Office of National Drug Control Policy -- Publications -- Pulse Check: Trends in Drug Abuse April 2002

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Highlights⁺

This report is based on discussions with 75 epidemiologists, ethnographers, law enforcement officials, and methadone and non-methadone treatment providers from 20 Pulse Check sites. Telephone discussions with these individuals, conducted between November 2001 and January 2002, reveal that overall, when comparing spring and fall 2001, the majority of Pulse Check sources believe their communities' drug abuse problem to be very serious but stable. (Exhibits 1 and 2)

Exhibit 1

How serious is the perceived drug problem in the 20 Pulse Check communities (fall 2001)?

Sources: Law enforcement, epidemiologic/ethnographic, and treatment respondents

The illicit drug situation is characterized by several key features:

The September 11 terrorist attacks and subsequent events had varied short- and long-term effects on illegal drug availability, trafficking routes and modes, local marketing strategies, and use patterns in 16 of the 20 sites.
Heroin has surpassed crack as the drug associated with the most serious consequences, as perceived by 27 sources in 17 sites. (Exhibits 3 and 4)
The number of female heroin users has increased in four cities, where sources are increasingly seeing gender equity among a number of chronic drug users.
Marijuana remains the most widely abused illicit drug, as reported by 35 sources in 18 sites. Sources in two sites report it as the drug with the most serious consequences. (Exhibits 3 and 4)
Methamphetamine continues to be reported as an emerging problem in several sites. (Exhibit 5) Furthermore, 14 sources in 8 cities consider it the drug contributing to the most serious consequences, doubling from only 4 cities since the last Pulse Check, and replacing crack in 2 instances. (Exhibits 3 and 4)
Most respondents continue to link methamphetamine sellers to domestic violence, more so than with any other drug. (Exhibit 6)
The emerging diversion and abuse problem involving OxyContin^®, a time-release formulation of the pharmaceutical opiate oxycodone, has spread to all but two sites and is associated with serious consequences. (Exhibits 5 and 7)
OxyContin^® abuse and diverted sales continue to emerge in the rave and nightclub scenes in seven cities: Boston, Detroit, Memphis, Miami, New Orleans, Philadelphia, and Sioux Falls.
"Ecstasy" (methylenedioxymethamphetamine or MDMA) continues to be an emerging problem in the majority of sites. (Exhibit 5)

Exhibit 2

How has the perceived drug problem changed (spring 2001 vs fall 2001)?

Sources: Law enforcement, epidemiologic/ ethnographic, and treatment respondents Worse

HIGHLIGHTS FROM THE SPECIAL TOPIC SECTION: THE IMPACT OF SEPTEMBER 11

After September 11, availability of illegal drugs, particularly heroin, declined in 12 cities: Baltimore, Columbia (SC), Denver, Detroit, El Paso, Honolulu, Memphis, Miami, New Orleans, New York, Seattle, and Sioux Falls.
Because heroin availability declined after September 11, heroin users are increasingly substituting prescription drugs for heroin in Baltimore, Columbia (SC), El Paso, and New York.
Heightened security at U.S. points of entry may have changed drug trafficking modes or routes in seven cities: Denver, Honolulu, Miami, New York, Portland (ME), St. Louis, and Seattle.
Signs of increased drug abuse were described in nine cities: Boston, Columbia (SC), Honolulu, Miami, New York, Portland (ME), St. Louis, Seattle, and Washington, DC. These signs include increases in demand for treatment, requests for services, and attempts to selfmedicate illicitly for anxiety or depression.
Trafficking shifts in some border areas, such as Detroit, Portland (ME), and El Paso, were only short term and soon reverted to "business as usual." Similarly, shortterm market effects, such as price gouging, "super sales," and drug adulteration, were reported in Boston, Miami, New York, and Washington, DC.

Exhibit 3

What are the most serious drug problems in the 20 Pulse Check sites, by type of source?*

	Most commonly abused?*			Most serious consequences?
City	L	E	N	L	E	N	M
Boston, MA	MJ	MJ	H	HCl	Crack	H	Benzos
New York, NY	MJ	MJ	Crack	H	Crack	Crack	Crack
Philadelphia, PA	MJ	MJ	H	H	H	H	H
Portland, ME	MJ	MJ	H	H+Pharm. opiates	Oxy	H	Oxy
Baltimore, MD	NR	H	NR	NR	H	NR	Alcohol
Columbia, SC	Crack	MJ	MJ	Crack	Crack	MJ	H
El Paso, TX	MJ	MJ	Cocaine	N/A	Crack	H	Cocaine
Memphis, TN	Meth	MJ	NR	Meth	Crack	NR	NR
Miami, FL	Crack	MJ	Crack	Oxy	H	Crack	Benzos
New Orleans, LA	Crack	Crack	Crack	H	Crack	Crack	Oxy
Washington, DC	Crack	MJ	Crack	Crack	H	Crack	H
Chicago, IL	Crack	MJ	H	Crack	H	Crack	H
Detroit, MI	MJ	MJ	Crack	H	H	Crack	H
St. Louis, MO	MJ	MJ	MJ	Crack	Crack	Meth	H
Sioux Falls, SD	MJ	MJ	Alcohol + MJ	Meth	Meth	Alchohol + MJ	Meth
Billings, MT	Meth	MJ	MJ	Meth	Meth	Meth	Meth
Denver, CO	MJ	MJ	Meth	HCl	HCl	Meth	H
Honolulu, HI	MJ	Meth	NR	Meth	Meth	NR	H
Los Angeles, CA	Crack	MJ	MJ	Crack	H	Meth	H
Seattle, WA	MJ	MJ	MJ	Meth	H	Cocaine	H

*Heroin is almost always, by definition, the most commonly used drug in methadone programs, so methadone treatment sources are excluded from this question. Note: HCl = Powder cocaine; MJ = Marijuana; H = Heroin; Meth = Methamphetamine; Benzos = Benzodiazepines; Oxy = OxyContin®; Cocaine = unspecified whether crack or HCl; NR= nonrespondent

Exhibit 4

What are the most serious drug problems in the 20 Pulse Check sites, by number of sources and sites?

Drug	Most commonly abused?*		Most serious consequences?
	No. of sources	No. of sites	No. of sources	No. of sites
Heroin	5	5	27	17
Crack	12	8	19	12
Powder cocaine	1	1	5	4
Marijuana	35	18	1	1
Methamphetamine	4	4	14	8
Diverted Oxycontin®	0	0	5	3
Benzodiazepines	0	0	2	2
Alcohol	1	1	2	2

*Methadone treatment sources are excluded from this count.
Sources: Law enforcement, epidemiologic/ethnographic, non-methadone treatment, and methadone treatment respondents

Exhibit 5

What new problems have emerged or intensified during fall 2001?

OxyContin®	Ecstasy/Club Drugs	Methamphetamine
Baltimore, MD^E	Baltimore, MD^E	Billings, MT^N
Billings, MT^L,N	Billings, MT^N	Chicago, IL^M,N
Boston, MA^L,E,N	Boston, MA^L	Columbia, SC^L
Columbia, SC^E,N	Chicago, IL^L	Detroit, MI^N
Denver, CO^M	Denver, CO^L	Memphis, TN^E
Detroit, MI^E	Detroit, MI^E	New Orleans, LA^M
El Paso, TX^M	El Paso, TX^E	Seattle, WA^L
Honolulu, HI^L,M	Honolulu, HI^E	Sioux Falls, SD^E,N
Los Angeles, CA^M	Los Angeles, CA^L,E	Washington, DC^E
Memphis, TN^L,E	Memphis, TN^L,E
Miami, FL^L,E	New Orleans, LA^L (Ketamine)
New Orleans, LA^L	New York, NY^E,N
New York, NY^M	Philadelphia, PA^L
Philadelphia, PA^L,M,N	Portland, ME^L,E
Portland, ME^L,M	Sioux Falls, SD^N
St. Louis, MO^M,N	Washington, DC^E,N
Seattle, WA^N
Sioux Falls, SD^E
Other Emerging Drug Problems		None
Benzodiazepines: Los Angeles, CA^L; Seattle, WA^E		Billings, MT^E
Clonidine (Catapres®): Baltimore, MD^M		Chicago, IL^E
Dextromethorphan (sold as ecstasy): Memphis, TN^E		Columbia, SC^M
Diverted methadone: Detroit, MI^E; Portland, ME^E		Denver, CO^N
Diverted pharmaceuticals: Boston, MA^E		Detroit, MI^L,M
*Fentanyl:** Boston, MA^E,M		El Paso, TX^L,N
Hallucinogens: Los Angeles, CA^L		Los Angeles, CA^N
Herbal supplements: Memphis, TN^E		Miami, FL ^M,N
Heroin: Billings, MT^N; Boston, MA^E (ODs); Denver, CO^E (young White suburbanite deaths); Memphis, TN^E		New Orleans, LA^E,N New York, NY^L Portland, ME^N
Injecting: Sioux Falls, SD^N		St. Louis, MO^L
Khat:** Boston, MA^L		Seattle, WA^M
PCP: Washington, DC^E		Sioux Falls, SD^L Washington, DC^L,M

*Fentanyl is a powerful synthetic opiate often confused with heroin, responsible for overdose deaths, and often found in patch form.
**Khat is a natural stimulant from the Catha Edulis plant, found in a flowering evergreen tree or large shrub from East Africa and Southern Arabia. Its leaves contain psychoactive ingredients structurally and chemically similar to d-amphetamine.

HIGHLIGHTS BY SPECIFIC ILLICIT DRUG

The 75 discussions also yielded key findings about heroin, crack, powder cocaine, marijuana, methamphetamine, synthetic opioids, and ecstasy.

HEROIN

Availability increased in only seven sites (Boston, Chicago, Detroit, El Paso, Miami, New Orleans, and Portland [ME]), declined in two (Denver and Honolulu), and remained stable elsewhere. Increases generally involve highpurity South American (Colombian) white heroin, which remains the most common. Mexican black tar still predominates in the West.
Street-level prices are generally stable, except for increases in Denver and Seattle and declines in El Paso and Washington, DC. Purity levels are also generally stable, except for increases in Boston, El Paso, and Portland and declines in Denver, New Orleans, and Seattle.
Drug sales increasingly involve referrals, beepers, cell phones, prearranged meeting places, home deliveries, and multi-tiered market structures.
Use is increasing among younger people. Many are suburban Whites, particularly in areas around Baltimore, Chicago, Denver, St. Louis, and Washington, DC.
Female users are increasing in some cities (Denver, Memphis, New Orleans, and Portland [ME]).
Although injecting still predominates, snorting and smoking have increased in many sites, often among younger users in suburban areas. In Boston and New York, however, some people are shifting from snorting to injecting.

CRACK COCAINE

Availability remains generally wide and stable. Increases are perceived in only three cities (Chicago, Detroit, and El Paso) and declines in another three (Boston, Denver, and Honolulu).
Street-level prices are generally stable.
Only a few sales scene changes are reported. In Columbia, SC, for example, young marijuana users increasingly sell crack.
Crack continues to be sold mainly in central city areas, but suburban and rural areas are sometimes mentioned. In Memphis, sales are moving from the city into the suburbs and rural areas.
Billings is the only site where adolescent users have increased.
Nearly half of the sources report males and females as equally likely to use crack�more so than any other illicit drug except ecstasy, as reported previously.
Crack-marijuana combinations have declined in Baltimore and Boston but increased in Memphis.

POWDER COCAINE

Availability remains wide, with increases in only three cities (Columbia [SC]), El Paso, and Portland [ME]) and declines in two (Honolulu and Washington, DC).
Price and purity levels are stable.
Although powder cocaine is sold primarily in central city locations, it is more likely than crack to be sold in suburban or rural areas. Use is up in suburbs around Memphis and New Orleans and in Denver's rural areas.
Like heroin users, powder cocaine users tend to be White males, older than 30. Only a few changes are reported in user characteristics. For example, in a Columbia, SC, treatment program, female adolescent novice users have been increasing. The source notes that "the perceived risk of cocaine is dropping among the clients."

MARIJUANA

Availability remains wide. Only four increases (in Boston, Columbia [SC], Denver, and Honolulu) and only one decline (in Chicago) are reported.
Indoor hydroponic growing operations have increased in Boston, Memphis, and Philadelphia.
Prices are stable except for a slight increase in Portland, ME, and a decline in El Paso.
Users are becoming younger (sometimes younger than 13) in Billings, Boston, Chicago, Columbia (SC), Miami, Philadelphia, and Sioux Falls. Female users have increased in New Orleans, Philadelphia, and Sioux Falls.
Flavored blunt wraps are a commercial product recently introduced in New York and Philadelphia. These tobacco leaves are moister, fresher, slower burning, and viewed as less messy than gutted cigars.
Five treatment sources (in Columbia [SC], El Paso, Miami, Seattle, and Washington, DC) mention clients who smoke joints that, without their knowledge, have been laced with crack.
Compared with other drug users, marijuana users are still more likely to reside in all locations (central city, suburban, and rural areas).

METHAMPHETAMINE

Methamphetamine has replaced crack as the most serious drug problem according to sources in Memphis and St. Louis and has replaced heroin according to the law enforcement source in Seattle.
Methamphetamine remains available predominantly in the West. However, availability has increased in all regions.
The number of users has increased in nine cities: Billings, Columbia (SC), Denver, Memphis, Miami, New Orleans, St. Louis, Seattle, and Washington, DC.
As reported previously, most respondents link methamphetamine sellers to domestic violence, more so than any other drug.
Several user characteristics have changed: females increased in Honolulu and Memphis; adults (>30 years) increased in Memphis and Washington, DC, and adolescents increased in Honolulu and Los Angeles; and Hispanics increased in Los Angeles and New York.

DIVERTED SYNTHETIC OPIODS

Oxycontin® was the synthetic opioid most frequently mentioned by Pulse Check sources as being diverted.
Nearly half of law enforcement and epidemiologic/ethnographic sources report increased availability of diverted OxyContin®. Availability is highest in the Northeast and South.
Diversion of OxyContin® has intensified in Billings (an emerging illegal market), Boston (increased pharmacy robberies), and New York (street sales reported for the first time).
Diversion and abuse of OxyContin® are not limited to rural areas: central city, suburban, and rural areas are mentioned equally by sources across all sites.
Abuse of OxyContin® has increased in 13 sites: Billings, Boston, Columbia (SC), Denver, Honolulu, Los Angeles, Memphis, New Orleans, Philadelphia, Portland (ME), St. Louis, Seattle, and Sioux Falls.
OxyContin� abusers remain predominantly young adults (18�30 years) or adults (older than 30). However, adolescent (13�17 years) abusers predominate in Columbia (SC), New Orleans, and Sioux Falls, and they are emerging in Boston.
Heroin is often substituted for OxyContin®, particularly in eastern cities. By contrast, in some cities, heroin users may be switching to OxyContin®. In Miami, it is often sold in the same neighborhoods as crack.
In some sites, abusers of OxyContin® are often current or former abusers of other prescription drugs, typically benzodiazepines or opiates.

ECSTASY AND CLUB DRUGS

Ecstasy continues to be the most available club drug, followed by gamma hydroxybutyrate (GHB), ketamine, and Rohyphol® (flunitrazepam). Ecstasy availability continues to increase in most sites, while other club drug availability is mostly stable.
Sales and use settings continue to expand from raves, nightclubs/bars, and private residences and parties to streets and in or around high schools.
User and seller populations also continue to expand and now include non-Whites and Hispanics. Additionally, adolescent sellers and users have increased in many cities.
Heroin, crack, and powder cocaine are now sold and used with ecstasy.
Two new precursors to GHB (GHV [gamma hydroxyvalerate] and GVL [gamma valeroactone]) are being sold as nutritional supplements in health food stores, on the Internet, at raves, and in nightclubs/bars.

Exhibit 6

In what other crimes are methamphetamine and other illicit drug sellers involved across Pulse Check cities?

Sources: Law enforcement and epidemiologic/ethnographic respondents

Exhibit 7

How has the perceived drug problem changed (spring 2001 vs fall 2001)?

Where has the drug with the "the most serious consequences" changed?
Site/Source	Spring 2001	Fall 2001
Boston, MA^L	Crack	Powder cocaine
Memphis, TN^L	Crack	Methamphetamine
Miami, FL^E	OxyContin®	Heroin
Miami, FL^L	Cocaine	OxyContin®
Portland, ME^L	Pharmaceutical opiates	Heroin/Pharmaceutical opiates (OxyContin®)
Portland, ME^E	Heroin	OxyContin®
Portland, ME^M	Benzodiazepines	OxyContin®
St. Louis, MO^N,M	Crack	Methamphetamine
Seattle, WA^L	Heroin	Methamphetamine
Where has the "the most commonly abused drug" changed?
Site/Source	Spring 2001	Fall 2001
Boston, MA^L	Powder cocaine	Marijuana
Boston, MA^M	Benzodiazepines	Crack
Columbia, SC^E	Crack	Marijuana
Columbia, SC^L	Marijuana	Crack
Columbia, SC^M	Heroin	OxyContin®
Memphis, TN^L	Crack	Methamphetamine
Portland, ME^L	Heroin/Pharmaceutical opiates	Marijuana
Portland, ME^M	Heroin/Other opiates	Heroin
Portland, ME^N	Cocaine	Heroin
Washington, DC^M	Crack	Heroin

⁺ The following symbols appear throughout these Highlights to indicate type of respondent: ^LLaw enforcement respondent, ^EEpidemiologic/ethnographic respondent, ^NNon-methadone treatment respondent, and ^MMethadone treatment respondent.

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