Ethnographers, Epidemiologists, and Ethnographic Sources (Table 1)
Reports on heroin use from ethnographic and epidemiological sources vary from place to place -- from low incidence areas like Minneapolis and two Florida cities (i.e., Miami and Petersburg) to areas of increased use in the West and along the U.S.-Mexico border. In St. Petersburg, Minneapolis, and Kansas City, sources report relatively low levels of heroin use. As reported in previous issues, Miami continues to see a slow but noticeable rise in the number of new snorters and skin-poppers. Like Miami, sources in Minneapolis report a very low level of heroin use in the area, but also note an increase in snorting. In Honolulu, sources report great variability in heroin use; within the city, some areas have seen an increase in use, some places find that use rates have remained stable, while others indicate virtually no heroin use. Sources in Los Angeles, Denver, and Newark (Delaware) report heroin use as stable. Heroin use remains stable at high levels in Bridgeport and New York. Finally, sources in San Francisco, Chicago, Austin, San Antonio, and Seattle report increased heroin use. San Antonio sources note that their increase is occurring among youth. The Seattle ethnographer notes an increase in heroin use and a decline in both treatment admissions and heroin-related deaths.
Several areas report younger heroin users are users from middle socioeconomic groups. Sources in both Miami and St. Petersburg cities indicate a significant number of young users snorting heroin. A Miami source comments that "ten years ago you couldn’t find a (heroin) user under 35. Now you can -- why is the question." San Francisco sources also note an increase in young users, and report college students smoking and snorting heroin. Contacts in Chicago relate an increase in young suburban users, users from higher socioeconomic groups, and female users. In Texas, San Antonio experienced an increase in the young and female users of heroin, and Austin found increased use by the middle and upper class Caucasian population. This group currently comprises 25% of the heroin-using population in Austin, where 5 years ago only one in ten users was younger than 25. Minneapolis also reports an increase in heroin use among young Caucasian users (i.e., those under 25 years of age). In Bridgeport, although sources report that the majority of heroin users are generally in their thirties and forties, there is also an increase in use by people in their twenties. Both Denver and Los Angeles sources report that heroin use still tends to concentrate among an older age cohort. New York reports heroin users as from all ages and ethnic groups.
Most sources identify injection as the predominant route of heroin administration though there continue to be users snorting or inhaling heroin, and to a far lesser extent, smoking it. San Francisco, Newark, Chicago, Minneapolis, and Austin sources report an increase in snorting, and in Miami, younger users both snort and skin-pop. In three of the fifteen cities -- Bridgeport, New York, and St. Petersburg -- snorting of heroin was identified as the most prevalent method of use. While Austin, Texas, found an increase in snorting, San Antonio sources related that users continue to smoke heroin, sometimes in combination with marijuana, and reported users "shebanging," squirting a mixture of heroin and an acidic liquid up the nose. New York sources also report some smoking of heroin, but note that it is still not a common method of administration.
Most sources report that many heroin abusers use other drugs, particularly cocaine, marijuana, and alcohol. In Denver, Chicago, Minneapolis, and New York "speedballing" (combining heroin and cocaine powder in an injection) is popular1. The Florida cities Miami and St. Petersburg also report use of MDMA, or "ecstasy," by heroin users. In the western cities of Los Angeles, San Francisco, and Seattle, some heroin users are also using amphetamines.
Heroin dealers vary in ethnicity and age, but many cities indicated Hispanic and Mexican sellers were predominant. In 8 of 15 cities -- San Francisco, Bridgeport, Newark, Miami, Honolulu, Chicago, Minneapolis, and San Antonio -- heroin sellers sell other drugs, in particular, cocaine and marijuana. Additionally, San Antonio sources report an increase in the number of younger sellers, noting that they seem to be perceived as more trustworthy by heroin users than older dealers. Sales methods appear to be changing in some cities. Denver, Bridgeport, and New York sources describe a decrease in street sales in favor of indoor sales, beeper sales, and home delivery.
Heroin purity appears to be high in all areas. Miami, which has reported lower purity of heroin than other areas in the past, now indicates purity has increased. Two eastern cities -- Bridgeport and New York -- report heroin purity remains consistently high. Interestingly, prices vary considerably among the cities with the difference ranging from less than $100 per gram on the coasts, to over $300 per gram in the Midwest cities. Sources in Chicago report that the DEA reported the lowest price per pure milligram last year in that area. The San Francisco source reports street prices of $25 for ¼ gram and the availability of $10 bags of heroin (1/8 gram). She comments that heroin prices are "the cheapest I have seen in years."
Law Enforcement Sources (Table 2)
None of the law enforcement sources report a decrease in heroin use over the past 6 months. Police in four of the ten cities contacted -- San Diego, Washington D.C., Trenton, Cleveland, and Seattle -- indicated heroin use has remained stable, while Bridgeport and Columbia police report an increase in heroin use. Sources in two western cities -- Yakima and San Antonio -- related that heroin use rates remain fairly stable with perhaps a slight increase.
Police in San Diego, Bridgeport, Washington D.C., Trenton, and San Antonio report that heroin users are more often male. As found by ethnographic sources in the Mid-Atlantic, Trenton police note increasing heroin use among females. Again consistent with ethnographic reports, most law enforcement sources report that heroin users are older, in their twenties and thirties, though some areas are experiencing a rise in heroin use among youth (i.e., Trenton, San Antonio, and Seattle). Generally, heroin users represent a variety of different ethnic groups reflecting the population mixes in their area.
Heroin injection remains the predominant route of administration in 8 of the 10 cities where law enforcement sources were contacted (i.e., San Diego, Washington D.C., Columbia, Cleveland, Trenton, San Antonio, Seattle, and Yakima). Bridgeport and Boston police report snorting as the most prevalent method of use. The practice of snorting seems to be growing in Columbia, Seattle, and Trenton. The shift toward snorting is consistent with the high heroin purity levels available in these urban areas. Law enforcement contacts in half of the cities (San Diego, Washington D.C., Columbia, Seattle, and Yakima) indicate combined heroin and cocaine use.
Seller characteristics vary across the country. Law enforcement professionals interviewed for this issue of Pulse Check inform us that "double-breasted" or joint sales of heroin and cocaine appear to be declining. Sources in San Diego, Bridgeport, Columbia, and Trenton all reported that heroin sellers in their communities tend to sell heroin only. "Double-breasted" dealing was only noted in Baltimore (by the Columbia source), Boston, and Yakima.
Most police reports indicate the street-level prices for heroin are stable at $10 to $20 per bag. There is notable variation among the 10 cities, however. For example, Boston reports 25 to 50 percent pure street-level bags selling for $4 to $10, while in Minneapolis a street unit can cost as much as $50.
Treatment Providers (Table 3)
The majority of treatment facilities in all regions report no change in the prevalence of heroin use among their clients (Northeast, 74 percent; Mid-Atlantic/South and Midwest, 67 percent; West/Southwest, 57 percent). Approximately 8 percent of clients receiving drug treatment in the Northeast region report heroin as their primary drug of abuse. This proportion is lower than in past issues of Pulse Check. Conversely, in the Mid-Atlantic/South region, this figure is up from past reports to 20 percent. In the Midwest, about 9 percent of clients report heroin as the primary drug of abuse, consistent with past reports. Finally, in the West/Southwest region, heroin is reported as the primary drug of abuse by 21 percent of clients -- consistent with findings of the last issue of Pulse Check. Of treatment facilities in the West/Southwest, however, 39 percent report an increase in heroin use among clients.
Like the ethnographic and law enforcement sources, treatment providers in all areas report injection as the most common method of heroin use. However, in the Northeast and Mid-Atlantic/South regions where heroin purity is high many treatment programs report a large proportion of clients entering treatment who primarily snort heroin (35 percent and 38 percent, respectively). In the past, this trend was limited to the Northeast region. Although smoking heroin remains the least popular method of administration, the proportion of clients reporting this method in all regions is not inconsequential (Northeast, 19 percent; Mid-Atlantic/South, 10 percent; Midwest, 16 percent; West/Southwest, 18 percent). In the West/Southwest region, where black tar heroin dominates the market, smoking is more frequent than snorting heroin.
The majority of treatment clients in all regions who abuse heroin also use alcohol. In all but the Northeast region, high proportions of heroin-abusing clients also use cocaine (Mid-Atlantic/South, 60 percent; Midwest, 46 percent; West/Southwest, 55 percent). Marijuana use by heroin users remains popular in all regions, ranging from 24%-42%. Finally, in the West/Southwest region, 26 percent of heroin users also report using amphetamines, consistent with the methamphetamine problem in that region.
Most clients using heroin in all regions are in their twenties and thirties. It is important to note, however, that in all regions but the West/Southwest a substantial number of heroin abusers in treatment are under 20 years old (Northeast, 17 percent; Mid-Atlantic/South, 13 percent; Midwest, 17 percent). This change may reflect the beginnings of a new treatment population -- new, younger users -- and may indicate a future treatment burden as experimenters become addicted with extended use. In the Mid-Atlantic/South and West/Southwest regions, heroin users aged 40 years and older comprise a substantial proportion of treatment recipients (20% and 28%, respectively).
In the Northeast, the majority of clients entering treatment for heroin use are Caucasian, whereas in other regions, African Americans comprise the majority of clients entering treatment for heroin use. Across the country, most clients receiving treatment for heroin are male and have previously received drug treatment.
1 It is important to distinguish between "combination use" and "concurrent use." Combination use, as in a speedball, implies a conscious use of two drugs together to create a unique effect. Concurrent use refers to drugs often used at the same time or in the same setting but not necessarily to create a combined effect, as with tobacco and alcohol.
