Pulse Check Trends in Drug Abuse November 2001

Heroin

Trends in Drug Use: Fall 2000 vs Spring 2001

HEROIN: THE PERCEPTION

How do Pulse Check sources perceive the heroin problem in their communities? Excluding sources associated with methadone programs, where heroin is by definition the most commonly used drug, only six sources in five cities consider heroin as their communities' most commonly used illicit drug: the ethnographic and law enforcement sources in Baltimore, the non-methadone treatment sources in Boston and Philadelphia, the epidemiologic source in Seattle, and the law enforcement source in Portland, ME (who also lists pharmaceutical opiates as an equally serious problem).

Additionally, sources in 10 cities consider heroin the second most commonly used illicit drug in their communities. They span the country, ranging from the Northeast (New York, Philadelphia, and Portland) to the South (Baltimore, El Paso, and Washington, DC) to the Midwest (Chicago), and the West (Honolulu, Los Angeles, and Seattle).

The numbers go up somewhat when discussing which drug has the most serious consequences—that is, medically, legally, societally, or otherwise. Heroin is named by 24 sources (of 82 who discussed this question) in 14 cities: all Pulse Check cities in the Northeast (Boston, New York, Philadelphia, Portland), as well as cities in the South (Baltimore, Columbia (SC), El Paso, and Washington, DC), the Midwest (Chicago, Detroit, and St. Louis), and the West (Denver, Los Angeles, and Seattle). In the case of Philadelphia, all Pulse Check sources agree that heroin is the drug with the most serious consequences. An additional 22 sources name heroin as the second most serious drug in terms of consequences to 11 Pulse Check communities.

In many cases, the perception of a community's drug abuse picture changes radically when distinguishing a city from its surrounding environs. In Seattle, for example, the epidemiologic source considers heroin and crack, respectively, to be the city's first and second most commonly abused drugs; in the surrounding rural areas, however, methamphetamine and marijuana hold those distinctions.

Exhibit 1. How available is heroin across the 21 Pulse Check cities?

According to law enforcement sources (N=21)...
According to epidemiologic and ethnographic sources (N=20)...*

*The epidemiologic source in Columbia, SC, did not provide this information.

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Has the perception of the heroin problem changed between fall 2000 and spring 2001? All but two of the Pulse Check sources who name heroin as the most commonly used illicit drug during the current reporting period also listed it as such during the previous period. The two exceptions occur in New York and Portland. According to the New York methadone treatment source, heroin has replaced crack as the most commonly used illicit drug, while the Portland law enforcement source states that it has replaced powder cocaine among hardcore users.

Three sources perceive that other drugs have replaced heroin as causing the most serious consequences. Crack has replaced heroin in El Paso, according to that city's epidemiologic source. And the diversion and abuse of the pharmaceutical opiate oxycodone (in its OxyContin® formulation) has replaced heroin in Miami and New Orleans, according to those cities' epidemiologic and methadone treatment sources, respectively.

Only one Pulse Check source considers heroin to be a new or emerging drug problem in comparison to the last Pulse Check reporting period: the Denver epidemiologic source, who notes an increase in suburban young White heroin users.

HEROIN: THE DRUG

How available is heroin across the country? (Exhibit 1) Approximately half of the Pulse Check law enforcement sources (11 of 21) consider heroin to be widely available in their communities: New York and Philadelphia in the Northeast; Baltimore, Columbia (SC), Miami, New Orleans, and Washington, DC, in the South; Detroit and St. Louis in the Midwest; and Denver and Seattle in the West. Similarly, the majority of epidemiologic and ethnographic sources who discussed this question (12 of 20) consider the drug widely available: New York, Philadelphia, and Portland in the Northeast; Baltimore, El Paso, New Orleans, and Washington, DC, in the South; Chicago and Detroit in the Midwest; and Denver, Honolulu, and Seattle in the West. Heroin is cited as not very available by only five sources in four cities (Billings, Birmingham, Memphis, and Sioux Falls), and only one source considers it not available at all (the law enforcement source in Sioux Falls). The remaining 12 sources describe the drug as "somewhat available."

Exhibit 2. How has heroin availability changed
(fall 2000 vs spring 2001)?*

L Law enforcement respondents
E Epidemiologic/ethnographic respondents
*The Columbia epidemiologic source did not provide this information.

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Has heroin availability changed? (Exhibits 2 and 3) Heroin availability remained stable between fall 2000 and spring 2001, according to the majority (18 of 21) of Pulse Check law enforcement sources. Increased availability is perceived in only three sites: Portland (ME) in the Northeast; and Birmingham and Washington, DC, in the South. No declines are reported. According to the 20 epidemiologic and ethnographic sources who discussed this question, heroin availability increased in 6 sites: El Paso, Memphis, Miami, and New Orleans in the South; Portland in the Northeast; and Denver in the West. The remaining 14 epidemiologic and ethnographic sources perceive stable supplies of heroin in general, but some of those 14 report increases in specific forms of heroin. In Detroit, for example, Southeast and Southwest Asian heroin availability appears up. Los Angeles is another example, with an increase reported in availability of Mexican black tar and brown heroin. A third example is Honolulu, where the predominant Mexican black tar has increased in availability, but where a white powder heroin has also been seized for the first time.

Traffic in reverse? According to the El Paso epidemiologic source, heroin is now cheaper and more abundant on the American side of the border than on the Mexican side–to the point where people from Mexico are crossing over to buy heroin in El Paso. These changes are attributed to competition for the market by three different cartels. El Paso's law enforcement source, on the other hand, gives heroin only a "somewhat available" rating.

Exhibit 3. How available are the different varieties of heroin? How has their availability changed
(fall 2000 vs spring 2001)?*

Sources: Law enforcement (L) and epidemiologic/ethnographic (E) respondents
Widely available Somewhat available Not very available Not available
* Arrows indicate up, down, or stable trends. Absence of an arrow indicates that respondent did not provide trend information.
**Southeast Asian ***Southwest Asian

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What kind of heroin is available across the country? (Exhibit 3) As in the last Pulse Check report, South American (Colombian) white heroin is the most common type, cited as widely available by sources in nine cities across all the regions except the West and as somewhat available by sources in six cities–again, spanning the Northeast, South, and Midwest regions. By contrast, this high-purity, snortable heroin is described as "not very available" or "not available" by sources in 11 cities: Portland in the Northeast; Birmingham, El Paso, and Memphis in the South; Sioux Falls and St. Louis in the Midwest; and Billings, Denver, Honolulu, Los Angeles, and Seattle in the West. Since the last Pulse Check reporting period, availability of Colombian heroin has increased in only five cities, spanning all four regions: Chicago, Los Angeles, Miami, Portland (ME), and Washington, DC. Stable trends are reported in all other Pulse Check cities.

Mexican black tar, a lower purity, injectable heroin, is ranked as widely available by sources in eight cities, mostly in the West and the South (and in St. Louis in the Midwest). Sources in five cities consider it somewhat available, and sources in nine cities consider it not very available. It is described as "not available at all" by sources in seven cities: all four northeastern Pulse Check cities; Miami and Washington, DC, in the South; and Sioux Falls in the Midwest. Since the last Pulse Check reporting period, black tar has become increasingly available in Honolulu, Los Angeles, and Portland (ME). Availability has declined in Chicago and (slightly) in El Paso. Stable trends are reported elsewhere. Southeast Asian and Southwest Asian heroin are the least common forms, with wide availability reported in only three cities apiece and increased availability reported only in Detroit, Portland, and Washington, DC.

White heroin hits St. Louis? According to the St. Louis epidemiologic source, that city's supply is almost exclusively Mexican black tar. However, a recent seizure involved a white heroin whose signature has not yet been established but is suspected to be of Nigerian origin.

How pure is heroin across the country? (Exhibit 4) According to law enforcement, epidemiologic, and ethnographic sources, street-level Colombian heroin purity ranges from as low as 7 percent in New Orleans to as high as 95 percent in Philadelphia. Typically, however, purity is at the higher end of that range. Street-level Mexican black tar heroin purity ranges from 14 to 58 percent, with both extremes reported in Seattle. Users often tend to complain about low purity despite evidence to the contrary. As the New York ethnographic source notes, "We continue to hear users complain about the 'bad dope,' when everybody is saying that there has never been such 'good dope' around." That source adds, however, that in this case the users' perceptions might be accurate, because "high availability and low prices are making it possible for street dealers to dilute the heroin."

Then and Now: Heroin purity (fall 2000 vs spring 2001) Heroin purity remained relatively stable in the majority of Pulse Check sites, according to law enforcement, epidemiologic, and ethnographic sources. Levels increased in only four cities (Honolulu, Miami, New Orleans, and Washington, DC) and declined in only one (Denver). None of these changes appears particularly dramatic.

What adulterants are added to heroin? A wide range of heroin adulterants, some benign and some harmful, are reported by law enforcement, epidemiologic, and ethnographic sources in several cities, particularly in the Northeast and South: "any powder" in Portland; lactose in Boston; rat poison, powdered milk, baking soda, and coffee creamer in New York; quinine and sugar in Baltimore; scopolamine and baby powder in Columbia (SC); cocaine and vitamin B12 in Memphis; baking soda and "any white powder" in Miami (the same adulterants as in cocaine, but one shade darker); baby laxatives and powder in Detroit; and sugar in Los Angeles (to give black tar a tan appearance).

"Tres pesos" and "benita"... New York, NY: According to the ethnographic source, "A user in Brooklyn stated that the heroin was being mixed with 'Tres Pesos' (meaning 'three steps'), which is a rat poison shipped from Santo Domingo. (They call it three steps because after the mice inhale it they take three steps and die.) The user said the reaction is intense, the rush is quicker, and they feel like they're going to die." Baltimore, MD: The ethnographic source reports that "'benita,' a type of heroin cut with quinine, which has been around for a while, is less available than before."

What are street-level heroin prices across the country? (Exhibit 4) The most commonly reported heroin street sales unit is 0.1 gram, which sells for as little as $4 for Colombian heroin in Boston to as much as $120 for Mexican black tar in Seattle. In some cities, however, street sales units are much larger: for example, the Birmingham law enforcement source states that "no one wants to sell less than 1 gram" of heroin. Purity, sales quantity, and dealer competition all play a part in determining heroin price. Sometimes, however, other more subtle factors—such as marketing strategies or barter—come into play. For example, according to the New York ethnographic source, "Some dealers in the Bronx and Brooklyn have been offering a $5 bag to lure customers." Another example is Hawaii, where the epidemiologic source notes that few people buy drugs for cash. Rather, they tend to barter goods, services, or other drugs. Many of the goods, such as stereos, cameras, and jewelry, are obtained via larceny and other forms of theft.

Then and Now: Heroin prices (fall 2000 vs spring 2001) Heroin prices appear to be relatively stable, according to the majority of law enforcement, epidemiologic, and ethnographic sources who provided this information. Prices increased in only four cities (Baltimore, Chicago, New Orleans, and Washington, DC) and declined in only three (El Paso, Los Angeles, and St. Louis).

Three of the reported price increases are in the South. In New Orleans, cellophane bags containing two or three doses of white heroin increased both in price and purity. Capsules (known on the street as "pills") are the most common street sales unit in Baltimore, where prices increased from $3–$6 to $10 for a pill of equal (but unknown) size while purity remained stable. In nearby Washington, DC, the milligram price increased from $1.13 to $1.36. In the Midwest, a slight increase is reported in the price of a medium- to large-sized bag of heroin (from $10 to $10–$20) in Chicago.

The El Paso price drop is dramatic, from $10 to $3 per "hit" (amount not specified), reflecting the increased availability and cartel competition described above. Also reflecting increased availability, black tar prices in Los Angeles declined sharply at the hit (0.25 gram) level (from $35–$100 to $20–$40), at the gram level (from $150–$300 to $100), and at the "eightball" (1/8 ounce) level (from $400–$600 to $300). The St. Louis price drop involves "bindles" of #6 gel caps, which sold for the "low 20s" in fall 2000 and the "high teens" in spring 2001.

How is heroin referred to across the country? (Exhibit 5) Street names throughout the country often vary by geographic region and by type of heroin. However, some terms, such as "horse," "H," and "boy" are common across regions. Street names (slang) and brand names (dealer designations) are often interchangeable, as is the case in New York ("millennium 2000") and Washington, DC ("jerry springer" and "747" ). Many factors other than brand names, however, can engender a street name. In Washington, DC, for example, the non-methadone source reports that a major news event, such as a hurricane or tornado, can trigger a new street name.

Exhibit 4. What are the prices and purity levels of different types of heroin in 18 Pulse Check cities?* How have prices and purity changed (fall 2000 vs spring 2001)?

City		Source	Unit	Size	Price/Change**	Purity/Change**
	Baltimore, MD	E	pill	NR	$10	NR
	Boston, MA	L	"bundle"	0.1 gm	$4-$6	60-70%
	Chicago, IL	L	"hit"	0.2 gm	$20	NR NR
	Columbia, SC	L	"bindle"	0.2 gm	$20-$25	62%
		L	"bundle"	2 gm	$225	NR NR
	Detroit, MI	L	"bindle"	1 gm	$125-$175	50%
		L	"pack"	2 dosage units	$10-$20	NR NR
	Miami, FL	E	"bag"	0.1 gm	$10	20%
	New Orleans, LA	L	"unit"	0.45 gm	$20-$25	7%
	New York, NY	L	"hit"	NR	$10-$14	80-90%
		L	"bundle"	10 bags	$95-$107	80-90%
		L	NR	1 gm	$60-74	80-90%
		L	NR	1 oz	$2,000	80-90%
	Philadelphia, PA	L	"baggie"	NR	$10-$20	40-95%
		L	"bundle"	(10-13 bags)	$100	40%
		E	"hit"	NR	$10	NR NR
	Denver, CO	L	"balloon"	0.2 gm	$20	20-30%
	El Paso, TX	L	NR	0.1 gm	$20	NR NR
		E	"hit"	NR	$3	NR
	Honolulu, HI	L	"bindle"	0.1 gm	$50-$75	NR NR
	Los Angeles, CA	L	"hit"	0.25 gm	$20-40	25%
		L	"eightball"	1/8 oz	$300	25%
		L	NR	1 gm	$100	20%
	St. Louis, MO	E	#6 gel cap-bindle	0.25-0.5 gm	"high teens"	NR NR
	Seattle, WA	E	"bindle"	NR	$20	20-25%
		L	NR	0.1 gm	$90-120 NR	14-58%
		E	NR	1 gm	$80	20-25% NR
		L	NR	1 oz	$600-$1,300 NR	14-58%
	Memphis, TN	L	"pack"	0.1 gm	$30	40-50%
		E	NR	1 gm	$125-175 NR	NR NR
		E	"hit"	square inch bag	$125-175 NR	NR NR
	Birmingham, AL	E	(powder)	1 gm	$500 NR	NR NR
	Chicago, IL	E	"bag"	NR	$10-$20	NR NR
	Denver, CO	E	NR	1 gm	$100	16-18%
	Washington, DC	L	"dime bag" (white powder)	50-75 mg	$10	10-50%
		E	"bag"	1 mg	$1.36	23%

Sources: Law enforcement (L) and epidemiologic and ethnographic (E) respondents
*Respondents in Billings, Portland, and Sioux Falls did not provide this information.
**Arrows indicate up, down, or stable between fall 2000 and spring 2001.

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In some cities, different dealers use different brand names or logos as a marketing strategy and for identification purposes. In other cities, brand names and logos are nonexistent. Brand names and logos are frequently changed, sometimes on a daily basis. In Baltimore, for example, the ethnographic source states: "Labels change daily. Dealers give out 'testers,' put a label on it, word gets out on what's 'good' that day and in which neighborhoods it's available, then users go to those neighborhoods to make their buys." Philadelphia is another example of a city where heroin brand names proliferate: the number of brand names identified by the epidemiologic source increased from 59 during the last reporting period to 86 during the current period—probably reflecting the dealers' strategy to increase their market. Conversely, New York's ethnographic source reports that "More dealers throughout the city are relying on generic heroin 'non-signature' brands in an effort not to be identified by law enforcement. Some dealers have gone away from name or signature bags and are using bag color to identify the source. Those still using brand names are constantly changing the name to avoid detection from police."

How is heroin packaged? Heroin is most commonly packaged in plastic, cellophane, glassine, or coin bags, usually the "zipper" type, as reported by law enforcement, epidemiologic, and ethnographic sources in every city except Detroit, El Paso, Billings, Denver, and Los Angeles. Other common packaging includes plastic or cellophane wrap (as reported in Baltimore, Chicago, St. Louis, Denver, and Honolulu), wax paper (in Boston, Portland, Baltimore, and Memphis), and balloons (in El Paso, Memphis, Denver, and Los Angeles). Some more unusual packaging is reported: lottery tickets in Detroit; "bricks" of compressed heroin in New York; loose single pills or capsules that melt when heated in Baltimore; double plastic bags with uncooked rice in between (to keep moisture out) in New Orleans; paper wrapping inside of plastic, or in folded magazine pages, in Billings; and latex pellets in Denver. Two recent changes are reported: in Chicago, bags are becoming more common, while foil is becoming rarer; and balloons are no longer used in Baltimore.

Exhibit 5. How is heroin referred to, and what types of heroin predominate, in different regions of the country?

H, boy, horse, dogfood, s--t, negro, chiva, smack, china white, monkey, big, heroin, train, foil, girl, doogie, stuff, mud, slag, dragon, mac, heron, 1-boldstep, magic, revenge, white dragon, jerry springer, orange bag, green bag, red bag, black bag, 747, carga, black coffee, white horse, lady, manteca, diesel, pink, doosey, black tar, bone, shake, grown man, tammy
Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents

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

HEROIN: THE SELLERS

How are street-level heroin sellers organized? Street-level heroin sellers tend to be independent of organized structures such as gangs, according to 13 of the 20 law enforcement sources who discussed this question. In Portland, ME, for example, most sellers are heroin addicts who go to neighboring Massachusetts to get the drug, import it, and sell it back home; only occasionally does an organized group from Massachusetts come in to sell the drug in Portland, but then they leave. Three additional sources—in Miami, New Orleans, and St. Louis—report both independent and organized sellers in their cities. In Miami, independent sellers are found on the streets, while organized sellers conduct their transactions in clubs. Organized sellers predominate in only four Pulse Check cities: Chicago, Columbia (SC), Denver, and Seattle. The Seattle organized structure consists of two kinds of sellers: a gobetween who is an addict, and "the guy in the car with the bags, who is not an addict," comments that city's law enforcement source. Recently, Asian groups have starting getting involved in heroin sales in New Orleans, and individuals from Russia and Eastern Europe have been getting involved in New York.

Epidemiologic and ethnographic sources paint a slightly different picture: they report organized sales structures in 10 cities. In five of those cities, law enforcement sources, by contrast, report independent operations: Baltimore, Detroit, El Paso, Memphis, and Washington, DC. These seeming discrepancies might be explained by differing definitions of what constitutes an organized group. In Baltimore, for example, the law enforcement source points out that while young adolescent sellers are not in gangs, they do work in small cliques (which might be construed as organized structures). According to that city's ethnographic source, heroin's organized sales structure has three or four tiers between the leader and the individual who delivers the drug to the customer. Similarly, the New Orleans epidemiologic source defines that city's organized structure as a series of loose connections, not gang-related, in which a seller has a dealer who gets calls to arrange pickups at specified locations.

Then and Now: How have street-level heroin sales changed across the country (fall 2000 vs spring 2001)?
Only a few changes (none in the Midwest) are reported in the heroin sales scene and in the kind of people who sell the drug at the street level.
In the Northeast...	Boston, MA: The law enforcement source describes heroin sales as being more underground than in the past and than other drug sales. New York, NY: Individuals from Russia and Eastern Europe are increasingly involved in heroin sales, according to the law enforcement source. Philadelphia, PA: The epidemiologic source reports that in the past each dealer sold one drug; now, in addition to all the "meat and potatoes" products (that is, heroin, crack cocaine, and marijuana), dealers also sell diverted pharmaceuticals, such as alprazolam (Xanax®) and oxycodone (Percodan®, Percocet®, and OxyContin®).
In the South...	Baltimore, MD: According to the law enforcement source, heroin sales activity appears to have increased. Columbia, SC: The law enforcement source reports an increase in drug dealers robbing other drug dealers, with some robberies resulting in shootings. New Orleans, LA: Recently, Asian groups have starting getting involved in heroin sales, according to the law enforcement source.
In the West...	Billings, MT: The law enforcement source reports that heroin trafficking and sales appear to be down.

Some cities have two kinds of sales structures... Honolulu, HI: The epidemiologic source describes most sellers of heroin, marijuana, methamphetamine, and cocaine as independent, with each seller having two or three "runners" to deliver drugs to customers and return the payments to the seller. Some sellers, however, have Mexican affiliations: youths with minimal English-speaking skills are recruited in Mexico, flown into Hawaii, given addresses via phone identifying where they should report to begin "running" drugs, and then returned to Mexico after 4–6 months. Miami, FL: The law enforcement source notes that independent sellers are found on the streets, while organized sellers conduct their transactions in clubs.

How old are street-level heroin sellers? Young adults (age 18–30) are the group most likely to sell heroin in the street, according to 11 of the 19 law enforcement sources who discussed this question and spanning all regions of the country. Moreover, they are just as likely as older adults (>30 years) to sell streetlevel heroin in an additional three Pulse Check cities (El Paso, Portland, and St. Louis). Older adults are the likeliest to sell heroin in five of the cities: Billings, Honolulu, Memphis, Philadelphia, and Washington, DC. Only 13 of the epidemiologic and ethnographic sources provided information on this question. Again, the majority (10) name young adults as the primary street-level sellers. Birmingham and Detroit are two of the three exceptions, with older adults more likely to sell heroin; the third exception is Chicago, where, most disturbingly, the epidemiologic source names adolescents (13–17 years) as the most likely to sell heroin on the street. Adolescents, while not the primary seller group in most cities, do sometimes sell heroin. In New York, for example, the epidemiologic source reports that "Street dealers are using teenagers to sell their drugs. These teenagers can be seen on small bikes loitering in front of local grocery stores or on the corners."

Does sales location have anything to do with the age of sellers? The New York ethnographic source notes that "Sellers on the street range in age from the late teens to the late thirties; dealers that sell from indoor locations range in age from the late teens to late fifties."

What type of crimes are heroin sellers involved in? All but 1 of the 19 law enforcement sources who discussed this question consider heroin sellers as somewhat or very likely to be involved in criminal activity. The Birmingham source, however, believes that sellers are not very involved in other crimes. Specifically, the law enforcement sources mention nonviolent crime more often than violent crime in association with heroin sales (in 12 versus 8 cities, respectively). Gang-related crime is mentioned in seven cities (none in the Northeast; Baltimore, El Paso, and New Orleans in the South; Chicago and St. Louis in the Midwest; and Honolulu and Seattle in the West). Prostitution is mentioned in six cities (Boston and Philadelphia in the Northeast; El Paso and New Orleans in the South; none in the Midwest; and Denver and Honolulu in the West). Other crimes mentioned by law enforcement sources include pharmaceutical diversion (in Portland, ME), domestic violence (in Boston), and money laundering (in Miami). The Columbia, SC, law enforcement source reports an increase in drug dealers robbing other drug dealers, with some robberies resulting in shootings.

Do heroin sellers use their own drug? (Exhibit 6) Of the 19 law enforcement sources who discussed this question, 7 consider heroin sellers very likely to use their own drug, 8 give a "somewhat likely" response," and 5 consider them not very likely to do so. The 15 epidemiologic and ethnographic sources who discussed the same question are more evenly divided, with 5 giving each of the above-named responses. One of the "somewhat likely" responses is given by the Boston ethnographic source, who comments that "Nearly all users eventually sell to help sustain their habit, usually just selling because it is a way to procure heroin." That source also notes, however, that young Dominican gang members, who constitute a small proportion of heroin sellers, are unlikely to use their own heroin. On the rare occasions they do, it is with crack. Similarly, the Baltimore the ethnographic source, who describes a sales structure with three or four tiers between the leader and the deliverer, notes that those at the bottom tier are very likely to use their own drug, while the actual seller at the top is not likely to do so.

Exhibit 6. How likely are heroin sellers to use their own drug?*

Sources: Law enforcement, epidemiologic, and ethnologic respondents
*The law enforcement source from New York and the epidemiologic sources from Billings, Columbia, Los Angeles, New York, Philadelphia, Seattle, and Sioux Falls did not provide this information

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Where is street-level heroin sold? (Exhibit 7) As in the last Pulse Check report, law enforcement sources generally agree that most heroin sales take place in central city areas. However, in New York and Portland, it is also sold in rural and suburban areas; in Memphis, it is also sold in rural areas; and in Miami, it is also sold in the suburbs. Epidemiologic and ethnographic sources also generally concur that central city areas are the most common sites for heroin sales. Two exceptions, however, are Miami and Sioux Falls, where suburban areas are reported as more common. Additionally, a rural border crossing area in El Paso is seeing much heroin sales activity.

Indoor and outdoor sales are equally common, according to the majority (13 of 20) of responding law enforcement sources. Indoor sales, however, are reportedly more prominent in Boston, Detroit, Memphis, and Portland; while outdoor sales are more evident in Baltimore, Honolulu, and Philadelphia. Most epidemiologic and ethnographic sources (10 of 15) concur that heroin sales are equally likely to take place indoors and outdoors, but indoor sales are reportedly more common in four sites (Miami, New York, Portland, and Sioux Falls), while outdoor sales are more prominent in Washington, DC. The New York ethnographic source elaborates that heroin continues to be sold mostly indoors because of law enforcement initiatives aimed at street sales. Similarly, the Boston law enforcement source describes heroin sales as being more underground than in the past and than other drug sales.

As the chart shows, law enforcement, epidemiologic, and ethnographic sources report a wide range of specific settings for heroin sales:

• Private residences and public housing developments: Mentioned in nearly every Pulse Check city
• Private parties, crack houses (or "crash houses," as the Memphis law enforcement source terms them), cars, and parks or playgrounds: Common venues
• Raves and nightclubs: Particularly common in the South, but not mentioned in the Midwest
• Schools and college campuses: Mentioned, respectively, in eight and seven cities—with both venues reported in four cities representing four different regions: Billings, Chicago, Memphis, and New York
• Shopping malls: Mentioned in five cities

Other heroin sales venues, not depicted in the chart, are also reported by law enforcement, epidemiologic and ethnographic sources:

• In or near supermarkets: In Billings, Columbia (SC), El Paso, Honolulu, New York, and New Orleans
• Over the Internet: In El Paso, Honolulu, and New York
• Hotels and motels: In Memphis

Settings for sales and use vary... New York, NY: The ethnographic source suggests that "Young Whites prefer Staten Island because of its close proximity to New Jersey and indoor selling locations. The buyers prefer paying a higher price (for security and the feeling that you get 'better dope' indoors than on the street) at indoor locations in New Jersey than to travel to outdoor locations in Brooklyn and Manhattan." Miami, FL: According to the law enforcement source, "distributors find someone in the central city, beep that person, then they meet. Often, they meet in the suburbs for delivery." Baltimore, MD: The ethnographic source notes that street-selling locations include open air markets. Indoor sales include some unusual settings, such as locally run fried chicken restaurants with plexiglass drive-up windows where drug transactions take place. Additionally, the law enforcement source describes slots, cut into vacant buildings, where "money goes in and drugs go out."

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

See larger version of Exhibit 7

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

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How is street-level heroin sold? As in the last Pulse Check report, hand-to-hand sales remain the most common way to sell user-level heroin, as reported by each of the 20 law enforcement sources who discussed this question. Sales involving beepers or cell phones are the second most commonly reported (in 14 cities), followed by the home delivery method (which also commonly involves beepers or cell phones) (in 11 cities) and acquaintance networks (in 10 cities). In the Midwest, the Detroit law enforcement source describes car "meets" with dealers by appointment, while the St. Louis source reports that sellers are becoming more guarded about what they say on cell phones. The Los Angeles law enforcement source, however, reports that dealers, after being paged to call the buyer, use sophisticated digital cell phone systems that create difficulties for narcotics officers to monitor or track person-to-person transactions.

Epidemiologic and ethnographic sources, similarly, report that handto- hand and beeper/cell phone sales are the most common (in 12 cities each), followed by acquaintance networks (in 9 cities) and home delivery (in 6 cities). New York features office delivery service. The Honolulu epidemiologic source describes a typical high-risk scenario: a buyer tells a runner what drug he wants, the runner then finds out the cost, returns to collect the money, then leaves and comes back to "make the drop."

What other drugs do heroin dealers sell? (Exhibit 8) Heroin dealers continue to sell additional drugs in nearly every Pulse Check city, except for Billings, Boston, Columbia (SC), and Honolulu, where neither law enforcement, epidemiologic, nor epidemiologic sources indicated such sales. Crack and powder cocaine are mentioned most frequently, followed by marijuana. Also mentioned are ecstasy (methylenedioxymethamphetamine, or MDMA) (in Miami and New York), pharmaceutical opiates such as OxyContin® (in Portland), and methamphetamine (in Denver). The Philadelphia epidemiologic source reports that in the past each dealer sold one drug; now, in addition to all the "meat and potatoes" products (that is, heroin, crack cocaine, and marijuana), dealers sell diverted pharmaceuticals, e.g., alprazolam and oxycodone (Percodan®, Percocet®, and OxyContin®). In Baltimore, some heroin sellers also sell powder cocaine, sometimes as a "one-and-one" (both drugs sold together as a unit); other dealers, however, sell the drugs separately. With Memphis heroin dealers also selling cocaine in various mixes, that city's epidemiologic source notes that buyers often don't know what they're getting. In St. Louis, dealers affiliated with gangs are particularly likely to run a "one-stop shop," selling heroin, crack, and marijuana.

Exhibit 8. What other drugs do heroin dealers sell?*

City		Crack	Powder Cocaine	Marijuana	Other	No other drug sold
	Boston, MA
	New York, NY				Ecstasy
	Philadelphia, PA				Alprazolam (Xanax®) Oxycolone (all forms)
	Portland, ME				OxyContin® Other pharmaceutical opiates
	Baltimore, MD
	Birmingham, AL
	Columbia, SC
	Memphis, TN
	Miami, FL				Ecstasy
	New Orleans, LA
	Washington, DC
	Chicago, IL
	Detroit, MI
	St. Louis, MO
	Billings, MT
	Denver, CO				Methamphetamine
	Honolulu, HI
	Seattle, WA

Sources: Law enforcement, epidemiologic, and ethnographic respondents
*Respondents in El Paso, Los Angeles, and Sioux Falls did not provide this information.

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Then and Now:
How have heroin user demographics changed across the country (fall 2000 vs spring 2001)? According to epidemiologic and ethnographic sources...
Age: Numerous shifts are reported:	Increases in the young adult (18–30 years) group are reported in the majority of Pulse Check cities: Boston in the Northeast; Baltimore, Columbia, Memphis, Miami, and Washington, DC, in the South; Detroit, St. Louis, and Sioux Falls in the Midwest; and Denver, Honolulu, and Seattle in the West. A new user group is emerging in El Paso: adolescents born into multigenerational families of heroin addicts and sellers (but young adults age 18–30 still predominate). More younger people (16–22 years) in Portland, ME, are initiating heroin use.
Race/ ethnicity: Distributions remain generally stable except for five reported shifts:	Denver, CO: Whites, who are the predominant heroin user group, continue to increase as a percentage of heroin users; however, they are still underrepresented relative to the city's general population. Miami, FL: Hispanics are an emerging group (but are still underrepresented relative to the general population). Philadelphia, PA: The proportion of Whites among heroin users has declined slightly, while Black and Hispanic representation has increased slightly. Seattle, WA: Slight increases are reported in heroin use by Hispanics. Washington, DC: Blacks remain the racial/ethnic group most likely to use heroin, but Whites have been increasingly using the drug.
Gender: Distributions remain stable, with three exceptions: the number of female heroin users has increased slightly in New Orleans, Philadelphia, and Portland (ME). Residence: Heroin use is spreading to the suburban areas surrounding four Pulse Check cities in the South (Baltimore, Memphis, Miami, and Washington, DC) and Seattle in the West. Use is also spreading to the rural areas surrounding Portland, ME (as suggested by rising hepatitis C figures), and El Paso (partly because many people are moving there).

HEROIN: THE USERS

How old are heroin users? (Exhibit 9) The vast majority of epidemiologic and ethnographic sources (17 of 21) in the Pulse Check sites agree that the people most likely to use heroin are generally older than 30. However, younger adults (18–30 years) sometimes comprise substantial proportions of users in those sites. Furthermore, in the South, younger adults are more likely than older adults to use heroin in four sites: Baltimore, El Paso, Memphis, and New Orleans. In two sites—Philadelphia and St. Louis—both the younger and older adult groups are cited as equally likely to use heroin. Moreover, the younger adult groups are increasing in many cities, such as Portland (ME) and Sioux Falls, where the older adults still predominate. Even more disturbingly, in some cities, including Baltimore, El Paso, and Portland, adolescents are increasingly initiating heroin use. By contrast, in Boston, the ethnographic source remarks that "It's rare to see young minority heroin users. They often saw its effects on their parents and tend not to use it."

The two Philadelphia treatment sources agree with that city's epidemiologic source that both the younger and older adult age groups are equally likely to use heroin. A similar consensus among all source categories occurs in Birmingham, Boston, Detroit, and Honolulu, where heroin users are perceived to be primarily older adults, and in New Orleans and St. Louis, where they are perceived to be primarily young adults. Overall, heroin users in methadone programs seem to be somewhat older than those in nonmethadone treatment: 10 out of 17 (59 percent) methadone treatment sources who discussed this question consider heroin users more likely to be older adults, versus 8 out of 18 (44 percent) non-methadone sources. Another disturbing report comes from Chicago, where the methadone program's heroin users are primarily both adolescents and young adults.

Then and Now: How h