increase Sedative-hypnotics (benzodiazepines, barbiturates and muscle relaxants) ) remain highly available for illicit use in Reports of current street prices for Suboxone® were the region. Participants and community professionals most consistent among participants with experience buying the often reported the current street availability of these drugs drug. Participants reported: “$25 a pill. Some people will pay as ‘10’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ $40; A lot of people are getting it for $20; They go for $20-$25 (highly available, extremely easy to get); the previous most in Defiance[County].” Overall, participants reported that common scores were also ‘10.’ A participant remarked, “Just the price of Suboxone® has remained the same during the walk down the street [to find Xanax®].” A treatment provider past six months. commented, “It’s been available at a high level.”

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Corroborating data indicated that sedative-hypnotics are

Current Street Prices for available for illicit use in the region. ODPS reported 19 drug Sedative-Hypnotics task force seizures of benzodiazepines in the Toledo region during the reporting period. $2-3 for 1 mg Klonopin® $4 for 2 mg Both participants and community professionals identified Sedative-

Hypnotics $2-5 for 1 mg Xanax® as the most available sedative-hypnotic in terms of Xanax® widespread illicit use. One participant explained, “It seems $5-7 for 2 mg like doctors are more comfortable prescribing [Xanax®], so I’ve seen a lot more of that.” A treatment provider commented, Participants reported obtaining these drugs for illicit use “Xanax® is definitely number one.” A law enforcement officer from doctors and friends. One participant shared, “I get 60 stated, “Xanax® is something that I found more often than any bars a month [from a doctor].” This participant shared that other pill.” he would take them all in nine days. Generally, the most common routes of administration for illicit use of sedative- Participants reported that the street availability of sedative- hypnotics are snorting and oral consumption. Participants hypnotics has increased during the past six months, while estimated that out of 10 illicit sedative-hypnotic users, five community professionals reported that it has remained would snort and five would orally consume the drugs. One the same. Participants commented: “Xanax® is going up; participant commented, “Mostly snort them, if you’re an I thought they became more available; I think social media addict.” Another participant shared, “Hits you a lot quicker if is like glorifying [use of sedative-hypnotics]; Yeah, music is you snort it.” glorifying it, too.” The BCI Bowling Green Crime Lab reported that the number of clonazepam (Klonopin®) cases it Participants described typical illicit sedative-hypnotics processes has increased during the past six months, while users as anyone, alcoholics and women. One participant the number of alprazolam (Xanax®), carisoprodol (Soma®), reported, “I know someone who is 15-years old and addicted diazepam (Valium®), lorazepam (Ativan®) and zolpidem to Xanax®, and I’ve seen someone who’s 50-years old that’s (Ambien®) cases it processes have decreased or remained addicted to Xanax®.” Another participant stated, “I think the same. ‘benzo’ (benzodiazepine) users are 90% of Americans ….” Another participant noted, “A lot of alcoholics abuse benzos.”

Reported Availability Community professionals described typical illicit sedative- hypnotics users as women. Treatment providers discussed:

Change during the Past 6 Months “I feel like it’s more women … like a lot of women; We see a lot of younger women [abuse sedative-hypnotics], more so than Participants Increase older [women].” Law enforcement No change Sedative- Hypnotics Marijuana Treatment providers No change Marijuana remains highly available in the region. Reports of current street prices for sedative-hypnotics were Participants and community professionals most often consistent among participants with experience buying reported the current availability of the drug as ‘10’ on a the drugs. Reportedly, sedative-hypnotics most often sell scale of ‘0’ (not available, impossible to get) to ‘10’ (highly for $2 per milligram. One participant stated, “’Bars’ (Xanax® available, extremely easy to get); the previous most 2 mg) [cost] about $5. I’ve seen them sell for as much as $10 common scores were also ‘10.’ A law enforcement officer though.” Overall, participants reported that the price of remarked, “What about a ‘12’ (stressing that marijuana in sedative-hypnotics has remained the same during the past his view is extremely available)?” One participant reported, six months. However, one participant explained, “[Cost] “‘Weed’ (marijuana) is a lot like (as available as) heroin ….” depends … people if they are on Xanax® and are craving [it] Corroborating data indicated that marijuana is available … they’ll pay [more].” in the region. The SBIRT program reported that of the 200 individuals in the Toledo region who reported

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 193 Page 8 Surveillance of Drug Abuse Trends in the Toledo Region substance use during the past 30 days, 89.0% reported driving under the influence of alcohol/drugs www.( using marijuana on one or more days. The Hancock shorenewsnetwork.com, Oct. 19, 2017). OSHP in Wood County Probate Court reported that of the 70 adult drug County arrested a California man during a traffic stop on screenings it completed during the past six months, Interstate 80 after a K-9 officer alerted to the presence 11.4% were positive for THC (tetrahydrocannabinol, the of drugs in the man’s vehicle; officers confiscated large psychoactive component of marijuana); the court also quantities of marijuana (www.wtol.com, Oct. 20, 2017). reported that 94.1% of the 51 positive juvenile drug tests it OSHP in Erie County arrested two California men during recorded during the past six months were positive for THC. a traffic stop on Interstate 80 after a K-9 officer alerted to In addition, ODPS reported 46 drug task force seizures the presence of drugs in their vehicle; officers seized 58 of marijuana in the Toledo region during the reporting pounds of marijuana (www.statepatrol.ohio.gov, Oct. 30, period (30.4% of the seizures were made in Wyandot 2017). The Mercer County Sheriff’s Office, Rockford Police, County). Grand Lake Drug Task Force and Coldwater Police’s K-9 unit (all Mercer County) collaborated to execute a search Media outlets reported on law enforcement seizures warrant at a home in Rockford, arresting a man after and arrests in the region this reporting period. Defiance confiscating marijuana, hashish, edible THC products, drug Police (Defiance County) arrested two men during a paraphernalia, cash and 10 firearms www.wdtn.com( , Nov. traffic stop on State Route 24 after a K-9 officer alerted to 1, 2017). Toledo Police were called to investigate the sale of the presence of drugs in the U-Haul truck in which they marijuana edibles to students at a local high school after a were traveling; officers seized 1,000 pounds of marijuana student was seen on surveillance cameras purchasing the (www.13abc.com, July 5, 2017). The Wood County Sheriff’s drug from another student; officers caught four students Office and the Ohio Bureau of Criminal Investigation in possession of the drug, sold as “Fruity Pebble marijuana collaborated on an operation in Bowling Green and other edibles” (www.toledoblade.com, Dec. 14, 2017). regional communities to confiscate 89 marijuana plants (www.13abc.com, Sept. 1, 2017). OSHP in Sandusky Participants and community professionals also discussed County arrested two people during a traffic stop on the the current availability of high-grade marijuana extracts Ohio Turnpike after criminal indicators prompted a search and concentrates, often appearing as oil and waxy forms of the passenger from whom officers seized a bottle of of the drug (aka “dabs”). Both participants and community liquid THC; officers searched the vehicle and found over a professionals rated the current availability of these pound of marijuana and 234 grams of marijuana “edibles” alternative forms of marijuana as ‘10;’ the previous most (food products containing THC) (www.statepatrol.ohio. common scores were ‘7.’ One participant explained, “My gov, Sept. 10, 2017). Erie County Sheriff’s officers arrested ‘dudes’ (dealers) got it. I mean … it’s like an ‘8 or 7.’ You really a man during a traffic stop in Berlin Heights after the smell got to know somebody [to obtain dabs].” A law enforcement of marijuana prompted a search of the man’s vehicle; officer commented, “Wax is more popular [than oil].” officers seized 150 grams of marijuana, a marijuana pipe and 11 Adderall® pills (www.sanduskyregister.com, Sept. Participants reported that the overall availability of 25, 2017). The Wood County Sheriff’s Office was notified marijuana has remained the same during the past of three juveniles who allegedly trafficked marijuana and six months. One participant stated, “I think that (high abused drugs on school grounds (www.sent-trib.com, availability) will never change.” Participants indicated that Sept. 27, 2017). OSHP in Lucas County arrested two men the availability of marijuana extracts and concentrates has during a traffic stop on Interstate 80 after a K-9 officer also remained the same during the past six months. alerted to the presence of drugs in their vehicle; officers Community professionals reported that the availability of confiscated 100 pounds of marijuana from the men’s marijuana has increased during the past six months. One vehicle and arrested them (www.wtol.com, Oct. 13, 2017). treatment provider reported, “I would say it has increased An investigation lead by the Toms River (New Jersey) because of the [medical marijuana] cards now.” Community Police Department’s Criminal Investigation Bureau and professionals indicated that the availability of marijuana the New Jersey Police Missing Persons Unit lead to the extracts and concentrates has remained the same. One law arrest of a man by OSHP in Defiance County responsible enforcement officer commented on his difficulty in finding for taking a 13-year-old girl to Ohio; officers arrested people that use dabs. He said, “It’s hard to find, honestly, the man and found him in possession of marijuana and because it doesn’t smell like marijuana and it’s just a gooey

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substance you put on a little piece of paper … burn it and just While there were a few reported ways of consuming suck it up … it’s gone that quick, and there’s no smell.” He also marijuana, generally the most common route of reported, “They put them in their little e-cigarettes.” administration remains smoking. Participants estimated that out of 10 marijuana users, all 10 would smoke the The BCI Bowling Green Crime Lab reported that the drug. One participant noted however, “There’s so many number of marijuana, including edible THC products and ways to use marijuana.” Another participant noted, marijuana extracts and concentrates (oils, “dabs”), cases it “Smoking it is different than vaporizing it … you’re only processes has decreased during the past six months getting the THC out of vaping it … you get the carcinogens out of smoking it. Smoking it is using fire and vaping is like Reported Availability [heating it to] 325 degrees Fahrenheit.” Change during the Past 6 Months A profile for a typical marijuana user did not emerge from the data. Both participants and community professionals Participants No change described typical users as everyone, while they described users of extracts and concentrates as marijuana Law enforcement Increase connoisseurs and as people with a good job. One Marijuana participant described a dab user: “The guy who’s got the Treatment providers Increase full-time, good job. He’s got his own place, he’s got a couple of cars, and he just smokes weed and chills.” A treatment Participant most often rated the current overall quality of provider reported the typical dabs user as, “younger … marijuana as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) teens to late 20s.” A law enforcement officer commented to ‘10’ (high quality); the previous most common score was that marijuana users are, “white kids, black kids, Hispanics also ‘10.’ Overall, participants indicated that the general … they all have been caught buying.” Another officer said, quality of marijuana has remained the same during the “Kids here have always done marijuana and they will always past six months. do marijuana.” Reports of current prices for marijuana were provided by Methamphetamine participants with experience buying the drug. Reportedly, the most common quantity of purchase is a “blunt” (cigar, usually filled with about a gram of marijuana). Overall, Methamphetamine’s current availability participants reported that the price of both low-grade and remains variable in the region. Participants high-grade marijuana has remained the same during the most often reported the current availability past six months. of powdered methamphetamine (aka “shake-and-bake”) as ‘10’ and of crystal methamphetamine as ‘2’ on a scale of ‘0’ (not available, Current Prices for impossible to get) to ‘10’ (highly available, extremely Marijuana easy to get); the previous most common scores for Low grade: methamphetamine generally were ‘10’ for rural areas and ‘1’ in urban areas. One participant said of powdered A blunt (cigar) or a gram $5 methamphetamine: “That’s everywhere but I’m hesitant 1/4 ounce $20-25 to buy that shit.” Community professionals most often reported the current availability of methamphetamine High grade: generally as ‘4’ in urban areas; the previous most common Marijuana A blunt (cigar) or a gram $10 score was ‘10’ in rural areas surrounding Toledo. One treatment provider said of availability in rural areas: Extracts and concentrates: “Methamphetamine is pretty prevalent.” A gram $30-40 Corroborating data indicated that methamphetamine is available in the region. ODPS reported 28 drug task force seizures of methamphetamine in the Toledo region during the reporting period.

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Media outlets reported on law enforcement seizures people who make methamphetamine can produce the and arrests in the region this reporting period. Law drug in approximately 30 minutes in nearly any location. enforcement in Erie County collaborated during a two- year investigation to arrest 15 people responsible for Participants reported that the availability of powdered trafficking and/or manufacturing methamphetamine methamphetamine has increased during the past six (www.yourerie.com, Aug. 10, 2017). Mercer County months, while the availability of crystal methamphetamine Sheriff’s officers arrested two people at a park in Celina has remained the same. One participant stated, “When after interviewing them and learning they were both you take the heroin away, the ‘meth’ (methamphetamine) is impaired from drug use; officers searched their car going to go up.” Community professionals reported that the and found methamphetamine, marijuana and drug availability of powdered and crystal methamphetamine paraphernalia (www.wdtn.com, Aug. 14, 2017). The has remained the same during the past six months. The Wyandot County Major Crimes Unit executed a search BCI Bowling Green Crime Lab reported that the number warrant at a residence in Nevada (small village in Wyandot of methamphetamine cases it processes has increased County), arresting two men after seizing large amounts of during the past six months; the lab reported processing methamphetamine and other drugs; the search stemmed crystal as well as white powdered methamphetamine. from a 3-month-long investigation by multiple law enforcement agencies, including OSHP, Upper Sandusky Reported Availability Police and Carey Police (www.wktn.com, Sept. 26, 2017). Change during the Past 6 Months Norwalk Police (Huron County) arrested two people after executing a search warrant at a residence and seizing Participants Increase undisclosed amounts of methamphetamine, heroin and criminal tools (www.norwalkreflector.com, Sept. 30, 2017). Law enforcement No change Hancock County Sheriff’s officers stopped a man on his motorcycle in Hicksville for a traffic violation and the man Treatment providers No change fled officers by foot, tossing a container of 20 grams of Methamphetamine methamphetamine, lysergic acid diethylamide (LSD), and two bundles of heroin while fleeing; officers caught up to the man and arrested him (www.wtol.com, Oct. 21, 2017). Participants most often rated the current overall quality The Multi-Area Narcotics Taskforce and Paulding County of methamphetamine as ‘7’ on a scale of ‘0’ (poor quality, Sheriff’s Office executed a search warrant at a residence “garbage”) to ‘10’ (high quality); the previous most in Paulding and arrested five people after finding crystal common score was ‘10.’ Participants discussed adulterants methamphetamine, drug paraphernalia and cash in the (aka “cuts”) that affect the quality of methamphetamine home; a 3-year-old child in the home at the time of the and reported the following cutting agents for the drug: arrest was taken into custody and placed with other family baby aspirin, baby laxatives, heroin, MSG (monosodium members (www.cresent-news.com, Nov. 3, 2017). OSHP glutamate), MSM (methylsulfonylmethane, a joint in Wood County arrested a Connecticut man during a supplement), niacinamide (dietary supplement) and traffic stop on Interstate 80 after a K-9 officer alerted to the vitamin B. A participant remarked, “When you get white presence of drugs in the man’s vehicle; officers seized 246 heroin it can be cut with meth.” The BCI Bowling Green ounces of methamphetamine (www.statepatrol.ohio.gov, Crime Lab reported dimethyl sulfoxide (topical analgesic) Nov. 3, 2017). as a cut for methamphetamine. Participants reported that methamphetamine is available In addition, a treatment provider discussed in powdered and crystal forms throughout the region. methamphetamine as a cut for other drugs: “It’s getting The powdered form of the drug is typically referred to mixed in a lot [with other drugs]. A straight heroin user, as “shake-and-bake,” which means users produce the they swear that is all they buy and [methamphetamine drug in a single-sealed container, such as a two-liter is] mixed in.” A participant observed that powdered soda bottle. By using common household chemicals methamphetamine is often sold as other drugs: “People along with ammonium nitrate (found in cold packs) and are ripping you off with ‘bottle dope’ (aka shake-and-bake). pseudoephedrine (found in some allergy medications), They’re disguising that shit as ‘molly’ (powdered MDMA) or they’re disguising it as ‘ice’ (crystal methamphetamine) …

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and I know the difference because I know how to make it.” ‘10’ on a scale of ‘0’ (not available, impossible to get) to Overall, participants reported that the quality of powdered ‘10’ (highly available, extremely easy to get); the previous and crystal methamphetamine has remained the same most common score was ‘7’. One participant commented, during the past six months. “It’s pretty easy to get a prescription for them.” Another participant added, “Pretty much any doctor will give them to Reports of current prices for methamphetamine were you.” consistent among participants with experience buying the drug. Reportedly, the most common amount of purchase Treatment providers most often reported the current is a gram. Overall, participants reported that the price of street availability of prescription stimulants as ‘4,’ while law powdered and crystal methamphetamine has remained enforcement most often reported it as ‘9’; the previous the same during the past six months. most common scores were ‘8’ for both treatment providers and law enforcement. Treatment providers observed: Current Prices for “You find more people going to the doctor and saying they Methamphetamine have issues with sitting still and ADHD (attention-deficit hyperactivity disorder), so they are going in there and being Powdered: prescribed those kinds of medications; [Parents are] taking their children to the doctor for ADHD and they are taking and A gram $60-70 using the meds or trading for something else.” Crystal: Both participants and community professionals identified Adderall® as the most available prescription stimulant in

Methamphetamine A gram $100 terms of widespread illicit use. One participant further identified, Adderall®“ extended release capsule 30 milligrams Participants reported that the most common route of … the orange ones.” Another participant noted, “In my administration for methamphetamine remains intravenous personal opinion [Adderall® is] one of the best, because it’s injection (aka “shooting”). Participants estimated that like twice the strength of Focalin®.” out of 10 methamphetamine users, four would shoot, three would smoke and three would snort the drug. One Participants and community professionals reported that participant stated, “You start out snorting it, then smoking the general street availability of prescription stimulants it, then shooting it.” Another participant claimed, “Some will has remained the same during the past six months. A law ‘hot rail’ meth.” Another participant clarified, To“ hot rail, you enforcement officer remarked,Adderall® “ has been around break out a line [of methamphetamine] … get a tube … get forever.” However one treatment provider reported, “I feel like the tube like red hot, then snort the line and it turns to smoke there has been an increase in amphetamines.” The BCI Bowling in the tube and then you just snort all the smoke.” Green Crime Lab reported that the number of amphetamine (Adderall®) and methylphenidate (Ritalin®) cases it processes Participants and community professionals described have decreased during the past six months. typical methamphetamine users as people that like to stay up for days, poor white people and people living in the Reported Availability

country. However, one participant reported, “I feel like a different variety of people are doing it now, like different, like Change during the Past 6 Months a lot more women I know … and other age groups … but it’s primarily white. I don’t know anyone who’s black or Hispanic Participants No change that does it.” Law enforcement No change Stimulants Prescription Prescription Stimulants Treatment providers No change

Prescription stimulants are moderately to highly available Reports of current street prices for prescription stimulants for illicit use in the region. Participants most often were consistent among participants with experience reported the current street availability of these drugs as buying these drugs. One participant shared, “My 20 mgs (Adderall® 20 mg) I sold them. The lowest I sold them for

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 197 Page 8 Surveillance of Drug Abuse Trends in the Toledo Region was $5.” Overall, participants reported that the price of Ecstasy prescription stimulants has remained the same during the past six months. Ecstasy (methylenedioxymethamphetamine: MDMA, or other derivatives containing BZP, MDA, and/or TFMPP) ) is

Current Street Prices for moderately to highly available in the region. Participants Prescription Stimulants most often reported the current availability of the pressed tablet form of ecstasy and of “molly” (powdered MDMA) $3-5 for 20 mg as ‘8’ on a scale of ‘0’ (not available, impossible to get) to Adderall® $6-7 for 30 mg ‘10’ (highly available, extremely easy to get); the previous Stimulants Prescription most common scores were ‘2-3’and ‘7,’ respectively. However, a participant noted, “Well, good molly is hard Participants reported obtaining prescription stimulants to find.” While treatment providers most often reported for illicit use from friends, drug dealers and doctors. A the current availability of both ecstasy and molly as ‘6,’ participant exclaimed, “On the street or doctors.” Other law enforcement most often reported both types as ‘9’; participants discussed: “I got them mostly from people the previous most common scores were ‘2’ for ecstasy who were prescribed them; A lot of the kids (students) buy and ‘4’ for molly. A treatment provider stated, “We hear Adderall® from other students during test time because they about [ecstasy/molly] every once in a while, but it’s not think it is going to work for them (improve their focus).” very prevalent.” One law enforcement officer described the current availability of molly as, “just as high as ‘weed’ Participants reported that the most common route of (marijuana).” administration for illicit use of prescription stimulants is snorting. Participants estimated that out of 10 illicit Although reportedly fairly easy to obtain, participants prescription stimulant users, eight would snort and two explained that ecstasy and molly are not a drug of choice. would orally ingest the drugs. One treatment provider explained that users may use the drug, but wouldn’t purposefully seek it out. She reported that Participants described typical illicit prescription stimulant users may say, “‘I’ll take this since I can’t take that,’ or ‘I’ll take users as high school and college aged, and some working this because here it is.’” Another provider commented that to people who use the drugs to get through the day. participants, using ecstasy and/or molly is akin to a “weekend Participants commented: “College kids for sure are the most fun thing.” By-in-large the users they see in treatment don’t common I see; It gives you focus, you get shit done; People seek out this drug and become addicted to it. who have jobs, that have responsibilities; I specifically sold [my prescription stimulants] to people who work in the food Media outlets reported on law enforcement seizures industry … I had a 50-year-old woman in the food industry and arrests in the region this reporting period. OSHP in that used it to get through her work shift.” Lucas County arrested two men during a traffic stop on Community professionals described typical illicit users as Interstate 80 after a probable cause search of their vehicle college students. One law enforcement officer based at revealed 25 tablets of ecstasy, two pounds of marijuana a university reported, “It’s always been the kids who party brownies, three jars of marijuana, LSD (liquid lysergic acid too much and then think, ‘Oh, I have to do really good on diethylamide) and a firearm www.statepatrol.ohio.gov( , this test, so let me try to take this miracle pill so I can retain Nov. 22, 2017). everything I didn’t listen to for the last six months.” Participants reported that the availability of ecstasy has remained the same during the past six months, while the availability of molly has increased. One participant commented, “Over the last couple years, [molly has] become like really popular … probably because of the music [that references its use].” Community professionals reported that the availability of ecstasy and molly has remained the same during the past six months. The BCI Bowling Green Crime Lab reported that the number of MDMA (ecstasy/

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molly) cases it processes has increased during the past six just depends.” Overall, participants reported that the price of months; the lab does not differentiate between ecstasy ecstasy and molly has remained the same during the past and molly. six months.

Reported Availability Current Prices for Change during the Past 6 Months Ecstasy/Molly Ecstasy: Participants No change $10-20 (unspecified Tablet dose) Ecstasy Law enforcement No change Molly:

Treatment providers No change Ecstasy/Molly 1/10 gram $10-15 Reported Availability A gram $50-60 Change during the Past 6 Months Participants indicated that ecstasy/molly is obtained in Participants Increase more urban areas. One participant reported, “I bought molly and ecstasy in Toledo.” Participants agreed that Molly Law enforcement No change ecstasy and molly are mostly obtained and used at dance clubs and at “raves” (dance parties). Participants reported Treatment providers No change that the most common route of administration for ecstasy and molly is snorting. Participants estimated that out of 10 Participants most often rated the current overall quality of ecstasy and molly users, eight would snort and two would ecstasy as ‘4’ and of molly as ‘9’ on a scale of ‘0’ (poor quality, “shoot” (intravenously inject) or dissolve the substances in “garbage”) to ‘10’ (high quality); the previous most common water to drink (aka “molly water”). Participants discussed: scores were ‘7’ for ecstasy and molly. One participant “There are some people who are going to drink molly; Molly reported, “I’ve done [ecstasy] a couple of times. I don’t think it’s water [or] you put it in Gatorade; Some people want to very good.” Reportedly, ecstasy and molly are often cut with eat it. Most people snorted it … like crushed the ‘shards’ other substances, including ketamine (an anesthetic typically (crystallized meth) [to snort].” used in veterinary medicine) and methamphetamine. A participant remarked, “There’s not really pure ecstasy around Participants described typical ecstasy and molly users here.” In addition, another participant observed, “Molly is as aged 16-23 years, people who frequent nightclubs being sold like meth … they’re thinking it is [molly] ….” Overall, and dance clubs (aka “party people”), college students, participants reported that the quality of ecstasy and molly gay people and white middle-class people. Participants has decreased during the past six months. A participant commented: “The younger crowd; Partiers like high- commented, “They’re shit anymore. They’re not as good as they school kids and college [aged] kids; I’ve only seen it at used to be back in the day.” Another participant said of the [music] festivals; It’s mostly like college or younger people.” quality of ecstasy, “… not worth it.” Community professionals described typical ecstasy and molly users as college students and people who attend Reports of current prices for ecstasy and molly were raves. One law enforcement officer commented,It “ is a rave consistent among participants with experience buying the drug. Kids will go out to the bars or they will have the parties drugs. Participants reported that molly is typically sold by at one of the houses. Someone will do it there.” the gram or 1/10 gram (aka “point”). Another participant noted, “It’s sold by the point, like $20 a point.” One participant reported, “The way like I saw molly sold was they sold it by points. It was like ‘shards’ (crystals) or powder, and I mean people could ‘pill it up’ (fill a capsule with it or combine it with other substances and press into a pill) … some people sold it for $10 a point, some people sold it for $50 or $60 a gram. It

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availability of Neurontin® as ‘10’ on a scale of ‘0’ (not available, Other Drugs in the Toledo Region impossible to get) to ‘10’ (highly available, extremely easy to get); a previous most common score was not reported. Participants and community professionals listed a variety Treatment providers commented: “We have a surge of of other drugs as being present in the region, but these Neurontin® [abuse], seriously; Huge. It’s a big issue here.” drugs were not mentioned by the majority of people One treatment provider shared, “I had a couple of patients interviewed: Neurontin® (gabapentin) and promethazine who asked to get the prescription … they made up all these (prescription-strength cough syrup). excuses why they had to have it…. One girl was totally honest In addition, secondary data sources reported having about why she gets them. She likes to … crack them open in processed other drugs not mentioned by respondents. The her mouth, and she [reportedly] gets this great euphoria … BCI Bowling Green Crime Lab reported that the number of she went to the doctor and complained that she has a lot of bath salts (synthetic cathinones; compounds containing back pain and since she can’t get Percocet® or anything like methylone, mephedrone, MDPV or other chemical that in the program … she can get the gabapentin and do analogues, including alpha-PVP, aka “flakka”) and synthetic what she wants to do.” Another provider stated, “I think our marijuana (synthetic cannabinoids) cases it processes doctors … they slowed down on the Percocet® [prescribing], have increased during the past six months, while the but they increased the Neurontin®.” number of DMT (dimethyltryptamine), LSD (lysergic acid Participants reported that Neurontin® sells for $2.50 for diethylamide) and psilocybin mushroom cases it processes two pills (unspecified dose). The typical illicit Neurontin® have decreased or remained the same. The lab also made user is reportedly a person in substance abuse treatment note of having processed 11 cases for U-47700 (synthetic or on probation. opioid) during the past six months.

Media outlets reported on law enforcement seizures Promethazine and arrests involving other drugs not mentioned by respondents in the region this reporting period. OSHP Promethazine (prescription-strength cough syrup with in Wyandot County arrested two people from Michigan codeine, aka “lean” when mixed with soda) is available for during a traffic stop near Upper Sandusky after a K-9 illicit use in the region. Although participants were unable officer alerted to the presence of drugs in their vehicle; to rate the current street availability of promethazine, officers seized 240 pounds of khat (a plant native to they reported that the availability and use of the drug has Africa and the Arabian Peninsula containing an alkaloid increased during the past six months. Law enforcement cathinone, an amphetamine-like stimulant) (www.fox8. most often reported current street availability as ‘4’ on a com, July 28, 2017). Prosecutors in Toledo Municipal Court scale of ‘0’ (not available, impossible to get) to ‘10’ (highly charged a man with the death of another man after he available, extremely easy to get); a previous most common provided him with drugs that resulted in his death; the score was not reported. A law enforcement officer Lucas County Coroner’s Office has yet to release the drug commented, “I know it’s accessible if people want it.” One that caused the death; during the man’s arrest, Toledo treatment provider stated, “We have been hearing of more Police found two bags of synthetic marijuana before promethazine use.” Reportedly, typical illicit promethazine taking him to the Lucas County Jail (www.toledoblade. users are African-American people, drug dealers and high com, Sept. 26, 2017). school students.

Neurontin®

Neurontin® (gabapentin, an anticonvulsant and nerve pain medication) is highly available for illicit use in the region. While participants discussed Neurontin® as highly available, they were not able to rate its current street availability. Treatment providers most often reported the current street

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medication. Both respondent types also noted that those with prescriptions sell all or part of their prescribed Conclusion Suboxone® for other drugs (i.e. heroin/fentanyl). Reportedly, the typical illicit Suboxone® user continues to be person addicted to opiates trying to alleviate Crack cocaine, heroin, marijuana, powdered cocaine, withdrawal symptoms in the absence of heroin/fentanyl. sedative-hypnotics and Suboxone® remain highly available in the Toledo region; also highly available Participants reported that the availability of powdered are fentanyl, prescription opioids and Neurontin® methamphetamine has increased during the past six (gabapentin). Changes in availability during the months. They explained that heroin users have switched past six months include: increased availability for from heroin to methamphetamine due to successful law fentanyl and Suboxone®; likely increased availability enforcement efforts in limiting the availability of heroin for methamphetamine; and decreased availability for in the region as a reason for the increased availability prescription opioids. and use of methamphetamine. In addition, participants and treatment providers discussed an increase in use While the current availability of heroin remains high, of methamphetamine as a “cut” (adulterant) for other participants discussed that most users seek heroin with drugs such as heroin and “molly” (powdered MDMA). The the knowledge that it would likely be adulterated with BCI Bowling Green Crime Lab reported that the number fentanyl. Both participants and community professionals of methamphetamine cases it processes has increased reported that the availability of fentanyl has increased during the past six months; the lab reported processing during the past six months. Participants explained that crystal as well as white powdered methamphetamine. once users do fentanyl, they can no longer go back to heroin because heroin will not get one as high as fentanyl. Lastly, Neurontin® is highly available for illicit use in Both participants and treatment providers indicated a the region. Participants and community professionals user preference for fentanyl over heroin. The BCI Bowling reported that some doctors are now prescribing Green Crime Lab reported that the number of fentanyl Neurontin® in lieu of opioids for chronic pain. Reportedly, and fentanyl analogues cases it processes has increased a typical illicit Neurontin® user is a person on probation during the past six months. and/or in substance abuse treatment. As a result of the increased demand for and supply of fentanyl, participants described decreased street availability of prescription opioids. They explained that fentanyl is a stronger and cheaper alternative to both heroin and prescription opioids. In addition, participants noted doctors cutting back on prescribing opioids as another reason for decreased availability. However, even though many treatment providers believed that doctors have tightened their prescribing of opioids, making many opioids less available, they continued to report that users can easily obtain these drugs for illicit use. In addition to obtaining Suboxone® from doctors, participants also reported getting the drug from drug dealers and other users with prescriptions. Both participants and community professionals reported that the street availability of the Suboxone® filmstrip form has increased during the past six months. There was consensus among respondents that there’s been an increase in the number of persons in treatment receiving Suboxone®, and thus an increase in prescribing of the

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Page 202 OSAM Drug Trend Report June 2017 - January 2018 Surveillance of Drug Abuse Trends in the Youngstown Region Surveillance of Drug Abuse Trends in the Youngstown Region OSAM Ohio Substance Abuse Monitoring Network

Drug Abuse Trends in the Youngstown Region

Regional Epidemiologist: Sarah Balser, MS, MPH, SWT, CHES Data Sources for the Youngstown Region This regional report was based upon qualitative data collected via focus group interviews. Participants were active and recovering drug users recruited from alcohol and other drug treatment programs in Ashtabula, Jefferson and Mahoning counties. Data triangulation was achieved through comparison of participant data to qualitative data collected from regional community professionals (treatment providers and law enforcement) via focus group interviews, as well as to data surveyed from the Ohio Bureau of Criminal Investigation (BCI) Richfield Crime Lab, which serves the Akron-Canton, Cleveland and Youngstown areas, and the Ohio Department of Public Safety (ODPS), which logs drug task force seizures from across Ohio. All secondary data are summary data of cases processed from January through June 2017. In addition to these data sources, Ohio media outlets were queried for information regarding regional drug abuse for July through December 2017.

Note: OSAM participants were asked to report on drug use/ knowledge pertaining to the past six months prior to the interview; thus, current secondary data correspond to the reporting period of participants.

OSAM Staff: R. Thomas Sherba, PhD, MPH, LPCC OSAM Principal Investigator Kathryn A. Coxe, MSW, LSW OSAM Coordinator Jessica Linley, PhD, MSW, LSW OSAM Quantitative Data Analyst

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Regional Profile Indicator1 Ohio Youngstown Region OSAM Drug Consumers Total Population, 2016 11,613,373 700,453 43 Gender (female), 2016 51.0% 50.7% 53.5% Whites, 2016 82.5% 88.0% 81.4% African Americans, 2016 12.8% 9.1% 4.7% Hispanic or Latino Origin, 2016 3.7% 3.3% 4.7% High School Graduation Rate, 2012-16 89.5% 88.7% 86.0% Median Household Income, 2012-16 $50,674 $42,911 $16,000-$19,9992 Persons Below Poverty Level, 2016 14.6% 17.9% 55.0%3 1 Ohio and Youngstown region statistics were derived from the most recent US Census. OSAM drug consumers were participants for this reporting period: June 2017 - January 2018. 2 Participants reported income by selecting a category that best represented their household’s approximate income for the previous year. Income was unable to be determined for 2 participants due to missing and/or invalid data. 3 Poverty status was unable to be determined for 3 participants due to missing and/or invalid data.

Youngstown Regional Participant Characteristics

Consumer Characteristics N=43*

Male 20 Female 23 20s 18 30s 14 Gender 40s 7 50s 4 Less than high school graduate 6 High school graduate 23 Some college or associate's degree 9 Education Bachelor's degree or higher 5 < $12,000 12 $12,000 to $19,999 10 $20,000 to $28,999 9 $29,000 to $36,999 2

Household Income ≥ $37,000 8 Alcohol 17 Cocaine, Crack 21 Cocaine, Powdered 13 Ecstasy/Molly 3 Heroin/Fentanyl 16 Marijuana 18 Methampehtamine 8

Drugs Used** Prescription Opioids 15 Prescription Stimulants 7 Sedative-Hypnotics 11 Suboxone®/Subutex® 16 Other Drugs*** 2

0 5 10 15 20 25 Number of Participants

*Not all participants filled out forms completely; therefore, numbers may not equal 43. **Some respondents reported multiple drugs of use during the past six months. ***Other drugs included: Lyrica® (pregabalin) and psilocybin mushrooms.

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Participants and law enforcement reported that the availability of high-grade marijuana, including marijuana Historical Summary concentrates and extracts (aka “wax” and “dabs”) increased during the reporting period. The BCI Richfield Crime Lab In the previous reporting period (January - June reported that the number of extracts and concentrates 2017), crack cocaine, heroin, marijuana, Neurontin® cases it processes increased during the reporting period. (gabapentin), prescription stimulants, sedative-hypnotics In addition, law enforcement noted increased availability and Suboxone® remained highly available in the of edible forms of marijuana (e.g. gummy bears and Youngstown region; also highly available were powdered suckers). cocaine and prescription opioids. Changes in availability during the reporting period included: likely increased Methamphetamine was moderately available in the availability for marijuana and methamphetamine. region; however, reportedly, availability was highest in rural areas of the region. Participants reported that Although participants and community professionals methamphetamine was available in powdered and crystal suspected that the majority of heroin sold in the region forms throughout the region, although they indicated was actually fentanyl, or heroin adulterated with fentanyl, powdered (aka “shake-and-bake”) as the most prevalent participants continued to report heroin as highly available. form of the drug. Law enforcement reported that the Community professionals reported the availability of type of available methamphetamine largely depended heroin, not adulterated with fentanyl, as moderate. on whether the county was rural or urban. They reported that crystal methamphetamine was more available A query of the National Forensic Laboratory Information in urban areas such as Youngstown, while powdered System (NFLIS) for the counties which comprise the methamphetamine was more available in rural areas such Youngstown region returned fewer heroin cases and as Ashtabula County. considerably more carfentanil, fentanyl and fentanyl analogue cases reported during the reporting period than Participants reported that the availability of both previously. The BCI Richfield Crime Lab reported that the powdered and crystal methamphetamine increased number of heroin cases it processes decreased during the during the reporting period. Law enforcement reported reporting period, while the number of carfentanil, fentanyl increased availability of crystal methamphetamine and fentanyl analogue cases increased. particularly. They explained that there was less legal risk in purchasing crystal methamphetamine than in While many types of heroin were available in the region, manufacturing powdered methamphetamine for personal participants and community professionals reported use. The BCI Richfield Crime Lab reported that the number powdered heroin as most available. Participants and of methamphetamine cases it processes increased law enforcement reported that a variety of colors for during the reporting period; the lab reported processing powdered heroin were available, including: brown, gray, crystal, off-white and white powdered, and brown pink, purple and white. Participants discussed adulterants crystals in smoking devices. Participants and community (aka “cuts”) that affected the quality of the drug and professionals described typical methamphetamine users reported that the top cutting agents were fentanyl, as white people living in rural areas, of low socio-economic prescription opioids and Xanax®. status, and blue-collar workers in positions that require Regarding the general availability of marijuana, a them to be awake for long hours. treatment provider described the availability of marijuana Lastly, Neurontin® remained highly available in the region as comparable to that of cigarettes: extremely easy to get. for illicit use. Treatment providers reported that the street Law enforcement discussed that a lot of the marijuana availability of Neurontin® increased during the reporting cases they worked involved marijuana brought into period. A treatment provider stated, “You’ll hear more the region from states where its use was legal in some and more that people’s relapses started with Neurontin®.” capacity (i.e. Michigan, California and Colorado). Participants and community professionals described typical illicit Neurontin® users as opiate addicts who used the drug when they could not obtain heroin.

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confiscating 24 grams of cocaine, 28 grams of heroin, four grams of crystal methamphetamine and 418 grams Current Trends of marijuana (www.starbeacon.com Aug. 22, 2017). The Columbiana County Drug Task Force and East Liverpool Powdered Cocaine Police arrested six people while executing a search warrant at a home in East Liverpool and seizing seven grams of cocaine and drug paraphernalia (www.wytv.com, Sept. Powdered cocaine remains highly available in 1, 2017). Ohio State Highway Patrol (OSHP) in Ashtabula the region. Participants most often reported County arrested a man during a traffic stop on Interstate the drug’s current availability as ‘10’ on a scale 90 after officers found 152 grams of cocaine in the man’s of ‘0’ (not available, impossible to get) to ‘10’ car (www.news5cleveland.com, Sept. 23, 2017). Law (highly available, extremely easy to get); the enforcement in Ashtabula County arrested a man from previous most common score was also ‘10.’ Participants Erie, Pennsylvania during a traffic stop after finding 69 commented: “It’s easy to get; It’s all over Steubenville grams of powdered cocaine and 83 grams of crack cocaine [Jefferson County].” in separate bags in his vehicle (www.wfxg.com, Sept. Community professionals most often reported the current 27, 2017). Prosecutors in Mahoning County charged a availability of powdered cocaine as ‘7;’ the previous most woman and her boyfriend with involuntary manslaughter common scores were ‘2’ and ‘8’ for treatment providers in the death of the woman’s 9-year-old son, who died of and ‘7’ for law enforcement. Treatment providers stated: an unintentional cocaine overdose; the woman and her “Among our clients, I would say a little more than half are boyfriend noticed the boy having seizures the day after testing positive for, or have a history of positive screens for Christmas and took him to get help; the mother claimed cocaine, and I think we’re also hearing that once they get her son had swallowed bleach; however, officers involved clean from the opiates, then the cocaine … is a drug that they in the case reported high levels of cocaine in the boy’s turn to; With medication assisted treatment … once they toxicology screen (www.vindy.com, Oct. 17, 2017). A get to a ‘therapeutic dose,’ they’re not going to be having as woman in Youngstown was given probation instead of a many opiate cravings, and if they’re still not in the right stage prison term for her 9-year-old son’s cocaine overdose; the of change … craving some type of euphoria which they can cocaine allegedly belonged to the woman’s boyfriend, receive from using cocaine.” who was sentenced to four and a half years in prison for the overdose (www.wdtn.com, Dec. 6, 2017). Law Law enforcement discussed: “We’ve also noticed in talking enforcement in Jefferson County worked with Steubenville to sources and users that have overdosed on heroin, that Police to confiscate 36 grams of cocaine, and undisclosed instead of trying to get into a program which would get them amounts of fentanyl and marijuana from a residence in off of narcotics completely, they think it’s safer to use cocaine Steubenville (www.wtov9.com, Dec. 7, 2017). instead; We have so many clients utilizing Vivitrol® for heroin use but are still able to get a high off of powdered cocaine or Although participants most often reported that the crack cocaine … dealers are able to sell it more easily now availability of powdered cocaine has remained the same than the heroin.” during the past six months, participants discussed that its availability is beginning to increase. One participant Corroborating data indicated that powdered cocaine is remarked, “Just talking to mutual friends, they just noticed available in the region. The Ohio Department of Public there’s a lot of cocaine around. There’s more people doing it Safety (ODPS) reported 15 drug task force seizures of now than six months ago.” powdered cocaine in the Youngstown region during the reporting period (66.7% of the seizures were made in Community professionals reported that the availability Mahoning County). of powdered cocaine has increased during the past six months. A treatment provider stated, “I think it’s changed Media outlets reported on law enforcement seizures and where it’s readily available because now we see a trend arrests in the region this reporting period. Multiple law of it being mixed with other drugs [like] fentanyl … we’re enforcement agencies in Ashtabula County collaborated seeing more of it show up [in urine drug screens].” Law to arrest 10 people during a county-wide drug sweep, enforcement commented: “The demand has definitely

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increased from the past year or so; Before, we didn’t see it as quantities of purchase are a gram and 1/8 ounce. Overall, much, but over the last couple of months, we’ve been seeing participants reported that the price of powdered cocaine more and more people come in with arrests for cocaine has remained the same during the past six months. possession.” The BCI Richfield Crime Lab reported that

the number of cocaine cases it processes has decreased Current Prices for during the past six months; the lab does not differentiate Powdered Cocaine between powdered and crack cocaine. A gram $50-80 Reported Availability

Cocaine 1/16 ounce (aka “teener”) $80-120

Change during the Past 6 Months Powdered

1/8 ounce (aka “eight ball”) $140-200

Participants No change Participants reported that the most common route of administration for powdered cocaine is intravenous

Cocaine Law enforcement Increase injection (aka “shooting). Participants estimated that out Powdered Powdered of 10 powdered cocaine users, five would shoot and five Treatment providers Increase would smoke or snort the drug. Participants discussed, “Some people will not use a needle at all. They will smoke Participants most often rated the current overall quality it; There’s lots of people who would shoot it up; Higher class of powdered cocaine as ‘5’ on a scale of ‘0’ (poor quality, people would snort it, or keep it in things where they can “garbage”) to ‘10’ (high quality); the previous most just take a little … they can dip into it while they’re at work common score was ‘4.’ Participants discussed adulterants or while they’re at the gym, or they do a line before they go (aka “cuts”) that affect the quality of the drug. A participant work out, or socially; The younger crowd, they’re going right stated, “There’s so many white powders that you can put into shooting it these days. If people are injecting ‘meth’ into cocaine … that will numb (cause a numbing sensation) (methamphetamine) or injecting heroin, they’re more likely to … and it makes you think that it’s all cocaine.” Participants inject cocaine.” reported the top cutting agents for powdered cocaine as: baking soda, baby laxatives and Similac®. Other Participants described typical powdered cocaine users as adulterates mentioned included: aspirin, benzocaine (local drug dealers, younger people who use the drug socially, anesthetic), fentanyl, inositol (dietary supplement), niacin and people who need or desire to stay awake for long and Sleepinal®. Participants commented: “Usually, it’s hours. Participants stated: “Drug dealers … anybody that baking soda or Similac®; [Baking soda is] like the number one wants to stay up for days; I think truck drivers because they ingredient besides cocaine.” Overall, participants reported need to stay awake; Strippers. It helps you keep weight down; that the quality of powdered cocaine has remained the Old school or young people, white girls that go to the bar … I same during the past six months. think middle to high class.” Community professionals described typical powdered cocaine users as white and male. Treatment providers

Cutting Agents Reported by Crime Lab reported: “The male clients that are on methadone … they’re looking for something to still function and get everything done throughout the day; I have heard too from males l Cocaine local anesthetics (benzocaine and lidocaine) that they use cocaine for its sexual benefits; Young adults Powdered Powdered between 18 to 21 [years of age]. I believe they are using it … it’s readily available to them … ‘speedball’ (use with heroin). Reports of current prices for powdered cocaine were That seems to be the thing today.” Law enforcement officers variable among participants with experience buying commented: “Mostly adult white males with full-time jobs, the drug. A participant commented, “It can go from just well educated, come from a good background … it’s much a $10 bag all the way to whatever you want … it goes to more expensive [than other drugs]; The drug tests we’re $60 to $100 … if you’re getting really a lot … you could go getting back … where people are testing positive …usually a couple hundred bucks.” Reportedly, the most common white males ….”

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Crack Cocaine vehicle where they found a bag containing an unspecified amount of crack cocaine (www.wkbn.com, Oct. 16, 2017). Youngstown Police arrested two men during a traffic Crack cocaine remains highly available in the region. stop after noticing the smell of raw marijuana coming Participants most often reported the drug’s current from their vehicle; the passenger of the car admitted to availability as ‘10’ on a scale of ‘0’ (not available, impossible smoking marijuana and gave officers his blunt (marijuana- to get) to ‘10’ (highly available, extremely easy to get); the filled cigar); however, during a search of the car, officers previous most common score was also ‘10.’ Participants also found a crack pipe and heroin; the driver admitted to commented: “I think ‘crack’ (crack cocaine) is the most readily officers he did not have a driver’s license and was receiving available drug in this area; It’s just huge. It’s always been huge driving lessons from the passenger in exchange for crack in Youngstown, in Warren … there’s a lot of crack addicts; I cocaine (www.nbc4i.com, Nov. 1, 2017). think that most people who do heroin, do crack, too; There’s a big demand for it; Everybody has it. Everybody wants it. Participants reported that the availability of crack cocaine Supply and demand; I can walk to a gas station in Mahoning has increased during the past six months. Participants or Trumbull [counties] and easily, within 10 minutes, get crack.” discussed: “That’s one of the only things I could find when I looked to get high; It’s coming up, coming back, more Community professionals most often reported the current common; Everybody’s getting busted. So, when one drug availability of crack cocaine as ‘7;’ the previous most goes down, another drug has to come up; A lot of the ‘heron’ common score was ‘10.’ Treatment providers commented: “I (heroin) dealers are getting scared now, so they’re trying to think it tends to be less expensive [than other drugs]; They can justify and go on to the next drug, and that’s cocaine.” mix it with the marijuana … lace the marijuana with crack; I think there’s a rising interest in crack cocaine … I will have Community professionals reported that the availability clients who are stable on their dose (medication to treat opiate of crack cocaine has remained the same during the past addiction) who hear about crack and all of a sudden, they’re six months. The BCI Richfield Crime Lab reported that the using crack. I’ve seen that a number of different times.” A law number of cocaine cases it processes has decreased during enforcement officer observed,More “ of the people that we the past six months; the lab does not differentiate between deal with that’s what they buy … less people buy powdered crack and powdered cocaine. cocaine.” Corroborating data indicated that crack cocaine is available Reported Availability Change during the Past 6 Months

in the region. ODPS reported 14 drug task force seizures of crack cocaine in the Youngstown region during the reporting period. Participants Increase

Media outlets reported on law enforcement seizures Crack

Cocaine Law enforcement No change and arrests in the region this reporting period. Warren Police Street Crimes Unit (Trumbull County) arrested Treatment providers No change eight people while conducting a raid of a home in Warren and confiscating two ounces of crack cocaine, a quarter ounce of powdered cocaine, a quarter ounce of Participants most often rated the current overall quality of methamphetamine, a half ounce of heroin, an unspecified crack cocaine as ‘8’ on a scale of ‘0’ (poor quality, “garbage”) amount of marijuana, two boxes of hypodermic needles, to ‘10’ (high quality); the previous most common score was firearms, ammunition and cash www.wkbn.com( , July 3, ‘7.’ Participants reported that crack cocaine in the region is 2017). A two-month investigation lead by the Niles Police most often adulterated (aka “cut”) with baking soda and Drug and Street Crimes Unit and Weathersfield Township isotol (dietary supplement). Overall, participants reported Police (both Trumbull County) lead to the arrest of a man that the quality of crack cocaine has remained the same for selling cocaine out of his home in Niles; police raided his during the past six months. One participant shared, “I don’t home and found an unspecified amount of crack cocaine think there has been any change in that.” (www.wkbn.com, Sept. 1, 2017). OSHP in Youngstown (Mahoning County) arrested a man during a traffic stop after the smell of raw marijuana lead officers to search the

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women. People who you wouldn’t think that have $100K a

Cutting Agents Reported by Crime Lab year jobs [use crack cocaine]. I think it’s universal.” Community professionals described typical crack cocaine users as predominantly female and unemployed. Treatment Crack Crack l Cocaine local anesthetics (benzocaine and lidocaine) providers reported: “I usually see unemployed single moms. I think it’s from wanting that level of energy to chase your kids around all day; Your money goes a lot farther with Reports of current prices for crack cocaine were reported by crack cocaine than it does with powdered cocaine.” One law participants with experience buying the drug. Participants enforcement officer stated,It’s “ usually females that we’ve discussed: “It all depends … sometimes you can get it for $75 found … a mix of black and white females.” a gram, sometimes it’s $100 … for a ‘ball’ (1/8 ounce, aka ‘eight ball’), usually it’s $200 to $225; They’ll pay anything to get it.” Reportedly, the most common quantity of purchase is a Heroin gram. Overall, participants reported that the price of crack cocaine has remained during the past six months. Heroin remains highly available in the region. Participants most often reported the current availability of the drug Current Prices for as ‘10’ on a scale of ‘0’ (not available, impossible to get) to Crack Cocaine ‘10’ (highly available, extremely easy to get); the previous

most common score was also ‘10.’ A participant remarked, 1/10 gram (aka “rock”) $10 “It’s easier to get than marijuana.” Community professionals A gram $50-100 most often reported the current availability of heroin as

Crack Crack 1/16 ounce (aka “teener”) $60-75 ‘10;’ the previous most common score was ‘5’ for treatment Cocaine providers and ‘7’ for law enforcement. Treatment providers 1/8 ounce (aka “eight ball”) $200-225 shared: “It’s their drug of choice; For our specific clientele … we focus on opioid addiction, they’re all coming in with it. I An ounce $800 mean it’s rare that someone comes in who’s only used opioid pills without eventually getting to heroin.” Law enforcement Participants reported that the most common routes shared: “Extremely available. Nine times out of 10, the people of administration for crack cocaine are smoking and that are coming into our drug court program or probation intravenous injection (aka “shooting”). Participants [heroin is their drug of choice]; Heroin is our number one estimated that out of 10 crack cocaine users, five would drug that we’ve seen come through our drug court and our smoke and five would shoot the drug. Participants [probation] office; The availability of heroin is a lot easier [as reported: “Most people I know shoot it nowadays; When you compared to prescription opioids] because you don’t have shoot it, you have to use vinegar or Kool-Aid® or lemon juice to go to the doctor and get a prescription … and it’s cheaper.” [to break the drug down for injection].” Some participants shared that users who tend to shoot the drug are more Corroborating data indicated that heroin is available in often heroin users, while anyone may smoke the drug. the region. ODPS reported 14 drug task force seizures of Participants described typical crack cocaine users as of low heroin and/or fentanyl in the Youngstown region during socio-economic status and drug dealers. Participants stated: the reporting period; drug task forces did not typically “Predominantly people in lower income neighborhoods. There differentiate between heroin and fentanyl due to the high are people from richer neighborhoods, but for the most part, incidence of heroin-fentanyl mixtures. lower income; Poverty and drugs go hand-in-hand; You find Media outlets reported on law enforcement seizures and a lot of drug dealers that lace their blunts with crack.” Many arrests in the region this reporting period. Ashtabula participants did not believe there is a typical user for crack Police collaborated with other law enforcement agencies cocaine. These participants shared: “As far as typical goes, to investigate a residence in Ashtabula with known drug I don’t know if there is a typical user; I’ve seen a lot of white activity and arrested 12 people after observing them in people, a lot of African-American people; I think it’s men, the process of intravenously injecting (aka “shooting”)

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 209 Page 8 Surveillance of Drug Abuse Trends in the Youngstown Region heroin, or high from heroin or methamphetamine; officers execution of a search warrant at a residence on the north also found an active methamphetamine laboratory on side of Youngstown, confiscating four bags of heroin, one the second floor of the home and called Ashtabula Fire bag of crack cocaine, pills, drug paraphernalia, a bulletproof Department to neutralize it (www.starbeacon.com, July 7, vest and ammunition (www.wfmj.com, Nov. 24, 2017). 2017). A Boardman Township (Mahoning County) woman A Trumbull County grand jury indicted a man for heroin faced criminal charges for inducing panic after overdosing possession; an investigation lead by the Warren Street in a motel room; officers used Narcan® (naloxone, an Crimes Unit resulted in the arrest of the man for selling opiate overdose reversal medication) to revive her (www. heroin in the area; officers found the man with 1,657 grams vindy.com, July 27, 2017). Youngstown Police arrested a of heroin (www.wfmj.com, Dec. 13, 2017). Warren Police woman after finding her passed out in the driver’s seat arrested a woman for child endangerment after responding of her car with the engine running; officers used Narcan® to a 911 call that the woman and her two young children to revive the woman, and she admitted to officers that were passed out on the floor of their home from a heroin she snorted heroin prior to driving; officers also found overdose; suspected heroin was found on the kitchen a small amount of heroin in the woman’s pocket at the counter within reach of the children (www.wkbn.com, Dec. time of her arrest (www.wkbn.com, July 31, 2017). A 14, 2017). Warren Police arrested a man after observing him Youngstown man plead guilty in Mahoning County at a gas station for an extended period without moving; Common Pleas Court to involuntary manslaughter and officers found the man asleep and woke him when he heroin trafficking for providing fentanyl-laced heroin to a admitted to taking two Klonopin® pills; officers searched friend that resulted in his overdose death; the man faced the man and found heroin in his pocket (www.nbc4i.com, three years in prison and five years of probation upon Dec. 28, 2017). release (www.vindy.com, Aug. 3, 2017). An investigation While many types of heroin are currently available in the lead by the Youngstown Police resulted in the indictment region, participants and treatment providers reported of 22 people by a federal grand jury for conspiring to brown powdered heroin as most available. A participant traffic heroin, powdered cocaine and crack cocaine in the remarked, “If it’s heroin, it’s usually tan or brown.” One Youngstown and Ravenna (Portage County) areas; the treatment provider shared, “Around here, what the clients report indicated that some of the heroin was purchased in tend to say is the type is brown in color. More and more, the Michigan before immediate transport to the Youngstown colors seem to be changing because it’s being laced with so area (www.wfmj.com, Aug. 15, 2017). Youngstown Police many different things.” Law enforcement reported heroin- administered Narcan® to an individual involved in a car fentanyl mixtures as most available in the region. Law crash where an SUV ran into a pole; officers found the enforcement reported: “Something that’s sold as heroin, person outside of the vehicle unresponsive due to an but it’s actually a mix of heroin and fentanyl … in a brown opiate overdose; officers revived the individual before powder form; Although we’re intending to go buy heroin … taking him to a local hospital (www.wkbn.com, Aug. 27, more than half of the time we are going to end up buying 2017). Federal prosecutors in Jefferson County charged a fentanyl …. The person selling is saying it’s heroin. When we man for operating a heroin trafficking ring in Steubenville; get back and test it, we realize it’s more fentanyl than it is the charges came as a result of a three-year investigation heroin; I can’t tell you the last time it was straight up heroin conducted by Youngstown law enforcement; the man come back from the lab.” was sentenced to over six years in prison and eight years of supervised release (www.wtov9.com, Aug. 31, 2017). Participants also reported high availability of white Jefferson County Sheriff’s officers arrested two people powdered heroin, as well as availability of gray and after conducting searches at two different residences in red-colored heroin in the region. Participants indicated Steubenville and seizing an undisclosed amount of heroin that gray heroin is most likely cut with fentanyl, while (www.wtov9.com, Aug. 29, 2017). OSHP in Youngstown red heroin is most likely cut with carfentanil. Treatment arrested a Maryland woman and her passenger during a providers and law enforcement also mentioned different traffic stop on Interstate 76 after finding large amounts colors of heroin as available in the region, including gray, of heroin and cash in their vehicle; the woman admitted pink, purple and tan. A treatment provider reported, “I’ve to officers she was driving to Chicago through Trumbull heard purple is associated with ‘benzos’ (benzodiazepines).” A County to deliver the drugs (www.wkbn.com, Sept. 26, law enforcement officer shared:It’s “ definitely a lighter color, 2017). Youngstown Police arrested a man during the tan or brown, no black tar. We haven’t seen any black tar ….”

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Participants and community professionals reported Cutting Agents that the availability of heroin has remained the same Reported by Crime Lab during the past six months. The BCI Richfield Crime Lab reported that the number of heroin cases it processes has decreased during the past six months; the lab reported l acetaminophen processing gray and tan heroin, and rarely black tar heroin, l carfentanil

although the lab does not typically differentiate between Heroin l cocaine black tar and powdered heroin. l diphenhydramine (antihistamine) l fentanyl and fentanyl analogues Reported Availability Change during the Past 6 Months Reports of current prices for heroin were consistent among participants with experience purchasing the drug. Participants No change Participants commented: “You would go to your dealer and be like, ‘I got 20 bucks,’ and they’d just give you [$20 worth]; Heroin Law enforcement No change If you go to a main dealer, it’s cheaper than the person who’s a middleman that uses.” Reportedly, the most common Treatment providers No change quantity of purchase is a gram. Overall, participants indicated that the price of heroin has decreased during Participants most often rated the current overall quality of the past six months. Participants stated: “The price has gone heroin as ‘3-4’ on a scale of ‘0’ (poor quality, “garbage”) to down; They can’t move the product because people are dying, ‘10’ (high quality); the previous most common score was ‘8.’ so they have so much product that they have to get rid of it.” A participant explained, “Regardless of the color, it’s crappy quality … everybody’s trying to make a quick buck … as Law enforcement comments on heroin pricing included: soon as it changes hands it gets ‘cut’ (adulterated) ….” Other “It’s far cheaper to buy fentanyl [than heroin], and far easier participants noted: “With this fentanyl out, that’s a really to buy it. Less risk … you can order it up off the Internet; They confusing question because nobody ever knows what they’re had a drug bust earlier this year where they confiscated like getting; Even drug dealers don’t know what they’re dealing 30 pairs of Air Jordan’s from this guy’s house, this dealer’s with half the time.” A treatment provider shared, “We’ve had house … people had stolen [the high-end sneakers] and people who say they’re using heroin and they’re not even given them to him as payment for heroin. They’ll take gas testing positive for opiates, so we don’t really know what’s in it.” cards, Visa gift cards, Tide Pods™ … people are stealing from family members to go to the pawn shop to get money to buy Participants discussed adulterants (aka “cuts”) that affect heroin.” the quality of the drug and reported the top cutting agents for heroin as fentanyl and vitamins. Additional Current Prices for cuts mentioned included: aspirin, baby laxatives, ether,

Heroin inositol (dietary supplement), niacin, powdered cocaine, prescription opioids and Sleepinal®. Many participants Powdered: described buying heroin that was actually fentanyl or 1/10 gram $20

heroin mixed with fentanyl. These participants explained: Heroin “You can’t find real heroin anymore around here; We’re calling 1/2 gram $60-70 fentanyl ‘heroin’ now; It’s harder to find powder heroin than A gram $100-120 it is to find fentanyl; There’s no way to measure[the amount of fentanyl in heroin] to where it’s safe … you don’t know While there were a few reported ways of using heroin, whether you’ll ‘OD’ (overdose) or not; I think [fentanyl-heroin generally, the most common route of administration mixtures is] all there is out there … it’s so powerful.” Overall, remains intravenous injection (aka “shooting”). Participants participants reported that the general quality of heroin reported that out of 10 heroin users, nine would shoot and has remained the same during the past six months. one would snort the drug. Participants reported: “I started out snorting it then I got to using the needle (intravenously injecting); I realized I was wasting it by snorting it … you

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 211 Page 8 Surveillance of Drug Abuse Trends in the Youngstown Region feel more of the effects when you intravenously put it in your … that’s probably more prevalent, that’s the most overdoses body. It’s a little more intense … you don’t have to use as we’ve encountered; It usually stays pretty much white males much.” and females, and black females. Every blue moon we might get a black male; Like they say, it doesn’t discriminate … Participants reported that injection needles are most all different backgrounds … religions … people with rich available from drug dealers and people with diabetes. parents who go to church every weekend … people who Additionally, participants reported obtaining needles are married, people who have kids, people who I know from from pharmacies and retail stores; and a few participants growing up. It comes in all shapes and sizes and ages.” mentioned receiving needles from other users, using someone else’s needle, using animal needles, or traveling to Cleveland or Pennsylvania to needle exchange Fentanyl programs. Participants reported: “I used to get mine through people that would go to a drug store. They would just buy a Fentanyl is highly available in the region. pack of them and they would sell them to users … like two Participants most often reported the current for $5; I had a hard time finding needles, they would usually availability of the drug as ‘10’ on a scale of be from my dealer; Some people go buy dog needles; We ‘0’ (not available, impossible to get) to ‘10’ used to be able to go to [retail stores] and say, ‘I need a box (highly available, extremely easy to get); of insulin syringes, 10 cc.’ If you say you’re a diabetic insulin the previous most common score was not reported. user, they’re going to sell them to you. Now you have to have Participants commented: “Everybody wants it. Everybody a prescription for insulin.” Reportedly, the most common got it; You can buy it online; People that are doing heroin get price for needles on the street is $3-5 for one or two a tolerance. The regular heroin’s not doing it for them, so they needles. go to fentanyl … the regular don’t get them high; There’s like Participants discussed sharing and reusing needles as 14 kinds of fentanyl … carfentanil ….” Many participants common practices: “I’d say 9 out of 10 people share needles shared not intentionally buying or seeking fentanyl, but at some point … when you get desperate; I’d always try to testing positive for it on drug screens. clean my needle … hot water and alcohol; If it was my needle, Treatment providers most often reported the current it was just hot water.” Participants reported the following availability of fentanyl as ‘10,’ while law enforcement most concerns with sharing needles: “Hep C (Hepatitis C) is like a often reported it as ‘9;’ the previous most common scores real big one; I had a friend die … they got an infection in their were not reported. Treatment providers reported: “It’s just heart; Blood clots … people get blood clots in their vein that recently come to our area. It’s being mixed in [heroin] a lot. kill them. It’s rare but it happens.” Probably the drug dealer’s mentality is that it gives them a Participants described typical heroin users as white people better high. Most of our clients do not realize they’re having and people who work labor-intensive jobs. Participants fentanyl mixed in with the heroin, and when you tell them, stated: “I think you see more white people, especially around it’s kind of a shocker; From what I hear from clients, it’s a way here; People who have jobs that are hard laborers … a lot to cut what they would think would be heroin to make it last of physical back-breaking work … a lot of those people get longer, to make it intensified, to keep them hooked, to make into prescription pain pills and might get into the heroin … more money.” Law enforcement reported: “The larger dealers factories … warehouse jobs ….” are making more money. You can cut [heroin] a lot more; You can buy it for less and sell it for the same price [as heroin].” Community professionals described typical heroin users as white people and people in their 20s and 30s, while noting Corroborating data indicated that fentanyl is available in an increase in females using the drug. Treatment providers the region. ODPS reported 14 drug task force seizures of reported: “Primarily Caucasian is what we see for the most heroin and/or fentanyl in the Youngstown region during part. But, all ages … we’re talking teenagers in high school; the reporting period; drug task forces did not typically Usually clients that are from the ages of 18 to 35 [years]. differentiate between heroin and fentanyl due to the high incidence of heroin-fentanyl mixtures. Typical clients are usually white Americans; More females than what it used to be.” Law enforcement stated: “If we had to go by a type, then mid to late teens, early 20s, Caucasian

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Media outlets reported on law enforcement seizures and to Youngstown, labeled “pants zipper;” agents confirmed arrests in the region this reporting period. Youngstown the packaged contained 273 grams of fentanyl, and placed Police arrested several people after executing search a tracking device on the package; they traced the package warrants at different residences across Youngstown and to the two men (www.wkbn.com, Nov. 30, 2017). confiscating 25 grams of fentanyl, a bag of crack cocaine, Participants and law enforcement reported that the marijuana, Suboxone®, drug paraphernalia and firearms availability of fentanyl has remained the same during (www.wkbn.com, July 20, 2017). An investigation lead by the past six months, while treatment providers reported the Mahoning County Heroin Overdose Task Force lead increased availability. Treatment providers shared: “They to a man being charged with involuntary manslaughter weren’t getting fentanyl until the last few months. It’s by a Mahoning County grand jury for providing fentanyl becoming as common as opiates in their system; Once we to another man who subsequently died from taking the start to notice a trend of drugs, we start adding it to our drug at a bar in Youngstown; prosecutors also charged drug screens, and we found that almost everyone’s testing the man with trafficking cocaine and corrupting another positive for fentanyl; It’s getting worse. What’s happening with drugs (www.wkbn.com, July 28, 2017). A grand jury now is … we’re seeing more deaths.” The BCI Richfield Crime in Jefferson County indicted a woman for involuntary Lab reported that the number of fentanyl and fentanyl manslaughter for providing fentanyl cut with morphine analogue cases it processes has increased during the past to a man who subsequently died from an overdose six months, while the number of carfentanil cases has at Geneva-on-the-Lake (Ashtabula County) (www. decreased. starbeacon.com, Aug. 25, 2017). A man was sentenced to eight years in prison for providing fentanyl to a pregnant woman who subsequently died after taking the drug; Reported Availability Trumbull County prosecutors also charged the man with Change during the Past 6 Months corrupting another with drugs in regard to the unborn Participants No change child (www.wfmj.com, Sept. 4, 2017). The Columbiana County Drug Task Force and Lisbon Police conducted a Law enforcement No change

search of a residence in Lisbon after receiving multiple Fentanyl complaints of possible drug trafficking; officers arrested a Treatment providers Increase Virginia man after finding 35 grams of fentanyl and eight grams of crack cocaine hidden in a Narcan® kit (www.wfmj. com, Oct. 2, 2017). Cleaning staff at a hotel in Youngstown Participants most often rated the current overall quality found a man dead in his hotel room; the Trumbull County of fentanyl as ‘10’ on a scale of ‘0’ (poor quality, “garbage”) Coroner ruled the death a result of an unintentional to ‘10’ (high quality); the previous most common score fentanyl, heroin and cocaine overdose (www.vindy.com, was not reported. Participants stated: “It’s killer; It’s gotta Oct. 12, 2017). Trumbull County reached a record high for be ‘10;’ Most people will overdose on it.” Participants did not number of overdoses ever experienced in the county in have knowledge of adulterants (aka “cuts”) that affect the a single month, with a total of 195 overdoses recorded in quality of the drug. Participants discussed: “It’s cut with September 2017, all of which were attributed to fentanyl; something. It’s got to be cut to be sold; When I overdosed, I the county experienced 1,113 overdoses as of November had no opiates in my system. It was straight fentanyl; In my 2017 (www.wfmj.com, Nov. 5, 2017). Drug Task Force last three overdoses, when the hospital tested me … straight officers in Columbiana County, along with U.S. Marshals fentanyl.” identified over 100 people responsible for a fentanyl, Reports of current prices for fentanyl were consistent carfentanil, heroin and cocaine trafficking ring during an among participants with experience purchasing the drug. investigation called “Operation Big Oak;” officers arrested Participants indicated that the price of fentanyl is the same two people from Cleveland and took an additional 22 as heroin. Participants reported: “They sell it for the same people into custody; officers claimed this as the largest as heroin; That’s why they’re pushing it because it’s so much drug trafficking case in Columbiana Countywww.nbc4i. ( cheaper and they’re making the same amount of money. So, com, Nov. 7, 2017). Two individuals in Youngstown were they’re like doubling their profit .”… arrested after investigators with Homeland Security noticed a strange package shipped from Shanghai, China

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grams of cocaine laced with mostly baking soda, and a bag of

Current Prices for Fentanyl marijuana (www.wkbn.com, Dec. 11, 2017). Youngstown Police arrested two people on separate occasions in the same home 1/10 gram $20 on the same night after an initial raid of the home yielded 1/2 gram $60-70 topiramate (a medication used to treat nerve pain); officers Fentanyl found five young children in the home and obtained a search A gram $100-120 warrant, where they confiscated tramadol, crack cocaine, marijuana, a firearm and cash www.wkbn.com( , Dec. 15, 2017). While there were a few reported ways of using fentanyl, generally, the most common route of administration is Participants and community professionals identified intravenous injection (aka “shooting”). Participants reported oxycodone, Vicodin® and Ultram® as the most available that out of 10 fentanyl users, all 10 would shoot the drug. prescription opioids in terms of widespread illicit use. A Participants and law enforcement described typical fentanyl participant commented, “Everyone was prescribed [Vicodin®].” users as people who use heroin. Treatment providers Treatment providers reported: “[Ultram®] seems easy to get. additionally noted use among people aged 18-35 years. It just seems like something they are prescribed and they’re learning to abuse it; That one’s real easy … seems like the doctors are giving them tramadol (Ultram®) thinking that it won’t take Prescription Opioids them to any level of addiction, and it is. They’re over taking their medication.” One law enforcement officer shared,Last “ year we Prescription opioids are moderately available for illicit use in seized about 60,000 pills of tramadol.” the region. Participants most often reported the current street availability of these drugs as ‘4’ on a scale of ‘0’ (not available, Participants reported that the street availability of prescription impossible to get) to ‘10’ (highly available, extremely easy to opioids has decreased during the past six months. Participants get); the previous most common score was ‘10.’ A participant commented: “Yeah, it’s a lot harder to find … better regulation, remarked on the decreased street availability of these drugs: fewer doctors, fewer pharmacies willing to fill prescriptions; “Better regulation.” Treatment providers most often reported They’re harder to get. I’m surprised that people are still getting current street availability as ‘5,’ while law enforcement reported them; More doctors are getting busted; The government is it as ‘2-4;’ the previous most common scores were ‘8’ and ‘5-7,’ cracking down on them.” Community professionals reported respectively. A treatment provider stated, “It’s not easy to get that the street availability of prescription opioids has remained … it’s why they’re heading to heroin, or what they think is heroin.” the same during the past six months. A law enforcement officer discussed,It’s “ a lot harder to get the The BCI Richfield Crime Lab reported that the number of pills. It’s not impossible, and if you find the right person that has a oxycodone/acetaminophen (Percocet®), methadone and supply from somewhere, then that supply is usually constant. But, Ultram® cases it processes has increased during the past finding that initial dealer is more difficult than finding a heroin or six months, while the number of hydrocodone (Vicodin®), cocaine dealer.” hydromorphone (Dilaudid®), oxymorphone (Opana®), Corroborating data indicated that prescription opioids are morphine and oxycodone (OxyContin®) cases has decreased. available for illicit use in the region. ODPS reported 13 drug task force seizures of prescription opioids in the Youngstown Reported Availability region during the reporting period. Change during the Past 6 Months

Media outlets reported on law enforcement seizures and Participants Decrease arrests in the region this reporting period. A man was sentenced in Columbiana County Common Pleas Court to 10 months in prison for selling hydrocodone on two separate Opioids Law enforcement No change occasions (www.salemnews.net, Dec. 6, 2017). Youngstown Prescription Police arrested a man during the execution of a search warrant Treatment providers No change at a residence in Campbell (Mahoning County) after the man readily admitted to officers that he had marijuana and “fake cocaine” on him to sell; officers confiscated the substances, which was actually 1.5 grams of crushed methadone pills, 10.4

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Reports of current street prices for prescription opioids were Participants described typical illicit prescription opioid users as consistent among participants with experience buying the drug dealers, people who had an injury and African-American drugs. Reportedly, the majority of prescription opioids sell people. Participants reported: “People that have been injured for $1 per milligram. A participant remarked, “One dollar and were prescribed and then the doctor cut them off so they per milligram, that’s across the board on everything.” Overall, have to find more; Mainly the dealers are into the pills; The dealer participants reported that the price of prescription opioids has is selling to a person with a script of ‘perks’ (Percocet®), so that remained the same during the past six months. person will trade their ‘perks’ for the ‘dope’ (heroin); Most drug dealers do pain pills because they like them, but don’t want to be Current Street Prices for heroin addicts; It’s more the black community. It goes along with Prescription Opioids the marijuana and the ‘syrup’ … the ‘methazine’ (promethazine) with codeine … that’s another prevalent pharmaceutical.” $5 for 4 mg Dilaudid® $10 for 8 mg Community professionals described typical illicit prescription Methadone $7-10 for 10 mg opioid users as white people, males and employed. However, a treatment provider reported: “It’s a wide range. I’ve seen clients in OxyContin® OP $40-50 for 80 mg the last six months that range from the early 20s to late 40s when $5 for 5 mg it comes to pills.” A law enforcement officer reported,White “ males that are employed. There’s not as much of a stigma there

Opioids Percocet® $7 for 7.5 mg if they’re using something that could be prescribed, for one, plus

Prescription $8-10 for 10 mg they have money to buy it. We live in such an industrial area and Roxicodone $1 per milligram it’s easy to get hurt at your job if you’re a male and working in the mill or a factory. Most of them are work-related injuries ….” $2-3 for 0.5 mg Vicodin® $5 for 7.5 mg $5-7 for 10 mg Suboxone®

Participants reported obtaining these drugs for illicit use from Suboxone® is moderately to highly available for illicit use drug dealers, doctors or from someone with a prescription for in the region. Participants most often reported the current them. Participants shared: “I had a prescription … legitimate street availability of Suboxone® in sublingual filmstrip form means. I have a bad back and went to see a licensed doctor … it as ‘9’ and in pill form as ‘3-4’ on a scale of ‘0’ (not available, took a little time for me to get up to the ‘oxy-30s’ (oxycodone 30 impossible to get) to ‘10’ (highly available, extremely easy mg) … I’ve been getting them for quite a while and when I would to get); the previous most common overall score was ‘10.’ run out, I would buy it on the street … people would sell them on Participants reported: “There’s a lot more people that want it the streets so that they could buy heroin; I used to sell them to drug now … the heroin epidemic has grown … there’s a lot more dealers.” Suboxone® doctors popping up, so there’s a lot more people While there were a few reported ways of consuming using Suboxone®; Drug dealers that have heroin have ‘subs’ prescription opioids, and variations in methods of use were (Suboxone®), so that if somebody can’t get heroin … they can noted among types of prescription opioids, generally the get ‘subs.’” Participants reported the most available type most common route of administration for illicit use is oral of Suboxone® as the sublingual filmstrip (aka “strip”) form. consumption. Participants estimated that out of 10 illicit Participants commented: “When the pills were around, I used prescription opioid users, seven would orally consume and the pills, but now I don’t know if you can get those anymore; It three would snort the drugs. Participants reported: “Taking seems like everybody has the strips.” them as you would a pill or grinding them up and snorting; Some people would snort them because it’s a faster effect than eating Treatment providers most often reported the current street them; If it’s a ‘perk’ (Percocet®) or a ‘vike’ (Vicodin®), I chew it up availability of Suboxone® as ‘2-3,’ while law enforcement most and eat it. If it’s a ‘roxi 30’ (Roxicodone® 30 mg), I’m going to ‘shoot’ often reported it as ‘6-7;’ the previous most common scores (intravenously inject) it …. And if it’s an ‘oxy’ (oxycodone), I’m just were ‘10’ and ‘8,’ respectively. Treatment providers discussed: going to cook it up in the spoon so I can shoot it.” “The doctors that I know that prescribe it, prescribe it one at a time or two at a time … they keep it at low levels and are very

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 215 Page 8 Surveillance of Drug Abuse Trends in the Youngstown Region strict about allowing the client to do the Suboxone® program. So, I haven’t seen much abuse of that; I just don’t see it as a problem in Reported Availability my group or groups that I’ve had. The clients I’ve had have chosen Change during the Past 6 Months not to do the Suboxone® program …. They go to a different type of maintenance program, which is called the Vivitrol® shot.” Participants Increase

Law enforcement reported: “It’s so overly prescribed … they Law enforcement No change

don’t need that much. So, they take what they need and sell Suboxone® the rest. We have had multiple people in the last six months Treatment providers No change get revoked or get kicked out of drug court for selling their Suboxone® strips; There are also the cash clinics in the area Reports of current street prices for Suboxone® were … the clinics don’t do strip counts … they don’t do random consistent among participants with experience buying drug screens.” Law enforcement most often reported the the drug. Overall, participants reported that the price filmstrip as the most available type of Suboxone® in the of Suboxone® has increased during the past six months. region. They commented: “Strips. I can’t tell you the last time Participants shared: “They’ve gotten more expensive; Just I saw a pill; It’s what doctors are prescribing.” depends on who you’re going through. Your typical dealer Media outlets reported on law enforcement seizures and would sell it for $20-25; I knew a dealer that would put $10 arrests in the region this reporting period. Youngstown worth of credit toward your heroin [purchase] for your Vice Squad and the Youngstown Community Police Unit Suboxone® as long as it was in the package.” arrested a woman after executing a search warrant at her home in Youngstown and seizing nine Suboxone® Current Street Prices for filmstrips, two bags of crack cocaine, a heroin press and a Suboxone® handgun; two children in the home at the time of the raid were placed into the custody of a relative (www.vindy.com, $5-10 for 4 mg Nov. 3, 2017). Warren Police (Trumbull County) arrested Filmstrip $10-20 for 8 mg a man for drug possession after responding to a call that $30 for 12 mg Suboxone® 30-40 gunshots were fired in a building in the area; during Pill $15-20 (unspecified dose) a search of the building, officers found a man with a pill grinder and pill bottle containing miscellaneous pills, suspected heroin, a hypodermic needle and gun rounds In addition to obtaining Suboxone® for illicit use on in his pocket; officers obtained a search warrant for the the street from drug dealers and Suboxone® clinics, building and arrested the man after finding an additional participants also reported getting the drug through 20 hypodermic needles, 17 Suboxone® doses, 1,160 other users who sell their prescriptions. Participants grams of marijuana, a magazine for an AK-47 and drug commented: “I used to buy it off the street before I came here paraphernalia (www.wkbn.com, Dec. 5, 2017). … I knew people that were in recovery and would want to get rid of them, so I’d buy off of them; A lot of people go to Participants reported that the street availability of clinics and then sell them … so they can get high … or just to Suboxone® has increased during the past six months, while have money to pay their bills; This is a small town, everybody community professionals reported that street availability knows at least one person that has Suboxone® and sells has remained the same. Participants commented: “More them.” Law enforcement officers discussed:Half “ are selling doctors are prescribing; People would rather buy Suboxone® part of their prescription. We’re fully supportive of medically than buy heroin and die.” The BCI Richfield Crime Lab assisted treatment but not forever. It’s just replacing the reported that the number of Suboxone® cases it processes heroin with something else; From what I’ve seen, you have a has increased during the past six months. user who is going through the program but is still using. So, what they’ll do is sell their strips to their dealer in exchange for heroin, and the dealer will go out and sell the strips and make money.”

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Participants reported that the most common route of doctors prescribing them this medication and they know how administration for illicit use of Suboxone® filmstrips to abuse it.” is oral consumption, and the most common routes of administration for illicit use of Suboxone® pills are Corroborating data indicated that sedative-hypnotics intravenous injection (aka “shooting”) and snorting. are available for illicit use in the region. ODPS reported Participants reported: “With the strips, you can melt them six drug task force seizures of benzodiazepines in the down and shoot them or eat them. With the pills, you can Youngstown region during the reporting period. crush them up and shoot them or snort them; Quicker relief. Media outlets reported on law enforcement seizures and People are used to using the needle [to get high].” arrests in the region this reporting period. Youngstown Participants described typical illicit Suboxone® users as Police executed a search warrant at a home on the south heroin addicts. Participants stated: “People who abused side of Youngstown after receiving multiple complaints opiates; Heroin addicts; People in jail … people come in with of drug-related activity; officers arrested three people them [illicitly].” Treatment providers described typical illicit after seizing 44 alprazolam (Xanax®) pills, three bags of Suboxone® users as someone struggling in treatment, marijuana, a bag of crack cocaine and cash; officers also young people, females and white people. Treatment found four young children living in the home and placed providers reported: “A lot of times they’re younger because them into the custody of a relative (www.wkbn.com, Oct. it’s the first go-to medication; It’s usually females and they 12, 2017). range from 21-35 [years of age] … white females.” Law Participants identified Klonopin® and Xanax® as the most enforcement described typical illicit Suboxone® users as available sedative-hypnotics in terms of widespread white males and heroin users. Law enforcement reported: illicit use. Participants reported: “People want [Xanax®]. “It’s been all over the board, but it’s typically white males that Everybody’s got them; People will pay money for [Xanax®]; are using it and selling; Same as users of heroin and fentanyl. [Xanax® is] not hard to get; I got a pretty stable supplier … You have the people who don’t want to quit [heroin], they may person with a prescription [for Klonopin®].” have insurance so they’ll go and get their Suboxone® strips in the program, and then go and sell those or trade those for Community professionals identified Ativan® and Xanax® heroin.” as the most available sedative-hypnotics in terms of widespread illicit use. A treatment provider commented, “[Xanax® is] the most popular. They’re all pretty easily Sedative-Hypnotics accessible.” Law enforcement stated: “Klonopin® is being prescribed more and more …. We don’t typically let our probationers or our drug court participants be on any Sedative-hypnotics (benzodiazepines, barbiturates and ‘benzos’ (benzodiazapines) unless it’s absolutely necessary muscle relaxants) are moderately available for illicit use in for their mental health; [Xanax® is] what the docs are the region. Participants most often reported the current prescribing; The only ones on this list that I’m absolutely street availability of these drugs as ‘6-7’ on a scale of ‘0’ positive are easy to get are Xanax® and Ativan® … Xanax® (not available, impossible to get) to ‘10’ (highly available, especially.” extremely easy to get); the previous most common score was ‘10.’ Participants discussed: “You have to find somebody Participants and community professionals reported that has them … usually they only have them for a day or that the general availability of sedative-hypnotics has two because they sell quick … they’re not that expensive; The remained the same during the past six months. Law doctors around here have gotten really strict about giving enforcement remarked, “[Xanax® has] been around for prescriptions.” a while.” The BCI Richfield Crime Lab reported that the number of carisoprodol (Soma®) and lorazepam (Ativan®) Treatment providers most often reported the current cases it processes have increased during the past six street availability of sedative-hypnotics as ‘7-8,’ while law months, while the number of alprazolam (Xanax®), enforcement most often reported it as ‘3;’ the previous clonazepam (Klonopin®), diazepam (Valium®) and most common scores were ‘7,’ and ‘5-6’ and 10,’ respectively. zolpidem (Ambien®) cases have decreased. Treatment providers commented: “They’re easy to get; I see

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Reported Availability the drugs, participants commented: “When you sniff it, your nose only absorbs like 30% of whatever you’re putting

Change during the Past 6 Months up it … so it’s really a waste; They would crush up the ‘bars’ (Xanax® 2 mg, aka ‘xanie bars’) and put them in NyQuil™; Participants No change They put [Xanax®] on their ‘blunts’ (marijuana-filled cigars).”

Law enforcement No change A profile for a typical illicit sedative-hypnotic user did Sedative- Hypnotics not emerge from the data. Participants were unable Treatment providers No change to describe typical users. One treatment provider described typical illicit sedative-hypnotics users as Reports of current street prices for sedative-hypnotics methamphetamine users. This provider remarked, “Former were consistent among participants with experience meth addicts who suffer from high levels of anxiety. They buying the drugs. Reportedly, sedative-hypnotics most usually see a mental health counselor and they prescribe often sell for $2 per milligram. Overall, participants them things like Xanax® and Klonopin® … I’ve seen a reported that the price of sedative-hypnotics has high increase in that since meth has been around.” Law remained the same during the past six months. enforcement described typical illicit users as white people, and poly-drug users. Law enforcement commented: “More Current Street Prices for Caucasian probably. It’s always with some other kind of Sedative-Hypnotics drug, too …. It’s unusual to make an arrest where you only find Xanax®; We’ve seen that pretty much across the board; It doesn’t get a bad rap like heroin does.” Ativan® $1 (unspecified dose)

$2 for 0.5 mg Klonopin® $2-3 for 1 mg Marijuana $5-6 for 2 mg

Sedative- $3-5 for 5 mg Marijuana remains highly available in Hypnotics Valium® $6 for 10 mg the region. Participants and community professionals most often reported the current $1-1.50 for 0.5 mg availability of marijuana as ‘10’ on a scale of Xanax® $2.50 for 1 mg ‘0’ (not available, impossible to get) to ‘10’ $5 for 2 mg (highly available, extremely easy to get); the previous Participants reported obtaining these drugs for illicit use most common scores were also ‘10.’ Participants stated: from drug dealers, friends and through prescription. A “Everywhere; Everybody smokes [marijuana]; Everyone participant shared, “I’ve been taking benzos my whole life either has it or grows it.” Treatment providers commented: and most of the time I’ve had a prescription for them. I just “Marijuana is at the very top; It’s just so easily available for abuse [the] prescription … [and] I know a couple people who them to get anywhere off the street. It’s their ‘go-to’ [drug] have them prescribed to them, so that’s how I could get them and most of them were raised smoking (by parents using ….” marijuana) and don’t think it’s a problem; They think it’s okay. You can’t overdose on it.” The most common routes of administration for illicit use Corroborating data indicated that marijuana is available in of sedative-hypnotics are snorting and oral consumption. the region. ODPS reported 12 drug task force seizures of Participants estimated that out of 10 illicit sedative- marijuana in the Youngstown region during the reporting hypnotic users, five would snort and five would orally period. consume the drugs. Regarding snorting the drugs, participants reported: “Crush them up and sniff (snort) Media outlets reported on law enforcement seizures and them; [Snorting] hits me faster. Instead of waiting 20-30 arrests in the region this reporting period. The Portage minutes for the pill to get into your system, I’d say about 10 County Sheriff’s Office and the U.S. DEA in Youngstown minutes it would hit me.” Regarding oral consumption of conducted an investigation that lead to the seizure of

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over 400 pounds of marijuana hidden in compartments the drug (aka “dabs”). Participants most often reported of new cars that were shipped to Lordstown (Trumbull the current availability of these alternative forms of County); staff members at a Ford dealership in Portage marijuana as ‘7;’ the previous most common score was County first noticed the drugs during car inspections, ‘10.’ Participants commented: “That’s available; You need and investigators learned cars shipped to Columbiana to know people for that. Certain people don’t know how to and Mahoning counties also contained the drug (www. make it, and they try to make it and blow themselves up …. wkbn.com, July 17, 2017). Canfield Police (Mahoning It’s hard to find people who do it right.” Law enforcement County) uncovered evidence of marijuana trafficking most often reported the current availability of marijuana during an investigation of a residence; officers found glass extracts and concentrates as ‘7-8;’ the previous most jars containing marijuana, materials used to extract THC common score was ‘8.’ Law enforcement discussed: “The (tetrahydrocannabinol, the psychoactive component of most in demand is going to be the high-quality strains marijuana) from marijuana plants and a firearm www.( from medical [marijuana] states … California, Colorado, vindy.com, Aug. 2, 2017). The Ashtabula County Sheriff’s Michigan; With the opinion … the push across the United Office, the Ashtabula County Heroin Overdose Task Force States to legalize [marijuana use], there’s a decreased and several other law enforcement agencies collaborated stigma and an increase in use of marijuana [extracts and to conduct a drug sweep at five different residences concentrates] ….” in Ashtabula, arresting two people and confiscating 418 grams of marijuana, 28 grams of heroin, 24 grams Participants and community professionals reported that of cocaine, four grams of crystal methamphetamine, a the general availability of marijuana has remained the firearm and cash www.starbeacon.com( , Aug. 22, 2017). same during the past six months. However, participants The Trumbull-Ashtabula Group Drug Task Force and indicated that the availability of marijuana extracts and OSHP collaborated after receiving an anonymous tip concentrates has increased during the past six months. of a marijuana grow operation in Saybrook Township Participants stated: “[Dabs are] more readily available (Ashtabula County); officers used an OSHP aircraft to because it’s more popular … people are wanting to smoke locate 75 plants growing in a swamp (www.starbeacon. that more; Because it’s hip, it’s cool; It’s the new thing now. com, Aug. 30, 2017). Youngstown Police arrested two men Everybody’s wanting to try it.” during the execution of a search warrant at a residence The BCI Richfield Crime Lab reported that the number of on the north side of Youngstown, seizing 21 bags of marijuana cases (including “edibles”) that it processes has marijuana, oxycodone, Viagra® and a firearm www.wkbn.( remained the same during the past six months, while the com, Sept. 1, 2017). OSHP in Ashtabula County arrested number of marijuana extracts and concentrates cases it a man from New York during a traffic stop on Interstate processes has increased. 90 after a K-9 officer alerted to drugs in the man’s vehicle; officers seized 300 grams of solid hash (cannabis resin) and three grams of liquid hash (www.wfmj.com, Sept. 25, Reported Availability 2017). Warren Police (Trumbull County) took into custody Change during the Past 6 Months a man with six felony warrants for his arrest; officers found the man in his home and arrested him for marijuana Participants Increase traffickingwww.wkbn.com ( , Dec. 6, 2017). Boardman Police (Mahoning County) arrested a mother of two young Law enforcement No change Marijuana children after searching her home and finding marijuana scattered throughout their house; the woman claimed Treatment providers No change that since she read that marijuana cannot kill anyone, she was not worried about the drug being in reach of her Participant most often rated the current quality of low- children; officers seized a total of 200 grams of marijuana grade marijuana as ‘5’ and of high-grade marijuana as (www.wkbn.com, Dec. 7, 2017). ‘9’ on a scale of ‘0’ (poor quality, “garbage”) to ‘10’ (high quality); the previous most common overall score was ‘10.’ Participants and community professionals discussed A participant remarked, “Depends on the strain … where current availability of high-grade marijuana extracts and you’re getting it from.” Participants most often rated the concentrates, often appearing as oil and waxy forms of current quality of marijuana extracts and concentrates as

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‘10;’ the previous most common score was not reported. all kinds … you heat it up and it’s hot and the oil goes over Participants indicated that the quality of marijuana and it and you put your dab on it and [smoke it]; It has to be marijuana extracts and concentrates have remained the smoked, you can’t eat it; [Smoking is] the only way you can same during the past six months. do it.” Reports of current prices for marijuana were provided by Participants described typical marijuana users as anyone. participants with experience buying the drug. Reportedly, Participants reported: “Everybody, every race; There’s people the most common quantity of purchase is 1/8 ounce who are loyal to ‘pot’ (marijuana) and that’s it; Hippies, high- for marijuana, and a gram for marijuana extracts and school [students], young kids, cancer patients.” Treatment concentrates. Overall, participants reported that the price providers and law enforcement also described typical of marijuana and marijuana extracts and concentrates marijuana users as anyone. Treatment providers reported: have remained the same during the past six months. “I don’t know a client who hasn’t used marijuana on my caseload; A lot of my clients that have abused marijuana Current Prices for are between 18 and 21 [years of age]. They don’t feel like Marijuana they have a problem.” Regarding marijuana extracts and concentrates, a treatment provider shared, “The younger Low grade: population, the dabs are more popular.” Law enforcement remarked: “There’s not really any specific type of person; A blunt (cigar) or a gram $10 [Dabs are] more of a Caucasian thing.” 1/8 ounce $25-25

High grade: Methamphetamine A blunt (cigar) or a gram $20 Methamphetamine is highly available 1/8 ounce $50 in the region. Participants most often Marijuana 1/4 ounce $70-90 reported the current availability of crystal methamphetamine as ‘8’ and of powdered 1/2 ounce $240-250 methamphetamine as ‘8-9’ on a scale of ‘0’ An ounce $300-400 (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common overall Extracts and concentrates: score was ‘6-7.’ One participant stated, “I know six people that sell it.” A gram $60-100 Treatment providers most often reported the overall While there were a few reported ways of consuming current availability of methamphetamine as ‘10;’ the marijuana, generally the most common route of previous most common score was ‘2.’ Treatment providers administration remains smoking. Participants estimated stated: “I hear from clients [that] they begin to use meth just that out of 10 marijuana users, nine would smoke and one to keep going. They don’t use it really to get high … and they would eat the drug. Participants reported: “You’re either find themselves addicted to it; Primarily, it’s to get through going to smoke it or you’re going to cook it and eat it … I the work day; It can be made through household products.” just smoked it; I’d usually get a glass pipe and smoke it out of Law enforcement most often reported the current that or I’d get a glass water bong ….” Participants discussed availability of methamphetamine as ‘5-6’ for the crystal that marijuana extracts and concentrates are most often form and ‘2-3’ for the powdered form; the previous most smoked. Participants estimated that out of 10 marijuana common overall score for methamphetamine was ‘4-6.’ extract and concentrated users, all 10 would smoke this A law enforcement officer discussed:Cartels “ are pushing form of the drug. Participants remarked: “They have these more ‘Mexican ice’ (crystal methamphetamine) over the things called ‘dab rigs.’ It’s like a metal nail that you heat up border along with cocaine and heroin to counteract loss with a torch. They have titanium, they have quartz, ceramic, of revenue from marijuana …. Traditionally, the Mexican

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marijuana is not good quality … they have the mass ability a residence in Struthers (Mahoning County) after finding to grow literally tons and tons of it, but the quality isn’t as the couple cooking methamphetamine in the home with high as the shit they’re growing in California and Colorado young children present (www.wkbn.com, Dec. 1, 2017). now. So basically, there’s an increase in demand for that high- Austintown Police arrested a man for breaking into a hotel quality marijuana, and the cartel isn’t going to lose money, room; a hotel manager called police due to suspicious so they push more ice across to counteract that. That’s the activity; officers found the man in the room watching prevailing theory.” Law enforcement generally reported pornography and in possession of methamphetamine, low availability of powdered methamphetamine due to marijuana and drug paraphernalia (www.wkbn.com, Dec. 6, the amount of work involved in manufacturing the drug in 2017). one’s home or personal space. Participants reported that methamphetamine is available Corroborating data indicated that methamphetamine is in powdered and crystal forms throughout the region. The available in the region. ODPS reported five drug task force powdered form of methamphetamine is typically referred seizures of methamphetamine in the Youngstown region to as “shake-and-bake,” which means users produce the during the reporting period. drug in a single-sealed container, such as a two-liter soda bottle. By using common household chemicals Media outlets reported on law enforcement seizures and along with ammonium nitrate (found in cold packs) and arrests in the region this reporting period. Multiple law pseudoephedrine (found in some allergy medications), enforcement agencies, including the Trumbull-Ashtabula people who make methamphetamine can produce the Group (TAG) Drug Task Force, made over 12 arrests after drug in approximately 30 minutes in nearly any location. executing a search warrant at a house with known drug activity; during the search, officers discovered multiple Participants reported that the availability of powdered people using heroin and selling heroin, and seized large methamphetamine has decreased during the past six quantities of methamphetamine and heroin (www. months, while the availability of crystal methamphetamine starbeacon.com, July 2, 2017). Mahoning County Drug has increased. Participants reported: “[Powdered Task Force officers arrested three people while executing a methamphetamine is] a lot harder to get because they search warrant at a residence in Youngstown after finding stopped selling the Sudafed®; [Crystal methamphetamine is] an active methamphetamine laboratory in the home; getting more popular.” seven children in the home at the time of the arrests were taken to stay with relatives (www.wkbn.com, Aug. 10, Community professionals reported that the availability 2017). Jefferson County Drug Task Force officers arrested a of crystal methamphetamine has increased during the man during a traffic stop in Steubenville after a K-9 officer past six months. Treatment providers reported: “It’s getting alerted to the presence of drugs in the man’s vehicle; worse … a lot of times when they get on a maintenance officers confiscated 30 grams of liquid methamphetamine; (medication assisted treatment) program, the program stops this arrest was the result of a two-month investigation the cravings for heroin, so the next thing they use would which lead to the discovery that the man was shipping be the meth; The reason they use meth with their heroin is approximately 50 grams of methamphetamine from because … when you do heroin you get sick, and it can be Oklahoma to Jefferson County www.heraldstaronline.( very bad. So, in order to avoid that sickness, they start using com, Sept. 29, 2017). Craig Beach Police (Mahoning County) meth.” arrested two people during a traffic stop after finding Law enforcement reported: “There’s a huge increase in undisclosed amounts of methamphetamine, cocaine, crystal; Supposedly, it all comes from Akron … according to heroin and marijuana in their vehicle (www.wfmj.com, Oct. our sources; We busted a lab on the west side of Youngstown 17, 2017). A federal grand jury indicted two men, one from a couple weeks ago … the demand is increasing over the California and one from Minnesota, for transporting 13 past six months for sure; The availability of crystal is way up. pounds of methamphetamine and an unspecified amount If people can buy a product that’s already made that’s far of cocaine in a vehicle into Austintown (Mahoning County); superior to what I can make myself, why would I go through the FBI reported this as the largest methamphetamine the risk of obtaining all the precursor chemicals, run the risk seizure in northeast Ohio to date (www.wfmj.com, Nov. of blowing myself up or burning myself to death, when I can 30, 2017). Mahoning County Drug Task Force officers go down and buy the far superior product that’s already arrested two parents while executing a search warrant at

OSAM Drug Trend Report JuneJanuary-June 2017 - January 2013 2018 Page 221 Page 8 Surveillance of Drug Abuse Trends in the Youngstown Region ready to snort or shoot or smoke, for probably cheaper than Current Prices for what I can manufacture myself?” Methamphetamine The BCI Richfield Crime Lab reported that the number Powdered: of methamphetamine cases it processes has increased during the past six months; the lab reported processing 1/2 gram $25 brown and clear crystal methamphetamine as well as off- A gram $50 white powdered methamphetamine. 1/16 ounce $60 Reported Availability 1/8 ounce $100-150 Change during the Past 6 Months An ounce $1,200

Participants Increase Crystal: 1/2 gram $40-50 Methamphetamine Law enforcement Increase A gram $60-80 1/16 ounce $100 Treatment providers Increase

Methamphetamine 1/8 ounce $250 An ounce $2,000 Participants most often rated the current quality of powdered methamphetamine as ‘3’ and of crystal methamphetamine as ‘7-8;’ the previous most common Participants reported that the most common route of scores were ‘5’ and ‘8-9,’ respectively. Participants administration for methamphetamine remains smoking. discussed adulterants (aka “cuts”) that affect the quality Participants estimated that out of 10 methamphetamine of the drug and reported the following as cutting users, five would smoke and five would intravenously agents for methamphetamine: bath salts and MSM inject (aka “shoot”), snort, or orally consume the drug. (methylsulfonylmethane, a joint supplement). However, Regarding smoking the drug, participants explained: a participant remarked, “It’s hard to cut ‘glass’ (crystal “It’s not as intense; It’s mellower. If I’m up for 10 days, I’d methamphetamine).” Overall, participants reported that the smoke it instead of shooting.” Regarding shooting the quality of powdered methamphetamine has decreased drug, participants discussed: “It’s way more intense; I shot it during the past six months, while the quality of crystal because I liked that it’s intense.” methamphetamine has remained the same. A participant Participants described typical methamphetamine users as said of powdered methamphetamine, “It’s weaker now.” rural, white and working-class people. Participants stated: Reports of current prices for methamphetamine were “I’ve heard it classified as a worker’s drug because it’s super consistent among participants with experience buying the cheap; White people, gay people, trailer park people; It’s a drug. Reportedly, the most common amount of purchase cheaper high that lasts longer. It’s for people who don’t have is 1/2 gram. Overall, participants reported that the price a lot of money; The trailer park thing also has to do with of methamphetamine has remained the same during the making it because you’re not in a neighborhood … usually past six months. on the outskirts [of a town or city].” Treatment providers described typical methamphetamine users as aged 18-40 years, while law enforcement described typical users as white people. A treatment provider remarked, “White male and female, age range between 18 to almost 40 [years].”

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Prescription Stimulants Reported Availability

Change during the Past 6 Months Prescription stimulants remain available for illicit use in the region. Participants most often reported the current Participants No change street availability of these drugs as ‘2’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, Law enforcement No change Stimulants extremely easy to get); the previous most common score Prescription Treatment providers No change was ‘7-10.’ Treatment providers most often reported current street availability as ‘4-5,’ while law enforcement most often reported it as ‘1;’ the previous scores were ‘5,’ Reports of current street prices for prescription stimulants and ‘1-2’ and ‘10,’ respectively. A treatment provider stated, were inconsistent among participants with experience “A lot of them say they need it to focus. Some people want buying these drugs. Participants discussed: “Instant it to lose weight or just to have sustained energy.” One law release go for more, the extended release go for less because enforcement officer remarked,Not “ too much … [we find] a they don’t hit you as hard; I got it for free through a friend.” pill here and a pill there, but nothing [substantial].” Overall, participants reported that the price of prescription stimulants has remained the same during the past six Media outlets reported on law enforcement seizures and months. arrests in the region this reporting period. Youngstown Police arrested a man after observing him throwing bags Participants reported obtaining prescription stimulants of drugs from a second-floor window of a home; officers for illicit use from friends or people with prescriptions for found six Adderall® pills, fentanyl, heroin, crack cocaine, them. Participants stated, “Someone with a prescription that tramadol pills, drug paraphernalia and firearms www.( has ADHD (attention-deficit hyperactivity disorder); I was vindy.com, Nov. 30, 2017). friends with a person [with ADHD] so they would give them to me. I would trade … painkillers [for ADHD medications].” Participants identified Adderall® and Ritalin® as the most available prescription stimulants in terms of widespread Participants reported that the most common routes of illicit use. Participants commented: “Everyone is prescribed administration for illicit use of prescription stimulants are that shit (Adderall®); I liked that it gave me energy. I liked it oral consumption and snorting. Participants estimated because it kept me up. When I was real tired, I would take that out of 10 illicit prescription stimulant users, five would an Adderall®.” Treatment providers identified Adderall® orally consume and five would snort the drugs. and Vyvanse® as most available. Treatment providers Participants described typical illicit prescription stimulant discussed: “[Adderall®] gets prescribed to children a lot. users as college students and middle-aged women. A [Parents are] getting it from their kids or from someone else’s participant remarked: “It’s a soccer mom drug.” Treatment kids; Vyvanse® is an amphetamine and it shows up in our providers described typical illicit users as females, while urine screens … we’re seeing a little trend start to happen.” law enforcement described typical illicit users as college Participants reported that the street availability of students. prescription stimulants has remained the same during the past six months; however, they indicated that the Ecstasy availability of Ritalin® has decreased. A participant remarked, “[Ritalin® availability] is a lot lower than it used to be.” Community professionals reported that the street Ecstasy (methylenedioxymethamphetamine: MDMA, or availability of prescription stimulants has remained the other derivatives containing BZP, MDA, and/or TFMPP) same during the past six months. The BCI Richfield Crime remains available in the region. Participants most often Lab reported that the number of amphetamine (Adderall®) reported the current availability of the pressed tablet cases it processes has increased during the past six form of ecstasy as ‘2’ and of “molly” (powdered MDMA) months, while the number of methylphenidate (Ritalin®) as ‘7’ on a scale of ‘0’ (not available, impossible to get) to cases has decreased. ‘10’ (highly available, extremely easy to get); the previous most common scores were ‘5-8’ and ‘10,’ respectively.

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Regarding ecstasy, a participant reported, “That ain’t a Current Prices for real common drug around here.” Community professionals Molly reported no knowledge of current availability of ecstasy or of molly; the previous most common scores for ecstasy 1/10 gram $10

generally were ‘5’ for treatment providers and ‘2’ for law Molly enforcement. A law enforcement officer commented,No, “ we have not been having issues with that at all.” 3.5 grams $200 Participants reported the availability of ecstasy has remained the same during the past six months, while the availability of Participants reported that the most common route of molly has decreased. One participant shared “[Molly is] lower administration for molly remains oral consumption. than it used to be.” The BCI Richfield Crime Lab reported that Participants estimated that out of 10 molly users, all 10 the number of MDMA (ecstasy/molly) cases it processes has would orally consume the drug. A participant reported, “I increased during the past six months. eat it. It’s a great trip.” Participants described typical ecstasy and molly users as white people in their early 20s and hippies. Reported Availability Change during the Past 6 Months

Participants No change Other Drugs in the Youngstown Region Ecstasy Law enforcement No comment Treatment providers No comment Reported Availability Participants and community professionals listed a variety Change during the Past 6 Months of other drugs as being present in the region, but these drugs were not mentioned by the majority of people Participants Decrease interviewed: hallucinogens (psilocybin mushrooms), Neurontin® (gabapentin) and promethazine (prescription- Molly Law enforcement No comment strength cough syrup). Treatment providers No comment In addition, secondary data sources reported other drugs not mentioned by respondents. The BCI Richfield Crime Lab reported that the number of bath salts Participants discussed the current quality of molly only (synthetic cathinones; compounds containing methylone, and rated it most often as ‘7’ on a scale of ‘0’ (poor quality, mephedrone, MDPV or other chemical analogues, “garbage”) to ‘10’ (high quality); the previous most including alpha-PVP, aka “flakka”) and synthetic marijuana common scores were no reported. Overall, participants (synthetic cannabinoids) cases it processes have increased reported that the quality of molly has remained the same during the past six months. The lab also reported that the during the past six months. number of U-47700 (synthetic opioid) cases it processes Reports of current prices for molly were consistent among has increased to 100 cases during the past six months, participants with experience buying the drug. Reportedly, from 11 cases for the six months previous. the most common quantity of purchase for molly is a gram. Overall, participants reported that the price of molly has remained the same during the past six months. Hallucinogens

Psilocybin mushrooms remain available in the region. Participants most often rated the current availability of psilocybin mushrooms as ‘4’ on a scale of ‘0’ (not available, impossible to get) to ‘10’ (highly available, extremely easy to get); the previous most common score was ‘1-4.’

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Participants commented: “I have some in my freezer right now; I go to the cow pastures and pick them.” Participants Reported Availability reported that the availability of psilocybin mushrooms ® Change during the Past 6 Months has decreased during the past six months. Reportedly, 1/8 ounce of psilocybin mushrooms sells for $40. Participants No change

The BCI Richfield Crime Lab reported that the number Law enforcement Increase

of DMT (dimethyltryptamine), LSD (lysergic acid Neurontin diethylamide), PCP (phencyclidine) and psilocybin Treatment providers No comment mushroom cases it processes has decreased during the past six months. Reportedly, Neurontin® 600 mg most often sells for $0.50, and 800 mg sells for $1. Participants reported that the Neurontin® most common route of administration for illicit use of Neurontin® is oral consumption. Participants described the Neurontin® (gabapentin, an anticonvulsant and nerve pain typical illicit Neurontin® user as a heroin user. Treatment medication) remains highly available for illicit use in the providers reported typical illicit users as anyone, while law region. Participants most often reported the drug’s current enforcement reported typical illicit users as white males, street availability as ‘10’ on a scale of ‘0’ (not available, aged 20-30 years. A treatment provider remarked, “I have a impossible to get) to ‘10’ (highly available, extremely easy number of people who have been given it for anxiety.” to get); the previous most common score was also ‘10.’ Participants explained: “It’s pretty available; You can get it prescribed like that [easily].” Treatment providers most Promethazine often reported the current street availability of Neurontin® as ‘6,’ while law enforcement most often reported it as ‘9;’ Promethazine (prescription-strength cough syrup with the previous most common score was ‘8’ for treatment codeine, aka “lean” when mixed with soda) is moderately providers, with no previous most common score reported to highly available for illicit use in the region. Participants by law enforcement. most often reported the current street availability of the Treatment providers discussed: “A lot of our clients have drug as ‘10’ on a scale of ‘0’ (not available, impossible to been prescribed that … sometimes for anxiety, sometimes get) to ‘10’ (highly available, extremely easy to get); the for restless leg syndrome, sometimes for sleep, sometimes previous most common score was not reported. Law for neuro therapy. A lot of people have started to abuse that. enforcement most often reported the current street That’s changed in the last six months; I think with not being availability of promethazine as ‘6-7;’ the previous most able to take any kind of pain medication with the methadone common score was not reported. A law enforcement that … means a lot of clients are seeking out the Neurontin® officer reported,I “ think you can buy it from the Internet.” because it helps with pain in some aspects … when you’re Participants reported that the availability of promethazine mixing it with certain substances or abusing it, it does have has remained the same during the past six months. a certain high effect.” A law enforcement officer reported, Reportedly, an ounce of the drug sells for $20. Participants “People are getting it prescribed … abusing it or selling it. We described typical illicit promethazine users as drug dealers had two gentlemen who got terminated from the drug court and young people. Law enforcement reported typical [program] for getting Neurontin® prescribed through their illicit users as drug dealers and African-American males. mental health counselor … not using it and exchanging it for Law enforcement commented: “It’s like a drug dealer’s cocaine.” recreational drug. It’s very common to find bottles of it in Participants reported that the street availability of drug traffickers’ homes; It’s for their personal use. We’re not Neurontin® has remained the same during the past six going out and buying this stuff …. [Dealers are] using it months, while law enforcement reported increased street themselves.” availability. A law enforcement officer stated,We “ have a newer mental health provider in this area and they are super big on all of those.”

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similar to those of users transitioning to cocaine use. In addition, treatment providers discussed heroin users using Conclusion methamphetamine in order to combat opiate withdrawal. The BCI Richfield Crime Lab reported that the number Crack cocaine, heroin, marijuana, Neurontin® (gabapentin) of methamphetamine cases it processes has increased and powdered cocaine remain highly available in the during the past six months; the lab reported processing Youngstown region; also highly available are fentanyl brown and clear crystal methamphetamine as well as and methamphetamine. Changes in availability during off-white powdered methamphetamine. Participants the past six months include: increased availability for described typical methamphetamine users as rural, white, methamphetamine; likely increased availability for and working-class people. Treatment providers described powdered cocaine; and possible increased availability for typical methamphetamine users as aged 18-40 years, and fentanyl and marijuana. law enforcement described typical users as white people. Participants discussed increased demand for fentanyl as While participants and community professionals reported more heroin users are exposed to the drug and increase that the general availability of marijuana has remained high their tolerance for opiates. They explained that fentanyl during the past six months, participants indicated that the is far more potent than heroin, thus once a heroin user availability of marijuana extracts and concentrates (oils, experiences the high of fentanyl, it is difficult for the user “dabs”) has increased. Participants referred to dabs use to be satisfied with a heroin high. While participants as the new and “hip” thing to do. The BCI Richfield Crime reported users seeking fentanyl, many participants shared Lab reported that the number of marijuana extracts and not intentionally buying or seeking the drug but testing concentrates cases it processes has increased during the positive for it on drug screens. Treatment providers also past six months. discussed dealers adulterating heroin with fentanyl, often unbeknownst to users, to increase their profits as fentanyl Neurontin® remains highly available for illicit use in the is cheaper than heroin but sells at heroin prices. The BCI region. Participants and community professionals reported Richfield Crime Lab reported that the number of fentanyl that some doctors are now prescribing Neurontin® in lieu and fentanyl analogues cases it processes has increased of opioids for some pain conditions as well as for anxiety during the past six months. and sleep issues. Participants described the typical illicit Neurontin® user as a heroin user. Community professionals reported that the availability of powdered cocaine has increased during the past six Lastly, the BCI Richfield Crime Lab reported that the months. They discussed a migration from heroin to cocaine number of U-47700 (synthetic opioid) cases it processes has as more opiate users become fearful of overdose and death increased to 100 cases during the past six months, from 11 due to fentanyl and carfentanil. Reportedly, users view cases for the six months previous. cocaine use as “safer” than heroin/fentanyl use. Moreover, as more users are treated with Vivitrol®, the demand for cocaine has increased among those receiving medication assisted treatment for opiate use disorder who still desire to get high. Although participants most often reported that the availability of powdered cocaine has remained the same during the past six months, participants discussed that its availability is beginning to increase; they reported increased availability of crack cocaine during the past six months. Participants and community professionals reported that the availability of crystal methamphetamine has increased during the past six months. Reportedly, there’s been an increase in heroin users migrating to the drug for reasons

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