Pulse Check - Winter 1995 (National Drug Control Policy). Introduction This iteration of the Office of National Drug Control Policy (ONDCP) Pulse Check represents one of a quarterly series which began in April 1992. Conducted by Abt Associates under the direction of Dr. Dana Hunt, the Pulse Check reports the results of telephone interviews with ethnographers and epidemiologists working in the drug research field, law enforcement contacts, and drug treatment programs across the country. Conversations follow the same general guidelines each quarter. However, sources may choose not to report on a particular aspect of an issue in a quarter or add information in areas not specifically included in the past. The name given this series--Pulse Check--captures its purpose: to provide a quick sense of what is happening with regard to drug abuse across the Nation. The Pulse Check uses quarterly conversations with police, ethnographers and epidemiologists working in the drug field, and providers of drug treatment services across the country to develop an up-to-date picture of what is going on in the world of illegal drug use. The police and ethnographic and epidemiologic reporters are generally the same from quarter to quarter. The sample of treatment providers, however, is randomly drawn, stratified by size from a listing of all treatment providers in each region; those called each quarter vary as the sample is refreshed. A further discussion of the sources used in development of the Pulse Check is included as Appendix A. The following sections describe briefly the sources used and summarize findings for this latest Pulse Check. Summary Of Findings Heroin The use of heroin continues to climb in most areas. Twelve of the fifteen ethnographic sources reported a high incidence of heroin use in their areas. The number of varieties and sources of heroin available, combined with an increased domestic demand make the heroin market the fastest growing drug market reported on in this Pulse Check. In those areas where high purity heroin is available, the practice of inhaling rather than injecting the drug continues to increase in popularity. Among new users of heroin, particularly the young, non-urban, middle income users who are increasingly evident in many areas, the ability to inhale the drug has made it more attractive and its use more acceptable than in the past, when injection was the only route of administration available. The combination of lower prices and increasingly active marketing to inhalers has had the effect of making heroin more accessible to a wider range of potential users. It should be noted that, while there are indications of increased use of heroin among younger, suburban users, it is the cadre of older, inner-city heroin users that drive the heroin market. These users may be both injecting and inhaling the drug. Almost all areas report that the majority of heroin users are older drug users (over 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. Ethnographers from four areas reported that heroin was being sold in nightclubs and at concerts, 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 clubs. In general, heroin prices are low, but there is considerable variation. Some areas report bags of heroin starting as low as $5.00. Others report somewhat higher prices. In general, purity is also high, though there is considerable variation even within the same geographic area. This quarter there are reports from some areas of changes in the way heroin is marketed. There continues to be an increase in the number of urban dealers who sell both heroin and crack, particularly in those areas where the crack market is on the decline. 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. Treatment providers report 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. 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. Cocaine The use of both cocaine and crack has stabilized in most areas. The only exception is in several areas near the Mexican border, where cocaine use is on the rise. There is some evidence that a portion of cocaine users, particularly in the West, are switching to methamphetamine, a less expensive drug that is both plentiful there and that has a longer stimulant effect than crack. However, it is important to bear in mind that while cocaine use has leveled off, it is still high. For example, in Chicago, while crack use has stabilized it is also described as "the most predominant of all drugs, with the most diverse composition of users including all ages, employed people, housewives, etc.". The same sentiments are echoed by a number of other sources. Crack is a serious continuing problem in most areas, but the number of new users and what seemed an almost ever-increasing activity surrounding crack for several years has begun to abate in many areas. Several sources note that both crack and cocaine HCl users seem to be an aging group. While in the initial phases of the crack problem use was concentrated among young adults, users now are described as in their late twenties and thirties in all areas but Texas. In the case of El Paso, teens are combining cocaine with marijuana, (a practice newly discovered in that area), and often moving from this combination to smoking crack. New York sources report that many of the older, established cocaine dealers are offering what is seen to be a poorer quality of cocaine than the new dealers in the city. Many of these newer dealers also deal in Colombian heroin. Established suppliers are offering a product described by users as "gummy" or having a "bad color," while new sources offer far better quality cocaine. This may signal an attempt by the Colombians to move from a market predominated by cocaine into one that relies on both drugs, or, ultimately, only heroin. Treatment providers continue to present a picture of leveling off of cocaine abuse in most areas of the country. Discussion with fifty-two treatment providers across the country indicates that the number of clients appearing for treatment of cocaine abuse may have stabilized. Over three-fourths of providers in each region report that the number of cocaine abuse clients is unchanged and no one reports an increase. Marijuana Marijuana use remains prevalent. The quality of marijuana varies from location to location, but the varieties available are numerous. Many areas markets offer both locally grown marijuana and marijuana brought in from outside the area. Supply is plentiful in most areas. All but two ethnographic sources (Atlanta and Los Angeles) reported high levels of marijuana use. There appears to be a wide variety of users in most areas, though it is a drug which is particularly popular among teens and young adults. "Blunts," cigar-like marijuana cigarettes --either made entirely of marijuana or with mixtures of marijuana, crack, or PCP -- continue to be popular. On the Texas border, the popular practice of smoking cocaine-laced blunts may also be leading to an increase among teens of smoking crack. In Chicago, a marijuana cigarette laced with both PCP and crack and called "Ozone" was marketed over the summer at $15. The popularity of PCP and marijuana mixtures in some areas is highlighted by the report from Delaware that many teens who report they only use marijuana are surprised when they also test positive for PCP on urinalysis. Trends in Drug Use HEROIN Ethnographers (Table 1) 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 (Table 2) 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 (Table 3) 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. COCAINE Ethnographers (Table 4) Almost all ethnographers report that cocaine use the their areas has stabilized. In Texas, crack has increased slightly along the border and in Atlanta cocaine HCl use has increased while crack has remained stable. In Baltimore, there is considerable cocaine injection in a "speedball" combination with heroin, but less crack use than in other areas. The Baltimore ethnographer explains that "cocaine came late to Baltimore," and suggests that its popularity may not have stabilized yet. In looking at these reports, it is important to bear in mind that in many of these areas cocaine use has leveled off, but at a high point. For example, in Chicago, while crack use has stabilized it is also described as "the most predominant of all drugs, with the most diverse composition of users including all ages, employed people, housewives, etc.". The same sentiments are echoed by a number of other sources. Crack is a serious continuing problem in most areas, but the number of new users and what seemed an almost ever-increasing activity surrounding crack for several years has begun to abate in many areas. For example, several sources note that both crack and cocaine HCl users seem to be an aging group. While in the initial phases of the crack problem use was concentrated among young adults, users now are described as in their late twenties and thirties in all areas but Texas. In the case of El Paso, teens are combining cocaine with marijuana, (a practice newly discovered in that area), and often moving from this combination to smoking crack. Two areas (Baltimore and El Paso) also report an increase in the use of crack by women. Sources in Chicago, El Paso, and Denver again describe various methods of dissolving crack so that it can be injected or ingested through some other method besides smoking. The Chicago ethnographer suggests that this practice may have started as an adjustment to decreased availability of cocaine HCl but gained popularity as users found they could get a more intense high from injecting the dissolved crack. These methods include using lemon juice or vinegar to dissolve the piece of crack, then injecting the solution. One drawback to this technique is the problem the dilutants may cause (abscesses, site infections, pain) if the user misses the target vein and injects into muscle tissue. There is an ethnic distinction between crack and cocaine HCl dealers many areas. Crack is more often dealt by young African Americans or Hispanics and cocaine HCl is more often dealt by Caucasians. Parts of the country also vary significantly as to the availability of pre-made crack versus cocaine in the powder form. In Chicago and Denver, there is little cocaine HCl available and most crack is sold as "ready rock," i.e., already processed. In New Jersey and New York, however, the reverse is true. Many crack users buy cocaine HCl in vials and then "cook up" or process their own crack supply. In Baltimore until recently it was common for cocaine to be available only in powdered form and for "chefs" to be paid for processing it into crack. Crack is now available in an already processed form in that area. New York sources report that many of the older, established dealers are offering what is seen to be a poorer quality of cocaine than the new dealers in the city. Many of these newer dealers also deal in Colombian heroin. Established suppliers are offering a product described by users as "gummy" or having a "bad color," while new sources offer far better quality cocaine. This may signal an attempt by the Colombians to move from a market predominated by cocaine into one that relies on both drugs, or, ultimately, only heroin. The appearance of new dealers has also resulted in considerable expansion in the number of places where cocaine can be purchased. The price of cocaine is fairly low ($60-100/gram for HCl or $3-15/vial for crack), though availability, particularly of cocaine HCl, differs by region. Cocaine HCl is more available in the Northeast, but relatively scarce in Miami and Chicago. There is also substantial variability in the purity or quality of cocaine across the country. Police (Table 5) Of the nine police sources reporting this quarter, all but one reported that cocaine use is stable or decreasing in their areas. One source in Washington State reported that there has been some increase in cocaine use, perhaps related to methamphetamine users switching or "crossing over" to cocaine HCl, due to a decline in the quality of methamphetamine in that area. According to police sources, there is little change in the composition of the generally diverse user group and crack is the most common form of cocaine except in the Northwest, where there is still considerable injection of cocaine HCl. Police report regional differences in the availability of crack and HCl. New York police report little change in price or availability in either, while other areas like the Northwest and Colorado describe some shortages. Prices range from $40 to $150 per gram and purity is variable. Treatment Providers (Table 6) Treatment providers continue to present a picture of leveling off of cocaine abuse in most areas of the country. Discussion with fifty-two treatment providers across the country indicates that the number of clients appearing for treatment of cocaine abuse may have stabilized. Over three-fourths of providers in each region report that the number of cocaine abuse clients is unchanged and no one reports an increase. Most areas report similar profiles of users: they are from all ethnic groups, most often in their twenties or older, and predominantly male. Depending on the region, about a third to a half are new to treatment. With the exception of the Western states (Region 4) where almost a third of clients in treatment for cocaine inject it, most cocaine treatment clients are smoking or inhaling the drug. MARIJUANA Ethnographers (Table 7) All but two ethnographic sources (Atlanta and Los Angeles) reported high levels of marijuana use. There appears to be a wide variety of users in most areas, though it is a drug which is particularly popular among teens and young adults. One New York ethnographer reported that more expensive marijuana is being used by more affluent, older "marijuana connoisseurs" who fancy exotic varieties. The bulk of marijuana available in that area, however, is consumed by younger, less affluent users. A recent New York State high school survey reports that 12 percent of New York teens said that they smoked marijuana at least four times a month, double the number in the 1990 survey. "Blunts," cigar-like marijuana cigarettes--either made entirely of marijuana or with mixtures of marijuana, crack, or PCP --continue to be popular. On the Texas border, the popular practice of smoking cocaine-laced blunts may also be leading to an increase among teens of smoking crack. In Chicago, a marijuana cigarette laced with both PCP and crack and called "Ozone" was marketed over the summer at $15. The popularity of PCP and marijuana mixtures in some areas is highlighted by the report from Delaware that many teens who report they use only marijuana are surprised when they also test positive for PCP on urinalysis. In most areas marijuana is sold by different dealers than those who deal heroin or cocaine. In Connecticut there are even distinctly separate marijuana dealers specializing in distribution to either the inner city or the suburban marijuana users. This is in contrast to the heroin/cocaine market in that city, where suburban dealers drive into the inner city to buy their drug supplies The suburban marijuana dealer is also likely to be offering PCP and LSD and to make their sales through a personal network of users. However, in San Francisco there is an increasing overlap between the heroin, cocaine, and marijuana dealers and the marijuana trade is described as "getting as rough as crack." The marijuana trade is particularly active at the Texas border, where families may be organized to carry on a tradition of marijuana growing and distribution. A study of gang activity conducted by the El Paso ethnographer found that many border area Mexican families permit their teenagers to participate in marijuana distribution, both because of the income it provides and because they have historical ties to hemp growing reaching back more than 50 years. Prices for marijuana vary widely depending on whether it is locally grown or imported. Many local varieties, particularly those grown hydroponically, sensemilla, or new, higher THC strains which have been developed, are more expensive than Mexican marijuana. Regardless of the type, marijuana is available everywhere in small units (bags costing $5 to $10) as well as in larger quantities costing far more. Police (Table 8) With the exception of sources in Cleveland, all police contacts report that marijuana use is stable in their areas and that it is being used by a diverse group, particularly young users. Police describe both local and Mexican or Jamaican sources for marijuana and the same variation in price and purity reported by the ethnographers. One source in Washington State also noted that there are large quantities of marijuana available for sale (as much as 25 pounds) from young dealers in that area. Treatment Providers (Table 9) As with the last quarter's report, only Region I providers report increases in the number of users in treatment with marijuana as their primary drug problem. In all regions, from one-third to one-half of the users in treatment for marijuana abuse are under 20 years old, are predominantly Caucasian, and male. Again, treatment providers often mention that users do not generally come to treatment with marijuana as their primary problem. They are more often polydrug users who present for treatment with a range of drug problems including alcohol, cocaine, and inhalants, as well as marijuana. EMERGING DRUGS This quarter the West, Southwest, and the South there are reports of methamphetamine and ephedrine as emerging drugs. According to DEA sources, Mexican manufacturers and distributors have replaced the outlaw motorcycle groups which had produced methamphetamine supplies for over twenty years. The new manufacturers are producing large quantities of high purity methamphetamine on both sides of the border, drawing on the legal supply of the precursor chemicals on the Mexican side. The price of methamphetamine had dropped significantly (to approximately $3000/pound in Southern California) until recent efforts to curtail ephedrine/pseudoephedrine supplies produced a slight shortage in some areas and a corresponding price increase. In Washington State, sources report that the resultant price increase has caused a number of methamphetamine users in that area to switch to cocaine. One Texas source cited a number of reports of adverse effects of ephedrine and pseudoephedrine, a common substance in a number of over the counter and/or health food products. Ephedrine tablets can be purchased in Mexico and are often seized at the border or in other locations in transit to U.S.-based manufacturers. Some of the ephedrine/pseudoephedrine products readily available in Texas include 40 or 50 milligrams of ephedrine as well as substantial quantities of caffeine. Adverse consequences of their use include agitation, palpitations, and fainting from the stimulant effect. Called "herbal ecstasy" in both Texas and Southern California and touted as "safe" or "legal" MDMA, it is reportedly available from some health food stores or through mail order. Methamphetamine continues to be popular in San Francisco. The ethnographer from that area reports that in addition to its use by young users who combine it with heroin ("a meth speedball") it can also be found in "biker's coffee," a combination of methamphetamine and coffee popular among young, fairly affluent urbanites. This is similar to the population of users described by the Los Angeles source. In that area, users are primarily snorting methamphetamine rather than smoking it as "ice" or injecting it. "Club drugs", a name which generally includes MDMA, Ketamine, 2C-B, LSD, psilocybin, and a range of other hallucinogens, are increasingly mentioned this quarter. We have discussed the appearance of several of these drugs (MDMA, LSD, Ketamine, Rohypnol) in prior Pulse Check reports. 2C-B (4-bromo-2, 5-dimethoxyphenethylamine), one of the earliest of the "club drugs" mentioned in the Northeast area, is now appearing in other parts of the country (the Mid-Atlantic and the South). 2C-B, often called "Nexus," "bromo" or "toonies, "is an illegal synthetic hallucinogen. It was originally sold in adult bookstores, nightclubs and health food stores until it was deemed to have no medical or commercial uses in 1994. Once touted as a "natural" drug by claiming that one of its ingredients (a fictional ingredient called brominated cathinine) was derived from the khat plant, Nexus had attracted a following who view it as a "healthy drug." In fact, the active ingredient is the synthetic 2C-B and this claim was simply a marketing tool. It now has a temporary status as a Schedule I controlled substance. 2C-B is available in capsule or powder and is taken either orally or snorted in 10-20 mg doses. It produces visual effects and euphoria lasting several hours at low doses and hallucinogenic effects similar to LSD at higher doses. APPENDIX A Description of the Sources Ethnographic sources Fifteen ethnographers, epidemiologists, and other ethnographic sources from urban areas were interviewed for this issue of Pulse Check. Ethnography is a qualitative research technique which, unlike highly structured observation methods, observes and records activity "on its own terms," that is, without predetermined ideas about the activity. It is important to understand that ethnography is not undercover work. The ethnographer, a social scientist fully revealed as someone doing research, enters the drug user's world, records and describes it. The ethnographic sources contacted by Pulse Check this quarter include some of the best known drug researchers in the country. In some cases, they are trained ethnographers; in other cases, they are epidemiologists with access to ethnographic information; a few are social researchers working in a field site collecting ethnographic data. For this Pulse Check we have added a new reporter from Baltimore, Maryland. Police sources Police sources are derived from the Abt staff's existing contacts within law enforcement and from contacts developed through the recommendations of law enforcement agencies. These sources are typically officers working on special squads, narcotics task forces, and DEA agents. This round of calls reached police sources in nine cities. Treatment providers The sample of treatment providers is derived from the directory of programs compiled by the National Institute on Drug Abuse (NIDA). We have divided the NIDA listings into four regions. The states comprising each region are listed on the Treatment Provider Summary Tables for each drug (Tables 3, 6, and 9). Each region has a similar number of treatment programs, so the four regions are treated equally for sampling. The original sample based on the 1991 National Drug Abuse Treatment Unit Survey has been refreshed using the more recent files. From each region, 20 to 25 programs are identified and ten are contacted. The remainder serve as replacements. The samples are stratified to include equal numbers of small (under 100 clients) and large programs. This round of calls reached 32 treatment providers.