Trends In Drug Use
Part I: Heroin
The popularity of heroin, which has been high for at least two years, has risen in Connecticut, Georgia, Colorado, Delaware, Maryland, parts of Texas (Houston/Austin), and Northern California. Ethnographers report that heroinžs popularity is beginning to stabilize, albeit at a high level, in New York, New Jersey, Washington, D.C., Southern California, and along the Texas border.
As in previous issues of Pulse Check, reporters in Florida find that there is a relatively low incidence of heroin use. However, sources report that Customs and law enforcement officials seize large amounts of heroin at airports, in the mails, and in warehouses. Clearly, most of these supplies are intended for other cities. The Miami source notes that some heroin is making its way into local markets, particularly in the southern part of the state, since there has been a marked increase in recent heroin related deaths.
The appearance of new, young heroin users continues in many areas of the country. Eight of the seventeen sources report that many heroin users are in their late teens and early twenties. In areas where high purity heroin is available (New York, New Jersey, Connecticut, Delaware, Maryland), new users are likely to inhale, rather than inject the drug. The ethnographer from Baltimore noted that many young users are "second generation"teenage/young adult children of an older cohort of heroin users. In addition, there are increases in two types of older users: older methadone clients ("old timers") returning to heroin use (Georgia) and low dose methadone clients who use heroin as well (Colorado). Some areas also report the presence of crack users who have switched to heroin (Georgia). In areas where lower purity black tar heroin is common (Colorado, Florida, Texas, Southern California), the majority of users are still older injectors. Sources in Washington, D.C. and Delaware report an increase in fIale heroin users.
In many areas, heroin users combine heroin with cocaine powder (HCl) or with crack and inject the mix. This practice is known as "speedballing." Heroin inhalers, in particular, often choose to use heroin and crack simultaneously. In California, where methamphetamine is plentiful, speedballing a mix of heroin and methamphetamine, through both injection and inhalation, is increasing in popularity. In addition to methamphetamine, sources report that the use of MDMA and Rohypnol is increasing in the heroin community. Some sources report that heroin is used in combination with alcohol (Washington, D.C., Colorado, New Jersey).
For the first time, in some areas (Colorado, Maryland), reporters mention a growing market for methadone. Methadone, which is used to treat heroin addiction, has always had some black market value, but it is rarely a primary drug of abuse. An ethnographer in Baltimore commented on the increased presence of methadone in that area: "People are using it for habit management when their habit is out of control -- not as the drug of choice." However, with more heroin users becoming addicted due to increased availability of high purity heroin, the use of illegally diverted methadone may indeed become more of a choice; that is, addicts may turn to street methadone to help deal with or reduce their heroin habit.
Notably, ethnographers report significant changes in the distribution market for heroin in some areas, particularly those where high purity heroin has been available for some time. In the past, street level markets have operated as separate entities for trade in heroin and trade in cocaine/crack. Recently, however, dealers are selling both drugs in joint sales markets. This practice is referred to in some areas as "double breasted dealing" or "one on one" sales. While this may not seI surprising, it is anomalous for street sales in most of the country. Street dealers for heroin and cocaine/crack in New York, for example, have traditionally operated "on their own corners," selling to different clientele. However, there has been an increase in joint sales in New York, which may stem from pressure put on middle and lower-level cocaine/crack dealers to sell bags of heroin. As "one on one" sales become more prevalent, market borders are blurring. These developments are discussed in greater detail in a section devoted specifically to the heroin trade at the end of this report.
Sources report a wide variety of street level dealers, including Hispanics (Texas, California, Colorado), Whites (Georgia), and African Americans (California, Georgia). Sellers are usually males in their twenties, and some belong to gangs. In Austin, sources report that West Africans sell Southeast Asian heroin, while Hispanics sell Mexican heroin.
Prices of heroin remain stable. At the street level, heroin is sold in $5, $10 and $15 bags that contain approximately 1/8 ounce of heroin and adulterant. Sources in California and Colorado report slightly higher prices. One notable exception is in Baltimore, where prices have dropped significantly since the last Pulse Check. In fact, the Baltimore ethnographer comments that "it is hard to imagine prices falling any lower, and there is no size or purity difference between a $6 and a $10 capsulejust the time of day the sale is made." Purchase amounts vary somewhat; heroin is sold in glassine bags, capsules or "pills," or balloons. Purity varies as well; in many areas it is high (over 50% in Connecticut, New York, New Jersey, Washington, D.C., Maryland) and in others it is quite poor (Texas, Florida).
Of the ten police sources contacted, six report that heroin use is increasing in their areas. Like the ethnographers, police report that heroin use is concentrated in older, urban populations. However, there are signs that use is increasing in younger, middle income suburban populations in several areas (Colorado, Washington, D.C., Massachusetts, Maryland). Colorado and Oregon law enforcement sources both note increased sales of heroin to working and middle class white males. Maryland State Police concur that heroin's popularity is rising as evidenced by an increase in the number of times it is found in cars during highway stops.
According to police sources, middle to upper-level heroin distributors vary across regions. In the West and along the Southwest border, Mexican nationals are sources for large quantities of heroin. In other areas, source dealers include Pakistanis, Lebanese, Nigerians, Dominicans, and Colombians. As is discussed later in this report, law enforcement sources in New York, Maryland, Massachusetts, and Washington, D.C. report an increase in cocaine traffickers and dealers who add heroin to their product line. These sources report that there is more South American heroin in their areas. In addition, sources report that street-level dealers and the neighborhoods where they sell have similar dIographic characteristics.
Prices vary according to the type of the heroin. Sources in Denver state that high quality Mexican black tar heroin sells for $600$800/gram, while prices for heroin powder in most areas is as low as $100$200/gram. Highly adulterated (poorer quality) heroin, most often destined for injectors, can sell for as low as $65$70/gram according to the Maryland State Police, a price consistent with the Baltimore ethnographer's comment that "it can't drop any lower!" Purity varies across sites; it is generally above 50 percent except for small sales at the street level.
Over half of the treatment providers surveyed report that the number of clients who enter treatment with heroin as their primary drug problem rIains stable (between 726%). However, in the Mid-Atlantic and Southern states (Region II), a substantial number of treatment providers (38%) report increases in heroin clients. In the West (Region IV), thirty percent of respondents state that the number of clients entering treatment with heroin as their primary drug of abuse is decreasing. This may be related to the substantial rise in clients dIanding methamphetamine treatment in this region, which is discussed in the section on Emerging drugs.
The majority of people in treatment for heroin addiction are older, experienced drug users. In all regions, 65 percent or over are in their thirties, and over 70 percent of them have been in drug treatment before. While several providers said they noticed more women in treatment, males still outnumber fIales two to one. One provider in a large New York methadone program commented that the increase in fIale addicts is placing a decided strain on resources, because it adds more complicated service needs related to pregnancy and child care. Two programs (California and Washington, D.C.) report that they are enrolling more working class and middle class heroin users.
The proportion of clients injecting versus inhaling increased in this round of interviews. Last winter, treatment providers in the Northeast and in the Mid-Atlantic and Southern states (Regions I and II) reported a fairly even split between clients who inhaled and clients who injected heroin. In contrast, providers in most areas now report approximately a three-fourths/one-fourth split favoring injection. Though the bias towards injection has been reported previously in the South and the West, in the Northeast, the number of heroin inhalers entering treatment had been growing, not shrinking. However, providers of large treatment programs in both Newark and Baltimore now report that 75 percent of their clientele are injecting. Injection is not limited to inner city users; providers in suburban California, Georgia, and North Carolina report that the number of working class addicts who inject is rising.
The return of high proportions of injectors entering treatment does not imply that inhaling heroin was a fad. More likely, it indicates that inhalation is a transition phase that changes to injection when addiction is established. Providers state that while there may be more new young users experimenting with inhalation, most heroin users are older addicts or returning users who still prefer to inject.