Trends in Drug Use: June–December 1997

Part I: Heroin

All ethnographic, law enforcement, and treatment provider sources report heroin use as either rising or stable. Older, long-term heroin users continue to abuse this drug, preferring injection as their route of administration. In this Pulse Check, most sources report an increase in new young users who begin by snorting or smoking the drug. Most sources also report that heroin prices are stable at $10 to $20 per bag, though purity varies greatly. Higher purity levels on the East Coast allow users to snort and smoke heroin, as opposed to injecting it. All sources report that "speedballing," or combining heroin with cocaine, is common. Treatment providers report that 75 percent of clients receiving treatment for heroin abuse claim to have a problem with cocaine abuse as well. "Double-breasted" dealing, or dealing of both heroin and cocaine, is reportedly rising.

Ethnographers, Epidemiologists, and Ethnographic Sources

Most of the ethnographic and epidemiologic sources report heroin use as rising (San Francisco, Newark, Atlanta, and Baltimore); stable at high levels (Bridgeport and Chicago) or stable (San Diego and Seattle). Most sources report a variety of users, with the majority being older, hardcore users. As reported in the last Pulse Check, sources in Bridgeport and Atlanta report that some crack users are shifting to heroin.

Notably, sources in San Francisco, Newark, Miami, and Atlanta report an increase in younger users. The Newark source notes "a definite increase in teenage users," and also reports that dealers, some from nearby Philadelphia, are making a clear attempt to establish a new market. For example, by encouraging young females to begin use, dealers hope to attract older male users. In that area, users start at around age 13, and the source reports that there are "chronic" users aged 15-17. Bridgeport sources note a continued increase in use by young people aged 16 to 21, particularly females.

Most sources identify injection as the predominant route of heroin administration. However, as reported in recent Pulse Checks, due to the rise in young users there has been a relative increase in snorting in some areas. Sources in San Francisco report a decline in injection and a rise in snorting, and sources in Bridgeport report that younger users prefer snorting to injection. In New York, new users are reported to start out avoiding injection. However, after they become addicted to heroin through smoking or snorting, they often turn to injection, incurring higher health risks. In Miami, heroin users are "skin-popping" -- injecting the drug into soft tissue rather than intravenously.

All sources report that heroin abusers are also using cocaine or crack; a number also cite alcohol abuse. This polydrug use occurs both simultaneously (i.e., ingesting different drugs at the same time) and sequentially (i.e., ingesting different drugs at different times). The level of speedballing -- combination heroin and cocaine use -- varies between sites. In Seattle, the ethnographer reports less than 20 percent of heroin users combining heroin with cocaine while in Denver, the ethnographer reports that speedballing is quite common.

Heroin sellers are of all ethnicities and age groups, but in most areas they are male. The majority of sources note that heroin sellers also sell cocaine, crack, and/or other drugs. Sources report that polydrug sellers are common in Chicago, Newark, San Diego, San Francisco, Denver, and New York. In Atlanta, the source notes that there are new young Caucasian male dealers in addition to the core group of long-time heroin, crack, and cocaine dealers. In Chicago, the source notes the presence of Southeast Asian heroin that is distributed by Nigerian trafficking groups.

There is also a change in market style in many areas. Though heroin has traditionally been sold primarily on the streets, the use of beepers is becoming more common. In Denver, the ethnographer states that "... [t]he heroin market has gotten very elusive. You have to know someone. If they don't know your number, they're probably not going to call you back." One New York source also notes "less outdoor activity," saying that heroin sales are now likely to be more private. Both of these reports suggest that the heroin market is becoming more organized.

Ethnographic sources report that heroin prices remain stable in most areas at around $10 to $20 per bag, but there are wide variations in purity. Some variation in prices may come from the presence of new users in the market. Newark sources report that young users in that area are often charged more because they are not familiar with customary prices. At the same time, ethnographers in Denver and Bridgeport emphasize the long-term stability of heroin prices in their regions.

Purity varies widely both between and within regions. In Miami, sources report that although still lower than in most areas, the purity of heroin (16%) in the community continues to rise. Similarly, in Seattle, it is approximately 20 percent. However, in Newark, it can vary from 20 to 90 percent. While high purity heroin has been available on street markets for a few years now, these purity levels are astonishing given that street-level heroin purity was about 2 to 4 percent in the 1970s when heroin was a very popular illicit drug of abuse. The implications of this high purity heroin for both older hardcore users and new users are immense.

Law Enforcement Sources

The majority of police sources report that heroin use in their areas is either rising or stable. Only Cleveland police report a decrease in use. Like the ethnographers, most police sources report that heroin users are predominantly male, with a wide age range. Sources in Miami, Boston, Baltimore, Columbia, New York, and Eugene report an increase in young users.

The practice of snorting seems to be growing in Miami, Boston, Columbia, Trenton, and New York. This popularity of snorting is consistent with an increase in new young users and with the high heroin purity levels. Most law enforcement sources report that injection remains the predominant route of administration. Injection alone is the predominant method of use in Birmingham, Los Angeles, Denver, Washington D.C., Cleveland, Austin, San Antonio, Seattle, and Yakima. Baltimore and Eugene officials report that smoking heroin is popular in their areas, in addition to injection.

Notably, in Denver, sources report that users are injecting black tar heroin, which is appearing at unusually high purity levels of 40 to 50 percent. This may indicate the continuance of a phenomenon first noted in the last Pulse Check: distributors of the Mexican black tar heroin, which dominates the Southwest border area, may be offering a higher purity product to compete with the new market entry of higher purity Colombian heroin. This can only lead to ever-greater potential for overdose, as black tar heroin is typically much lower in purity than other types. Indeed, the series of heroin overdoses in Plano, Texas reportedly involved high purity Mexican black tar.

In the Northwest, sales seem to be dominated by Mexican nationals. In other areas, seller characteristics vary. Many sources continue to report the practice of double-breasted dealing, that is, the same sellers dealing both heroin and cocaine. In addition, many sources (i.e., Seattle, Yakima, Eugene, Austin, Miami) also report that heroin sellers are involved in sales of methamphetamine and/or marijuana.

Although two police sources (i.e., Trenton and Yakima) report a decrease in heroin prices, other reports indicate stability at the typical $10 to $20 per bag range. Sources on the East Coast (i.e., Boston, Baltimore, Trenton, and New York) all report increasing purity levels in their areas; on the low end the range is 15-40 percent while on the high end it is 60-90 percent.

Treatment Providers

In the Northeast, approximately 22 percent of clients receiving drug treatment cite heroin as their primary drug of abuse, and in the West/Southwest region, this figure isapproximately 17 percent. This is consistent with the rapid increase in the presence of heroin in large urban centers in recent years. Indeed, in the Northeast, almost half of the treatment facilities report an increase in heroin use among clients. In the Mid-Atlantic/South region, the proportion of clients who report that heroin is their primary drug of abuse is only 5 percent, and in the Midwest, about 7 percent of clients report heroin as the primary drug of abuse. Most treatment facilities (70%) in the Mid-Atlantic/South, Midwest, and West/Southwest regions report that this figure is approximately the same as the last Pulse Check.

The majority of clients entering treatment in all areas (over 60%) reportedly prefer to inject heroin rather than snort or smoke it. This is somewhat different from recent Pulse Check reports. In areas where heroin purity is high, many programs report a large proportion of clients who primarily snort heroin.

The majority of clients in all regions who use heroin also use alcohol; in the West/Southwest, this number is almost 80 percent.

The average age of clients using heroin remains fairly stable in this Pulse Check; most are over 31 years old. A significant number of younger users are in the West/Southwest region, however, with 18 percent under 20 years old. In all regions, the majority of clients entering treatment for heroin abuse are older, Caucasian males who have received drug treatment previously.