Crack and Powder Cocaine

CRACK AND POWDER COCAINE: THE PERCEPTION

How serious a problem is cocaine in Pulse Check communities? Sources in more than half of the Pulse Check sites (12 of 20) consider cocaine, in crack and powder forms combined, to be the most serious drug problem in their communities (41 percent of 70 responding sources). Half of those sites are in the South (Birmingham, Columbia [South Carolina], El Paso, Memphis, Miami, and Washington, DC), and the other half span the country's three other regions: Chicago, Detroit, and St. Louis in the Midwest; Denver and Los Angeles in the West; and only New York in the Northeast. (Note: In discussing their perception of how serious their communities' drug problem is, most Pulse Check sources do not distinguish between the two forms of cocaine.) Cocaine is also considered the second most serious drug problem by 29 percent of Pulse Check sources (N=66). Although it is the most mentioned drug problem, it is considered an emerging problem in only one site: Billings, Montana (according to a law enforcement source).

Has the perception of the seriousness of the cocaine problem changed between 1999 and 2000? Cocaine continues to be considered the most serious drug problem across sites, with more than 7 of 10 sources ranking it as either the most serious or second most serious drug problem. In some communities, sources note that heroin replaced cocaine (either form) as the most serious drug problem over the past year; in Detroit, New Orleans, and Portland (Maine), some (but not all) sources indicate that heroin is overtaking cocaine. Conversely, in Birmingham and El Paso, sources indicate that cocaine is replacing heroin.

CRACK COCAINE: THE DRUG
Availability, Purity, and Price

How available is crack cocaine across the country? (Exhibit 1) Of the law enforcement, epidemiologic, and ethnographic sources discussing this question, 81 percent (N=31) report crack as widely available in their communities, and 17 percent report it as somewhat available. Only in Sioux Falls is it considered not very available (as reported by the epidemiologic source)

Exhibit 1. How available is cocaine?

Has the availability of crack cocaine changed between 1999 and 2000? (Exhibit 2) The majority (53 percent) of responding sources report crack availability as stable. Only one-fourth (N=32) report an increase in crack availability, and only 19 percent report decreased availability. According to law enforcement sources, crack availability increased in three sites (Billings, Denver, and Portland) and decreased in four sites (Chicago, Honolulu, Sioux Falls, and Washington, DC). Ethnographic and epidemiologic sources report increases in five southern and northeastern sites (Birmingham, El Paso, Miami, New York, and Portland) and declines in two western sites (Denver and Honolulu).

How pure is crack cocaine across the country? (Exhibit 3) Crack purity varies widely, ranging from 20 percent (in Denver) to 90 percent (in Honolulu and Washington, DC) in the 11 Pulse Check sites where purity was reported.

What are crack cocaine prices across the country? (Exhibit 3) The cost of a crack cocaine gram ranges from $20 in Miami to $250 in Honolulu. According to law enforcement, epidemiologic, ethnographic, and treatment provider sources, crack most commonly sells by the rock for $3 to $35 depending on geographic location and rock size. Crack also sells as "kibbles and bits" (small amounts of rock) in Seattle for $2 to users with little money. Similarly, in Washington, DC, "crumbs" (small amounts of rock) sell for $3 and "working bags" (bags containing several small rocks) sell for $20.

How is crack cocaine made? Typically, in Pulse Check communities, local crack sellers and, less often, crack users process powder cocaine into crack cocaine. In most cities, baking soda is the standard ingredient added to powder cocaine to make crack, as cited by law enforcement sources. However, sources mention other adulterants, including sugar in Portland, lidocaine in Sioux Falls, brake fluid and rat poison in Memphis, and vitamin B-12 in Birmingham. Epidemiologic and ethnographic sources similarly note crack adulterants, such as diphenhydramine (Benadryl ®) in Boston and Detroit, procaine (Novocaine ®) and "anything white" in Detroit, and the pain reliever aurosol (Ambesol ®) in Portland.

POWDER COCAINE: THE DRUG
Availability, Purity, and Price

How available is powder cocaine across the country? (Exhibit 1) Powder cocaine (cocaine hydrochloride [HCl]) is judged as widely available, yet somewhat less available than crack, with 60 percent of law enforcement, epidemiologic, and ethnographic sources (N=35) reporting it as widely available, particularly in the South, and 37 percent reporting it as somewhat available. It is considered widely available in eight cities (Columbia, Denver, Memphis, Miami, New York, New Orleans, Philadelphia, and Seattle) and widely or somewhat available in five cities (Birmingham, Boston, El Paso, Portland, and St. Louis). Honolulu sources differ in their perspective on the powder cocaine supply: the law enforcement source states that it is widely available; the epidemiologic source states it is not very available.

Has powder cocaine availability changed between 1999 and 2000? (Exhibit 4) Most (61 percent) of the 31 responding law enforcement, epidemiologic, and ethnographic sources, spanning 15 of the 20 Pulse Check cities, perceive powder cocaine availability as stable. About one–quarter (26 percent) of the sources, spanning eight cities, perceive it as increasing; and 13 percent (in three cities) perceive it as declining.

How pure is powder cocaine across the country? (Exhibit 5) The purity of powder cocaine varies widely, ranging from 25 percent (in Honolulu) to 90 percent (in Boston and Miami).

What are powder cocaine prices across the country? (Exhibit 5) Powder cocaine gram prices typically mirror or are slightly lower than crack prices, although typically crack cocaine can be purchased in smaller (and less expensive) amounts (rocks) than powder cocaine (grams). Powder cocaine ranges from $20 per gram in Sioux Falls to $200 in Honolulu and Washington, DC. Some of the lowest prices are found in the South.

What adulterants are added to powder cocaine? Powder cocaine adulterants cited by law enforcement sources include lactose, isotol, manitol, inositol, baking soda, and sugar. In 1999 in Miami, law enforcement officials seized powder cocaine colored blue and yellow with food coloring, perhaps used to disguise the cocaine.

Exhibit 5. Powder cocaine gram prices and purity by city

CRACK COCAINE: THE USERS
Who, Where, How, and With What?

How have crack cocaine users changed across the country between 1999 and 2000? According to epidemiologic and ethnographic sources, crack trends appear generally stable across the country, with a few exceptions, as noted below. Several treatment sources, however, note increases in the number of crack clients in their programs, particularly among the younger population.

Are people initiating crack use? (Exhibit 8) Epidemiologic and ethnographic sources report few signs of crack initiation. For example, the New York ethnographic source reports that new users are not entering the scene, but a high level of chronic use by long-term addicts continues. From the treatment perspective, however, some sources do note novice use among clients. As the arrows show (in Exhibit 8), treatment sources in six Pulse Check sites report stable trends in novice crack use at their programs.

However, treatment sources in 10 cities, spanning all regions of the country, report an increase. Further, eight of those sources perceive the increase at their programs to parallel an increase in their local communities. A Boston treatment source, for example, reports that novice users are increasing in number and reportedly prefer "freebasing"; moreover, in the local area, the source comments that "smoking crack is so common that even some public safety professionals use this drug, and they don't feel that it is a problem."

How old are crack cocaine users? (Exhibit 9) According to Pulse Check epidemiologic and ethnographic sources, crack users tend to be older adults (30 years and older). Four exceptions occur in Birmingham, Honolulu, Los Angeles, and Sioux Falls: in those cities, the younger crack-using populations exceed the older user groups. In Sioux Falls, the crack-using population is particularly young: 18–24 years. Young crack users (in their late teens through early twenties) are reported as the population second most likely to use crack in Billings, Honolulu, Seattle, and Washington, DC.

By contrast, treatment sources in 18 sites identify young adults (18–30 years) as the predominant age group of crack clients, followed by older adults. Moreover, a non-methadone treatment provider in New Orleans identifies adolescents as the predominant group. Only in Billings do older adults in a reporting program outnumber the young adults.

Are there gender differences in who uses crack? The majority of crack users tend to be male, as reported by epidemiologic and ethnographic sources in every Pulse Check city except four: the group reported most likely to use crack in Miami is age 35-and-older and female; in Sioux Falls and Washington, DC, users are evenly split between males and females; and in Seattle, male users only slightly outnumber female users among the group most likely to use crack.

Similarly, in most cities, treatment sources report that the majority of crack clients are male, with three exceptions where females are in the majority: Boston, Chicago, and Seattle. Moreover, the number of female crack clients has increased at programs in Memphis and Seattle. In the latter, female clients report initiation to crack use via male companions.

Is any racial/ethnic or socioeconomic group more likely to use crack? Blacks account for the largest proportions of crack users in 13 of the 20 Pulse Check cities, according to epidemiologic and ethnographic sources. In Boston, black and Hispanic representation among crack users is approximately equal. Whites are more likely than other racial/ethnic groups to use crack in Billings, Denver, and El Paso; and the Sioux Falls crack-using population crosses all racial/ethnic categories.

Crack-using populations are predominately in lower SES categories in all but 2 of the 20 cities, according to epidemiologists and ethnographers: in El Paso, crack users are predominantly middle class; and in Sioux Falls, users cross all SES categories but are primarily from an upper SES group. Additionally, in the cities where the lower SES groups predominate, some crack users come from other groups. For example, lower/middle SES groups are reported in Honolulu and Los Angeles; Miami's younger (age 20–30) white and Hispanic suburban group is described as "middle and upper" SES; and Detroit has a small, young, black user group that crosses all SES categories.

Treatment programs in the Northeast region vary by city in the racial/ethnic distribution of their crack clients. Among programs responding on race, whites account for the largest proportion of crack clients in Boston and Portland, reflecting those cities' population distributions; blacks are overrepresented in New York and Philadelphia, where they account for the largest crack-using groups at reporting treatment programs. In the South, blacks are generally overrepresented, accounting for the largest proportion of crack clients in five out of seven Pulse Check treatment programs reporting on race: the non-methadone programs in Birmingham, Columbia, Memphis, and New Orleans, and the methadone program in Washington, DC. Whites, however, account for the largest proportion of crack clients in the Birmingham and Memphis methadone programs, whereas Hispanics account for the largest proportion in El Paso. In the Midwest, blacks are demographically overrepresented, accounting for the largest crack-using population at three of seven reporting programs: the non-methadone programs in Chicago and Detroit, and the methadone program in Chicago. Whites predominate in Sioux Falls. The West has the most variation across sites in the racial/ethnic groups that account for the largest number of crack clients: whites in Billings; Asian/Pacific Islanders in Honolulu; Hispanics in Los Angeles; and blacks in Denver and Seattle, where they are overrepresented.

Like the epidemiologic and ethnographic sources, treatment sources generally report that crack users are found in the lower SES groups. However, in Billings, Birmingham, Boston, El Paso, and Sioux Falls, crack users are often in the middle SES groups.

Where do crack users tend to reside? Without exception, epidemiologic and ethnographic sources report crack as primarily an inner-city drug, but some suburban use is reported. In Honolulu, for example, some people from rural areas come into the inner city to buy the drug. Detroit's young crack-using population reside both in the inner city and in the suburbs. Similarly, Miami has a young (age 20–30) male cohort of crack users who reside in the suburbs.

Treatment sources generally concur that the majority of crack users reside in inner-city areas. In only 4 of 25 programs where place of residence was discussed, sources cite non-inner-city areas: Boston, Sioux Falls, and New York sources report that users are more likely to live in the suburbs; an El Paso source reports that they are more likely to live in rural areas.

Where and with whom is crack used? (Exhibit 10) Crack use, as the table indicates, takes place in a wide variety of contexts and settings. Epidemiologic and ethnographic sources mention indoor settings slightly more often than street settings, but the latter still feature prominently in many cities. New York's ethnographic source notes that the drug is sold and used on the street because it is short acting. The indoor settings range from crack houses to private parties, residences, abandoned buildings, bars, porn parlors, and video shops.

In some areas, epidemiologists categorize the various user groups by their use settings and contexts: in Miami, for example, crack houses are the venue for the user group of older, black, inner-city females, while the younger, male users who are white and Hispanic middle- and upper-class suburbanites tend to use crack at private parties, in houses, and in cars.

Treatment sources concur that crack use takes place in a variety of settings, mostly involving group contexts. Solo use is reported in only a few programs— in Denver, Miami, Columbia, El Paso, and Washington, DC—but group use is also reported in some of those programs. Crack houses are reported in Birmingham and Chicago (also known there as "smoke houses"). Other reported venues include parties (in New Orleans), the street (in Honolulu), and the home (in Birmingham, Denver, El Paso, Portland, Sioux Falls, Los Angeles, and Memphis).

How do crack users take their drug? Smoking, by far, is the predominant route of administration among all user groups in nearly all cities. But epidemiologic and ethnographic sources report some unusual practices. In Boston, for example, crack is sometimes dissolved in lemon juice or vinegar and then injected. Crack injection is also reported in Billings, Chicago, New York, and Washington, DC. Crack snorting is reported in Chicago.

Similarly, treatment sources report smoking as the most common method of ingesting crack. They, too, note some unusual exceptions: injection is the most common route of crack administration among clients at the El Paso methadone program, and it is also cited among clients of the New Orleans and Sioux Falls non-methadone programs. At the latter program, novice crack users are among those who inject. Further, novice users at the Boston non-methadone program freebase their crack.

What other drugs do crack users take? Alcohol is the most common substance consumed with crack, according to epidemiologic and ethnographic sources in nearly every city. Marijuana and heroin are also reportedly taken by crack users in many cities (marijuana in Denver, Detroit, El Paso, Honolulu, Miami, New Orleans, New York, Philadelphia, St. Louis, and Washington, DC; heroin in Chicago, New Orleans, New York, and Seattle). In Philadelphia, crack users also take alprazolam (Xanax ®) and phencyclidine (PCP).

Treatment sources concur that alcohol is commonly abused by crack users, as reported in Birmingham, Boston, Columbia, Denver, Honolulu, Miami, New Orleans and Portland. Marijuana use among crack users is reported by treatment sources in Birmingham, Boston, El Paso, Miami, and Sioux Falls. And heroin is used by crack users in Boston, Chicago, and New Orleans.

POWDER COCAINE: THE USERS

How have powder cocaine users changed across the country between 1999 and 2000? Powder cocaine users follow a somewhat different trend than do crack users. Signs of increase in some powder-cocaine- using populations, particularly younger ones, are reported by epidemiologic and ethnographic sources in five cities: Boston, Denver, Los Angeles, Miami, and Memphis.

By contrast, treatment providers report varying trends among novice users of powder cocaine. The number of novice users in treatment has declined at programs in four Pulse Check cities (Denver, Detroit, Honolulu, and Philadelphia), remained stable in eight programs (in Boston, Chicago, El Paso, Los Angeles, Miami, New York, Portland, and Seattle), and increased in four (in New York, Sioux Falls, Columbia, and Memphis).

How old are powder cocaine users? In the majority of Pulse Check cities, epidemiologic and ethnographic sources report that powder cocaine users are likely to be in their thirties and older. However, users tend to be slightly younger (twenties through early thirties) in five cities: Billings, Birmingham, Honolulu, Los Angeles, and Seattle. In El Paso, powder cocaine users are most likely to be between ages 14 and 21.

As is the case with crack treatment clients, powder cocaine clients in Pulse Check cities are often likely to be young adults, according to treatment sources in Birmingham, Boston, Memphis, New York, Portland, and Washington, DC. Moreover, adolescents are reported as the largest powder cocaine-using group in Los Angeles. Older adults, however, are most likely to use powder cocaine, according to Chicago, Denver, Detroit, El Paso, Honolulu, and Miami treatment sources.

Are there any gender differences in who uses powder cocaine? In only three Pulse Check cities do epidemiologic and ethnographic sources report that males and females are equally likely to use powder cocaine: Boston, El Paso, and Philadelphia. In all other Pulse Check cities, epidemiologic and ethnographic sources agree that males are more likely to use. According to treatment sources, however, females actually outnumber males in three methadone programs: in Chicago, Sioux Falls, and Washington, DC. (Females are also in the majority at the non-methadone programs in New York, but that program targets women and children.) At the Honolulu non-methadone program, the treatment source reports that older men give powder cocaine to younger women.

Is any racial/ethnic or socioeconomic group more likely to use powder cocaine? Powder cocaine users are more similar to heroin users than to crack users in that their racial/ethnic diversity mirrors the Nation's diversity. According to epidemiologists and ethnographers, whites are more likely than other groups to use powder cocaine in eight Pulse Check cities (Billings, Denver, Honolulu, Los Angeles, New Orleans, Portland, Seattle, and St. Louis); blacks are the primary user group in nine cities (Birmingham, Boston, Chicago, Columbia, Detroit, Los Angeles, New York, Philadelphia, and Washington, DC); and Hispanics are more likely to use it in two (El Paso and Miami). Native Americans are reported as the second most likely racial/ethnic group to use powder cocaine in Billings.

Powder cocaine users and crack users also differ socioeconomically: unlike crack users, whom epidemiologists and ethnographers tend to report in the lower SES categories, powder cocaine users in the majority of the Pulse Check cities are in middle SES categories or they span a wider range of categories. The few exceptions include Chicago, Detroit, Philadelphia, and Washington, DC, where powder cocaine users tend to be in the lower SES categories.

Similarly, treatment sources suggest that powder cocaine clients come from a wide range of SES backgrounds: among 14 programs where SES classification is discussed, powder cocaine users are most likely to be middle SES according to 6 sources (in Detroit, El Paso, Honolulu, Memphis, and Sioux Falls), upper SES according to 3 (in Birmingham, Denver, and Miami), and lower SES according to 5 (in Chicago, Los Angeles, New York, Portland, and Washington, DC).

Where do powder cocaine users tend to reside? As is the case with their diverse race/ethnicity and SES classification, powder cocaine users seem more akin to heroin users than to crack users in their places of residence. Epidemiologic and ethnographic sources report both inner-city and suburban residences for the various user populations in the various cities. The suburbs are mentioned specifically for some user groups (in addition to inner-city groups) in Birmingham, Detroit, Los Angeles, Miami, and St. Louis. In some cities, such as Boston, powder cocaine use extends from the city into the outlying areas. In other cities, such as Seattle and Washington, DC, many users reside in small affluent neighborhoods within the city, not necessarily in the downtown areas.

By contrast, 11 of the 14 treatment sources reporting on place of residence state that powder cocaine users are more likely to live in inner-city areas. The suburbs, however, are a more likely place of residence for powder cocaine clients in the Sioux Falls methadone program and the Detroit non-methadone program; and powder cocaine clients at the New York non-methadone program are more likely to live in rural areas.

Where and with whom is powder cocaine used? (Exhibit 11) Like heroin, powder cocaine is usually used indoors, both privately and in social contexts, including private residences, raves, parties, and nightclubs, as indicated in the table (Exhibit 11). Street use is reported only in Boston, El Paso (parks), and Washington, DC (alleys). Memphis is the only city where crack houses are mentioned as a site for powder cocaine use.

Nearly all treatment sources report that powder cocaine is generally used in groups. Only in Denver and Chicago is solo use reported. The home is the most commonly reported setting. Other reported settings include clubs (in Miami), work (in Denver), and parties (in Columbia and Washington, DC).

How and with what other drugs do powder cocaine users take their drug? Powder cocaine users, like crack users, often consume alcohol, according to epidemiologists and ethnographers in nearly every city. In many cities, they combine powder cocaine with heroin, often in a speedball, as reported in Chicago, New York (where speedballs are both injected and snorted), Philadelphia (where the combination is cooked and injected), Seattle, and Washington, DC. Marijuana is another substance commonly combined with powder cocaine, as reported in seven cities: Denver, Detroit, El Paso, Los Angeles, Miami, Philadelphia, and Washington, DC.

Some powder cocaine users also use ecstasy, as reported by epidemiologists and ethnographers in several cities: in Los Angeles, where the two drugs are part of the "rave salad of drugs”; in Miami, where the two drugs, along with"everything else” are part of the club scene; and in Philadelphia, where powder cocaine users also use propoxyphene (Darvon ®), oxycodone (Percodan ®), and phencyclidine (PCP).

Clients in treatment for powder cocaine use continue to primarily snort their drug. However, treatment sources note some exceptions: smoking is reported at the non-methadone programs in Billings and Birmingham and at the methadone program in Washington, DC; freebasing is reported at the Denver non-methadone program; and injecting is reported at the non-methadone programs in Birmingham and Honolulu and at the Memphis methadone program.

Treatment sources also report that powder cocaine clients at their programs use additional drugs: marijuana (in Billings, Birmingham, Miami, New York, and Sioux Falls); heroin (in Boston, Miami, and Columbia ["speedballs"]); LSD ("acid") (in Boston); and alcohol (in Birmingham, Memphis, Miami, Portland, and Washington, DC).

CRACK COCAINE: THE SELLERS
Who, How, Where, and With What?

How are crack cocaine sellers organized? According to law enforcement sources in Pulse Check cities, crack sellers are seldom affiliated with trafficking organizations, unlike street-level heroin sellers. However, similar to heroin sellers, crack sellers often are involved in gangs in many cities (Chicago, Columbia, Denver, Honolulu, Los Angeles, Memphis, Portland, and Washington, DC). Law enforcement sources also report that crack sellers are independent in some cities, including Boston, El Paso, Portland (where they are often crack addicts), Sioux Falls, and Washington, DC (where they may have three to four people working for them).

Epidemiologic and ethnographic sources in many cities agree with law enforcement sources that crack-selling organizations often involve gangs, as reported in Chicago, Denver, Detroit, El Paso, Miami, New Orleans, and anecdotally in St. Louis and Washington, DC (where gangs are loosely organized, smaller than most street gangs, and known as "crews"). Only in Honolulu did the Pulse Check epidemiologic source report crack sellers as affiliated with trafficking organizations (Mexican). In New York, crack sellers are reportedly independent, and in Philadelphia, crack sellers are organized, but not as street gangs.

How old are crack sellers? In almost all Pulse Check cities, law enforcement officials cite young adults (18–30 years) as street-level crack dealers. However, in almost half of the sites, adolescents (in Birmingham, Boston, Columbia, Denver, Los Angeles, New Orleans, Portland, St. Louis, and Washington, DC) and preadolescents (in Denver) are also involved in crack sales. Young adults are also the most common age group reported as crack sellers by epidemiologic and ethnographic sources, although sources also mention adolescents as sellers in Chicago, Detroit, El Paso, and New York. In Washington, DC, older adults, as well as younger adults, sell crack. As with heroin, the Honolulu source reports that youth are picked up in bars in Mexico and offered free trips to Hawaii to sell crack there.

Where is crack cocaine sold? (Exhibit 12) Law enforcement, epidemiologic, and ethnographic sources agree that most crack sales occur in inner-city areas. However, law enforcement sources report that in Birmingham, crack is also distributed in suburban areas; in Portland, it is also sold in rural and suburban areas; and in Philadelphia, it is sold throughout the city. Additionally, the epidemiologic source in New Orleans reports that crack is sold"everywhere."

Crack is sold mostly on street corners, indoors in private residences, and in crack houses, according to law enforcement sources. Epidemiologic and ethnographic sources add that in New York crack is sold in the street, and in Portland crack is often sold in hotels.

How is crack cocaine sold? Hand-to-hand crack street sales in cities such as Los Angeles, Memphis, and Washington, DC, are the most common way crack is sold. But, as found in the last issue of Pulse Check, telephone and beeper sales, as well as home delivery, continue to be used to purchase and deliver illegal drugs. For example, law enforcement sources cite phone and beeper contact sales as common in Chicago, Memphis, Portland, and Sioux Falls. In Sioux Falls, word-of-mouth contact is also common.

Epidemiologic and ethnographic sources add that telephone orders are also used to sell crack in Detroit; in Miami, crack is often sold around a two-to-three-block area, and the buyers and sellers identify one another with hand signals; in New York, sellers approach prospective buyers on the street; in Philadelphia, street sales involve lookouts, beepers, and hiding places for crack stashes; and in St. Louis, dealers often deliver crack to private residences.

What other drugs do crack dealers sell? (Exhibit 13) Crack dealers are often polydrug sellers, as was found in the last issue of Pulse Check. Drugs they sell include heroin, powder cocaine, marijuana, methamphetamine, MDMA, and diverted pharmaceuticals. In only five cities (Boston, Chicago, El Paso, Honolulu, Portland, and Seattle) do law enforcement sources report that crack dealers sell no other drugs. Conversely, epidemiologic and ethnographic sources in Chicago and Portland report that crack dealers sometimes sell heroin. Also in Detroit, New York, and St. Louis, epidemiologic and ethnographic sources add that crack dealers sometimes sell heroin.

How is crack packaged and marketed? Dealers often sell crack in small, plastic zipper bags; in plain, glassine bags; in the torn-off corners of plastic bags tied with one knot (known as the "Dominican tie" in some cities); in bindles; in film canisters; and as loose "rocks." Crack containers are rarely labeled, according to law enforcement sources. However, according to epidemiologic and ethnographic sources in Portland and Boston, small plastic bags containing crack are often stamped with logos, perhaps to appeal to younger users. Additionally, epidemiologic and ethnographic sources report that in Boston dealers sometimes sell crack in balloons, and in New York they sell it in a variety of differently shaped vials with variously colored tops and as "puffs" from a crack pipe. In Seattle, very small amounts of loose rocks, known as "kibbles and bits" are sold to people with little money, as are "seconds," the second inhalation of crack from a pipe.

POWDER COCAINE: THE SELLERS
Who, How, Where, and With What?

How are street-level powder cocaine sellers organized? According to law enforcement sources, the affiliations of powder cocaine distributors vary. The most mentioned affiliations (in seven cities each) are gangs and independent sellers. Gangs are reported in Honolulu, Los Angeles, and Seattle in the West; Chicago in the Midwest; and El Paso and Memphis in the South. Independent sellers are reported in Los Angeles in the West; Sioux Falls in the Midwest; El Paso, Memphis, and Washington, DC (where three to four people typically work for them) in the South; and Boston and Portland (where these sellers are mostly addicts) in the Northeast.

Compared with heroin, powder cocaine sellers are not cited as often as affiliated with trafficking organizations: only in Denver, where they are affiliated with Mexican and South American cartels, is sellers' involvement with trafficking organizations mentioned. In both New Orleans and Washington, DC, Hispanic organizations are said to be major sellers of powder cocaine. In Columbia, the nightclub crowd is now affiliated with powder cocaine sales.

Epidemiologic and ethnographic sources add that in El Paso, the night-club crowd is affiliated with powder cocaine sales; in Denver, Mexican nationals tied to Hispanic gangs primarily sell the drug; in Philadelphia, sellers are organized, but not as street gangs; and in Washington, DC, sellers are members of crews (small, loosely organized gangs).

How old are street-level powder cocaine sellers? Street-level powder cocaine sellers range widely in age, from 17 to 65 years, with young adults (18–30) mentioned by law enforcement sources in 10 cities (Boston, Columbia, El Paso, Los Angeles, Memphis, Miami, Portland, St. Louis, Sioux Falls, and Washington, DC), followed by older adults in six cities (Boston, Chicago, Los Angeles, Memphis, St. Louis, and Sioux Falls). Law enforcement sources, including those from Denver, New Orleans, and Philadelphia, state that the ages of street-level powder cocaine sellers range widely.

Similarly, all reporting epidemiologic and ethnographic sources (nine of nine) cite young adults as powder cocaine sellers, followed by older adults (three of nine sources). Only in El Paso, are adolescents mentioned as involved in sales. In Honolulu, as is the practice with heroin and crack cocaine sales, youth are reportedly picked up in bars in Mexico and offered free trips to Hawaii to sell powder cocaine there.

Where is powder cocaine sold? (Exhibit 14) In many Pulse Check cities, street-level powder cocaine sales, like heroin and crack sales, take place in inner-city areas; unlike heroin and crack sales, powder cocaine is also sold in suburban areas. Furthermore, many law enforcement sources, including those in Denver, El Paso, Los Angeles, Miami, and Philadelphia, state that powder cocaine sales occur citywide. The Memphis epidemiologic source reports that powder cocaine sales are more widespread throughout the city than crack sales.

Powder cocaine is sold throughout the United States indoors in residences, outdoors on the street, indoors in commercial buildings (including nightclubs, private bars, and restaurants), and in crack houses. According to the Memphis law enforcement source, its sale is more covert than crack or heroin sales. Additionally, epidemiologic and ethnographic sources report powder cocaine sales in cars, houses, and bars in El Paso, houses and hotels in Portland, homes in St. Louis, and homes and nightclubs in New York.

How is street-level powder cocaine sold? Most powder cocaine transactions, according to Pulse Check law enforcement sources, involve a phone or beeper; further, in many cities, sellers use a delivery service method, in which dealers have lists of contacts, and sellers drive to customers' houses to deliver the product. Only sources in Washington, DC, and Memphis mention hand-to-hand powder cocaine sales.

Reporting epidemiologic and ethnographic sources concur with law enforcement sources that powder cocaine sales typically involve beepers, telephone orders, deliveries, and meetings between sellers and buyers. In St. Louis, sales reportedly occur through acquaintance networks.

What other drugs do powder cocaine dealers sell? (Exhibit 15) According to law enforcement sources, other drugs sold by powder cocaine dealers include heroin, crack cocaine, marijuana, methamphetamine, and MDMA. Epidemiologic and ethnographic sources (in Detroit, El Paso, Philadelphia, and Portland) agree with law enforcement sources that heroin is often sold by powder cocaine dealers. The Denver epidemiologic source reports that some crack and heroin dealers sell powder cocaine.

How is street-level powder cocaine packaged? Powder cocaine is sold mostly in plastic sandwich bags in Pulse Check cities, although it is also sold wrapped in tin foil (in Chicago and Denver), paper diamond folds ("bindles") (in El Paso and Portland), in corners of plastic bags knotted around the drug (in El Paso), in manilla baggies (in Miami), and in small glass vials (in Sioux Falls). In Miami, the manilla baggies are stamped with pictures, such as unicorns, which serve as brand identifications. Cartoon characters stamped on powder cocaine packaging often serve as brands in Chicago. Law enforcement sources from most reporting Pulse Check cities (including Columbia, Honolulu, Memphis, Portland, and Sioux Falls) state that brand names are not used on powder cocaine packaging.

Additionally, epidemiologic and ethnographic sources report the use of balloons for packaging powder cocaine in El Paso and Boston. In Detroit, "seals" (paper wrappers that resemble magazine covers and do not absorb the powder) are often used to package powder cocaine; in Miami, pictures on plastic bags sometimes serve as brands; and in Washington, DC, “Pacman” was reportedly used as a brand name in 2000.

COCAINE: THE COMMUNITY

What is the impact and community reaction to the cocaine problem? According to epidemiologic and ethnographic sources, the high levels of cocaine use, despite its stabilization in many communities, continues to affect events and the quality of life in those communities in a variety of ways:

• Birmingham, AL: Studies of crack users who successfully participate in treatment show a substantial reduction in their risk for HIV. The epidemiologic source notes the connection between crack use and HIV risk, particularly surrounding unsafe and risky sexual activity, for both men and women—suggesting that the perception of injecting as the main source for an increase in HIV is not necessarily true.
• Denver, CO: Deaths involving cocaine and heroin have been increasing over the past several years. But the two types of mortality stem from different causes: the heroin-related deaths result from both the increase in new users and from purity changes; the cocaine-related deaths are more related to older users whose addiction has intensified and whose health has deteriorated.
• Detroit, MI: A decline in the homicide rate reflects a long-term decline in heroin and crack-related violence.
• Honolulu, HI: A large multidrug, multiperson bust in neighboring Maui early in 2000 involved large amounts of cocaine (as well as black tar heroin and methamphetamine), temporarily impacting cocaine availability.
• Memphis, TN: A dramatic increase in Department of Housing and Urban Development (HUD) housing initiatives, particularly for the homeless, is believed to have contributed to a slight decline in alcohol abuse and cocaine use.
• New Orleans, LA: A regional task force on cocaine and heroin use, consisting of regional and local police departments and sheriffs in many Louisiana parishes, as well as the Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA), is considering the inclusion of the New Orleans area due to its drug problem.
• Seattle, WA: With the area's economic boom, and the gentrification of the downtown area, more attention is being focused on"cleaning up the street," particularly with regard to the street trade of crack. Local businesses' efforts to develop the downtown area into a destination point have led the press to change their profile of the crack situation, with a greater attention to quality of life. The resulting community response has been a coordinated one, not just involving law enforcement, and has included the rise of drug courts over the past 3 years. The media has been increasingly focusing on the record number of crack arrests, even mapping out the course of those arrests.

Law enforcement sources also note a variety of interrelationships between cocaine use, community life, community events, and community responses:

• El Paso, TX: Gang activity and prostitution associated with cocaine has remained stable.
• Los Angeles, CA: Violent criminal acts (turf issues) and nonviolent criminal acts (robberies and burglaries) have increased. The level of prostitution activities related to cocaine, however, has remained stable.
• Miami, FL: A seizure in the first 2 months of 2000 involved 3,436 pounds of cocaine. In addition, nonviolent criminal acts associated with cocaine have increased.
• Philadelphia, PA: Large cocaine seizures are reported. For example, a recent seizure of 75 pounds of cocaine has impacted somewhat on the cocaine supply.

What cocaine treatment issues do communities face? Treatment sources point out several inter-relationships between the cocaine problem, the treatment system, and community issues such as law enforcement referrals, funding, outreach, and prevention programs:

• Birmingham, AL: Cocaine-related problems have caused longer waiting lists and increased the need for case management. The increase in waiting lists has caused treatment providers to refer clients out to other programs.
• Miami, FL: The number of cocaine users needing treatment has increased, but the number of available treatment slots is limited. Program outreach is responsible for an increase in prevention and awareness.
• New Orleans, LA: Law enforcement referrals to cocaine treatment are increasing, particularly through drug courts. The increase has caused programs to function at high capacity. Insufficient funding for cocaine treatment has left gaps in treatment follow-through. Women and children are sent to special treatment facilities.
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• ioux Falls, SD: Outreach and prevention has helped reduce numbers in treatment.