Heroin

HEROIN: THE PERCEPTION

How serious a problem is heroin in Pulse Check communities? During 2000, heroin was perceived as the most serious drug problem by 19 sources in 8 Pulse Check cities (26 percent of 70 responding sources): Los Angeles and Seattle in the West; Detroit in the Midwest; Columbia (South Carolina) and New Orleans in the South; and Boston, Philadelphia, and Portland (Maine) in the Northeast. It ranked second only to cocaine (all forms). Furthermore, heroin was considered the second most serious drug problem by 20 percent of Pulse Check sources (N=66). Finally, it was seen as an emerging problem drug by 4 sources in 4 cities, 3 of which are in the South (8 percent of 52 reporting sources): Billings, Birmingham, Columbia, and Miami.

Has the perception of the heroin problem changed between 1999 and 2000?

In comparing the two reporting periods, sources citing heroin as the most serious drug problem in their communities increased from 22 to 26 percent. Furthermore, during the current reporting period, four sources reported that heroin replaced cocaine (all forms) as the most serious drug problem in their communities: the epidemiologic source from Detroit, both the epidemiologic and the law enforcement sources from New Orleans, and the law enforcement source from Portland. Conversely, epidemiologic and ethnographic sources in Birmingham and El Paso reported that cocaine (either form) replaced heroin as the most serious drug problem. Heroin was reported as an emerging drug problem during the current reporting period by sources in Billings, Birmingham, Columbia (all non-methadone treatment providers), and Miami (law enforcement source).

HEROIN: THE DRUG
Availability, Purity, and Price

How available is heroin across the country? Of the 31 law enforcement, epidemiologic, and ethnographic sources discussing this question, 61 percent (n=19) report heroin as widely available in their communities, and 32 percent (n=10) report it as somewhat available. Only in Sioux Falls is heroin reported as not very available (by the epidemiologic source) or not available at all (by the law enforcement source).

Has heroin availability changed? (Exhibit 1) Nearly half (45 percent) of the 29 responding epidemiologic, ethnographic, and law enforcement sources perceive that heroin availability increased in their communities from 1999 to 2000, while 55 percent (17 sources) perceive that availability remained stable. No declines are reported. According to epidemiologic and ethnographic sources, heroin availability increased in seven sites, four of which are southern (Billings, Birmingham, El Paso, Miami, New Orleans, Portland, and Seattle); law enforcement sources report increases in six sites (Birmingham, Chicago, Honolulu, New Orleans, Portland, and Washington, DC).

What kind of heroin is available across the country? (Exhibits 2 and 3) South American (Colombian) white and Mexican black tar heroin are the most common types of heroin in Pulse Check cities, cited as widely available by eight and seven sources, respectively, and as somewhat available by five and eight sources, respectively.

Colombian heroin is a high&3150;purity, snortable heroin most common in the Northeast; Mexican black tar heroin is a lower purity, injectable heroin most common in the West and South. Heroin forms in the Midwest vary widely and may include Colombian, Mexican, Southeast Asian, and Southwest Asian.

How pure is heroin across the country? (Exhibit 4) Street–level Colombian heroin ranges from 25 to 80 percent pure, and typically is at the higher end of that range. Street-level Mexican black tar heroin ranges from 14 to 60 percent pure, according to Pulse Check sources, with the highest purity occurring near the U.S.–Mexican border in El Paso.

What are street–level heroin prices across the country? (Exhibit 4) Street–level heroin prices tend to be similar across the country regardless of heroin type. During 2000, heroin prices ranged from $70 to $300 per gram in reporting areas, with Mexican black tar ranging from $90 to $300, Mexican brown ranging from $75 to $150, and Colombian white ranging from $75 to $300. The most common unit of street sale in reporting cities is a bag (unspecified amount) of heroin, which sells from $5 to $30. Packaging of heroin sold at the street level ranges from $20–$25 per bindle (about 1/34 gram) in Columbia, to $2 per 2-cc needle in Miami, and $20 per "fix" in El Paso.

How is heroin referred to across the country? (Exhibit 3) Street names throughout the United States often vary by geographic region and by type of heroin. However, some terms, such as "horse" and "H," are common across regions. Street names (slang) and brand names (dealer designations) are often interchangeable, as is the case in New York and Washington, DC. (Note: Brand names are further discussed later in this chapter, under "How is heroin packaged and marketed?") New heroin names encountered during 2000 included "cheese" in Denver (referred to by youth) and "thanie" in Washington, DC. A particularly wide range of street names is reported by sources in Washington, DC, which is located on the outer edge of the South Region.

What adulterants are added to heroin? Heroin adulterants cited by law enforcement, epidemiologic, and ethnographic sources include baby powder, scapolamine, lactose, manite, strychnine, baking soda, manitol, isotol, quinine, procaine, powdered rug cleaner, cocaine, lidocaine, and ketamine. In Washington, DC, laxatives are often added to heroin that has been adulterated with manite to assuage its constipating effects, and meat tenderizers used as adulterants may cause skin abscesses. In Pulse Check sites with highly pure snortable heroin, adulterants are few or nonexistent.

HEROIN: THE USERS
Who, Where, How, and With What?

How have heroin users changed across the country between 1999 and 2000? Epidemiologic, ethnographic, and treatment sources in 13 of Pulse Check's 20 cities perceive numerous changes in various heroin–using populations and the ways they use the drug. No user changes, however, are reported in Billings, Birmingham, Columbia, Memphis, Philadelphia, Seattle, or Sioux Falls. Several common themes emerge, all involving increases: in younger populations, in recreational heroin use, in snorting, in suburban use, and in overdoses among younger adults (age 18–30).

How old are heroin users?
(Exhibit 5) According to epidemiologic and ethnographic sources in the majority of Pulse Check sites, particularly in the Northeast and Midwest, the people most likely to use heroin are generally older than 30, with younger adults (generally in their twenties) comprising a smaller proportion of users in those sites. However, younger adults (age 18–30) are more likely than older adults to use heroin in Billings, Birmingham, El Paso, Los Angeles, and New Orleans. Teenage use is reported in several cities, including Los Angeles, Miami, New Orleans, Portland (where the numbers are still low), Seattle, Sioux Falls, St. Louis, and Washington, DC; increases in use by teens is reported in Los Angeles, New Orleans, New York, and Portland.

According to responding treatment providers, age breakdowns follow a somewhat regional pattern in their specific programs. For example, young adults (age 18–30) account for the largest group of heroin clients in most Northeast Region programs (New York, Philadelphia, and Portland). Boston is an exception, however, with adolescents featuring most prominently in the methadone program, and older adults (age 30 and older) most prominent in the non-methadone program. Similarly, in the South Region, young adults outnumber older clients in numerous programs (in Birmingham, Columbia, Memphis, and Washington, DC), and adolescents are the largest heroin group at the New Orleans non-methadone program. In the Midwest and West Regions, however, the younger and older adult age groups are split fairly evenly among the cities and between responding methadone and non-methadone programs.

Are there gender differences in who uses heroin? All but 1 of the 20 epidemiologic and ethnographic sources agree that males are more likely than females to use heroin, at least among the largest user groups. The exception is Seattle, where males and females are equally likely to use the drug. The sexes, however, are evenly split in some of the smaller user groups, such as late adolescents in Portland (whose numbers are still low) and a suburban cohort of white middle–class users in Seattle's suburbs.

Four Pulse Check treatment sources report females to be the largest heroin-using group: Columbia, Honolulu, Memphis, and New York. (Note: The New York source is from a treatment program targeted at women.) In Miami, males and females are equally likely to use. According to treatment sources in El Paso and New York, an increase in female heroin use has led to an increase in prostitution.

Is any racial/ethnic or socioeconomic group more likely to use heroin? Heroin appears to present an equal opportunity problem to all racial/ethnic groups. The Pulse Check cities are representative of the Nation's diversity, and the heroin problem appears to mirror that diversity. For example, according to epidemiologic and ethnographic sources, whites are the primary users in Billings, Boston, Denver (where they are in majority, but underrepresented relative to the city's population), Miami, Philadelphia, Portland, Seattle (where they are slightly underrepresented), and Sioux Falls; blacks are more likely than other groups to use heroin in Chicago, Detroit (where they are overrepresented relative to the city's population), New Orleans, St. Louis, and Washington, DC; and Hispanics are the primary user group El Paso, Los Angeles, and New York.

Pulse Check treatment sources similarly report diverse racial/ethnic distributions at their programs: whites are the primary users in Billings, Los Angeles, Memphis, New York, Sioux Falls, and Portland; blacks are most likely to use in Chicago and Detroit; and Hispanics are more likely than other groups to use heroin in El Paso.

Unlike race/ethnicity, socioeconomic status (SES) seems to play a major role in the groups of people most likely to use heroin: in every Pulse Check city, the largest group of users reported by epidemiologic, ethnographic, and treatment sources is in the lower SES category. However, the second-most-likely user groups show more diverse SES: for example, the middle class is cited by epidemiologic and ethnographic sources in Boston, Chicago, Los Angeles, Miami, Seattle, and St. Louis; and the upper class is cited in Miami.

Some treatment sources note that heroin use by middle–class whites is growing as the glamorization of heroin becomes more accepted. In Miami, for example, heroin is emerging as a popular drug among the "beach chic"—white, middle-to-upper-class, urban young adults. In Seattle and Los Angeles, the glamorization and use of heroin is crossing all classes and ethnic groups.

Are high school dropouts more likely to use heroin? According to responding treatment sources, among clients at the different programs for whom heroin is the primary drug of use, about one–half completed and one-half did not complete high school. For example, heroin clients at reporting programs are more likely to be high school graduates in Birmingham, Denver, Detroit, El Paso (non-methadone), Honolulu, Miami, Portland, and Sioux Falls. Conversely, they are more likely to have only "some high school" education at the programs in Boston, Chicago, Columbia, El Paso (methadone), Los Angeles, New York, New Orleans, Philadelphia, and Seattle.

Where do heroin users tend to reside? Inner–city areas are generally cited by epidemiologists and ethnographers as the most likely place of residence for heroin users. El Paso's largest heroin-using group is the homeless. The suburbs, however, are reported as a place of residence for some users in many sites, including Boston, Chicago, Denver, Detroit, Los Angeles, Miami, New York, Seattle, and St. Louis. Moreover, epidemiologists and ethnographers report that use in the suburbs has increased recently in at least four sites: Boston and New York in the Northeast, and Chicago and Detroit in the Midwest.

Treatment sources similarly indicate that most heroin users reside in urban areas. However, they too note heroin users in many suburban areas, including Billings, Boston, Denver, Honolulu, and New York, with an increase in suburban users in El Paso. As a matter of fact, most of the clients in one of the Detroit programs live in the suburbs and come into the city for treatment.

How do heroin users administer heroin? (Exhibit 6) Injecting is the most common route of heroin administration, according to epidemiologic and ethnographic sources in the majority of cities. Snorting, however, features more prominently than injecting in Chicago, Detroit, New Orleans, and New York; and the number of snorters is also fairly high in several cities, including Boston, Miami, St. Louis, and Washington, DC. An unusual form of snorting is reported among St. Louis' younger user group (late teens and early twenties): they often mix the heroin with water in an eyedrop squeeze bottle and snort it from the bottle. In Sioux Falls, smoking is reported as the most common route of administration among the younger (age 17–25) using population. "Chasing the dragon "–placing heroin on aluminum foil, lighting a fire underneath it, and sniffing the resulting smoke through a straw or other means–is reported by epidemiologists in New York and Honolulu.

Treatment sources report a similar pattern for route of administration across the country, with injection predominating in Boston, Chicago, Detroit, El Paso, and New York. Snorting is more common in Columbia, Miami, Memphis, and New Orleans. In Sioux Falls, young adults are the most likely to use heroin via snorting. In Billings, Denver, and Seattle, smoking is the route of initiation to heroin for younger adults. Adolescent snorters are reported in New Orleans and Miami. In a Washington, DC, treatment program, snorting among all clients is increasing. Columbia treatment sources report that snorters prefer this practice to injection because they mistakenly view it as nonaddictive.

Treatment sources in Boston, Chicago, and New York attribute increases in heroin overdoses to the myth among users that snorting prevents overdoses. Even more disturbing than these misconceptions about snorting, however, is the possible shift in young people's perceptions about injecting. The New York ethnographer reports an increase in suburban adolescents shifting from snorting to injecting, with a growing number traveling to inner–city needle exchange programs. A similar phenomenon is noted in Portland, Maine, a much smaller, more sparsely populated, more rural site: the epidemiologist there, too, reports adolescents in needle exchange programs.

What other drugs do heroin users take? Cocaine is the drug most often taken along with heroin, either in combination ("speed-balling") or sequentially, according to epidemiologists and ethnographers in the majority of Pulse Check cities (Boston, Chicago, Detroit, El Paso, Los Angeles, Miami, New Orleans, New York, Philadelphia, Seattle, and Washington, DC). Speedballs can involve either powder cocaine (often cooked) or crack (sometimes dissolved, as in Boston); they are generally injected, but they can also be smoked. In New York, for example, speedballs are both injected and smoked.

Heroin users also sometimes consume benzodiazepines, according to epidemiologists and ethnographers in six Pulse Check cities: Boston, Miami, New York, Philadelphia, Portland, and Seattle. In Boston, they are taken sequentially, substitutionally, or sometimes simultaneously with heroin. Concurrent benzodiazepine usage is also reported in Portland, but most heroin in that city is consumed without other drugs. Specifically, alprazolam (Xanax ®) is mentioned in New York and Philadelphia and clonazepam is mentioned in Seattle. Additionally, the New York ethnographer reports that heroin users also consume other prescription drugs such as amitriptyline (Elavil ®) and clonodine (Catapres ®), often purchased around methadone clinics, to enhance their heroin high or to calm them down.

Miami's younger heroin–using cohort consumes a variety of substances, including methylenedioxymethamphetamine ("ecstasy" or MDMA) and ketamine ("special K") as well as powder cocaine and benzodiazepines. The younger cohort in Washington, DC, consumes marijuana and malt liquor. Alcohol is also mentioned by epidemiologic and ethnographic sources in Denver (a distant second in use among the younger cohort), Detroit, Philadelphia, and St. Louis.

The majority of Pulse Check treatment sources across the country report that primary heroin clients also use alcohol. In Los Angeles, they also use cocaine. In El Paso, "speedballing" is defined as methamphetamine plus heroin, and in Honolulu heroin is used in combination with "ice." In a Birmingham program, the concurrent use of opiates and benzodiazepines surpasses the use of heroin as the primary drug problem. Methadone clinics in Memphis, Portland, and St. Louis identify an increase in the past year of opiate and related pharmaceuticals use. Younger users in Boston are combining heroin with PCP. In most sites where heroin use among young adults is reported, these younger users reportedly experiment with dangerous drug combinations that frequently produce psychotic states.

Where and with whom is heroin used? (Exhibit 7) Heroin use tends to be an indoor activity. Some street use, however is noted by epidemiologic and ethnographic sources in Boston, Detroit, El Paso, Honolulu, and New York. Even the street settings, however, tend to be in private areas, such as quiet back alleys. The indoor settings are more varied, ranging from apartments, cars, and abandoned houses to the bars of El Paso, the clubs of Miami, the coffee shop bathrooms of Seattle, and the "shooting galleries" of Boston, Miami (where they are known as "get-off houses"), New York, and Philadelphia. According to the Philadelphia epidemiologic source, a shooting gallery in that city, as opposed to a "hit house," is a place where "the hitter does the injecting for you." Use tends to be alone, but small group settings (particularly among younger users) are reported by epidemiologists and ethnographers in Birmingham, Denver, Honolulu, Los Angeles, and St. Louis. Treatment providers report that heroin use is becoming more recreational and social. The increase in heroin availability in most of the Pulse Check sites, and the misconceptions among users that snorting is less dangerous and does not cause overdose, are the bases of the emerging social dynamic. Treatment providers in Columbia, Boston, Honolulu, Sioux Falls, and Seattle report the casual use of heroin among young adults. In most sites, the use of heroin occurs at home and is seen as an indoor activity.

Although heroin use is occurring in isolated areas in Chicago, it is seen in clubs in Miami and at work in Denver.

How is heroin impacting the health of users? (Exhibit 8) In general, responding treatment providers indicate that heroin use is having an increased medical impact on the health of their clients, particularly with respect to acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV), hepatitis C, and comorbidity (dual diagnosis of substance abuse and mental health disorders). Stable or declining trends are reported by treatment sources in only four Pulse Check cities: Billings, Columbia, and Los Angeles (for HIV/AIDS); and Washington, DC (for hepatitis C).

What are the barriers to treatment? Several treatment sources indicate that heroin users face a variety of barriers&3150;ranging from staff issues to limited slot capacity to transportation problems–in obtaining effective treatment:

• Billings, MT: Trained and certified staff are in short supply.
• Birmingham, AL: The number of available treatment beds is insufficient to meet the need.
• Columbia, SC: The local area lacks a good mass transit system, thus impacting client access to treatment.
• Chicago, IL: Programs lack the monetary support to hire and retain quality staff, especially trained psychiatric staff.
• Los Angeles, CA: Funding for treatment slots has been reduced. Transportation issues present challenges for providers who are trying to keep clients in treatment.
• New Orleans, LA: The program lacks funding to provide transportation for clients. In addition, a medical detoxification facility would assist in improving services for clients.
• Sioux Falls, SD: The area is economically depressed, and few funding options are available. Clients have a difficult time locating treatment and finding the transportation to get them to treatment.
• Washington, DC: Clients cannot afford medications, and some cannot afford the sliding scale.

HEROIN: THE SELLERS
Who, How, Where, and with What?

How are street–level heroin sellers organized? According to law enforcement sources, heroin distributors are affiliated with trafficking organizations in only 4 of 17 reporting Pulse Check cities: Dominican nationals work for Colombian trafficking organizations in Boston, street sellers are affiliated with Mexican and South American cartels in Denver, and sellers are affiliated with Mexican trafficking organizations in El Paso and Honolulu. Other organized distributors in U.S. cities include street gangs in Chicago, El Paso, Memphis, and Seattle; loose&3150;knit gangs in Columbia; Dominican national organizations in Portland; and Hispanic organizations in Washington, DC. Also in Washington, DC, street–level heroin is distributed by fairly independent individuals with three to four people working for them. In Los Angeles, heroin is distributed primarily among family and friends; in Portland, heroin addicts sell some of the street–level heroin.

Information from epidemiologic and ethnographic sources in Pulse Check cities corroborates the affiliation of street-level heroin distributors with traffickers in Boston, Denver, and Honolulu. Additionally, epidemiologic and ethnographic sources report that street gangs distribute heroin in Miami, New York (where gangs are known as"crews"), and St. Louis. In St. Louis and Philadelphia, organized crime groups unconnected with street gangs reportedly sell heroin; in Washington, DC, young crews, which are smaller and more loosely organized than typical street gangs, plus their"runners" are involved in heroin sales. Many street–level heroin sellers are independent in Detroit and New York.

How old are street–level heroin sellers? The ages of heroin sellers vary by type of distribution, according to law enforcement sources. For example, young adults (18–30) tend to be involved in street gangs, where–as both young adults and older adults (<30) are involved with trafficking affiliated organizations. Only in Miami are adolescents, as well as young adults, cited by law enforcement officials as heroin distributors, although the El Paso ethnographer states that many heroin sellers are as young as 14. Although the law enforcement source in Honolulu states that older adults typically sell heroin, the epidemiologic source there adds that many youth, who are "picked up" in bars in Mexico and offered free trips to Hawaii, sell heroin in Honolulu.

Where is street–level heroin sold? (Exhibit 9) Law enforcement sources agree that most heroin sales take place in inner–city areas. However, in Portland, it is also sold in rural and suburban areas; in Philadelphia, it is sold throughout the city; and in Miami, it is sold in night–clubs throughout the city.

Additionally, epidemiologic and ethnographic sources in Denver and St. Louis note that although heroin is mostly sold in inner–city areas, it is also beginning to be sold in more suburban areas of the cities. Pulse Check sources report that heroin is sold on street corners, indoors in private residences, in crack houses, in cars, in shooting galleries, and in indoor, commercial settings. Additional settings for heroin sales, according to epidemiologic and ethnographic sources, include shopping centers in Boston, bars in El Paso, and hotels in Portland.

How is street–level heroin sold? Hand-to-hand sales in cities such as Los Angeles, Memphis, and Washington, DC, are the most common way to sell user–level heroin; however, many law enforcement sources cite prearranged, delivery–service sales as common. For example, a Boston law enforcement source compares the heroin delivery system— a new and more discreet way of selling—to a pizza delivery service: buyers contact sellers, and sellers deliver heroin to buyers' residences. In Chicago, buyers contact sellers, and sellers drive up to buyer's residences and honk. Beeper and cell phone use continues in several other cities, including Chicago, Memphis, and Portland, where buyers contact sellers, and both meet on the street or in an apartment for the exchange.

Corroborating law enforcement information, epidemiologic and ethnographic sources report the use of cell phones and beepers in buyer–level heroin sales. They are used for home deliveries in Boston, Chicago, Denver, Honolulu, and Seattle and are also used in Detroit, Philadelphia, and St. Louis. In New York, where street sales are prevalent, sellers use signals, such as a safety pin pinned to a seller's clothing, to show buyers that they are selling heroin. In Philadelphia, street sales involve the use of lookouts, beepers for setting up meetings, and hiding places for camouflaging heroin "stashes."

What other drugs do heroin dealers sell? (Exhibit 10) Drugs commonly sold by heroin dealers include crack and powder cocaine, especially powder cocaine for use in combination with heroin ("speed-ball"). In Denver, methamphetamine and marijuana are also sold by heroin dealers; in Miami, heroin is sold by MDMA dealers in the nightclub scene, and marijuana is often sold by heroin dealers; in Honolulu, methamphetamine ("ice") is often sold with heroin; and in Seattle and Washington, DC, diverted pharmaceuticals, such as methadone and clonazepam (Klonopin), are sold by heroin dealers. Only in Boston and Columbia are other drugs reportedly not sold by heroin dealers.

Exhibit 10. What other drugs do heroin dealers sell?*

How is heroin packaged and marketed? (Exhibit 11) In Pulse Check cities, heroin is sold mostly in small, plastic zipper bags; wrapped in tin foil; in corners of plastic bags that are cut off and knotted around the heroin; and in glassine bags. In El Paso and Los Angeles, it is sold in balloons, and in Detroit, it may be sold in lottery tickets or paper gum wrappers.

In many cities, plastic bags containing heroin or other heroin packaging may sport colored stamps, designs, logos, or brand names. For example in Chicago, faces are stamped on some bags; in Boston, aliens, stars, and devils appear on some bags; in Philadelphia, new logos of orange basketballs and bees appeared in 2000; and in Washington, DC, the plastic bags containing heroin often are colored (and are referred to as "black bag," "blue bag," and "yellow bag").

Heroin logos and brand names vary by locality, with Philadelphia's and some of Columbia's current brands connoting death and some of New York's and Columbia's brands alluding to movie titles, high–class product names, and other pop culture products. New York dealers alter brand names and markings frequently —sometimes weekly or even daily–in the belief that they are staying one step ahead of the law.

In many cities, including Chicago, Denver, Los Angeles, Honolulu, Memphis, Miami, and Seattle, heroin bags are not labeled, perhaps so that sellers can avoid connection to a product and possible conviction.

HEROIN: THE COMMUNITY

What is the impact of and community reaction to the heroin problem? The growing heroin problem in some Pulse Check communities has triggered events which, in turn, have kicked off a wide range of community responses, such as task forces, law enforcement initiatives, legislation, and media attention. These responses, in turn, have affected heroin users, heroin dealers, and the ways in which heroin data can be interpreted. During the current reporting period, this cyclical relationship is evident in the following examples:

• Boston, MA: According to the Pulse Check epidemiologic source, the increase in heroin overdoses and deaths over the last 3 years has recently translated into more awareness and concern, including interagency coordination, a data gathering initiative, and a law enforcement initiative targeted at heroin.
• New York, NY: The ethnographic source states that police initiatives have affected the heroin situation in two ways: heroin dealers are increasingly transacting sales indoors; and the dealers are constantly changing brand names, which they perceive can be traced back to them.
• Philadelphia, PA: The methadone treatment source reports that drug courts, and law enforcement efforts in general, are responsible for an increase in the number of clients in treatment for heroin problems.
• Portland, ME: According to treatment sources, law enforcement accounts for the decrease in heroin–related crime.
• Portland, ME: Several recent overdoses involving OxyContin ®, a long-acting form of the opiate oxycodone, prescribed for severe pain, has ignited much attention from the local media and district attorney's office. This drug has been problematic among heroin injectors, especially in the rural areas, for some time; however, it is only recently that a new phenomenon has arisen–prescription altering. Several meetings have been held with physician groups about prescription protection.
• Seattle, WA: The Pulse Check epidemiologic source reports on several recent developments:
• The county posted on their web–site a Seattle drug trends report, developed for the National Institute on Drug Abuse (NIDA) Community Epidemiology Work Group (CEWG); the posting subsequently sparked several community responses, such as an international heroin conference and a lot of media attention.
• An FBI allegation connecting heroin addicts to a recent increase in bank robberies led to a meeting with the local drug court and Division of Substance Abuse to look at exercising mandatory sentences.
• A mayoral and county executive heroin task force is examining issues such as prevention, treatment, media, harm reduction messages, and emergency medical response.
• The local health department has established a task force on how to interact with emergency medical personnel to prevent heroin overdoses.
• The increased focus of policymakers and legislators on the heroin problem during the last year and a half has led to increased treatment capacity and to discussion on innovative ways to expand treatment access, such as a physician-based methadone program in a hospital.
• A recent article in a local newspaper sparked interest in the record number of drug arrests and heroin deaths.

Several methadone treatment sources report an increase in media attention on heroin addiction:

• Columbia, SC: Articles have portrayed methadone treatment in a positive light.
• Memphis, TN: The media have helped clients become aware of links between heroin use and HIV.
• Seattle, WA: The media is responsible for "fast–tracking" clients in jail to treatment.
• Portland, ME: The media has placed attention on non–heroin opiates.
• Sioux Falls, SD: The public and community seem better informed due to media attention on heroin.