Ethnographers
Twelve of the fifteen ethnographic sources reporting this
quarter stated the incidence of heroin use in their areas as
"high." Sources in both Florida and Southern California report
that the level of use is still low or that it has increased "only
slightly" in those areas. In Baltimore, reporting for the first
time, the impact of heroin on the area is described as "hitting
like a hammer."
Almost all areas report that the majority of heroin users are
older drug users (over age 30) who have been using for many years.
However, as has been true in the last two editions of the Pulse
Check, many areas (eleven of the fifteen) are reporting an increase
in the number of new, young users. Some of these are described as
fairly affluent, non-urban dwellers who come into the city to buy
heroin. In most cases, these new users are snorting the drug
rather than injecting it. However, in both Denver and Miami
injection is still the most common method of ingestion among all
users. In some areas like Chicago there is also an increase in
heroin use among young, inner-city minority teens. The Chicago
ethnographer describes these as a new cohort of users reminiscent
of those of the epidemic in young heroin users in the late 1960s
and early 70s. A major difference in this era of heroin use is
that users are becoming addicted while snorting, rather than
injecting.
It is important to keep in mind that while there is increased
use of heroin among younger, suburban users, it is the cadre of
older, inner-city heroin user that still appear to drive the heroin
market. These users may be both injecting and inhaling the drug.
Reports from New Jersey and New York indicate that the option of
snorting heroin (due to the availability of inexpensive, high
purity heroin) has not only increased the pool of interested users,
but has also provided an impetus to injectors who may be fearful of
HIV infection or whose veins may be damaged from years of
injection.
There are increased reports of the combined use of heroin and
cocaine in ways other than the long- popular injected combination
known as "speedball". This quarter there are increasing reports
of users snorting heroin and smoking crack in combination
(Baltimore, Chicago and Connecticut), a variant on the traditional
"speedball" practice. In the case of the injected speedball, the
primary drug is usually heroin with cocaine in powdered form added
to the injection periodically as "a bonus." In the heroin/crack
combination, however, the primary drug is more likely to be crack,
with heroin added to ease agitation associated with crack use or as
part of a transition from crack to heroin use.
The Chicago ethnographer reports that many new heroin users
there are transition users who find heroin (snorted) an effective
way to "come down" from crack or as a substitute for crack. He
notes that the users feel that, "It (heroin) makes them less crazy
and less likely to binge and gives them a greater sense of control
over their drug habit." Atlanta also reports the practice of
"speedballing" heroin and powdered cocaine by snorting lines of
each in rapid succession. Finally, in San Francisco there are
reports of another stimulant, methamphetamine, used in combination
with heroin and either inhaled or injected in a variant on the
speedball.
This quarter there are reports from some areas of changes in
the way heroin is marketed. New York sources report that, like
cocaine, heroin can now be purchased in many off-street locations,
such as superettes or bodegas, as well as on the street. They also
note that Colombian suppliers who in the past have primarily dealt
only cocaine, are now insisting that their street level sellers
also take heroin for distribution.
Heroin is reported to be available in more varieties and from
more sources than ever before. Sources in Chicago report the
appearance of a high potency, dark brown heroin on the West Side.
Affluent users are reported to be traveling into the city to buy
this new product. Also, Southeast Asian heroin has virtually
replaced Mexican brown or black tar heroin on the South Side. Each
type is imported and distributed by different groups: Mexican
brown by Latinos and Southeast Asian by Nigerians.
In Baltimore heroin is increasingly being aggressively
marketed by youths in "crews", rather than by the older,
traditional heroin dealing organizations in that city. In the
past, heroin users in Baltimore were likely to buy supplies in
"1-2-3 sales": the customer hands money to the dealer on one corner,
who then goes to another corner to pick up the drugs. He then
meets the original customer at a third corner, where he makes the
delivery. But now all aspects of the transaction are concluded in
open air street dealing at the same location. There is also
evidence in Baltimore of dealers coming into the city from other
areas (New York or Washington, D.C.) to sell inexpensive heroin
for a week or two and then disappearing.
Several ethnographic sources also report different pricing and
different "cuts" or adulterants mixed with heroin. For example, in
some areas of Chicago the mix used for heroin destined for the
intranasal user is milder to the mucous membranes than traditional
adulterants would be. But this new mix of heroin cannot be "cooked
up" or heated and liquefied for injection, because, when heated,
the milder or softer adulterants result in a gelatinous mixture
that can not be injected. In Bridgeport, poorer quality heroin cut
with quinine (for injection) is called "scramble" and only sold in
one area of the city. Those who wish to buy heroin for injection
must go there to find it. Higher purity heroin intended for users
who inhale is not available in that area. In effect, users who
rely on different routes of administration are separated by market
site. This may lead to a more rapid growth in the population who
inhale or smoke, since they will not see the more insidious effects
of long-term heroin use so apparent among users who regularly
inject heroin.
In some cities, including New York, there is evidence that
both injection and inhalation are plentiful. In some
neighborhoods, heroin shooting galleries have begun to appear
again. In others, the glassine bags normally used for $5 and $10
purchases are found discarded and littering the streets -- an
indication that the heroin they contained was quickly inhaled by
the user at the point and time of purchase .
Four ethnographers (in New York, Atlanta, San Francisco, and
Newark, Delaware) report that heroin is being sold in nightclubs
and at concerts in their areas. In Delaware, heroin (and many
other drugs) are sold at clubs and at "raves" -- often to very
young users. Though far less common than other "club drugs" like
MDMA, ketamine, or LSD, heroin can also be found for sale in some
New York clubs.
Heroin prices are, in general, low, but there is considerable
variation. Some areas, including New York and the Mid-Atlantic,
report bags of heroin starting at $5.00. Other areas like Atlanta,
Denver, and Los Angeles report somewhat higher prices. In general,
purity is also high (with the exception of Miami), though there is
considerable variation even within the same geographic area. For
example, in Chicago users report considerable variation in purity,
by location. In one western suburb there were five overdose deaths
related to heroin, two of whom were longtime heroin users. This
may, imply the possibility of some recent, drastic changes in
purity. In Baltimore, capsules of heroin intended for injectors
sell for $6-10 and purity can be as low as 10 percent. However,
higher purity heroin (70-90% pure) is also available, sold in
glassine bags (50 mg) for $50 and marketed for snorting.
Police
Police sources report a similar though somewhat more stable
heroin picture than that of the ethnographers. About half of the
areas describe increasing heroin use; all others report that it
appears to be stabilizing. As with the ethnographic reports,
police sources in Maryland, Colorado, and Oregon report they are
seeing both traditional older heroin users and an increase in the
number of young, often suburban users. Injection dominates as the
method of ingestion in the West and South, while there are both
injectors and snorters in the East and Mid-Atlantic.
Police sources in Boston and New York both cite the increased
presence of Colombian heroin in those areas. Several overdose
deaths in Boston were cited as indications of the higher purity
Colombian heroin now available in the area. One Boston police
contact noted that "heroin must be coming in by the boatload"
given the amount now available on that city's streets.
Police in Colorado, Maryland, and Oregon describe an expanding
market for heroin among suburban users. In Denver, a sting
operation launched by the police resulted in the arrest of over 100
suburban users who had come into the market area to buy black tar
heroin.
Miami police report that, though there is little heroin use in
that area, the number of seizures of heroin indicates Miami may be
an increasingly popular transshipment point. The amount of
Colombian heroin sized by Florida customs officials has increased
from 371 lbs in 1994 to 650 lbs in 1995. In addition there has
been a marked increase in the number of arrests at Miami
International Airport of heroin "bodypackers" (persons who
transport drugs by swallowing them in balloons, condoms, or other
containers) -- from 3 in 1991 to 87 in 1993 to 103 in 1995.
Heroin prices reported by police vary by area: $250-300 per
gram in the Northwest to $150 per gram in Colorado, to $60-70 per
gram in the East. This is due, in part, to the type of heroin
available (Mexican, Southeast Asian, Colombian). Purity is also
variable from lows of less than 10 percent in the Northwest to
highs of more than 60 percent in the East.
Treatment Providers
As with the reports from ethnographic sources, treatment
providers are finding a steady population of older heroin addicts
entering treatment. However, they also report that an increasing
number of young, less experienced users are coming into treatment.
The numbers of clients entering treatment with heroin as the
primary drug problem look similar to that reported last quarter.
In most areas (Regions I, II, and IV) the percentage has declined
somewhat, while in the Midwest (Region III) it has increased
slightly. More noticeable is the percentage of clients who enter
treatment for heroin use who are inhaling rather than injecting.
The Northeast and Mid-Atlantic areas (Region I) continue to report
an almost even balance between inhalers and injectors. Regions II
and III, are now also reporting an increase in inhalers entering
treatment this period: 47 percent of heroin clients in Region II
and 34 percent in Region III.
Treatment providers also report more young users entering
treatment for heroin problems. Region I now reports 15 percent of
heroin abuse clients are under 20; Region II reports 6 percent
under 20 and Region III reports 18 percent under 20. The older
addict still dominates treatment programs, however. In all
regions, over 60 percent of the heroin clients are over 30 years
old.
Another indication of a more youthful heroin addict is the
proportion of clients who are new to treatment. Continuing a trend
reported last quarter, in all regions an increasing percentage of
clients in treatment for heroin abuse have never been in treatment
before.
