PULSE CHECK HIGHLIGHTS ⁺

This report is based on discussions with 78 epidemiologists, ethnographers, law enforcement officials, and methadone and non-methadone treatment providers from 20 Pulse Check sites. Telephone discussions with these individuals, conducted between late June and early August 2002, reveal that overall, when comparing spring 2002 with the previous fall period, the majority of Pulse Check sources believe their communities’ drug abuse problem to be very serious but stable, although a substantial percentage believe the situation to be somewhat worse. (Exhibits 1 and 2)

The illicit drug situation is characterized by several key features: Heroin continues to surpass crack as the drug associated with the most serious consequences, as perceived by 31 sources in 15 cities, particularly in the Northeast and Midwest. (Exhibits 3 and 4) Crack remains a serious problem, according to 21 sources in 14 cities, particularly in the South. One source in Memphis suggests that crack has overtaken marijuana as the most commonly abused drug. (Exhibits 3, 4, and 5) Marijuana remains the most widely abused illicit drug, as reported by 34 sources in 17 cities. (Exhibits 3 and 4) Methamphetamine is reported as an emerging or intensifying problem in 10 cities. (Exhibit 6) Furthermore, sources in eight cities, particularly in the West, consider it the drug contributing to the most serious consequences. (Exhibits 3 and 4) Some signs indicate that diversion of OxyContin® (oxycodone hydrochloride controlled-released) might have peaked during the last reporting period. However, it continues to be reported as an emerging problem by sources in 14 Pulse Check cities. (Exhibit 6) Ecstasy (methylenedioxymethamphetamine or MDMA) continues to emerge or intensify as a problem in all but five Pulse Check cities: in Detroit, Miami, New Orleans, New York, and Portland (ME), it has now either leveled off or has become an established drug of abuse. (Exhibit 6)

HIGHLIGHTS FROM THE SPECIAL TOPIC SECTION: A LOOK AT LOCAL DRUG MARKETS

Exhibit 1. How serious is the perceived drug problem in the 20 Pulse Check communities (spring 2002)?

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

• Marijuana is the illicit drug most easily purchased by both users and undercover police, followed by crack.
• Users find it a bit more difficult than undercover police to purchase powder cocaine.
• Heroin is also relatively easy to purchase on the street. Undercover police generally find it slightly more difficult to purchase than crack or powder cocaine. Users, on average, purchase heroin with more difficulty than crack but with less difficulty than powder cocaine.
• Of the five drugs discussed, methamphetamine is the most difficult to purchase overall. It is easiest to purchase the drug in Honolulu, Los Angeles, Memphis, and Sioux Falls.
• Only a few sources report that users or undercover police had a hard time buying drugs at any specific times during this reporting period.
• Drug markets in several Pulse Check cities appear more active when users receive paychecks or Government checks, on or before weekends and holidays, when police presence is low, and when supply is up.
• Beepers and cell phones are the most common means of communication between dealers and their buyers, suppliers, and fellow dealers.
• Motor vehicles, usually personal cars, are the most frequently mentioned means of moving drugs.
• Dealers generally accept mostly cash in payment for drugs. They do, however, occasionally accept other modes of payment, such as sex, property or merchandise, other drugs, drug transport, and other items or services.

  Exhibit 2. How has the perceived drug problem changed (fall 2001 vs spring 2002)?

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

• Dealers dispose of cash from drug sales in many ways, including money laundering in various forms, “re-upping” supplies, spending on entertainment, and passing money up the supply ladder.
• An intense and visible police presence is, by far, the most effective, albeit short-term, deterrent to street drug buys.

HIGHLIGHTS OF TREATMENT ISSUES

Epidemiologic/ ethnographic and treatment sources discuss various treatment issues, such as methadone maintenance capacity, treatment referral sources, adverse health consequences, barriers to treatment, and diagnoses of psychiatric comorbidity:

• Since the last Pulse Check, public methadone maintenance capacity has decreased somewhat in Chicago. Private capacity, however, has increased in Memphis, Miami, New Orleans, and Portland (ME), although waiting lists are reported by six sources.
• Drug users, particularly those who use marijuana or crack, are predominantly referred to treatment through courts or the criminal justice system. Referral sources have remained generally stable since the last reporting period.
• The impact of drug use on AIDS and HIV seems to have stabilized in the majority of treatment programs. Reported hepatitis C cases, however, continue to increase, usually because of increased screening and awareness.
• The most reported barriers to drug treatment (in descending order) are limited slot capacity, lack of trained staff to treat comorbid mental health disorders, and violent behavior among presenting clients.
• Mood and conduct disorders are the most commonly reported mental health diagnoses among drug treatment clients, according to treatment respondents.

Exhibit 3. What are the most serious drug problems in the 20 Pulse Check cities, by type of source?

Northeast	Drug	Most commonly abused?*			Most serious consequences?
		L	E	N	L	E	N	M
	Boston, MA	MJ	MJ	H	HCl	Crack	H	H
	New York, NY	MJ	MJ	Crack	H	Crack	Crack	Crack
	Philadelphia, PA	MJ	MJ	H	H	H	Crack	H
	Portland, ME	H	MJ	H	H	H	H	H
South	Baltimore, MD	MJ	H	H	Crack	H	H	Benzos
	Columbia, SC	Crack	MJ	MJ	Crack	Crack	MJ	H
	El Paso, TX	MJ	MJ	Cocaine	H	Crack	H	Cocaine
	Memphis, TN	Meth	Crack	Crack	Meth	Crack	Crack	Benzos
	Miami, FL	Crack	MJ	Crack	Oxy	HCl + Crack	Crack	Benzos
	New Orleans, LA	Crack	H	Crack	H	Crack	Crack	NR
	Washington, DC	MJ	MJ	Crack	Crack	H	H	H
Midwest	Chicago, IL	Crack	MJ	MJ	Crack	H	H	H
	Detroit, MI	MJ	MJ	Crack	H	H	Crack	H
	Sioux Falls, SD	MJ	MJ	MJ	Meth	Meth	MJ	NR
	St. Louis, MO	MJ	MJ	MJ	Crack	Crack	Meth	H
West	Billings, MT	Meth	MJ	MJ	Meth	Meth	Meth	Meth
	Denver, CO	MJ	MJ	Meth	Meth	HCl	Meth	H
	Honolulu, HI	Meth	Meth	Meth	Meth	Meth	Meth	Benzos
	Los Angeles, CA	Crack	MJ	MJ	Crack	H	Meth	H
	Seattle, WA	MJ	MJ	MJ	Meth	H	MJ	H
*Methadone treatment sources are excluded from this count. Sources: Law enforcement, epidemiologic/ethnographic, non-methodone treatment, and methadone treatment respondents NR = Not reported

Exhibit 4. What are the most serious drug problems in the 20 Pulse Check cities, by number of sources and sites?

Drug	Most commonly abused?*		Most serious consequences?
	No. of sources	No. of sites	No. of sources	No. of sites
Heroin	7	5	31	15
Crack	12	9	21	14
Powder cocaine	1	1	3	3
Marijuana	34	17	3	3
Methamphetamine	6	4	15	8
Diverted OxyContin®	0	0	1	1
Benzodiazepines	0	0	4	4
*Methadone treatment sources are excluded from this count. Sources: Law enforcement, epidemiologic/ethnographic, non-methodone treatment, and methadone treatment respondents

HIGHLIGHTS BY SPECIFIC ILLICIT DRUG

The 78 discussions also yielded key findings about heroin, crack, powder cocaine, marijuana, methamphetamine, synthetic opioids, ecstasy, and GHB (gamma hydroxybutyrate).

Exhibit 5. How has the perceived drug problem changed (fall 2001 vs spring 2002)?

Where has “the most commonly abused drug” changed?			Where has the drug with “the most serious consequences” changed?
City/Source	Fall 2001	Spring 2002	City/Source	Fall 2001	Spring 2002
Memphis, TNE	Marijuana	Crack	Denver, COL	Powder cocaine	Methamphetamine
El Paso, TXM	Cocaine	Heroin	Honolulu, HIM	Heroin	Benzodiazepines
Honolulu, HIL	Marijuana	Methamphetamine	Memphis, TNL	Marijuana	Methamphetamine
New Orleans, LAE	Crack	Heroin	Miami, FLE	Heroin	Cocaine + narcotics
Portland, MEL	Marijuana	Heroin	Portland, MEL,E	Pharmaceutical opiates	Heroin
Washington, DCM	Heroin	Benzodiazepines	Seattle, WAN	Cocaine	Marijuana
Washington, DCL	Crack	Marijuana	Washington, DCN	Crack	Heroin

HEROIN

• Heroin availability remains generally stable. Only six increases are reported (in Boston^E, Columbia [SC]^E, Denver^L, Memphis^L, Miami^E, and Portland [ME]^L,E) and one decline (in Philadelphia^L). Highpurity snortable South American (Colombian) white heroin remains the most common variety, especially in the Northeast.
• Sources report declining prices, especially for larger quantities of heroin, in six cities in the Northeast and West.
• Brand names still proliferate in the Northeast and South, but they are becoming less common in several cities, such as Boston and Philadelphia. Possibly, dealers fear that labels and brand names make them vulnerable to law enforcement.
• Local drug market structures vary from city to city, but they are generally stable, with a few exceptions. For example, sales in Boston continue to decentralize, as users increasingly support their habits by selling heroin; by contrast, in nearby Portland, independent locals are increasingly working together.
• A younger cohort of heroin users is reported in Boston, Miami, New Orleans, Portland, St. Louis, Seattle, and Washington, DC. By contrast, aging heroin-using populations are reported in El Paso, Philadelphia, and St. Louis.
• Users of diverted OxyContin® in Portland are switching to heroin, which is now easier to obtain.
• The number of heroin clients has increased in non-methadone programs in nine Pulse Check cities.
• Snorting has increased in seven nonwestern cities. Injecting, however, has reportedly increased in Boston^E and Portland^E,N, resulting in new hepatitis C cases among young adults.

Exhibit 6. What new problems have emerged or intensified during spring 2002?

Ecstasy/Club Drugs	OxyContin®	Methamphetamine	Other Emerging Drug Problems
Baltimore, MDM Billings, MTN Boston, MAL Chicago, ILL Columbia, SCL Denver, COL,E El Paso, TXE Honolulu, HIN Los Angeles, CAL,E,N Memphis, TNN Philadelphia, PAE,M St. Louis, MOE Seattle, WAL Sioux Falls, SDL Washington, DCL	Baltimore, MDL Billings, MTN Boston, MAL,E,M,N Columbia, SCE,N Denver, COM El Paso, TXM Honolulu, HIE,M,N Memphis, TNL New Orleans, LAL,E New York, NYM Philadelphia, PAE,M,N St. Louis, MON Seattle, WAL,E,M,N Washington, DCE	Columbia, SCL Denver, COE Detroit, MIE El Paso, TXN Memphis, TNE Miami, FLE New York, NYL St. Louis, MOL,E Seattle, WAL,N Sioux Falls, SDE	Benzodiazepines: Boston, MAE Clonidine (Catapres®): Baltimore, MDM Cocaine: Portland, MEM Diverted methadone: Portland, MEL,E,N DXM (dextromethorphan): Denver,COE GHB: Denver, COE; Los Angeles, CAE Ketamine: Denver, COE; El Paso, TXE; New Orleans, LAL; Sioux Falls, SDL Khat*: Boston, MAL Other opiates: Billings, MTN Boston, MAE Columbia, SCE Denver, COE PCP: Philadelphia, PAE Washington, DCM Powder Cocaine: Sioux Falls, SDE,N
*Khat is a natural stimulant from the Catha Edulis plant, found in a flowering evergreen tree or large shrub from East Africa and Southern Arabia. Its leaves contain psychoactive ingredients structurally and chemically similar to d-amphetamine.

CRACK COCAINE

• Availability remains generally wide and stable. Declines are perceived in four cities (Boston^L,E, Honolulu^E, Philadelphia^L, and Seattle^E), and increases are perceived in another four (Billings^L, Memphis^E, New York^E, and Sioux Falls^L).
• Crack tends to be processed locally (from powder cocaine), either by local distributors or users, because Federal guidelines for distributing crack are stricter than for powder.
• Overall, street-level crack sellers are equally likely to operate independently than as part of organized sales structures—unlike sellers of other illicit drugs, who are more likely to operate independently.
• Only a few changes are reported in market techniques and locations. For example, in Boston, sales continue to be more “underground” than before, with more beeper and cell phone use. In Philadelphia, sales are similarly moving indoors, while outdoor markets are constantly relocating to evade law enforcement.
• Crack sales are associated with prostitution, gang-related crime, and violent crime more often than other drug sales. (Exhibit 7)
• Crack users tend to be predominantly young adults (18–30 years), but adolescent users are increasing in Billings, Los Angeles, and Sioux Falls.

POWDER COCAINE

• Availability remains generally wide and stable, with declines in two cities (Honolulu^E and Philadelphia^L) and increases in four (Memphis^L, New York^E, Portland [ME]^L, and Sioux Falls^E).
• Powder cocaine sellers are predominantly young adults (18–30 years), but adolescents also sell the drug in Chicago^E and Los Angeles^L,E.
• Powder cocaine sellers are more likely to use their own drug than heroin or crack sellers (Exhibit 8).
• Unlike heroin and crack markets, which are located primarily in central city areas, powder cocaine markets are more evenly distributed among geographic areas.
• Indoor and outdoor sales are equally common in the majority of cities. Frequent settings include nightclubs, bars, raves, and concerts.
• In Portland, sellers are increasingly organized and are selling greater quantities of powder cocaine. Elsewhere, the market appears relatively stable.
• The number of powder cocaine users in treatment increased according to seven sources (in Chicago^N, Columbia [SC]^N, Denver^E, Honolulu^N, Miami^E, and Sioux Falls^E,N) and declined according to four (in Columbia^E, Denver^N,M, and Portland^N).
• Preadolescent and adolescent powder cocaine users in the Sioux FallsN program have increased since the last reporting period.
• Injecting has increased in El Paso and Sioux Falls. It is a common route of administration when powder cocaine is used in combination with heroin. Snorting, however, remains the predominant route of administration across sites.

MARIJUANA

• Honolulu, Memphis, and New Orleans are the only three cities where no Pulse Check source names marijuana as their community’s most widely abused drug.
• Non-methadone treatment sources in Columbia (SC), Seattle, and Sioux Falls consider marijuana the drug that contributes to the most serious consequences.
• Availability remains wide and generally stable. A few increases are reported in availability of indoorgrown hydroponic marijuana. British Columbian marijuana (“BC bud”) availability has increased in five cities, mostly in the West.
• Marijuana wraps, often sold in several colors and flavors, are becoming increasingly common, as reported in El Paso, Miami, Philadelphia, and Washington, DC. Sometimes, as in El Paso, they are specifically marketed toward young girls.
• Marijuana sellers are very likely to use their own drug, much more so than sellers of other drugs. (Exhibit 8)
• Marijuana users are more likely to reside in all locations (central city, suburban, and rural areas) than users of other drugs.
• The age of marijuana users has been declining in several cities, including Boston, Columbia, Honolulu, Los Angeles, Memphis, and Sioux Falls.
• More than half of responding epidemiologic/ ethnographic and treatment sources name arrests as an adverse consequence of marijuana use. More than one-third name poor academic performance, deteriorating family or social relationships, poor workplace performance, school absenteeism or truancy, and short-term memory loss (in descending order of frequency).

METHAMPHETAMINE

• Methamphetamine has replaced powder cocaine as the drug contributing to the most serious drug consequences in Denver^L. It has replaced marijuana as such in Memphis^E.
• The majority of sources report stable availability, but sources in 12 cities believe availability has increased since the last reporting period.
• The number of small, local methamphetamine labs has increased in nine Pulse Check cities: Boston, Chicago, Denver, Detroit, Los Angeles, Miami, Portland (ME), St. Louis, and Sioux Falls. Nevertheless, availability levels remain low in many of these cities.
• Methamphetamine sellers are more likely to be involved in domestic violence than sellers of other drugs, according to law enforcement and epidemiologic/ethnographic respondents. (Exhibit 7)
• Methamphetamine markets and use have been spreading within communities: sometimes from the city toward rural areas, as in Denver, Memphis, Seattle, and Sioux Falls; sometimes from rural toward city areas, as in Chicago, Los Angeles, Miami, parts of New York, and St. Louis.

DIVERTED SYNTHETIC OPIOIDS

• Availability of diverted OxyContin® has remained stable according to half of the Pulse Check sources, particularly in the Midwest. Increases, however, are still reported in 10 cities, while declines are reported in 4.
• In Philadelphia and Portland (ME), declines in some aspects of the diverted OxyContin® problem are attributed to a combination of legislation, arrests, education, press coverage, and changed prescription policies.
• Despite declining or stabilizing availability, adverse consequences are still increasing in Philadelphia (in mortality and emergency department episodes) and Portland (in people initiating use).
• In Boston, pharmacy robberies involving OxyContin® continue to increase, and sales of the diverted drug appear more organized than in the past.
• Diverted OxyContin® is sold by a wide range of individuals, mostly independent—from elderly “pill ladies” in Columbia (SC) to “bad” doctors and pharmacists in Seattle to addicts as well as armed criminals in Boston.
• Since the last reporting period, among treatment programs where abuse of diverted OxyContin® is reported, the number of users has increased substantially in 3, increased somewhat in 16, and remained stable in 10 Pulse Check cites.
• Abusers of OxyContin® reside predominantly in central city areas according to sources in half of the Pulse Check cities, dispelling the myth of “hillbilly heroin.”

ECSTASY (methylenedioxymethamphetamine or MDMA)

• About half of the respondents report that ecstasy availability has increased. Approximately half report that it has remained stable, often at elevated levels.
• Fewer sources report adulterated ecstasy than in the last Pulse Check. However, fraudulent substitutions (such as hormone replacement pills) have been confiscated in some cities (such as Detroit, St. Louis, and Seattle).
• Nearly all respondents believe that sellers are very likely or somewhat likely to use their own ecstasy. (Exhibit 8)
• The ecstasy market continues to move to the street—beyond the rave, concert, and club scene—unlike markets for drugs like heroin and cocaine, which are increasingly moving indoors in some cities.
• Younger students are using ecstasy in some cities (such as Baltimore and Boston).
• While users tend to be middle socioeconomic Whites, increasing use is reported among some minorities and lower socioeconomic groups (in Memphis, New York, St. Louis, and Sioux Falls).

GHB (gamma hydroxybutyrate)

• GHB is mentioned as an emerging problem in Denver and Los Angeles.
• Wide availability is reported in Denver, Los Angeles, Miami, and New Orleans. Availability has increased in Los Angeles^L,E, Memphis^L, and Sioux Falls^L. It has declined in Miami^E and St. Louis^L,E.

KETAMINE (“Special K”)

• Ketamine is reported as an emerging or intensifying drug problem in Denver, El Paso, New Orleans, and Sioux Falls. It is increasingly available in Memphis.
• The drug is sometimes associated with the club or rave scene.

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

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