PULSE CHECK Trends in Drug Abuse Mid–Year 2000
Executive Office of the President Office of National Drug Control Policy Washington, DC 20503 NCJ 186747 March 2001 ACKNOWLEDGEMENTS
ACKNOWLEDGEMENTS The Office of National Drug Control Policy (ONDCP) acknowledges the contributions made by the 74 Pulse Check sources who voluntarily prepared for and participated in the in-depth discussions that are the basis for this report. Their names (unless they requested anonymity) appear in an appendix. Information presented in this publication reflects the views of those sources, and not necessarily those of the Federal Government. Marcia Meth, Rebecca Chalmers, Gail Bassin, and the staff of Johnson, Bassin & Shaw, Inc., produce the Pulse Check for ONDCP, under Contract Number 282-98-0011, Task Order Number 008. Anne McDonald Pritchett, Office of Programs, Budget, Research, and Evaluation, ONDCP, serves as the project director and editor for Pulse Check.
All material in this publication is in the public domain and may be reproduced or copied without permission from ONDCP. Citation of the source is appreciated. The U.S. Government does not endorse or favor any spe- cific commercial product. Trade or proprietary names appearing in this publication are used only because they are considered essential in the context of the information reported.
This issue and previous issues of Pulse Check are available online at
NCJ 186747
March 2001 CONTENTS
CONTENTS Highlights ...... 1
Introduction ...... 5
Heroin ...... 7
Cocaine ...... 22
Marijuana ...... 40
Methamphetamine ...... 49
Special Topic: “Ecstasy” and Other Club Drugs ...... 56
Appendix 1: Methodology ...... 63
Appendix 2: Population Demographics in the 20 Pulse Check Sites ...... 66
Appendix 3: National-Level Data Sources Available in the 20 Pulse Check Sites ...... 67
Appendix 4: Pulse Check Sources ...... 67
EXHIBITS Highlights Exhibit 1. How serious is the perceived drug problem? ...... 2 Exhibit 2. How has the perceived drug problem changed between 1999 and 2000? ...... 2 Exhibit 3. What are the most serious drug problems in the 20 Pulse Check communities? ...... 2 Exhibit 4. In which sites has the “most serious” drug problem changed? ...... 3 Exhibit 5. What new problems have emerged or intensified during 2000? ...... 3 Exhibit 6. How available are illegal drugs in Pulse Check communities? ...... 3
Heroin Exhibit 1. How has heroin availability changed (1999 vs 2000)? ...... 7 Exhibit 2. How available are the different forms of heroin? ...... 8 Exhibit 3. How is heroin referred to, and what types of heroin predominate, in different regions of the country? ...... 9 Exhibit 4. Heroin gram prices and purity, by heroin type and city ...... 9 Exhibit 5. What age group is most likely to use heroin? ...... 12 Exhibit 6. How do users administer heroin? ...... 13 Exhibit 7. Where and with whom is heroin used? ...... 15 Exhibit 8. How has heroin use impacted the health of users? ...... 16 Exhibit 9. Where is street-level heroin sold? ...... 19 Exhibit 10. What other drugs do heroin dealers sell? ...... 19 Exhibit 11. Heroin brand names in selected Pulse Check sites ...... 20
Pulse Check: Mid-Year 2000 page iii CONTENTS
Cocaine Exhibit 1. How available is cocaine? ...... 22 Exhibit 2. How has crack cocaine availability changed (1999 vs 2000)? ...... 23 Exhibit 3. Crack cocaine gram prices and purity by city ...... 23 Exhibit 4. How has powder cocaine availability changed (1999 vs 2000)? ...... 24 Exhibit 5. Powder cocaine gram prices and purity by city ...... 25 Exhibit 6. How is crack cocaine referred to across different regions of the country? ...... 25 Exhibit 7. How is powder cocaine referred to across different regions of the country? ...... 25 Exhibit 8. How has the number of novice crack users in Pulse Check sources’ treatment programs changed (1999 vs 2000)? ...... 27 Exhibit 9. What age group is most likely to use crack? ...... 27 Exhibit 10. Where and with whom is crack used? ...... 29 Exhibit 11. Where and with whom is powder cocaine used? ...... 32 Exhibit 12. Where is street-level crack sold? ...... 35 Exhibit 13. What other drugs do crack dealers sell? ...... 35 Exhibit 14. Where is street-level powder cocaine sold? ...... 37 Exhibit 15. What other drugs do powder cocaine dealers sell? ...... 37
Marijuana Exhibit 1. How available are the different forms of marijuana? ...... 40 Exhibit 2. How has marijuana availability changed (1999 vs 2000)? ...... 40 Exhibit 3. Marijuana prices by ounce, by type and city ...... 41 Exhibit 4. How is marijuana referred to in different regions of the country? ...... 43 Exhibit 5. How are different drug users referred to treatment? ...... 44 Exhibit 6. How are marijuana sellers organized? ...... 47 Exhibit 7. Where is street-level marijuana sold? ...... 47 Exhibit 8. What other drugs do marijuana dealers sell? ...... 48
Methamphetamine Exhibit 1. How available is methamphetamine by U.S. region? ...... 49 Exhibit 2. How has methamphetamine availability changed by region? ...... 49 Exhibit 3. Methamphetamine gram prices and purity by region and city ...... 50 Exhibit 4. How is methamphetamine referred to in different regions of the country? ...... 51 Exhibit 5. Where is street-level methamphetamine sold? ...... 54
Special Topic: “Ecstasy” and Other Club Drugs Exhibit 1. How available are club drugs across the United States? ...... 57 Exhibit 2. How available are the different forms of ecstasy? ...... 57 Exhibit 3. Has club drug availability changed between 1999 and 2000? ...... 58 Exhibit 4. Slang terms for club drugs and club drug combinations across the United States ...... 58 Exhibit 5. Ecstasy prices per pill by region and city ...... 59 Exhibit 6. Where do ecstasy users tend to live? ...... 60 Exhibit 7. Where is street-level ecstasy sold? ...... 61 Exhibit 8. How are ecstasy pills labeled in reporting Pulse Check cities? ...... 61 Exhibit 9. Club drug user and seller characteristics ...... 62 page iv Pulse Check: Mid-Year 2000 HIGHLIGHTS
MID-YEAR 2000 PULSE CHECK HIGHLIGHTS
Unlike previous issues of Pulse Check, ! Crack and powder cocaine: " Law enforcement sources this issue reports on changes between indicate that sellers span a wide " Availability is stable in the 1999 and 2000. Future Pulse Checks age range but are predominantly majority of sites. will be issued by the Office of adolescents and young adults. " Only a few isolated changes are National Drug Control Policy " Sellers are usually users, as reported in user groups. Some (ONDCP) twice annually. The current reported by law enforcement young people are increasingly report is based on discussions with sources in nearly every site, but abusing powder cocaine, epidemiologists, ethnographers, law are seldom involved in violence. enforcement officials, and methadone sometimes as a club drug, as ! Methamphetamine: and non-methadone treatment noted by sources in Boston, providers. More specifically, 74 tele- Columbia (South Carolina), " Availability has increased in phone discussions were conducted Denver, Los Angeles, Memphis, numerous sites, particularly in between September and October Miami, and New Orleans. the West, but findings are mixed 2000. Based on these conversations, " While epidemiologic and elsewhere. two key features characterize an ethnographic sources report " Lab seizures have increased, otherwise stable illicit drug problem few signs of crack initiation, often due to increased targeted in comparing 1999 and 2000. treatment sources in 10 cities, law enforcement efforts. spanning all regions of the " While the methamphetamine ! An emerging club drug scene country, report increases in scene is generally a rural continues to grow across the novice use of crack. phenomenon, it has started Nation. " Street-level crack and powder spreading to some suburban and ! In some cities, heroin has cocaine sellers usually use their inner-city areas, as in Seattle. increased in supply, in purity lev- own drug and are often involved " Demographic shifts are noted, els, and in the number of users. in violence, according to law such as an increase in metham- enforcement sources in nearly Following are the highlights of phetamine use among women in every site. findings on heroin, cocaine, Denver and Honolulu, increased marijuana, methamphetamine, club ! Marijuana: adolescent use in Los Angeles, and the initiation of use in New drugs, and prescription drug abuse. " According to law enforcement, York’s gay community. epidemiologic, and ethnographic ! Heroin: " sources, availability is stable in Route of administration varies widely across sites, and some " In several areas, sources note the majority of sites; however, shifts are noted. increases in supply, purity, potency has increased in at least aggressive marketing strategies, seven cities, mostly due to ! Club drugs: and indoor selling. improved cultivation techniques, " Availability of club drugs has " such as hydroponic growing of Several increases are noted in increased dramatically across the marijuana. the numbers of younger people, Nation, especially for ecstasy, " often suburbanites, starting to Users span a wide range of age, which has increased in nearly use the drug, usually via racial/ethnic, gender, socioeco- every city. snorting. nomic, and residence groups, " Ketamine availability is " with adolescent users often In New York and Portland increasing in most cities, whereas outnumbering young adult users. (Maine), some adolescents are gamma hydroxybutyrate (GHB) reportedly shifting from snorting and flunitrazepam (Rohypnol) is to injecting as the primary route concentrated in the South and of administration. West, where availability trends are mixed.
Pulse Check: Mid-Year 2000 page 1 HIGHLIGHTS
" Club drug users and sellers How serious is the perceived Exhibit 2. How has the perceived tend to be young, white, middle- drug problem? (Exhibit 1) Among drug problem changed between class males and females who use the Pulse Check sources, 73 discussed 1999 and 2000? or sell the drugs in combination their perception of how serious the Percent (N=73) 100 with other drugs, such as illegal drug problem was in their 90 hallucinogens, cocaine, heroin, communities during 2000. The 80 marijuana, methamphetamine, majority (71 percent) describe the 70 and prescription drugs. problem as “very serious,” and about 60 50 " Club drug activity generally one-quarter (27 percent) consider it 40 occurs in suburban areas, to be “somewhat serious.” Only one 30 although ecstasy activity is source (in El Paso) describes drugs as 20 a “not very serious” problem in the 10 moving to urban areas as well. 0 community. No one considers drugs Much Same No Longer a " Ecstasy user and seller groups “not a problem.” Worse Concern are also expanding to include Somewhat Less Serious Worse more blacks and Hispanics, and Exhibit 1. How serious is the use and sales settings continue to Sources: Epidemiologic, ethnographic, perceived drug problem? treatment, and law enforcement respondents expand from exclusively night- Percent (N=73) What are the most serious drug clubs and raves to high schools, 100 streets, and open venues. 90 problems in the 20 Pulse Check " As the ecstasy supply increases, 80 communities? (Exhibits 3 and 4) the use of ecstasy adulterants, 70 Cocaine is most commonly described especially other stimulants, is 60 as the most serious drug problem, 50 also increasing. especially in terms of adverse conse- 40 quences. Sources, however, tend to ! 30 Prescription drugs: combine both crack and powder 20 " ® OxyContin : This long-acting 10 cocaine into one category. If those form of the opiate oxycodone, 0 two cocaine forms could be separated, Very Some- Not it is possible that heroin would equal prescribed for severe pain, is Serious what Very abused in some areas, such as Serious Serious or even surpass crack as the most serious drug problem. Portland, Maine. Recently, it has Sources: Epidemiologic, ethnographic, been involved in numerous over- treatment, and law enforcement respondents Exhibit 3. What are the most doses and prescription altering serious drug problems in the 20 schemes in Portland, especially How has the perceived drug Pulse Check communities? in rural areas. problem changed between 1999 Percent (N=70) " Viagra® (sildenafil citrate): Use and 2000? (Exhibit 2) In comparing 100 of this drug with methampheta- the two reporting periods, nearly half 90 mine has resulted in medical (45 percent) of the 73 responding 80 consequences in the Los Angeles sources describe their community’s 70 drug problem as “unchanged.” About 60 Most gay community. It is also used serious with club drugs in that city to one-third (36 percent) consider the 50 Second gain a “better bump.” situation to have worsened somewhat, 40 most and 16 percent feel the problem has 30 serious gotten much worse. Only two sources 20 (in Memphis and New York) perceive 10 that their community’s drug problem 0 Heroin Marijuana has become less serious. Cocaine Methampetamine
Sources: Epidemiologic, ethnographic, treatment, and law enforcement respondents page 2 Pulse Check: Mid-Year 2000 HIGHLIGHTS
Marijuana is perceived as the most Exhibit 5. What new problems have emerged or intensified during 2000? serious drug problem by seven Club drugs Methamphetamine Prescription Drugs sources in six cities (Billings, Boston, E,M E Boston, MA Birmingham, AL Billings, MTE Columbia, Denver, Los Angeles, and L,E N Chicago, IL Denver, CO Boston, MAN Sioux Falls), and methamphetamine is E,M E Columbia, SC Philadelphia, PA L,E considered the most serious drug Portland, ME Denver, COL Seattle, WAM problem by another seven sources in Detroit, MIE Sioux Falls, SDE Marijuana three cities (Billings, Honolulu, and El Paso, TXE Honolulu, HIE Sioux Falls). Honolulu, HIN Heroin Washington, DCE N Exhibit 4. In which sites has the Los Angeles, CAL,E Billings, MT N “most serious” drug problem Memphis, TNL Birmingham, AL Crack N L changed? Miami, FLE,M Columbia, SC Billings, MT L New Orleans, LAL,E Miami, FL Site/Source 1999 2000 New York, NYL,E E Detroit, MI Cocaine Heroin Philadelphia, PAE New Orleans, LAL,E Cocaine Heroin Portland, MEN Portland, MEL Cocaine Heroin Seattle, WAL,E Birmingham, ALE Heroin Cocaine Sioux Falls, SDL,M El Paso, TXE Heroin Cocaine Washington, DCL
L Law enforcement respondents L Law enforcement respondents N Non-methadone treatment respondents E Epidemiologic/ethnographic respondents E Epidemiologic/ethnographic respondents M Methadone treatment respondents
In only five Pulse Check sites do any Heroin is named as an emerging by cocaine, then heroin. As reported sources perceive a change between problem by sources in four sites: in previous Pulse Checks, metham- 1999 and 2000 in the drug that pres- Billings, Birmingham, Columbia, phetamine continues to be the least ents the most serious problem: heroin and Miami. widely available of the four major replaced cocaine as the most serious illegal drug groups, with supply Marijuana is named in two sites drug problem according to sources in remaining concentrated heavily in the (more as an intensifying, rather than three cities (Detroit, New Orleans, western Pulse Check sites (Billings, an emerging, problem): Honolulu and Portland); and, conversely, Denver, Honolulu, Los Angeles, and and Washington, DC. cocaine replaced heroin as the most Seattle). serious drug problem according to Crack is described as an emerging Exhibit 6. How available are sources in Birmingham and El Paso. problem by only one source, in illegal drugs in Pulse Check Billings. communities? What new problems have emerged or intensified during Percent Abuse of prescription drugs is named 100 2000? (Exhibit 5) Club drugs, Widely as the most serious emerging problem 90 available particularly “ecstasy” (methylene- in three sites: Billings, (particularly 80 dioxymethamphetamine, or MDMA), Somewhat sedatives); Birmingham, and Portland, 70 available are named as the largest emerging 60 (OxyContin). Not very 50 illicit drug problem in all but two available 40 sites: Billings and Birmingham. How available are the major 30 illegal drug groups in Pulse Methamphetamine is a distant 20 Check communities? (Exhibit 6) second, with sources in five sites, 10 Marijuana, by far, is the most widely 0 spanning all census regions, naming Heroin Cocaine Marijuana Metham- available illicit drug, according to law it as an emerging problem. (N=31) (N=31) (N=35) phetamine enforcement, epidemiologic, and (N=35) ethnographic sources. It is followed Sources: Law enforcement, epidemiologic, and ethnographic respondents
Pulse Check: Mid-Year 2000 page 3 INTRODUCTION
INTRODUCTION Check has been and continues to be across the four census regions; merely to describe patterns in illicit representation of both rural and Since 1992, the Office of National drug use and illicit drug markets that urban areas; and overlap with Drug Control Policy (ONDCP) has are emerging in local communities. other sources such as ONDCP’s published the Pulse Check, a source for High Intensity Drug Trafficking timely information on drug abuse and Enhancements to Pulse Check Area (HIDTA) sites. drug markets. The report aims to describe hardcore drug-abusing popu- As in the past, the Pulse Check data ! New sources plus past sources lations, emerging drugs, new routes of collection methodology has involved to provide a more comprehen- administration, varying use patterns, telephone discussions with three types sive snapshot of hardcore drug changing demand for treatment, drug- of sources: law enforcement officials; abuse problems—As detailed in related criminal activity, the Methodology appen- and shifts in supply and The 20 Pulse Check Sites dix, new sources were distribution patterns. recruited based on a Pulse Check regularly range of selection crite- addresses four drugs of ria and identification serious concern: cocaine, strategies. To preserve marijuana, heroin, and continuity—since much methamphetamine. of the information is Additionally, the current qualitative and relies on issue provides informa- the source’s observa- tion on the emerging tions of patterns and problem of “ecstasy” trends—many of the (methylenedioxymetham- selected individuals are phetamine, or MDMA) also past Pulse Check and other club drugs. sources. The Pulse Check is not ! Data collection designed to be used as a law enforce- epidemiologists and ethnographers; enhancements— Past Pulse Check ment tool but rather to be a research and treatment providers from selected discussion guides were enhanced report presenting findings on drug sites across the country. Additionally, with probing questions to elicit use patterns and drug markets as the current Pulse Check issue reflects more explanations and insights reported by ethnographers, epidemi- the latest in ONDCP’s ongoing effort into the data and ologists, treatment providers, and law to enhance the project and keep up policy-relevant issues, as further enforcement officials. With regards to with the changing nature of the described in the appendix. race and ethnicity, just as the Nation’s drug abuse situation in several ways: National Household Survey on Drug ! A “new look” for the report— Abuse and other national data sources The new report format was ! Expansion of study sites— report findings by race and ethnicity, designed to visually integrate Using a systematic site sampling sources contributing to the Pulse the qualitative and quantitative plan, described in the Methodology Check are asked to describe the age, information gathered. ethnicity, and gender of illegal drug appendix, 20 study sites were users and those who sell drugs and selected, as highlighted on the map Use and Interpretation of Pulse any changes in these characteristics. above. Check Information The information provided to Pulse Some of these cities are past Pulse By contacting professionals from Check reflects the observations of the Check sites, some are new ones. different disciplines—ethnography/ sources, and their descriptions are These sites reflect several enhance- epidemiology, law enforcement, and purely for determining the size, ments: greater geographic diversity treatment—a rich picture of the scope, and diversity of the drug than in the past; distribution changing drug abuse situation problem. The intent of the Pulse emerges. Though this approach offers
Pulse Check: Mid-Year 2000 page 5 INTRODUCTION
substantial strengths in timeliness and number (N) of respondents to any the various regions of the country. depth, Pulse Check is not a measure one question might be less than 74. These individuals discussed their of the prevalence of drug abuse or its perceptions of the drug abuse consequences. As an anecdotal source Any contradictory reports within an situation as it was during the first 6 of information, any interpretation or individual site are not necessarily a months of 2000 and in comparison conclusion drawn from Pulse Check Pulse Check limitation. Just as the site to the same 6 months in 1999. must be viewed carefully and in con- sampling methodology was designed junction with other more quantifiable to reflect the country’s geographic The law enforcement sources who direct and indirect measures of the and population diversity, recruiting provided information include 19 drug abuse problem. four sources per site was incorporated narcotics officers from local police into the design to reflect diversity departments, field office agents of the More specifically, several of the within each of the 20 sites. For exam- Drug Enforcement Administration limitations of Pulse Check are briefly ple, a law enforcement source in one (DEA), and representatives of High discussed below. site might perceive cocaine to be the Intensity Drug Trafficking Areas community’s most serious problem, (HIDTAs). The epidemiologists and ! Pulse Check is limited to a report while an ethnographic source at that ethnographers are 20 researchers on the drug abuse situation in 20 same site might consider the most associated either with local health specific sites throughout the serious problem to be heroin. And departments, university-based Nation. Though considerable they would both be right—because research groups, or other community effort was made to select sites each might come in contact with health organizations. Some of those across a broad range of geographic different populations or each might 20 individuals are qualitative areas, including Census regions deal with a specific geographic researchers who employ ethnographic and divisions, urban and rural neighborhood. techniques to obtain observational States, racial/ethnic coverage, and data directly from the drug user’s high intensity drug trafficking Information from treatment sources world; others are epidemiologists areas, Pulse Check cannot be is particularly susceptible to variance who access both qualitative and viewed as a national study, and because some facilities target specific quantitative data. The treatment information cannot be reasonably populations. Furthermore, treatment sources are 34 providers (from 19 aggregated up to a national level. providers from methadone and non- non-methadone programs and 16 methadone programs are likely to methadone programs) randomly ! Of the 80 sources identified have very different perspectives on selected for each site from the 1998 and recruited across the three their communities’ drug problems Uniform Facility Data Set (UFDS). disciplines, 74 provided informa- because their respective clientele dif- tion for this Pulse Check issue. The fer in the nature of their drug prob- These sources offer a wealth of information presented in this report lems. It is for this reason that two information that, when taken is based solely on the observations treatment sources were selected from together, provides a comprehensive and perceptions of those 74 indi- each of the 20 sites—one from a snapshot of drug abuse patterns in viduals. These individuals may not methadone program, and one from a communities across the country. be knowledgeable about every non-methadone program. Taken Further, these individuals provide aspect of the drug abuse situation together, all four sources at each site expertise that can alert policy makers in their sites, and they may have provide a richer picture of the drug to any short-term changes or newly biases based on their experiences problem’s nature. emerging problems concerning specific and exposures. drugs, drug users, and drug sellers. Current Sources and Reporting ! Due to the comprehensive nature Periods The appendices at the end of this of the telephone discussions, The current report includes report provide a list of these sources, sources were asked to discuss only information gathered during describe the methodology used to areas in which they were thorough- September and October 2000 from select them, and discuss the content ly knowledgeable. Thus, the total telephone conversations with 74 of the approximately 1-hour sources, representing 20 sites across conversations held with them. page 6 Pulse Check: Mid-Year 2000 HEROIN
TRENDS IN DRUG USE: 1999 VS 2000 HEROIN: THE PERCEPTION Exhibit 1. heroin as widely available in their How has heroin availability communities, and 32 percent (n=10) How serious a problem is heroin changed (1999 vs 2000)?* report it as somewhat available. Only in Pulse Check communities? in Sioux Falls is heroin reported as During 2000, heroin was perceived as not very available (by the epidemio- the most serious drug problem by 19 logic source) or not available at all sources in 8 Pulse Check cities (26 (by the law enforcement source). percent of 70 responding sources): Los Angeles and Seattle in the West; E Has heroin availability changed? Detroit in the Midwest; Columbia Billings, MT L,E (Exhibit 1) Nearly half (45 percent) (South Carolina) and New Orleans in Birmingham, AL Chicago, ILL of the 29 responding epidemiologic, the South; and Boston, Philadelphia, El Paso, TXE ethnographic, and law enforcement and Portland (Maine) in the Northeast. Honolulu, HIL sources perceive that heroin availa- It ranked second only to cocaine (all E Miami, FL bility increased in their communities forms). Furthermore, heroin was con- L,E New Orleans, LA from 1999 to 2000, while 55 percent sidered the second most serious drug L,E Portland, ME (17 sources) perceive that availability problem by 20 percent of Pulse Check E Seattle, WA remained stable. No declines are sources (N=66). Finally, it was seen L Washington, DC reported. According to epidemio- as an emerging problem drug by 4 logic and ethnographic sources, sources in 4 cities, 3 of which are heroin availability increased in in the South (8 percent of 52 L,E L seven sites, four of which are reporting sources): Billings, Boston, MA Miami, FL Columbia, SCL,E New York, NYL southern (Billings, Birmingham, Columbia, Denver, COL,E Philadelphia, PAE Birmingham, El Paso, and Miami. El Paso, TXL St. Louis, MOL,E Miami, New Orleans, Honolulu, HIE Sioux Falls, SDL,E Portland, and Seattle); law Has the perception of Los Angeles, CAL Washington, DCE enforcement sources report the heroin problem increases in six sites changed between 1999 and (Birmingham, Chicago, Honolulu, 2000? L Law enforcement respondents New Orleans, Portland, and In comparing the two reporting E Epidemiologic/ethnographic respondents Washington, DC). periods, sources citing heroin as the *Sources in Detroit did not respond. most serious drug problem in their drug problem. Heroin was reported What kind of heroin is available communities increased from 22 to 26 as an emerging drug problem during across the country? (Exhibits 2 percent. Furthermore, during the cur- the current reporting period by and 3) South American (Colombian) rent reporting period, four sources sources in Billings, Birmingham, white and Mexican black tar heroin reported that heroin replaced cocaine Columbia (all non-methadone are the most common types of heroin (all forms) as the most serious drug treatment providers), and Miami (law in Pulse Check cities, cited as widely problem in their communities: the enforcement source). available by eight and seven sources, epidemiologic source from Detroit, respectively, and as somewhat both the epidemiologic and the law HEROIN: THE DRUG available by five and eight sources, enforcement sources from New Availability, Purity, and Price respectively. Orleans, and the law enforcement source from Portland. Conversely, How available is heroin across epidemiologic and ethnographic the country? Of the 31 law sources in Birmingham and El Paso enforcement, epidemiologic, and reported that cocaine (either form) ethnographic sources discussing this replaced heroin as the most serious question, 61 percent (n=19) report
Pulse Check: Mid-Year 2000 page 7 HEROIN
Exhibit 2. What are street-level heroin How available are the different forms of heroin? prices across the country? (Exhibit 4) Street-level heroin prices Percent tend to be similar across the country 70 regardless of heroin type. During 60 Widely Somewhat Not Very 2000, heroin prices ranged from $70 Available Available Available to $300 per gram in reporting areas, 50 with Mexican black tar ranging from 40 $90 to $300, Mexican brown ranging from $75 to $150, and Colombian 30 white ranging from $75 to $300. The 20 most common unit of street sale in reporting cities is a bag (unspecified 10 amount) of heroin, which sells from 0 $5 to $30. Packaging of heroin sold Heroin Colombian Mexican Mexican brown at the street level ranges from (any form) (N=25) black tar (N=25) $20–$25 per bindle (about 1/34 (N= 31) (N=25) gram) in Columbia, to $2 per 2-cc needle in Miami, and $20 per Sources: Law enforcement, epidemiologic, and ethnographic respondents “fix” in El Paso.
How is heroin referred to across Colombian heroin is a high-purity, Has street-level heroin purity the country? (Exhibit 3) Street names snortable heroin most common in changed? the Northeast; Mexican black tar throughout the United States often heroin is a lower purity, injectable Heroin purity increased in eight sites vary by geographic region and by type and declined in two from 1999 to heroin most common in the West of heroin. However, some terms, such 2000: and South. Heroin forms in the Midwest vary widely and may include Colombian, Mexican, Have street-level heroin prices changed? Southeast Asian, and Southwest Boston, MA Asian. Chicago, IL El Paso, TX Only a few changes in heroin prices Columbia, SC Seattle, WA were reported from 1999 to 2000: How pure is heroin across the Denver, CO country? (Exhibit 4) Street-level Detroit, MI Colombian heroin ranges from 25 to Honolulu, HI Denver, CO 80 percent pure, and typically is at Memphis, TN Honolulu, HI the higher end of that range. Miami, FL Memphis, TN Chicago, IL Street-level Mexican black tar heroin Miami, FL El Paso, TX ranges from 14 to 60 percent pure, Purity may be increasing in several according to Pulse Check sources, areas along with increases in supply with the highest purity occurring (availability) and increasingly aggressive Street prices often decline due to marketing, according to law enforce- near the U.S.-Mexican border in increases in supply. According to Pulse ment, epidemiologic, and ethnographic El Paso. Check sources, heroin prices declined sources. due to increased supply (availability) in Denver, Honolulu, and Miami. However, in Chicago, heroin prices increased, as did its availability and use.
page 8 Pulse Check: Mid-Year 2000 HEROIN
as “horse” and “H,” are common Exhibit 3. across regions. Street names (slang) How is heroin referred to, and what types of heroin predominate, and brand names (dealer designations) in different regions of the country? are often interchangeable, as is the case NORTHEAST WEST in New York and Washington, DC. MIDWEST Horse, H, (Note: Brand names are further smack, Tar, chiva, boy, dope, discussed later in this chapter, under dope, “cheeba, sheeba, nurse. shiva,” Boy, blow, blows, “How is heroin packaged and raw, horse, H, marketed?”) New heroin names brown, smack, H, smack. dope, stuff, s_ _t, encountered during 2000 included cheese, horse, “cheese” in Denver (referred to by brown sugar, carga, Washington, youth) and “thanie” in Washington, down. DC. DC. A particularly wide range of street names is reported by sources in Jerry Springer, Washington, DC, which is located on orange line, the outer edge of the South Region. Tar, chiva, boy brown tape, 747, blue bag, What adulterants are added to yellow bag, SOUTH brown bag, heroin? Heroin adulterants cited by silk, blue, law enforcement, epidemiologic, and Horse, H, boy, foil, steel, no Mostly Mexican ethnographic sources include baby smack, carga, heron, name, 2000, black tar available sheeba, shiva, chiva, scramble powder, scapolamine, lactose, manite, papers, mud, tar, (adulterated), strychnine, baking soda, manitol, Mostly Colombian black powder, snort (pure), isotol, quinine, procaine, powdered white available dogfood, s_ _t, thanie, chiva dope, junk. white, mud, rug cleaner, cocaine, lidocaine, and Heroin type varies H, dope. ketamine. In Washington, DC, laxatives are often added to heroin Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents that has been adulterated with manite to assuage its constipating effects, Exhibit 4. and meat tenderizers used as Heroin gram prices and purity, by heroin type and city* adulterants may cause skin abscesses. CITY GRAM PRICE PURITY In Pulse Check sites with highly pure snortable heroin, adulterants are Mexican black tar El Paso, TX $80–$160 60% few or nonexistent. Honolulu, HI $125–$200 20–30%
Heroin adulterants have changed Los Angeles, CA $150–$300 25% in several cities between 1999 Seattle, WA $90–$120 14–58% and 2000: St. Louis, MO $100 NR Mexican brown ! Columbia, SC: Scapolamine has Chicago, IL $150 NR decreased as a heroin adulterant. New Orleans, LA $75 7% ! Miami, FL: Use of adulterants has South American increased; virtually any white powder (Colombian) white is being used as a heroin adulterant. Miami, FL $100–$200 70–80% ! Seattle, WA: There has been a New York, NY $70–$95 25–70% perceived increase in adulterants. Philadelphia, PA $75–$300 70–75% ! Washington, DC: Purity has Sources: Law enforcement, epidemiologic, and ethnographic respondents increased, and use of adulterants has *Respondents in 10 sites did not provide this information. decreased.
Pulse Check: Mid-Year 2000 page 9 HEROIN
HEROIN: THE USERS themes emerge, all involving increases: twenties) comprising a smaller Who, Where, How, and With What? in younger populations, in recreational proportion of users in those sites. heroin use, in snorting, in suburban However, younger adults (age 18–30) How have heroin users changed use, and in overdoses among younger are more likely than older adults to across the country between 1999 adults (age 18–30). use heroin in Billings, Birmingham, and 2000? Epidemiologic, ethno- El Paso, Los Angeles, and New graphic, and treatment sources in 13 of How old are heroin users? Orleans. Teenage use is reported in Pulse Check’s 20 cities perceive numer- (Exhibit 5) According to epidemiologic several cities, including Los Angeles, ous changes in various heroin-using and ethnographic sources in the Miami, New Orleans, Portland (where populations and the ways they use the majority of Pulse Check sites, particu- the numbers are still low), Seattle, drug. No user changes, however, are larly in the Northeast and Midwest, Sioux Falls, St. Louis, and Washington, reported in Billings, Birmingham, the people most likely to use heroin DC; increases in use by teens is Columbia, Memphis, Philadelphia, are generally older than 30, with reported in Los Angeles, New Orleans, Seattle, or Sioux Falls. Several common younger adults (generally in their New York, and Portland.
Then and Now: How have heroin users changed across the country (1999 vs 2000)?*
According to epidemiologic and ethnographic According to treatment sources... sources... THE NORTHEAST A new cohort of suburban snorters, first reported Boston, Younger users are increasingly snorting heroin, using it about 3 years ago, continues to grow. MA casually, and experimenting with dangerous drug combinations, including heroin plus PCP.
While the larger established heroin user groups remain New York, There is an increase in younger adult heroin users due to its relatively stable, some new groups are emerging. For NY easy accessibility. They view heroin as a social drug instead example, young suburban adolescents are increasingly of a back alley drug. Younger adults are also getting more initiating use by snorting, and some are shifting to involved in selling heroin. injection use; and Russian youths in their late teens and early twenties, residing in inner-city neighborhoods, are increasingly “shooting” heroin.
Some younger teens have been experimenting with Portland, Heroin use has increased noticeably among young adults. heroin for the past few years. This shift has continued ME Although males are the primary users, female use to increase during the past year. Also in that city, older is increasing. males have been introducing heroin to younger females.
THE MIDWEST Reports suggest more younger users, more suburban Chicago, Heroin use is increasing among younger adults. Snorting users, and more injecting (but snorting still predominates). IL has become more common than injecting as availability continues to increase. Drug overdoses have increased.
Heroin deaths increased in suburban Macomb County. Detroit, Heroin is more available to younger suburban users. New use among young suburbans is a potentially MI Treatment outreach remains in the urban area, emerging problem. but the need to reach younger adults in suburban communities is being noticed.
A recent increase in heroin use is probably due to new St. Louis, No changes are reported. younger users. A recent increase in snorting could be MO due to fear of AIDS, increased heroin purity, or possibly both factors.
*No major changes in heroin-using populations are reported by sources in seven sites: Billings, Birmingham, Columbia, Memphis, Philadelphia, Seattle, and Sioux Falls. page 10 Pulse Check: Mid-Year 2000 HEROIN
According to responding treatment program. Similarly, in the South Are there gender differences in providers, age breakdowns follow a Region, young adults outnumber older who uses heroin? All but 1 of the 20 somewhat regional pattern in their clients in numerous programs (in epidemiologic and ethnographic specific programs. For example, young Birmingham, Columbia, Memphis, and sources agree that males are more like- adults (age 18–30) account for the Washington, DC), and adolescents are ly than females to use heroin, at least largest group of heroin clients in most the largest heroin group at the New among the largest user groups. The Northeast Region programs (New Orleans non-methadone program. In exception is Seattle, where males and York, Philadelphia, and Portland). the Midwest and West Regions, howev- females are equally likely to use the Boston is an exception, however, with er, the younger and older adult age drug. The sexes, however, are evenly adolescents featuring most prominently groups are split fairly evenly among the split in some of the smaller user in the methadone program, and older cities and between responding meth- groups, such as late adolescents in adults (age 30 and older) most adone and non-methadone programs. Portland (whose numbers are still low) prominent in the non-methadone and a suburban cohort of white middle-class users in Seattle’s suburbs.
Then and Now: How have heroin users changed across the country (1999 vs 2000)?*
According to epidemiologic and ethnographic According to treatment sources... sources... THE WEST Slightly increasing numbers are reported for younger Denver, Heroin is less expensive and easy to find on the street. heroin users (age 18–25), new users, and white users; CO Younger, white adults are using the drug at work and slightly declining numbers are reported for users combining use with cocaine and alcohol. Snorting age 26–34 and for black and Hispanic users. and smoking are increasing, and users believe While the vast majority of heroin users still inject, that they will not be at risk for overdosing. a slight increase in smoking and inhaling suggests a change in route of administration.
No changes are reported. Honolulu, Females use heroin more often than males. Novice HI users are experimenting with smoking heroin, but the majority still inject.
Teens are perceived to be increasingly abusing Los Heroin users are able to maintain some type of employment. heroin, increasingly smoking it, and using with Angeles, Gang members and female users are showing up more peers rather than alone. CA frequently in treatment.
THE SOUTH
The number of black heroin users appears to be El Paso, White suburban users (young adults) are increasing, but increasing. TX Mexican-Hispanics remain the primary user group.
The second largest group of heroin users is Miami, Recreational heroin use, emerging among young adults, reportedly becoming younger. FL is considered “South Beach chic.” More females are using the drug, and its use crosses over all ethnic groups. It is being used orally and in group settings, especially on weekends in clubs.
More younger people are starting to snort heroin. New Orleans, As availability is increasing, adolescents are snorting the drug, LA often due to the misconception that this practice is safe. As a result, drug overdoses by snorting are increasing.
The younger group of heroin users are a small but Washington, Older adults are more likely to use heroin, but younger growing problem. The number of snorters, a DC users are increasing. More users are snorting heroin, as relatively new group, is increasing. more pure heroin becomes available on the street.
Pulse Check: Mid-Year 2000 page 11 HEROIN
Exhibit 5. What age group is most likely to use heroin?
According to non-methadone treatment sources... According to methadone treatment sources...
West Midwest Northeast West Midwest Northeast
(Nonrespondents: Billings, Denver, Honolulu, Miami, New York, (Nonrespondents: Billings, Philadelphia Los Angeles, Memphis, and St. Louis) South St. Louis, Seattle, and South Washington, D.C.)
According to epidemiologists and ethnographers...
West Midwest Northeast Different Sources, Different Populations
Epidemiologic and ethnographic sources tend to report somewhat older user groups than do treat- ment sources —highlighting the need for multiple sources in order to capture all populations and get (Nonrespondent: Seattle) a more comprehensive picture.
South
>50 percent of sources report 30+ years. About 50 percent of sources report 30+, and >50 percent of sources report 18–30 years. 50 percent of sources report 18–30. Insufficient respondents to draw a conclusion.
Four Pulse Check treatment sources cities are representative of the and Washington, DC; and Hispanics report females to be the largest heroin- Nation’s diversity, and the heroin are the primary user group El Paso, using group: Columbia, Honolulu, problem appears to mirror that Los Angeles, and New York. Memphis, and New York. (Note: The diversity. For example, according to New York source is from a treatment epidemiologic and ethnographic Pulse Check treatment sources program targeted at women.) In sources, whites are the primary users similarly report diverse racial/ethnic Miami, males and females are equally in Billings, Boston, Denver (where likely to use. According to treatment they are in majority, but under- An Unusual Population of Youthful sources in El Paso and New York, an represented relative to the city’s Heroin Users increase in female heroin use has led population), Miami, Philadelphia, New York, NY: Russian youths in their to an increase in prostitution. Portland, Seattle (where they are late teens and early twenties are increas- slightly underrepresented), and Sioux ingly shooting heroin, according to the Is any racial/ethnic or socioeco- Falls; blacks are more likely than ethnographic source. This population is nomic group more likely to use other groups to use heroin in particularly difficult to reach because of heroin? Heroin appears to present Chicago, Detroit (where they are cultural bias in views on treatment, an equal opportunity problem to all overrepresented relative to the city’s approaches to treatment, and access to racial/ethnic groups. The Pulse Check population), New Orleans, St. Louis, treatment. page 12 Pulse Check: Mid-Year 2000 HEROIN
sources in Boston, Chicago, Los report that use in the suburbs has Where do young new users live? Angeles, Miami, Seattle, and St. Louis; increased recently in at least four New York, NY: According to the and the upper class is cited in Miami. sites: Boston and New York in the ethnographic source, “a growing Northeast, and Chicago and Detroit population of young affluent white Some treatment sources note that in the Midwest. adolescents in Long Island have been heroin use by middle-class whites is initiating heroin use: they start off growing as the glamorization of hero- Treatment sources similarly indicate snorting, then many move to injecting. in becomes more accepted. In Miami, that most heroin users reside in urban Many come into needle exchange pro- for example, heroin is emerging as a areas. However, they too note heroin grams in Brooklyn, pick up free needles, popular drug among the “beach users in many suburban areas, includ- buy heroin, return to Long Island, and sell enough to support their habit. Many chic”—white, middle-to-upper-class, ing Billings, Boston, Denver, Hono- are being thrown out of their homes.” urban young adults. In Seattle and lulu, and New York, with an increase Similarly, a treatment source in New Los Angeles, the glamorization and in suburban users in El Paso. As a York indicates that both male and female use of heroin is crossing all classes matter of fact, most of the clients in use is growing in the suburbs among and ethnic groups. one of the Detroit programs live in white college-educated groups. the suburbs and come into the city Are high school dropouts more for treatment. Denver, CO: Anecdotal reports likely to use heroin? According to suggest a big change in new users: they responding treatment sources, among How do heroin users administer are younger, more affluent, suburban, white users who subscribe to “heroin clients at the different programs for heroin? (Exhibit 6) Injecting is the chic.” Anecdotal reports also suggest whom heroin is the primary drug of most common route of heroin admin- more rural and suburban adolescents are use, about one-half completed and istration, according to epidemiologic using “chiva.” one-half did not complete high school. and ethnographic sources in the For example, heroin clients at report- majority of cities. Snorting, however, Portland, ME: “Many street-involved ing programs are more likely to be features more prominently than kids ‘hang’ on the street and use high school graduates in Birmingham, injecting in Chicago, Detroit, New heroin,” reports the epidemiologic source Denver, Detroit, El Paso (non- in that small urban community. “Also, Exhibit 6. methadone), Honolulu, Miami, some students who consider themselves How do users administer heroin? ‘artistic’ subscribe to heroin ‘chic.’” Portland, and Sioux Falls. Conversely, they are more likely to have only Injecting is most common in... E E,N distributions at their programs: whites “some high school” education at the Denver Birmingham E,M E,N,M are the primary users in Billings, Los programs in Boston, Chicago, Honolulu Columbia E,N,M E,N,M
West Los Angeles El Paso Angeles, Memphis, New York, Sioux Columbia, El Paso (methadone), Los SeattleE,M MemphisE,N,M
Falls, and Portland; blacks are most Angeles, New York, New Orleans, South MiamiE Philadelphia, and Seattle. ChicagoE,M likely to use in Chicago and Detroit; New OrleansM DetroitM and Hispanics are more likely than E,N,M E,M Washington, DC other groups to use heroin in El Paso. Where do heroin users tend to Midwest Sioux Falls reside? Inner-city areas are generally St. LouisE BostonE,N,M E,N Unlike race/ethnicity, socioeconomic cited by epidemiologists and ethnog- Philadelphia E,N,M status (SES) seems to play a major role raphers as the most likely place of Northeast Portland in the groups of people most likely to residence for heroin users. El Paso’s Snorting is most common in... largest heroin-using group is the use heroin: in every Pulse Check city, ChicagoE MemphisM homeless. The suburbs, however, are the largest group of users reported by DetroitE,N MiamiN reported as a place of residence for M South E,N epidemiologic, ethnographic, and treat- Midwest Sioux Falls New Orleans ment sources is in the lower SES cate- some users in many sites, including New YorkE gory. However, the second-most-likely Boston, Chicago, Denver, Detroit, Los Angeles, Miami, New York, user groups show more diverse SES: Northeast for example, the middle class is cited Seattle, and St. Louis. Moreover, E According to epidemiologists/ethnographers by epidemiologic and ethnographic epidemiologists and ethnographers N According to non-methadone treatment providers M According to methadone treatment providers
Pulse Check: Mid-Year 2000 page 13 HEROIN
Orleans, and New York; and the Treatment sources in Boston, Chicago, number of snorters is also fairly high and New York attribute increases in Heroin Use in the Music Industry in several cities, including Boston, heroin overdoses to the myth among Los Angeles, CA: The epidemiologic Miami, St. Louis, and Washington, users that snorting prevents overdoses. source reports the perception that a DC. An unusual form of snorting is Even more disturbing than these mis- disproportionate number of people in reported among St. Louis’ younger conceptions about snorting, however, the music industry use heroin and user group (late teens and early is the possible shift in young people’s are becoming increasingly impaired twenties): they often mix the heroin perceptions about injecting. The New because of their addiction. Unlike the with water in an eyedrop squeeze York ethnographer reports an increase “grunge rockers” of the early 1990s, bottle and snort it from the bottle. In in suburban adolescents shifting from this group is not part of the “heroin chic” scene; rather, they behave more Sioux Falls, smoking is reported as snorting to injecting, with a growing like “a cohort that will be around the most common route of adminis- number traveling to inner-city needle for a while.” tration among the younger (age exchange programs. A similar phenom- 17–25) using population. “Chasing enon is noted in Portland, Maine, a the dragon”—placing heroin on alu- much smaller, more sparsely populat- without other drugs. Specifically, ® minum foil, lighting a fire underneath ed, more rural site: the epidemiologist alprazolam (Xanax ) is mentioned it, and sniffing the resulting smoke there, too, reports adolescents in in New York and Philadelphia and through a straw or other means—is needle exchange programs. clonazepam is mentioned in Seattle. reported by epidemiologists in New Additionally, the New York ethnogra- York and Honolulu. What other drugs do heroin pher reports that heroin users also users take? Cocaine is the drug consume other prescription drugs Treatment sources report a similar most often taken along with heroin, such as amitriptyline (Elavil®) and pattern for route of administration either in combination (“speed- clonodine (Catapres®), often pur- across the country, with injection balling”) or sequentially, according chased around methadone clinics, predominating in Boston, Chicago, to epidemiologists and ethnographers to enhance their heroin high or to Detroit, El Paso, and New York. in the majority of Pulse Check cities calm them down. Snorting is more common in (Boston, Chicago, Detroit, El Paso, Columbia, Miami, Memphis, and New Los Angeles, Miami, New Orleans, Miami’s younger heroin-using cohort Orleans. In Sioux Falls, young adults New York, Philadelphia, Seattle, and consumes a variety of substances, are the most likely to use heroin via Washington, DC). Speedballs can including methylenedioxymethamphet- snorting. In Billings, Denver, and involve either powder cocaine amine (“ecstasy” or MDMA) and Seattle, smoking is the route of (often cooked) or crack (sometimes ketamine (“special K”) as well as initiation to heroin for younger adults. dissolved, as in Boston); they are powder cocaine and benzodiazepines. Adolescent snorters are reported in generally injected, but they can The younger cohort in Washington, New Orleans and Miami. In a also be smoked. In New York, for DC, consumes marijuana and malt Washington, DC, treatment program, example, speedballs are both injected liquor. Alcohol is also mentioned by snorting among all clients is increas- and smoked. epidemiologic and ethnographic ing. Columbia treatment sources sources in Denver (a distant second in report that snorters prefer this practice Heroin users also sometimes consume use among the younger cohort), to injection because they mistakenly benzodiazepines, according to epi- Detroit, Philadelphia, and St. Louis. view it as nonaddictive. demiologists and ethnographers in six Pulse Check cities: Boston, Miami, The majority of Pulse Check treatment New York, Philadelphia, Portland, and sources across the country report that primary heroin clients also use Are youth forgetting the fear of Seattle. In Boston, they are taken needles? sequentially, substitutionally, or some- alcohol. In Los Angeles, they also use times simultaneously with heroin. cocaine. In El Paso, “speedballing” is Portland, ME: Needle exchange Concurrent benzodiazepine usage is defined as methamphetamine plus workers are being approached by youth also reported in Portland, but most heroin, and in Honolulu heroin is younger than 18 who view injecting as heroin in that city is consumed used in combination with “ice.” In a a “badge of courage.” Birmingham program, the concurrent page 14 Pulse Check: Mid-Year 2000 HEROIN
use of opiates and benzodiazepines Boston are combining heroin with Where and with whom is heroin surpasses the use of heroin as the PCP. In most sites where heroin use used? (Exhibit 7) Heroin use tends primary drug problem. Methadone among young adults is reported, to be an indoor activity. Some street clinics in Memphis, Portland, and these younger users reportedly use, however is noted by epidemio- St. Louis identify an increase in the experiment with dangerous drug logic and ethnographic sources in past year of opiate and related combinations that frequently Boston, Detroit, El Paso, Honolulu, pharmaceuticals use. Younger users in produce psychotic states. and New York. Even the street set- tings, however, tend to be in private Exhibit 7. areas, such as quiet back alleys. Where and with whom is heroin used?* The indoor settings are more varied, Site Setting or context ranging from apartments, cars, and Denver, CO In homes, small group settings (not in shooting galleries) abandoned houses to the bars of El Honolulu, HI In small groups, quiet back alleys (don't cause trouble) Paso, the clubs of Miami, the coffee
West shop bathrooms of Seattle, and the Los Angeles, CA At home (alone or with other groups of users) “shooting galleries” of Boston, Miami Seattle, WA At home, in bathrooms of coffee shops, in bars (where they are known as “get-off Chicago, IL In apartments; some in automobiles houses”), New York, and Philadel- phia. According to the Philadelphia Detroit, MI In homes, cars, private settings on street (no shooting galleries or group use) epidemiologic source, a shooting gallery in that city, as opposed to a
Midwest Sioux Falls, SD In housing units “hit house,” is a place where “the St. Louis, MO In very private, small groups or alone; some anecdotal data hitter does the injecting for you.” about social use at parties, in small groups Use tends to be alone, but small Birmingham, AL In fellow user's house group settings (particularly among El Paso, TX In bars, on streets; sometimes in parks, in homeless shelters; younger users) are reported by epi- more rarely, in friends' homes demiologists and ethnographers in Memphis, TN Not applicable ("a cocaine and alcohol town") Birmingham, Denver, Honolulu, Los
South Miami, FL In "get-off" houses (shooting galleries); some in clubs Angeles, and St. Louis.
New Orleans, LA In abandoned houses, indoor settings; some in social Treatment providers report that heroin settings indoors use is becoming more recreational and Washington, DC In abandoned buildings, alleys, apartments; some on streets social. The increase in heroin availabil- Boston, MA On street, in shooting galleries; some indoors ity in most of the Pulse Check sites, and the misconceptions among users New York, NY Indoors (shooting galleries, private hallways, abandoned that snorting is less dangerous and apartments), but also on streets, in parks does not cause overdose, are the bases Philadelphia, PA In "hit" houses, shooting galleries (hitter does injecting for you) of the emerging social dynamic. Northeast Portland, ME Underground, in room or apartment; no street scene; difficult to Treatment providers in Columbia, be anonymous in rural environment, so law enforcement can move Boston, Honolulu, Sioux Falls, and in easily, tends to push activity indoors Seattle report the casual use of heroin among young adults. In most sites, the Sources: Epidemiologic and ethnographic respondents use of heroin occurs at home and is *Sources in two sites did not respond: Billings and Columbia. seen as an indoor activity.
Pulse Check: Mid-Year 2000 page 15 HEROIN
Exhibit 8. How has heroin use impacted the health of users?
Health Pulse Check Adverse Consequences Site Impact Comments
HIV/AIDS El Paso, TX The practice of unprotected sex has not declined. Miami, FL HIV/AIDS is increasing due to exchanging sex for drugs. New Orleans, The number of cases has increased statewide. New York, NY Clients elect not to get tested for HIV/AIDS. Portland, ME The popularity of heroin is seen as the cause of increased cases of HIV/AIDS. Seattle, WA The number of local area HIV/AIDS cases has increased dramatically. Los Angeles, CA HIV cases have remained stable in the program over the past year but have increased in the local area due to unprotected sex. Billings, MT HIV/AIDS has decreased over the last year; the change is credited to effective education. Columbia, SC
Hepatitis C Billings, MT Health professionals view the increase in hepatis C as a serious problem. Columbia, SC Hepatitis C cases have increased in the program and in the local area. Los Angeles, CA Clients seeking admission frequently test positive for hepatitis C. Cases have increased in the community due to use of unclean needles. Portland, ME Treatment providers attribute a dramatic increase in hepatitis C to more rigorous testing. Washington, DC Cases have remained stable.
Comorbidity Honolulu, HI The mixing of dangerous drugs has caused an increase in psychiatric and societal issues problems and crime. Los Angeles, CA Cases of conduct disorders have increased. New York, NY Many clients are presenting with psychiatric disorders. Portland, ME Dually diagnosed clients have increased.
Sources: Methadone and non-methadone treatment providers
Although heroin use is occurring in having an increased medical impact (dual diagnosis of substance abuse isolated areas in Chicago, it is seen in on the health of their clients, and mental health disorders). Stable clubs in Miami and at work in particularly with respect to acquired or declining trends are reported by Denver. immunodeficiency syndrome (AIDS), treatment sources in only four Pulse human immunodeficiency virus Check cities: Billings, Columbia, and How is heroin impacting the (HIV), hepatitis C, and comorbidity Los Angeles (for HIV/AIDS); and health of users? (Exhibit 8) In Washington, DC (for hepatitis C). general, responding treatment providers indicate that heroin use is
page 16 Pulse Check: Mid-Year 2000 HEROIN
What are the barriers to HEROIN: THE SELLERS Drug Use and Violence Among treatment? Several treatment sources Who, How, Where, and with What? Heroin Sellers indicate that heroin users face a How are street-level heroin variety of barriers—ranging from Independent and trafficking-affiliated sellers organized? According to staff issues to limited slot capacity to heroin sellers are cited as using heroin law enforcement sources, heroin more frequently than gang-affiliated transportation problems—in obtaining distributors are affiliated with traf- sellers. Often, they sell the drug to use effective treatment: ficking organizations in only 4 of 17 it. Violence—namely turf wars and gunfire among organized distributors— ! Billings, MT: Trained and reporting Pulse Check cities: is associated with heroin sales in most certified staff are in short supply. Dominican nationals work for Colombian trafficking organizations in (13) cities. In most Pulse Check cities, violence is less associated with heroin ! Birmingham, AL: The number Boston, street sellers are affiliated with sales than with powder and crack Mexican and South American cartels of available treatment beds is cocaine sales. insufficient to meet the need. in Denver, and sellers are affiliated with Mexican trafficking organizations ! Columbia, SC: The local area in El Paso and Honolulu. Other sellers are independent in Detroit and lacks a good mass transit system, organized distributors in U.S. cities New York. thus impacting client access include street gangs in Chicago, El to treatment. Paso, Memphis, and Seattle; loose-knit How old are street-level heroin gangs in Columbia; Dominican nation- sellers? The ages of heroin sellers ! Chicago, IL: Programs lack the al organizations in Portland; and vary by type of distribution, according monetary support to hire and Hispanic organizations in Washington, to law enforcement sources. For retain quality staff, especially DC. Also in Washington, DC, street- example, young adults (18–30) tend trained psychiatric staff. level heroin is distributed by fairly to be involved in street gangs, where- independent individuals with three to as both young adults and older adults ! Los Angeles, CA: Funding for four people working for them. In Los (<30) are involved with trafficking- treatment slots has been reduced. Angeles, heroin is distributed primarily affiliated organizations. Only in Transportation issues present among family and friends; in Portland, Miami are adolescents, as well as challenges for providers who are heroin addicts sell some of the street- young adults, cited by law enforce- trying to keep clients in treatment. level heroin. ment officials as heroin distributors, although the El Paso ethnographer ! New Orleans, LA: The program Information from epidemiologic and states that many heroin sellers are as lacks funding to provide transpor- ethnographic sources in Pulse Check young as 14. Although the law tation for clients. In addition, a cities corroborates the affiliation of enforcement source in Honolulu medical detoxification facility street-level heroin distributors with states that older adults typically sell would assist in improving services traffickers in Boston, Denver, and heroin, the epidemiologic source there for clients. Honolulu. Additionally, epidemiologic adds that many youth, who are and ethnographic sources report that “picked up” in bars in Mexico and ! Sioux Falls, SD: The area is street gangs distribute heroin in offered free trips to Hawaii, sell economically depressed, and few Miami, New York (where gangs are heroin in Honolulu. funding options are available. known as “crews”), and St. Louis. In Clients have a difficult time St. Louis and Philadelphia, organized Where is street-level heroin locating treatment and finding crime groups unconnected with street sold? (Exhibit 9) Law enforcement the transportation to get them to gangs reportedly sell heroin; in sources agree that most heroin sales treatment. Washington, DC, young crews, take place in inner-city areas. However, in Portland, it is also sold ! Washington, DC: Clients cannot which are smaller and more loosely in rural and suburban areas; in afford medications, and some organized than typical street gangs, Philadelphia, it is sold throughout the cannot afford the sliding scale. plus their “runners” are involved in heroin sales. Many street-level heroin city; and in Miami, it is sold in night- clubs throughout the city.
Pulse Check: Mid-Year 2000 page 17 HEROIN
Additionally, epidemiologic and Then and Now: ethnographic sources in Denver and How have street-level heroin sales changed (1999 vs 2000)? St. Louis note that although heroin is Heroin sales are mostly sold in inner-city areas, it is " Boston law enforcement and epidemiologist/ethnographer: becoming more also beginning to be sold in more sub- Heroin is not being sold as often on the street or openly as it was discreet in some 1 year ago. Law enforcement: “Heroin distribution has become urban areas of the cities. Pulse Check Pulse Check cities: sources report that heroin is sold on more of a pizza delivery service operation in which a dealer has a street corners, indoors in private resi- list of names or contacts and s/he drives to customers’ houses to dences, in crack houses, in cars, in deliver the product.” shooting galleries, and in indoor, " Boston law enforcement: Fewer brand-named bags and more commercial settings. Additional plain, glassine bags of heroin were encountered during 2000. settings for heroin sales, according to epidemiologic and ethnographic " Chicago law enforcement: During this reporting period, fewer sources, include shopping centers in sellers are driving up to customers’ residences and honking; Boston, bars in El Paso, and hotels in sellers are becoming more cautious and won’t sell heroin unless Portland. they know a customer.
How is street-level heroin sold? " New York epidemiologist/ethnographer: Due to street policing, Hand-to-hand sales in cities such as some heroin sales activity has moved indoors. Los Angeles, Memphis, and " Washington, DC, epidemiologist/ethnographer: In some areas, Washington, DC, are the most com- heroin sales are moving inside due to street policing, mon way to sell user-level heroin; gentrification, and neighborhood development. however, many law enforcement sources cite prearranged, delivery- There are " Miami epidemiologist/ethnographer: Former cocaine-only sellers service sales as common. For exam- indications of are now selling heroin and cocaine. ple, a Boston law enforcement source an increase in " compares the heroin delivery sys- heroin sales in Seattle law enforcement: Dealers who sell cocaine and heroin tem—a new and more discreet way of some cities: have increased, and speedball use is common. selling—to a pizza delivery service: " Washington, DC, law enforcement: “Heroin is on a comeback: buyers contact sellers, and sellers former crack dealers are selling heroin, and shooting galleries are deliver heroin to buyers’ residences. supplanting crack houses.” In Chicago, buyers contact sellers, Other features of and sellers drive up to buyer’s resi- " Denver and St. Louis epidemiologist/ethnographer: The use of dences and honk. Beeper and cell the sales scene pagers and cell phones for heroin sales has increased. phone use continues in several other have changed in " cities, including Chicago, Memphis, some cities: New Orleans law enforcement: Heroin dealers (and users) are and Portland, where buyers contact younger than they were 1 year ago. sellers, and both meet on the street or " New York treatment provider: Drug selling has increased, and in an apartment for the exchange. younger adults are increasingly involved in the trade.
Corroborating law enforcement " Seattle law enforcement: Heroin-sales-related violence is down. information, epidemiologic and ethnographic sources report the use of cell phones and beepers in buyer- level heroin sales. They are used for home deliveries in Boston, Chicago, Denver, Honolulu, and Seattle and are also used in Detroit, Philadelphia, and St. Louis. In New York, where page 18 Pulse Check: Mid-Year 2000 HEROIN
Exhibit 9. Where is street-level heroin sold?* What other drugs do heroin Private Crack Shooting Commercial dealers sell? (Exhibit 10) Drugs Site Street Residences Houses Galleries Settings Cars commonly sold by heroin dealers Denver, CO # include crack and powder cocaine, Honolulu, HI # especially powder cocaine for use
West Los Angeles, CA ## in combination with heroin (“speed- Seattle, WA ## # ball”). In Denver, methamphetamine Chicago , IL # and marijuana are also sold by heroin dealers; in Miami, heroin is sold by Midwest MDMA dealers in the nightclub scene, Birmingham, AL ## Columbia, SC ## and marijuana is often sold by heroin El Paso, TX # dealers; in Honolulu, methampheta- Memphis, TN ## mine (“ice”) is often sold with heroin; South Miami, FL ##and in Seattle and Washington, DC, New Orleans, LA ## diverted pharmaceuticals, such as Washington, DC ## # # methadone and clonazepam Boston, MA ## (Klonopin), are sold by heroin dealers. New York, NY # Only in Boston and Columbia are Philadelphia, PA ## #other drugs reportedly not sold by Northeast ## Portland, ME heroin dealers. Source: Law enforcement respondents *Sources in four sites did not respond: Billings, Detroit, St. Louis, and Sioux Falls. How is heroin packaged and marketed? (Exhibit 11) In Pulse street sales are prevalent, sellers use Philadelphia, street sales involve the Check cities, heroin is sold mostly in signals, such as a safety pin pinned to use of lookouts, beepers for setting small, plastic zipper bags; wrapped in a seller’s clothing, to show buyers up meetings, and hiding places for tin foil; in corners of plastic bags that that they are selling heroin. In camouflaging heroin “stashes.” are cut off and knotted around the heroin; and in glassine bags. In El Paso Exhibit 10. What other drugs do heroin dealers sell?* and Los Angeles, it is sold in balloons, Diverted and in Detroit, it may be sold in lot- Crack Powder Mari- Metham- Pharma- No Other Site Cocaine Cocaine juana phetamine ceuticals Ecstasy Drugs Sold tery tickets or paper gum wrappers. Honolulu, HI # Los Angeles, CA # In many cities, plastic bags containing heroin or other heroin packaging may West Seattle, WA ## Denver, CO #### sport colored stamps, designs, logos, St. Louis, MO ## or brand names. For example in Chicago, IL # Chicago, faces are stamped on some
Midwest Detroit, MI # bags; in Boston, aliens, stars, and Columbia, SC # devils appear on some bags; in El Paso, TX # Philadelphia, new logos of orange New Orleans, LA ## basketballs and bees appeared in 2000; South Memphis, TN # and in Washington, DC, the plastic Miami, FL ## # bags containing heroin often are Washington, DC ## # colored (and are referred to as “black Philadelphia, PA ## Boston, MA # bag,” “blue bag,” and “yellow bag”). Portland, ME ## Northeast Heroin logos and brand names vary Sources: Law enforcement, epidemiologic, and ethnographic respondents by locality, with Philadelphia’s and *Sources in four sites did not respond: Billings, Birmingham, New York, and Sioux Falls. some of Columbia’s current brands
Pulse Check: Mid-Year 2000 page 19 HEROIN
connoting death and some of New Exhibit 11. York’s and Columbia’s brands Heroin brand names in selected Pulse Check sites. alluding to movie titles, high-class product names, and other pop culture Columbia, SC Playboy, skull-to-skull, Mercedes, crossbones products. New York dealers alter New York, NY Aries, HBO, payday, iceburg, blackout, Desert Storm, double brand names and markings frequent- jeopardy, red bag, that s_ _t, face off, high energy, attraction, ly —sometimes weekly or even slamming, gladiator, the power, side affects, millenium 2000, white daily—in the belief that they are angel, limit, hot shot, Pokemon, king of New York, Viagra, cobra, staying one step ahead of the law. final notice, psycho, Tommy Hilfiger, cocheese, mankind, the heap, embryo, beyond 2000, DVD, straight to the head, smack down, In many cities, including Chicago, Power Ranger, Goya, top choice, west side, hit me off, Genesis, heat, Denver, Los Angeles, Honolulu, warning, one way, passion, rough rider, top of the ninth, K9, excel- Memphis, Miami, and Seattle, heroin lent, spider, eternity, Gatorade, flying high, tyson, sniper, f_ _k you, bags are not labeled, perhaps so that iceberg, Lexus, drama, 24 hours sellers can avoid connection to a Philadelphia, Poison, pure hell, suicide, dead calm, murder, homicide, x-hell, product and possible conviction. PA diabolic, VZ, spice girl, turbo, one+done, black demon, hate monger, ex-con, death row, demolition, murder one, hard to kill, died in HEROIN: THE COMMUNITY peace, lethal injection, Old Navy What is the impact of and community reaction to the heroin Portland, ME Red eagle, dolphin, black eagle, batman problem? The growing heroin prob- Washington, Jerry Springer, orange line, brown tape, 747, blue bag, lem in some Pulse Check communities DC yellow bag, 2000 has triggered events which, in turn, have kicked off a wide range of com- munity responses, such as task forces, increasingly transacting sales attorney’s office. This drug has law enforcement initiatives, legislation, indoors; and the dealers are been problematic among heroin and media attention. These responses, constantly changing brand names, injectors, especially in the rural in turn, have affected heroin users, which they perceive can be traced areas, for some time; however, heroin dealers, and the ways in which back to them. it is only recently that a new phe- heroin data can be interpreted. During nomenon has arisen—prescription the current reporting period, this ! Philadelphia, PA: The methadone altering. Several meetings have cyclical relationship is evident in the treatment source reports that drug been held with physician groups following examples: courts, and law enforcement about prescription protection. efforts in general, are responsible ! Boston, MA: According to the for an increase in the number of ! Seattle, WA: The Pulse Check Pulse Check epidemiologic source, clients in treatment for heroin epidemiologic source reports on the increase in heroin overdoses problems. several recent developments: and deaths over the last 3 years has recently translated into more ! Portland, ME: According to " The county posted on their web- awareness and concern, including treatment sources, law enforce- site a Seattle drug trends report, interagency coordination, a data ment accounts for the decrease developed for the National gathering initiative, and a law in heroin-related crime. Institute on Drug Abuse (NIDA) enforcement initiative targeted Community Epidemiology Work at heroin. ! Portland, ME: Several recent Group (CEWG); the posting overdoses involving OxyContin®, subsequently sparked several ! New York, NY: The ethnographic a long-acting form of the opiate community responses, such as an source states that police initiatives oxycodone, prescribed for severe international heroin conference have affected the heroin situation pain, has ignited much attention and a lot of media attention. in two ways: heroin dealers are from the local media and district page 20 Pulse Check: Mid-Year 2000 HEROIN
" An FBI allegation connecting " The increased focus of Several methadone treatment sources heroin addicts to a recent policymakers and legislators on report an increase in media attention increase in bank robberies led to the heroin problem during the on heroin addiction: a meeting with the local drug last year and a half has led to court and Division of Substance increased treatment capacity and ! Columbia, SC: Articles have Abuse to look at exercising to discussion on innovative ways portrayed methadone treatment in mandatory sentences. to expand treatment access, such a positive light. as a physician-based methadone ! " A mayoral and county executive program in a hospital. Memphis, TN: The media have heroin task force is examining helped clients become aware of issues such as prevention, treat- " A recent article in a local links between heroin use and HIV. ment, media, harm reduction newspaper sparked interest in ! messages, and emergency the record number of drug Seattle, WA: The media is medical response. arrests and heroin deaths. responsible for "fast-tracking" clients in jail to treatment. " The local health department has ! established a task force on how Portland, ME: The media has to interact with emergency placed attention on non-heroin medical personnel to prevent opiates. heroin overdoses. ! Sioux Falls, SD: The public and community seem better informed due to media attention on heroin.
Pulse Check: Mid-Year 2000 page 21 CRACK AND POWDER COCAINE
CRACK AND POWDER COCAINE: CRACK COCAINE: THE DRUG Has the availability of crack THE PERCEPTION Availability, Purity, and Price cocaine changed between 1999 and 2000? (Exhibit 2) The majority How serious a problem is cocaine How available is crack cocaine (53 percent) of responding sources in Pulse Check communities? across the country? (Exhibit 1) Of report crack availability as stable. Sources in more than half of the Pulse the law enforcement, epidemiologic, Only one-fourth (N=32) report an Check sites (12 of 20) consider cocaine, and ethnographic sources discussing increase in crack availability, and only in crack and powder forms combined, this question, 81 percent (N=31) 19 percent report decreased availa- to be the most serious drug problem in report crack as widely available in bility. According to law enforcement their communities (41 percent of 70 their communities, and 17 percent sources, crack availability increased in responding sources). Half of those sites report it as somewhat available. Only three sites (Billings, Denver, and are in the South (Birmingham, in Sioux Falls is it considered not Portland) and decreased in four sites Columbia [South Carolina], El Paso, very available (as reported by the (Chicago, Honolulu, Sioux Falls, and Memphis, Miami, and Washington, epidemiologic source). DC), and the other half span the Washington, DC). Ethnographic and country’s three other regions: Chicago, epidemiologic sources report increases Detroit, and St. Louis in the Midwest; Exhibit 1. in five southern and northeastern sites How available is cocaine? Denver and Los Angeles in the West; (Birmingham, El Paso, Miami, New and only New York in the Northeast. York, and Portland) and declines in Percent Widely two western sites (Denver and (Note: In discussing their perception of 100 Available how serious their communities’ drug Honolulu). problem is, most Pulse Check sources 90 Somewhat Available How pure is crack cocaine do not distinguish between the two 80 across the country? (Exhibit 3) forms of cocaine.) Cocaine is also con- Not Very Crack purity varies widely, ranging sidered the second most serious drug 70 Available from 20 percent (in Denver) to 90 problem by 29 percent of Pulse Check 60 percent (in Honolulu and Washington, sources (N=66). Although it is the DC) in the 11 Pulse Check sites where most mentioned drug problem, it is 50 purity was reported. considered an emerging problem in 40 only one site: Billings, Montana (according to a law enforcement 30 Has crack purity changed? source). 20 Only a few changes in crack purity 10 Has the perception of the serious- were noted between 1999 and 2000: ness of the cocaine problem 0 changed between 1999 and 2000? Cocaine Crack Powder Cocaine continues to be considered the (both forms) cocaine cocaine (N=31) (N=36) (N=35) most serious drug problem across sites, Columbia, SC Birmingham, AL with more than 7 of 10 sources Memphis, TN Chicago, IL Sources: Law enforcement, epidemiologic, ranking it as either the most serious or and ethnographic respondents Portland, ME second most serious drug problem. In Sioux Falls, SD some communities, sources note that heroin replaced cocaine (either form) A Sioux Falls treatment source suggests as the most serious drug problem over that purity has increased because the the past year; in Detroit, New Orleans, dealers’ crack manufacturing process and Portland (Maine), some (but not is improving. all) sources indicate that heroin is overtaking cocaine. Conversely, in Birmingham and El Paso, sources indi- cate that cocaine is replacing heroin. page 22 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
What are crack cocaine prices Exhibit 2. How is crack cocaine made? across the country? (Exhibit 3) How has crack cocaine availability Typically, in Pulse Check communities, The cost of a crack cocaine gram changed (1999 vs 2000)? local crack sellers and, less often, ranges from $20 in Miami to $250 in crack users process powder cocaine Honolulu. According to law enforce- into crack cocaine. In most cities, bak- ment, epidemiologic, ethnographic, Billings, MTL ing soda is the standard ingredient and treatment provider sources, crack Birmingham, ALE added to powder cocaine to make most commonly sells by the rock for Denver, COL crack, as cited by law enforcement $3 to $35 depending on geographic El Paso, TXE sources. However, sources mention location and rock size. Crack also Miami, FLE other adulterants, including sugar in L sells as “kibbles and bits” (small New York, NY Portland, lidocaine in Sioux Falls, L,E amounts of rock) in Seattle for $2 Portland, ME brake fluid and rat poison in
L,E L Memphis, and vitamin B-12 in to users with little money. Boston, MA New York, NY Similarly, in Washington, DC, Columbia, SCL New Orleans, LAE Birmingham. Epidemiologic and “crumbs” (small amounts of Denver, COE Philadelphia, PAL,E ethnographic sources similarly rock) sell for $3 and “working El Paso, TXL St. Louis, MOL,E note crack adulterants, such bags” (bags containing several Los Angeles, CAL Seattle, WAL,E as diphenhydramine small rocks) sell for $20. Memphis, TNL Sioux Falls, SDE (Benadryl®) in Boston and Miami, FLL Washington, DCE Detroit, procaine (Novocaine®) and “anything white” in Detroit, L Chicago, IL and the pain reliever aurosol Honolulu, HIL,E (Ambesol®) in Portland. Sioux Falls, SDL Have crack prices changed? Washington, DCL Crack prices remained stable between 1999 and 2000, with the following Changes in Crack Rock Size L exceptions: Law enforcement respondents E Epidemiologic/ethnographic respondents ! Birmingham, AL: The law *Sources in Detroit did not respond. enforcement source notes that a new Birmingham, AL crack adulterant, vitamin B-12, is Columbia, SC Exhibit 3. being used to make crack rock Chicago, IL Memphis, TN Crack cocaine gram prices and appear larger so dealers can sell Sioux Falls, SD purity by city* them for a higher price.
CITY GRAM PRICE PURITY ! Philadelphia, PA: Rocks have According to sources in Birmingham, Billings, MT $100 NR become smaller since late 1999, but price per rock has not prices have declined due to the Denver, CO $150 20% changed, so dealers are now decreased quality and the increased Honolulu, HI $100–$250 90% availability of crack on the street. West making more money according Los Angeles, CA $70–$100 NR Similarly in Columbia, prices are to the epidemiologic source. declining because crack may be more Seattle, WA $60 40–85% accessible. Birmingham, AL $80 <70% Columbia, SC $100 NR The Sioux Falls price increase might be El Paso, TX $80 80%
related to increased purity. In Chicago, South however, purity has decreased; the Miami, FL $20 NR price increase, according to the law Washington, DC $100 30–90% enforcement source, might reflect an increase in major seizures at the New York, NY $28 50–75% kilogram level. Northeast
Sources: Law enforcement, epidemiologic and ethnographic respondents *Sources in nine sites, mostly in the Northeast and Midwest, did not provide this information. Pulse Check: Mid-Year 2000 page 23 CRACK AND POWDER COCAINE
POWDER COCAINE: THE DRUG Exhibit 4. What adulterants are added to How has powder cocaine avail- Availability, Purity, and Price powder cocaine? Powder cocaine ability changed (1999 vs 2000)?* adulterants cited by law enforcement How available is powder cocaine sources include lactose, isotol, across the country? (Exhibit 1) manitol, inositol, baking soda, Powder cocaine (cocaine hydrochloride and sugar. In 1999 in Miami, law [HCl]) is judged as widely available, E Boston, MA enforcement officials seized powder yet somewhat less available than crack, Columbia, SCL cocaine colored blue and yellow with 60 percent of law enforcement, Denver, COL,E with food coloring, perhaps used to epidemiologic, and ethnographic El Paso, TXE E disguise the cocaine. sources (N=35) reporting it as widely Miami, FL L available, particularly in the South, and New York, NY E 37 percent reporting it as somewhat Philadelphia, PA Portland, MEL available. It is considered widely available in eight cities (Columbia, Billings, MTL New Orleans, LAL,E Denver, Memphis, Miami, New Birmingham, ALE Philadelphia, PAL York, New Orleans, L Boston, MA E L Portland, ME Philadelphia, and Seattle) and El Paso, TX L,E L St. Louis, MO widely or somewhat available Los Angeles, CA L,E L Seattle, WA in five cities (Birmingham, Memphis, TN E L Sioux Falls, SD Boston, El Paso, Portland, and St. Miami, FL L L Washington, DC Louis). Honolulu sources differ in New York, NY their perspective on the powder Chicago, ILL cocaine supply: the law enforcement Has powder cocaine purity Honolulu, HIL source states that it is widely avail- changed? Several changes in powder Washington, DCE able; the epidemiologic source states cocaine purity are reported from 1999 it is not very available. to 2000:
Has powder cocaine availability Birmingham, AL changed between 1999 and L Law enforcement respondents El Paso, TX E 2000? (Exhibit 4) Most (61 percent) Epidemiologic/ethnographic respondents Boston, MA *Sources in Detroit did not respond. Washington, of the 31 responding law enforcement, Chicago, IL DC epidemiologic, and ethnographic Columbia, SC What are powder cocaine prices sources, spanning 15 of the 20 Pulse Portland, ME across the country? (Exhibit 5) Check cities, perceive powder cocaine Powder cocaine gram prices typically availability as stable. About one- In most cases, these changes are mirror or are slightly lower than quarter (26 percent) of the sources, similar to those noted for crack. In crack prices, although typically crack Chicago, however, treatment sources spanning eight cities, perceive it as cocaine can be purchased in smaller note a decline in crack purity but an increasing; and 13 percent (in three (and less expensive) amounts (rocks) increase in the purity of powder cocaine. cities) perceive it as declining. than powder cocaine (grams). Powder cocaine ranges from $20 per gram in Chicago and Portland treatment sources How pure is powder cocaine Sioux Falls to $200 in Honolulu and suggest that powder cocaine purity has across the country? (Exhibit 5) Washington, DC. Some of the lowest increased because the sale and use rates The purity of powder cocaine varies have decreased. In El Paso dealers are prices are found in the South. widely, ranging from 25 percent (in adding more adulterants to powder Honolulu) to 90 percent (in Boston cocaine in an attempt to increase their and Miami). profits.
page 24 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
Exhibit 5. Exhibit 6. Powder cocaine gram prices and How is crack cocaine referred to across different regions of the country? purity by city
CITY GRAM PRICE PURITY NORTHEAST Billings, MT $100 NR WEST MIDWEST Denver, CO $100–$125 15–75% Honolulu, HI $100–$200 25% Rock, girl, p-dogs Crack, rock West Los Angeles, CA $70–$100 80–85% (combined with Rock, crack marijuana), crack, Seattle, WA $30 57–68% rock, dope, Chicago, IL $50–$125 NR boulders, pebbles, kibbles and bits, Sioux Falls, SD $20–$100 NR seconds (second hit Midwest St. Louis, MO $100 NR on the crack pipe) Birmingham, AL NR <70% Twenty, hard, I wanna be a rock star, rock, crack, stones, yay (both powder Columbia, SC $100 NR and crack) onion (1 oz), cookie (41/2 oz), 1/4 El Paso, TX $30–$40 80% g (gram), quarter ( oz), rock, boulders, butter, crack, kibbles and bits, rock, South Miami, FL $40–$60 40–90% Rock, ma’a, O.J., white, snow bird, lady, blow, New Orleans, LA $35 35% (Samoan for rock) smack, dick, crack coke, piedra Washington, DC$100–$200 60% SOUTH Boston, MA $90–$100 70–90% New York, NY $50–$120 75% Philadelphia, PA$100–$125 60–80% Sources: Law enforcement, treatment, epidemiologic and ethnographic respondents Northeast Portland, ME $90–$100 60–70%
Sources: Law enforcement and Street names (slang) throughout the United States vary by epidemiologic/ethnographic respondents geographic region. Crack and powder cocaine names are Respondents in Detroit and Memphis did not not interchangeable in most U.S. cities. provide this information.
Exhibit 7. How is powder cocaine referred to across different regions of the country?
WEST MIDWEST NORTHEAST
Yay, blow, snow, coke, Powder, white lines, Girl, powder, C, flake, dope girl, blow, sniff, coke, blow, snow, up, flake, white blanks, coke, white stuff
Powder, white dragon, Girl, blow, girl, blow, soda, coca, snow, coke blanca, shake, bump, snow, soft SOUTH
Sources: Law enforcement, treatment, epidemiologic and ethnographic respondents
Pulse Check: Mid-Year 2000 page 25 CRACK AND POWDER COCAINE
CRACK COCAINE: THE USERS Are people initiating crack use? However, treatment sources in 10 (Exhibit 8) Epidemiologic and cities, spanning all regions of the Who, Where, How, and With What? ethnographic sources report few signs country, report an increase. Further, How have crack cocaine users of crack initiation. For example, the eight of those sources perceive the changed across the country New York ethnographic source reports increase at their programs to parallel between 1999 and 2000? that new users are not entering the an increase in their local communities. According to epidemiologic and scene, but a high level of chronic use A Boston treatment source, for ethnographic sources, crack trends by long-term addicts continues. From example, reports that novice users are appear generally stable across the the treatment perspective, however, increasing in number and reportedly country, with a few exceptions, as some sources do note novice use prefer “freebasing”; moreover, in the noted below. Several treatment among clients. As the arrows show (in local area, the source comments that sources, however, note increases in Exhibit 8), treatment sources in six “smoking crack is so common that the number of crack clients in their Pulse Check sites report stable trends even some public safety professionals programs, particularly among the in novice crack use at their programs. use this drug, and they don’t feel that younger population. it is a problem.”
Discussion: Why do epidemiologic, Then and Now: ethnographic, and treatment How have crack cocaine users changed across the country sources sometimes see different (1999 vs 2000)?* trends in the same city? According to epidemiologic and ethnographic sources...
U.S. cities abound with people Denver, The number of crack users younger than 18 has increased slightly, from various neighborhoods, various CO as has the number who are females. The number of white and Hispanic cultures, and various socioeconomic crack users is also increasing, while the number of black users is backgrounds. Each of the four sources declining. A growing number of crack users are reporting no income. in any Pulse Check city provides a Smoking has declined slightly, while snorting has slightly increased. different perspective on the drug situation because they deal with New York “Speeder” is a new and problematic combination: crack is diluted different populations. For example, NY with lemon juice and vinegar, heroin is added, then the combination young affluent partygoers or clubgoers is lit up and injected. This combination reportedly can create a fungus are not likely to seek treatment, at throughout body. least in their early stages of drug use; Washington, Two relatively recent user groups are reported: a somewhat younger thus, any increased powder cocaine DC group starting to smoke crack in blunts, and heroin shooters who are snorting in the club scene is more starting to smoke crack. likely to be detected by an ethnographic source. By contrast, a treatment According to treatment sources... provider might be in a better position Columbia, Adult crack clients, age 25–44, have been increasing. to detect an increased crack-smoking SC problem in a specific neighborhood. Honolulu, A second generation of crack users is appearing. HI
Memphis, More younger users and female users are emerging. TN
Seattle, An increase in all age groups may be attributable to low crack prices. WA The number of female crack clients has increased, with more women reporting initiation to crack from male companions.
*No major changes in crack-using populations are reported by sources in 13 sites.
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Exhibit 8. How old are crack cocaine older user groups. In Sioux Falls, the How has the number of novice users? (Exhibit 9) According to crack-using population is particularly crack users in Pulse Check Pulse Check epidemiologic and ethno- young: 18–24 years. Young crack sources’ treatment programs graphic sources, crack users tend to be users (in their late teens through changed (1999 vs 2000)?* older adults (30 years and older). Four early twenties) are reported as the exceptions occur in Birmingham, population second most likely to use Honolulu, Los Angeles, and Sioux crack in Billings, Honolulu, Seattle, Falls: in those cities, the younger and Washington, DC. crack-using populations exceed the Northeast BostonN Exhibit 9. New YorkN What age group is most likely to use crack? PortlandN South According to non-methadone treatment sources... El PasoM M Memphis West Midwest Northeast New OrleansN Midwest M (Nonrespondents: Billings, Chicago Philadelphia, St. Louis, Seattle, N,M Sioux Falls and Washington, D.C.) West DenverN Los AngelesM
Different Sources, South Different Populations Northeast As in the case of heroin, New YorkM epidemiologic and According to epidemiologists and ethnographers... South ethnographic sources tend to N Northeast Miami West Midwest report somewhat older user Midwest groups than do treatment DetroitN sources—once again high- West lighting the need for multiple HonoluluN sources in order to capture Los AngelesN all populations and get a SeattleN,M more comprehensive picture.
(Nonrespondents: New Orleans South and Portland) PhiladelphiaM
>50 percent of sources report About 50 percent of sources report N Non-methadone providers 30+ years. 30+, and 50 percent of sources report M Methadone providers *Sources in five sites did not respond: >50 percent of sources report 18–30. Billings, Birmingham, Columbia, St. Louis, 18–30 years. Insufficient respondents to draw a and Washington, DC. conclusion.
Note: Not enough methadone treatment sources responded in order to draw any conclusions.
Pulse Check: Mid-Year 2000 page 27 CRACK AND POWDER COCAINE
By contrast, treatment sources in 18 Is any racial/ethnic or overrepresented in New York and sites identify young adults (18–30 socioeconomic group more likely Philadelphia, where they account for years) as the predominant age group to use crack? Blacks account for the the largest crack-using groups at of crack clients, followed by older largest proportions of crack users in reporting treatment programs. In the adults. Moreover, a non-methadone 13 of the 20 Pulse Check cities, South, blacks are generally overrepre- treatment provider in New Orleans according to epidemiologic and sented, accounting for the largest identifies adolescents as the ethnographic sources. In Boston, black proportion of crack clients in five predominant group. Only in Billings and Hispanic representation among out of seven Pulse Check treatment do older adults in a reporting pro- crack users is approximately equal. programs reporting on race: the non- gram outnumber the young adults. Whites are more likely than other methadone programs in Birmingham, racial/ethnic groups to use crack in Columbia, Memphis, and New Are there gender differences in Billings, Denver, and El Paso; and the Orleans, and the methadone program who uses crack? The majority of Sioux Falls crack-using population in Washington, DC. Whites, however, crack users tend to be male, as crosses all racial/ethnic categories. account for the largest proportion of reported by epidemiologic and ethno- crack clients in the Birmingham and graphic sources in every Pulse Check Crack-using populations are pre- Memphis methadone programs, city except four: the group reported dominately in lower SES categories whereas Hispanics account for the most likely to use crack in Miami is in all but 2 of the 20 cities, according largest proportion in El Paso. In the age 35-and-older and female; in to epidemiologists and ethnogra- Midwest, blacks are demographically Sioux Falls and Washington, DC, phers: in El Paso, crack users are overrepresented, accounting for the users are evenly split between males predominantly middle class; and in largest crack-using population at and females; and in Seattle, male Sioux Falls, users cross all SES three of seven reporting programs: users only slightly outnumber female categories but are primarily from an the non-methadone programs in users among the group most likely to upper SES group. Additionally, in the Chicago and Detroit, and the use crack. cities where the lower SES groups methadone program in Chicago. predominate, some crack users come Whites predominate in Sioux Falls. Similarly, in most cities, treatment from other groups. For example, The West has the most variation sources report that the majority of lower/middle SES groups are reported across sites in the racial/ethnic groups crack clients are male, with three in Honolulu and Los Angeles; that account for the largest number exceptions where females are in the Miami’s younger (age 20–30) white of crack clients: whites in Billings; majority: Boston, Chicago, and and Hispanic suburban group is Asian/Pacific Islanders in Honolulu; Seattle. Moreover, the number of described as “middle and upper” SES; Hispanics in Los Angeles; and blacks female crack clients has increased at and Detroit has a small, young, black in Denver and Seattle, where they are programs in Memphis and Seattle. user group that crosses all SES cate- overrepresented. In the latter, female clients report gories. initiation to crack use via male Like the epidemiologic and companions. Treatment programs in the Northeast ethnographic sources, treatment region vary by city in the racial/ethnic sources generally report that crack distribution of their crack clients. users are found in the lower SES Among programs responding on race, groups. However, in Billings, whites account for the largest Birmingham, Boston, El Paso, and proportion of crack clients in Boston Sioux Falls, crack users are often in and Portland, reflecting those cities’ the middle SES groups. population distributions; blacks are
page 28 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
Where do crack users tend to cohort of crack users who reside in Where and with whom is crack reside? Without exception, the suburbs. used? (Exhibit 10) Crack use, as the epidemiologic and ethnographic table indicates, takes place in a wide sources report crack as primarily an Treatment sources generally concur variety of contexts and settings. inner-city drug, but some suburban that the majority of crack users reside Epidemiologic and ethnographic use is reported. In Honolulu, for in inner-city areas. In only 4 of 25 sources mention indoor settings example, some people from rural programs where place of residence slightly more often than street areas come into the inner city to buy was discussed, sources cite non-inner- settings, but the latter still feature the drug. Detroit’s young crack-using city areas: Boston, Sioux Falls, and prominently in many cities. New population reside both in the inner New York sources report that users York’s ethnographic source notes that city and in the suburbs. Similarly, are more likely to live in the suburbs; the drug is sold and used on the street Miami has a young (age 20–30) male an El Paso source reports that they because it is short acting. The indoor are more likely to live in rural areas. settings range from crack houses to private parties, residences, abandoned Exhibit 10. buildings, bars, porn parlors, and Where and with whom is crack used?* video shops. City Setting or context In some areas, epidemiologists Denver, CO In crack houses (more for distribution than use) categorize the various user groups by Honolulu, HI In bars, porn parlors, video shops (used as crack houses); their use settings and contexts: in not in public; houses, parties Miami, for example, crack houses are West Los Angeles, CA At home, on street, in crack houses the venue for the user group of older, black, inner-city females, while the Seattle, WA On street, in back alleys younger, male users who are white Chicago, IL In apartments; some in crack houses and Hispanic middle- and upper-class Detroit, MI Private settings (same as heroin); some party scene suburbanites tend to use crack at private parties, in houses, and in cars. Sioux Falls, SD At parties
Midwest St. Louis, MO Some in crack houses, often in vacant houses, sometimes Treatment sources concur that crack on the street, usually used alone or in small groups, use takes place in a variety of settings, use is usually private mostly involving group contexts. Solo Birmingham, AL In crack houses use is reported in only a few pro- grams—in Denver, Miami, Columbia, El Paso, TX At friends’ homes, parties; some crack houses; sometimes gay bars El Paso, and Washington, DC—but group use is also reported in some of Memphis, TN Probably crack houses and private residences
South those programs. Crack houses are Miami, FL In crack houses; private parties, houses, cars reported in Birmingham and Chicago New Orleans, LA On street, in houses, everywhere (also known there as “smoke houses”). Other reported venues Washington, DC In apartment buildings, abandoned buildings, some on street include parties (in New Orleans), the Boston, MA Mostly on the street, a few crack houses street (in Honolulu), and the home New York, NY On street, in parks, shooting galleries (in Birmingham, Denver, El Paso, Portland, Sioux Falls, Los Angeles, Philadelphia, PA In crack houses; sometimes for barter (sex for crack, and Memphis). Northeast goods for crack–not a lot of credit or price negotiation)
Portland, ME NA (Not much crack) Risky Contexts
Sources: Epidemiologic and ethnographic respondents Philadelphia, PA: Sex for crack is part of *Sources in two sites did not respond: Billings and Columbia. the bartering context in crack houses.
Pulse Check: Mid-Year 2000 page 29 CRACK AND POWDER COCAINE
How do crack cocaine users wind What other drugs do crack users POWDER COCAINE: THE USERS take? Alcohol is the most common up in treatment? How have powder cocaine users substance consumed with crack, changed across the country According to the responding Pulse according to epidemiologic and Check treatment sources, courts and between 1999 and 2000? Powder ethnographic sources in nearly every the criminal justice system are the most cocaine users follow a somewhat city. Marijuana and heroin are also common referral sources for clients different trend than do crack users. reportedly taken by crack users in entering treatment for crack addiction. Signs of increase in some powder- many cities (marijuana in Denver, Individual referrals follow closely as cocaine-using populations, particularly Detroit, El Paso, Honolulu, Miami, the second most common referral younger ones, are reported by New Orleans, New York, Philadel- source. epidemiologic and ethnographic phia, St. Louis, and Washington, DC; sources in five cities: Boston, Denver, heroin in Chicago, New Orleans, Los Angeles, Miami, and Memphis. How do crack users take their New York, and Seattle). In Philadel- drug? Smoking, by far, is the phia, crack users also take alprazolam By contrast, treatment providers predominant route of administration (Xanax®) and phencyclidine (PCP). report varying trends among novice among all user groups in nearly all users of powder cocaine. The number cities. But epidemiologic and ethno- Treatment sources concur that of novice users in treatment has graphic sources report some unusual alcohol is commonly abused by crack declined at programs in four Pulse practices. In Boston, for example, users, as reported in Birmingham, Check cities (Denver, Detroit, crack is sometimes dissolved in lemon Boston, Columbia, Denver, Honolulu, Honolulu, and Philadelphia), juice or vinegar and then injected. Miami, New Orleans and Portland. remained stable in eight programs (in Crack injection is also reported in Marijuana use among crack users is Boston, Chicago, El Paso, Los Billings, Chicago, New York, and reported by treatment sources in Angeles, Miami, New York, Portland, Washington, DC. Crack snorting is Birmingham, Boston, El Paso, Miami, and Seattle), and increased in four (in reported in Chicago. and Sioux Falls. And heroin is used by New York, Sioux Falls, Columbia, crack users in Boston, Chicago, and and Memphis). Similarly, treatment sources report New Orleans. smoking as the most common method How old are powder cocaine of ingesting crack. They, too, note users? In the majority of Pulse Check some unusual exceptions: injection is Drug Slang cities, epidemiologic and ethnographic the most common route of crack sources report that powder cocaine administration among clients at the El “Geek joint”: The Miami term for users are likely to be in their thirties Paso methadone program, and it is crack plus marijuana in a joint and older. However, users tend to be also cited among clients of the New “Diablito”: The New York term for slightly younger (twenties through Orleans and Sioux Falls non- crack plus marijuana in a cigarette early thirties) in five cities: Billings, methadone programs. At the latter Birmingham, Honolulu, Los Angeles, program, novice crack users are “Speeder”: The New York term for and Seattle. In El Paso, powder among those who inject. Further, crack diluted with lemon juice and cocaine users are most likely to be novice users at the Boston non- vinegar, combined with heroin, and lit between ages 14 and 21. methadone program freebase “Kibbles and bits”: The Seattle their crack. term for very small amounts of loose As is the case with crack treatment rocks of crack sold to people with clients, powder cocaine clients in little money Pulse Check cities are often likely to be young adults, according to treat- ment sources in Birmingham, Boston, Memphis, New York, Portland, and Washington, DC. Moreover, adolescents are reported as the largest powder cocaine-using group in Los page 30 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
Then and Now: the lower SES categories, powder How have powder cocaine users changed across the country cocaine users in the majority of the (1999 vs 2000)?* Pulse Check cities are in middle SES According to epidemiologic and ethnographic sources... categories or they span a wider range of categories. The few exceptions Boston, MA The local high school study shows a small upward “blip,” include Chicago, Detroit, Philadelphia, but use remains stable at a low level in that population. and Washington, DC, where powder Denver, CO Increased use is reported among those age 25 and younger, cocaine users tend to be in the lower and among females and whites. SES categories. Los Angeles, Increases are reported among young people and among whites. Similarly, treatment sources suggest CA The drug is back on college campuses, and some of the stigma that powder cocaine clients come associated with it attenuating. It is also leaking back into the club scene. from a wide range of SES back- grounds: among 14 programs where Miami, FL A group of multidrug users in the club scene—not necessarily SES classification is discussed, powder a new group, but a newly discovered group—includes powder cocaine users are most likely to be cocaine as a ritualistic part of their “evening of drugs.” middle SES according to 6 sources (in Memphis, TN The number of users appears to be increasing slightly. Detroit, El Paso, Honolulu, Memphis, and Sioux Falls), upper SES according *No major changes in powder-cocaine-using populations in 15 sites. to 3 (in Birmingham, Denver, and Angeles. Older adults, however, are Is any racial/ethnic or socioeco- Miami), and lower SES according to most likely to use powder cocaine, nomic group more likely to use 5 (in Chicago, Los Angeles, New according to Chicago, Denver, powder cocaine? Powder cocaine York, Portland, and Washington, DC). Detroit, El Paso, Honolulu, and users are more similar to heroin users Where do powder cocaine users Miami treatment sources. than to crack users in that their tend to reside? As is the case with racial/ethnic diversity mirrors the their diverse race/ethnicity and SES Are there any gender differences Nation’s diversity. According to classification, powder cocaine users in who uses powder cocaine? In epidemiologists and ethnographers, seem more akin to heroin users than only three Pulse Check cities do epi- whites are more likely than other to crack users in their places of demiologic and ethnographic sources groups to use powder cocaine in eight residence. Epidemiologic and report that males and females are Pulse Check cities (Billings, Denver, ethnographic sources report both equally likely to use powder cocaine: Honolulu, Los Angeles, New Orleans, inner-city and suburban residences for Boston, El Paso, and Philadelphia. In Portland, Seattle, and St. Louis); the various user populations in the all other Pulse Check cities, epidemio- blacks are the primary user group in various cities. The suburbs are men- logic and ethnographic sources agree nine cities (Birmingham, Boston, tioned specifically for some user that males are more likely to use. Chicago, Columbia, Detroit, Los groups (in addition to inner-city According to treatment sources, Angeles, New York, Philadelphia, and groups) in Birmingham, Detroit, Los however, females actually outnumber Washington, DC); and Hispanics are Angeles, Miami, and St. Louis. In males in three methadone programs: more likely to use it in two (El Paso some cities, such as Boston, powder in Chicago, Sioux Falls, and and Miami). Native Americans are cocaine use extends from the city into Washington, DC. (Females are also in reported as the second most likely the outlying areas. In other cities, the majority at the non-methadone racial/ethnic group to use powder such as Seattle and Washington, DC, programs in New York, but that pro- cocaine in Billings. gram targets women and children.) many users reside in small affluent At the Honolulu non-methadone Powder cocaine users and crack users neighborhoods within the city, not program, the treatment source also differ socioeconomically: unlike necessarily in the downtown areas. reports that older men give powder crack users, whom epidemiologists cocaine to younger women. and ethnographers tend to report in
Pulse Check: Mid-Year 2000 page 31 CRACK AND POWDER COCAINE
By contrast, 11 of the 14 treatment social contexts, including private resi- How and with what other drugs sources reporting on place of resi- dences, raves, parties, and nightclubs, do powder cocaine users take dence state that powder cocaine users as indicated in the table (Exhibit 11). their drug? Powder cocaine users, are more likely to live in inner-city Street use is reported only in Boston, like crack users, often consume areas. The suburbs, however, are a El Paso (parks), and Washington, DC alcohol, according to epidemiologists more likely place of residence for (alleys). Memphis is the only city and ethnographers in nearly every powder cocaine clients in the Sioux where crack houses are mentioned as city. In many cities, they combine Falls methadone program and the a site for powder cocaine use. powder cocaine with heroin, often in Detroit non-methadone program; and a speedball, as reported in Chicago, powder cocaine clients at the New Nearly all treatment sources report New York (where speedballs are both York non-methadone program are that powder cocaine is generally used injected and snorted), Philadelphia more likely to live in rural areas. in groups. Only in Denver and (where the combination is cooked Chicago is solo use reported. The and injected), Seattle, and Where and with whom is powder home is the most commonly reported Washington, DC. Marijuana is cocaine used? (Exhibit 11) Like setting. Other reported settings another substance commonly heroin, powder cocaine is usually include clubs (in Miami), work (in combined with powder cocaine, as used indoors, both privately and in Denver), and parties (in Columbia reported in seven cities: Denver, and Washington, DC). Detroit, El Paso, Los Angeles, Miami, Philadelphia, and Washington, DC. Exhibit 11. Where and with whom is powder cocaine used?* Some powder cocaine users also use City Setting or context ecstasy, as reported by epidemiologists and ethnographers in several cities: in Denver, CO At home; at work Los Angeles, where the two drugs are Honolulu, HI At parties; some in homes part of the “rave salad of drugs”; in
West Los Angeles, CA At raves; some at schools, dance clubs Miami, where the two drugs, along with “everything else” are part of the Seattle, WA Alone in cars, houses; some at parties club scene; and in Philadelphia, Chicago, IL In apartments; some at parties where powder cocaine users also ®
Midwest Detroit, MI In private settings (same as heroin); some party scene use propoxyphene (Darvon ), ® Birmingham, AL In fellow user’s house oxycodone (Percodan ), and phencyclidine (PCP). Columbia, SC At parties El Paso, TX In parks, at parties; some in apartment buildings Clients in treatment for powder cocaine use continue to primarily Memphis, TN In crack houses snort their drug. However, treatment South Miami, FL At home; some in clubs sources note some exceptions: smok- New Orleans, LA At home ing is reported at the non-methadone programs in Billings and Birmingham Washington, DC In abandoned buildings, alleys, apartments; some in clubs, parties, bars, apartments and at the methadone program in Washington, DC; freebasing is report- Boston, MA On the street; some at home ed at the Denver non-methadone New York, NY In private homes, apartments; some in bars, nightclubs program; and injecting is reported at Philadelphia, PA At parties, in groups; some in homes the non-methadone programs in
Northeast Birmingham and Honolulu and at the Portland, ME In residences, more in social context than heroin, fits into Memphis methadone program. party drug scene
Sources: Epidemiologic, ethnographic, and treatment respondents *Sources in three sites did not respond: Billings, Sioux Falls, and St. Louis. page 32 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
Treatment sources also report that Then and Now: powder cocaine clients at their How have crack sellers and sales changed (1999 vs 2000)? programs use additional drugs: Signs point " marijuana (in Billings, Birmingham, Boston law enforcement and Detroit epidemiologist: to a decrease in Crack-related violence has declined. Miami, New York, and Sioux Falls); crack-related heroin (in Boston, Miami, and activity in many " Denver epidemiologist: Crack distribution is diminishing because Columbia [“speedballs”]); LSD Pulse Check of its poor quality. (“acid”) (in Boston); and alcohol (in cities: Birmingham, Memphis, Miami, " Miami law enforcement: “Crack is no longer the primary drug of Portland, and Washington, DC). sale for most drug dealers; it is sold on the side.”
" Seattle and Washington, DC, law enforcement: The number of “Doing a Bump” crack houses has decreased. According to the Miami epidemiologic source... Signs point to an " Memphis law enforcement: Crack-related gang activity increase in crack- has increased. “In the club scene, a ‘bump’ (line) of related activity in powder cocaine is used to bump up the some Pulse Check " New Orleans law enforcement: Crack-related violence clubbers to another level of stimulation cities: has increased. and alertness as an introduction to an evening of drugs. Cocaine is a ritualistic " Seattle law enforcement: “Recently, crack-related, part of the evening. These individuals law enforcement activity has increased in central city areas— are cautious about quantity, using only the same areas where the crack epidemic of the 1980s and a little of each drug.” 1990s occurred.”
Crack marketing " New York ethnographer: “Sellers are starting to sell has changed in crack rock(s) wrapped in cellophane because crack is now CRACK COCAINE: THE SELLERS several cities: available in larger quantities.” Who, How, Where, and With What? " How are crack cocaine sellers Philadelphia epidemiologist: “Vials containing crack (referred to as ‘skinny’) are starting to reappear.” organized? According to law enforcement sources in Pulse Check Crack distribution " Boston epidemiologist: Crack distribution is becoming more cities, crack sellers are seldom affiliat- methods have discreet, and turf wars are declining. ed with trafficking organizations, changed in several " unlike street-level heroin sellers. Pulse Check cities: Denver epidemiologist: Gang control of crack distribution is However, similar to heroin sellers, declining in some areas due to the decentralization of gangs. crack sellers often are involved in " gangs in many cities (Chicago, New Orleans epidemiologist: “Crack dealers are now a Columbia, Denver, Honolulu, Los one-stop shop for all types of illicit drugs.” Angeles, Memphis, Portland, and " Washington, DC, epidemiologist: Young adult sellers Washington, DC). Law enforcement (typically members of crews) are beginning to use crack. sources also report that crack sellers are independent in some cities, " Washington, DC, law enforcement: Many formerly including Boston, El Paso, Portland crack-only dealers have started to sell heroin and crack. (where they are often crack addicts), Sioux Falls, and Washington, DC (where they may have three to four people working for them).
Pulse Check: Mid-Year 2000 page 33 CRACK AND POWDER COCAINE
Epidemiologic and ethnographic reported as crack sellers by Epidemiologic and ethnographic sources in many cities agree with law epidemiologic and ethnographic sources add that telephone orders are enforcement sources that crack-selling sources, although sources also mention also used to sell crack in Detroit; in organizations often involve gangs, as adolescents as sellers in Chicago, Miami, crack is often sold around a reported in Chicago, Denver, Detroit, Detroit, El Paso, and New York. In two-to-three-block area, and the El Paso, Miami, New Orleans, and Washington, DC, older adults, as well buyers and sellers identify one another anecdotally in St. Louis and as younger adults, sell crack. As with with hand signals; in New York, sellers Washington, DC (where gangs are heroin, the Honolulu source reports approach prospective buyers on the loosely organized, smaller than most that youth are picked up in bars in street; in Philadelphia, street sales street gangs, and known as “crews”). Mexico and offered free trips to involve lookouts, beepers, and hiding Only in Honolulu did the Pulse Check Hawaii to sell crack there. places for crack stashes; and in St. epidemiologic source report crack Louis, dealers often deliver crack to sellers as affiliated with trafficking Where is crack cocaine sold? private residences. organizations (Mexican). In New York, (Exhibit 12) Law enforcement, epidemiologic, and ethnographic crack sellers are reportedly independ- City Snapshots: How do heroin sources agree that most crack sales ent, and in Philadelphia, crack sellers sales differ from crack cocaine are organized, but not as street gangs. occur in inner-city areas. However, sales? law enforcement sources report that in How old are crack sellers? In Birmingham, crack is also distributed Boston law enforcement: “Crack almost all Pulse Check cities, law in suburban areas; in Portland, it is cocaine dealers are less discreet than enforcement officials cite young adults also sold in rural and suburban areas; heroin dealers and are not as involved in the delivery method of selling their (18–30 years) as street-level crack and in Philadelphia, it is sold through- product.” dealers. However, in almost half of the out the city. Additionally, the epidemi- sites, adolescents (in Birmingham, ologic source in New Orleans reports Denver epidemiologist: “Fewer beepers Boston, Columbia, Denver, Los that crack is sold “everywhere.” and pagers are used for crack sales than Angeles, New Orleans, Portland, for heroin sales—crack distribution is a St. Louis, and Washington, DC) and Crack is sold mostly on street corners, sloppier market.” preadolescents (in Denver) are also indoors in private residences, and in involved in crack sales. Young adults crack houses, according to law enforce- What other drugs do crack are also the most common age group ment sources. Epidemiologic and dealers sell? (Exhibit 13) Crack ethnographic sources add that in New dealers are often polydrug sellers, as Drug Use Among Crack Sellers York crack is sold in the street, and in was found in the last issue of Pulse Portland crack is often sold in hotels. According to law enforcement sources Check. Drugs they sell include heroin, powder cocaine, marijuana, in all Pulse Check sites, except for four How is crack cocaine sold? (Columbia, Los Angeles, Miami, and methamphetamine, MDMA, and Hand-to-hand crack street sales in New Orleans), crack sellers use the diverted pharmaceuticals. In only five cities such as Los Angeles, Memphis, drug. The Washington, DC, epidemio- cities (Boston, Chicago, El Paso, logic source reports that young adult and Washington, DC, are the most Honolulu, Portland, and Seattle) do sellers (typically members of “crews”) common way crack is sold. But, as law enforcement sources report that are beginning to use crack. found in the last issue of Pulse Check, crack dealers sell no other drugs. telephone and beeper sales, as well as Violence Related to Crack Sales Conversely, epidemiologic and home delivery, continue to be used to ethnographic sources in Chicago and According to law enforcement sources purchase and deliver illegal drugs. For Portland report that crack dealers in all cities but El Paso and Seattle, example, law enforcement sources sometimes sell heroin. Also in crack dealers are involved in violence, cite phone and beeper contact sales as Detroit, New York, and St. Louis, including homicides, strong-arm tactics common in Chicago, Memphis, epidemiologic and ethnographic with other dealers, and turf wars. The Portland, and Sioux Falls. In Sioux sources add that crack dealers Washington, DC, law enforcement Falls, word-of-mouth contact is also sometimes sell heroin. source states that crack sellers are the common. most violent drug-selling group. page 34 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
Exhibit 12. Where is street-level crack sold?* Boston, small plastic bags containing Private Crack Shooting crack are often stamped with logos, City Street Residences Houses Galleries Cars perhaps to appeal to younger users. Denver, CO # Additionally, epidemiologic and Honolulu, HI # ethnographic sources report that in
West Los Angeles, CA # Boston dealers sometimes sell crack in Seattle, WA ## balloons, and in New York they sell it Chicago , IL # in a variety of differently shaped vials with variously colored tops and as Midwest Birmingham, AL ## “puffs” from a crack pipe. In Seattle, Columbia, SC ## very small amounts of loose rocks, El Paso, TX # known as “kibbles and bits” are sold Memphis, TN ## to people with little money, as are South Miami, FL # “seconds,” the second inhalation of New Orleans, LA ## crack from a pipe. Washington, DC ## # # Boston, MA ## POWDER COCAINE: THE SELLERS Philadelphia, PA ## # Who, How, Where, and With What? Portland, ME ## Northeast How are street-level powder Sources: Law enforcement, epidemiologic, and ethnographic respondents cocaine sellers organized? *Sources in four sites did not respond: Billings, Detroit, St. Louis, and Sioux Falls. According to law enforcement sources, the affiliations of powder cocaine Exhibit 13. What other drugs do crack dealers sell?* distributors vary. The most mentioned Diverted affiliations (in seven cities each) are Powder Mari- Metham- Pharma- No Other gangs and independent sellers. Gangs City Cocaine Heroin juana phetamine Ecstasy ceuticals Drugs Sold are reported in Honolulu, Los Denver, CO ### Angeles, and Seattle in the West; Honolulu, HI # Chicago in the Midwest; and El
West Los Angeles, CA ## Seattle, WA # Paso and Memphis in the South. Chicago, IL # Independent sellers are reported in Detroit, MI # Los Angeles in the West; Sioux Falls in
Midwest St. Louis, MO ## the Midwest; El Paso, Memphis, and Birmingham, AL # Washington, DC (where three to four El Paso, TX # people typically work for them) in the Memphis, TN # South; and Boston and Portland
South Miami, FL ## # (where these sellers are mostly addicts) New Orleans, LA ## in the Northeast. Washington, DC ## # Philadelphia, PA # Compared with heroin, powder Portland, ME ## # cocaine sellers are not cited as often as
Northeast affiliated with trafficking organizations: Sources: Law enforcement, epidemiologic and ethnographic respondents only in Denver, where they are affiliat- *Sources in five sites did not respond: Billings, Boston, Columbia, New York, and Sioux Falls. ed with Mexican and South American How is crack packaged and in bindles; in film canisters; and as cartels, is sellers’ involvement with marketed? Dealers often sell crack in loose “rocks.” Crack containers are trafficking organizations mentioned. In small, plastic zipper bags; in plain, rarely labeled, according to law both New Orleans and Washington, glassine bags; in the torn-off corners of enforcement sources. However, DC, Hispanic organizations are said to plastic bags tied with one knot (known according to epidemiologic and be major sellers of powder cocaine. In as the “Dominican tie” in some cities); ethnographic sources in Portland and
Pulse Check: Mid-Year 2000 page 35 CRACK AND POWDER COCAINE
Then and Now: offered free trips to Hawaii to sell How have street-level powder cocaine sales changed (1999 vs 2000)? powder cocaine there.
" Powder cocaine Boston law enforcement: The more discreet delivery service Where is powder cocaine sold? distribution method of sale was not seen 1 year ago. (Exhibit 14) In many Pulse Check has changed cities, street-level powder cocaine in several Pulse " Chicago law enforcement: Sales are more discreet than they were Check cities: 1 year ago. sales, like heroin and crack sales, take place in inner-city areas; unlike hero- " Denver epidemiologist: “One-on-ones” (equal amounts of heroin in and crack sales, powder cocaine is and powder cocaine) are no longer sold. also sold in suburban areas. Furthermore, many law enforcement " Los Angeles law enforcement: The number of powder cocaine sources, including those in Denver, sellers has increased. El Paso, Los Angeles, Miami, and Philadelphia, state that powder " Miami law enforcement: Violence among Haitian cocaine-selling organizations (which was rated as very high) has increased, but cocaine sales occur citywide. The violence among Jamaican cocaine-selling organizations has Memphis epidemiologic source declined. reports that powder cocaine sales are more widespread throughout the city Club drug sales " Columbia law enforcement: The nightclub crowd is increasingly than crack sales. are changing affiliated with powder cocaine sales. “Powder cocaine may be the way powder becoming the drug of choice in that setting.” Powder cocaine is sold throughout cocaine is sold in the United States indoors in resi- " some Pulse Check Columbia law enforcement: Now MDMA sometimes is sold dences, outdoors on the street, cities: with powder cocaine. indoors in commercial buildings " New Orleans law enforcement: “As rave drug sales (including nightclubs, private bars, have increased in certain settings (raves and nightclubs), powder and restaurants), and in crack houses. cocaine sales have decreased.” According to the Memphis law enforcement source, its sale is more covert than crack or heroin sales. Columbia, the nightclub crowd is now Angeles, Memphis, Miami, Portland, Additionally, epidemiologic and affiliated with powder cocaine sales. St. Louis, Sioux Falls, and ethnographic sources report powder Washington, DC), followed by older cocaine sales in cars, houses, and bars Epidemiologic and ethnographic adults in six cities (Boston, Chicago, in El Paso, houses and hotels in sources add that in El Paso, the night- Los Angeles, Memphis, St. Louis, and Portland, homes in St. Louis, and club crowd is affiliated with powder Sioux Falls). Law enforcement sources, homes and nightclubs in New York. cocaine sales; in Denver, Mexican including those from Denver, New nationals tied to Hispanic gangs Orleans, and Philadelphia, state that Drug Use Among Cocaine Sellers primarily sell the drug; in Philadelphia, the ages of street-level powder cocaine Most law enforcement sources state that sellers are organized, but not as street sellers range widely. powder cocaine sellers use their product. gangs; and in Washington, DC, sellers Nearly all independent powder cocaine are members of crews (small, loosely Similarly, all reporting epidemiologic sellers are said to use the drug, while organized gangs). and ethnographic sources (nine of fewer organized sellers reportedly use it. nine) cite young adults as powder How old are street-level powder cocaine sellers, followed by older Violence Related to Powder Cocaine Sales cocaine sellers? Street-level adults (three of nine sources). Only in powder cocaine sellers range widely El Paso, are adolescents mentioned as Violence is associated with powder in age, from 17 to 65 years, with involved in sales. In Honolulu, as is cocaine sales in all reporting cities, except young adults (18–30) mentioned by the practice with heroin and crack for El Paso and Washington, DC, law enforcement sources in 10 cities cocaine sales, youth are reportedly according to law enforcement sources. (Boston, Columbia, El Paso, Los picked up in bars in Mexico and page 36 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
Exhibit 14. Where is street-level powder cocaine sold?* methamphetamine, and MDMA. Epidemiologic and ethnographic City Private Crack Nightclubs/ Street Residences Houses Bars Cars sources (in Detroit, El Paso, Philadelphia, and Portland) agree Denver, CO # with law enforcement sources that Honolulu, HI # heroin is often sold by powder
West Los Angeles, CA ## Seattle, WA # cocaine dealers. The Denver Chicago , IL # epidemiologic source reports that St. Louis, MO # some crack and heroin dealers sell
Midwest Sioux Falls, SD # powder cocaine. Birmingham, AL ### Columbia, SC # How is street-level powder El Paso, TX ## ##cocaine packaged? Powder
South housing cocaine is sold mostly in plastic New Orleans, LA developments # sandwich bags in Pulse Check cities, Washington, DC # although it is also sold wrapped in tin Boston, MA # foil (in Chicago and Denver), paper New York, NY ##diamond folds (“bindles”) (in El Paso Philadelphia, PA ## #
Northeast and Portland), in corners of plastic Portland, ME ## bags knotted around the drug (in El Sources: Law enforcement, epidemiologic, and ethnographic respondents Paso), in manilla baggies (in Miami), *Sources in four sites did not respond: Billings, Detroit, Memphis, and Miami and in small glass vials (in Sioux Falls). In Miami, the manilla baggies How is street-level powder What other drugs do powder are stamped with pictures, such as cocaine sold? Most powder cocaine cocaine dealers sell? unicorns, which serve as brand identi- transactions, according to Pulse Check (Exhibit 15) According to law fications. Cartoon characters stamped law enforcement sources, involve a enforcement sources, other drugs sold on powder cocaine packaging often phone or beeper; further, in many by powder cocaine dealers include serve as brands in Chicago. Law cities, sellers use a delivery service heroin, crack cocaine, marijuana, enforcement sources from most method, in which dealers have lists of contacts, and sellers drive to cus- Exhibit 15. What other drugs do powder cocaine dealers sell?* tomers’ houses to deliver the product. Only sources in Washington, DC, and City Heroin Crack Marijuana Metham- Ecstasy No Other Memphis mention hand-to-hand Cocaine phetamine Drugs Sold powder cocaine sales. Denver, CO ### Honolulu, HI #
Reporting epidemiologic and ethno- West Los Angeles, CA # graphic sources concur with law Seattle, WA ## enforcement sources that powder Chicago, IL # ## cocaine sales typically involve beep- Detroit, MI
Midwest St. Louis, MO # ers, telephone orders, deliveries, and El Paso, TX ## meetings between sellers and buyers. Memphis, TN ## In St. Louis, sales reportedly occur Miami, FL ## # through acquaintance networks. South New Orleans, LA ## Washington, DC # Philadelphia, PA ## Portland, ME ## Northeast Sources: Law enforcement, epidemiologic, and ethnographic respondents *Sources in six sites did not respond: Billings, Birmingham, Boston, Columbia, New York, and Sioux Falls.
Pulse Check: Mid-Year 2000 page 37 CRACK AND POWDER COCAINE
reporting Pulse Check cities (includ- source for an increase in HIV is tion (DEA) and Food and Drug ing Columbia, Honolulu, Memphis, not necessarily true. Administration (FDA), is consider- Portland, and Sioux Falls) state that ing the inclusion of the New brand names are not used on powder ! Denver, CO: Deaths involving Orleans area due to its drug prob- cocaine packaging. cocaine and heroin have been lem. increasing over the past several Additionally, epidemiologic and years. But the two types of mortal- ! Seattle, WA: With the area’s ethnographic sources report the use ity stem from different causes: the economic boom, and the of balloons for packaging powder heroin-related deaths result from gentrification of the downtown cocaine in El Paso and Boston. In both the increase in new users and area, more attention is being Detroit, “seals” (paper wrappers that from purity changes; the cocaine- focused on “cleaning up the street,” resemble magazine covers and do not related deaths are more related to particularly with regard to the absorb the powder) are often used to older users whose addiction has street trade of crack. Local busi- package powder cocaine; in Miami, intensified and whose health has nesses’ efforts to develop the down- pictures on plastic bags sometimes serve deteriorated. town area into a destination point as brands; and in Washington, DC, have led the press to change their “Pacman” was reportedly used as a ! Detroit, MI: A decline in the profile of the crack situation, with a brand name in 2000. homicide rate reflects a long-term greater attention to quality of life. decline in heroin- and crack- The resulting community response COCAINE: THE COMMUNITY related violence. has been a coordinated one, not What is the impact and just involving law enforcement, and ! Honolulu, HI: A large multidrug, community reaction to the has included the rise of drug courts multiperson bust in neighboring cocaine problem? According to over the past 3 years. The media Maui early in 2000 involved large epidemiologic and ethnographic has been increasingly focusing on amounts of cocaine (as well as sources, the high levels of cocaine use, the record number of crack arrests, black tar heroin and metham- despite its stabilization in many com- even mapping out the course of phetamine), temporarily impacting munities, continues to affect events and those arrests. cocaine availability. the quality of life in those communities Law enforcement sources also note a in a variety of ways: ! Memphis, TN: A dramatic variety of interrelationships between increase in Department of Housing ! Birmingham, AL: Studies of crack cocaine use, community life, commu- and Urban Development (HUD) users who successfully participate nity events, and community responses: housing initiatives, particularly for in treatment show a substantial the homeless, is believed to have ! reduction in their risk for HIV. El Paso, TX: Gang activity and contributed to a slight decline in The epidemiologic source notes prostitution associated with alcohol abuse and cocaine use. the connection between crack use cocaine has remained stable. and HIV risk, particularly sur- ! New Orleans, LA: A regional task ! Los Angeles, CA: Violent criminal rounding unsafe and risky sexual force on cocaine and heroin use, acts (turf issues) and nonviolent activity, for both men and consisting of regional and local criminal acts (robberies and women—suggesting that the per- police departments and sheriffs in burglaries) have increased. The ception of injecting as the main many Louisiana parishes, as well as level of prostitution activities the Drug Enforcement Administra-
page 38 Pulse Check: Mid-Year 2000 CRACK AND POWDER COCAINE
related to cocaine, however, has problem, the treatment system, and for an increase in prevention remained stable. community issues such as law and awareness. enforcement referrals, funding, ! Miami, FL: A seizure in the first outreach, and prevention programs: ! New Orleans, LA: Law 2 months of 2000 involved 3,436 enforcement referrals to cocaine pounds of cocaine. In addition, ! Birmingham, AL: Cocaine-related treatment are increasing, nonviolent criminal acts associated problems have caused longer particularly through drug courts. with cocaine have increased. waiting lists and increased the The increase has caused programs need for case management. The to function at high capacity. ! Philadelphia, PA: Large cocaine increase in waiting lists has caused Insufficient funding for cocaine seizures are reported. For example, treatment providers to refer treatment has left gaps in treat- a recent seizure of 75 pounds of clients out to other programs. ment follow-through. Women and cocaine has impacted somewhat on children are sent to special treat- the cocaine supply. ! Miami, FL: The number of ment facilities. cocaine users needing treatment What cocaine treatment issues has increased, but the number of ! Sioux Falls, SD: Outreach and do communities face? Treatment available treatment slots is limited. prevention has helped reduce sources point out several inter- Program outreach is responsible numbers in treatment. relationships between the cocaine
Pulse Check: Mid-Year 2000 page 39 MARIJUANA
MARIJUANA: THE PERCEPTION Exhibit 1. How available are the different forms of marijuana? How serious a problem is marijuana in Pulse Check Percent 100 communities? During this reporting period, marijuana was perceived as 90 Widely Available the most serious drug problem by 7 80 Somewhat Available sources in 6 Pulse Check cities (10 70 Not Very Available percent of 70 responding sources): Billings, Denver, and Los Angeles in 60 Not Available the West; Sioux Falls in the Midwest; 50 Columbia (South Carolina) in the 40 South; and Boston in the Northeast. Overall, it is the third most common- 30 ly named “most serious” problem in 20 the 20 Pulse Check cities—the same 10 as methamphetamine—following cocaine and heroin. Furthermore, 0 In general Sinsemilla Local commercial Mexican British marijuana is considered the second (N= 34) (N=26) grade Commercial Columbian most serious drug problem by 15 (N=28) (N=28) (N=28) sources in 10 cities (23 percent of 66 Sources: Law enforcement, epidemiologic, and ethnographic respondents responding sources): Billings, Birmingham, Chicago, Columbia, Exhibit 2. marijuana, in all its varieties, as widely How has marijuana availability Detroit, El Paso, Honolulu, available—consistent with reports changed (1999 vs 2000)?* Memphis, Sioux Falls, and St. Louis. from the last few issues of Pulse Check. Only three sources describe Has the perception of the the drug as “somewhat available” (the law enforcement sources in marijuana problem changed Billings, MTL Boston, Chicago, and El Paso). between 1999 and 2000? No Birmingham, ALE changed perceptions are reported: Denver, COL The most common variety of any sources who perceived marijuana El Paso, TXE marijuana is locally produced as their community’s most serious Miami, FLE drug problem during 2000 also listed New York, NYE commercial grade, ranked as widely it as such in 1999. However, the epi- Portland, MEL,E available by 20 law enforcement, demiologic source in Honolulu notes Sioux Falls, SDE epidemiologic, or ethnographic an increase in the marijuana problem sources in 14 Pulse Check cities (71 Birmingham, ALL Miami, FLL following decreased interdiction percent of 28 responding sources) Boston, MAL,E New York, NYL spanning all regions of the country: efforts on the Big Island of Hawaii; L L,E Columbia, SC New Orleans, LA Billings, Denver, Honolulu, and and the Washington, DC, epidemio- E L,E Denver, CO Philadelphia, PA Seattle in the West; Sioux Falls logic source notes increased press El Paso, TXL Sioux Falls, SDL and St. Louis in the Midwest; El coverage of marijuana trafficking. Honolulu, HIL Seattle, WAL,E Paso, Memphis, Miami, New Los Angeles, CAL St. Louis, MOL,E MARIJUANA: THE DRUG Memphis, TNL Washington, DCE** Orleans, and Washington, DC, in the South; and New York, Philadelphia, Availability, Purity, and Price Chicago, ILL and Portland (Maine) in the How available is marijuana Northeast. Only three sources report across the country? (Exhibit 1) marijuana as only “somewhat avail- Of the 34 law enforcement, able,” four report it as not very avail- epidemiologic, and ethnographic L Law enforcement respondents E Epidemiologic/ethnographic respondents able, and only one source (in Miami) sources discussing this question, the *Sources in Detroit did not respond. rates it as not available at all. vast majority (91 percent) report **Respondent reports that availability “fluctuates.” page 40 Pulse Check: Mid-Year 2000 MARIJUANA
Mexican commercial grade is the sources in 6 cities. Another variety, marijuana, with a typically higher second most common variety report- Jamaican or Caribbean marijuana, is THC content than sinsemilla. In ed in Pulse Check cities, cited as reported in Miami. New York, it is more potent and widely available by 13 sources in 12 much more popular than local, cities (46 percent of 28 responding Has marijuana availability outdoor-grown marijuana (“bio”). law enforcement, epidemiologic, and changed? (Exhibit 2) Availability of ethnographic sources), again spanning marijuana remains stable at high levels Exhibit 3. all regions of the country: Billings, in 14 Pulse Check cities, according to Marijuana prices by ounce, by Denver, Honolulu, and Los Angeles about two-thirds (n=19) of the 29 type and city* responding epidemiologic, ethno- in the West; Chicago, Sioux Falls, and OUNCE PURITY St. Louis in the Midwest; Birmingham graphic, and law enforcement sources CITY PRICE (% THC) and El Paso in the South; and Boston, who discussed this subject. Only nine Commercial New York, and Philadelphia in the sources (31 percent) in eight cities report increased availability, and only grade (domestic Northeast. Another 10 sources in 8 or Mexican) cities consider Mexican commercial one source—a law enforcement official Billings, MT $120 NR as somewhat available, two sources in Chicago—reports a decline. (in Boston and Miami) rate it as not Birmingham, AL $20–$25 NR very available, and three sources (in Similarly, the majority of law Boston, MA $100–$200 NR New Orleans, Philadelphia, and enforcement, epidemiologic, and Columbia, SC $80–$150 NR Washington, DC) say Mexican ethnographic sources report that Denver, CO $100–$300 4.5% commercial marijuana is not available availability for the different marijuana El Paso, TX $200–$300 NR varieties has remained stable, and at all in their communities. Los Angeles, CA $300–$500 4–6% nearly all the remaining sources Memphis, TN $50 NR Sinsemilla, or the seedless variety of report increased availability. Only five Miami, FL $200–$400 NR marijuana, is the third most common cases of declining availability are New Orleans, LA $20–$120 NR type of marijuana available in Pulse reported: for Mexican commercial- Check cities. It is reported as widely grade, by the law enforcement source Philadelphia, PA $150–$200 NR available by 9 sources in 7 cities (35 in Billings; for sinsemilla, by the Portland, ME $350 NR percent of 26 responding sources): ethnographic source in El Paso and Seattle, WA $150 8–15% Billings, Denver, and Honolulu, in the the epidemiologic source in Sioux Sioux Falls, SD $50–$500 NR West; St. Louis in the Midwest; Falls; and for British Columbian Washington, DC $120 NR Memphis and Miami in the South; marijuana, by the ethnographic Sinsemilla and Portland in the Northeast. It is source in El Paso and the considered somewhat available by epidemiologic source in Seattle. Denver, CO $100–$500 15–20% another 12 sources in 10 cities, and El Paso, TX $40 NR not very available by 5 sources in 5 How potent is marijuana across Honolulu, HI $400–$800 5–21% different cities. the country? (Exhibit 3) According Los Angeles, CA $1,000–$2,000 20–25% to law enforcement, epidemiologic, Miami $400 12–26% and ethnographic sources, the One of the least commonly reported New York, NY $70–100 NR tetrahydrocannabinol (THC) content marijuana varieties is British Portland, ME $450 NR Columbian (“BC bud”), with only two of commercial-grade marijuana ranges sources (in Billings—perhaps due to its from 4 to 15 percent in Pulse Check British proximity to the Canadian border— cities, with most at the lower end of Columbian and New York) reporting it as widely that range. Sinsemilla, a higher- (BC) bud available, and six sources (in Billings, potency marijuana, ranges from 5 to Denver $500 15–20% Denver, Miami, Portland, Seattle, and 30 percent THC content, and British Seattle $300–425 20–30% Sioux Falls) reporting it as somewhat Columbian ranges from 15 to 30 Sources: Law enforcement, epidemiologic, available. By contrast, it is considered percent. Hydroponic marijuana and ethnographic respondents not very available by 10 sources in 9 (“hydro”), available in most Pulse *Respondents in Chicago, Detroit, and St. Louis did not provide this information. cities, and not available at all by 7 Check cities, is a high-potency Pulse Check: Mid-Year 2000 page 41 MARIJUANA
Has marijuana potency changed? Have marijuana prices changed? and Washington, DC. In Miami, marijuana dealers often sell hash oil THC levels increased in seven Pulse Prices increased in only three of the (1–20 percent THC content) at $25 Check cities between 1999 and 2000, seven Pulse Check cities where THC per ounce. while levels declined in only one city: levels increased; thus, in Denver, El Paso, Memphis, and Washington, DC, How is marijuana referred to potency is up, but prices are stable. across the country? (Exhibit 4) Chicago, IL Prices declined in two cities. Billings, MT Similar to reports in previous Pulse Denver, CO Check issues, “grass,” “Mary Jane,” El Paso, TX Columbia, SC Memphis, TN Honolulu, HI “pot,” “reefer,” and “weed” remain Chicago, IL New York, NY the common slang terms for marijuana New York, NY Sioux Falls, ND throughout the United States. Other Sioux Falls, SD Washington, DC marijuana street names vary by geo- graphic region. In Chicago, “philips” As reported in the last Pulse Check marijuana costs $800–$2,500 per is new slang (in 2000) for marijuana. issue, most sources attribute any pound in New York and $400–$600 increases to improved cultivating MARIJUANA: THE USERS per pound in Washington, DC. techniques by marijuana growers Marijuana joints, blunts, and bags are Who, Where, How, and With What? (especially hydroponic growers). common quantities sold in Pulse How have marijuana users been Check cities: commercial-grade blunts changing across the country? What are street-level marijuana range from $5 in Philadelphia to Epidemiologic and ethnographic prices across the country? $10–$20 in Washington, DC; sources generally agree that marijuana (Exhibit 3) Commercial-grade commercial-grade joints range from use appears to have stabilized at ele- marijuana prices range from $20–$25 $1–$3 in Columbia to $10–$15 in vated levels, covering a wide range of per ounce in Birmingham to Los Angeles; and $5, $10, and $20 demographic and socioeconomic $300–$500 per ounce in Los Angeles. street bags can be purchased in many groups. In Portland, Maine, for Sinsemilla and British Columbian cities, including Chicago, Philadelphia, example, marijuana users continue to prices tend to be higher. Hydroponic
Then and Now: How have marijuana users changed (1999 vs 2000)?* According to epidemiologic and ethnographic sources...
Denver, CO The number of younger (<18) users has declined, the number of older (35+) users has increased, and the number of users age 18–34 has remained stable.
Memphis, TN More young people appear to be smoking marijuana, and the number of black female marijuana users has increased.
Miami, FL Some users have recently revived an old practice, which supposedly increases marijuana’s THC level: they roll a big joint of marijuana, dip it into a new product known as “hash oil” (see description on page 45), let it dry, then smoke it.
New York, NY Younger users are getting even younger (12 and 13 years old). Many youngsters smoke “bidis” or “beedies”—thin, brown, 3-inch long Indian cigarettes surrounded by a pink thread—pretending that they are marijuana joints (although they contain tobacco)
Philadelphia, While marijuana users appear to be aging, an increase is noted among teens. The number of black PA users is also increasing.
Washington, Continuing an ongoing trend, the number of female marijuana users has increased. DC
* No major changes in marijuana-using populations are reported by sources in 14 sites. page 42 Pulse Check: Mid-Year 2000 MARIJUANA
Exhibit 4. Boston, report that a growing number How is marijuana referred to in different regions of the country? of adolescents consider marijuana use to be safe. WEST MIDWEST NORTHEAST
Bio (outdoor grown, Are there any gender differences commercial-grade), in who uses marijuana? In four Doobies (joints), Jane, hydro (hydroponic), Pulse Check cities—Honolulu, Los 13, smack, chronic, Philips (new), bud, happy smoke stogies, blizzies, green, reefer, carb, MJ dutchies, L’s (blunts), Angeles, New Orleans, and Portland— ditchweed (local, males and females are equally likely outdoor-grown) to use marijuana, according to epi- demiologic and ethnographic sources. Wood, tree, hay, broccoli, greeny Elsewhere, males outnumber females green, herb, bud, smoke, MJ, morta, within the larger user groups. In bud, mata, mota, gunge, Acapulco many of those cities, however, such as Bud, Maui wowie, Kona gold, Maui wowie, kryptonite, fire, gold, ganja, pakalolo woodie, hash, stick, black rope, Memphis, the percentage of users (crazy tobacco) hydro (hydroponic) who are females is larger for marijua- na than for other drugs. Moreover, in SOUTH Billings, females outnumber males in Sources: Law enforcement, treatment, epidemiologic and ethnographic respondents that city’s younger (age 15–24) and smaller user group. outnumber heroin and cocaine users. most likely to use marijuana. Users as Treatment sources concur that most Some changes, however, are noted in young as 10 years are also reported in marijuana users in their programs are a few cities, as indicated above. Honolulu, and 12-year-old users are male. However, at programs in reported in New York and Seattle. Chicago, New York, and Sioux Falls, How old are marijuana users? The Denver epidemiologic source females are more likely to be in treat- As reported in Pulse Check issues over suggests that the older (35+) group is ment for marijuana use than males. In the past few years, marijuana users increasingly using the highly potent Birmingham, female and male users continue to span all ages, according to and readily available marijuana in the are about equal in number. Female epidemiologic and ethnographic mistaken notion that it alleviates “the users appear to be catching up to sources in many cities. In Portland, aches and pains of getting older.” their male counterparts at programs Maine, for example, marijuana use is in several Pulse Check cities, including initiated in high school and use contin- According to treatment sources, El Paso, Honolulu, Memphis, and ues through middle age. Similarly, the adolescents outnumber other age Portland. St. Louis epidemiologic source reports groups among marijuana clients at fairly high use “among everyone, from programs in 11 of the 20 Pulse Check Is any racial/ethnic or socio- teenagers up to adults in their early cities: Billings, Boston, Chicago, economic group more likely to fifties.” Columbia, Denver, Detroit, Los use marijuana? Even more than the Angeles, Miami, New Orleans, heroin problem, the marijuana Adolescent users often outnumber Portland, and Sioux Falls. Young adults problem cuts across all racial/ethnic the young adult and older adult user are more likely to use marijuana at groups. Epidemiologic and ethno- groups, according to epidemiologic reporting programs in the other graphic sources report that racial/ and ethnographic sources in Boston, cities. Pre-adolescents constitute the ethnic distributions are fairly represen- Columbia, Denver, El Paso, Seattle, second largest group of marijuana tative of their respective cities’ Sioux Falls, and St. Louis. El Paso has clients at programs in Billings and populations in Boston, Chicago, the youngest reported age range Sioux Falls. In Seattle, treatment Honolulu, Los Angeles, New Orleans, (10–14 years) for the group most like- sources report that the availability of New York, and St. Louis. White users ly to use marijuana; by contrast, that potent marijuana has promoted more are more prominent in Birmingham, city also has the oldest age range use and related debilitating circum- Denver (but they are underrepresented (45–54) reported for the group second stances. Some treatment sources, as in there), Miami (where Hispanics are a
Pulse Check: Mid-Year 2000 page 43 MARIJUANA
close second), Portland, and Seattle. in El Paso; the lower-to-middle SES Treatment sources paint a slightly Blacks are more likely to use marijua- groups are cited in Memphis; and the different picture, however, with the na in Columbia, Detroit (where they lower SES groups are cited in majority of marijuana clients at the are overrepresented), Memphis, Philadelphia and Washington, DC. reporting non-methadone programs Philadelphia, and Washington, DC. generally residing in inner-city areas. Both the lower and middle SES groups Suburban users, however, reportedly Treatment sources in the majority of are represented among marijuana predominate at the non-methadone cities, more so than epidemiologic and clients at reporting non-methadone programs in Denver, New York, and ethnographic sources, report that mar- programs in Pulse Check cities. The Portland, while rural users are most ijuana users in their programs are pre- lower SES group is more likely to use prominent at the Billings and dominantly black. Whites, however, marijuana at the programs in Billings, Honolulu programs. predominate among marijuana clients Chicago, El Paso, Honolulu, New at programs in Boston, Denver, Miami, York, New Orleans, and Washington, How do marijuana users wind up Portland, and Sioux Falls. Reflecting DC. The middle SES group, however, in treatment? (Exhibit 5) Of the general population distributions in has higher representation at the 17 non-methadone treatment sources their respective cities, Hispanics are non-methadone programs in Denver, discussing this question, nearly half the largest racial/ethnic group among Detroit, Miami, Memphis, and (47 percent, n=8) report that marijuana clients at the programs in Portland. marijuana clients at their programs Los Angeles and El Paso, and Asian/ come mainly from court or criminal Pacific Islanders are the predominant Where do marijuana users tend justice referrals—more so than crack group in treatment in Honolulu. In to reside? More so than other drug clients (40 percent) or heroin clients the Sioux Falls methadone program, users, marijuana users reside “every- (38 percent). By comparison, schools Native Americans constitute the sec- where”—a term used by numerous are the primary referral source for ond largest group of marijuana clients. responding epidemiologists and marijuana clients at only three ethnographers to refer to inner-city, programs (in Billings, Detroit, and As with race/ethnicity, marijuana use other urban, suburban, and rural Portland), and other health care knows no socioeconomic bounds: places of residence. Two of the few providers are the primary referral epidemiologic and ethnographic exceptions are Birmingham, where source at another three (in Boston, sources report that all SES groups are marijuana users are reportedly more Honolulu, and New York). represented relatively evenly among likely to reside in the suburbs, and marijuana users in at least 10 Pulse Philadelphia, where urban areas How do marijuana users take Check cities: Boston, Chicago, Denver, reportedly predominate. marijuana? As was found in the last Detroit, Honolulu, Los Angeles, New few Pulse Check issues, “blunts,” or Orleans, Portland, Seattle, and Sioux hollowed-out cigars, are reported Falls. Similarly, marijuana use cuts across all SES groups in Miami, but Exhibit 5. How are different drug users referred to treatment? the middle class predominates there; it also runs the gamut of SES groups in Percent (N=17) New York, but lower-to-middle SES 50 Marijuana Heroin Crack groups are cited as more prominent; 40 and it is found among all groups in St. Louis, but it is slightly more common 30 among that city’s lower SES groups. 20 By contrast, epidemiologic and ethno- graphic sources do note predominance 10 of specific SES groups in five cities. In 0 Birmingham, the largest group of Court/crim- School Other health Individual Other com- Alcohol/DA marijuana users is in the middle SES inal justice provider munity referral care provider
group; the lower middle class is cited Sources: Non-methadone treatment respondents page 44 Pulse Check: Mid-Year 2000 MARIJUANA
as common vehicles for smoking Philadelphia, where the Pulse Check What are some slang terms for marijuana in several cities, including epidemiologic source reports occur- drug combinations involving Boston, Chicago, Philadelphia, and rences of hallucinogenic behavior, marijuana? Washington, DC, according to such as people jumping into traffic The New York ethnographer reports epidemiologic, ethnographic, and or off buildings. In New Orleans, by several street names for marijuana treatment sources. Boston marijuana contrast, PCP lacing is not the norm combinations: users also reportedly smoke “bongs” but, rather, an occasional practice by and “joints.” Detroit and New “uptown” affluent young marijuana !$$“Illie” or “illing”: Marijuana dipped Orleans, by contrast, do not have users. A Washington, DC, treatment in PCP
large blunt cultures. Joints are the source reports that clients are !$$“B-40”: A blunt plus a 40-ounce most common marijuana vehicle in smoking high-purity marijuana laced bottle of beer or malt liquor, via one those cities, as well as in Los Angeles with PCP. of two techniques: and Portland. In Seattle, grams of Users dip the blunt into the “40,” “bud” are smoked through glass pipes drip-dry it, and smoke it, or they puff “Hash Oil” or “Jamaican Crude”: or other pipes. the blunt, blow smoke into the 40, A New Substance Used in a New shake it, and drink it. Practice What other drugs do marijuana !$$“Coolie”: Marijuana plus powder users take? Epidemiologic and Miami, FL: Not the traditional, highly cocaine in a cigarette or blunt ethnographic sources in nearly every refined “hash oil,” this new product is Pulse Check city report that marijuana a highly flammable, highly viscous dark !$$“Woola” or “woolie”: Marijuana plus users also use alcohol (sometimes malt green (almost black) oil. It is produced heroin in a cigarette or blunt by a crude operation: after the mari- liquor). Cocaine use is also reported Elsewhere, treatment sources report juana plant harvest, the leftovers are among marijuana users in some cities. additional terms: boiled down in 55-gallon drums and For example, blunts in Boston and shipped in gas containers. Some users !$$“Happy stick”: The Chicago term for Philadelphia sometimes contain dip marijuana joints into this substance, marijuana laced with PCP marijuana combined with either let it dry, and then smoke it, believing !$$ powder cocaine or crack. In New that this practice increases the “Primo”: The Chicago term for York, marijuana is combined with marijuana’s THC level. marijuana plus powder cocaine powder cocaine in either a blunt or a !$$“Geek joint”: The Columbia and cigarette. Crack is also reportedly used Miami term for marijuana laced by marijuana smokers in Washington, Some epidemiologic and ethnographic with cocaine and smoked DC (as a dip, and sometimes including sources mention other drugs used by heroin too), and Detroit. Adolescent marijuana smokers: flunetrazepam !$$“Tobacco 51s”: The Detroit term marijuana smokers in the Miami (Rohypnol) in El Paso; alprazolam for marijuana plus cocaine suburbs use both forms of cocaine. (Xanax®) in Philadelphia; and meth- ylenedioxymethamphetamine users, both at their programs and Heroin is sometimes included in (MDMA, or “ecstasy”), lysergic acid in their local communities, also use blunts in Boston and in either (LSD), and some methamphetamine cocaine (in Birmingham, Chicago, cigarettes or blunts in New York. among a small group of young, white, Columbia, Detroit, El Paso, Also in New York, marijuana is middle-class partygoers and clubgoers Honolulu, Los Angeles, and Miami), sometimes dipped in phencyclidine in Washington, DC. PCP (in Chicago), club drugs (PCP). PCP use by marijuana smokers (in Denver), methamphetamine (in is also an ongoing problem in Treatment sources, like epidemiologic Billings and Seattle), and ice (in and ethnographic sources, report that Honolulu, where the marijuana marijuana is used most commonly supposedly smooths out the effects with alcohol. Additionally, marijuana of ice).
Pulse Check: Mid-Year 2000 page 45 MARIJUANA
Where and with whom is MARIJUANA: THE SELLERS Detroit. However, street gangs are marijuana used? The word Who, How, Where, and With What? mentioned much less often as “everywhere,” once again, is involved with marijuana sales than How are street-level marijuana frequently mentioned by Pulse Check with heroin or cocaine sales. In sellers organized? (Exhibit 6) The epidemiologic and ethnographic Denver, as with heroin and cocaine, way marijuana sellers are organized sources, not just in response to where Mexican cartels are involved with in the United States varies widely, marijuana users reside, but also in marijuana sales. In Memphis, some with independent dealers cited most response to where they use the drug. marijuana is sold by marijuana grow- often as marijuana dealers. Biker From the malls and railroad tracks of ers. Epidemiologic and ethnographic gangs are mentioned as dealers in El Paso to the beaches of Honolulu sources add that in Miami, many Seattle (where they sell high-quality to the reggae concerts of Miami, small organizations consisting of British Columbian marijuana) and in marijuana is used in a wide range of 3–10 male members sell marijuana. settings and contexts, both indoors and outdoors, both alone and socially. Then and Now: Similarly, treatment sources report that How have street-level marijuana sales changed (1999 vs 2000)? marijuana users smoke their drug both alone and socially, and almost any- Signs point to " Memphis law enforcement: Indoor marijuana growing increased. where: at home, in cars, at parties, on increasing mari- the job (as reported in Denver), in the juana availability " Philadelphia epidemiologist/ethnographer: “In 2000, we’ve seen street, and in other public areas. At and sales in some more marijuana availability, more volatility in the market, and the Seattle methadone program, Pulse Check cities: more competition for selling.” solitary use of marijuana has increased " Washington, DC, law enforcement and epidemiologist/ethnogra- since the previous reporting period; pher: Marijuana sales, use, and related violence have increased. however, group use still predominates at that program and in the greater Other features and " Chicago law enforcement: “Marijuana sellers are more local area. Additionally, eight of the methods of sales cautious now.” non-methadone treatment sources have changed in report frequent use (four to six times some cities: " Miami epidemiologist/ethnographer: New people are entering a week) or daily use of marijuana in the marijuana sales business. The weight of street-level marijuana their local communities (in Billings, buys has changed recently: the 1/4- gram amount replaced the Birmingham, Boston, El Paso, ounce. Los Angeles, Miami, New Orleans, " Philadelphia epidemiologist/ethnographer: Sales of Portland). formaldehyde-soaked marijuana joints increased.
" St. Louis epidemiologist/ethnographer: “Younger, small time marijuana dealers are beginning to sell ecstasy.”
" Seattle law enforcement: More British Columbian marijuana (“BC bud”) is staying in the local market. Furthermore, biker gangs selling the drug may have left the United States for British Columbia and may be becoming more organized.
" Washington, DC, law enforcement: Law enforcement officials first encountered local hydroponic marijuana (“hydro”) in 2000.
page 46 Pulse Check: Mid-Year 2000 MARIJUANA
Exhibit 6. How are marijuana sources reporting it as sold “every- sellers organized?* where.” In Birmingham, Boston, Drug Use Among Marijuana Sellers Memphis, and New Orleans, it is sold Site How organized? Almost all responding law enforcement in inner-city, as well as suburban, sources (15 of 17) report that marijua- Denver, CO Mexican trafficking areas. In El Paso’s inner-city areas, na sellers use their drug. Only in two organizations smaller amounts of marijuana are sites (Miami and Seattle) do marijuana sellers reportedly not use the drug. Honolulu, HI Independent sold per transaction than in its subur- ban areas. In Birmingham, suburban Marijuana Sales-Related Violence West New Orleans, Independent; distributors receive marijuana from LA crack-dealing gangs sources outside the State, store large Violence among marijuana sellers is Seattle, WA Independent; biker quantities in the suburbs, then con- reported by law enforcement sources gangs tact city residents to distribute there, only in five areas (Birmingham, Boston in crack houses and on street corners. [at low levels], Denver, Miami, and Detroit, MI Biker gangs Washington, DC). Epidemiologic and
Midwest According to law enforcement ethnographic sources agree that violence related to marijuana sales is Columbia, SC Closely knit groups sources, marijuana is sold mostly on nonexistent or low level. Miami, FL Small gangs the street, followed by homes and nightclubs. It is sold in high schools
South Washington, Independent; in New Orleans and even in hospitals residences, streets, and nightclubs, DC Hispanic organized in Columbia. Epidemiologic and but they cite schools as the second groups ethnographic sources agree that mari- most common place (along with streets) for marijuana sales. They add Portland, ME Independent juana is commonly sold in private that in El Paso, marijuana is sold at
Northeast New York, NY Independent Exhibit 7. concerts; in Miami, it is sold at open Where is street-level marijuana street markets; in New York, small Source: Law enforcement respondents *Respondents in 10 sites did not provide this sold? amounts are sold on the street, and information. larger amounts are sold indoors; and 10 Number of cities in Philadelphia, it is sold in streets, rundown areas, and abandoned How old are street-level 9 Law Enforcement buildings. marijuana sellers? As with seller 8 affiliation, the ages of street-level Epidemiologists/ How is street-level marijuana 7 ethnographers marijuana sellers vary widely, ranging sold? As with the setting of marijuana from 10 to 65 years. According to 6 sales, marijuana distribution methods most law enforcement sources, 5 vary widely. Hand-to-hand marijuana adolescents and young adults sales are mentioned by Los Angeles, predominate among marijuana sellers. 4 Memphis, and Washington, DC, law Epidemiologic and ethnographic 3 enforcement sources. Beepers are used sources concur that the ages of in Memphis, and beepers and cellular 2 marijuana dealers range widely. Those phones are used in Chicago, where sources cite adolescents and young 1 sellers also drive up to residences and adults as the predominant age groups honk. According to the epidemiolo- of marijuana sellers. 0 Street Private Night- In/ gist in Boston, most marijuana is sold Resi- clubs Around through informal networks of friends. Where is street-level marijuana dences Schools Some telephone ordering of marijua- sold? (Exhibit 7) In reporting Pulse na is reported in Detroit, and delivery Check sites, marijuana is sold Setting services are noted in St. Louis. throughout the city, with many Sources: Law enforcement, epidemiologic, and ethnographic respondents
Pulse Check: Mid-Year 2000 page 47 MARIJUANA
What other drugs are sold by Exhibit 8. What other drugs do marijuana dealers sell?* marijuana dealers? (Exhibit 8) City Heroin Crack Powder Metham- Ecstasy Halluci- No Other Crack cocaine and heroin are the most Cocaine Cocaine phetamine (MDMA) nogens Drugs Sold common drugs other than marijuana Honolulu, HI # Los Angeles, CA #
sold by marijuana dealers, according to West Seattle, WA ## # law enforcement, epidemiologic, and Chicago, IL # ethnographic sources. Other drugs sold Detroit, MI # by marijuana dealers include powder Sioux Falls, SD # cocaine, methamphetamine, ecstasy, Midwest St. Louis, MO ## # LSD, and PCP. The latter is combined El Paso, TX ### with marijuana and sold in several Memphis, TN # Miami, FL ##
cities, including El Paso, New York, South ## and Washington, DC. In St. Louis, New Orleans, LA Washington, DC ## younger marijuana dealers sometimes Boston # sell ecstasy, and in Seattle, sources state New York, NY # that other drugs sold by marijuana #
Northeast Portland, ME dealers depend on what drugs are Sources: Law enforcement, epidemiologic, and ethnographic respondents available. In Philadelphia, adolescents *Sources in five sites did not respond: Billings, Birmingham, Columbia, Denver, and Philadelphia. report sales of formaldehyde-soaked marijuana joints. In five sites (three of MARIJUANA: THE COMMUNITY treatment programs are noting more them in them Midwest), no other drugs calls for help from youth, but there What is the impact of and com- are reportedly sold with marijuana. are not enough treatment slots munity reaction to the marijuana available to treat them. problem? Widespread marijuana use How is marijuana packaged and has had a variety of repercussions in marketed? The most common ! Portland, ME: Maine’s new medical local communities; conversely, the packaging for marijuana in U.S. cities marijuana bill, which allows for varied community responses have had is plastic zipper bags, according to possession of a number of plants, varied impact on the problem: Pulse Check sources. Sources also has not been fully operationalized. mention wrapped bundles in El Paso, Its impact, notes the epidemiologic ! Denver, CO: The epidemiologic cigar boxes in New Orleans, and source, remains to be seen. source links the recent increase small, glassine bags or by the bale in in marijuana-related hospital Portland. In Washington, DC, local ! St. Louis, MO: According to emergency room visits to the hydroponic marijuana (“hydro”) is the epidemiologic source, large increase in new users. packaged in small, glass bottles, and marijuana seizures occur every few weeks on the local interstate high- commercial-grade marijuana is often ! Honolulu, HI: After operating for way, increasing the general public’s sold in $10 “street bags.” Brand names 15 years, the Big Island’s Operation awareness of the problem. A treat- or labels for marijuana were not men- Green Harvest marijuana eradica- ment source notes an increase in tioned except in New York (where tion effort has been nearly stopped marijuana-related media attention in plastic bags containing marijuana are by threats of legal action against the local area. stamped with four leaf clover designs), the county council. The epidemio- in El Paso (where brand names include logic source notes concern about ! Washington, DC: The epidemio- “red colitas”), and in Miami (where increased marijuana availability logic source reports a new sentenc- brand names for sinsemilla include throughout the State. “krippie” and “Seattle,” and brand ing practice: selling more than half a pound of marijuana, which used to names for commercial-grade marijuana ! Miami, FL, and New York, NY: be a misdemeanor (up to 1 year in include “regs”). According to treatment sources, jail), is now considered a 5-year marijuana has become the target for felony. Also, a recent drug bust in program outreach activities. In neighboring Prince George’s County Miami, illegal drugs used by youth involved 38 pounds of marijuana. are particularly targeted. As a result, page 48 Pulse Check: Mid-Year 2000 METHAMPHETAMINE
METHAMPHETAMINE: Exhibit 1. THE PERCEPTION How available is methamphetamine by U.S. region?
How serious a problem is Percent methamphetamine in Pulse 100 Widely Available Check communities? During 2000, 90 methamphetamine was perceived as 80 Somewhat Available the most serious drug problem by 7 70 Not Very or Not Available responding sources (10 percent of 70) 60 50 in 3 cities: Billings and Honolulu in 40 the West; and Sioux Falls in the 30 Midwest. Furthermore, it was 20 considered the second most serious 10 drug problem by 6 responding 0 sources (9 percent of 70) in 5 cities: All regions West Midwest South Northeast Billings and Denver in the West; (N= 35) (N=8) (N=6) (N=13) (N=8) Memphis in the South; and Sioux Sources: Law enforcement, epidemiologic, and ethnographic respondents Falls and St. Louis in the Midwest. available or not available at all (in methamphetamine availability Has the perception of the Chicago); in the South, it ranges from between 1999 and 2000, and another methamphetamine problem not available (in Miami) to widely 48 percent of responding sources changed between 1999 and available (in Birmingham and report stable availability between 2000? No changes are reported: all Memphis); and in the Northeast, those time periods; only 4 percent sources who considered methamphet- methamphetamine is reported as either report declines. By region, the vast amine as either the first or second not very available or somewhat avail- majority of western sources most serious drug problem in their able (by sources in Boston, New York, (86 percent) report methamphetamine cities during 2000 also reported that Philadelphia, and Portland). availability increases, while southern the drug’s status had remained stable and midwestern sources report mostly since the previous year. The drug, How has methamphetamine increasing or stable trends, and however, was seen as an emerging or availability changed? (Exhibit 2) northeast sources generally report intensifying problem by five sources Nearly half (48 percent) of Pulse stable trends (85 percent). in five cities: Denver and Seattle in Check sources report increases in the West; Sioux Falls in the Midwest; Exhibit 2. Birmingham in the South; and How has methamphetamine availability changed by region? Philadelphia in the East. Percent METHAMPHETAMINE: THE DRUG 100 90 Up Stable Down Availability, Purity, and Price 80 How available is methampheta- 70 mine? (Exhibit 1) More than any 60 other drug on which Pulse Check 50 reports, methamphetamine availability 40 varies by U.S. region: in the West, it is 30 considered widely available by every 20 reporting source (in Billings, Denver, 10 Honolulu, Los Angeles, and Seattle); in 0 Across the U. S. West South Northeast Midwest the Midwest, it ranges from widely (N=27) (N=7) (N=9) (N=7) (N=4) available to somewhat available (in Sources: Law enforcement, epidemiologic, and ethnographic respondents Sioux Falls and St. Louis) to not very
Pulse Check: Mid-Year 2000 page 49 METHAMPHETAMINE
What type of methamphetamine is Exhibit 3. Gram prices for methamphetamine available? Low- to mid-grade Methamphetamine gram prices range from $40–$60 in El Paso to methamphetamine is the most avail- and purity by region and city* $80–$330 in Chicago. In Honolulu, able type of methamphetamine CITY GRAM PRICE PURITY high-purity ice (widely available there) according to 10 law enforcement, costs $200–$300 per gram. From Billings, MT $100 NR epidemiologic, and ethnographic 1999 to 2000, prices increased only in Denver, CO $100–$125 20% sources in 7 cities: Billings, Denver, Chicago and Denver, and decreased Honolulu, HI $200–$300 60% Los Angeles, and Seattle in the West; West only in Columbia and Memphis Sioux Falls and St. Louis in the Los Angeles, CA $80–$100 $15–$20 according to law enforcement, Midwest; El Paso in the South; and Seattle, WA $80–$120 epidemiologic, and treatment sources. Boston in the Northeast. “Ice” (nearly Chicago, IL $80–$330 NR 100 percent pure methamphetamine) St. Louis, MO $100 How is methamphetamine is not very available or not available Midwest referred to? (Exhibit 4) Street names Columbia, SC $125 NR at all, according to the majority (63 (slang) for methamphetamine across El Paso, TX $40–$60 50% percent) of Pulse Check sources. the United States include crank, meth, Miami, FL $80–$100 NR speed, and crystal. Other names are However, it is widely available South according to sources in four cities in New Orleans, LA $150 NR based on the appearance of the the West (Billings, Denver, Honolulu, Washington, DC $150 methamphetamine available. For and Los Angeles) and one city in the New York, NY $200 example, “sparkle” is a somewhat South (Memphis). Ice is considered Philadelphia, PA $80–$100 shiny methamphetamine available in
“somewhat available” by sources in Northeast Portland, ME $120 50% Denver, “clear” is a clear high-purity only three cities: Birmingham, El methamphetamine in Honolulu, and Sources: Law enforcement, epidemiologic, “peanut butter” describes the yellow- Paso, and New York. and ethnographic respondents *Respondents in five sites did not provide this ish methamphetamine available in Most methamphetamine available information: Birmingham, Boston, Detroit, Washington, DC. Memphis, and Sioux Falls. in the United States is produced in METHAMPHETAMINE: THE USERS clandestine labs, either in Mexico or Check sources, and many sources locally. The ephedrine/pseudoephe- report both methods within one area. Who, Where, How, and With What? drine reduction method and cold- Two other methods mentioned are the How old are methamphetamine cooking method (“nazi method” made red phosphorous and the phenyl-2- users? In most Pulse Check sites, with anhydrous ammonia and lithium) propanone (P2P) methods. Local young adults are most likely to use are the two types of methamphetamine clandestine lab “busts” (especially in methamphetamine, except in Miami manufacturing most cited by Pulse rural areas) seem to be increasing in and Los Angeles where treatment many Pulse Check cities, including sources indicate that adolescents are Changes in methamphetamine Denver, Memphis, St. Louis, and the most common age group. Older manufacture? Seattle. adults also use methamphetamine in According to epidemiologic and many areas. In Denver, use among ethnographic sources... How pure is methamphetamine, young adults is slightly up while older and how much does it cost? adult use appears to be declining ! Seattle, WA “Mexican metham- (Exhibit 3) Actual methamphetamine slightly. Los Angeles treatment phetamine may be losing its market purity levels are reported only by law providers are observing an increase in share due to the increase of locally enforcement, epidemiologic, and adolescent clients. produced methamphetamine.” ethnographic sources in Denver, El ! Philadelphia, PA “Traditionally, Paso, Honolulu, Los Angeles, and Is any racial/ethnic or socioeco- cookers used the ‘P2P [phenyl-2- Portland. Purity changes between 1999 nomic group more likely to use propanone] method’ to manufacture and 2000 were reported only by treat- methamphetamine? According to methamphetamine, but more recently, ment sources in Billings, where purity epidemiologic and ethnographic the ephedrine reduction and ‘nazi’ levels decreased, and in Chicago and sources in 13 Pulse Check reporting methods are being used.” Columbia, where they increased. cities, whites appear to be the page 50 Pulse Check: Mid-Year 2000 METHAMPHETAMINE
Exhibit 4. the black community. Middle and How is methamphetamine referred to in different regions of the country? lower socioeconomic groups are more WEST MIDWEST NORTHEAST Motorcycle likely to use methamphetamine, crack except in New Orleans where moderate to upper socioeconomic groups are reported by epidemiologic Elbow (1 lb), and ethnographic sources. pellet Are there any gender differences in who uses methamphetamine? Peanut butter (yellow), The majority of methamphetamine hydro (high-quality powder), glass (high users are male, except in five Pulse Ice, clear, purity), ice (highest Check cities: in Los Angeles, New Sparkle SOUTH batu, wash purity) Orleans, Sioux Falls, and Washington, Sources: Law enforcement, treatment provider, epidemiologic, and ethnographic respondents DC, users are evenly split between males and females; and in El Paso, predominant users of methampheta- Angeles epidemiologist reports an users are more commonly females. mine. Some use, however, is reported increase in methamphetamine use Methamphetamine use is reportedly among other racial/ethnic groups, among Hispanics. Treatment an increasing problem among women especially in cities where they are providers report similarly, except in in Denver and Honolulu. The drug is substantially represented, such as the El Paso where they serve a Hispanic a particular problem within the gay following: Hispanics in Denver and population reportedly using communities in Los Angeles and Los Angeles; Native Americans in methamphetamine. In Washington, Seattle, where the drug is perceived Billings and Sioux Falls; and Filipinos DC, epidemiologic and ethnographic by users as a “health aid” to combat in Honolulu. In particular, the Los sources suggest possible new use in chronic fatigue associated with HIV.
Then and Now: How have methamphetamine users changed across the country (1999 vs 2000)?* According to epidemiologic, ethnographic, and treatment sources...
Denver, CO According to epidemiologic and ethnographic sources, use among young adults is slightly up, while older adult use appears to be declining slightly, and the problem is reportedly increasing among women. Treatment sources report an increase in cocaine use as a secondary drug. Users have switched from snorting to injecting, according to both types of respondents.
Honolulu, HI Methamphetamine use is reportedly an increasing problem among women.
Los Angeles, Treatment sources observe an increase in adolescent clients, and the epidemiologic source reports an CA increase in use among Hispanics. Continuing a 5-year upward trend, smoking has increased.
New York, NY According to the ethnographic source, methamphetamine use is beginning to be observed in the gay community
Seattle, WA Smoking has increased, according to treatment sources. According to the epidemiologic source, anecdotal reports of methamphetamine-related child abuse and neglect and cases of domestic abuse have increased. That source also notes the spread of methamphetamine use from older adults to adolescents and young adults.
Washington, DC The epidemiologic source suggests initiation of use in the black community.
*No major changes in methamphetamine-using populations are reported in 14 sites.
Pulse Check: Mid-Year 2000 page 51 METHAMPHETAMINE
Seattle, according to epidemiologic epidemiologic and ethnographic Methamphetamine in the Gay and ethnographic sources; by contrast, sources. They cite parties, raves, Community users in Chicago, Detroit, and trailer parks, bars, bathhouses, and Denver, CO: According to the Washington, DC, most frequently homes as the usual places for epidemiologic source, gays of all ages snort methamphetamine. Smoking methamphetamine use. In contrast, inject cocaine and methamphetamine. is the most common route of admin- treatment sources indicate that Los Angeles, CA: Methamphetamine istration in Honolulu, Los Angeles methamphetamine is often taken taken with sildenafil citrate (Viagra®) (where it is increasing), and Sioux alone in many cities. In most report- has produced adverse medical effects in Falls. In Birmingham and El Paso, ing cities, methamphetamine is used the gay community, according to the epidemiologic and ethnographic several times each week, but multiple epidemiologic source. sources report that oral administra- daily use is reported by epidemiologic New York, NY: The Pulse Check tion is the most common route, while and ethnographic sources in Billings, ethnographic source notes, “You don’t treatment providers report injecting Columbia, and Seattle. see much methamphetamine, but gays as the most common route. In have been starting to use it within the Denver, users have been switching METHAMPHETAMINE: last year, especially in bars. Now that the from snorting to injecting, according THE SELLERS AIDS epidemic is slowing, the ‘fear fac- to epidemiologic and ethnographic Who, How, Where, and With What? tor’ among younger gays is down, and sources. In Seattle, treatment sources How are street-level metham- they are going back to risky behaviors.” cite an increase in smoking. phetamine sellers organized? Methamphetamine distributors are What other drugs do In Denver, gays reportedly inject affiliated with trafficking organizations methamphetamine users take? cocaine with methamphetamine. in 5 of the 12 reporting Pulse Check Many methamphetamine users also Methamphetamine use is also cities where law enforcement sources have problems with other licit and beginning to be observed in the gay reported on the subject. Ties with illicit substances of abuse. Alcohol is community in New York, according Mexican organizations are reported the most common substance they use. to epidemiologic and ethnographic in Denver, Honolulu, and Seattle. Marijuana is also frequently used, as sources. Domestic organizations are reported in Denver, where it is used to “come in Denver and Honolulu (Californian Where do methamphetamine down” after methamphetamine use. groups), and biker gangs are reported users tend to reside? Suburban Other drugs cited by epidemiologic in New Orleans and Philadelphia. and rural areas are the most likely and ethnographic sources are cocaine Other Philadelphia distributors place of residence for methampheta- injection in Denver (in the gay com- include some Italian groups and some mine users in Birmingham, Chicago, munity), club drugs in New Orleans independent groups. Independent Detroit, New Orleans, Los Angeles, and Washington, DC, and poppers groups are also cited by the other and St. Louis. Conversely, metham- in Seattle. In the Los Angeles gay seven reporting law enforcement phetamine use is more frequently community, medical consequences sources in the following cities: observed among those in urban areas have resulted from methamphetamine Boston; El Paso, where the law in Billings, Boston, El Paso, Memphis, taken with sildenafil citrate (Viagra®). enforcement source notes that and Philadelphia. Methamphetamine Treatment providers in Denver report “makers are users”; Los Angeles, use appears to be a problem in all an increase in cocaine use as a secon- where the drug is obtained from types of areas in Denver, Honolulu, dary drug, and the El Paso non- friends and intimates; Memphis; and Seattle. methadone source lists heroin, inject- Sioux Falls, where “independents” ed with methamphetamine as a who deal methamphetamine are How do users administer metham- “speedball,” as the most common slightly more organized, via family phetamine? Route of administration concurrently used drug. varies widely across Pulse Check cities, ties, than those who distribute other drugs; and St. Louis, where with no clear regional pattern. Where and with whom is independent distributors are affiliated Injecting is the most common route in methamphetamine used? with other users and sellers. Billings, Denver, Philadelphia, and Methamphetamine use tends to be a group activity, according to page 52 Pulse Check: Mid-Year 2000 METHAMPHETAMINE
Then and Now: because the stuff is everywhere.” By How have street-level methamphetamine sales changed (1999 vs 2000)? contrast, sellers’ age ranges are nar- rower in El Paso (18–25), Sioux Falls Despite the many reported increases in availability, the methamphetamine sales scene (20–35), and St. Louis (26–38). has remained remarkably stable since the previous reporting period, with only a few exceptions: Epidemiologic and ethnographic Lab seizures have " Detroit epidemiologist: Methamphetamine labs have recently sources generally note that sellers are increased: been seized in western Michigan. in their twenties and thirties, except in Detroit where the small number of " Denver epidemiologist: Many methamphetamine lab busts methamphetamine sellers have a have recently been reported in the Rocky Mountain area: for wider age range of 20–50. example, in the second quarter of fiscal year 2000, 166 such busts were reported. Violence Among Methamphetamine " Seattle epidemiologist and law enforcement: The number of Sellers local lab seizures has gone up dramatically, totaling 76 in the first 8 months of 1998, 171 during the same period in 1999, Violence is a part of the methampheta- and 233 during that period in 2000. mine sales scene in 11 of 12 Pulse Check cities whose law enforcement sources " Sioux Falls epidemiologist: The number of methamphetamine discussed this question. In Honolulu, for busts has increased. example, “ice” plays a large role in domestic violence (both on the part of " The number of Memphis law enforcement: The number of sellers has the perpetrators and victims) and it is sellers has increased. involved in other violent criminal acts. increased: In Seattle, methamphetamine-related " Seattle epidemiologist: The number of sellers, both local and domestic violence (again, both on the Mexican, has increased. part of the perpetrators and victims) has reportedly increased since the last The problem has " Seattle epidemiologist and law enforcement: While the reporting period. Sioux Falls is another spread from rural methamphetamine scene remains generally a rural phenomenon, example, with methamphetamine areas: it has started spreading to suburban and inner-city areas. involved in gang activity, prostitution, violent criminal acts, and domestic vio- lence (perpetrators). Only in El Paso is Epidemiologic and ethnographic How old are street-level violence not seen as part of the metham- sources corroborate the Mexican methamphetamine sellers? In phetamine scene. connection in Denver and Seattle and 9 of the 12 Pulse Check cities where also indicate a similar connection in law enforcement sources reported on Epidemiologic and ethnographic sources, Sioux Falls. They cite biker gangs in seller age, the age range is remarkably however, describe a more mixed picture. Detroit (where those gangs are not a wide: 20–50 in Billings; 18–40 in Low-level methamphetamine-related vio- lence is reported in Denver, Detroit, visible group) and New York, local Boston; 15–65 in Denver; 17–early- Honolulu (only when turf problems are cooks in Seattle and the rural areas fifties in Honolulu; 20–40 in Los encountered), St. Louis (domestic violence outside of Detroit, small “mom-and- Angeles; early-twenties-late-forties in in rural areas), and Washington, DC. pop” lab operators in St. Louis rural Memphis; 20–45 in New Orleans; Higher levels of violence are reported in areas, and independent distributors in and “all ages” in New York. In Seattle, involving both turf wars and Washington, DC. Seattle, the law enforcement source domestic violence and both local and notes that it is “hard to establish Mexican sellers. By contrast, metham- a(n age) pattern for the local labs phetamine is not associated with violence in Birmingham and Chicago.
Pulse Check: Mid-Year 2000 page 53 METHAMPHETAMINE
Do methamphetamine sellers Exhibit 5. use their own drugs? In all 13 Where is street-level methamphetamine sold?* cities whose Pulse Check law Private Bars, enforcement sources discussed this resi- restaurants, Busi- Hand-to- Truck City dences Street clubs, parties nesses hand Cars stops question, methamphetamine sellers do indeed use their own drug. As a Billings, MT # Denver, CO ## matter of fact, just about all the Honolulu, HI ## # # sellers in Denver reportedly do so, West Los Angeles, CA ## ## as do the majority in Honolulu and Seattle, WA # approximately 80 percent of sellers in Chicago, IL # St. Louis. In Seattle, “cooks” often St. Louis, MO ### start their trade because they are users Midwest Sioux Falls, SD # to begin with. In Sioux Falls, however, El Paso, TX ## quite a few methamphetamine sellers Memphis, TN ## # # do not use their drug. South Washington, DC #
Epidemiologic and ethnographic New York, NY #
sources confirm that the sellers use Northeast their own drug. In Seattle, however, Sources: Law enforcement, epidemiologic, and ethnographic respondents while local cooks reportedly use their *Sources in eight sites did not respond: Detroit in the Midwest; Birmingham, Columbia, Miami, and New Orleans in the South; and Boston, Philadelphia, and Portland in the Northeast. own methamphetamine, Mexican sellers do not. methamphetamine is also sold in the ! New Orleans, LA: Methcathinone suburbs of Birmingham and Chicago. (“cat”) Where and how is street-level methamphetamine sold? Methamphetamine sales take place ! Seattle, WA: Marijuana (Exhibit 5) Methamphetamine is often both outdoors—as reported in sold in rural areas, as reported by law Denver, Honolulu, Los Angeles, and ! Sioux Falls, SD: Marijuana enforcement sources in Memphis, Memphis—and indoors in a variety Seattle, and St. Louis. In other cities, of settings, such as private residences, The Seattle epidemiologic source however, it is sold in urban areas: in El bars, clubs, restaurants, parties, cars, corroborates that methamphetamine Paso, labs are small enough to be in truck stops, and even places of busi- sellers also sell marijuana, and the residential areas; in Memphis, metham- ness. The drug is often sold in small Washington, DC, epidemiologic source phetamine is sold in the inner city, but closed social groups—hand-to-hand, adds that some methamphetamine to a lesser extent than in rural areas; in friend-to-friend, or acquaintance-to- sellers also sell “ecstasy” and LSD. New Orleans the drug is processed in acquaintance—as reported in El Paso, How is methamphetamine rural areas but sold in urban areas; in Los Angeles, Memphis, St. Louis, and packaged and marketed? Small New York it is sold in both residential Sioux Falls. None of the midwestern plastic bags are the most commonly and commercial urban areas; in sources report methamphetamine reported packaging for methampheta- Philadelphia, it is sold in the northern sales in the club or bar scene. part of the city; and in Seattle sales are mine, according to Pulse Check law beginning to spread from the rural What other drugs do enforcement sources in El Paso, areas into the suburbs and inner city. methamphetamine dealers sell? Honolulu, Los Angeles, New Orleans, Moreover, methamphetamine is report- Only five law enforcement sources New York, Sioux Falls, and St. Louis. edly sold “all over” or “citywide,” report that methamphetamine dealers Other reported packaging includes according to law enforcement sources also sell other drugs: foil in Denver and, in Memphis, in Billings, Honolulu, Los Angeles, either a small cellophane pack or wax and Sioux Falls. Epidemiologic and ! Denver, CO: Marijuana, cocaine paper knotted up. An epidemiologic ethnographic sources corroborate source adds that methamphetamine in many of these reports and add that ! Honolulu, HI: Marijuana, cocaine, Detroit is packaged in paper wrappers. heroin (“everything”) page 54 Pulse Check: Mid-Year 2000 METHAMPHETAMINE
METHAMPHETAMINE: THE COMMUNITY
How is the impact of and community reaction to the methamphetamine problem? Methamphetamine affects communities in many ways: it is associated with violence, as discussed above, and with adverse medical consequences. As a result, media attention often focuses on the problem and communities react with a variety of prevention efforts, law enforcement efforts, and changing sentencing practices.
Adverse medical " Honolulu, HI: Methamphetamine-related episodes are sporadically reported from psychiatric consequences: wards, where the drug is viewed as a real problem.
Media and other " Detroit, MI: The Pulse Check epidemiologic source notes some media efforts, such as TV spots, prevention efforts: targeted at methamphetamine. It is still too early to assess the impact on the community.
" Honolulu, HI: The Women’s Amphetamine Treatment for Community Health (WATCH) has sponsored several public service announcements (PSAs) targeting female users of crystal metham- phetamine. The epidemiologic source notes, however, that these PSAs are usually aired at around 2:00 am, thus having a limited impact.
" Sioux Falls, SD: The epidemiologic source suggests that the community’s education efforts, based on zero tolerance and increased parent involvement, have resulted in a drop in adolescent use of methamphetamine.
" Seattle, WA: Methamphetamine lab education sessions for the community were started in Olympia, Washington, a little more than a year ago. The sessions are extremely popular and are growing statewide; they now train others to educate. The law enforcement source notes that the impact of these sessions should be evident by the next Pulse Check issue.
Law enforcement " Detroit, MI: Recent methamphetamine lab busts have gotten some publicity. efforts: " Los Angeles, CA: Newspaper reports of major methamphetamine seizures so far have not affected supply, which remains high.
" Seattle, WA: The epidemiologic source notes that the sharp increase in methamphetamine lab seizures is the direct result of the Washington State Patrol response team, which targets these labs. The law enforcement source suggests that these efforts are completely reactive: as the community knows more, the budget targeted at methamphetamine increases, and more busts occur.
" Sioux Falls, SD: The epidemiologic source links the increase in methamphetamine busts as to a methamphetamine task force.
" Denver, CO: Law enforcement efforts have targeted methamphetamine specifically.
" Miami, FL: Some law enforcement efforts and legislation have targeted precursors: in a major national case, massive amounts of ephedrine were seized in the Ft. Lauderdale area, where a drug ring was involved in warehousing the drug for shipment to Los Angeles.
Changing sentenc- " Portland, ME: Possession of methamphetamine is now considered a felony, according to the ing practices: law enforcement source, who also notes that more aggressive judges are taking more interest in these cases.
Pulse Check: Mid-Year 2000 page 55 CLUB DRUGS
SPECIAL TOPIC: “ECSTASY” AND OTHER CLUB DRUGS The last issue of Pulse Check food stores and over the Internet, first-hand knowledge of club drug addressed “club drugs” as a special often in powder or capsule form. use, suggesting that club drug users topic because of increasing reports have not yet entered the treatment that a wide variety of illicit drugs ! Ketamine is a prescription anesthetic system in large numbers. were being used and sold, mostly by with hallucinogenic and dissociative white youth from middle to upper properties and marketed for human Pulse Check discussions suggest that SES groups, in nightclub and rave set- use, but primarily for veterinary use. club drug availability and use are tings. Since then—amid concern Ketamine can be used in liquid or increasing, corresponding to reports about increased consequences and powder form. from the sources listed above. For possible spread to other populations example, according to DAWN, emer- ! and broader settings and contexts— Rohypnol (flunitrazepam) is a gency department mentions for GHB this problem has continued to be benzodiazepine, no longer marketed and MDMA increased significantly monitored by numerous sources, in the United States, that is obtained between 1998 and 1999 (from 1,282 including the Drug Abuse Warning by prescription in Mexico (and GHB mentions in 1998 to 2,973 in Network (DAWN), the Monitoring sometimes Colombia) and smuggled 1999, and from 1,143 MDMA the Future (MTF) study, the across the border. It has been mentions in 1998 to 2,850 in 1999), Community Epidemiology Work involved in numerous drug rapes, whereas other club drugs did not Group (CEWG), the Drug but its most common abuse pattern increase significantly during this time Enforcement Administration (DEA), is episodic use by teenagers and period. Additionally, emergency and numerous local law enforcement young adults as an “alcohol exten- department episodes involving club and public health agencies. The der” and disinhibitory agent, most drugs usually involve multiple sub- growth of the problem, particularly often in combination with beer. stances, such as marijuana, cocaine, the proliferation of “ecstasy” and other club drugs. Alcohol is a ! Methamphetamine is a stimulant (methylenedioxymethamphetamine or common factor in these episodes. (discussed in the previous section). MDMA), has warranted further Similarly, MTF data showed that scrutiny by Pulse Check, and so this ! Nitrous oxide is an inhalant often ecstasy use (both lifetime and issue once again devotes a special referred to as laughing gas. focus to this broad category of drugs, past-30-day use) continued to rise sharply between 1999 and 2000 which includes the following: ! Lysergic acid diethylamide (LSD) among 8th, 10th, and 12th graders. (“acid”) is a hallucinogen, most ! Furthermore, perceived ecstasy Ecstasy, a synthetic, psychoactive commonly distributed on blotter availability among 12th graders substance with stimulant and mild paper and taken orally. hallucinogenic properties, is most (the only grade for which perceived often used in pill form. The club or rave experience typically ecstasy availability was reported) also involves music, dancing, and socializ- increased markedly during that time ! Gamma hydroxybutyrate (GHB) is a ing and usually lasts through the period. The other club drugs included central nervous system depressant night. Club drugs are commonly in the survey are LSD, Rohypnol, and usually sold as an odorless, colorless combined with one another and with methamphetamine, use of which liquid in spring water bottles or as a other illicit drugs and alcohol. declined among 8th, 10th, and 12th powder and mixed with beverages. graders. GHB, ketamine, nitrous GHB precursors, gamma butyrola- For this issue, all four categories of oxide use were not specifically tone (GBL) (a chemical used in Pulse Check sources were asked about surveyed. many industrial cleaners) and 1,4- club drug use and activity in their butanediol (BDL), convert into GHB areas. The law enforcement, epidemi- Pulse Check discussions in 2000 in the body and have been sold as ologic, and ethnographic sources further indicate that club drug activity nutritional supplements in health provided most of the information, may be expanding from nightclubs whereas treatment sources had little and raves to high schools, streets, and page 56 Pulse Check: Mid-Year 2000 CLUB DRUGS
open venues; further, they suggest Exhibit 1. Exhibit 2. that whites are no longer the How available are club How available are the different exclusive users and sellers, which now drugs across the United States? forms of ecstasy? include more blacks and Hispanics. Percent Percent Pulse Check sources corroborate the 100 Widely 100 Widely Available Available DAWN reports of the continuing 90 90 practice of combining club drugs with Somewhat Somewhat Available Available one another, with other illicit drugs, 80 80 and with alcohol. Not Available Not Available 70 or Not Very 70 or Not Very Available Available ECSTASY AND OTHER CLUB 60 60 DRUGS: THE PERCEPTION 50 50
How serious a problem are club 40 40 drugs in Pulse Check communi- 30 30 ties in 2000? Club drugs (including ecstasy) or ecstasy alone were per- 20 20 ceived as the emerging drugs in their 10 10 communities by 27 sources in 18 of the 20 Pulse Check cities (52 percent 0 0 In general Pill Powder Liquid of 52 responding enforcement, Ecstasy GHB Ketamine Rohypnol (N=36)(N=33) (N=35) (N=33) (N=36) (N=32) (N=19) (N=23) epidemiologic, ethnographic, and treatment sources). Billings and Sources: Law enforcement, epidemiologic, ethnographic respondents Birmingham were the only two cities where these drugs were not named as availability are from cities in the West 2000; only one source (in Portland, an emerging problem. While no or South: Denver, Los Angeles, Maine) reports that ecstasy availability sources reported club drugs or ecstasy Miami, New Orleans, and Seattle. declined. Ketamine availability as their communities’ most serious Similarly, Rohypnol is considered increased or remained stable according drug problem in 2000, three did widely available by respondents only to most respondents, whereas GHB report club drugs as the in western and southern cities: availability was mixed, with 48 percent second most serious drug problem: Denver, El Paso, and Los Angeles. of sources from all four U.S. regions the non-methadone treatment source reporting increases, and 18 percent in Boston, the law enforcement The most common type of ecstasy reporting declines (in El Paso, Los source in Miami, and the law available in Pulse Check cities, by far, Angeles, and Miami). Rohypnol enforcement source in New Orleans. is the pressed pill (tablet), followed by availability trends are also mixed, powder and liquid forms. In Brooklyn, with increases in Denver, El Paso, Los ECSTASY AND OTHER CLUB New York, a street gang is reportedly Angeles, Memphis, New Orleans, and DRUGS: selling a powder form of ecstasy that, St. Louis and declines in Los Angeles Availability, Form, Price, and Purity like heroin, may be snorted or inject- and Miami. ed. In Los Angeles, homemade ecstasy How available are club drugs in is reportedly increasing, albeit not Miami, FL: According to the law Pulse Check communities? widely available, according to the enforcement source, ecstasy availability (Exhibits 1 and 2) Ecstasy is the most epidemiologic source. and use are surging. The drug is available of club drugs, with more replacing crack, GHB, and Rohypnol. than 90 percent of epidemiologic, Has club drug availability ethnographic, and law enforcement changed? (Exhibit 3) More How are club drugs and their respondents reporting it as somewhat than 80 percent of epidemiologic, combinations referred to across or widely available, followed by GHB ethnographic, and law enforcement the United States? (Exhibit 4) (and its precursors). Interestingly, all respondents report that ecstasy avail- Slang terms for ecstasy are similar respondents reporting wide GHB ability increased between 1999 and across the Nation. It is generally
Pulse Check: Mid-Year 2000 page 57 CLUB DRUGS
Exhibit 3. referred to as “X,” although “E,” Has club drug availability changed between 1999 and 2000? “roll,” and “the hug drug” are more recent names. The practice of taking Percent 100 ecstasy is referred to as “rolling.” 90 80 Up Stable Down Miami: The epidemiologic source notes 70 that users have stopped referring to 60 ecstasy as MDMA or ‘X’ and are now 50 calling it ‘E.’ Also, fewer users think of 40 it as a drug and more as a feeling, a 30 pick-me-up, a fantasy. 20 10 0 Ketamine is referred to as “K” or Ecstasy Ketamine GHB Rohypnol (N=22) (N=25) (N=21) (N=22) “special K” in most cities, with additional terms by locality. Where Sources: Law enforcement, epidemiologic, and ethnographic respondents available, Rohypnol is referred to by many names, including “roofies,” Exhibit 4. “roches,” and “R-2.” Slang for other Slang terms for club drugs and club drug combinations across the club drug and drug combinations are United States national or vary by city. The numerous terms for club drug combinations (for Drug or drug combinations Slang term City example, LSD combined with ecstasy GHB, GBL, 1,4-BD date rape drug Birmingham, AL is referred to as “candy flipping” liquid X, liquid E Boston, MA across the Nation) highlight the liquid G, G Chicago, IL practice of using club drugs with other wonder stuff Columbia, SC club drugs, hallucinogens, heroin, and liquid E, liquid X, G, scoop, water Detroit, MI cocaine, particularly in eastern cities. shot (liquid), hit (powder), G Los Angeles, CA Blue Nitro, ReNewtrient (GBL What are street-level ecstasy “nutritional supplement” brand names) Miami, FL prices across the country and G, gamma New Orleans, LA G, liquid X, verve New York, NY have they changed? (Exhibit 5) Georgia home boy St. Louis, MO Ecstasy ranges from $10 to $45 per liquid ecstasy Seattle, WA pill in Pulse Check cities, according to Ketamine cat Denver, CO law enforcement, epidemiologic, and super K Los Angeles, CA ethnographic sources. Price ranges in bump (one dose), cat valium New York, NY the Midwest seem to start at higher been rowing Columbia, SC levels than elsewhere, while the lowest Nitrous Oxide nitrous, N-2, hippie crack Los Angeles, CA prices are reported in southern cities. Ecstasy + LSD trolling Miami, FL Little information is available on the Ecstasy + LSD (in pill form) nexus Washington, DC purity of ecstasy or any club drug. Ecstasy + psilocybin mushrooms hippie flipping Boston, MA What adulterants are added to Ecstasy + powder cocaine bump Miami, FL ecstasy across the country? Ecstasy + heroin down ecstasy Washington, DC According to law enforcement, Ecstasy + methamphetamine up ecstasy Washington, DC Ketamine + LSD the matrix Chicago, IL epidemiologic, and ethnographic sources, ecstasy may contain many Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents substances other than MDMA, and adulterants include mostly stimulants. page 58 Pulse Check: Mid-Year 2000 CLUB DRUGS
Exhibit 5. Then and Now: Ecstasy prices per pill by region How have ecstasy users changed across the country between 1999 and and city 2000?
CITY PRICE Ecstasy user groups " New Orleans, LA: In the recent past, ecstasy was used only Denver, CO $22 and settings seem to be in underground, private settings, but in the last 2 months a Honolulu, HI $25–$45 shifting or expanding New York promoter publicly advertised raves and concerts,
West Los Angeles, CA $20–$30 according to where club drugs are used fairly openly. Seattle, WA $15–$20 epidemiologic sources: " New York, NY: As ecstasy availability has increased on the Chicago, IL $25–$35 street, Hispanics and blacks are starting to use the drug. St. Louis, MO $35 " Midwest Sioux Falls, SD $30 St. Louis, MO: “Ecstasy use has become more noticeable in the past 6 months.” Columbia, SC $25–$35 El Paso, TX $10–$30 are predominantly adolescents and Miami, FL $14–$30 City Adulterants South young adults, with many sources New Orleans, LA $30 Boston, MA amphetamine, caffeine mentioning high school and college Washington, DC $20–$30 Chicago, IL caffeine, vitamins, students (in Boston, Los Angeles, Boston, MA $20–$40 heroin (anecdotal) Philadelphia, St. Louis, and New York, NY $20–$25 Los Angeles, caffeine, Washington, DC). Of 14 epidemio- Philadelphia, PA $20–$35 CA methamphetamine logic and ethnographic respondents, Northeast Portland, ME $20–$30 Memphis, TN ephedrine half report that ecstasy users are New York, NY amphetamine, caffeine, predominantly male, and half report Sources: Law enforcement and epidemiologic/ ethnographic respondents ephedrine, heroin that they are evenly divided between (anecdotal) the genders. Nearly all epidemiologic Washington, DC heroin (anecdotal) and ethnographic respondents (87 Have ecstasy prices changed? percent) report that ecstasy users are The few 1999-to-2000 changes report- Sources: Law enforcement, epidemiologic, predominantly whites. In El Paso, ed show mixed trends: and ethnographic respondents however, both Hispanics and whites are reportedly the predominant users, Denver, CO Seattle, WA: According to the law and in Sioux Falls, users represent a Los Angeles, CA Portland, ME enforcement source, what is being sold cross-section of the general popula- Miami, FL as GHB and ecstasy may be metham- tion. Most ecstasy users range from New Orleans, LA phetamine, and this practice seems to middle to upper socioeconomic sta- be increasing substantially. tus, although in New York, users reportedly fall into all socioeconomic Do some ecstasy tablets contain According to a law enforcement groups. Treatment sources who heroin? source, very weak, home-pressed provided information on club drug ecstasy pills were seized in Columbia, use concur that the groups most likely Heroin is mentioned anecdotally as an South Carolina, where the seller to use ecstasy are adolescents (in adulterant in Chicago, New York, and reportedly “sold as many as he Honolulu and Portland) and young Washington, DC. However, two Miami wanted to for $25 each.” sources (both law enforcement and adults (in Denver, El Paso, and Los Angeles). epidemiologic) suggest that sellers ECSTASY: THE USERS falsely claim that their ecstasy pills Who, Where, How and With What? contain heroin as a marketing scheme: Seattle, WA: According to a treatment if ecstasy users believe that they have Who uses ecstasy? According to respondent, ecstasy users are becoming tried heroin once, they might be willing all responding epidemiologic and more prevalent across all income levels. to use heroin (with or without ecstasy) ethnographic sources, ecstasy users at a later time.
Pulse Check: Mid-Year 2000 page 59 CLUB DRUGS
Where do ecstasy users tend to Then and now: reside? (Exhibit 6) Suburban and How have street-level ecstasy sales changed in the last year? urban areas are equally mentioned by Ecstasy sales " Pulse Check epidemiologic and ethno- Miami, FL: According to the law enforcement source, the settings are shift- settings for club drug sales seem to be changing constantly: graphic sources as areas where ecstasy ing or expanding from raves to homes and nightclubs. Legitimate nightclubs are users reside, with sources in Chicago, in several Pulse now sponsoring “electronights” and “technonights,” which are St. Louis, and Seattle mentioning Check cities: profitable rave-like parties. Club drugs are everywhere, even both suburbia and the central city as at ice skating rinks. areas where ecstasy users live. Additionally, users tend to reside in " New York, NY: Ecstasy is more available on the street partially affluent areas in Los Angeles and in due to the involvement of organized crime and street gangs in college apartments and dorms in sales and the involvement of Long Island youth in sales via the Philadelphia. In New Orleans, most Internet and in malls. ecstasy users are young out-of-town- " Portland, ME: According to a law enforcement source, rave ers who visit the city. activity has increased dramatically. Exhibit 6. " Seattle, WA: The law enforcement source states that ecstasy, Where do ecstasy users tend to GHB, and ketamine are finding their way into high schools live? and colleges. Suburban Urban City Areas Areas What other drugs do ecstasy ECSTASY: THE SELLERS Seattle, WA ##users take? According to law Who, How, Where, and With What? West enforcement, epidemiologic, ethno- Chicago, IL ## Who sells ecstasy? According to graphic, and treatment sources, ecsta- Detroit, MI # law enforcement, epidemiologic, and sy—and all club drugs, for that mat- Midwest ethnographic sources, ecstasy sellers, Birmingham, AL # ter—is often used in combination like ecstasy users, are predominantly El Paso, TX # with many other drugs, most com- white, male, middle-class young adults, St. Louis, MO ##monly alcohol, other club drugs
South whose ages range from 14 to 32 years. Miami, FL # (including GHB and ketamine), mari- In Miami, rave operators, nightclub Washington, DC # juana, methamphetamine, psilocybin personnel, and security guards at raves mushrooms, and LSD. Other combi- also sell ecstasy, and in St. Louis, Boston, MA # nations vary geographically: sellers are predominantly high school Rohypnol in El Paso; antidepressants Northeast and college students. In Birmingham, or sildenafil citrate (Viagra®) in Los Sources: Epidemiologic and ethnographic sellers are often “regular” nightclub providers Angeles (to gain a “better bump”); patrons who may or may not know powder cocaine in Miami; benzodi- the owners of the clubs. Similarly, in Where and how is ecstasy used? azepines in Miami, New York, and Billings, sellers are often nightclub fre- Ecstasy is used at social settings Philadelphia; powder heroin or cough quenters and rave partygoers. In New (mostly nightclubs and dance clubs, syrup in Philadelphia; opiates other York, street gangs and organized crime raves, and private parties), although it than heroin in Portland, Maine; and are becoming involved in ecstasy sales. is also reportedly used in private heroin and diverted pharmaceuticals homes, on college campuses (includ- in Washington, DC. ing dorms), and at bars. Ecstasy is Drug Use Among Ecstasy Sellers almost exclusively taken orally in pill Miami, FL: The law enforcement source Law enforcement, epidemiologic, and or powder form, although it has also reports a new phenomenon in club drug ethnographic sources overwhelmingly been reportedly used anally in Miami combinations: the practice of placing report that ecstasy dealers use their (only one case reported), snorted in five to nine “lines” of drugs (including drug. Only in Billings and Los Angeles Philadelphia, and diluted with water marijuana and powder cocaine) on a do some sources report that dealers do and drunk in St. Louis. tray and taking one after the other. not tend to use ecstasy. page 60 Pulse Check: Mid-Year 2000 CLUB DRUGS
Where is ecstasy sold? (Exhibit 7) Exhibit 7. Similar to ecstasy user settings, Pulse Where is street-level ecstasy sold? Check law enforcement, epidemio- Nightclubs/ Private Private College High logic, and ethnographic sources over- City Bars Raves parties residences campuses Streets schools whelmingly mention nightclubs and Billings, MT ## raves as the settings for ecstasy sales, Denver, CO # with nightclubs or bars mentioned in Honolulu, HI ## 17 of 20 Pulse Check cities (by 24 West Los Angeles, CA ### sources), raves in 16 cities (by 19 Seattle, WA #### # # sources), followed by private parties, Chicago, IL ## private residences, college campuses, Detroit, MI # St. Louis, MO ## streets, and high schools. Other set- Midwest ## tings for ecstasy sales include dealers’ Sioux Falls, SD Birmingham, AL ## homes in Los Angeles, sex and strip Columbia, SC ## clubs in Miami, shopping malls in El Paso, TX #### New York, and coffee shops in Memphis, TN ## Washington, DC. Law enforcement South Miami, FL #### sources in New York and Philadelphia New Orleans, LA ## also report use of the Internet by Washington, DC ## promoters to advertise nightly raves Boston, MA ## # and by rave goers to locate them. New York, NY ## # Philadelphia, PA ## How is ecstasy sold? According to Northeast Portland, ME ### # law enforcement, epidemiologic, and ethnographic sources, the way that Sources: Law enforcement, epidemiologic, and ethnographic respondents ecstasy is sold often depends on the to user, and in Washington, DC, it is as loose pills. Additionally, the pills setting. For example, in Birmingham sold through contacts and beepers. are packaged in various ways: in and Chicago nightclubs, buyers are small, plastic zipper bags in referred to and approach sellers. At How is ecstasy packaged and Honolulu, Los Angeles, Miami, and Los Angeles raves, buyers may ask marketed? (Exhibit 8) All law New Orleans; in plastic pill bottles in users who seem “high” to refer them enforcement, epidemiologic, and Memphis; and in bottles in New to an on-site dealer. At Miami raves ethnographic respondents reporting Orleans and St. Louis. Liquid ecstasy and nightclubs, “runners” on dance on packaging state that ecstasy is sold in New Orleans is packaged in floors are used as liaisons between ecstasy dealers and buyers, and rave Exhibit 8. operators, security guards, and bar How are ecstasy pills labeled in reporting Pulse Check cities? personnel may sell the drug. At raves City Label in Columbia, South Carolina, young, Los Angeles, CA Nike and other logos female heroin addicts sell ecstasy and West other club drugs for male dealers Chicago, IL Ferrari and other logos (“hustling”), so that they can support Detroit, MI cartoon characters, colored pills their heroin habits. In settings other Midwest Sioux Falls, ND buddha than nightclubs and raves, ecstasy is Columbia, SC double dip diamond, double dip, democrat, republican most often sold hand-to-hand among El Paso, TX “E” friends and associates or through South Washington, DC Star of David, Versace, Mitsubishi introductions and referrals by friends (as reported in Billings, Boston, Boston, MA rabbits, race car logos Columbia, Detroit, and Seattle). In Portland, ME “E” Philadelphia, ecstasy is sold from user Northeast Sources: Law enforcement, epidemiologic, and ethnographic respondents
Pulse Check: Mid-Year 2000 page 61 CLUB DRUGS
bottles. Most sources report that mainly associated with ketamine, and ecstasy pills are stamped or Hispanic involvement in use and sales Miami, FL: According to the epidemiologic respondent, 20–40- impressed with a wide variety of is mentioned only for Rohypnol. year-old, middle-class whites of both designs and logos and that new genders who use GBL at home have designs and logos emerge often. Treatment sources report that become a problematic user subgroup. Only in Memphis and St. Louis are the number of clients in treatment Indications of addiction in this group pills reportedly unlabeled. for club drugs is small but increased during 2000, probably due warrants watching: to the supply cutoff when GBL was OTHER CLUB DRUGS: THE USERS banned from health food stores. Boston, MA: Treatment sources AND SELLERS These users are now being treated in identified ketamine users as white sub- emergency departments for depression Who uses and sells ketamine, urban adolescents and preadolescents. and suicides. GHB, and Rohypnol? (Exhibit 9) Referrals to treatment in these cases Regardless of the specific drug, club were generally made by school drug user and seller characteristics professionals. are usually similar with a few key Birmingham, AL: Young adults are differences. For example, Internet using GHB due to its easy access. sales are mentioned primarily in conjunction with GHB, veterinary Denver, CO: GHB is easily obtained break-ins and pharmacy diversions are and available, according to some young adults in treatment.
Exhibit 9. Club drug user and seller characteristics
Club drugs Who uses? Where reside? Where used? Who sells? Where sold?
GHB, GBL, "$White middle-class "$Suburban areas "$Raves "$White, male, middle-class "$Raves 1,4-BDL youth "$Nightclubs "$Companies (many interna- "$Nightclubs "$Males "$Private residences tional) over the Internet "$College campuses "$Young adult "$Health clubs and gyms body builders "$Health food stores "$Internet Ketamine "$White middle class "$Suburban areas "$Raves "$White middle-class youth "$Raves youth "$Gay communities "$Nightclubs who divert them from "$Nightclubs "$Urban areas "$Private residences pharmacies or veterinary "$Private parties "$Private parties offices "$College campuses Rohypnol "$Hispanic and white "$Urban areas "$Raves "$Hispanic and white male "$Raves youth "$Suburban areas "$Private parties youth from legal "$Nightclubs "$Urban high schools prescription drug sales "$Private parties in Mexico "$College campuses "$High schools "$Gyms Nitrous "$White adolescents "$Suburban areas "$Raves "$Raves oxide "$Outdoor concerts "$Outdoor concerts
Sources: Law enforcement, epidemiologic, and ethnographic respondents
page 62 Pulse Check: Mid-Year 2000 APPENDIX 1: METHODOLOGY
APPENDIX 1: METHODOLOGY Maine has the only Atlantic coastline Applying these criteria resulted in the and shares the longest border with final selection of the following 20 How were the sites selected? Canada. It also includes an ONDCP- Pulse Check sites: (See map in the Introduction) A total designated High Intensity Drug of 20 sites were studied for this issue Billings, Montana Trafficking Area (HIDTA). of Pulse Check. We selected sites Birmingham, Alabama Portland is Maine’s most populous using Census Bureau regions and Boston, Massachusetts metropolitan area. Chicago, Illinois divisions with a goal of achieving geo- Columbia, South Carolina graphic and demographic diversity. In ! Region II (South): Columbia, South Denver, Colorado addition, we made an effort to select Carolina—The three other rural Detroit, Michigan sites in areas with special drug abuse States in the South census region are El Paso, Texas problems of national concern. More Kentucky, Mississippi, and West Honolulu, Hawaii specifically, we applied the following Virginia. However, South Carolina’s Los Angeles, California methodology in selecting sites. location along a major drug Miami, Florida Memphis, Tennessee trafficking corridor makes that State We purposely selected the most New Orleans, Louisiana a strategic choice. Recent cocaine populous States in the four census New York City, New York seizures in Columbia further regions: New York in Region I Philadelphia, Pennsylvania highlight its strategic importance. (Northeast Region); Texas in Region II Portland, Maine (South Region); Illinois in Region III St. Louis, Missouri ! Region III (Midwest): Sioux Falls, (Midwest Region); and California in Seattle, Washington South Dakota—Sioux Falls is the Region IV (West Region). In three of Sioux Falls, South Dakota most populous metropolitan area Washington, DC these States, we selected the most within the Midwest Region’s two populous metropolitan areas: New rural States (North Dakota and How do the 20 sites vary York City, Chicago, and Los Angeles. South Dakota). demographically? Appendix 2 In Texas, however, we selected El highlights the demographic diversity Paso—a known high trafficking area ! Region IV (West): Billings, of these 20 sites. For example, their with particularly high levels of Montana—Montana is the only population density per square unemployment, population growth, census-designated rural State in the kilometer ranges from a sparse 18.4 and poverty—because of its proximity West Region, and Billings is its most in Billings, Montana, to a crowded to the United States border with populous metropolitan area. 2,897.4 in New York City (1997 Mexico. estimates). Their unemployment rates The remaining 12 sites were selected range from a 2.7 low in Columbia, We included four rural States, one per to ensure that the entire list included South Carolina, to an 11.2 high in census region. (Rural States are at least 2 sites from each of the 9 El Paso, Texas. The racial/ethnic defined by the Census Bureau as those Census Bureau divisions (East North breakdowns in the 20 sites further in which 50 percent or more Central, Mountain, Middle Atlantic, exemplify their diversity: white of the State’s population reside in New England, Pacific, South Atlantic, representation ranges from 31.4 census-designated rural areas.) The South East Central, South West percent in Honolulu, Hawaii, to 96.7 four rural sites selected are as follows: Central, and West North Central). percent in Sioux Falls, South Dakota; Additional selection criteria included ! Region I (Northeast): Portland, black representation ranges from 0.5 population density, representation of Maine—Of the three rural States in percent in Billings, Montana, to 42.1 racial/ethnic minorities, and emphasis the Northeast Region (including percent in Memphis, Tennessee. on high drug trafficking areas. New Hampshire and Vermont),
Pulse Check: Mid-Year 2000 page 63 APPENDIX 1: METHODOLOGY
What other data are available at facilities that reported more than 50 with Pulse Check sources, noting the 20 selected sites? Information percent of their clientele as having a source opinions about the drug use from other national-level data sources primary alcohol abuse problem, served problem in 2000 compared with the will be useful for framing, comparing, a caseload of fewer than 100 clients, previous year: corroborating, enhancing, or explain- or provided only prevention or detox ing the information obtained for Pulse services. We then divided the ! An overall snapshot of the Check. The following data sources are remaining facilities into two groups— community’s drug use situation, available in nearly every site: methadone and non-methadone including the perceived seriousness ONDCP’s past Pulse Check reports; treatment facilities—in order to of the problem and the relative con- the National Institute on Drug Abuse capture two client populations whose cern about specific major drugs of (NIDA) Community Epidemiology demographic characteristics and use abuse—heroin, cocaine, marijuana, Work Group (CEWG); the Substance patterns often differ widely. We methamphetamine, club drugs, and Abuse and Mental Health Services selected one from each of these two any emerging drug abuse problems Administration (SAMHSA) Drug categories of programs for each of the ! Abuse Warning Network (DAWN); 20 selected sites. Because Billings, Population groups in the site most and the National Institute of Justice Montana, has no UFDS-listed likely to use major drugs of abuse, (NIJ) Arrestee Drug Abuse Monitoring methadone treatment facilities, we user characteristics (such as age, (ADAM) program. selected two non-methadone facilities gender, race/ethnicity, socio- in this site. Despite several attempts, economic status, and residence), Who are the Pulse Check in a few sites we were unable to and patterns of use (such as route of sources, and how were they recruit a second treatment provider, administration, concomitance, set- selected? Consistent with previous so we solicited a referral from the ting, and context) issues, the information sources for one treatment provider successfully ! Availability of major drugs of use Pulse Check were telephone discus- recruited from the UFDS data file. sions with 4 knowledgeable individuals (such as drug forms, supply levels, in each of the 20 sites: 1 ethnographer Of the 80 sources identified and quantities, prices, and purity) or epidemiologist, 1 law enforcement recruited, we successfully obtained ! Trafficking patterns (such as how official, and 2 treatment providers. information for this Pulse Check drugs are manufactured or grown, Ethnographers and epidemiologists issue from 74: a response rate of 93 where drugs originate, where they were recruited based on several percent. The nonresponding individu- are transshipped, how they enter criteria: past participation in the Pulse als included a law enforcement official local areas, and where they Check program; membership in in Detroit, the methadone treatment ultimately end up) NIDA’s CEWG; research activities in providers in Denver, Miami, and local universities; or service in local Honolulu, and the non-methadone ! Seller characteristics (such as gang community programs. We recruited treatment providers in Philadelphia or organized crime affiliation, age, law enforcement officials by contacting and St. Louis. gender, race/ethnicity, seller drug local police department narcotic units, use patterns, and drug-associated What kind of data were collected, Drug Enforcement Administration violence) (DEA) local offices, and HIDTA and how? For each of the 74 sources, directors. we conducted a single telephone ! Sales practices (such as where drugs discussion, lasting about 1 hour. We are sold, settings, street names, To identify treatment sources, we asked sources to explore with us their packaging, adulterants, marketing randomly selected providers from the perceptions of the change in the drug strategies) 1998 Uniform Facility Data Set abuse situation between 1999 and (UFDS), a listing of Federal, State, 2000, reflecting back on the first 6 ! Other activities associated with local, and private facilities that offer months of 1999 compared with the drug sales or use (such as gang drug abuse and alcoholism treatment same 6 months in 2000. In general, we activity, prostitution, violence) services. For this purpose, we excluded discussed the following topic areas
page 64 Pulse Check: Mid-Year 2000 APPENDIX 1: METHODOLOGY
! Community context issues that Not surprisingly, ethnographic and to provide a broader perspective might have impacted on the drug epidemiologic sources seemed to be about the communities extending use situation during the study very knowledgeable about users and beyond their individual programs. periods (such as treatment patterns of use; they were somewhat Among the three Pulse Check source availability, medical consequences, knowledgeable about drug availability; types, law enforcement officials large Seizures, law enforcement and they were less informed about appeared to be most knowledgeable policy initiatives, policing and sellers, distribution, and trafficking about drug availability, trafficking sentencing practices, legislation, patterns. Treatment providers had a patterns, seller characteristics, sales task forces, media campaigns, or similar range of knowledge, but they practices, and other associated major news events) generally focused on the specific pop- activities; they were, understandably, ulations targeted by their programs. less knowledgeable about user groups Some providers, however, were able and characteristics.
Pulse Check: Mid-Year 2000 page 65 APPENDIX 2: SITE DEMOGRAPHICS
APPENDIX 2: POPULATION DEMOGRAPHICS IN THE 20 PULSE CHECK SITES
Race Percenta American Asian Violent Percent MSA Indian and Population Percent Crime/ Persons Under Size* Eskimo Pacific Percent Density/ Population 100,000 18 Below Unemploy- Proposed Site (S, M, L) White Black Aleut. Islander Hispanica Square KMa Changeb Populationc Poverty Leveld ment Ratea Billings, MT S 95.8 0.5 3.1 0.6 3.1 18.4 10.9 NA 17.0 4.5 Denver, CO M 90.0 6.2 0.8 2.9 14.4 195.4 17.1 460 13.1 2.8 Honolulu, HI M 31.4 3.8 0.5 64.3 7.4 559.8 4.0 313 12.6 5.3 West Los Angeles, CA1 L 75.3 11.1 0.6 13.0 43.7 869.7 3.2 1,278 33.7 6.8 Seattle, WA2 M 85.4 4.6 1.2 8.7 3.9 197.9 11.6 421 11.7 3.3 Chicago, IL L 76.0 19.4 0.2 4.4 14.1 592.6 4.9 NA 19.0 4.5 Detroit, MI L 75.3 22.5 0.4 1.9 2.4 442.3 4.6 957 22.5 3.9 Sioux Falls, SD S 96.7 0.8 1.7 0.8 0.8 44.7 15.4 385 11.2 2.0 Midwest St. Louis, MO-IL M 80.9 17.6 0.2 1.2 1.4 154.5 2.6 745 17.9 4.1 Birmingham, AL M 70.3 29.0 0.2 0.5 0.7 109.0 7.2 782 22.1 3.4 Columbia, SC M 68.3 30.1 0.2 1.4 1.8 133.5 11.0 999 19.8 2.7 El Paso, TX M 94.5 3.5 0.5 1.5 74.4 267.4 18.6 811 41.9 11.2 Memphis, TN M 56.6 42.1 0.2 1.1 1.2 139.0 7.5 1,419 27.7 4.6 South Miami, FL M 77.1 21.0 0.2 1.7 55.7 406.0 5.5 NA 36.0 7.1 New Orleans, LA M 62.7 34.9 0.3 2.1 4.9 148.5 1.8 1,355 32.6 5.5 Washington, DC3 M 67.9 25.4 0.3 6.3 7.0 273.0 9.0 678 11.5 3.7 Boston, MA4 M 90.5 5.8 0.2 3.5 5.3 348.0 2.5 560 13.1 3.8 New York City, NY L 61.7 29.1 0.4 8.7 25.0 2,897.4 0.8 1,195 36.1 8.5 Philadelphia, PA-NJ L 76.8 20.0 0.2 3.0 4.4 494.8 0.4 NA 18.0 4.9 Northeast Portland, ME S 97.9 0.7 0.2 1.1 0.8 116.2 3.4 249 12.3 2.9
*Small = <150,000 persons; Medium = 1Includes Los Angeles-Long Beach a1997 250,000–999,999 persons; Large = >1 million 2Includes Seattle, Bellevue-Everett, WA b1990–1997 persons (NOTE: None of the sites are in the 3Includes Washington, DC-MD-VA-WVA c1996 150,000–249,000 category.) 4Includes Worcester, Lawrence, Lowell, d1995 Brockton MA-NH Source: 1999 County and City Extra: Annual Metro, City, and County Data Book, Eighth Edition. Eds: Gaquin, D.A., and Littman, M.S. Washington, DC: Bernan Press
page 66 Pulse Check: Mid-Year 2000 APPENDIX 3: OTHER DATA SOURCES
APPENDIX 3: NATIONAL-LEVEL DATA SOURCES AVAILABLE IN THE 20 PULSE CHECK SITES
Site HIDTA1 Past Pulse CEWG2 DAWN3 ADAM4 State Check Billings, MT Denver, CO ### ## Los Angeles, CA ### ## West Honolulu, HI ### Seattle, WA ### ## Chicago, IL ### ## Detroit, MI #### Sioux Falls, SD # Midwest St. Louis, MO ### Birmingham, AL # Columbia, SC El Paso, TX ### Memphis, TN # South Miami, FL ### ## New Orleans, LA #### Washington, DC ### ## Boston, MA ### # New York, NY ### ## Philadelphia, PA #### Northeast Portland, ME #
1High Intensity Drug Trafficking Area of the Drug Enforcement Administration (DEA) 2Community Epidemiology Work Group of the National Institute on Drug Abuse (NIDA) 3Drug Abuse Warning Network of the Substance Abuse and Mental Health Services Administration (SAMHSA) 4Arrestee Drug Abuse Monitoring program of the National Institute of Justice (NIJ) Note: Shaded boxes indicate that selected cities are in a rural area.
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Epidemiology/Ethnography Law Enforcement Billings, MT Roland Mena Scott Forshee Department of Health/Substance Abuse City/County Special Investigations Unit Birmingham, AL Sergeant T.E. (Thomas) Thrash Birmingham Police Department Vice and Narcotics Division Boston, MA Thomas W. Clark Lieutenant Francis Armstrong Health and Addictions Research, Inc. Drug Control Division Boston Police Department Chicago, IL Larry Ouellet, Ph.D. Prefers anonymity University of Illinois at Chicago School of Public Health Columbia, SC Prefers anonymity Prefers anonymity Denver, CO Bruce Mendelson, M.P.A. Prefers anonymity State Treatment Needs Assessment Contract Colorado Department of Human Services Alcohol and Drug Abuse Division Stephen Koester, Ph.D. Urban Links Detroit, MI Richard F. Calkins Nonrespondent Michigan Department of Community Health Division of Substance Abuse Quality and Planning El Paso, TX Alviane, Inc. Prefers anonymity Honolulu, HI D. William Wood, Ph.D., M.P.H. Lieutenant Mike Moses University of Hawaii Narcotics, Vice Division Department of Sociology Hawaii Police Department Los Angeles, CA Richard Rawson, Ph.D. Prefers anonymity University of California, Los Angeles Integrated Substance Abuse Programs (ISAP) Memphis, TN Randy Dupont, Ph.D. Sergeant Richard Parker University of Tennessee Memphis Police Department Department of Psychiatry Vice Narcotics Unit Miami, FL James N. Hall Prefers anonymity Up Front Drug Information Center New Orleans, LA Gail Thornton-Collins Lieutenant Commander Bruce Adams New Orleans Health Department Narcotics Major Case Section New Orleans Police Department New York, NY John A. Galea, M.A. Drug Enforcement Administration New York State Office of Alcoholism New York Division and Substance Abuse Services Street Studies Unit Philadelphia, PA Philadelphia Behavioral Health System Drug Enforcement Administration Coordinating Office for Drug Philadelphia Field Division and Alcohol Abuse Programs Divisional Intelligence Group Portland, ME Nate Nickerson, R.N., M.S.N. George Connick Public Health Division Augusta Field Office/ Maine Drug Enforcement Agency Department of Health and Human Services City of Portland Seattle, WA Thomas R. Jackson, M.S.W. Steve Freng Evergreen Treatment Services High Intensity Drug Trafficking Area Sioux Falls, SD Darcy Jensen, CCDCIII, CPS Lieutenant Mark Moberly Prairie View Prevention Services Sioux Falls Police Department, Narcotics Division St. Louis, MO James M. Topolski, Ph.D. Detective Leo Rice Missouri Institute of Mental Health St. Louis Police Department, Narcotics Division Washington, D.C. Alfred Pach, Ph.D., M.P.H. Sergeant John Brennan National Opinion Research Center Washington, D.C., Police Department page 68 Pulse Check: Mid-Year 2000 APPENDIX 4: PULSE CHECK SOURCES
Non-Methadone Treatment Methadone Treatment Billings, MT Deena Vandersloot Illegal in the State of Montana South Central Mental Health Center Journey Recovery Program Mona Sumner Rimrock Foundation Birmingham, AL Eleanor Powers Bill Garrett, M.P.H. Alcohol and Drug Treatment Centers, Inc. University of Alabama Substance Abuse Program Boston, MA Prefers anonymity Jayne Wilson, LICSW CAB Health and Recovery Services Chicago, IL Del Larkin Cornell Interventions Association House of Chicago Columbia, SC Carolyn Flemming Columbia Metro Treatment Center Lexington/Richland Alcohol and Drug Abuse Council Denver, CO Beth Leighton, R.N., M.S.N. Nonrespondent Addiction Treatment Service Presbyterian St. Luke’s Medical Center Detroit, MI Prefers anonymity Octavius Sapp, CAC City of Detroit Detroit Department of Human Services Drug Treatment El Paso, TX Casa Blanca Therapeutic Communities James Sabal, M.D. El Paso Methadone Maintenance and Detox Treatment Center Honolulu, HI Prefers anonymity Nonrespondent Los Angeles, CA Mari Radvik, M.D. Sandy MacNicoll Substance Abuse Treatment Program, West LA Treatment Program Division of Adolescent Medicine Children’s Hospital of Los Angeles Memphis, TN Prefers anonymity Prefers anonymity Miami, FL Prefers anonymity Nonrespondent New Orleans, LA Eleanor Glapion Letetia Nelson, BA, LPN, LSBCSAC, RCS New Orleans Substance Abuse Clinic Metropolitan Treatment Center, Inc. New York, NY (Prefers anonymity) Eugenia Curet, M.D. The New York Presbyterian Hospital Adult Service Clinic Philadelphia, PA Nonrespondent Peter A. Demaria, Jr., M.D., FASAM Department of Psychiatry and Human Behavior Jefferson Medical College Portland, ME Stephen Leary Prefers anonymity Milestone Foundation, Inc. Seattle, WA Prefers anonymity Therapeutic Health Services Sioux Falls, SD Prefers anonymity Robin Erz, CCDCIII Avera McKennan - Turning Point Heisler Adolescent Treatment Program St. Louis, MO Nonrespondent Prefers anonymity Washington, D.C. Prefers anonymity LaTonya Sullivan Umoja Treatment Center
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