Trends in Drug Use: Spring-Fall 1996
Part I: Heroin
Most sources contacted for this Pulse Check report that the market for heroin is stable or growing. The majority of heroin abusers are within the traditional, older cohort of long-term users, and some former addicts have begun using again since high purity, low price heroin is available. However, some areas report that there are more new, young heroin users. These new users include college students and suburban kids, but the majority are inner city youth. Sources also report that double breasted dealing -- selling both heroin and cocaine -- continues in many areas. While heroin use is rising in many areas, both by long-term users and new users, treatment providers have not noticed a marked increase in heroin abusers seeking treatment.
Ethnographers and Epidemiologic Sources
Heroin use continues to be common in almost all of the areas contacted, and eight of the eleven sources contacted report an increase in young heroin users. These users may be college or suburban kids (as in Denver, Trenton, and Newark), or low-income inner city youth (as in Chicago, New York, Bridgeport, and Newark). In Denver, sources report "cafeteria use" of drugs on local campuses where students try a number of drugs, such as LSD, MDMA, cocaine, marijuana, and Ketamine, as well as heroin. In New York, heroin use is reportedly popular with middle class teens and young adults who are part of a "club scene" and experiment with a variety of drugs.
The bulk of the new, young users they see are "street kids," that is, they are from inner city areas, are sometimes runaways, and are often minority teens (as in Chicago and Denver). Typically, they feel that heroin use can be better "controlled" or that their behavior under its influence is less volatile than it would be if they were using crack. Some are former crack users, while others have never used crack.
While there has been an increase in new, young users, heroin users are primarily adults, many of whom are former long-term users tempted back into use by the lower price, higher purity heroin now available. In Miami, where heroin use is relatively uncommon but increasing gradually, sources report that "more of the old-time shooters are at least trying to get a taste of heroin again" as availability increases.
In sections of Manhattan, large, stable cohorts of users in their 30s and 40s continue to use heroin with little change in their long-established routines. Greater availability of better quality heroin may simply prompt them to "add a bag or two if they hear of good stuff somewhere" to their typical consumption, but it does not significantly escalate their use.
As described in the last several Pulse Checks, snorting heroin is most common in areas of the country where high purity heroin (generally white heroin from Colombia or Southeast Asia) is available. These areas include the Northeast, the Mid-Atlantic region, and the Northwest. In contrast, in areas such as the Texas border and the West where lower purity Mexican brown and black tar heroin dominate the market, users are more likely to inject.
Contrary to the myth that snorting alone does not lead to addiction, many users establish addiction this way. After becoming habituated, these users switch to injection, which is a more efficient route of administration. Chicago, Newark and New York sources report a shift toward injection among heroin snorters, even in areas where high purity heroin is available. This could show that more users are becoming habituated, or that more users start out injecting when they initiate heroin use.
In these areas where there has been a shift toward injection, there appears to be less fear of HIV than there was a year or two ago. The Newark source states that most young users snort heroin, but more and more are trying it intravenously, and comments that "the idea of sharing needles and AIDS simply doesn't seem to bother them." This could indicate that new young users are not responding to public health messages about the risks of needle sharing. Alternatively, it could show that when heroin inhalers switch to injection, or switch back and forth between inhaling and injecting, they choose to ignore the extra risks associated with needle use. This trend has been reported in previous Pulse Checks in several areas, including Bridgeport, San Francisco, and Chicago.
Miami sources report that some heroin users, primarily those that experiment with a variety of drugs, are "skin-popping" heroin. Skin-popping -- injecting a drug under the skin or into soft tissue rather than directly into the bloodstream -- has long been associated with the early stages of injection drug use. Miami sources report that skin-popping is common among white, upper middle class, young adults in the Miami beach club scene.
In places as diverse as New York, Denver and the Texas border, sources report that dealers, primarily those who previously dealt only cocaine or crack, are now "double breasting," that is, selling both heroin and cocaine. As described in the last Pulse Check, heroin and cocaine markets have traditionally been distinct, with different dealers selling each drug. For example, the traditional heroin market consists of older users, selling to networks of friends and acquaintances.
In contrast, the new "crews," who in some cases are double breasting, consist primarily of young, entrepreneurial non-users who have developed more efficient distribution networks. One New York ethnographer reports a noticeable increase in the number of organized crews selling both heroin and cocaine on the street. The two drugs are sold in similar packages using similar bag markings, indicating a common supplier. He describes the crews as more efficient and better organized than traditional heroin distributors have ever been. Further, most crew members are not users themselves. These crews may be organized and supported as part of the marketing strategies of mid-level distributors. Notably, these young crews usually distribute Colombian heroin.
With crack use declining in many of the areas that report double-breasted dealing, new drug distribution networks, that may be made up of second generation dealers, have emerged. Sources in New York, Bridgeport, San Diego, and Newark note that heroin dealers are more frequently using beepers or pagers to conduct sales. This practice coincides with a decrease in open air or public street sales of heroin in favor of indoor sales or "home deliveries" reported in New York, Bridgeport and San Diego. While large sales of heroin and cocaine have always been delivered, small amounts of heroin have traditionally been sold on the street and/or through acquaintances. However, current beeper sales can involve fairly small quantities of heroin and cocaine distributed to a wide range of customers, not just wealthier customers who pay much more than the street price. For example, beeper sales are common in areas where heroin is part of the after hours club scene (e.g., Bridgeport and New York). This pattern of distribution -- a network of street sellers, using beepers to communicate and make delivery sales -- is reminiscent of the methods that crews of crack entrepreneurs developed in the 1980s.
Heroin is also available to young users from street dealers in traditional "copping areas" -- public areas where drugs are sold frequently -- and from other young users in the community or in school. The Trenton/Newark source points out that unlike crack suppliers, who typically do not use, these suppliers are most often older students or recent graduates who are users. This distinguishes these young dealers from the more organized heroin crews described above. They are familiar faces among the students and can establish themselves unobtrusively as suppliers for a number of other students.
The Trenton/Newark source points out that in his area, the two markets are still fairly separated: heroin users sell heroin and cocaine distributors sell cocaine powder and crack. If joint sales occur, it is more likely to be serendipitous than part of a marketing plan. This is more typical of the old style heroin markets.
Ethnographers in Bridgeport, Chicago, and New York report that the drug trade has become more violent in their areas. For example, while many cities are reporting a decrease in violent crime, Bridgeport reported a higher homicide rate in mid-1996 than was reported for the entire previous year. In one two-week period in September, the city suffered ten drug-related homicides, reportedly related to the heroin trade. Similarly, in Chicago and New York, competition for the lucrative drug market is fierce, as many different groups as well as "independents" vie for customers and territory.
White heroin from both Southeast Asia and Colombia dominates the Northeast markets, while Mexican brown and black tar heroin is more prevalent in the West and South. Chicago, whose market had traditionally been dominated by Mexican brown and black tar heroin, has witnessed more white heroin in some parts of the city. Sources report that white heroin has been moving westwards for about a year. Miami sources also report that there is more white heroin on the street. Since Miami is an important transshipment point, this heroin is probably the residual from larger shipments that have moved through the city on the way to other places.
In New York, one source notes that there are more "independent" dealers who are not connected to an established heroin selling network, but are typically associated with high purity heroin. These dealers are reportedly double-breasting, and are believed to be using odd adulterants (e.g., Dramamine, acetaminophen, scopolamine) to cut the drugs they sell. The increase in independent dealers, and more new dealers in general has led to more variety in purity at the street level, even within the same area. For example, a $10 bag that is 2-5 percent pure in one part of the city may be 25 percent pure in another part. These independent dealers could be former cocaine dealers who have developed relationships with mid-level distributors, and are trying their hand in dealing the high purity heroin that has recently emerged.
Prices remain fairly stable, though the purity of heroin sold on the street varies considerably. Street level purchases are generally in 1/8th-1/10th gram units that cost between $10 and $20. Units are sold as small bags, balloons, folded paper/foil or in a small capsule.
Police sources in most of the areas surveyed report that heroin use is up or stable in their area. Only sources in Birmingham report that heroin is not widely available, and its use is relatively rare. Miami police describe use as stable, though its prevalence is still quite low compared to other drugs; they note, however, that several teenagers in the Orlando area recently overdosed on what appeared to be heroin. Most police sources report that the majority of users are still older, long-term addicts, though the appearance of the younger users described by ethnographic sources is also reported by police sources in New York, Miami and Boston.
Many police sources report that heroin users in their areas prefer to inject. Two areas (New York and Boston) report that snorting also is popular; this is consistent with the appearance of new, young users in these areas. Police sources report that cocaine and methamphetamine are also popular among heroin users.
In the Northwest, mid-level sales, particularly of larger quantities, are dominated by Mexican nationals. In the East and South, these mid-level dealers vary widely; they may be South American, Middle Eastern, Nigerian, or Russian. In Miami, Seattle, New York and Boston, police also note that more street level dealers are double-breasting (handling both heroin and cocaine).
Prices for heroin remain stable in most places ($10–$25/bag), though the purity or quality can vary considerably within an area. In Miami, purity can run from as high as 95 percent for large quantities seized in transport to lows of 2-5 percent on the street.
In the Northeast, Mid-Atlantic and the South, approximately 19 percent of people who enter treatment cite heroin as their primary drug of abuse. In the Midwest, South, and Southwest, this figure is about 10 percent. Though this proportion of people rose slightly in the West and Midwest, and fell slightly in the Northeast and the South, these changes did not represent a great increase or decrease for most of the 61 programs reporting in this Pulse Check.
Most heroin users entering treatment inject the drug, with the exception of the Northeast, where more clients inhale. One treatment provider in the Northeast points out that while the majority of heroin clients usually snort, many of these same clients also inject, especially when they are unable to find high purity heroin, or when they want to speedball with cocaine powder. Cocaine is commonly mentioned as a secondary drug of abuse (by 33-92 percent of clients in all regions) as is alcohol (by 60-92 percent of clients in all regions).
Heroin users seeking treatment in all regions tend to be older (i.e., over 30), though sources in the Northeast and Mid-Atlantic region report higher percentages of clients under twenty years old. In all areas contacted, the majority of heroin treatment clients are white, except in the Midwest where just over half of the clients are African American. Over 75 percent of the clients have been in treatment before, and there continues to be a 70/30 split between men and women.
