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 <EM>Pulse Check</EM> 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.