PULSE CHECK

Trends in Drug Abuse

November 2001

Executive Office of the President

Office of National Drug Control Policy

Washington, DC 20503

NCJ 191248
ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS

The Office of National Drug Control Policy (ONDCP) acknowledges the contributions made by the 83 Pulse

Check sources who voluntarily prepared for and participated in the in-depth discussions that are the basis for

this report. Their names (unless they requested anonymity) appear in an appendix. Information presented in

this publication reflects the views of those sources, and not necessarily those of the Federal Government.

Marcia Meth and Rebecca Chalmers of Johnson, Bassin & Shaw, Inc., produce the Pulse Check for ONDCP,

under Contract Number 282-98-0011, Task Order Number 10. Anne McDonald Pritchett, Office of Programs,

Budget, Research, and Evaluation, ONDCP, serves as the project director and editor for Pulse Check.

All material in this publication is in the public domain and may be reproduced or copied without permission

from ONDCP. Citation of the source is appreciated. The U.S. Government does not endorse or favor any specific commercial product. Trade or proprietary names appearing in this publication are used only because they

are considered essential in the context of the information reported.

This issue and previous issues of Pulse Check are available online at <www.whitehousedrugpolicy.gov>. 
CONTENTS

Pulse Check: November 2001 page iii

CONTENTS

Highlights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Heroin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Crack Cocaine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Powder Cocaine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Marijuana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Methamphetamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Ecstasy and Other Club Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Special Topic: Synthetic Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Appendix 1: Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Appendix 2: Population Demographics in the 21 Pulse Check Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Appendix 3: National-Level Data Sources Available in the 21 Pulse Check Sites . . . . . . . . . . . . . . . . . 101

Appendix 4: Pulse Check Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Appendix 5: List of Discussion Areas by Source Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

EXHIBITS

Highlights

Exhibit 1. How serious is the perceived drug problem in the 21 Pulse Check communities? . . . . . . . . . . . . . . . . . . . . . 1

Exhibit 2. How has the perceived drug problem changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . .1

Exhibit 3. What new problems have emerged or intensified during spring 2001? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Exhibit 4. How has the perceived drug problem changed (fall 2000 vs spring 2001)?. . . . . . . . . . . . . . . . . . . . . . . . . . 3

Exhibit 5. What are the most serious drug problems in the 21 Pulse Check sites, by type of source? . . . . . . . . . . . . . . . 4

Exhibit 6. What are the most serious drug problems in the 21 Pulse Check sites, by number of sources and sites? . . . . . 4

Heroin

Exhibit 1. How available is heroin across the 21 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Exhibit 2. How has heroin availability changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Exhibit 3. How available are the different varieties of heroin? 

How has their availability changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
CONTENTS

page iv Pulse Check: November 2001

Exhibit 4. What are the prices and purity levels of different types of heroin in 18 Pulse Check cities? 

How have prices and purity changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Exhibit 5. How is heroin referred to, and what types of heroin predominate, in different regions of the country? . . . .12

Exhibit 6. How likely are heroin sellers to use their own drug? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Exhibit 7. Where is street-level heroin sold and used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Exhibit 8. What other drugs do heroin dealers sell? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Exhibit 9. What demographic groups predominate among heroin users, according to different Pulse Check sources? . .19

Exhibit 10. How do users administer heroin? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Exhibit 11. How has heroin use impacted the health of users? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Crack Cocaine

Exhibit 1. How available is crack cocaine across the 21 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Exhibit 2. How has crack cocaine availability changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Exhibit 3. How much does crack cocaine cost in 19 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Exhibit 4. How is crack cocaine referred to across different regions of the country? . . . . . . . . . . . . . . . . . . . . . . . . .31

Exhibit 5. What other drugs do crack dealers sell? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Exhibit 6. How likely are crack sellers to use their own drug? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Exhibit 7. Where is street-level crack sold and used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Exhibit 8. What age group is most likely to use crack? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Exhibit 9. Which genders are the predominant users of specific drugs in the 21 Pulse Check cities? . . . . . . . . . . . . . .38

Exhibit 10. What racial/ethnic group is most likely to use crack? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Powder Cocaine

Exhibit 1. How available is powder cocaine across the 21 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

Exhibit 2. How has powder cocaine availability changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . .44

Exhibit 3. How much do grams and "eight-balls" of powder cocaine cost in 17 Pulse Check cities? . . . . . . . . . . . . . . .44

Exhibit 4. How is powder cocaine referred to across different regions of the country? . . . . . . . . . . . . . . . . . . . . . . . .45

Exhibit 5. What other drugs do powder cocaine dealers sell? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46

Exhibit 6. Where is street-level powder cocaine sold and used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

Exhibit 7. What racial/ethnic group is most likely to use specific drugs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Exhibit 8. What is the predominant socioeconomic status of powder cocaine users? . . . . . . . . . . . . . . . . . . . . . . . . . .51

Marijuana

Exhibit 1. How available is marijuana across the 21 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Exhibit 2. What varieties of marijuana are described as “widely” or “somewhat” available 

across the 21 Pulse Check cities? How has availability changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . .56

Exhibit 3. How has marijuana availability changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

Exhibit 4. How much does marijuana cost in 19 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Exhibit 5. How is marijuana referred to in different regions of the country? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Exhibit 6. What age group is most likely to use marijuana? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Exhibit 7. Where are drug users most likely to reside? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
CONTENTS

Pulse Check: November 2001 page v

Exhibit 8. How are different drug users referred to treatment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Exhibit 9. What are some slang terms for drug combinations involving marijuana? . . . . . . . . . . . . . . . . . . . . . . . . . .65

Methamphetamine

Exhibit 1. How available is methamphetamine across the 21 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

Exhibit 2. How has methamphetamine availability changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . .68

Exhibit 3. How much does methamphetamine cost in 16 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Exhibit 4. How is methamphetamine referred to in different regions of the country? . . . . . . . . . . . . . . . . . . . . . . . . .69

Exhibit 5. In what other crimes are illicit drug sellers involved, by different drugs, across Pulse Check sites? . . . . . . . .71

Exhibit 6. Where is methamphetamine sold and used across 18 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . .71

Exhibit 7. What age group is most likely to use methamphetamine? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Club Drugs

Exhibit 1. Where are club drugs emerging? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Exhibit 2. How available is club drugs across the 21 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

Exhibit 3. Has club drug availability changed across the 21 Pulse Check cities (fall 2000 vs spring 2001)? . . . . . . . . . .77

Exhibit 4. How are ecstasy and ecstasy combinations referred to across Pulse Check cities? . . . . . . . . . . . . . . . . . . . .78

Exhibit 5. How are ecstasy pills labeled in reporting Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Exhibit 6. How much does a pill (one dose) of ecstasy cost in 17 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . .79

Exhibit 7. What other substances might be contained in ecstasy tablets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Exhibit 8. Where is ecstasy sold and used across the 21 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

Exhibit 9. Has the number of novice ecstasy users in treatment changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . .84

Exhibit 10. How much do GHB, ketamine and Rohypnol cost? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86

Exhibit 11. What are the predominant characteristics of club drug sellers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88

Exhibit 12 What are the predominant characteristics of club drug users? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88

Synthetic Opioids

Exhibit 1. How much of a problem is OxyContin® diversion and abused, by U.S. Region? . . . . . . . . . . . . . . . . . . . .90

Exhibit 2. How has the perceived OxyContin® problem changed since the last reporting period, by U.S. region? . . . .90

Exhibit 3. How serious a problem is OxyContin® diversion and abuse in Pulse Check cities and how

has the problem changed (fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

Exhibit 4. Where is OxyContin® emerging? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92

Exhibit 5. How available is diverted OxyContin® in 17 Pulse Check cities, and how has availability changed 

(fall 2000 vs spring 2001)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92

Exhibit 6. How is diverted OxyContin® referred to in Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93

Exhibit 7. What are the most commonly sold units of diverted OxyContin®? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94

Exhibit 8. Where is diverted OxyContin® sold and abused across 17 Pulse Check cities? . . . . . . . . . . . . . . . . . . . . . .95

Exhibit 9. How has the number of novice OxyContin® treatment clients changed (fall 2000 vs spring 2001)? . . . . . .96

Exhibit 10. Who abuses OxyContin®, according to epidemiologic and ethnographic respondents? . . . . . . . . . . . . . . .98

Exhibit 11. Who abuses OxyContin®, according to methadone and non-methadone treatment respondents? . . . . . . .98
page vi Pulse Check: November 2001

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HIGHLIGHTS

Pulse Check: November 2001 page 1

PULSE CHECK HIGHLIGHTS

The situation is characterized by several key features:

➤ Diversion and abuse of OxyContin®, a high-dose formulation of the pharmaceutical opiate oxycodone, is the latest and most rapidly emerging problem.

(Exhibits 3 and 4)

➤ Heroin and crack are both equally associated with more serious 

consequences than any other illicit drugs, as reported in 14 Pulse Check sites

each. (Exhibits 5 and 6)

➤ Marijuana remains the most widely abused illicit drug, as reported in 19

sites. (Exhibits 5 and 6)

➤ The emerging problem of "ecstasy" (methylenedioxymethamphetamine, or

MDMA) and, to a lesser extent, other club drug use continues to intensify.

(Exhibit 4)

➤ Methamphetamine continues to be reported as an emerging problem in 

some areas. (Exhibit 4)

Pulse Check sources asked about 

synthetic opiates reported the diversion and abuse of the prescription

pain reliever OxyContin® as the

emerging drug problem in their sites:

" Nearly all law enforcement

sources report increased availability of diverted OxyContin®,

with sources in the Northeast 

generally reporting higher 

availability than elsewhere.

" Although in most cities OxyContin® abusers are predominantly young adults (18–30 years) or

adults (older than 30), adolescent

(13–17 years) users are emerging in

a few cities, such as Portland (ME)

and Miami. Similarly, sources in six

cities (in Billings, Boston, Detroit,

Miami, Portland, and St. Louis) 

report OxyContin® abuse specifically among adolescents who have

not used opiates previously. 

" OxyContin® abuse and diverted

sales are emerging in the rave and

nightclub scene in Billings, Boston,

Miami, New Orleans, Philadelphia,

and St. Louis. 

" While the media often refer to

diverted OxyContin® as "hillbilly

heroin," its use is not isolated to

rural areas. For example, in

Baltimore, Philadelphia, and

Washington, DC, abusers reside

primarily in central city areas; in

Birmingham, Detroit, and Memphis,

they reside in rural areas and the

suburbs; and in Columbia (SC) and

Miami, they reside predominantly in

the suburbs. 

This report is based on discussions with 83 epidemiologists, ethnographers, law enforcement officials, and methadone and

non-methadone treatment providers from 21 Pulse Check sites. Telephone discussions with these individuals, conducted

between May and July 2001, reveal that overall, when comparing spring 2001 with fall 2000, the majority of Pulse Check

sources consider the drug problem to be very serious but stable. (Exhibits 1 and 2)

Exhibit 2.

How has the perceived drug

problem changed (fall 2000 vs

spring 2001)?

Sources: Epidemiologic, ethnographic, 

treatment, and law enforcement respondents

Somewhat

Worse

Much

Worse

Less

Serious

Percent (N=83)

Same

100

90

80

70

60

50

40

30

20

10

0

Exhibit 1.

How serious is the perceived

drug problem in the 21 Pulse

Check communities?

Sources: Epidemiologic, ethnographic, 

treatment, and law enforcement respondents

Somewhat

Serious 

Very

Serious

Not Very

Serious

Percent (N=83) 100

90

80

70

60

50

40

30

20

10

0

HIGHLIGHTS FROM THE SPECIAL SECTION TOPIC: Synthetic Opiates
" Since the last reporting period,

OxyContin® diversion has 

intensified. For example, in

Portland (ME), armed robberies of

pharmacies for OxyContin® and

home invasions of clients who

have legitimately filled prescriptions have increased. In Miami,

dealers recruit patients from 

substance abuse treatment 

facilities, drive them to doctors

who prescribe the drug, have the

prescriptions filled, then sell the 

pills illegally.

HIGHLIGHTS BY SPECIFIC 

ILLICIT DRUG

The 83 discussions also yielded key

findings about heroin, crack cocaine,

powder cocaine, marijuana, methamphetamine, and club drugs:

HEROIN

" Heroin availability remains generally stable at high levels, with only a

few increases and no declines

reported. High-purity, snortable

South American (Colombian) white

heroin is the most commonly cited 

type, followed by lower purity,

injectable Mexican black tar, which

predominates in the West and in

some parts of the South.

" Street-level prices and purity are

generally stable—at low and high

levels, respectively—with a few exceptions, such as a price drop in El

Paso and an increase in Baltimore.

" Young adults (18–30 years) are

increasingly using heroin in the

majority of Pulse Check sites,

accor-ding to epidemiologic and

ethnographic sources. The number

of novice heroin users (any drug

treatment client who has recently

begun using heroin) has increased

in programs across nine Pulse

Check sites.

" Heroin use is spreading to 

suburban areas surrounding five

Pulse Check sites: Baltimore,

Memphis, Miami, and Washington, DC, in the South; and Seattle

in the West. Use is also spreading

to the rural areas surrounding

Portland (ME) and El Paso.

" Injecting remains the most 

common route of heroin administration. Snorting, however, either

equals or surpasses injecting in

nine Pulse Check sites, and it has

increased in six sites: Columbia

(SC), Denver, El Paso, Miami,

New Orleans, Philadelphia, and

Washington, DC. New and

younger users tend to snort 

rather than inject.

" "Speedballs" containing heroin 

plus crack (as opposed to powder

cocaine) have increased in El Paso

and Los Angeles. Reports of heroin

combined with ecstasy have

increased in three southern Pulse

Check sites: Birmingham, Memphis,

and Miami.

HIGHLIGHTS

page 2 Pulse Check: November 2001

Exhibit 3.

What new problems have emerged or intensified during spring 2001?

OxyContin® Ecstasy/Club Drugs Methamphetamine

Baltimore, MDE,N

Billings, MTL,N

Birmingham, ALL,N,M

Boston, MAL,E,M

Columbia, SCE

Denver, COM

Detroit, MIE

Miami, FLL,E,N

Honolulu, HIM

Philadelphia, PAL,E,N,M

Portland, MEL,E,N

New Orleans, LAL,N,M

St. Louis, MOE,M

Washington, DCE,M

Baltimore, MDL

Boston, MAL,N

Columbia, SCN,M

Denver, COL,E,N

Detroit, MIL

El Paso, TXE

Honolulu, HIL,E,N

Los Angeles, CAL,E

Memphis, TNE,N

New York, NYE

Philadelphia, PAN,E

Portland, MEL

Seattle, WAN

St. Louis, MOE

Sioux Falls, SDL,E

Columbia, SCL

Detroit, MIE

El Paso, TXN

Memphis, TNL

St. Louis, MOE

Sioux Falls, SDN

Seattle, WAL

Washington, DCL

Other Emerging Drug Problems

Clonidine (Catapres®): Chicago, ILM

"Devil's trumpet" herbal: Honolulu, HIE

Dextromethorphan (DXM): Washington, DCE

Diphenhydramine (Benadryl®): Portland, MEM

Hydromorphone (Dilaudid®): Memphis, TNE

Marigolds, Khat: Boston, MAL

Marijuana + Methamphetamine: Sioux Falls, SDN

Marijuana + Cocaine or Heroin: El Paso, TXM

PCP: New York, NYN

"Red ferrari" (designer amphetamine): Los Angeles, CAN

White heroin: Honolulu, HIE

L

Law enforcement respondents EEpidemiologic/ethnographic respondents NNon-methadone treatment respondents MMethadone treatment respondents
CRACK COCAINE

" Crack remains widely available in

the majority of Pulse Check sites,

with few changes in availability or

price. The crack sales scene has

remained relatively stable, with

only a few isolated changes,

including the following:

➤ Younger crack sellers are increasingly reported in the South.

➤ Electronic equipment, such as

cell phones and beepers, continue to be increasingly involved in

sales. As a result, sales are moving indoors in some cities, and

crack houses are becoming less

prominent in others.

➤ Gangs have recently started 

taking over sales in New York.

➤ Sales in the Denver area are

starting to take place in the

suburbs.

" Females are equally or more likely

than males to use crack in many

cities, more so than any other 

illicit drug except ecstasy, 

according to epidemiologic and

ethnographic sources. 

" While crack is nearly always

smoked, increased crack injection

is reported in Baltimore and

Washington, DC.

POWDER COCAINE

" Powder cocaine remains widely

available, with few changes in

price or purity. El Paso, however,

is one exception: powder cocaine

and heroin are now cheaper and

more abundant on the American

side of the border than on the

Mexican side.

" Availability and purity levels are

particularly high in New York.

" Powder cocaine users often 

resemble heroin users, rather than

crack users. For example, they are

more likely to be male, rather than

female, and White, rather than

Black.

" Young adults and, in some cases,

adolescents are increasingly using

powder cocaine in five sites:

Birmingham, Detroit, Los Angeles,

Sioux Falls, and Washington, DC.

" In some sites, such as Washington,

DC, powder cocaine use is 

increasing among White middle

socioeconomic suburbanites—

sometimes in nightclubs, bars, and

private parties. 

" Powder cocaine sellers in New York

have recently added ecstasy to the

many other drugs they sell. In Los

Angeles, powder cocaine plus 

ecstasy is a recent combination.

MARIJUANA

" Marijuana availability continues to

be wide and stable in nearly every

Pulse Check site. However, 

hydroponically grown marijuana

availability is increasing in several

cities, including Chicago, Miami,

St. Louis, and Washington, DC.

" Young adult (18–30 years) user

groups are increasing in several

cities: Detroit, Los Angeles, and

Memphis.

" Compared with heroin, crack, and

powder cocaine users, who tend to

reside predominantly in central

city areas, marijuana users reside in

all areas (central, suburban, and

rural), reflecting the pervasiveness

of marijuana use.

" More than 80 percent of nonmethadone treatment sources

report that marijuana users are

referred to treatment by the criminal justice system, an increase from

the last reporting period. Criminal

justice referrals involving heroin

and crack have also increased dramatically. The next Pulse Check will

continue to monitor this trend.

METHAMPHETAMINE

" Methamphetamine continues to be

more widely available in the West

than in other U.S. regions. Moreover, half of western sources

report increasing availability.

Exhibit 4.

How has the perceived drug problem changed (fall 2000 vs spring 2001)? 

HIGHLIGHTS

Pulse Check: November 2001 page 3

Where has the drug with "the most 

serious consequences" changed?

Site/Source Fall 2000 Spring 2001

El PasoE Heroin Crack

MiamiE Heroin OxyContin®

New OrleansM Heroin OxyContin®

MemphisN Crack Powder

cocaine

PortlandL Powder Pharmaceucocaine tical opiates

Where has "the most commonly abused

drug" changed?

Site/Source Fall 2000 Spring 2001

New YorkM Crack Heroin

PortlandL Powder Heroin and

cocaine pharmaceutical opiates

MemphisN Powder Crack

cocaine

L

Law enforcement respondents EEpidemiologic/ethnographic respondents NNon-methadone treatment respondents MMethadone treatment respondents
HIGHLIGHTS

page 4 Pulse Check: November 2001

" Methamphetamine is considered

the most widely used drug in two

western Pulse Check cities: Billings

and Honolulu. It is reported as

the drug contributing to the most

serious consequences by 13 sources

in 4 cities: Billings, Denver, Honolulu, and Sioux Falls. 

" Most sources link methamphetamine sellers to domestic violence,

much more so than any other 

illicit drug sellers.

CLUB DRUGS

" Ecstasy continues to be the most

available club drug (more than 90

percent of law enforcement, epidemiologic, and ethnographic

sources report it as widely or

somewhat available), followed by

gamma hydroxybutyrate (GHB),

ketamine, and flunitrazepam

(Rohypnol). Ecstasy availability

continues to increase in most sites,

while GHB, ketamine, and

Rohypnol availability is stable. 

" Ecstasy is reported as an emerging

drug of abuse in 15 sites.

" Ecstasy seller and user populations

continue to expand to include 

various ethnic sellers in the Northeast, Black sellers in the South,

adolescent users across the country,

and non-White and Hispanic users

in some southern and western

cities. Ecstasy sale and use settings

also continue to expand from

raves, concerts, nightclubs, and

bars to streets, private residences,

and private parties.

" Drugs sold and used with ecstasy

are expanding from marijuana and

other club drugs to heroin and

powder and crack cocaine. 

Exhibit 6.

What are the most serious drug problems in the 21Pulse Check sites, by

number of sources and sites?

Drug Most commonly abused?* Most serious consequences?

No. of sources No. of sites No. of sources No. of sites

Heroin 6 5 24 14

Crack 20 14 29 14

Powder cocaine 1 1 2 1

Marijuana 30 19 1 1

Methamphetamine 3 2 13 4

Pharmaceutical opiates 1 1 3 3

Benzodiazepines 1 1 3 3

Alcohol 2 2 2 2

*Methadone treatment sources are excluded from this count.

Sources: Law enforcement, epidemiologic/ethnographic, non-methadone treatment, and

methadone treatment respondents

Exhibit 5.

What are the most serious drug problems in the 21 Pulse Check sites, by

type of source?*

Most commonly abused?* Most serious consequences?

City L E N L E N M 

Boston, MA HCl MJ H Crack Crack H Cocaine+ 

Alcohol

New York, NY MJ MJ Crack H Crack Crack Crack

Philadelphia, PA MJ MJ H H H H+Crack H

Portland, ME H/Pharm. MJ Crack Pharm. H H Benzos

Opiates opiates

Baltimore, MD H H Crack H H Crack+H NR

Birmingham, AL Crack MJ Crack Crack Crack Crack Any IV 

drugs

Columbia, SC MJ Crack MJ Crack Crack Alcohol H

El Paso, TX MJ MJ Crack NR Crack H H

Memphis, TN Crack MJ MJ Crack Crack HCl NR

Miami, FL Crack MJ Crack Crack Oxy Crack NR

New Orleans, LA MJ Crack Crack Crack Crack Crack Oxy

Washington, DC Crack Cocaine Crack MJ H Crack H

Chicago, IL Crack MJ Crack Crack Crack Crack H

Detroit, MI MJ MJ Crack Crack H Crack H

St. Louis, MO MJ MJ NR Crack Crack Crack H

Sioux Falls, SD MJ MJ MJ Meth Meth Meth Meth

Billings, MT Meth MJ Alcohol Meth Meth Meth NR

Denver, CO MJ MJ Crack HCl HCl Meth MJ

+HCl

Honolulu, HI MJ Meth MJ Meth Meth Meth Benzos + 

Meth

Los Angeles, CA Crack MJ MJ Crack H Meth H

Seattle, WA MJ H MJ H H Cocaine Benzos

West South Northeast Midwest

*Heroin is almost always, by definition, the most commonly used drug in methadone programs, 

so methadone treatment sources are excluded from this question.

Note: HCl = Powder cocaine; MJ = Marijuana; H = Heroin; Meth = Methamphetamine; 

Benzos = Benzodiazepines; Oxy = OxyContin® L

Law enforcement respondents EEpidemiologic/ethnographic respondents NNon-methadone treatment respondents MMethadone treatment respondents
INTRODUCTION

Pulse Check: November 2001 page 5

INTRODUCTION

Since 1992, the Office of National

Drug Control Policy (ONDCP) has

published the Pulse Check, a source

for timely information on drug abuse

and drug markets. The report aims to

describe hardcore drug-abusing populations, emerging drugs, new routes

of administration, varying use patterns, changing demand for treatment, drug-related criminal activity,

and shifts in supply and distribution

patterns. Pulse

Check regularly

addresses five drugs

of serious concern:

cocaine, marijuana,

heroin, methamphetamine, and—as

of the last issue—

“ecstasy” (methylenedioxymethamphetamine, or

MDMA) and other

club drugs.

Additionally, the

current issue provides information

on an emerging

problem: diversion

and abuse of OxyContin®, a high-dose formulation of

the pharmaceutical opiate oxycodone.

The Pulse Check is not designed to be

used as a law enforcement tool but

rather to be a research report presenting findings on drug use patterns and

drug markets as reported by ethnographers, epidemiologists, treatment

providers, and law enforcement officials. With regards to race and ethnicity, just as the National Household

Survey on Drug Abuse and other

national data sources report findings

by race and ethnicity, sources contributing to the Pulse Check are asked

to describe the age, ethnicity, and

gender of illegal drug users and those

who sell drugs and any changes in

these characteristics. The information

provided to Pulse Check reflects the

observations of the sources, and their

descriptions are purely for determining the size, scope, and diversity of

the drug problem. The intent of the

Pulse Check has been and continues

to be merely to describe patterns in

illicit drug use and illicit drug markets

that are emerging in local communities.

Enhancements to Pulse Check

The current Pulse Check issue

includes two changes over the previous issue, reflecting ONDCP’s ongoing effort to enhance the project and

keep up with the changing nature of

the Nation’s drug abuse situation.

First, due to particular concerns

about the drug abuse situation in

Baltimore, MD, that city was added

to the list of Pulse Check sites, bringing the total to 21 geographically

diverse cities—highlighted on the

map above—spread across the four

Census regions and representing both

rural and urban areas. Second, to

ensure regular reporting, any treatment provider who was unavailable

to participate was replaced via 

purposeful selection, in consultation

with experts in the field, rather than

the random selection that was used in

the past. 

Use and Interpretation of Pulse

Check Information

By contacting professionals from

three different disciplines—ethnography/epidemiology,

law enforcement,

and treatment—a

rich picture of the

changing drug abuse

situation emerges.

Though this

approach offers substantial strengths in

timeliness and depth,

Pulse Check is not a

measure of the

prevalence of drug

abuse or its consequences. As an anecdotal source of information, any interpretation or conclusion

drawn from Pulse

Check must be viewed carefully and

in conjunction with other more quantifiable direct and indirect measures

of the drug abuse problem.

More specifically, several of the 

limitations of Pulse Check are briefly

discussed below.

" Pulse Check is limited to a report

on the drug abuse situation in 21

specific sites throughout the

Nation. Though considerable

effort was made to select sites

across a broad range of geographic

areas, including Census regions

The 21 Pulse Check Sites
INTRODUCTION

page 6 Pulse Check: November 2001

and divisions, urban and rural

States, racial/ethnic coverage, and

high intensity drug trafficking

areas, Pulse Check cannot be

viewed as a national study, and

information cannot be reasonably

aggregated up to a national level.

" Of the 85 sources identified and

recruited across the three disciplines, 83 provided information

for this Pulse Check issue. The

information presented in this

report is based solely on the observations and perceptions of those

83 individuals. These individuals

may not be knowledgeable about

every aspect of the drug abuse 

situation in their sites, and they

may have biases based on their

experiences and exposures.

" Due to the comprehensive nature

of the telephone discussions,

sources were asked to discuss only

areas in which they were thoroughly knowledgeable. Thus, the

total number (N) of respondents to

any one question might be less

than 83.

Any contradictory reports within an

individual site are not necessarily a

Pulse Check limitation. Just as the site

sampling methodology was designed

to reflect the country’s geographic

and population diversity, recruiting

four sources per site was incorporated

into the design to reflect diversity

within each of the 21 sites. For example, a law enforcement source in one

site might perceive cocaine to be the

community’s most serious problem,

while an ethnographic source at that

same site might consider the most

serious problem to be heroin. And

they would both be right—because

each might come in contact with 

different populations or each might

deal with a specific geographic 

neighborhood. 

Information from treatment sources is

particularly susceptible to variance

because some facilities target specific

populations. Furthermore, treatment

providers from methadone and nonmethadone programs are likely to

have very different perspectives on

their communities’ drug problems

because their respective clientele 

differ in the nature of their drug

problems and in their demographic

characteristics. It is for this reason

that two treatment sources were

selected from each of the 21 sites—

one from a methadone program, and

one from a non-methadone program.

Taken together, all four sources at

each site provide a richer picture of

the drug problem’s nature. 

Current Sources and Reporting

Periods

The current report includes information gathered during May through

July 2001 from telephone conversations with 83 sources, representing 21

sites across the various regions of the

country. These individuals discussed

their perceptions of the drug abuse

situation as it was during the spring

months of 2001 and in comparison 

to a period 6 months earlier, during

fall 2000.

The law enforcement sources who

provided information include 21 

narcotics officers from local police

departments, field office agents of the

Drug Enforcement Administration

(DEA), and representatives of High

Intensity Drug Trafficking Areas

(HIDTAs). The epidemiologists and

ethnographers are 21 researchers

associated either with local health

departments, university-based

research groups, or other community

health organizations. Some of those

21 individuals are qualitative

researchers who employ ethnographic

techniques to obtain observational

data directly from the drug user’s

world; others are epidemiologists

who access both qualitative and 

quantitative data. The treatment

sources are 41 providers from 23

non-methadone programs and 18

methadone programs across the 21

sites. Those providers include two

non-methadone sources each from

Billings and Sioux Falls because those

cities do not have methadone programs. They also include two methadone sources from Boston, both of

whom were available to contribute

information. They do not include two

methadone sources from Baltimore

and Memphis, who were unable to

participate in this round of discussions.

These sources offer a wealth of 

information that, when taken together,

provides a comprehensive snapshot of

drug abuse patterns in communities

across the country. Further, these

individuals provide expertise that can

alert policy makers to any short-term

changes or newly emerging problems

concerning specific drugs, drug users,

and drug sellers.

The appendices at the end of this

report provide a list of these sources,

describe the methodology used to

select them, and discuss the content

of the approximately 1-hour 

conversations held with them. 
HEROIN

Pulse Check: November 2001 page 7

HEROIN: THE PERCEPTION

How do Pulse Check sources perceive the heroin problem in their

communities? Excluding sources

associated with methadone programs,

where heroin is by definition the most

commonly used drug, only six sources

in five cities consider heroin as their

communities’ most commonly used

illicit drug: the ethnographic and law

enforcement sources in Baltimore, the

non-methadone treatment sources in

Boston and Philadelphia, the epidemiologic source in Seattle, and the law

enforcement source in Portland, ME

(who also lists pharmaceutical opiates

as an equally serious problem).

Additionally, sources in 10 cities 

consider heroin the second most 

commonly used illicit drug in their

communities. They span the country,

ranging from the Northeast (New

York, Philadelphia, and Portland) to 

the South (Baltimore, El Paso, and

Washington, DC) to the Midwest

(Chicago), and the West (Honolulu,

Los Angeles, and Seattle).

The numbers go up somewhat when

discussing which drug has the most

serious consequences—that is, medically, legally, societally, or otherwise.

Heroin is named by 24 sources (of 82

who discussed this question) in 14

cities: all Pulse Check cities in the

Northeast (Boston, New York, Philadelphia, Portland), as well as cities in

the South (Baltimore, Columbia (SC),

El Paso, and Washington, DC), the

Midwest (Chicago, Detroit, and St.

Louis), and the West (Denver, Los

Angeles, and Seattle). In the case of

Philadelphia, all Pulse Check sources

agree that heroin is the drug with the

most serious consequences. An additional 22 sources name heroin as the

second most serious drug in terms 

of consequences to 11 Pulse Check

communities.

In many cases, the perception of a

community’s drug abuse picture

changes radically when distinguishing

a city from its surrounding environs.

In Seattle, for example, the epidemiologic source considers heroin and

crack, respectively, to be the city’s first

and second most commonly abused

drugs; in the surrounding rural areas,

however, methamphetamine and 

marijuana hold those distinctions.

TRENDS IN DRUG USE: FALL 2000 VS SPRING 2001

*The epidemiologic source in Columbia, SC, did not provide this information.

According to epidemiologic and ethnographic sources (N=20)...*

According to law enforcement sources (N=21)...

Exhibit 1.

How available is heroin across the 21 Pulse Check cities?

Widely Available

Not Very Available

Somewhat Available

Not Available
HEROIN

page 8 Pulse Check: November 2001

Has the perception of the heroin

problem changed between fall

2000 and spring 2001? All but

two of the Pulse Check sources who

name heroin as the most commonly

used illicit drug during the current

reporting period also listed it as such

during the previous period. The two

exceptions occur in New York and

Portland. According to the New York

methadone treatment source, heroin

has replaced crack as the most commonly used illicit drug, while the

Portland law enforcement source

states that it has replaced powder

cocaine among hardcore users.

Three sources perceive that

other drugs have replaced heroin as causing the most serious

consequences. Crack has replaced

heroin in El Paso, according to that

city’s epidemiologic source. And the

diversion and abuse of the pharmaceutical opiate oxycodone (in its

OxyContin® formulation) has

replaced heroin in Miami and New

Orleans, according to those cities’

epidemiologic and methadone treatment sources, respectively.

Only one Pulse Check source considers heroin to be a new or emerging

drug problem in comparison to the

last Pulse Check reporting period: the

Denver epidemiologic source, who

notes an increase in suburban young

White heroin users.

HEROIN: THE DRUG

How available is heroin across

the country? (Exhibit 1)

Approximately half of the Pulse

Check law enforcement sources (11

of 21) consider heroin to be widely

available in their communities: New

York and Philadelphia in the Northeast; Baltimore, Columbia (SC), 

Miami, New Orleans, and Washington, DC, in the South; Detroit and St.

Louis in the Midwest; and Denver

and Seattle in the West. Similarly, the

majority of epidemiologic and ethnographic sources who discussed this

question (12 of 20) consider the drug

widely available: New York, Philadelphia, and Portland in the Northeast;

Baltimore, El Paso, New Orleans, and

Washington, DC, in the South;

Chicago and Detroit in the Midwest;

and Denver, Honolulu, and Seattle in

the West. Heroin is cited as not very

available by only five sources in four

cities (Billings, Birmingham, Memphis,

and Sioux Falls), and only one source

considers it not available at all (the law

enforcement source in Sioux Falls).

The remaining 12 sources describe the

drug as “somewhat available.”

Has heroin availability changed?

(Exhibits 2 and 3) Heroin availability

remained stable between fall 2000 and

spring 2001, according to the majority

(18 of 21) of Pulse Check law enforcement sources. Increased availability is

perceived in only three sites: Portland

(ME) in the Northeast; and Birmingham and Washington, DC, in the

South. No declines are reported.

According to the 20 epidemiologic

and ethnographic sources who 

discussed this question, heroin availability increased in 6 sites: El Paso,

Memphis, Miami, and New

Orleans in the South; Portland in

the Northeast; and Denver in the

West. The remaining 14 epidemiologic and ethnographic

sources perceive stable supplies

of heroin in general, but some of

those 14 report increases in specific

forms of heroin. In Detroit, for

example, Southeast and Southwest

Asian heroin availability appears up.

Los Angeles is another example, with

an increase reported in availability of

Mexican black tar and brown heroin.

A third example is Honolulu, where

the predominant Mexican black tar

has increased in availability, but

where a white powder heroin has also

been seized for the first time.

Exhibit 2.

How has heroin availability changed

(fall 2000 vs spring 2001)?*

L Law enforcement respondents

E Epidemiologic/ethnographic respondents

*The Columbia epidemiologic source did

not provide this information.

Birmingham, ALL

Denver, COE

El Paso, TXE

Memphis, TNE

Miami, FLE

New Orleans, LAE

Portland, MEL,E

Washington, DCL

Traffic in reverse?

According to the El Paso epidemiologic

source, heroin is now cheaper and more

abundant on the American side of the

border than on the Mexican side–to the

point where people from Mexico are

crossing over to buy heroin in El Paso.

These changes are attributed to competition for the market by three different

cartels. El Paso’s law enforcement

source, on the other hand, gives heroin

only a “somewhat available” rating.

Baltimore, MDL,E

Billings, MTL,E

Birmingham, ALE

Boston, MAL, E

Chicago, ILL,E

Columbia, SCL

Denver, COL

Detroit, MIL,E

El Paso, TXL

Honolulu, HIL,E

Los Angeles, CAE

Memphis, TNL

Miami, FLL

New Orleans, LAL

New York, NYL,E

Philadelphia, PAL,E

Seattle, WAL,E

Sioux Falls, SDL,E

St. Louis, MOL,E

Washington, DCE
HEROIN

Pulse Check: November 2001 page 9

What kind of heroin is available

across the country? (Exhibit 3) As

in the last Pulse Check report, South

American (Colombian) white heroin

is the most common type, cited as

widely available by sources in nine

cities across all the regions except the

West and as somewhat available by

sources in six cities–again, spanning

the Northeast, South, and Midwest

regions. By contrast, this high-purity,

snortable heroin is described as “not

very available” or “not available” by

sources in 11 cities: Portland in the

Northeast; Birmingham, El Paso, and

Memphis in the South; Sioux Falls

and St. Louis in the Midwest; and

Billings, Denver, Honolulu, Los

Angeles, and Seattle in the West. Since

the last Pulse Check reporting period,

availability of Colombian heroin has

increased in only five cities, spanning

all four regions: Chicago, Los Angeles,

Miami, Portland (ME), and

Washington, DC. Stable trends are

reported in all other Pulse Check cities.

Mexican black tar, a lower purity,

injectable heroin, is ranked as widely

available by sources in eight cities,

mostly in the West and the South

(and in St. Louis in the Midwest).

Sources in five cities consider it 

somewhat available, and sources in

nine cities consider it not very available. It is described as “not available

at all” by sources in seven cities: all

four northeastern Pulse Check cities;

Miami and Washington, DC, in the

South; and Sioux Falls in the

Midwest. Since the last Pulse Check

reporting period, black tar has

become increasingly available in

Honolulu, Los Angeles, and Portland

(ME). Availability has declined in

Chicago and (slightly) in El Paso.

Stable trends are reported elsewhere.

Southeast Asian and Southwest Asian

heroin are the least common forms,

with wide availability reported in

only three cities apiece and increased

availability reported only in Detroit,

Portland, and Washington, DC.

How pure is heroin across the

country? (Exhibit 4) According to

law enforcement, epidemiologic, and

ethnographic sources, street-level

Colombian heroin purity ranges from

as low as 7 percent in New Orleans

to as high as 95 percent in Philadelphia.

Typically, however, purity is at the

higher end of that range. Street-level

Mexican black tar heroin purity

ranges from 14 to 58 percent, with

both extremes reported in Seattle.

Users often tend to complain about

low purity despite evidence to the

contrary. As the New York ethnographic source notes, “We continue to

hear users complain about the ‘bad

dope,’ when everybody is saying that

there has never been such ‘good

dope’ around.” That source adds,

however, that in this case the users’

perceptions might be accurate,

because “high availability and low

prices are making it possible for street

dealers to dilute the heroin.”

White heroin hits St. Louis?

According to the St. Louis epidemiologic source, that city’s supply is almost

exclusively Mexican black tar. However, a recent seizure involved a white

heroin whose signature has not yet been

established but is suspected to be of

Nigerian origin.

Boston, MA ! ↔ ! ↔ ! ↔ NR ❍ ↔ NR ❍ ↔ NR ❍ ↔ NR ❍ ↔ NR

New York, NY ! ↔ ! ↔ ! ↔ ! ↔ ❍ ↔ ❍↓ ❍ ↔ ❍↓ ! ↔❍ ↔ ! ↔ ❍↓

Philadelphia, PA ! ↔ ! ↔ ! ↔ ! ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔❍ ↔ ❍ ↔❍ ↔

Portland, ME !↑ ! ↑ !↑ ❍↑ ❍ ❍↑ ❍ !↑ NR !↑ !↑

Baltimore, MD ! ↔ ! ↔ ! ↔ ! ↔ ❍ ↔ ! ❍ ↔ ❍ ! ↔ NR ❍ ↔ NR

Birmingham, AL** !↑ ❍ ↔ NR NR NR NR NR NR NR NR NR NR

Columbia, SC ! ↔ NR ! ↔ NR ! ↔ NR ! ↔ NR ! ↔ NR ! ↔ NR

El Paso, TX ! ↔ !↑ ❍ ↔ ❍ ! ↔ !↓ ! ↔ !↓ ❍ ↔ ❍ ❍ ↔ ❍

Memphis, TN ❍ ↔ !↑ ❍ ↔ ! ! ↔ ! ! ↔ NR ! ↔ NR ❍ ↔ NR

Miami, FL ! ↔ !↑ ! ↔ ! ↑ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔❍ ↔ ❍ ↔❍ ↔

New Orleans, LA ! ↔ !↑ ! ↔ ! ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔! ↔ ❍ ↔! ↔

Washington, DC !↑ ! ↔ !↑ ! ❍ NR ❍ ❍ !↑ NR !↑ NR

Chicago, IL ! ↔ ! ↔ !↑ ! ↔ ❍↓ ! ↔ ❍ ↔ ! ↔ ! ↔! ↔ ❍↓ ! ↔

Detroit, MI ! ↔ ! ↔ ! ↔ ! ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ! ↔ !↑ ! ↔ ! ↑

St. Louis, MO ! ↔ ! ↔ ! ↔ ❍ ↔ ! ↔ ! ↔ ! ↔ NR ❍ ↔❍ ↔ ❍ ↔❍ ↔

Sioux Falls, SD ❍ ↔ ❍ ↔ ❍ ↔ NR ❍ ↔ ❍ ↔ NR ❍ ↔ NR ❍ ↔ NR

Billings, MT ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔ ❍ ↔❍ ↔ ❍ ↔❍ ↔

Denver, CO ! ↔ !↑ ! ↔ ❍ ! ↔ ! ↔ ! ↔ !↑ ❍ ↔ ❍ ! ↔ ❍

Honolulu, HI ! ↔ ! ❍ ↔ NR !↑ ! ↔ !↑ NR ! ↔ NR ❍ ↔ NR

Los Angeles, CA ! ↔ ! ↔ ❍↑ ! ↔ !↑ !↑ ! ↔ !↑ ! ↔❍ ↔ ! ↔❍ ↔

Seattle, WA ! ↔ ! ↔ ❍ ↔ ❍ ! ↔ NR ❍ ↔ NR ❍ ↔ ❍ ❍ ↔ ❍

All Mexican Mexican

City forms Colombian black tar brown SEA** SWA***

L E L E L E L E L E L E

Exhibit 3. How available are the different varieties of heroin? How has

their availability changed (fall 2000 vs spring 2001)?* Northeast Midwest West South

Sources: Law enforcement (L) and epidemiologic/ethnographic (E) respondents

! Widely available ! Somewhat available ❍ Not very available ❍ Not available

* Arrows indicate up, down, or stable trends. Absence of an arrow indicates that respondent did

not provide trend information.

**Southeast Asian ***Southwest Asian
HEROIN

page 10 Pulse Check: November 2001

What adulterants are added to

heroin? A wide range of heroin 

adulterants, some benign and some

harmful, are reported by law enforcement, epidemiologic, and ethnographic sources in several cities, particularly

in the Northeast and South: “any 

powder” in Portland; lactose in

Boston; rat poison, powdered milk,

baking soda, and coffee creamer in

New York; quinine and sugar in

Baltimore; scopolamine and baby

powder in Columbia (SC); cocaine and

vitamin B12 in Memphis; baking soda

and “any white powder” in Miami

(the same adulterants as in cocaine,

but one shade darker); baby laxatives

and powder in Detroit; and sugar in

Los Angeles (to give black tar a tan

appearance).

What are street-level heroin

prices across the country?

(Exhibit 4) The most commonly

reported heroin street sales unit is 0.1

gram, which sells for as little as $4

for Colombian heroin in Boston to as

much as $120 for Mexican black tar

in Seattle. In some cities, however,

street sales units are much larger: for

example, the Birmingham law

enforcement source states that “no

one wants to sell less than 1 gram” of

heroin. Purity, sales quantity, and

dealer competition all play a part in

determining heroin price. Sometimes,

however, other more subtle factors—

such as marketing strategies or

barter—come into play. For example,

according to the New York ethnographic source, “Some dealers in the

Bronx and Brooklyn have been offering a $5 bag to lure customers.”

Another example is Hawaii, where

the epidemiologic source notes that

few people buy drugs for cash.

Rather, they tend to barter goods,

services, or other drugs. Many of the

goods, such as stereos, cameras, and

jewelry, are obtained via larceny and

other forms of theft.

Three of the reported price increases

are in the South. In New Orleans, cellophane bags containing two or three

doses of white heroin increased both

in price and purity. Capsules (known

on the street as “pills”) are the most

common street sales unit in Baltimore, where prices increased from

$3–$6 to $10 for a pill of equal (but

unknown) size while purity remained

stable. In nearby Washington, DC, the

milligram price increased from $1.13

to $1.36. In the Midwest, a slight

increase is reported in the price of a

medium- to large-sized bag of heroin

(from $10 to $10–$20) in Chicago.

The El Paso price drop is dramatic,

from $10 to $3 per “hit” (amount

not specified), reflecting the increased

availability and cartel competition

described above. Also reflecting

increased availability, black tar prices

in Los Angeles declined sharply at the

hit (0.25 gram) level (from $35–$100

to $20–$40), at the gram level (from

$150–$300 to $100), and at the

“eightball” (1/8 ounce) level (from

$400–$600 to $300). The St. Louis

price drop involves “bindles” of #6

gel caps, which sold for the “low

20s” in fall 2000 and the “high teens”

in spring 2001. 

How is heroin referred to across

the country? (Exhibit 5) Street

names throughout the country often

vary by geographic region and by

type of heroin. However, some terms,

such as “horse,” “H,” and “boy” are

common across regions. Street names

(slang) and brand names (dealer designations) are often interchangeable,

as is the case in New York (“millennium 2000”) and Washington, DC

(“jerry springer” and “747” ). Many

factors other than brand names, 

however, can engender a street name.

In Washington, DC, for example, the

non-methadone source reports that a

major news event, such as a hurricane

or tornado, can trigger a new street

name.

Then and Now: Heroin purity (fall

2000 vs spring 2001) 

Heroin purity remained relatively stable

in the majority of Pulse Check sites,

according to law enforcement, epidemiologic, and ethnographic sources. Levels

increased in only four cities (Honolulu,

Miami, New Orleans, and Washington,

DC) and declined in only one (Denver).

None of these changes appears particularly dramatic.

“Tres pesos” and “benita”...

New York, NY: According to the ethnographic source, “A user in Brooklyn stated that the heroin was being mixed with

‘Tres Pesos’ (meaning ‘three steps’),

which is a rat poison shipped from Santo

Domingo. (They call it three steps

because after the mice inhale it they take

three steps and die.) The user said the

reaction is intense, the rush is quicker,

and they feel like they’re going to die.”

Baltimore, MD: The ethnographic source

reports that “‘benita,’ a type of heroin

cut with quinine, which has been around

for a while, is less available than before.”

Then and Now: Heroin prices (fall

2000 vs spring 2001)

Heroin prices appear to be relatively

stable, according to the majority of 

law enforcement, epidemiologic, and

ethnographic sources who provided this

information. Prices increased in only

four cities (Baltimore, Chicago, New

Orleans, and Washington, DC) and

declined in only three (El Paso, Los

Angeles, and St. Louis). 
HEROIN

Pulse Check: November 2001 page 11

In some cities, different dealers use

different brand names or logos as a

marketing strategy and for identification purposes. In other cities, brand

names and logos are nonexistent.

Brand names and logos are frequently

changed, sometimes on a daily basis.

In Baltimore, for example, the ethnographic source states: “Labels change

daily. Dealers give out ‘testers,’ put a

label on it, word gets out on what’s

‘good’ that day and in which neighborhoods it’s available, then users go to

those neighborhoods to make their

buys.” Philadelphia is another example

of a city where heroin brand names

proliferate: the number of brand names

identified by the epidemiologic source

increased from 59 during the last

reporting period to 86 during the current period—probably reflecting the

dealers’ strategy to increase their 

market. Conversely, New York’s ethnographic source reports that “More

dealers throughout the city are relying

on generic heroin ‘non-signature’

brands in an effort not to be identified

by law enforcement. Some dealers have

gone away from name or signature

bags and are using bag color to identify

the source. Those still using brand

names are constantly changing the

name to avoid detection from police.” 

How is heroin packaged? Heroin

is most commonly packaged in plastic, cellophane, glassine, or coin bags,

usually the “zipper” type, as reported

by law enforcement, epidemiologic,

and ethnographic sources in every

city except Detroit, El Paso, Billings,

Denver, and Los Angeles. Other 

common packaging includes plastic or

cellophane wrap (as reported in

Baltimore, Chicago, St. Louis,

Denver, and Honolulu), wax paper

(in Boston, Portland, Baltimore, and

Memphis), and balloons (in El Paso,

Memphis, Denver, and Los Angeles).

Exhibit 4. What are the prices and purity levels of different types 

of heroin in 18 Pulse Check cities?* How have prices and purity changed

(fall 2000 vs spring 2001)?

City Source Unit Size Price/Change** Purity/Change**

Baltimore, E pill NR $10 ↑ NR ↔

MD

Boston, MA L “bundle” 0.1 gm $4–$6 ↔ 60–70% ↔

Chicago, IL L “hit” 0.2 gm $20 ↔ NR NR

Columbia, L “bindle” 0.2 gm $20–$25 ↔ 62% ↔

SC L “bundle” 2 gm $225 ↔ NR NR

Detroit, MI L “bindle” 1 gm $125–$175 ↔ 50% ↔

L “pack” 2 dosage units $10–$20 ↔ NR NR

Miami, FL E “bag” 0.1 gm $10 ↔ 20% ↑

New Orleans, L “unit” 0.45 gm $20–$25 ↑ 7% ↔

LA

New York, L “hit” NR $10–$14 ↔ 80–90% ↔

NY L “bundle” 10 bags $95–$107 ↔ 80–90% ↔

L NR 1 gm $60–$74 ↔ 80–90% ↔

L NR 1 oz $2,000 ↔ 80–90% ↔

Philadelphia, L “baggie” NR $10–$20 ↔ 40–95% ↔

PA E “hit” NR $10 ↔ NR NR

L “bundle” (10–13 bags) $100 ↔ 40% ↔

Denver, CO L “balloon” 0.2 gm $20 ↔ 20–30% ↓

El Paso, TX L NR 0.1 gm $20 ↔ NR NR

E “hit” NR $3 ↓ NR ↔

Honolulu, HI L “bindle” 0.1 gm $50–$75 ↔ NR NR

Los Angeles, L “hit” 0.25 gm $20–$40 ↓ 25% ↔

CA L “eightball” 1/8 oz $300 ↓ 25% ↔

L NR 1 gm $100 ↓ 20% ↔

St. Louis, E #6 gel cap- 0.25–0.5 gm “high teens” ↓ NR NR

MO “bindle”

Seattle, E “bindle” NR $20 ↔ 20–25% ↔

WA L NR 0.1 gm $90–$120 NR 14–58% ↔

E NR 1 gm $80 ↔ 20–25% NR

L NR 1 oz $600–$1,300 NR 14–58% ↔

Memphis, L “pack” 0.1 gm $30 ↔ 40–50% ↔

TN E NR 1 gm $125–$175 NR NR NR

E “hit” square inch bag $125–$175 NR NR NR

Birmingham, L (powder) 1 gm $500 NR NR NR

AL

Chicago, IL E “bag” NR $10–$20 ↑ NR NR

Denver, CO E NR 1 gm $100 ↔ 16–18% ↔

Washington, L “dime bag” 50–75 mg $10 ↔ 10–15% ↔

DC (white powder)

E “bag” 1 mg $1.36 ↑ 23% ↑

Sources: Law enforcement (L) and epidemiologic and ethnographic (E) respondents

*Respondents in Billings, Portland, and Sioux Falls did not provide this information. 

**Arrows indicate up, down, or stable between fall 2000 and spring 2001. South American (Colombian) white Mexican black tar Unspecified Southeast Asian
HEROIN

page 12 Pulse Check: November 2001

Some more unusual packaging is

reported: lottery tickets in Detroit;

“bricks” of compressed heroin in

New York; loose single pills or capsules that melt when heated in

Baltimore; double plastic bags with

uncooked rice in between (to keep

moisture out) in New Orleans; paper

wrapping inside of plastic, or in 

folded magazine pages, in Billings;

and latex pellets in Denver. Two

recent changes are reported: in

Chicago, bags are becoming more

common, while foil is becoming

rarer; and balloons are no longer

used in Baltimore.

HEROIN: THE SELLERS

How are street-level heroin 

sellers organized? Street-level

heroin sellers tend to be independent

of organized structures such as gangs,

according to 13 of the 20 law

enforcement sources who discussed

this question. In Portland, ME, for

example, most sellers are heroin

addicts who go to neighboring

Massachusetts to get the drug, import

it, and sell it back home; only occasionally does an organized group

from Massachusetts come in to sell

the drug in Portland, but then they

leave. Three additional sources—in

Miami, New Orleans, and St. Louis—

report both independent and organized sellers in their cities. In Miami,

independent sellers are found on the

What heroin brand names (and logos) are seen in different cities?

Brand names (dealer designations) and logos are not used in all cities. In cities where they are, including those below, brand names are

sometimes—but not always—interchangeable with street names (slang).

Baltimore, MD

Chicago, IL

Columbia, SC

Detroit, MI

Miami, FL

New York, NY

Philadelphia, PA

Portland, ME

Washington, DC

G-money, murder one, john hinkley, code blue; (colored packaging, spider symbols, eagle symbols)

Doorway, one stop; (faces printed on bags)

New york, new york; skull and crossbones; mercedes; plymouth; playboy

Danger; (skull and crossbones)

(cartoon characters)

Tres pesos, shark, first class, america on-line, death certificate, murder, 777, dead president, millenium 2000

747, 911, bone collector, creeper, devil’s advocate, eagle, fatal, m & m, maggie 2, movada, old navy, one

life,opium, rabbit, really hot, river, rose, samurai, scorpio, scorpion, super AT&T, super hot, super nautica,

thumbs up, timberland, WCW, 7up, bad habit, bart simpson, big mac, body bag, chevrolet, cobra, cold water, 

colt 45, dead on arrival (DOA), dead.com, demolition, diesel, DMX, do-wop, dracula, fingers, fuega, godfather,

holyfield, homicide, I’ll be back, K & A, kill over, knock out, land rover, laser, legend, life after death, lucifer,

mike tyson, motorola, nautica, no joke, octopus, one and done, pacman, painkiller, poison, star, suicide, super

buick, super slow, titanick TNT, tommy hilfiger, too hot to handle, soo strong, toyota, UPS, USA, V-8, viper,

white control, white house

Red devil, batman, black eagle, TNT

Jerry springer, 747, $; (different colored bags)

Exhibit 5. 

How is heroin referred to, and what types of heroin predominate, 

in different regions of the country?

WEST

H, boy, horse, smack,

dope, stuff, tar, chiva,

treat, china white,

boy, Mexican tar, 

brown tar, chiba, 

A-house, junk, spoon.

H, boy, horse, dogfood, s--t, negro, chiva, smack, china white, monkey, big, heroin, train,

foil, girl, doogie, stuff, mud, slag, dragon, mac, heron, 1-boldstep, magic, revenge, white

dragon, jerry springer, orange bag, green bag, red bag, black bag, 747, carga, black coffee,

white horse, lady, manteca, diesel, pink, doosey, black tar, bone, shake, grown man, tammy

H, boy, horse,

blow, junk, hayron, cap, stuff,

china white, raw,

getting snotty

(using heroin).

H, horse, smack,

dope, p-dope,

choco-fan, millenium 2000 (“the

best s--t around”),

DK, red devil, batman, TNT, bag,

stuff, smack, E.

MIDWEST NORTHEAST

SOUTH

Mostly Mexican

black tar available

Mostly Colombian

white available

Heroin type varies

Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents
HEROIN

Pulse Check: November 2001 page 13

streets, while organized sellers 

conduct their transactions in clubs.

Organized sellers predominate in only

four Pulse Check cities: Chicago,

Columbia (SC), Denver, and Seattle.

The Seattle organized structure consists of two kinds of sellers: a gobetween who is an addict, and “the

guy in the car with the bags, who is

not an addict,” comments that city’s

law enforcement source. Recently,

Asian groups have starting getting

involved in heroin sales in New

Orleans, and individuals from Russia

and Eastern Europe have been getting

involved in New York.

Epidemiologic and ethnographic

sources paint a slightly different 

picture: they report organized sales

structures in 10 cities. In five of those

cities, law enforcement sources, by

contrast, report independent operations: Baltimore, Detroit, El Paso,

Memphis, and Washington, DC.

These seeming discrepancies might be

explained by differing definitions of

what constitutes an organized group.

In Baltimore, for example, the law

enforcement source points out that

while young adolescent sellers are not

in gangs, they do work in small

cliques (which might be construed as

organized structures). According to

that city’s ethnographic source, 

heroin’s organized sales structure has

three or four tiers between the leader

and the individual who delivers the

drug to the customer. Similarly, the

New Orleans epidemiologic source

defines that city’s organized structure

as a series of loose connections, not

gang-related, in which a seller has a

dealer who gets calls to arrange pickups at specified locations.

How old are street-level heroin

sellers? Young adults (age 18–30)

are the group most likely to sell 

heroin in the street, according to 11

of the 19 law enforcement sources

who discussed this question and 

spanning all regions of the country.

Moreover, they are just as likely as

older adults (>30 years) to sell streetlevel heroin in an additional three

Pulse Check cities (El Paso, Portland,

and St. Louis). Older adults are the

likeliest to sell heroin in five of the

cities: Billings, Honolulu, Memphis,

Philadelphia, and Washington, DC.

Then and Now:

How have street-level heroin sales changed across the country (fall

2000 vs spring 2001)?

Only a few changes (none in the Midwest) are reported in the heroin sales scene and in

the kind of people who sell the drug at the street level.

In the Northeast...

In the South...

In the West...

➤ Boston, MA: The law enforcement source describes heroin sales

as being more underground than in the past and than other

drug sales.

➤ New York, NY: Individuals from Russia and Eastern Europe are

increasingly involved in heroin sales, according to the law

enforcement source.

➤ Philadelphia, PA: The epidemiologic source reports that in the

past each dealer sold one drug; now, in addition to all the

“meat and potatoes” products (that is, heroin, crack cocaine,

and marijuana), dealers also sell diverted pharmaceuticals, 

such as alprazolam (Xanax®) and oxycodone (Percodan®,

Percocet®, and OxyContin®).

➤ Baltimore, MD: According to the law enforcement source,

heroin sales activity appears to have increased.

➤ Columbia, SC: The law enforcement source reports an increase

in drug dealers robbing other drug dealers, with some robberies

resulting in shootings.

➤ New Orleans, LA: Recently, Asian groups have starting getting

involved in heroin sales, according to the law enforcement

source.

➤ Billings, MT: The law enforcement source reports that heroin

trafficking and sales appear to be down.

Some cities have two kinds of

sales structures...

Honolulu, HI: The epidemiologic

source describes most sellers of heroin,

marijuana, methamphetamine, and

cocaine as independent, with each 

seller having two or three “runners” to

deliver drugs to customers and return

the payments to the seller. Some sellers,

however, have Mexican affiliations:

youths with minimal English-speaking

skills are recruited in Mexico, flown

into Hawaii, given addresses via phone

identifying where they should report to

begin “running” drugs, and then

returned to Mexico after 4–6 months.

Miami, FL: The law enforcement source

notes that independent sellers are found

on the streets, while organized sellers

conduct their transactions in clubs. 
Only 13 of the epidemiologic and

ethnographic sources provided information on this question. Again, the

majority (10) name young adults as

the primary street-level sellers.

Birmingham and Detroit are two of

the three exceptions, with older

adults more likely to sell heroin; the

third exception is Chicago, where,

most disturbingly, the epidemiologic

source names adolescents (13–17

years) as the most likely to sell heroin

on the street. Adolescents, while not

the primary seller group in most

cities, do sometimes sell heroin. In

New York, for example, the epidemiologic source reports that “Street dealers are using teenagers to sell their

drugs. These teenagers can be seen on

small bikes loitering in front of local

grocery stores or on the corners.”

What type of crimes are heroin

sellers involved in? All but 1 of the

19 law enforcement sources who discussed this question consider heroin

sellers as somewhat or very likely to be

involved in criminal activity. The

Birmingham source, however, believes

that sellers are not very involved in

other crimes. Specifically, the law

enforcement sources mention nonviolent crime more often than violent

crime in association with heroin sales

(in 12 versus 8 cities, respectively).

Gang-related crime is mentioned in

seven cities (none in the Northeast;

Baltimore, El Paso, and New Orleans

in the South; Chicago and St. Louis in

the Midwest; and Honolulu and

Seattle in the West). Prostitution is

mentioned in six cities (Boston and

Philadelphia in the Northeast; El Paso

and New Orleans in the South; none

in the Midwest; and Denver and

Honolulu in the West). Other crimes

mentioned by law enforcement sources

include pharmaceutical diversion (in

Portland, ME), domestic violence (in

Boston), and money laundering (in

Miami). The Columbia, SC, law

enforcement source reports an increase

in drug dealers robbing other drug

dealers, with some robberies resulting

in shootings. 

Do heroin sellers use their own

drug? (Exhibit 6) Of the 19 law

enforcement sources who discussed

this question, 7 consider heroin sellers very likely to use their own drug,

8 give a “somewhat likely” response,”

and 5 consider them not very likely

to do so. The 15 epidemiologic and

ethnographic sources who discussed

the same question are more evenly

divided, with 5 giving each of the

above-named responses. One of the

“somewhat likely” responses is given

by the Boston ethnographic source,

who comments that “Nearly all users

eventually sell to help sustain their

habit, usually just selling because it is

a way to procure heroin.” That source

also notes, however, that young Dominican gang members, who constitute a

small proportion of heroin sellers, are

unlikely to use their own heroin. On

the rare occasions they do, it is with

crack. Similarly, the Baltimore the

ethnographic source, who describes a

sales structure with three or four tiers

between the leader and the deliverer,

notes that those at the bottom tier are

very likely to use their own drug,

while the actual seller at the top is not

likely to do so. 

Where is street-level heroin

sold? (Exhibit 7) As in the last Pulse

Check report, law enforcement

sources generally agree that most

heroin sales take place in central city

areas. However, in New York and

Portland, it is also sold in rural and

HEROIN

page 14 Pulse Check: November 2001

Exhibit 6. 

How likely are heroin sellers to

use their own drug?*

Boston

MA

New York,

NY

Philadelphia

PA

Portland

ME

Baltimore

MD

Birmingham

AL

Columbia,

SC

El Paso

TX

Memphis

TN

Miami

FL

New Orleans

LA

Washington

DC

Chicago

IL

Detroit

MI

St. Louis

MO

Billings

MT

Denver

CO

Honolulu

HI

Los Angeles

CA

Seattle

WA

Not very

Somewhat

Very

Sources: Law enforcement, epidemiologic,

and ethnologic respondents

*The law enforcement source from New York

and the epidemiologic sources from Billings,

Columbia, Los Angeles, New York,

Philadelphia, Seattle, and Sioux Falls did

not provide this information

Law enforcement

sources

Epidemiologic and

ethnographic sources

Northeast South Midwest West

Does sales location have anything

to do with the age of sellers?

The New York ethnographic source

notes that “Sellers on the street range

in age from the late teens to the late

thirties; dealers that sell from indoor

locations range in age from the late

teens to late fifties.” 
HEROIN

Pulse Check: November 2001 page 15

suburban areas; in Memphis, it is also

sold in rural areas; and in Miami, it is

also sold in the suburbs. Epidemiologic and ethnographic sources also

generally concur that central city

areas are the most common sites for

heroin sales. Two exceptions, however, are Miami and Sioux Falls, where

suburban areas are reported as more

common. Additionally, a rural border

crossing area in El Paso is seeing

much heroin sales activity.

Indoor and outdoor sales are equally

common, according to the majority

(13 of 20) of responding law enforcement sources. Indoor sales, however,

are reportedly more prominent in

Boston, Detroit, Memphis, and

Portland; while outdoor sales are

more evident in Baltimore, Honolulu,

and Philadelphia. Most epidemiologic

and ethnographic sources (10 of 15)

concur that heroin sales are equally

likely to take place indoors and outdoors, but indoor sales are reportedly

more common in four sites (Miami,

New York, Portland, and Sioux Falls),

while outdoor sales are more 

Exhibit 7. Where is street-level heroin sold and used?*

Private Public Play- Shop- Total #

Resi- Hous- Private Crack Inside grounds/ Night- College ping of

Street dence ing Parties Houses Cars Parks Raves Clubs Campus Schools Malls Settings

Site Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell

Boston, MA & && & & & & & 2 6

New York, NY & && & & & & && & & & & & & & & & && & 9 12

Philadelphia, PA && & & & & & & 3 4

Portland, ME & && && & & & & & & 8 3

Baltimore, MD & && && && & && & & & & & && & & 10 9

Birmingham, AL && && && & & & & 3 7

Columbia, SC & & NA 2

El Paso, TX & && & & && & && & & & & & & & & & & && & 12 11

Memphis, TN & && && && & && & & & & && & & 9 9

Miami, FL && && && & && & & & & & & & & & & 7 12

New Orleans, LA & & && & & && & & & & & 3 10

Washington, DC & && && & & & & 3 5

Chicago, IL & && && && & & & & & & 6 7

Detroit, MI & && & && & & 4 4

St. Louis, MO & && && & & && & & & 4 8

Sioux Falls, SD & && & 1 3

Billings, MT && & & & & 3 3

Denver, CO && && && & & & & & & & & 5 9

Honolulu, HI && & & & & & & & & 2 9

Los Angeles, CA && && & & & & 3 3

Seattle, WA & && && && & & & & & & & 8 6

West South Northeast Midwest

Sources: Law enforcement, epidemiologic, and ethnographic respondents for seller settings

Epidemiologic and ethnographic respondents for user settings

*The law enforcement sources in Sioux Falls, and the epidemiologic/ethnographic sources in Billings, Columbia, Los Angeles, and Seattle, did not provide

seller setting information. The epidemiologic source in Columbia did not provide user setting information.

Settings for sales and use vary...

New York, NY: The ethnographic source suggests that “Young Whites prefer Staten

Island because of its close proximity to New Jersey and indoor selling locations. The

buyers prefer paying a higher price (for security and the feeling that you get ‘better

dope’ indoors than on the street) at indoor locations in New Jersey than to travel to

outdoor locations in Brooklyn and Manhattan.”

Miami, FL: According to the law enforcement source, “distributors find someone in 

the central city, beep that person, then they meet. Often, they meet in the suburbs for

delivery.”

Baltimore, MD: The ethnographic source notes that street-selling locations include

open air markets. Indoor sales include some unusual settings, such as locally run fried

chicken restaurants with plexiglass drive-up windows where drug transactions take

place. Additionally, the law enforcement source describes slots, cut into vacant buildings, where “money goes in and drugs go out.”
HEROIN

page 16 Pulse Check: November 2001

prominent in Washington, DC. The

New York ethnographic source 

elaborates that heroin continues to be

sold mostly indoors because of law

enforcement initiatives aimed at street

sales. Similarly, the Boston law

enforcement source describes heroin

sales as being more underground than

in the past and than other drug sales.

As the chart shows, law enforcement,

epidemiologic, and ethnographic

sources report a wide range of specific

settings for heroin sales:

' Private residences and public housing developments: Mentioned in

nearly every Pulse Check city

' Private parties, crack houses (or

“crash houses,” as the Memphis

law enforcement source terms

them), cars, and parks or playgrounds: Common venues 

' Raves and nightclubs: Particularly

common in the South, but not

mentioned in the Midwest

' Schools and college campuses:

Mentioned, respectively, in eight

and seven cities–with both venues

reported in four cities representing

four different regions: Billings,

Chicago, Memphis, and New York

' Shopping malls: Mentioned in five

cities

Other heroin sales venues, not depicted in the chart, are also reported by

law enforcement, epidemiologic and

ethnographic sources:

' In or near supermarkets: In Billings,

Columbia (SC), El Paso, Honolulu,

New York, and New Orleans

' Over the Internet: In El Paso,

Honolulu, and New York

' Hotels and motels: In Memphis

How is street-level heroin sold?

As in the last Pulse Check report,

hand-to-hand sales remain the most

common way to sell user-level heroin,

as reported by each of the 20 law

enforcement sources who discussed

this question. Sales involving beepers

or cell phones are the second most

commonly reported (in 14 cities), followed by the home delivery method

(which also commonly involves beepers or cell phones) (in 11 cities) and

acquaintance networks (in 10 cities).

In the Midwest, the Detroit law

enforcement source describes car

“meets” with dealers by appointment,

while the St. Louis source reports that

sellers are becoming more guarded

about what they say on cell phones.

The Los Angeles law enforcement

source, however, reports that dealers,

after being paged to call the buyer,

use sophisticated digital cell phone

systems that create difficulties for

narcotics officers to monitor or track

person-to-person transactions.

Epidemiologic and ethnographic

sources, similarly, report that handto-hand and beeper/cell phone sales

are the most common (in 12 cities

each), followed by acquaintance networks (in 9 cities) and home delivery

(in 6 cities). New York features office

delivery service. The Honolulu epidemiologic source describes a typical

high-risk scenario: a buyer tells a 

runner what drug he wants, the runner then finds out the cost, returns to

collect the money, then leaves and

comes back to “make the drop.”

What other drugs do heroin dealers sell? (Exhibit 8) Heroin dealers

continue to sell additional drugs in

nearly every Pulse Check city, except

Exhibit 8. 

What other drugs do heroin dealers sell?*

Boston, MA &

New York, NY &&& Ecstasy

Philadelphia, PA & & Alprazolam (Xanax®)

Oxycodone (all forms)

Portland, ME OxyContin® 

Other pharmaceutical opiates

Baltimore, MD &

Birmingham, AL &&&

Columbia, SC &

Memphis, TN & &

Miami, FL & Ecstasy

New Orleans, LA &&&

Washington, DC & &

Chicago, IL & &

Detroit, MI &&&

St. Louis, MO & &

Billings, MT &

Denver, CO &&& Methamphetamine

Honolulu, HI

Seattle, WA &&&

Powder Mari- No other

City Crack Cocaine juana Other drug sold

Northest Midwest West South

Sources: Law enforcement, epidemiologic, and ethnographic respondents

*Respondents in El Paso, Los Angeles, and Sioux Falls did not provide this information.
HEROIN

Pulse Check: November 2001 page 17

for Billings, Boston, Columbia (SC),

and Honolulu, where neither law

enforcement, epidemiologic, nor epidemiologic sources indicated such

sales. Crack and powder cocaine are

mentioned most frequently, followed

by marijuana. Also mentioned are

ecstasy (methylenedioxymethamphetamine, or MDMA) (in Miami and

New York), pharmaceutical opiates

such as OxyContin® (in Portland),

and methamphetamine (in Denver).

The Philadelphia epidemiologic

source reports that in the past each

dealer sold one drug; now, in addition to all the “meat and potatoes”

products (that is, heroin, crack

cocaine, and marijuana), dealers 

sell diverted pharmaceuticals, e.g., 

alprazolam and oxycodone

(Percodan®, Percocet®, and

OxyContin®). In Baltimore, some

heroin sellers also sell powder cocaine,

sometimes as a “one-and-one” (both

drugs sold together as a unit); other

dealers, however, sell the drugs separately. With Memphis heroin dealers

also selling cocaine in various mixes,

that city’s epidemiologic source notes

that buyers often don’t know what

they’re getting. In St. Louis, dealers

affiliated with gangs are particularly

likely to run a “one-stop shop,” selling

heroin, crack, and marijuana.

HEROIN: THE USERS

How old are heroin users?

(Exhibit 9) The vast majority of epidemiologic and ethnographic sources

(17 of 21) in the Pulse Check sites

agree that the people most likely to

use heroin are generally older than

30. However, younger adults (18–30

years) sometimes comprise substantial

proportions of users in those sites.

Furthermore, in the South, younger

adults are more likely than older

adults to use heroin in four sites:

Baltimore, El Paso, Memphis, and

New Orleans. In two sites—Philadelphia and St. Louis—both the younger

and older adult groups are cited as

equally likely to use heroin.

Moreover, the younger adult groups

are increasing in many cities, such as

Portland (ME) and Sioux Falls, where

the older adults still predominate.

Even more disturbingly, in some

cities, including Baltimore, El Paso,

and Portland, adolescents are 

increasingly initiating heroin use. By

contrast, in Boston, the ethnographic

source remarks that “It’s rare to see

young minority heroin users. They

often saw its effects on their parents

and tend not to use it.”

The two Philadelphia treatment

sources agree with that city’s 

Then and Now:

How have heroin user demographics changed across the country 

(fall 2000 vs spring 2001)? 

According to epidemiologic and ethnographic sources...

Age:

Numerous

shifts are

reported:

Race/

ethnicity:

Distributions

remain 

generally 

stable except

for five

reported

shifts: 

Gender: Distributions remain stable, with three exceptions: the number of female heroin

users has increased slightly in New Orleans, Philadelphia, and Portland (ME). 

Residence: Heroin use is spreading to the suburban areas surrounding four Pulse Check

cities in the South (Baltimore, Memphis, Miami, and Washington, DC) and Seattle in the

West. Use is also spreading to the rural areas surrounding Portland, ME (as suggested by

rising hepatitis C figures), and El Paso (partly because many people are moving there).

➤ Increases in the young adult (18–30 years) group are reported in the

majority of Pulse Check cities: Boston in the Northeast; Baltimore,

Columbia, Memphis, Miami, and Washington, DC, in the South;

Detroit, St. Louis, and Sioux Falls in the Midwest; and Denver,

Honolulu, and Seattle in the West.

➤ A new user group is emerging in El Paso: adolescents born into multigenerational families of heroin addicts and sellers (but young adults

age 18–30 still predominate).

➤ More younger people (16–22 years) in Portland, ME, are initiating

heroin use.

➤ Denver, CO: Whites, who are the predominant heroin user group,

continue to increase as a percentage of heroin users; however, they 

are still underrepresented relative to the city’s general population. 

➤ Miami, FL: Hispanics are an emerging group (but are still underrepresented relative to the general population). 

➤ Philadelphia, PA: The proportion of Whites among heroin users has

declined slightly, while Black and Hispanic representation has

increased slightly. 

➤ Seattle, WA: Slight increases are reported in heroin use by Hispanics.

➤ Washington, DC: Blacks remain the racial/ethnic group most likely to

use heroin, but Whites have been increasingly using the drug.
HEROIN

page 18 Pulse Check: November 2001

epidemiologic source that both the

younger and older adult age groups

are equally likely to use heroin. A

similar consensus among all source

categories occurs in Birmingham,

Boston, Detroit, and Honolulu,

where heroin users are perceived to

be primarily older adults, and in New

Orleans and St. Louis, where they are

perceived to be primarily young

adults. Overall, heroin users in

methadone programs seem to be

somewhat older than those in nonmethadone treatment: 10 out of 17

(59 percent) methadone treatment

sources who discussed this question

consider heroin users more likely to

be older adults, versus 8 out of 18

(44 percent) non-methadone sources.

Another disturbing report comes

from Chicago, where the methadone

program’s heroin users are primarily

both adolescents and young adults. 

Are there gender differences in

who uses heroin? (Exhibit 9) All

but 2 of the 21 epidemiologic and

ethnographic sources agree that males

are more likely than females to use

heroin, at least among the largest user

groups. The exceptions are in

Birmingham and Washington, DC,

where males and females are equally

likely to use the drug. Since the last

Pulse Check reporting period, the

number of female heroin users has

increased slightly in New Orleans,

Philadelphia, and Portland (ME).

Similarly, the vast majority of reporting non-methadone treatment sources

cite males as the largest heroin-using

group. In methadone treatment programs, however, males and females

are equally likely to use heroin, as

reported by 10 of 17 methadone

treatment sources who discussed this

question. The only changes reported

are in two non-methadone programs:

increases in female heroin users entering the Baltimore program (which

remains predominantly male) and in

male users entering the Honolulu

program (which used to be evenly

split but is now predominantly male).

Then and Now:

How have heroin user demographics changed across the country (fall

2000 vs spring 2001)? 

According to treatment sources...

The number of novice heroin users (any drug treatment client who has recently begun

using heroin) in methadone and non-methadone treatment has increased in five

methadone programs (in Billings, Denver, El Paso, St. Louis, and Portland) and five 

non-methadone programs (in Boston, Chicago, Columbia, El Paso, and Miami) across

nine Pulse Check cities. Additionally, that number has increased in the teen facility of the

Honolulu non-methadone program while the number adult novice users has remained

stable. Stable numbers are reported in all other programs where this information was

available: in 10 non-methadone programs (in Baltimore, Billings, Birmingham, Boston,

Chicago, Columbia, Honolulu, Miami, New Orleans, and Philadelphia), and in 7

methadone programs (in Birmingham, Boston, Chicago, Honolulu, New Orleans, 

St. Louis, and Seattle). No declines are reported.

In addition to changes in the number of novice users, only a handful of Pulse Check

treatment sources report any demographic changes between fall 2000 and spring 2001:

Non-methadone programs 

Gender shifts: In Baltimore, more female heroin

users have been entering treatment; nevertheless,

the program’s heroin-using population remains

predominantly male. In Honolulu, males and

females used to be evenly represented among

heroin users; now the program’s heroin users are

predominantly males.

Residence shifts: While clients in the El Paso nonmethadone program are predominantly suburban,

central city representation is increasing.

Methadone programs 

Younger clients: Heroin users

coming into one of the two

Boston methadone programs 

represented in Pulse Check appear

to be younger than in the past. 

Older clients: Heroin users in

Columbia (SC), El Paso, and

Portland (ME) appear to be older

than in the past. 

Recent age shifts among heroin users in treatment: 

Some possible explanations...

Only four treatment sources report any recent changes relating to age. In one of the

two Boston methadone programs, heroin users entering treatment appear to be a little

younger than previously. The Pulse Check source speculates that this shift might be

occurring because younger people who have been abusing diverted oxycodone (in the

OxyContin® form) might be unable to sustain the costs of that drug. Conversely, 

heroin clients coming into the Columbia (SC), El Paso, and Portland methadone programs appear older than in the past. The Columbia source explains that users must be

addicted for at least a year to be admitted. Similarly, the El Paso source speculates that

people are taking longer to come in for treatment. 
HEROIN

Pulse Check: November 2001 page 19

Is any racial/ethnic or socioeconomic group more likely to use

heroin? (Exhibit 9) According to 

epidemiologic and ethnographic

sources, heroin users are most likely

to be Whites in 12 Pulse Check cities

and Blacks in five cities. Whites and

Blacks are equally represented among

heroin users in Birmingham and

Columbia (SC), and Hispanics are the

predominant user groups in El Paso

and Los Angeles. Epidemiologic and

ethnographic sources also note that

some racial/ethnic groups who are

not the most likely to use heroin in

their cities are, nevertheless, overrepresented. For example, in Denver and

Philadelphia, Whites predominate in

heroin use, but Hispanics are overrepresented relative to the general

population. Similarly, in Boston,

where Whites are in the majority

among heroin users, Blacks are 

nevertheless overrepresented.

Demographic differences between

clients in methadone and nonmethadone programs...

According to Pulse Check treatment

sources, heroin-using clients in the two

types of programs differ somewhat in

age and gender distributions:

' Age: Overall, heroin users in

methadone programs seem to be 

somewhat older than those in 

non-methadone treatment.

' Gender: Heroin users in the 

non-methadone programs are 

predominantly males. Even gender

distributions are much more 

common in methadone programs.

' Race/Ethnicity: Methadone treatment

sources are more likely to report

Whites as the predominant heroin

user group in their programs, while

non-methadone treatment sources are

more likely to report Blacks.

' Socioeconomic status (SES): Heroin

users in methadone programs are more

likely than those in non-methadone

programs to be from middle SES 

backgrounds. Conversely, those from

non-methadone programs are more

likely to be from low SES backgrounds.

' Employment and education:

Employment rates and education 

levels are higher among heroin users

in methadone programs than among

those in non-methadone programs.

' Residence: Suburban representation is

somewhat higher among heroin users

in methadone treatment than among

those in non-methadone treatment.

Exhibit 9.

What demographic groups predominate among heroin users, according

to different Pulse Check sources?*

City Age Gender Race/Ethnicity

E N M E N M E N M 

Boston, MA >30 18–30; 18–30; Males Males Both Whites Whites Whites

>30 >30

New York, NY >30 18-30 >30 Males Females Males Whites Whites Whites

Philadelphia, PA 18–30; 18–30; 18–30; Males Males Males Whites Blacks, Whites

>30 >30 >30 Hispanics

Portland, ME >30 >30 >30 Males Males Both Whites Whites Whites

Baltimore, MD 18–30 >30 >30 Males Males NR Blacks Blacks NR

Birmingham, AL >30 >30 >30 Both Males NR Whites/ Blacks NR

Blacks 

Columbia, SC >30 NR 18–30 Males Males Both Whites/ NR NR

Blacks

El Paso, TX 18–30 NR >30 Males Males Males Hispa- Hispa- Hispanics nics

Memphis, TN 18–30 NR NR Males Males NR Whites NR NR

Miami, FL >30 >30 18-30 Males Males Males Whites Hispa- NR

nics

New Orleans, LA 18–30 >30 >30 Males Males Both Blacks Blacks Whites

Washington, DC >30 18–30 >30 Both Both Males Blacks Blacks Blacks

Chicago, IL >30 >30 18-30 Males Males Both Blacks Blacks Blacks

Detroit, MI >30 >30 >30 Males Males Both Whites Blacks Blacks

St. Louis, MO 18–30; >30 >30 Males Males Both Blacks Blacks NR

>30

Sioux Falls, SD >30 18–30 NA Males Males NA Whites NR NA 

Billings, MT >30 18–30 NA Males Both NA Whites Whites NA

Denver, CO >30 >30 18–30 Males Males Both Whites Whites Whites

Honolulu, HI >30 >30 >30 Males Both Males Whites Whites Whites/

Asians

Los Angeles, CA >30 NR >30 Males Males Both Hispa- NR Hispanics nics

Seattle, WA >30 NR >30 Males Males Both Whites NR Whites

West South Northeast Midwest

Sources: Epidemiologic/ethnographic (E), non-methadone treatment (N), and methadone treatment (M) respondents

*Shaded boxes indicate that a given heroin-using racial/ethnic group is overrepresented relative

to that city’s general population. Not all sources, however, had this information available.
HEROIN

page 20 Pulse Check: November 2001

Only a few minor changes are 

reported by epidemiologic and ethnographic sources. In Washington, DC,

for example, Whites, have been

increasingly using heroin, but they

still reflect their distribution in the

general population and are still not

the predominant user group. In

Denver, Whites, who are the predominant heroin user group, have been

increasing; however, they are still

underrepresented relative to the city’s

general population. And in Philadelphia, the proportion of Whites

among heroin users has declined

slightly, while Black and Hispanic

representation has increased slightly.

Heroin use by Hispanics has also

increased slightly in Seattle.

Pulse Check treatment sources 

similarly report diverse racial/ethnic

distributions at their programs. Whites

are the predominant heroin user group

in nine methadone programs but only

six non-methadone programs. Conversely, Blacks are the primary user group

among heroin clients in eight nonmethadone programs but only four

methadone programs. Hispanics are

more likely than other groups to use

heroin at the El Paso and Miami nonmethadone programs and at the El

Paso and Los Angeles methadone programs, and they equal Blacks as the

primary heroin-using group in the

Philadelphia non-methadone program.

In Honolulu, heroin users at the

methadone program are about half

Asians and half Whites; the nonmethadone program’s teen center has

primarily Asian heroin clients, while

that program’s adult center heroin

clients are primarily Whites. No treatment sources report any major changes

in racial/ethnic distributions since the

last Pulse Check reporting period.

What is the most common

socioeconomic background of

heroin users? In all but four of the

Pulse Check cities, the largest heroinusing group reported by epidemiologic and ethnographic sources is in the

low SES category. Heroin users are

more likely to be middle SES in

Memphis (where they have

increased), Miami, and Sioux Falls,

while the Detroit source reports that

all SES groups are equally likely to

use heroin.

Similarly, the vast majority of nonmethadone treatment sources report

that their programs’ heroin-using

clients are from low SES backgrounds.

Only four programs are exceptions: 

in Billings, where high SES clients predominate; in Honolulu, where the

middle SES is named; and in Boston

and Washington, DC, where heroin

clients are equally likely to be from

either low or middle SES backgrounds. 

Methadone treatment providers are

the only Pulse Check sources who

name middle SES more frequently

than low SES as the predominant status of their heroin clients: of the 15

respondents who discussed this question, 8 name the former, 5 name the

latter, and 2 name both low and middle SES clients as equally represented.

This finding is not surprising because

methadone clients tend to be on 

long-term maintenance, so they are

less likely to be currently active drug

users and are more likely to be

employed and to be able to afford

treatment fees.

Employment figures from both types

of treatment programs bear out this

explanation to some extent. Less than

half of clients are employed, either

part-time or full-time, in 12 of 14

non-methadone programs but in 8 of

14 methadone programs where this

information was available.

What is the education level of

heroin users? According to

responding treatment sources, heroin

users in methadone treatment seem to

have a higher education level than

those in non-methadone programs.

Among the 17 methadone treatment

sources who provided this information, only 4 report that the majority

of their programs’ clients have not

completed high school (in Chicago,

Detroit, Los Angeles, and Philadelphia); the comparable dropout figures

for the non-methadone are 7 out of

13 responding programs. El Paso 

provides an example of the disparity

in education levels between the two

types of heroin users: the majority in

the non-methadone program have

only completed junior high, while the

majority of those in the methadone

Middle socioeconomic heroin

users: A hidden population?

St. Louis, MO: Heroin users often

come from low SES backgrounds, as in

St. Louis. But that city’s epidemiologist

points out that middle SES heroin users

might be a hidden population because

they tend to use private physicians for

treatment.

Conditions that contribute to low

socioeconomic status among nonmethadone clients...

The Washington, DC, non-methadone

source explains that SES is low at the

program for three reasons: lack of

employment; lack of education; and

lack of family support resulting from

the addicts’ drug use.
HEROIN

Pulse Check: November 2001 page 21

program are split evenly between

people who have completed high

school and those who have completed

2 years of college. In two other programs, Pulse Check sources report

that heroin users have completed 2

years of education beyond high

school: the methadone program in

New York, and the non-methadone

program in Honolulu.

Where do heroin users tend to

reside? Central city areas are 

generally cited by epidemiologic and

ethnographic sources as the most likely place of residence for heroin users.

The suburbs, however, are the most

likely residence area for heroin users

in Sioux Falls and Los Angeles. In

Detroit, heroin users are equally likely to reside in both central city and

suburban areas Additionally, many

smaller heroin-using populations

reside in suburban areas, as mentioned in at least two northeastern

areas (Boston and New York), four

southern areas (Baltimore, Memphis,

Miami, and Washington, DC), three

western areas (Denver, Honolulu, and

Seattle), and one midwestern area

(Chicago). An increasing spread of

heroin use to suburban areas is

reported by several epidemiologic and

ethnographic sources, including those

in Baltimore, Memphis, Seattle, and

Washington, DC.

Some heroin users reside in rural

areas, as reported in Portland, El

Paso, and St. Louis. In Portland, 

rising hepatitis C figures suggest an

increase of heroin use in those rural

areas, but heroin users continue to

reside predominantly in the central

city. In El Paso, heroin users are most

likely to reside in several barrios in

the central city; however, heroin is

increasingly reported in the rural

areas, partly because many people are

moving into those areas. The St.

Louis epidemiologist is watching for

growth in the heroin-using population in Springfield, Missouri—once

considered a rural area, but now

becoming more urbanized. This latter

case shows how the lines between

city, suburban, and rural areas are

often becoming blurred. 

Pulse Check treatment sources also

name the central city more frequently

than other areas. Among the 15 nonmethadone sources who discussed the

subject, only 2 (in Denver and in El

Paso) report that their clients are

more likely to be suburban, and 1 (in

Honolulu) reports that adult clients

New York, NY: The drug and the

user on the move...

According to the New York ethnographic source, “Researchers report

that young Whites, both males and

females, continue to come to Brooklyn

to purchase heroin and use the needle

exchange programs. The heroin and

needles are transported back to Long

Island, where they are sold.”

Then and Now:

How have heroin use patterns changed across the country 

(fall 2000 vs spring 2001)? 

According to epidemiologic and ethnographic sources...

Sources in three regions—particularly in the South— report some slight changes in the

way heroin users take their drug and in the other drugs they use. No such changes are

reported in the Midwest.

➤ Increased snorting: While injecting still predominates, snorting has increased in

Columbia (SC), Denver, El Paso, Miami, New Orleans, and Washington, DC. 

➤ Increased smoking: Smoking has increased in Denver and Memphis, but injection

remains the primary route of administration in both cities.

➤ Increased injecting: In Honolulu, some young adults are shifting from “chasing the

dragon” to needle use.

➤ Increased crack combinations: Speedballs containing heroin plus crack have increased

in El Paso (where they used to include only powder cocaine, but now crack cocaine is

as likely to be included as powder) and in Los Angeles (where speedballs continue to

contain primarily heroin plus powder cocaine).

➤ Changes in benzodiazepine use: Alprazolam use, common among Philadelphia heroin

addicts, has been increasing, while diazepam use has been declining.

➤ Increased ecstasy use: Heroin combined with ecstasy has recently been reported in

Memphis (as users move away from crack) and Miami.

According to treatment sources...

Use patterns remain relatively stable in the treatment population. Only two changes are

reported. In Philadelphia, the Pulse Check methadone treatment source reports a shift

from injecting to snorting due to increased heroin purity. And in Birmingham, the nonmethadone treatment source notes a “trail mix” used by adolescents, consisting of heroin,

cocaine, and ecstacy, which showed up about a year ago.
HEROIN

page 22 Pulse Check: November 2001

are most likely to be from rural areas

(although clients at that program’s

teen facility are more likely to be

from the central city). The El Paso

source adds that even though clients

are predominantly suburban, central

city representation is increasing. The

St. Louis source mentions that while

the largest proportion of clients are

from central city areas, a large proportion also resides in the suburbs. 

Methadone treatment sources report

slightly higher suburban representation than their non-methadone 

counterparts: of the 15 sources who

discussed this subject, 4 report the

suburbs as the likeliest place of residence (in Boston, Columbia (SC),

Denver, and New Orleans), and

another 2 (in Los Angeles and Seattle)

report suburban and central city areas

as equally likely places of residence. 

How do heroin users administer

heroin? (Exhibit 10) As in the last

Pulse Check report, injecting remains

the most common route of heroin

administration, according to epidemiologic and ethnographic sources in

the majority of cities. Snorting, however, either equals or surpasses injecting in nine sites, including all four

midwestern sites. Since the last Pulse

Check reporting period, smoking has

reportedly increased in Memphis,

where the heroin is smoked in combination with other drugs, and in

Denver (continuing a trend ongoing

since the early 1990s). Heroin smoking is also occasionally reported in

Miami, usually related to the

European tourist scene. Some young

adults in Honolulu are reportedly

shifting from “chasing the dragon”

(placing heroin on aluminum foil,

lighting a fire underneath it, and

sniffing the resulting smoke through a

straw or other means) to needle use.

The epidemiologic source suggests,

however, that they might switch back

to chasing the dragon if white heroin

continues to become increasingly

available. 

Pulse Check methadone treatment

sources concur that injection is the

most common route for administering

heroin, as reported in 12 out of 17

cities where this information was

available. The exceptions are five 

programs in Chicago, New Orleans,

and Philadelphia (where snorting is

more common), in New York (where

snorting and injecting both predominate), and in Denver (where snorting

and smoking both predominate). In

the New York program, new patients,

compared to the overall heroin-using

population, are much more likely 

to snort than inject—about 60–70

percent are snorters. Similarly, in

Boston, novice users are primarily

snorters, while the program’s overall

heroin-using population are primarily

injectors. In the Philadelphia program, the Pulse Check source reports

a shift from injecting to snorting due

to increased heroin purity.

Do route of administration and

demographics interrelate?

Several epidemiologic and ethnographic

sources note a strong relationship

between these two variables, as in the

following examples:

' New York, NY: “The younger crowd

prefer snorting,” notes the ethnographic source, “because they feel 

they can’t get addicted and they fear

contracting HIV.... Sharing of needles

by older drug users continues to

increase as people live longer with the

virus. The feeling is it’s okay to share

your works.”

' St. Louis, MO: Snorting has overtaken

injecting for the first time in St. Louis

(although the two are nearly equal),

“probably,” notes the epidemiologic

source, “because of the increase in

young adults who tend to snort.”

Injection, however, still predominates

in that city’s rural areas.

' Detroit, MI: Young adult heroin users

tend to snort the drug; the older user

group, however, is equally likely to

snort and inject it.

Exhibit 10.

How do users administer heroin?

Boston, MAE

*,M,N* Boston, MAE*,M,N*

New York, NYM* New York, NYE,M*

Philadelphia, PAE,N Philadelphia, PAM

Portland, MEE, M Portland, MEN

Baltimore, MDN Baltimore, MDE

Birmingham, ALE*,N Birmingham, ALE*

Columbia, SCE,M New Orleans, LAM

El Paso, TXE,M,N Washington, DCN

Memphis, TNE

Miami, FLE,M,N

New Orleans, LAE,N

Washington, DCE,M

Detroit, MIE*,M Chicago, ILE,M,N

St. Louis, MOE,M Detroit, MIE*

St. Louis, MOE

*,N

Sioux Falls, SDE,N

Billings, MTN* Billings, MTE,N*

Denver, COE Denver, COM,N

Honolulu, HIE,M,N

Los Angeles, CAE,M

Seattle, WAE,M

Injecting is most Snorting is most 

common in... common in...

*Respondent considers injecting and 

snorting as approximately equal.

E

Epidemiologic/ethnographic respondents

N

Non-methadone treatment respondents

MMethadone treatment respondents

NOTE: One of the two treatment sources in

the following cities did not provide this

information: Billings, Birmingham,

Columbia, Los Angeles, Memphis, Sioux

Falls, and Seattle. Northest Midwest West South
HEROIN

Pulse Check: November 2001 page 23

Snorting is mentioned much more frequently by Pulse Check non-methadone

sources than by their epidemiologic,

ethnographic, and methadone treatment counterparts. Out of 16 sources

who provided this information, 6 cited

snorting as the most common route

used by their programs’ heroin users, 7

cited injecting, 1 cited both snorting

and injecting, 1 cited smoking, and 1

cited both snorting and smoking.

What other drugs do heroin users

take? Cocaine is the drug most often

taken along with heroin, either in

combination (“speedballing”) or

sequentially, according to epidemiologic and ethnographic sources in the

majority of Pulse Check cities.

Speedballs can involve either powder

cocaine (often cooked) or crack (sometimes dissolved). They are generally

injected, but they can also be smoked

or snorted. In Baltimore, for example,

“bipping” refers to snorting heroin or

cocaine, either separately or together.

Speedballing in that city usually

involves injecting heroin and powder

cocaine that are cooked together; less

often it involves heroin combined with

crack. Similarly, in Seattle, heroin and

powder cocaine are injected simultaneously, while heroin and crack are

smoked sequentially. In Miami, speedballs are heroin plus crack, which may

be smoked or snorted rather than

injected. Sequential use of the two

drugs is more common than speedball

use in some cities, such as Columbia

(SC) and St. Louis. 

Often, the choice of speedballs is

related to demographic variables. In

New York, for example, the ethnographic source notes that “in speaking

with many heroin addicts...older

addicts prefer speedballing because

the effect is greater when heroin is

mixed with cocaine.”

Speedballing is also frequently 

mentioned by treatment sources.

Specifically, heroin plus powder

cocaine is used by clients in 15 

programs, and heroin plus crack is

used by clients in 16 programs.

To enhance the effects of heroin,

heroin users also sometimes consume

benzodiazepines, such as alprazolam,

as noted by epidemiologic and ethnographic sources in Baltimore, Boston,

Philadelphia, and Seattle. The

Baltimore ethnographic source notes

that some heroin injectors purchase

alprazolam as a heroin substitute

(depending on the price of heroin) to

“get out the gate”–that is, to get their

first shot (“gate shot”) in the morning

until they can “do a hustle for the

dopeman.”

Clonazepam (Klonopin®) is another

benzodiazepine taken by Boston and

Seattle heroin users. The Boston

ethnographic source notes that 

“benzodiazepine-heroin mixers are

generally working to middle class.” In

El Paso, some users of speedballs

(heroin plus powder cocaine) also use

flunitrazepam (Rohypnol) to help

them sleep and “soften the fall when

coming down.” Additionally, the

Honolulu and Seattle methadone

treatment sources mention that heroin users also take benzodiazepines. In

Honolulu, such users usually alternate

between the two drugs; however, a

few inject them simultaneously.

When heroin is scarce or low in 

purity in some cities, users sometimes

supplement or replace it with other

opiates. Such is the case in El Paso,

where heroin users in the nonmethadone treatment program sometimes use diverted propoxyphene

(Darvon®) and other opiates. In

Birmingham, however, the reverse

holds true: according to the epidemiologic source, the prescription drug 

hydromorphone (Dilaudid®) is 

illegally sold and and more available

than heroin, so heroin may be used as

a supplement or replacement. 

Marijuana is another drug frequently

smoked by heroin users, as mentioned

by epidemiologic and ethnographic

sources in Columbia (SC), Philadelphia, St. Louis, and Seattle. Methamphetamine is sometimes combined with

heroin, as mentioned in Honolulu

(where that combination is sometimes

called a “speedball”) and Billings.

The Memphis epidemiologic source

notes an increased tendency to mix

heroin with other drugs, with the 

latest mixture being heroin plus 

ecstasy. The heroin-ecstasy combination is also mentioned by the Miami

epidemiologic source. In Birmingham,

the non-methadone treatment source

notes a “trail mix” used by adolescents, consisting of heroin, cocaine

and ecstacy, which showed up about 

a year ago.

Where and with whom is heroin

used? (Exhibit 7) Heroin use tends

to be an indoor activity. Only two

epidemiologic and ethnographic

sources, in El Paso and Honolulu,

perceive that outdoor use is more frequent than indoor use. An additional

three, in Boston, Memphis, and

Washington, DC, perceive indoor and

outdoor use to be about equal. Street

use does, however, take place to some

extent, as reported in 12 sites.

Similarly, parks and playgrounds are

reported as heroin use areas in 10

sites. The Baltimore ethnographic

source points out that heroin use

tends to take place indoors due to its

illegal nature; but outdoor use tends

to increase seasonally, as the weather
improves, especially in parks and

playgrounds. The Boston ethnographic source adds that “All users

seek the most private available 

setting. The homeless use a public

restroom or back alley because that is

the most private place they can find.”

Pulse Check treatment sources 

concur that most heroin use takes

place indoors, as reported by all but

four respondents: in Boston (nonmethadone and methadone), Denver

(non-methadone), and Honolulu

(methadone).

The indoor settings most commonly

cited (by 10 or more of the 20 epidemiologic and ethnographic sources

who discussed this question) are 

private residences, public housing

developments, private parties, cars,

and crack houses. Raves and nightclubs are cited in only six sites each,

schools are cited in El Paso and

Memphis, and shopping malls are

also cited in El Paso and New York.

In El Paso, in addition to every 

aforementioned use setting, the epidemiologic source lists some unusual

settings, such as jails, court bathrooms, public bathrooms, alleys, and

side roads. Indoor settings in

Baltimore include abandoned row

houses, otherwise known as “abandominiums,” as well as bathrooms in

fast-food restaurants. Abandoned

buildings, rarely used buildings, and

public restrooms are also mentioned

by the ethnographic source in Boston.

Treatment sources paint a similar picture of the various indoor heroin use

settings, with the top-six responses (in

order of response frequency) being

private residences, crack houses, cars,

public housing, parties, and nightclubs. 

One unusual setting, described by the

Honolulu methadone treatment

source, is parties for heroin users that

take place in the dealer’s home.

Heroin use tends to take place in

small group settings, as reported by

the majority of epidemiologic/ethnographic and non-methadone treatment sources. Only four epidemiologic and ethnographic sources (in

Chicago, Los Angeles, Memphis, and

New York) and five non-methadone

sources (in Birmingham, Denver,

Honolulu, New York, and Philadelphia) perceive that users are more

likely to take heroin when alone. By

contrast, heroin users in methadone

maintenance are more likely to use

their drug while alone, as reported by

sources in 8 out of 14 sites where this

information was provided. 

Use contexts are related to demographic variables. For example, the Detroit

and Miami epidemiologic sources note

that older users tend to take heroin

while alone, but younger adults tend to

take it in groups or among friends. By

contrast, in Baltimore, heroin users

increase their social activity and networking as they age.

How is heroin impacting the

health of users? (Exhibit 11) Since

the last Pulse Check reporting period,

the impact of heroin use on acquired

immunodeficiency syndrome (AIDS)

and human immunodeficiency virus

(HIV) seems to have stabilized in the

majority of non-methadone and

methadone programs, except as listed

in the table. Any declines are noted in

the Northeast, while any increases are

noted in the Midwest and South. By

contrast, cases of hepatitis C have

increased among heroin users in the

majority of reporting programs–in

many cases because of increased

screening, awareness, and early 

detection. Overdose cases have also

increased in numerous programs,

especially in the South, and often due

to drug mixing. Cases of high-risk

pregnancy are generally stable, 

except as noted.

HEROIN: THE COMMUNITY

How available is methadone

treatment in Pulse Check communities? Methadone maintenance

is not available at all in Billings or

Sioux Falls. In the remaining Pulse

Check cities, about half of the epidemiologic and ethnographic

sources—mainly in the South—

consider methadone to be available

in selected areas only (in Baltimore,

Boston, Columbia, El Paso, Honolulu, Memphis, Miami, New Orleans,

HEROIN

page 24 Pulse Check: November 2001

Being “in the mix”...

According to the Baltimore ethnographic source, “Over the life of their

addiction, heroin users tend to increasingly ‘be in the mix’: they become

more networked, more ritualistic in

behavior, more involved in social 

activity, so they can pool resources to

purchase drugs or ‘do a hustle.’”

“Abandonimiums,” public bathrooms, and other unusual heroin

use settings...

Baltimore, MD: “Abandominiums,”

according to the epidemiologic source,

are abandoned row houses where users

shoot heroin. Users also inject heroin in

the bathrooms of fast-food restaurants.

El Paso, TX: “Addicts inject heroin in

any place immediately available,” says

the epidemiologic source, “including

jails, court bathrooms, public bathrooms, alleys, and side roads....”
HEROIN

Pulse Check: November 2001 page 25

Exhibit 11. 

How has heroin use impacted the health of users?

Pulse Check Adverse Comments

Site Impact

Boston, MA ↓ Less needle use and needle sharing; more needle exchange programs, education, snorting other opiates 

Portland, ME ↓ Prevention activities having impact 

Philadelphia, PA ↓ Clients are tested in the program: 15% positive 

Chicago, IL ↑ More AIDS hospitalizations and deaths 

Detroit, MI ↑ Not necessarily up in community, but more education causes more HIV+ clients to seek treatment

Baltimore, MD ↑ More criminal justice referrals; more funding sources for social and health care services

Birmingham, AL ↑ More HIV screening; some women resorting to prostitution to get drugs 

Miami, FL ↑ Injecting drug use

Washington, DC ↑ More unprotected sex; Prostitutes don’t get tested till they reach treatment

Boston, MA ↑ More screening, diagnosis, early detection; some becoming symptomatic after long time since infection

New York, NY ↑ Users not tested till reach treatment; Mainly unhealthy sex practices

Portland, ME ↑ More injecting drug use

Baltimore, MD ↑ Increasing among criminal justice population

Birmingham, AL ↑ More screening and diagnosis

Columbia, SC ↑ Lack of knowledge; younger users think they are invincible, don’t take precautions

El Paso, TX ↑ Long-term exposure to drugs, more body piercing and tattooing

Memphis, TN ↑ Needle sharing 

Miami, FL ↑ Injecting drug use

Washington, DC ↑ Testing started at program in November 2000

Chicago, IL ↑ More testing available this year

St. Louis, MO ↑ Up especially among adolescents and 40+ users who started using in the 1970s;

more physician awareness, more testing 

Billings, MT ↑ Increased heroin use

Denver, CO ↑ More testing

Seattle, WA ↑ Injecting drug use

Detroit, MI ↓ Improved access to treatment on demand, so people enter treatment earlier

Seattle, WA ↓ Possibly because fewer juvenile clients (juveniles are most likely to OD)

Boston, MA ↑ Users don’t know how pure the drug is 

El Paso, TX ↑ Heroin potency up, price down; detox center recently closed;

not enough treatment available for increasing demand

Sioux Falls, SD ↑ Increases generally in fall, when students return to college

Baltimore, MD ↑

Birmingham, AL ↑ Mainly because used in combination with diverted OxyContin®

Columbia, SC ↑ More drug mixing, more copycat drugs (especially ecstasy), more peer pressure 

Memphis, TN ↑ Due to interactions with other drugs

New Orleans, LA ↑ Mainly because used in combination with diverted OxyContin®

Billings, MT ↑

Honolulu, HI ↑ Increasing benzodiazepine use 

Los Angeles, CA ↓ Because of perinatal program 

Sioux Falls, SD ↑ Increase in Native American population, who are more frequently under influence 

of substances as well as victims of rape by perpetrators under the influence 

Boston, MA ↑ Predominantly Hispanics; More risk-taking teenagers, more people taking drugs 

Portland, ME ↑ More awareness by medical community

Columbia, SC ↑ Proportion of heroin users up

Washington, DC ↑ More unprotected sex and prostitution

Billings, MT ↑ More pregnant females applying for treatment services

Honolulu, HI ↑

Health Consequences

HIIV/AIDS Hepatitis C Overdose High-Risk Pregnancy

Sources: Non-methadone and methadone treatment providers
HEROIN

page 26 Pulse Check: November 2001

Portland, and Washington, DC), while

the other half—mainly in the

Midwest and West—consider it to be

available throughout their areas. 

Waiting lists for admission to public

methadone programs are reported by

epidemiologic and ethnographic

sources in 12 cities, with particularly

large numbers reported in Boston

(1,000 people) and the longest wait

reported in Honolulu (about 3

months). Only three sources report

adequate capacity (in Denver, Miami,

and New Orleans). In private programs, the majority of epidemiologic

and ethnographic sources report adequate capacity, with waiting lists

reported only in Birmingham,

Columbia, and Miami.

How have methadone treatment

availability and capacity changed

(fall 2000 vs spring 2001)? Since

the last Pulse Check reporting period,

according to epidemiologic and ethnographic sources, methadone treatment

in public programs has declined in

Boston and El Paso, become more

available in Chicago and somewhat

more available in five additional cities

(Baltimore, Detroit, Philadelphia,

Seattle, and Washington, DC), and has

remained stable in eight cities. Private

treatment has declined in two cities

(Boston and New Orleans), become

more available in three cities (Detroit,

Memphis, and Seattle), become somewhat more available in two cities

(Portland and Birmingham), and

remained stable in nine cities.

Slot capacity in public programs 

has remained stable in eight cities,

declined somewhat in El Paso and 

New Orleans, and increased 

somewhat in Baltimore, Chicago,

Detroit, Philadelphia, Seattle, and

Washington, DC. In private programs, capacity has remained stable in

12 cities, increased greatly in Portland

(ME), and increased somewhat in

Detroit, Memphis, and Seattle.

To what extent is there a

methadone diversion problem

from programs in Pulse Check

communities? The majority of law

enforcement sources who discussed

this question do not consider

methadone diversion a problem. It is

considered somewhat of a problem,

however, by sources in Baltimore,

Denver, Los Angeles, and Portland

(ME). And sources in Memphis, New

Orleans, and Washington, DC, consider diversion to be a serious problem in certain parts of their communities. Since the last Pulse Check

reporting period, diversion has

declined in Portland and St. Louis,

increased in Columbia and Memphis,

and remained stable elsewhere.

What is the impact of and 

community reaction to the heroin

problem? Recent developments in

various Pulse Check communities are

relevant to the heroin problem and

the drug abuse situation in general in

a variety of ways:

In the Northeast...

' Portland, ME: The epidemiologic

source reports on two recent

developments in the criminal justice and treatment communities:

(1) The drug court program,

defunded about 1 year ago, will be 

starting up again imminently. (2) A

satellite of the area’s only methadone

program (which is private–—the area

has no public programs) has recently

opened, easing some of that program’s

pressure. Additionally, the local Office

of Substance Abuse is considering

funding a public detox and methadone

maintenance program.

' New York, NY: The ethnographic

source suggests that police initiatives aimed at street-level drug 

selling has driven most of the

heroin dealers indoors. 

' Philadelphia, PA: Drug-related

deaths have been increasing 

dramatically, particularly those

involving heroin (from 236 heroin

toxicology reports in 1999 to 332

in 2000). Additionally, the average

number of drugs per death has

been increasing.

In the South...

' Baltimore, MD: The ethnographic

source reports on recent developments in medical consequences,

research efforts, law enforcement

initiatives, and community 

collaboration:

➤ A dramatic increase in heroin

overdoses over the past 9

months has prompted plans for

further investigation, via focus

groups and other exploratory

techniques.

➤ Similar to the aggressive law

enforcement approach recently

used in New York, Baltimore’s

new mayor and police chief have

been adopting the J.Q. Wilson

“broken window” model during
HEROIN

Pulse Check: November 2001 page 27

the past year: go into a specific

neighborhood, put more police

on the beat, engage in community

relations, establish a law enforcement presence, and prevent that

first broken window. It is still too

early to gauge whether this strategy has affected crime and the

perception of crime. 

➤ The Safe and Sound crime

prevention effort, targeted at

youth, brings together the teams

of health professionals and law

enforcement officials to address

the immediate and specific needs

of both victims and assailants.

' El Paso, TX: Its unique location,

its indigent population, and recent

developments make El Paso vulnerable to drug abuse problems,

according to the Pulse Check

epidemiologic source:

➤ The only local detox center

recently closed, leaving a large

gap in services, possibly related

to a recent increase in hospital

emergencies and deaths.

➤ A small grant for hepatitis C 

testing among indigents, begun in

September 2000, has recently

yielded a 92-percent-positive rate

in injecting drug users (IDUs). 

' Memphis, TN: Several recent

developments are relevant to the

local drug abuse situation, according to the epidemiologic source:

➤ After a major central city hospital recently closed, drug-related

incidents increased in all other

local emergency departments.

➤ Two ongoing task forces on

mental health and substance

abuse have recently increased

their activities.

➤ A recent diversion program

focuses on moving misdemeanor

drug abusers out of law enforcement and into appropriate health

care, such as local emergency

departments or detox. Inpatient

service can be provided, regardless of ability to pay. 

In the West...

' Seattle, WA: Current events, social

issues, legislative efforts, and drug

abuse are intertwined in a variety

of ways, according to the Pulse

Check epidemiologic source: 

➤ A major international conference

on heroin overdoses, held in

Seattle in January 2000, spurred

a variety of local public activities, such as a joint mayoral/

county executive task force that

developed recommendations for

a variety of approaches to deal

with Seattle’s long-standing

heroin overdose problem. 

➤ Recent legislation enables the

various counties to open new

methadone clinics, and many

methadone treatment slots are

likely to open up over the next

year. Another recently introduced bill aims at reducing

mandatory sentencing and sending incarcerated drug abusers to

treatment before their release.

➤ A movement is underway to

change the criteria for diverting

people to drug court: currently,

only users are diverted, while

both dealers and “cluckers”

(middlemen who “facilitate”

connections between the buyers

and sellers) are excluded; with

the proposed change, both 

users and cluckers would go 

to drug court.

Baltimore, MD: “The first-of-themonth phenomenon”...

According to the Baltimore ethnographic source, the drug scene, like the general street scene, rotates in a 30-day cycle:

it blossoms during the first half of the

month, particularly from the first

through the eighth day, with more sales,

more people on the street, more merchants restocking their shelves, and

more business activity in general; then it

de-escalates during the second half.

Similarly, drug sales, drug-related crime,

and drug-related emergency department

visits, seem to follow this up-down

cycle. One theory to explain this phenomenon is its relation to the compensation cycle: items such as wages, food

stamps, welfare, and Social Security

checks, tend to be received toward the

beginning of the month.
page 28 Pulse Check: November 2001

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CRACK COCAINE

Pulse Check: November 2001 page 29

CRACK: THE PERCEPTION

How do Pulse Check sources

perceive the crack cocaine 

problem in their communities?

Crack is considered the most 

commonly used drug in Pulse Check

communities by 20 law enforcement,

epidemiologic, ethnographic, and

non-methadone treatment sources in

14 cities. As reported in the last Pulse

Check issue, more than half of those

cities are in the South (all eight Pulse

Check sites in that region). The rest

span the remaining regions: the

Northeast (New York and Portland,

ME); the Midwest (Chicago and

Detroit); and the West (Los Angeles,

and Seattle). Additionally, the Denver

non-methadone treatment source

considers both crack and powder

cocaine as the most commonly used

drugs. Further, crack is considered

the second most commonly used drug

by sources in Boston, Philadelphia,

and St. Louis.

Crack is also named as the drug with

the most serious consequences in

Pulse Check communities by 29 of the

82 sources who provided this information. These sources span 14 cities,

and again, more than half are in the

South (all 8 Pulse Check sites). The

rest span the remaining three regions:

the Northeast (Boston and New

York); the Midwest (Chicago, Detroit,

and St. Louis); and the West (Los

Angeles). Another two sources (in

Baltimore and Philadelphia) name

both crack and heroin as the most

serious drug problem, while two

name cocaine without differentiating

between the two types. Crack is

named as the drug with the second

most serious consequences by 22

additional sources in 16 cities, and it

is considered equal to other drugs 

(in causing the second most serious

consequences) in another 5 cities:

powder cocaine in Denver and Seattle;

heroin in Baltimore and Los Angeles;

and benzodiazepines in Philadelphia.

Has the perception of the crack

problem changed between fall

2000 and spring 2001? One

source in Memphis believes that crack

has overtaken powder cocaine as the

most commonly abused drug among

hardcore users in the community.

However, all other sources who list

crack as the most commonly abused

drug during the current 

period report a stable trend since the

previous period. Similarly, all but two

sources report a stable trend in crack

as the drug with the most serious

consequences in their communities. 

El Paso is one exception: that city’s

epidemiologic source believes that

crack has been making inroads and is

replacing heroin in terms of serious

consequences. Memphis is the other

exception, but in reverse: the nonmethadone treatment source believes

that powder cocaine has overtaken

crack in this area. 

Exhibit 1.

How available is crack cocaine across the 21 Pulse Check cities?

According to epidemiologists and ethnographers (N=20)...*

According to law enforcement sources (N=21)...

*The epidemiologic source in Columbia, SC, did not provide this information

Widely Available Somewhat Available

Not Very Available Not Available
CRACK: THE DRUG

How available is crack cocaine

across the country? (Exhibit 1)

More than three-quarters (32 of 42)

of law enforcement, epidemiologic,

and ethnographic Pulse Check sources

who discussed this question consider

crack to be widely available in their

community. Only six sources give

a “somewhat available”

response: three in the West

(Denver, Los Angeles, and

Seattle); the two sources in

Portland, ME; and one

source in Chicago. And

only three sources, in three

different regions, consider it

not very available: in Billings,

El Paso, and Sioux Falls.

Has crack availability changed?

(Exhibit 2) Crack availability

remained stable between fall 2000

and spring 2001, according to the

majority of Pulse Check sources who

discussed this question (17 of 20 law

enforcement sources and 14 of 19

epidemiologic and ethnographic

sources). Increased availability of

crack is reported by only one law

enforcement source (in Sioux Falls)

and one epidemiologic source (in

Seattle). Two law enforcement

sources perceive a decline in crack

availability (in Chicago and in

Portland, ME), as do four epidemiologic and ethnographic sources: two

in the West (Denver and Los

Angeles), one in the South (El Paso),

and one in the Northeast (Portland). 

What are crack cocaine prices

across the country? (Exhibit 3)

Crack tends to be sold in 0.1 and 0.2

gram rocks, which generally cost

approximately $10 and $20, respectively, according to law enforcement,

epidemiologic, and ethnographic

sources. Gram prices tend to be

approximately $100, but prices are as

low as $24 in New York and as high

as $250 in Honolulu. Purity levels are

usually not reported. Nearly all prices

are stable in comparison to the last

Pulse Check reporting period. Two

minor changes are reported: the Los

Angeles law enforcement source

reports some market fluctuation,

resulting in a slight increase in the

price of some rocks (0.2 gram); and

the Seattle epidemiologic source

reports a price decline for “kibbles

and bits,” a unit smaller than the

standard rock size (not included in

the chart), to $5.

How and where is crack cocaine

made? Crack continues to be

processed locally in most Pulse Check

communities, as noted in the last

issue. In Denver and Portland (ME),

however, sources note that it is

processed prior to arriving in the

community, while in Washington,

DC, crack may be processed

locally or in New York. Baking

soda continues to be the 

standard ingredient added

to powder cocaine to 

convert it into crack. A

few sources, however,

mention the use of other

adulterants. In New York,

for example, the ethnographic

source reports vitamin B12 and

lidocaine. Vitamin B12 is also

mentioned by the epidemiologic

source in Memphis. The Baltimore

ethnographic source notes different

types of cooking solutions and ammonia as crack cocaine adulterants. 

CRACK COCAINE

page 30 Pulse Check: November 2001

Exhibit 2.

How has crack cocaine 

availability changed (fall 2000 vs

spring 2001)?*

L Law enforcement respondents

E Epidemiologic/ethnographic respondents

*The Columbia (SC) epidemiologic and the

Memphis law enforcement sources did not

provide this information.

Seattle, WAE

Sioux Falls, SDL

Chicago, ILL

Denver, COE

El Paso, TXE

Los Angeles, CAE

Portland, MEL,E

Baltimore, MDL,E

Billings, MTL,E

Birmingham, ALL,E

Boston, MAL,E

Chicago, ILE

Denver, COL

Detroit, MIL,E

El Paso, TXL

Honolulu, HIL,E

Los Angeles, CAL

Memphis, TNE

Miami, FLL,E

New Orleans, LAL,E

New York, NYL,E

Philadelphia, PAL,E

Seattle, WAL

Sioux Falls, SDE

St. Louis, MOL,E

Washington, DCL,E

Do-it-yourself “chemistry”...

The New York ethnographic source

notes that “One crack user told a

researcher that while a lot of crack is

available it is better to buy your own

powder cocaine and cook it yourself”

(rather than buy ready-made crack) “if

you want to get your money’s worth.

These people refer to themselves as

‘chemists.’”

Crack by bus...

According to the El Paso epidemiologic

source, street outreach workers report

that some individuals regularly travel

by bus between Los Angeles and El

Paso for personal reasons and, in the

process, also transport crack. Thus, not

all of El Paso’s crack comes from

across the border: some of the supply

comes from California.
CRACK COCAINE

Pulse Check: November 2001 page 31

How is crack referred to across

the country? (Exhibit 4) Slang

names for crack seem particularly

common in the South, with numerous

names listed by law enforcement, epidemiologic, and ethnographic sources

in all eight Pulse Check sites. The

majority of the names listed for the

Northeast come from Philadelphia.

Few slang names are reported by

sources in the Midwest and the West.

How is crack packaged and 

marketed? The New York ethnographic source reports that small

glassine bags and light plastic wrap

Exhibit 3.

How much does crack cocaine cost in 19 Pulse Check cities?*

MOST COMMON STREET UNIT 1 GRAM

City Unit Size Price Purity Price Purity

Boston, MA“jum” (small rock) 0.1 gm $10 NR NR NR

New York, NY bag NR $3–$10 NR $24–$30 58%

“eightball” 1/8 oz $20 58% NR NR

rock NR $7–10 58%

Philadelphia, PA rock 0.05–0.1 gm $5–$10 80% NR NR

Portland, ME rock NR $80 75% NR NR

“100-rock” 0.5 gm $100 80%

Baltimore, MD vial NR $5–$10 NR NR NR

Birmingham, AL rock 0.2–0.5 gm $10–$20 NR $100 NR

Columbia, SC rock 0.2 gm $20 NR $100 NR

“slab” 0.5 gm $100 NR

El Paso, TX rock 0.25 gm $20 NR NR NR

Memphis, TN rock 0.2 gm $20 40–50% $100 40–50%

Miami, FL rock 0.1 gm $5–$20 80% NR 80–90%

New Orleans, LA rock 0.25 gm $10 NR $40–$50 NR

Washington, DC “dimebag” 75 mg $10 30–60% $80–$100 NR

Chicago, IL rock 0.2 gm $5–$20 NR $123 NR

Detroit, MI rock 0.1 gm $10 90% $70–$125 90%

Sioux Falls, SD rock 0.3–0.5 gm $50 NR NR NR

Denver, CO rock 0.1–0.2 gm $20 70% $100–$125 NR

Honolulu, HI rock 0.25 gm $25–$35 70% $100–$250 NR

Los Angeles, CA rock 0.2 gm $20 NR $80 NR

Seattle, WA “20 rock” 0.1–0.125 gm $20 NR $100 40–85%

“40 rock” 0.2–0.25 gm $40 NR

Sources: Law enforcement, epidemiologic, and ethnographic respondents *Respondents in Billings and St. Louis did not provide this information. Northeast South West Midwest

Exhibit 4. 

How is crack cocaine referred to across different regions of the country?

WEST

Rock, crack, ready rock, scottie, red top, bule top, hard, ball

(four and eightball), 20, I wanna be a rock star, snow, primo,

woody, momo, geek, joint, blooper, white stuff, big momma,

bump, crumb, monkey nut, (a big rock), yam, (big rock),

twinkie, loose rock, stones

Ma’a (rock

in Samoan)

Rock, crack

Rock, crack,

hard stuff,

bumper, bopper

Rock, crack, jum, 

$ sign, batman, cards,

clover, devils, ghost,

gold crowns, gun, nike,

pacman, spotlight, stars

MIDWEST

NORTHEAST

SOUTH

Sources: Law enforcement, epidemiologic, and ethnographic respondents
CRACK COCAINE

page 32 Pulse Check: November 2001

knotted at both ends are replacing

plastic colored vials as the preferred

method of packaging crack cocaine.

The Portland, ME, law enforcement

source mentions a similar packaging:

a plastic bag whose corner is knotted

in “Dominican ties.” Elsewhere, packaging remains relatively unchanged

since the last Pulse Check reporting

period. The most commonly reported

packaging, as in the case of heroin,

remains small plastic, cellophane,

glassine, or coin bags, often the 

“zipper” type, particularly throughout

the Northeast, the South, and the

Midwest. In the West, however, that

packaging is reported only in

Honolulu. Other types of packaging

are more common in that region:

plastic or glass vials (as reported in

Denver, Los Angeles, and Seattle);

foldover bindles of plastic, paper, or

magazine pages (as reported in

Billings, Denver, Honolulu, Los

Angeles, and Seattle); plastic wrap or

cellophane (in Denver, Honolulu, and

Los Angeles); foil (in Los Angeles and

Seattle); plastic balloons (in Los

Angeles); and just loose rocks (in

Seattle). Loose rocks are mentioned

most frequently in the South

(Birmingham, Columbia, Memphis,

Miami, New Orleans, and Washington, DC), but are also found in the

Northeast (in Boston and New York)

and the Midwest (Detroit and St.

Louis). Baltimore is the only Pulse

Check city outside of the West where

sources report crack sold in vials.

According to that city’s ethnographic

source, different neighborhoods use

different colors on the crack vial tops

for identification: “The vial tops are

red on Monroe Street, but blue on

East Baltimore....” Elsewhere in the

South, the El Paso law enforcement

source reports balloon packaging and

paper diamond folds—similar to

packaging found nearby in the West.

CRACK: THE SELLERS

How are crack cocaine sellers

organized? According to law

enforcement sources, crack sellers in

all four Pulse Check cities in the

Northeast operate independently.

Recently, however, gangs have started

taking over sales in New York. In the

South, by contrast, sales structures

vary: independent operations are

reported in Baltimore, El Paso,

Miami, and Washington, DC; both

types of sales structures—independent

and organized—are reported in

Birmingham and New Orleans; and

loosely organized structures or small

networks are reported in Columbia

(SC) and Memphis. Sales structures

also vary in the Midwest: operations

are organized in Chicago and (loosely)

in Sioux Falls, while both independent

and organized structures are reported

in Detroit and St. Louis. Similarly, in

the West, sales structures vary, from

organized in Billings, Denver, and

Seattle to independently run operations in Honolulu, to a mix of structures in Los Angeles.

By contrast, nearly all epidemiologic

and ethnographic sources who provide

this information report that crack sellers are affiliated with organized sales

structures, such as gangs. As is the case

with heroin, this seeming discrepancy

might be explained by differing 

definitions of what constitutes an

organized group.

Then and Now:

How have crack sellers and sales changed across the country (fall 2000

vs spring 2001)?

The crack sales scene has remained relatively stable since the last Pulse Check report.

Only a handful of changes are reported, with no discernible regional trends:

Baltimore, MD; Birmingham, AL;

Columbia, SC; and Memphis, TN: 

Boston, MA: 

Denver, CO: 

Los Angeles, CA: 

New York, NY: 

St. Louis, MO: 

➤ Law enforcement sources note a tendency 

toward younger crack sellers.

➤ Continuing a trend noted in the last issue 

of Pulse Check, crack sales are increasingly 

moving indoors, with more deliveries made via

beeper orders. The Boston ethnographic source

attributes this phenomenon to increased law

enforcement efforts and to urban renewal.

➤ Sales are starting to take place in the suburbs,

according to the law enforcement source.

➤ The law enforcement source notes that electronic equipment, such as cell phones, continues

to be increasingly involved in crack sales.

➤ The law enforcement source reports that gangs

have recently started taking over sales.

➤ According to the epidemiologic source, crack

used to come into the area from Colombia

through Mexico, but now more seems to be

coming directly from Mexico.
CRACK COCAINE

Pulse Check: November 2001 page 33

How is street-level crack sold?

Hand-to-hand crack sales are reported by law enforcement sources in

every Pulse Check city, as noted in the

last Pulse Check, and similar to the

most common method for selling

heroin. Sales involving beepers or cell

phones are also quite common—

reported by law enforcement sources

in 16 cities: all four Pulse Check sites

in the Midwest, all but one (Washington, DC) of the sites in the South, all

but one (Seattle) in the West, and New

York in the Northeast. Acquaintance

networks are mentioned in 13 cities,

and home delivery (which often also

involves beeper or cell phone use) is

mentioned in 11. Internet sales are

reported in New York.

Epidemiologic and ethnographic

sources, similarly, report that handto-hand sales are the most common

(in 14 cities), followed by beeper/cell

phone sales (in 10 cities), then by

home delivery and acquaintance networks (in 7 cities each). In El Paso,

crack is also reportedly sold over 

the Internet.

How old are street-level crack

sellers? As reported in the last Pulse

Check issue, young adults (18–30

years) continue to be the predominant crack sellers at the street level,

according to law enforcement sources

in nearly every city. Several exceptions, however, are noteworthy. In

the Northeast, for example, older

adults are more likely to sell crack in

Philadelphia. In the South, adolescents are the primary sellers in

Baltimore, while all three age groups

(adolescents, young adults, and older

adults) are equally likely to sell crack

in Memphis. In the Midwest, both

young and older adults are named as

the primary crack sellers in Sioux

Falls and St. Louis. And in the West,

all three age groups are listed for

Denver, while adolescents reportedly

predominate in Seattle crack sales. In

comparing the fall 2000 and spring

20001 reporting periods, four law

enforcement sources—all in the

South—note a tendency toward

younger crack sellers: in Baltimore,

Birmingham, Columbia (SC), and

Memphis.

Epidemiologic and ethnographic

sources concur that young adults are

the most likely to sell crack, as reported in nearly every city where this

information was provided. Five exceptions, however, are noted in the South

and the Midwest: young adults and

adolescents are equally likely to be the 

primary crack sellers in Birmingham

and Detroit; young adults and older

adults are equally likely in Memphis;

and adolescents are considered the

predominant seller group in Baltimore

and Chicago. Adolescents are also

noted, to a lesser extent, as sellers in

other cities. In New York, for example, the ethnographic source reports

that “some dealers in Manhattan are

as young as 13.”

What other drugs do crack dealers sell? (Exhibit 5) As reported in

previous issues of Pulse Check, crack

dealers are often polydrug sellers. In

New York, law enforcement, epidemiologic, and ethnographic sources

report that some dealers sell as many 

Exhibit 5. 

What other drugs do crack dealers sell?*

Mari- Powder Metham- No Other

City juana Cocaine Heroin phetamine Ecstasy Drugs Sold

LE E LE E LE E LE E LE E LE E

Boston, MA " "

New York, NY "" "" "" "

Philadelphia, PA "

Portland, ME " "

Baltimore, MD " "

Birmingham, AL "" "

Columbia, SC " "

El Paso, TX "

Memphis, TN " "

Miami, FL " "

New Orleans, LA " " ""

Washington, DC "

Chicago, IL "" "

Detroit, MI "" ""

St. Louis, MO "" "

Sioux Falls, SD "

Billings, MT " "

Denver, CO "

Honolulu, HI "

Los Angeles, CA "

Seattle, WA " "

Sources: Law enforcement (LE), epidemiologic, and ethnographic (E) respondents

*Epidemiologic sources in Billings, Columbia, El Paso, Denver, Honolulu, Los Angeles,

Philadelphia, Portland, Seattle, Sioux Falls, and Washington, DC, did not provide this information West South Northeast Midwest
CRACK COCAINE

page 34 Pulse Check: November 2001

as four drugs in addition to crack.

Other “one-stop shops,” where dealers sell two or three drugs in addition

to crack, are particularly common in

the South (Birmingham, Columbia,

and New Orleans) and the Midwest

(Chicago, Detroit, and St. Louis);

they are less commonly reported in

the Northeast (Portland, ME) and the

West (Billings and Seattle). Overall,

marijuana is reported in 11 cities, 

followed by heroin (in 8 cities) and

powder cocaine (in 7 cities). Methamphetamine is mentioned in only two

western sites, and ecstasy is named

only in New York. Eight law enforcement sources and three epidemiologic

and ethnographic sources, however,

report that crack sellers in their 

communities sell no other drugs. 

Do crack sellers use their own

drug? (Exhibit 6) In Miami, St.

Louis, and Seattle, crack sellers usually do not use the product they sell,

according to law enforcement

sources. In all other Pulse Check sites,

sellers are somewhat or very likely to

use their own drug. Epidemiologic

and ethnographic sources, however,

generally consider crack sellers as less

likely to use their own drug. Only in

Boston, El Paso, Memphis, New

Orleans, and St. Louis do these

sources describe crack dealers as 

very or somewhat likely to use crack

themselves. The Boston ethnographic

source adds that “nearly all users

eventually sell” and that “older sellers

are selling to make enough to ‘hustle’

their own crack,” but that “a few of

the dealers are younger, in gangs, and

less likely to use.” Nearly all the

remaining epidemiologic and ethnographic sources who addressed this

issue believe that crack sellers are not

very likely to use crack. Furthermore,

in Baltimore, the ethnographic source

reports that sellers, who are predominantly adolescents, do not use crack.

What type of crimes are crack

sellers involved in? All law

enforcement sources consider crack

sellers as somewhat or very likely to

be involved in other criminal activity.

The majority name both violent and

nonviolent crimes (15 and 16 sources,

respectively, out of 21). The most

commonly mentioned crime is gangrelated activity, as noted by 13 sources,

heavily concentrated in the South (in

Baltimore, Birmingham, Columbia,

Memphis, New Orleans, and

Washington, DC) and the West (in

Denver, Honolulu, Los Angeles, and

Seattle), and to a lesser extent in the

Northeast (in Boston) and the

Midwest (in Chicago and St. Louis).

Prostitution is also mentioned frequently, again particularly in the South

(Birmingham, Columbia, El Paso, New

Orleans, and Washington, DC), and to

a lesser extent elsewhere (Boston and

Philadelphia in the Northeast; St. Louis

in the Midwest; and Denver and

Honolulu in the West). Domestic 

violence is noted in six cities (Baltimore, Birmingham, Boston, Denver,

Memphis, and St. Louis). Other crimes

specified include theft and burglary (in

Billings and Chicago), robberies and

shootings involving other dealers (in

Columbia, SC), and money laundering

(in Detroit).

Exhibit 6. 

How likely are crack sellers to

use their own drug?* 

Boston

MA

Philadelphia

PA

Portland

ME

Baltimore

MD

Birmingham

AL

Columbia,

SC

El Paso

TX

Memphis

TN

Miami

FL

New Orleans

LA

Washington

DC

Chicago

IL

Detroit

MI

Sioux Falls

SD

St. Louis

MO

Billings

MT

Denver

CO

Honolulu

HI

Los Angeles

CA

Seattle

WA

Not at all

Not very

Somewhat

Very

Sources: Law enforcement, epidemiologic,

and ethnologic respondents

*The law enforcement source from New

York and the epidemiologic sources from

Billings, Columbia, Los Angeles, New York,

Philadelphia, Portland, Seattle, and Sioux

Falls did not provide this information.

Law enforcement sources

Epidemiologic and ethnographic

sources

Northeast South Midwest West

One-stop shopping...

In some cities, such as St. Louis—as

noted by that city’s epidemiologic

source—crack dealers affiliated with

gangs are the ones most likely to run a

“one-stop shop,” selling multiple drugs.
CRACK COCAINE

Pulse Check: November 2001 page 35

Where is crack cocaine sold?

(Exhibit 7) All but 6 of the 21 law

enforcement sources agree that crack

sales generally take place in central

city areas. Five of those six exceptions are in the South. In Miami and

New Orleans, crack is equally likely

to be sold in central city and suburban areas. In El Paso, crack sales are

more likely to occur in the suburbs.

In Birmingham, Memphis, and—

outside of the South—New York,

crack is sold in a wide range of areas,

including central city, suburban, and

rural areas. The locations for crack

sales remain the same since the last

Pulse Check reporting period, except

for Denver, where crack sales have

expanded to suburban areas, according to the law enforcement source.

Similarly, nearly every epidemiologic

and ethnographic source who provided this information indicates that

crack is sold primarily in central city

areas. In Birmingham and El Paso,

however, it is sold both in central city

and rural areas. And in Detroit, crack

is sold in central city, rural, and suburban areas.

Both outdoor and indoor sales occur

across sites, with a few exceptions.

According to law enforcement

sources, outdoor sales are more common in Chicago and Philadelphia

while indoor sales predominate in

Baltimore. According to epidemiologic and ethnographic sources, indoor

sources are more common in Detroit 

while outdoor sales predominate in

Washington, DC.

The specific settings for crack sales,

like for heroin sales, are varied.

Public housing developments, cars,

and crack houses are mentioned by

law enforcement, epidemiologic, or

ethnographic sources in nearly every

city. Parties and schools are the next

most common settings, followed by

parks, private housing, and clubs.

College campuses and raves are also

mentioned in at least half the sites,

while sales in shopping malls, outside

supermarkets, and over the Internet

are mentioned in some cities. Overall,

several cities have a particularly wide

range of crack sales settings.

Exhibit 6. Where is street-level crack cocaine sold and used?*

Public Private Shop- #

Crack Hous- Hous- Inside ping Super- Inter- of

City Street Houses ing ing Cars Parties Parks Schools Clubs College Raves Malls markets net Settings

S U S U S U S U S U S U S U S U S U S U S U S U S U S S U

Boston, MA "" " " "" " 7 NR

New York, NY """" "" " " "" " " "" " " " " " " 14 6

Philadelphia, PA """" "" " "" " " 5 6

Portland, ME " " "" " 3 2

Baltimore, MD " " " " " " " " " " " " "" " " "" " " " " 10 12

Birmingham, AL " " " " " " " " " " "" " " " " " " 13 5

Columbia, SC "" " " " 5 NR

El Paso, TX " " " " " " " " " " " " "" " "" " " " " " " " " 13 12

Memphis, TN " " " " " " " " " " " "" " " " " " " " 14 6

Miami, FL " "" "" " " " " " " " " " 11 3

New Orleans, LA " " " " " " " " " " " " " "" " " " " " 12 8

Washington, DC """" "" " " " " " " 4 8

Chicago, IL """" "" " " "" " "" " " " 11 6

Detroit, MI " " " " " " " " " " "" " " " " 11 6

St. Louis, MO """" "" " " "" " "" " " 9 6

Sioux Falls, SD " " " "" " " 4 2

Billings, MT " " " " " "" " " " " " " " " " 13 2

Denver, CO " " " " " " " " " " " "" " " 9 6

Honolulu, HI " " " " " " " " "" " " " " " 14 1

Los Angeles, CA """ "" " " " 3 6

Seattle, WA """ "" " "" " " " " " "" 6 10

West South Northeast Midwest

S = Sell U = Use

Sources: Law enforcement, epidemiologic, and ethnographic respondents

*The epidemiologic/ethnographic sources in Billings, Boston, Columbia, Los Angeles, Seattle, and Sioux Falls did not provide seller setting information.

The Columbia epidemiologic/ethnographic source did not provide user setting information. The Boston source for user setting responded, 

“most private setting available.”
CRACK COCAINE

page 36 Pulse Check: November 2001

CRACK: THE USERS

How old are crack cocaine

users? (Exhibit 8) Epidemiologic

and ethnographic sources vary in

their views of which age groups are

most likely to use crack. Three (in

Boston, Birmingham, and Detroit)

consider both young adults (18–30

years) and older adults (older than 

30 years) equally likely to use the

drug, although in Birmingham, crack

use among young adults has declined.

Young adults are considered the primary user group in nine Pulse Check

cities: Philadelphia in the Northeast;

Baltimore, El Paso, and New Orleans

in the South; St. Louis and Sioux

Falls in the Midwest; and Billings,

Honolulu, and Seattle in the West.

Older adults are named in eight

cities: Portland, ME, in the

Northeast; Columbia, Memphis,

Miami, and Washington, DC, in the

South; Chicago in the Midwest; and

Denver and Los Angeles in the West.

In Washington, DC, however, while

older adults remain the primary user

group, use among younger adults is

increasing. These findings differ from

those in the last Pulse Check issue,

when epidemiologic and ethnographic sources named older adults as the

group likeliest to use crack in all but

four cities (Birmingham, Honolulu,

Los Angeles, and Sioux Falls). 

All reporting Pulse Check treatment

sources note that the age of crack

users in treatment has remained stable. The non-methadone treatment

providers are more likely to report

younger adults (18–30 years) than

older adults (>30 years) as the 

predominant crack users. Both age

groups are considered equally likely

to use crack in three cities: Birmingham, Memphis, and Philadelphia.

The younger adult group is named in

Then and Now:

How have crack cocaine users changed across the country (fall 2000 vs

spring 2001)?

According to epidemiologic and ethnographic sources...

Crack use has remained relatively stable since the last Pulse Check reporting period. Only

a few changes are reported among young adults, among Hispanics, among women, and in

where crack users reside:

Among young adults: 

Among Hispanics: 

Among women: 

Where crack users reside:

According to treatment sources...

Crack user demographic

characteristics and use 

patterns have remained

stable since the last Pulse

Check reporting period,

with only a few 

exceptions:

➤ Birmingham, AL: Crack use has declined among young

adults (18–30 years), who are now as likely to use the

drug as older adults (>30 years). 

➤ Washington, DC: Crack use has increased among

younger adults, but older adults remain most likely to

use the drug.

➤ Columbia, SC: A small increase in the number of

Hispanics using crack reflects a similar increase in the

overall population. The numbers, however, remain small. 

➤ Philadelphia, PA: Hispanics, who are overrepresented

among crack users, have increased in proportion since

the last Pulse Check report. 

➤ Columbia, SC: The percentage of females among crack

users has been fluctuating during the past 12 months

(between 38 and 56 percent), with no particular pattern.

➤ St. Louis, MO: While crack users are still predominantly

males (approximately 60 percent), the number of female

users has been increasing over the past 5 or 6 years. 

➤ St. Louis, MO: With the mass exodus from the city into

the surrounding counties over the past few years, the

crack problem is becoming more concentrated among

people of lower SES, who remain in the city. 

➤ Washington, DC: Crack users continue to reside 

primarily in the central city, but increases are noted

among suburban dwellers. 

➤ Novice use: Recent initiation of crack use by any

drug treatment client has increased in only four nonmethadone programs (in Billings, Memphis, Portland,

and Sioux Falls) and one methadone program (in

Columbia, SC).

➤ Female use: The Washington, DC, non-methadone

provider notes an increase in females smoking crack.
CRACK COCAINE

Pulse Check: November 2001 page 37

11 cities: Boston and Portland in the

Northeast; El Paso, Miami, New

Orleans, and Washington, DC, in the

South; Chicago and Detroit in the

Midwest; and Honolulu, Los Angeles,

and Seattle in the West. Older adults,

exclusively, are named in only two

cities: Baltimore and Denver. Most

disturbingly, adolescents (younger

than 18) are the largest crack-using

group in the Columbia, SC, nonmethadone program, and they share

the dubious number-one spot with

young adults in Los Angeles, and with

older adults in Sioux Falls.

By contrast, crack-using clients in the

methadone programs appear older

than those in the non-methadone

programs: nearly all responding Pulse

Check sources in this category report

that any clients who use crack tend

to be in the older adult (>30 years)

category. This finding, similar to findings about heroin-using clients, is not

surprising because methadone maintenance tends to involve people who

have been treated over a long period

of time. The only exceptions are in

Boston, Philadelphia, Columbia (SC),

and New Orleans programs, where

the younger adults outnumber the

older adults among crack users in

methadone maintenance.

Are there any gender differences

in who uses crack? (Exhibit 9)

According to the New York ethnographic source, females are the predominant crack users in that city.

Moreover, females and males are

evenly split among crack users

according to epidemiologic and

ethnographic sources in nine Pulse

Check cities: Chicago and Sioux Falls

in the Midwest; Boston and

Philadelphia in the Northeast;

Baltimore, Columbia, Miami, and

Washington, DC, in the South; and

Seattle in the West. The remaining 11

epidemiologic and ethnographic

sources report males as the predominant crack users in their respective

cities. In St. Louis, while crack users

are still predominantly males

(approximately 60 percent), the number of female users has been increasing over the past 5 or 6 years.

Non-methadone treatment sources,

like epidemiologic and ethnographic

sources, report an even gender split

among crack-using clients in several

Pulse Check cities: Philadelphia in the

Northeast; Washington, DC, in the

South; Sioux Falls and St. Louis in

the Midwest; and Billings, Honolulu,

Los Angeles, and Seattle in the West.

Males are the predominant crack

users among clients in the remaining

non-methadone treatment programs.

The only reported change is in

Washington, DC, where more females

are smoking crack than ever before.

Only four methadone treatment

providers report males as predominant among crack users in their 

programs: in Birmingham, Boston,

What drugs do female users tend

to take? 

The Boston ethnographic source comments that “females are more likely to

use crack than IV drugs such as heroin

and powder cocaine.” Indeed, as

Exhibit 9 shows, epidemiologic and

ethnographic sources tend to consider

females as equally or more likely than

males to use crack, more so than any

other illicit drug except ecstasy.

Exhibit 8. 

What age group is most likely to use crack?

Adolescents (<18) Young Adults (18–30) Adults (>30)

Boston, MAE,N,M Boston, MAE,M

Philadelphia, PAE,N,M Philadelphia, PAN

Portland, MEN Portland, MEE

Columbia, SC N Baltimore, MDE Baltimore, MDN

Birmingham, ALE,N Birmingham, ALE,N,M

Columbia, SC M Columbia, SCE

El Paso, TXE,N Memphis, TNE,N

Memphis, TNN Miami, FLE

Miami, FLN Washington, DCE,M

New Orleans, LAE,N,M

Washington, DCN

Sioux Falls, SDN Chicago, ILN Chicago, ILE,M

Detroit, MIE,N Detroit, MIE,M

St. Louis, MOE St. Louis, MON

Sioux Falls, SDE Sioux Falls, SDN

Los Angeles, CAN Billings, MTE Denver, COE,N

Honolulu, HIE,N Honolulu, HIM

Los Angeles, CAN Los Angeles, CAE,M

Seattle, WAE,N Seattle, WAME

E Epidemiologic/ethnographic respondents N Non-methadone treatment respondents M Methadone treatment respondents Northeast South Midwest West
CRACK COCAINE

page 38 Pulse Check: November 2001

New Orleans, and Seattle. Both males

and females are equally likely to use

crack in another five methadone programs (in Boston, Columbia, Detroit,

Los Angeles, and Washington, DC).

Females comprise the majority of

crack-using clients in the Chicago and

Honolulu methadone programs. Eight

methadone sources, however, did not

supply breakdowns of their client

population by gender.

Is any racial/ethnic group more

likely to use crack? (Exhibit 10)

According to epidemiologic and

ethnographic sources, Blacks account

for the largest proportion of crack

users in 11 of the 21 Pulse Check

cities, where they are overrepresented

relative to the general population. In

Birmingham, Blacks and Whites are

equally likely to use crack, reflecting

their distributions in the general population. El Paso has two distinct

racial/ethnic groups of crack users:

Blacks are the predominant sole crack

users; but Hispanics are the most

likely to use both crack and heroin.

Whites are more likely than other

racial/ethnic groups to use crack in

seven cities and are overrepresented

relative to the general population in

three of those cities. Only two

race/ethnicity changes are reported:

in Philadelphia, Hispanics, who are

overrepresented among crack users,

have increased in proportion since

the last report; and in Columbia, SC,

a small increase in the number of

Hispanics using crack (which remains

small) reflects a similar increase in the

overall population. 

According to Pulse Check treatment

sources, Blacks are the predominant

crack users among clients in 11 nonmethadone programs but only 5

methadone programs. Whites account

for the largest proportions of crack

users at four non-methadone programs and six methadone programs.

Blacks and Whites are split approximately evenly as the foremost crack

users in the Columbia, SC,

methadone program, while Blacks,

Whites, and Hispanics are about

equally represented at three nonmethadone programs: in El Paso, Los

Angeles, and Philadelphia. No

racial/ethnic shifts are reported by

any treatment sources since the last

Pulse Check reporting period.

What is the most common

socioeconomic background of

crack users? Crack-using populations are predominantly in lower SES

categories in all but 4 of the 21 cities,

according to epidemiologic and

Exhibit 9. Which genders are the predominant users of specific drugs 

in the 21 Pulse Check cities?

Male

Split

evenly

Female

Powder

Cocaine

(N=20)

Heroin

(N=21)

Percent of respondents

Crack

(N=21)

Marijuana

(N=20)

Methamphetamine

(N=15)

Ecstasy

(N=16)

Source: Epidemiologic and ethnographic respondents

100

80

60

40

20

0

White crack users in Boston?

“The majority of crack users are

Black,” states Boston’s ethnographic

source. “White crack users tend to be

heroin addicts who are losing injectable

surface veins.”

Exhibit 10.

What racial/ethnic group is most

likely to use crack?

City Crack

E N M

Boston, MA Black White White

New York, NY NR NR NR

Philadelphia, PA Black All Black

Portland, ME White White NR

Baltimore, MD Black Black Black

Birmingham, AL Black/ Black Black

White

Columbia, SC Black White Black/

White

El Paso, TX Black All NR

Memphis, TN White Black NR

Miami, FL Black Black NR

New Orleans, LA Black Black White

Washington, DC Black Black Black

Chicago, IL Black Black Black

Detroit, MI White Black Black

St. Louis, MO Black Black NR

Sioux Falls, SD White Black N/A

Billings, MT White White/ N/A

American

Indian

Denver, CO White Black Black

Honolulu, HI White NR White

Los Angeles, CA Black All White

Seattle, WA Black White White

West South Northeast Midwest

Sources: Epidemiologic/ethnographic (E), 

non-methadone treatment (N), and

methadone treatment (M) respondents 

Note: Shaded boxes indicate that a given drugusing population is overrepresented relative to

that city’s general population. Not all sources,

however, had this information available.
CRACK COCAINE

Pulse Check: November 2001 page 39

ethnographic sources. In Honolulu

and Sioux Falls, crack users are primarily middle SES; in Birmingham,

they are both lower and middle SES;

and in Detroit, users cross all SES 

categories. Treatment sources concur

that crack users are generally found

in the lower SES groups. The only

exceptions are in Boston, Columbia

(SC), Honolulu, Los Angeles, New

Orleans, and Sioux Falls, where either

the middle SES or both lower and

middle SES groups are cited by treatment providers.

Where do crack users tend to

reside? Crack users reside primarily

in central city areas, as reported by

nearly all (18 of the 21) epidemiologic

and ethnographic sources. In El Paso

and Sioux Falls, however, crack users

are more likely to reside in the suburbs, while in Detroit users reside

throughout the area. While Birmingham’s crack users reside primarily in

the central city, the epidemiologic

source notes that many users reside

throughout small rural towns all 

over Alabama.

Similarly, all but three treatment

sources report that the majority of

crack users reside in central city

areas. Two exceptions are in Sioux

Falls, where crack users in the two

non-methadone Pulse Check sites are

more likely to live in rural areas.

Seattle is the third exception, with

crack users equally likely to reside in

both central city and suburban locations. Additionally, smaller populations of crack users reside in the suburban and rural areas surrounding

Honolulu and St. Louis, as reported

by those cities’ methadone and 

non-methadone treatment sources,

respectively.

How do users take crack?

Smoking, by far, remains the predominant route of crack administration in

every Pulse Check city, according to

all epidemiologic and ethnographic

sources and nearly all treatment

sources. The only exceptions are in

three non-methadone treatment 

programs: in Boston, injecting equals

smoking; in Memphis, snorting predominates; and in Sioux Falls, both

snorting and smoking are common.

Occasional crack injection is also

mentioned by epidemiologic and

ethnographic sources in Baltimore

(where solid crack is sometimes

cooked and injected), New Orleans

(where crack is injected with heroin

in speedballs), and Washington, DC

(where it is injected with heroin and

marijuana).

Crack in St. Louis: Increasingly a

lower SES problem...

As the St. Louis epidemiologic source

notes, “With the mass exodus from the

city into the surrounding counties over

the past few years, St. Louis’ crack

problem is becoming more concentrated among people of lower SES, who

remain in the city.”

How do crack cocaine users wind

up in treatment?

As reported in the last Pulse Check issue,

courts and the criminal justice system

remain the most common referral

sources for clients entering treatment for

crack addiction, according to the

responding treatment sources. Individual

referrals, again, follow closely as the 

second most common referral source.

Then and Now:

How have crack cocaine use patterns changed across the country 

(fall 2000 vs spring 2001)?

According to epidemiologic and ethnographic sources...

Increased crack injection: 

More drugs:

Decline in crack houses:

Increased public use:

➤ Baltimore, MD: Solid crack is sometimes cooked and

injected, according to recent reports.

➤ Washington, DC: Crack is being injected with heroin

and marijuana.

➤ Philadelphia, PA: Crack users are taking a wider range

of other drugs than before, including heroin, marijuana,

ecstasy, and diverted prescription drugs such as alprazolam (Xanax®), diazepam, amitriptyline (Elavil®), and,

most recently, oxycodone (OxyContin®).

➤ Denver, CO: Crack houses have become less prominent,

but this change is long term, rather than recent.

➤ St. Louis, MO: Crack houses have become less prominent, possibly because cell phones and beepers are

increasingly used and because users know which blocks

to drive down in order to make their “connections.”

➤ Seattle, WA: Public smoking of crack has increased since

the last report. Users are now equally likely to smoke

the drug either in public or in private.
CRACK COCAINE

page 40 Pulse Check: November 2001

How frequently do users take

crack? The majority of nonmethadone treatment sources (15 of

21) report that crack users in their

program tend to take the drug daily.

Less frequent usage is reported in six

programs, three of which are in midwestern Pulse Check cities: Chicago

(four to seven times a week),

Columbia (SC) (once to twice a

month), Los Angeles (twice a month),

Portland (ME) (three to four times a

week), St. Louis (three to four times a

week), and Sioux Falls (once to twice

a month). In methadone programs, by

comparison, usage frequency appears

lower: only seven Pulse Check sources

report daily crack usage by clients in

their programs, while another seven

report less than daily use. In Philadelphia, for example, some clients use

crack daily, but binge use is more 

typical.

What other drugs do crack users

take? Aside from alcohol, the substances most commonly consumed

with crack—either sequentially or in

combination—are marijuana and

heroin. Marijuana is mentioned by

epidemiologic, ethnographic, and

treatment sources across the country:

Philadelphia in the Northeast;

Baltimore, Birmingham, Columbia,

Miami, New Orleans, and

Washington, DC, in the South;

Detroit and St. Louis in the Midwest;

and Denver, Honolulu, and Seattle in

the West. Heroin is also mentioned

by the same source categories in all

four regions: Boston, New York,

Philadelphia, and Portland in the

Northeast; El Paso, Memphis, New

Orleans, and Washington, DC, in the

South; only Chicago in the Midwest;

and Denver, Honolulu, and Los

Angeles in the West.

The marijuana-crack combination 

(in a blunt) in Philadelphia is known

as a “diablito” or a “turbo.” That

city’s epidemiologic source also lists 

a variety of diverted prescription

drugs abused by crack users, 

including alprazolam and diazepam

(benzodiazepines); amitriptyline (an

antidepressant); and oxycodone (the

opiate in Percodan®, Percocet®, and

OxyContin®). The New York ethnographic source similarly mentions the

crack-diazepam combination, stating

that “A woman in the Bronx told a

researcher that when she cooked up

her crack she would put ‘a valium’ 

in it. She said when she smoked this

crack combination it felt like she was

using heroin.” New York users also

combine crack with PCP, a practice

known as “space basing.” Further

south, alprazolam and diazepam are

also commonly taken by crack users

in Memphis, according to the epidemiologic source. In the West, three

treatment sources—in Billings,

Honolulu, and Los Angeles—report

that crack users in their programs

also abuse diverted benzodiazepines,

such as diazepam and clonazepam.

The Los Angeles methadone 

treatment source adds that some

crack-using clients also abuse the 

diverted prescription muscle 

relaxant carisoprodol (Soma®).

Where and with whom is crack

used? (Exhibit 7) Unlike crack sales,

which occur both indoors and outdoors, crack use is more likely to take

place indoors than outdoors (according to 12 out of 20 responding epidemiologic and ethnographic

sources). Users also prefer to smoke

crack in private, rather than public

(13 out of 20 sources) and in small

groups or among friends, rather than

while alone (11 out of 20 sources). 

Nearly all the remaining epidemiologic

and ethnographic sources report that

sales and use occur both indoors and

outdoors and in both private and

public locations. But sources in six

cities (Baltimore, Los Angeles,

Memphis, Miami, New York, and

Portland) report that crack users tend

to use their drug while alone, rather

than in a group. The Baltimore

ethnographic source explains that

“crack users tend to smoke their drug

alone, not in groups, because of the

short duration of the high.” Baltimore

is also the only city where outdoor

use is slightly more common than

indoor use, but the ethnographic

source notes a particularly wide range

of use settings, including “abandominiums” (abandoned row houses)

and fast-food restaurant bathrooms.

Similarly, the El Paso epidemiologic

source lists a particularly wide range

of use settings. El Paso is also the

only city where use in public places is

more common than use in private

locations.

Overall, a wide variety of specific 

settings are reported, with private residences most commonly mentioned,

followed by crack houses and public

housing developments. Crack houses,

however, are becoming less prominent

in some areas, such as Denver and St.

Louis. Other venues mentioned, in

descending order of frequency,

include parties, cars, nightclubs,

schools, and college campuses. The

Honolulu epidemiologic source adds

two other unusual crack use settings:

adult video galleries, and hotel rooms. 

Treatment sources concur that crack

is usually used indoors, in private,

and in small groups or among friends.

Outdoor use is more common than

indoor use in only two programs 

(the Boston and Columbia [SC] 
CRACK COCAINE

Pulse Check: November 2001 page 41

non-methadone programs), public 

use is more common than private use

in only one (the Columbia nonmethadone program), and solo use is

more common than social use in only

six programs (at the methadone 

programs Chicago, Detroit, New

Orleans, and Washington, DC, and at

the non-methadone programs in the

Miami and Washington, DC). A treatment source in Honolulu points out

that people tend to use crack in small

groups and among friends in order to

share costs and, when availability is

low, to share the drug.

Indoor versus outdoor crack use in

Boston...

Outdoor use in Boston, while slightly less

common than indoor use, is still widespread. As that city’s ethnographic source

points out, “crack is used outdoors more

than other drugs because it’s easier to

‘do’ without being seen.” By contrast, a

Boston treatment source states that “crack

can’t be used in public because of its distinct odor.”

Crack houses on the decline...

The St. Louis epidemiologic source notes

a decline in crack houses, possibly

because cell phones and beepers are

increasingly used and because users know

which blocks to drive down in order to

make their “connections.” The Denver

epidemiologic source also reports a longterm decline in crack houses.

Small-group versus private use...

The Baltimore ethnographic source

explains that “crack users tend to smoke

their drug alone, not in groups, because

of the short duration of the high.” A

Honolulu treatment source points out,

however, that group use is more economical: friends can share costs and, when

availability is low, they can share the drug.
page 42 Pulse Check: November 2001

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POWDER COCAINE: 

THE PERCEPTION

How do Pulse Check sources

perceive the powder cocaine

problem in their communities?

Boston is the only community in

which a Pulse Check source (the law

enforcement source) names powder

cocaine as the most widely abused

drug. In Denver, one source (from

non-methadone treatment) considers

both crack and powder cocaine as

that city’s most widely abused drugs,

and the other three Pulse Check

sources consider powder cocaine as

the second most widely abused drug

(following marijuana). It is also 

considered the second most widely

abused drug by sources in El Paso,

New Orleans, and New York.

Also in Denver, two sources (law

enforcement and epidemiologic) name

powder cocaine as the drug with the

most serious consequences, whether

medically, legally, societally, or otherwise. In Memphis, too, one source

(non-methadone treatment) puts 

powder cocaine into that category.

Has the perception of the 

powder cocaine problem

changed between fall 2000 and

spring 2001? Two sources who

named powder cocaine as their 

communities’ most widely abused drug

during the last Pulse Check reporting

period perceive a change: the

Memphis non-methadone treatment

source believes that crack has replaced

powder cocaine, and the Portland

(ME) law enforcement source believes

that heroin and diverted pharmaceutical opiates have replaced it. The

Portland law enforcement source also

believes that diverted pharmaceutical

opiates have replaced powder cocaine

as the drug with the most serious consequences. By contrast, in Memphis,

the non-methadone source perceives

that powder cocaine has replaced

crack in causing the most serious 

consequences. No sources in any other

Pulse Check cities believe powder

cocaine to be associated with any 

new or emerging problems.

POWDER COCAINE: THE DRUG

How available is powder cocaine

across the country? (Exhibit 1)

Powder cocaine is considered widely

available in 18 of the 21 Pulse Check

cities (the 3 exceptions are St. Louis,

Sioux Falls, and Washington, DC),

according to nearly two-thirds (27 of

41) of law enforcement, epidemiologic, and ethnographic sources who 

discussed this question. Ten sources in

eight cities describe it as “somewhat

available”: Boston and Philadelphia 

in the Northeast; Baltimore and

Washington, DC, in the South; St.

Louis and Sioux Falls in the Midwest;

and Honolulu and Seattle in the West.

Only four sources consider the drug

not very available: two in the West

(Billings and Los Angeles), and two in

the Midwest (Chicago and St. Louis).

Exhibit 1.

How available is powder cocaine across the 21 Pulse Check cities?

POWDER COCAINE

Pulse Check: November 2001 page 43

According to epidemiologists and ethnographers (N=21)...*

According to law enforcement sources (N=21)...

Widely Available Somewhat Available Not Very Available

*The epidemiologic source in Columbia did not provide this information.
Has powder cocaine availability

changed? (Exhibit 2) Powder

cocaine availability remained stable

between fall 2000 and

spring 2001, according to the majority

(18 of 20) of Pulse

Check law enforcement sources who discussed this question.

Only two of those

sources perceive an

increase (in Columbia, SC, and in

Portland, ME), and

no declines are

reported. Trends are

more mixed, however, according to

the 20 epidemiologic and ethnographic sources

who discussed

this question:

powder cocaine

availability

increased in 5 sites,

declined in 5, and

remained stable in

10. Regionally, trends

are mixed: in the

Northeast, stable

trends are reported in

New York,

Philadelphia, and

Portland, while a

decline is reported in

Boston; in the South,

supply declined in El

Paso, Miami, and

Washington, DC,

remained stable in Memphis and New

Orleans, and increased in

Birmingham; in the Midwest, 

availability increased in Chicago and

Detroit and remained stable in Sioux

Falls and St. Louis;

and in the West, 

availability increased

in Denver and Seattle

and remained stable in

Billings and Los

Angeles.

What are powder

cocaine prices and

purity levels across

the country?

(Exhibit 3) Grams

and “eightballs”

(1/8 ounce) are

the sales units

most commonly reported by

law enforcement, epidemiologic,

and ethnographic

sources. Grams

range in price

from a low of $28

in New York to a

high of $150 in New

Orleans, with $100

the most frequently

reported price.

Eightballs sell for as

low as $80 in Seattle

and as high as $400 in

Memphis. Gram-level

purity ranges from a

low of 20 percent in

Denver and Washington, DC, to a high of 90 percent in

Detroit and Miami. 

How much powder cocaine can $10 buy? In several cities, law enforcement, epidemiologic, and ethnographic sources report units

of sale, often called “dime bags,” that sell for $10 apiece:

page 44 Pulse Check: November 2001

POWDER COCAINE

Exhibit 3. 

How much do grams and “eightballs” of powder cocaine cost in

17 Pulse Check cities?*

GRAM

City Price Purity

Boston, MA $60 50–60%

New York, NY $28–$30 75%

Philadelphia, 

PA $100–$125 60–80%

Portland, ME $80–$100 30–70%

Birmingham, AL $100 NR

Columbia, SC $100 NR

Memphis, TN $100 40–50%

Miami, FL $40–$60 80–90%

New Orleans, $25–$150 NR

LA 

Washington, DC $100 20–60%

Chicago, IL $125 NR

Detroit, MI $70–$125 60–90%

Sioux Falls, SD $80–$100 NR

Denver, CO $100 20–50%

Honolulu, HI $100–$120 NR

Los Angeles, CA $80 80–85%

Seattle, WA $80–$100 57–58%

“EIGHTBALLS” (1/8 OUNCE)

City Price Purity

Boston, MA $200–$250 60% 

Portland, ME $250 50%

Columbia, SC $250–$300 NR 

Memphis, TN $350–$400 40–50% 

Sioux Falls, SD $275 NR

Seattle, WA $80–$100 NR

Sources: Law enforcement, epidemiologic, and

ethnographic respondents

*Respondents in Baltimore, Billings, El Paso,

and St. Louis did not provide this information. Northeast South West Midwest Northeast South West Midwest

! “A little cellophane bag” in Baltimore

! 0.1–0.2 grams in Denver

! 0.1 gram in Detroit

! 0.5 gram in New Orleans

! 0.25 gram in Seattle

! 150–150 milligrams in Washington, DC 

Exhibit 2.

How has powder cocaine 

availability changed (fall

2000 vs spring 2001)?*

L Law enforcement respondents

E Epidemiologic/ethnographic

respondents

*The Boston and Columbia 

epidemiologic/ethnographic

sources and the Memphis law

enforcement source did not

respond.

Birmingham, ALE

Chicago, ILE

Columbia, SCL

Denver, COE

Detroit, MIE

Portland, MEL

Seattle, WAE

Boston, MAE

El Paso, TXE

Honolulu, HIE

Miami, FLE

Washington, DCE

Baltimore, MDL,E

Billings, MTL,E

Birmingham, ALL

Boston, MAL

Chicago, ILL

Denver, COL

Detroit, MIL

El Paso, TXL

Honolulu, HIL

Los Angeles, CAL,E

Memphis, TNE

Miami, FLL

New Orleans, LAL,E

New York, NYL,E

Philadelphia, PAL,E

Portland, MEE

Seattle, WAL

Sioux Falls, SDL,E

St. Louis, MOL,E

Washington, DCL
POWDER COCAINE

Pulse Check: November 2001 page 45

What adulterants are added to

powder cocaine? In addition to

baking soda, which is a standard

ingredient added to powder cocaine

to make crack, Pulse Check law

enforcement, epidemiologic, and

ethnographic sources cite several

adulterants, including crystalline

stereoisomeric cyclic alcohols (such as

inositol and mannitol) in Columbia

(SC), El Paso, Honolulu, and Miami.

Other adulterants mentioned include

lactose in Boston, “any powder” in

Miami and Portland (ME), and baby

laxatives, vitamin B, and vitamin C in

Memphis. The Detroit law enforcement source reports that powder

cocaine might be mixed with other

drugs, such as heroin.

How is powder cocaine referred

to across the country? (Exhibit 4)

As in the case of crack, users in the

South refer to powder cocaine with a

wider variety of slang names than

users in the other three regions.

Crack and powder cocaine names are

not interchangeable in most cities.

How is powder cocaine packaged

and marketed? Powder cocaine is

generally packaged in plastic bags of

some sort—whether cellophane,

glassine, coin, zipper type, heat

sealed, or even just the torn-off corner of a sandwich bag (as is the case

in Columbia, SC)—according to law

enforcement, epidemiologic, and

ethnographic sources in all but one

Pulse Check city. Los Angeles is the

exception: that city's law enforcement

source reports that the drug is sold

only in “bindles.” Bindles—foldover,

stapled, knotted, or taped packages

made of plain paper, cellophane,

glassine, magazine paper, dollar bills,

or lottery tickets—are reported in 

several other cities as well: New York

in the Northeast; Baltimore, El Paso,

and Memphis (where folded pieces of

paper are called “pony packs”) in the

South; Chicago, Detroit, and St.

Louis in the Midwest; and Honolulu,

Los Angeles (as mentioned above),

and Seattle in the West. Other 

methods of packaging include tin or

aluminum foil (in Detroit, New York,

and Washington, DC), compressed

bricks (in Billings and New York), 

balloons (in Denver and El Paso),

vials (in Baltimore, Philadelphia, and

Seattle), and glue tubes (in Denver).

In Billings, the law enforcement

source reports that plastic bags containing powder cocaine are sometimes

inserted into perfume containers or

motor oil cans.

Exhibit 4. 

How is powder cocaine referred to across different regions of the country?

WEST

Coke, blow, big,

C, toot, white

girl, nose candy,

product, flake

Coke, powder, girl,

white, snow, shirt

MIDWEST

NORTHEAST

SOUTH

Coke, blow,

product,

snow, flave

Coke, powder, blow, the lady, girl, yay, snow, soft, soda,

white, blanca, funk, nose candy, sugar boogers, vc, coc,

white powder, white ghost, white girl, white horse,

geekin, tweekin, wiggin, schizo, fruit, bump, toot,

shake, snow white, snag

Coke,

flake

Sources: Law enforcement, treatment, epidemiologic, and ethnographic respondents

Then and Now: Powder cocaine

prices and purity, fall 2000 vs

spring 2001 

Powder cocaine prices and purity levels

remained relatively stable since the last

Pulse Check reporting period, according

to law enforcement sources, with only

two exceptions: the Los Angeles source

notes an increase in the gram price

(from $70 to $80) attributable to market fluctuation, while the El Paso

source notes a drop in the price of a

“hit” (weight unknown), from $10 to

$3. The El Paso epidemiologic source

confirms a price drop, noting that powder cocaine, like heroin, is now cheaper

and more abundant on the American

side of the border than on the Mexican

side. Again, these changes are apparently the result of competition for the market by the same three different cartels

involved in the heroin trade. Similarly,

in the Northeast, the New York ethnographic source notes that high availability and purity levels are allowing dealers to sell three separate qualities: pure

(the most expensive); semi-pure (medium priced); and compressed (the least

expensive). Also, because powder

cocaine is so plentiful and cheap in

New York, some crack users are buying

powder cocaine to snort it, freebase it,

or mix their own crack.

“Retro” packaging for powder

cocaine: Back to the Seventies?

One dealer in New York informed the

Pulse Check ethnographic source, “I’m

packaging coke in sexy magazine

paper, like Playboy, like in the

Seventies.” He also stated that “coke

keeps better in the magazine paper

than in plastic or aluminum.”
POWDER COCAINE

page 46 Pulse Check: November 2001

In some cities, dealers add logos,

insignias, or pictures to the packaging. Such is the case in three southern

cities: Memphis (logos on baggies

sold in head shops), Miami (brand

name insignia), and New Orleans

(pictures of horses, cats, and stars on

bags). Logos in New Orleans reportedly change often. In Chicago, kilo

packages sometimes have cartoon

characters stamped on the wrappers,

and sometimes the inner and outer

wrappers have different cartoon

stamps. In Denver, too, wrappers

have various logos, such as scorpions

and stars.

POWDER COCAINE: THE SELLERS 

How are powder cocaine sellers

organized? In only three cities do

law enforcement sources report that

powder cocaine sales operate predominantly within an organized

structure, such as a gang: Birmingham

in the South, and Billings and Seattle

in the West. Both independent and

organized sales structures are reported in Chicago, El Paso, New Orleans,

Los Angeles, and Portland, ME (loose

networks, not ganglike). In every other

Pulse Check city, law enforcement

sources report that powder cocaine

dealers operate independently. By 

contrast, as in the case of heroin and

crack, epidemiologic and ethnographic

sources generally categorize powder

cocaine dealers as affiliated with some

sort of organized structure. Independent dealers are mentioned only in

Boston, Birmingham, Memphis, and

Denver. In Boston, where both types

of operations are reported, those who

are organized tend to be Dominican

people who are part of a larger distribution network.

How old are street-level powder

cocaine sellers? All but four law

enforcement sources name young

adults (18–30 years) as the predominant sellers of powder cocaine. In El

Paso and Portland (ME), young adults

and adults older than 30 are equally

likely to sell the drug. In Los Angeles,

both young adults and adolescents are

named as the primary sellers. And in

Philadelphia, older adults predominate.

Epidemiologic and ethnographic

sources are even more in agreement

that young adults are the predominant sellers of powder cocaine. Only

two report otherwise. In Boston, both

young and older adults are likely to

sell the drug. And, in Chicago, disturbingly, the primary sellers are

reportedly adolescents.

What other drugs do powder

cocaine dealers sell? (Exhibit 5)

New York is the only Pulse Check site

in the Northeast where law enforcement, epidemiologic, and ethnographic sources report polydrug sales

by powder cocaine dealers—sometimes as many as four additional

drugs (marijuana, crack cocaine,

heroin, and ecstasy). In the West, by

contrast, polydrug sales are reported

Then and Now:

How have powder cocaine sellers

and sales changed across the

country (fall 2000 vs spring 2001)?

Only one notable change is noted since

the previous Pulse Check reporting 

period: in New York, powder cocaine

dealers have added ecstasy to the many

other drugs they sell. Elsewhere, the

powder cocaine sales market has

remained generally stable.

Exhibit 5.

What other drugs do powder cocaine dealers sell?*

Crack Metham- No Other

Marijuana Heroin Cocaine phetamine Ecstasy Drugs Sold

City LE E LE E LE E LE E LE E LE E

Boston, MA " "

New York, NY "" " " "" "

Philadelphia, PA "

Portland, ME "

Baltimore, MD " "

Birmingham, AL "" " "

Columbia, SC "

El Paso, TX "

Memphis, TN "" "

Miami, FL " ""

New Orleans, LA " " ""

Washington, DC "

Chicago, IL "" "

Detroit, MI " "

St. Louis, MO "

Sioux Falls, SD " ""

Billings, MT " "

Denver, CO " "" ""

Honolulu, HI " "

Los Angeles, CA "

Seattle, WA " "

West South Northeast Midwest

Sources: Law enforcement (LE) and epidemiologic and ethnographic (E) respondents

*Epidemiologic and ethnographic sources in Billings, Columbia, El Paso, Honolulu, Los Angeles,

Philadelphia, Portland, St. Louis, Seattle, and Washington, DC, did not provide this information.
POWDER COCAINE

Pulse Check: November 2001 page 47

in every site. Sources in the South and

Midwest, however, paint a mixed 

picture, with dealers in some cities

engaged in multiple drug sales and

dealers in other cities selling only 

powder cocaine. Overall, marijuana is

reported in 11 cities, followed by

crack and heroin (in 7 cities each).

Methamphetamine is mentioned in

only four cities (three in the West), as

is ecstasy. Additionally, the Detroit epidemiologic source reports that some

powder cocaine dealers also sell LSD.

The only change in this aspect of the

sales scene is reported in New York,

where ecstasy sales by powder cocaine

dealers are a new phenomenon.

Do powder cocaine sellers use

their own drug? Law enforcement

sources in Billings, Boston, Sioux

Falls, and Washington, DC, believe

that powder cocaine sellers are very

likely to use their own drug. In nearly

every other Pulse Check city, they

describe these sellers as “somewhat

likely” to use it. Only in Denver and

Miami do law enforcement sources

believe that powder cocaine dealers

are not very likely to use their drug.

Epidemiologic and ethnographic

sources in four cities, all in the South

(Baltimore, Birmingham, El Paso, and

Memphis), believe that powder

cocaine sellers are very likely to use

their own drug. Independent dealers

in Boston are also very likely to use

their own powder cocaine, but dealers affiliated with an organization in

that city are not likely to do so at all.

The Detroit source considers sellers

somewhat likely to use their own

drug. The remaining sources who discussed this topic believe that this

practice is not very likely.

What type of crimes are powder

cocaine sellers involved in? All

but three Pulse Check law enforcement sources believe that cocaine sellers are very likely or somewhat likely

to be involved in crime. The exceptions are in Columbia (SC), St. Louis,

and Washington, DC, where dealer

involvement in crime is considered

not very likely. The majority of the

responding sources (14 out of 20)

name nonviolent crime, and half (10)

name violent crime (less so than for

crack). Specifically, gang-related activity is mentioned in nine cities (Boston

in the Northeast; Chicago in the

Midwest; Baltimore, Birmingham,

Memphis, and New Orleans in the

South; and Billings, Los Angeles, and

Seattle in the West), while prostitution is mentioned in eight (Boston,

Philadelphia, and Portland in the

Northeast; Birmingham, Memphis,

and New Orleans in the South; and

Denver and Honolulu in the West).

The nonviolent crimes specified

include burglaries, auto break-ins,

and shoplifting in Columbia; money

laundering in Miami; and aiding illegal aliens in El Paso.

Epidemiologic and ethnographic

sources in the South express varied

opinions on whether powder cocaine

sellers are involved in crime. Those in

Baltimore, El Paso, and Miami believe

that very likely to be the case, while

those in Memphis and New Orleans

consider it somewhat likely, and those

in Birmingham and Washington, DC,

consider it not very likely. The most

commonly named activities are violent crime and gang-related crimes (in

Detroit and in four southern cities),

nonviolent crime (in Honolulu and

four southern cities), and prostitution

(in Boston and in three southern 

cities). Domestic violence is 

mentioned in El Paso, and drug 

rape is mentioned in Miami.

Where is powder cocaine sold?

(Exhibit 6) In many Pulse Check

cities, street-level powder cocaine

sales, like heroin and crack sales, take

place in central city areas, as reported

in the last Pulse Check. However, as

also reported in the last Pulse Check,

suburban areas are frequently mentioned as well, more so than for heroin or crack. Specifically, both suburban and central city locations are

named by law enforcement sources in

seven sites: Miami and New Orleans

in the South; Detroit and Sioux Falls

in the Midwest; and Denver, Los

Angeles, and Seattle in the West.

Furthermore, areawide sales (spanning central city, suburban, and rural

areas) are reported in the Northeast

(Boston, New York, and Portland)

and the South (Birmingham and

Memphis). In El Paso, the suburbs,

exclusively, are named as the likeliest

location for powder cocaine sales.

According to epidemiologic and

ethnographic sources who discussed

this question, central city areas are

the predominant sales locations in

Baltimore, Memphis, New Orleans,

New York, and Washington, DC.

Suburban areas are named in Detroit,

Miami, and Sioux Falls. Both types of

areas are named in Boston, Chicago,

Birmingham, and El Paso. In Denver,

sales occur in all three types of city

locations (including rural areas).

Powder cocaine is sold both indoors

and outdoors, according to the majority (14 of 21) of law enforcement

sources. However, indoor sales locations are more frequent in Chicago,

Detroit, Portland (ME), and Seattle, 
POWDER COCAINE

page 48 Pulse Check: November 2001

while outdoor locations are more frequent in Miami, Philadelphia, and

Sioux Falls. Epidemiologic and ethnographic sources similarly report both

types of locations in Chicago,

Baltimore, Denver, El Paso, Memphis,

and New Orleans. Indoor locations,

however, are more frequent in

Birmingham, Detroit, Miami, New

York, and Sioux Falls, while outdoor

locations are more frequent in

Washington, DC.

The specific settings for powder

cocaine sales are as varied as those for

heroin and crack. Private residences,

public housing, and clubs are named as

sales sites by law enforcement, epidemiologic, and ethnographic sources

in nearly every Pulse Check city. Cars

and parties are the next most common

settings, followed by college campuses, schools, and raves. No rave sales

are reported in the Midwest. Crack

houses are mentioned in only 10

cities, predominantly in the Northeast

and the South. Supermarket areas are

also mentioned in 10 cities, but none

are in the Midwest.

POWDER COCAINE: THE USERS

How old are powder cocaine

users? Young adults (18–30 years)

are the predominant powder cocaine

users in 10 of 20 Pulse Check cities,

according to responding epidemiologic and ethnographic sources. People

older than 30 are more likely to use

the drug in nine cities, mainly in the

South (Baltimore, Memphis, Miami,

New Orleans, and Washington, DC)

as well as in Boston, Chicago,

Denver, and Seattle. In Detroit, both

younger and older adults are equally

likely to use the drug.

Findings are even more dramatic in

non-methadone treatment programs:

young adults are the age group likeliest to use powder cocaine in nearly

every Pulse Check city. There are only

five exceptions. Young adults and

older adults alike are the predominant users in Philadelphia. Older

adults are more predominant in

Denver. Young adults and adolescents

are equally predominant in Los

Angeles. And adolescents are actually

the most likely to use powder cocaine

in Columbia (SC) and one of the

Sioux Falls programs.

Exhibit 6. Where is street-level powder cocaine sold and used?*

Private Public Shop- #

Resi- Hous- Crack ping Inside Super- of

City Street dences Clubs ing College Houses Schools Parties Malls Cars Parks Raves markets Settings

Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use

Boston, MA " """ " " " " " " " " " 12 1

New York, NY "" " "" "" "" " " " " "" " "" " "" " " 13 10

Philadelphia, PA " """ " "" " "" 5 3

Portland, ME " "" " " " " 3 4

Baltimore, MD "" " " "" "" "" " " "" " " "" " "" " 11 11

Birmingham, AL " " """ " " " " " "" " " " " 12 4

Columbia, SC "" " 3 0

El Paso, TX "" " " "" "" "" " " "" " "" " "" " "" " "" 13 13

Memphis, TN "" " " "" "" " " " " " "" " " " " 12 7

Miami, FL " " """ " "" " " " """ "" " " 11 7

New Orleans, LA " """ " "" " """ " " " 11 3

Washington, DC " " " " "" " " " " "" " 9 4

Chicago, IL "" " " "" "" " " " " "" " " 8 8

Detroit, MI " " """ " " " "" " 5 6

St. Louis, MO " " "" "" "" " "" "" 8 5

Sioux Falls, SD " " " "" " " 5 2

Billings, MT " """ " " " " " "" " " 11 2

Denver, CO "" " " "" "" "" " " "" " " " 10 7

Honolulu, HI " """ " """ " " " " 10 3

Los Angeles, CA """ " " " 3 3

Seattle, WA " " "" "" "" " "" " 5 7

West South Northeast Midwest

Sources: Law enforcement, epidemiologic, and ethnographic respondents

*The epidemiologic/ethnographic sources in Billings, Boston, Columbia, Los Angeles, Seattle, and Sioux Falls did not provide seller setting information.

*The epidemiologic/ethnographic source in Columbia did not provide user setting information. The Boston source for user setting gave an overall

response: “most private setting available.”
POWDER COCAINE

Pulse Check: November 2001 page 49

Then and Now:

How have powder cocaine users changed across the country (fall 2000 vs spring 2001)?

According to epidemiologic and ethnographic sources....

In five Pulse Check cities, more

younger people—sometimes 

adolescents—are reportedly using

powder cocaine:

A few reported shifts reflect a spread

to the suburbs and to different racial/

ethnic and socioeconomic groups:

Shifting use patterns are reported in

four cities: 

According to treatment sources...

The number of novice users of 

powder cocaine (any drug treatment

client who has recently begun using

the drug) has increased among

clients in several programs in 

five cities:

Conversely, novice use has declined

among clients in non-methadone

programs in two cities:

➤ Birmingham, AL: Young adults are the most likely to use powder cocaine, but the drug is

becoming trendier among adolescents, who are moving away from crack.

➤ Detroit, MI: Young adults (18–30 years) have been increasingly using powder cocaine, so

that they now equal older adults (>30 years) as the groups most likely to use the drug.

➤ Los Angeles, CA: Young adults are the most likely to use powder cocaine, reflecting a slight

resurgence in use among “business person types.”

➤ Sioux Falls, SD: Young adults are the most likely to use powder cocaine, but an increase is

reported among adolescents, particularly females.

➤ Washington, DC: While older adults (>30 years) remain most likely to use powder cocaine,

the younger adult (18–30 years) group is increasing. 

➤ Portland, ME: Anecdotal data suggest that powder cocaine use might be spreading from the

central city into the suburbs.

➤ Washington, DC: While Blacks remain the racial/ethnic group most likely to use powder

cocaine, Whites have been increasingly using the drug. Likewise, powder cocaine users are

predominantly lower SES central city residents, but use is reportedly increasing among middle SES suburbanites. 

➤ Columbia, SC: A slight shift to injection is noted, but snorting still predominates.

➤ Los Angeles, CA: Some resurgence of injection (with no other drugs) is reported, but snorting still predominates. Also, a new combination is reported: powder cocaine plus ecstasy.

➤ Portland, ME: Smoking is increasing, but snorting still predominates.

➤ Washington, DC: While powder cocaine is usually injected (in speedballs), snorting has been

increasing, particularly in nightclubs, bars, and private parties. Such locations are emerging

settings for powder cocaine use. However, the predominant settings remain crack houses,

private residences, public housing developments, and cars. 

➤ Chicago, IL (methadone)

➤ Columbia, SC (methadone and non-methadone)

➤ El Paso, TX (methadone and non-methadone)

➤ Memphis, TN (non-methadone)

➤ New York, NY (non-methadone)

➤ Denver, CO

➤ Portland, ME
Methadone treatment clients who use

powder cocaine tend to be older than

their counterparts in non-methadone

treatment. People older than 30 are

named as the predominant user group

in seven cities (Boston, Chicago,

Detroit, Los Angeles, and Washington, DC), while younger adults are

named in five (Boston, Columbia,

Denver, El Paso, and New Orleans).

Are there any gender differences

in who uses powder cocaine?

Epidemiologic and ethnographic

sources generally agree that males are

more likely than females to use powder cocaine. In this respect, powder

cocaine users resemble heroin users

(who are more likely to be males)

rather than crack users (who are

equally likely to be males and females

in many cities). In three Pulse Check

cities, however, males and females are

equally likely to use the drug: New

York, Portland (ME), and Sioux Falls.

Furthermore, the gender of powder

cocaine users is sometimes related to

their age. In Detroit, for example,

older (>30 years) powder cocaine

users are predominantly males, but

the younger adult (18–30 years) user

group is evenly split between the 

genders.

Treatment sources, by contrast, paint

a picture that includes more females.

Women and men are equally likely to

use powder cocaine in nine nonmethadone programs (in Chicago,

Los Angeles, Seattle, Philadelphia,

Washington, DC, and both programs

in Billings and Sioux Falls) and six

methadone programs (in Boston,

Columbia [SC], Chicago, Detroit,

Denver, and Seattle). Moreover, in

the Los Angeles methadone program,

female powder cocaine users outnumber males.

Is any racial/ethnic group more

likely to use powder cocaine?

(Exhibit 7) Powder cocaine users,

compared with crack users, are more

likely to be White, as reported by

both epidemiologic and ethnographic

sources and non-methadone treatment sources; conversely, they are less

likely to be Black than crack users. As

reported in the last Pulse Check, their

racial/ethnic breakdowns are more

similar to those of heroin users than

to those of crack users. 

Regionally, according to epidemiologic

and ethnographic sources, the South is

the only region with a mix of racial/

ethnic groups as the predominant

powder cocaine users: Blacks are

named in four cities, Whites in three,

and Hispanics in one (Miami). The

other three regions seem to have predominantly White users in every city

except Chicago, where Blacks are the

predominant group. Non-methadone

treatment sources give slightly different regional breakdowns: Black users

seem to be more concentrated in the

Midwest than in the other regions,

while Whites generally tend to be the

predominant user group elsewhere.

Hispanics, however, are considered

the likeliest racial/ethnic group to use

powder cocaine in El Paso and

Miami, and they are about equal to

Whites and Blacks in Philadelphia

and Los Angeles.

Exhibit 7. 

What racial/ethnic group is most likely to use specific drugs?*

POWDER COCAINE

page 50 Pulse Check: November 2001

City Heroin Crack Powder Cocaine

E N E NE N

Boston, MA White White Black White White White

New York, NY White White NR NR NR NR

Philadelphia, PA White Black/ Black All White All

Hispanic

Portland, ME White White White White White White

Baltimore, MD Black Black Black Black Black White

Birmingham, AL Black/White Black Black/White Black Black/White White

Columbia, SC Black/White NR Black White Black White

El Paso, TX Hispanic Hispanic Black All White Hispanic

Memphis, TN White NR White Black Black Black

Miami, FL White Hispanic Black Black Hispanic Hispanic

New Orleans, LA Black Black Black Black White NR

Washington, DC Black Black Black Black Black Black

Chicago, IL Black Black Black Black Black Black

Detroit, MI White Black White Black White Black

St. Louis, MO Black Black Black Black White Black/White

Sioux Falls, SD White NR White Black White Black/White

Billings, MT White White White White/ White White

American

Indian

Denver, CO White White White Black White Black

Honolulu, HI White White White NR White White

Los Angeles, CA Hispanic Hispanic Black All White All

Seattle, WA White NR Black White/ White White

Hispanic

West South Northeast Midwest

Sources: Epidemiologic/ethnographic (E) and non-methadone treatment (N) respondents

*Shaded boxes indicate that a given drug-using population is overrepresented relative to that 

city’s general population. Not all sources, however, had this information available.
What is the most common

socioeconomic background of

powder cocaine users? (Exhibit 8)

Low and middle SES backgrounds are

reported approximately equally by

epidemiologic and ethnographic

sources in their descriptions of powder cocaine users–unlike their

descriptions of heroin and crack

users, which tend to be more on the

“low” side. The only exceptions are

in New Orleans and St. Louis, where

sources describe powder cocaine users

as “middle to high” SES, and in

Detroit, where users come from all

backgrounds. No regional patterns

are evident. Similarly, methadone

treatment sources are split about

evenly in the two responses. Nonmethadone treatment sources, by 

contrast, tend to name low SES

groups more frequently (15 of 22

respondents).

Where do powder cocaine users

tend to reside? Suburban areas are

named as the predominant place of

residence for powder cocaine users by

five epidemiologic and ethnographic

sources (in Boston, Los Angeles,

Miami, St. Louis, and Sioux Falls).

Additionally, users are equally likely

to reside in either the central city or

the suburbs in New Orleans and

Seattle; they reside predominantly in

rural areas in El Paso; and all three

types of areas are named in Detroit.

The remaining 12 epidemiologic and

ethnographic sources, however,

believe that powder cocaine users

reside, for the most part, in central

city areas. In Baltimore, the ethnographic source points out that while

most powder cocaine users reside in

the central city, some suburban 

residents purchase their drug in the

central city “because the suburbs have

no open air markets.” Similarly, in

Portland, ME, users continue to

reside predominantly in the central

city, but anecdotal data suggest that

use might be spreading to the suburbs.

Similarly, powder cocaine users in

treatment generally tend to live in

central city areas, but many also live

in the suburbs, particularly in the

South. Among 21 responding nonmethadone treatment sources, 10

name central city areas as the likeliest

place of residence, 7 name the suburbs (in Birmingham, Columbia, El

Paso, and Memphis in the South, and

Exhibit 8.

What is the predominant socioeconomic status of powder cocaine users?*

Boston, MA**

New York, NY

Philadelphia, PA

Portland, ME

Baltimore, MD

Birmingham, AL

Columbia, SC

El Paso, TX

Memphis, TN

Miami, FL

New Orleans, LA

Washington, DC

Chicago, IL

Detroit, MI

St. Louis, MO

Sioux Falls, SD**

Billings, MT

Denver, CO

Honolulu, HI

Los Angeles, CA

Seattle WA

Low Low/

Middle

Middle Middle/

High

High All

*This information was not provided by the ethnographic source in New York, the non-methadone

treatment sources in New York and one of the Billings programs, and by the methadone treatment

sources in Honolulu, Miami, New York, Philadelphia, Portland, and St. Louis.

**Information was provided from two methadone programs in Boston and two non-methadone 

programs in Sioux Falls.

Epidemiologic and

ethnographic sources

Methadone treatment sources

Northeast South Midwest West

Non-methadone treatment

sources

SES Group

POWDER COCAINE

Pulse Check: November 2001 page 51
POWDER COCAINE

page 52 Pulse Check: November 2001

Honolulu and Seattle in the West), 2

name rural areas (in both Sioux Falls

programs), and 2 name all locations

throughout the area (in Billings and

St. Louis). According to responding

methadone treatment sources, central

city places of residence are more

common in Boston, Birmingham,

Chicago, Detroit, El Paso, Los

Angeles, and Washington, DC, while

the suburbs are more common in the

second Boston program and in

Columbia (SC), Denver, and New

Orleans. In Los Angeles and Seattle,

non-methadone clients who use powder cocaine are equally likely to live

in central city and suburban areas.

How do powder cocaine users

take their drug? Snorting is the 

primary route of administration for

powder cocaine, according to the vast

majority of epidemiologic and ethnographic sources, with a few notable

exceptions: injecting (as part of a

speedball) is cited as more common

in Philadelphia and Washington, DC,

and smoking is as common as snorting in Honolulu. In some cities, route

of administration varies with age. For

example, in Detroit, young adult

(18–30 years) powder cocaine users

tend to snort the drug, while the

older (>30 years) user group is 

equally likely to snort and smoke it.

Epidemiologic and ethnographic

sources report three changes in cities

where snorting still predominates: a

shift towards smoking in Portland

(ME), some resurgence of injection in

Los Angeles (with no other drugs),

and a slight shift to injection in

Columbia (SC). Conversely, in

Washington, DC, where injection 

predominates, snorting has been

increasing.

Non-methadone treatment sources

concur that snorting is generally the

primary route of administration for

powder cocaine, but, again, some

exceptions are noteworthy. Smoking

is the primary route at the programs

in Denver and Honolulu. Smoking

equals snorting as the primary route

in Baltimore and Los Angeles. And

injecting equals snorting as the primary route in Billings. Not surprisingly, injecting is mentioned as a primary route of administration by powder cocaine users in some methadone

programs, as in Boston, Los Angeles,

and Seattle. Moreover, the El Paso

methadone treatment source reports

that powder cocaine users are likely

to either smoke or inject the drug.

What other drugs do powder

cocaine users take? Epidemiologic

and ethnographic sources report that

powder cocaine users also consume a

variety of other drugs, sometimes in

combination, and sometimes sequentially. For example, powder cocaine is

often taken as part of a “speedball”

combination with heroin, as reported

in New York, Philadelphia, and

Portland in the Northeast; Memphis

in the South; Chicago and Sioux Falls

in the Midwest; and Denver and

Seattle in the West. In Portland,

diverted OxyContin® is sometimes

used instead of heroin in this type of

speedball. Marijuana is frequently

smoked by powder cocaine users in

many cities (sometimes sequentially,

sometimes laced together), as reported

in Boston, Columbia (SC), Detroit,

Philadelphia, St. Louis, and Sioux

Falls. Diverted benzodiazepines are

mentioned by sources in Boston, El

Paso (alprazolam, or Xanax®), and 

St. Louis (diazepam). As part of the

club drug scene, powder cocaine is

sometimes combined with ecstasy in El

Paso; with ecstasy and a whole gamut

of club drugs in Miami; and with

ecstasy, GHB, or both in Birmingham.

Non-methadone treatment sources in

Baltimore, Birmingham, Chicago,

Denver, and Philadelphia similarly

report that powder cocaine is sometimes combined with heroin.

Marijuana is cited by non-methadone

treatment sources in Columbia (SC),

Denver, Detroit, Los Angeles,

Memphis, and Sioux Falls (where the

source specifies that it is laced in with

the powder cocaine). The combination of powder cocaine and ecstasy is

mentioned in four programs: in

Billings; in Birmingham, where this

phenomenon first appeared around a

year ago; in Columbia, where the

drugs are specified as a club drug

combination; and in Portland, ME,

where the use of this combination has

increased. Finally, powder cocaine is

sometimes combined with methamphetamine in the West, as reported by

non-methadone treatment sources in

Billings and Honolulu.

Nearly every methadone treatment

source, again not surprisingly, reports

that powder cocaine is sometimes

combined with heroin. Additionally,

diverted benzodiazepines are sometimes taken either together with 

powder cocaine or afterwards to 

mitigate the side effects, as noted at

What motivates different age

groups to choose snorting over

injecting?

In Baltimore, where speedballing is common, the ethnographic source explains

that “street-knowledgeable folks tell

how inserting a needle in the skin produces abscesses, so they are more likely

to snort, especially with the increased

potency. For newcomers, fear of HIV is

a deterrent to needle use.” 
POWDER COCAINE

Pulse Check: November 2001 page 53

programs in Boston, Columbia (SC),

and Seattle. The El Paso methadone

treatment source adds that some

clients also use “roche” (pronounced

ro-cha), presumably the benzodiazepine flunitrazepam (Rohypnol),

brought in from Mexico.

Where and with whom is powder

cocaine used? (Exhibit 6) Powder

cocaine is usually used indoors, in

private, and in small groups among

friends. Indoor use is cited by every

epidemiologic and ethnographic

source except in Washington, DC,

where both indoor and outdoor use

are equally common. The Baltimore

ethnographic source notes seasonal

increases in outdoor use as the 

weather improves, as is the case with

heroin use. Private, as opposed to

public, use is cited by all the sources

but three: in Birmingham, El Paso,

and Washington, DC, powder cocaine

is used both in public and in private.

Only three sources—in New York,

Miami, and Los Angeles—report that

the drug is used while alone, rather

than in small groups among friends.

Similarly, among non-methadone

treatment sources, only rare reports

are given for outdoor use (only in

Honolulu, Los Angeles, and Boston),

public use (only in Honolulu and

Seattle, although both private and 

public use are reported in Billings, Los

Angeles, Memphis, and Washington,

DC), or solo use (only in Boston,

although both solo and group use 

is reported in Memphis and

Philadelphia).

Private residences, by far, are the

most common settings for powder

cocaine use, according to epidemiologic and ethnographic sources (as

shown previously, in exhibit 6) as

well as non-methadone treatment

sources. The other most common 

settings are clubs, parties, and cars. A

few unusual use settings are noted by

epidemiologic and ethnographic

sources. For example, in Portland,

ME, powder cocaine is sometimes

used on boats (during long fishing

trips) and in the woods. In Miami, it

is used in restaurant kitchens. And in

Baltimore, like heroin and crack, 

powder cocaine is sometimes used 

in abandoned row houses (abandominiums) and fast-food restaurant

bathrooms.

Overall, any specific setting is usually

more likely to be a sales site than a use

site for powder cocaine, according to

law enforcement, epidemiologic, and

ethnographic sources. Schools are a

particular case in point: in 11 cities,

they are reported as a place where

dealers sell powder cocaine but not as

a place where users take it. Only in

Baltimore and El Paso are schools

mentioned as settings for both sales

and use. Similarly, public housing

developments and the areas around

supermarkets are named much more

frequently as places where sales, 

rather than use, occur. In a few cases,

however, the opposite holds true. 

For example, in Portland, ME, three

settings named as use sites (clubs, 

public housing, and parties) are not

mentioned as sales sites. Similarly, in

Chicago, Detroit, and Los Angeles,

powder cocaine is used but not sold 

in parks. 
page 54 Pulse Check: November 2001

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MARIJUANA

Pulse Check: November 2001 page 55

MARIJUANA: THE PERCEPTION

How do Pulse Check sources

perceive the marijuana problem

in their communities? Baltimore

and Washington, DC, are the only

two cities where no Pulse Check

source names marijuana as their community’s most widely abused drug. In

the other 19 Pulse Check cities, 30

law enforcement, 

epidemiologic,

ethnographic, and

non-methadone

treatment sources

indeed name 

marijuana as such.

Interestingly,

Washington, DC, is

the only city where

a source (law

enforcement) considers marijuana to

be the drug with

the most serious

consequences.

However, an 

additional 10

sources in 9 

cities (Billings,

Birmingham,

Denver, Detroit,

Los Angeles,

Miami, Seattle, St.

Louis, and Sioux Falls) name 

marijuana as the drug related to the

second most serious consequences.

Has the perception of the marijuana problem changed between

fall 2000 and spring 2001? No

sources report any change in their

perception of marijuana as a widely

abused drug or as a drug related to

serious consequences in their communities. Three sources, however,

perceive that marijuana has been

replaced by another drug contributing

to the second most serious consequences in their communities: the

Birmingham law enforcement source

believes that the diversion and abuse

of prescription drugs have replaced

marijuana, the Columbia (SC) nonmethadone treatment source believes

that LSD has done so, and the Sioux

Falls epidemiologic source believes

that club drugs have done so.

MARIJUANA: THE DRUG

How available is marijuana

across the country and what

type of marijuana is available?

(Exhibits 1 and 2) Similar to reports

in the last Pulse Check, nearly all (39

of 41) epidemiologic, ethnographic,

and law enforcement sources who

discussed this question consider marijuana to be widely available in their

communities. The two exceptions are

in Boston and Chicago, where one

source in each city describes the drug

as somewhat available. 

The types of marijuana, compared

with marijuana in general, vary more

in availability as perceived by the

Pulse Check sources knowledgeable

on the subject. The most common

variety is locally produced commercial

-grade marijuana, ranked as widely

available by 24 law enforcement, 

epidemiologic, and ethnographic

sources in all but 

3 of the 21 Pulse

Check cities:

Birmingham,

Detroit, and St.

Louis. Six sources

describe local 

commercial-grade

marijuana as somewhat available,

three describe it as

not very available,

and two (in El

Paso and Washington, DC) consider

it not available 

at all.

Sinsemilla, or the

seedless variety of

marijuana, is the

second most common variety

reported in Pulse

Check cities, cited

as widely available by 13 law enforcement, epidemiologic, and ethnographic sources in 10 cities spanning

all regions of the country: Boston,

New York, and Portland (ME) in the

Northeast; El Paso and Miami in the

South; Detroit and St. Louis in the

Midwest; and Billings, Honolulu, and

Seattle in the West. Another 13

sources in 10 cities describe sinsemilla

as somewhat available, 8 sources in 

7 cities report it as not very available,

and only 1 source (in El Paso) says it

is not available at all.

Exhibit 1.

How available is marijuana across the 21 Pulse Check cities?*

According to law enforcement, epidemiologic, and ethnographic sources...

Widely Available,

according to both

source types

*The Columbia (SC) epidemiologic source did not provide this information.

Widely Available, according to epidemiologic 

and ethnographic sources; somewhat available

according to law enforcement sources
MARIJUANA

page 56 Pulse Check: November 2001

Mexican commercial-grade marijuana

is as available as sinsemilla, with wide

availability cited by 13 sources in 10

cities: Boston and New York in the

Northeast; Columbia (SC), El Paso,

and Memphis in the South; Detroit in

the Midwest; and Billings, Denver,

Los Angeles, and Seattle in the West.

It is described as somewhat available

by another 12 sources across all the

regions, not very available by 6

sources, and not available by 3

sources (in New York, New Orleans,

and Washington, DC).

Hydroponically grown marijuana is

considered widely available by eight

sources in seven cities, all either in

the Northeast or the South: all four

law enforcement sources in the

Northeast; both sources in Washington, DC; and the law enforcement

sources in Miami and New Orleans.

Another 13 sources in 11 cities

describe hydroponic marijuana as

somewhat available, 9 sources in 9

cities rate it as not very available, and

3 law enforcement sources—in

Baltimore, Billings, and El Paso—

consider it not available at all.

As reported in the last Pulse Check, of

all the marijuana varieties discussed,

British Columbian (“BC bud”) is least

commonly considered widely available, with only four sources reporting

it as such. Two are in the Northeast

(New York and Philadelphia), one is

in the South (El Paso), and one is in

the West (Billings). An additional 7

sources in 6 cities give it a somewhat

available rating, 8 sources in 7 cities

consider it not very available, and it is

not available at all according to 10

sources in 8 cities: Boston in the

Northeast; Baltimore, El Paso,

Memphis, Miami, New Orleans, and

Washington, DC, in the South; and

Detroit in the Midwest.

It is important to note that in some

cases, the different varieties of 

marijuana can overlap. In Seattle, for

example, the categories of “sinsemilla,”

“locally grown,” and “hydroponic” are

synonymous: the most common form

available is locally grown hydroponic

sinsemilla.

Has marijuana availability

changed? (Exhibit 3) Marijuana

availability remained stable at high

levels between fall 2000 and spring

2001, according to the majority of

Pulse Check sources who discussed

this question (18 of 20 law enforcement sources and 16 of 19 epidemiologic and ethnographic sources). The

two law enforcement exceptions are

in Baltimore and Sioux Falls, where

increased availability appears driven

by increases in local commercial

grades. The three exceptions among

epidemiologic and ethnographic

sources are increases in Boston,

Denver (where both local and

Mexican commercial grades have

increased in supply), and New 

York (where an increase in local

Exhibit 2. 

What varieties of marijuana are described as “widely” or “somewhat”

available across the 21 Pulse Check cities? How has availability changed

(fall 2000 vs spring 2001)?*

Boston, MA !↔ ! !↔ ❍ ❍↔ ! !↔

New York, NY !↔ !↑ !↔ !↔ !↔ !↔ ❍↔ !↔

Philadelphia, PA !↔ ❍↔ ❍↔ ❍↔ !↔ ❍↔ !↔

Portland, ME !↔ !↔ !↔ !↔ ❍↔ ❍ !↔ ❍↔ ❍↔ ❍↔

Baltimore, MD !↑ !↔ ❍↔ ❍↔ ❍↔ ❍↔

Birmingham, AL**

Columbia, SC !↔ !↔ ❍

El Paso, TX !↔ !↔ !↔ !↔ !↔

Memphis, TN ! ❍ ❍ ! ❍ ❍

Miami, FL !↔ !↔ !↑ !↑

New Orleans, LA !↔ ❍↔ !↔ ❍↔

Washington, DC !↔ ❍↔ !↑ !↔

Chicago, IL ❍↔ !↔ ❍↔ ❍↔ ❍↔ ❍↔ ❍↑

Detroit, MI ❍↔ !↔ ❍↔ ❍↔ !↔ ❍↔ ❍

St. Louis, MO !↔ ❍↔

Sioux Falls, SD !↑

Billings, MT !↔ !↔ !↔ !↔

Denver, CO !↔ !↑ ❍↔ !↔ !↑ ❍↔ ❍↔

Honolulu, HI !↑ !↔ !↑ ❍↔ ❍↓ ❍↔ ❍↔ ❍↑

Los Angeles, CA ❍↔ !↔ !↔ !↔ ❍↔

Seattle, WA ❍↔ !↔ ❍↔ !↔ ❍↔ !↔ ❍↔ ❍↔

Local Mexican

City Commercial Sinsemilla Commercial Hydroponic BC Bud

L E LEL E L E L E

Northeast Midwest West South

Sources: Law enforcement (L) and epidemiologic/ethnographic (E) respondents

! Widely available

❍ Somewhat available

* Arrows indicate up, down, or stable trends. Absence of an arrow indicates that respondent did

not provide trend information.

**While both Birmingham sources noted marijuana as widely available, neither rated the 

different varieties.
MARIJUANA

Pulse Check: November 2001 page 57

commercial-grade marijuana is

noted). No sources report declines in

overall marijuana availability. 

In some sites where overall availability is stable at high levels, some shifts

are reported for specific varieties. For

example, the Birmingham law

enforcement source reports declining

availability for three varieties:

Mexican commercial, BC bud, and

hydroponic marijuana.

Conversely, the Honolulu law

enforcement source reports

increasing availability for

three varieties: local commercial grade, sinsemilla,

and BC bud. Several sources

report increases in hydroponic marijuana availability: the

epidemiologic source in St. Louis

and the law enforcement sources

in Chicago, Miami, and

Washington, DC. The St. Louis epidemiologic source also reports periodic rumors, thus far unconfirmed, of

the emergence of BC bud. And the

Miami epidemiologic source reports

that two varieties have increased in

supply: sinsemilla and Jamaican. 

How potent is marijuana across

the country and how has potency

changed? (Exhibit 4) Marijuana

potency ranges from 1–5 percent

tetrahydrocannabinol (THC) for

Mexican commercial-grade marijuana

in Detroit to 15–22 percent THC for

sinsemilla in Honolulu, according to

reporting law enforcement, epidemiologic, and ethnographic sources. Since

the last Pulse Check, potency levels

remained relatively stable in most

reporting cities, except in Memphis,

where potency for commercial-grade

(domestic and Mexican) marijuana

increased, and in Portland (ME),

where potency of marijuana in general has increased. 

What are street-level marijuana

prices across the country and

have they changed since the last

reporting period? (Exhibit 4)

According to law enforcement, 

epidemiologic, and ethnographic

sources, commercial-grade marijuana

(Mexican or domestic) ounce prices

are generally in the $100–$200

range, except in Memphis, where a

$25 price is reported. Sinsemilla

tends to be more expensive, as in

Denver, where it sells for $300 per

ounce, although it costs as little as

$80–$100 per ounce in Boston. BC

bud is even more expensive, as in

Denver, where it sells for $500 per

ounce. The highest reported prices,

however, are for hydroponic and

organic marijuana, which sell for

$700–$800 in New York. Joints

and bags of either domestic or

Mexican commercial-grade

marijuana tend to sell for

$5–$10. Since the last

reporting period, prices

have remained relatively

stable in reporting Pulse

Check cities, except in

Seattle, where BC bud

prices declined since the last

reporting period. 

How is marijuana referred to

across the country? (Exhibit 5)

Similar to reports in previous Pulse

Check issues, “grass,” “pot,” and

“weed” remain common slang terms

for marijuana across Pulse Check

sites. Additionally, as the New York

ethnographic source states, “Brand

names dominate the scene.” Such is

also the case in Philadelphia and in

some southern cities, such as

Memphis and Miami. Some of the

more recent names in New York

include “texas tea,” “purple haze,”

“arizona,” “elo,” “hydro,” “dro,”

“pellet,” “beef and broccoli” (a 

combination of hydro and pellet), and

“trees.” In Philadelphia, some of the

latest names include “$ signs,” “8

ball,” “horse heads,” and “marijuana

leaf.” The Miami epidemiologic

source gives further insight into some

of the other names: for example,

“‘kryppy’ is short for ‘kryptonite’–

because it’s THAT strong,” and

“killer” is so named “because it’s the

worst; it stinks.”

Exhibit 3.

How has marijuana availability

changed (fall 2000 vs spring

2001)?*

Baltimore, MDL

Boston, MAE

Denver, COE

New York, NYE

Sioux Falls, SDL

Baltimore, MDE

Billings, MTL,E

Birmingham, ALL,E

Boston, MAL

Chicago, ILL,E

Columbia, SCL

Denver, COL

Detroit, MIL,E

El Paso, TXL,E

Honolulu, HIL,E

Los Angeles, CAL,E

Miami, FLL,E

New Orleans, LAL,E

New York, NYL

Philadelphia, PAL,E

Portland, MEL,E

Seattle, WAL,E

Sioux Falls, SDE

St. Louis, MOL,E

Washington, DCL,E

L Law enforcement respondents

E Epidemiologic/ethnographic respondents

*The Boston and Columbia (SC) epidemiologic

sources and the Memphis law enforcement

source did not provide that information.

“Early-in-the-month” bags?

According to the Baltimore ethnographic source, as a new marketing

strategy, marijuana is available in 

individual joints, for $2–$3 each,

toward the latter part of the month,

when users’ income is lower; then,

early in the following month, it is sold

in $5 and $10 bags.
MARIJUANA

page 58 Pulse Check: November 2001

How is marijuana packaged and

marketed? As reported in the last

Pulse Check, the most common marijuana packaging in Pulse Check cities

is plastic zipper or sandwich bags.

Additional packaging includes loose

joints in Baltimore and Portland

(ME); manilla envelopes, aluminum

foil, and plastic wrap in New York;

plastic coin zipper bags with logos in

Philadelphia; balloons in Denver; and

blunts in Washington, DC. No new

packaging was reported since the last

Pulse Check.

MARIJUANA: THE SELLERS

How are street-level marijuana

sellers organized? In most Pulse

Check cities, independent sellers are

the norm, according to law enforcement respondents. Conversely, in

Portland (ME), where major local

growers organize out-of-State and

local distribution of the drug, most

sellers are organized. In four cities,

independent and organized distribution networks are mentioned: El

Paso, Los Angeles (where organized

distributors are affiliated with

Mexican cartels), St. Louis, and

Seattle. Epidemiologic and ethnographic respondents report organized

distribution networks more frequently

than do their law enforcement counterparts: most marijuana sellers are

organized in Baltimore, Denver

(where they are Mexican nationals),

Detroit, El Paso, Honolulu (where

they are loosely organized groups of

two to three “runners” and often

affiliated with Mexican nationals),

and New Orleans (where they are

organized loosely). Additionally, the

epidemiologic sources in Chicago and

St. Louis report marijuana sellers as

both organized and independent.

How is street-level marijuana

sold? Marijuana distribution methods continue to vary widely. All (21)

law enforcement respondents report

marijuana as sold hand-to-hand

through acquaintance networks; most

also report the use of beepers and

delivery-type services. Epidemiologic

respondents also report hand-to-hand

sales, and most report that these sales

occur via acquaintance networks.

Moreover, beeper and cell phone use

is also reported by epidemiologic

sources in Chicago, El Paso,

Memphis, Miami, New Orleans, New

York, and Sioux Falls, and deliverytype methods are reported in

Exhibit 4.

How much does marijuana cost in 19 Pulse Check cities?*

Purity

City Type Unit Price (%THC)

Boston, MA Sinsemilla 1 oz $80–$100 NR 

New York, NY NR Bag $10 NR

Hydroponic 1 oz $700–$800 NR 

and organic 

Philadelphia, PA Local commercial 1 oz $150–$200 NR 

Portland, ME NR 1 oz $175 NR

Baltimore, MD NR Bag $5–$10 NR 

Birmingham, AL NR 1 gm (joint) $10 NR 

Columbia, SC Local or 3–4 gm $10 NR

Mexican commercial 

El Paso, TX Mexican commercial 1/4 oz $20 NR

Memphis, TN Local commercial 1 oz $25 5–6%

NR 1/4 oz $25–$30 NR

Miami, FL Sinsemilla 1/4 oz $100 10–18% 

Sinsemilla Bag $750–$1,200 NR

New Orleans, LA Domestic commercial Joint $5–$10 NR 

Washington, DC Local or 1/4 oz $25–$75 NR

Mexican commercial 

Local or 750 mg bag $20 NR

Mexican commercial

Chicago, IL Local or Bag $5–$10 NR

Mexican commercial 

Detroit, MI Mexican commercial 1 oz $150–$200 1–5%

Sioux Falls, SD Local commercial 1 oz $100–$150 NR

Denver, CO Local or 1 oz $100–$200 4%

Mexican commercial 

Sinsemilla 1 oz $300 NR 

BC bud 1 oz $500 4%

Honolulu, HI Mexican commercial Joint $5 NR

Kona gold Joint $20 NR

Sinsemilla 1 gm $25 15–22%

Los Angeles, CA Mexican commercial Joint $10 4–6%

Seattle, WA BC bud 1 gm $15–$25 NR

Sources: Law enforcement, epidemiologic, and ethnographic respondents

*Respondents in Billings and St. Louis did not provide this information. Northeast South West Midwest
MARIJUANA

Pulse Check: November 2001 page 59

Birmingham, Chicago, Denver, El

Paso, Miami, New York, and

Washington, DC. Additionally, in

New York, marijuana is often 

delivered to offices, and in

Philadelphia, it is sold primarily

hand-to-hand on street corners. 

How old are street-level 

marijuana sellers? Marijuana 

sellers are predominantly young adults

(18–30 years), according to most law

enforcement, epidemiologic, and

ethnographic respondents across Pulse

Check sites, but ages vary widely. For

example, all age groups are equally

likely to sell the drug in Billings,

Memphis, and Portland (ME), according to law enforcement sources there.

The Baltimore law enforcement and 

epidemiologic sources report adolescents (13–17 years) as the predominant sellers, and they are split evenly

between adolescents and young

adults, according to five sources: the

law enforcement sources in

Birmingham, Los Angeles, and New

Orleans; and the epidemiologic

sources in Chicago and Detroit. As in

many other cities, Memphis has a

wide diversity in the age of sellers:

marijuana sellers there are predominantly young adults, but some are as

young as preadolescents (<13 years),

according to the 

epidemiologic source.

What other drugs do marijuana

dealers sell? According to 11 of 21

law enforcement sources, marijuana

sellers sell other drugs, most commonly (and as reported in the last

Pulse Check) crack and powder

cocaine (in Birmingham, Columbia

[SC], Detroit, Honolulu, Los Angeles,

New York, and St. Louis). Additionally, methamphetamine is sold with

marijuana in Billings, Honolulu, and

Memphis; ecstasy in Honolulu,

Miami, and New York; heroin in

New York; and PCP in New Orleans.

Marijuana sellers typically do not sell

other drugs in Baltimore, Boston,

Chicago, Denver, El Paso, Philadelphia, Portland (ME), Seattle, Sioux

Falls, and Washington, DC. 

Then and Now:

How have marijuana sellers and sales changed (fall 2000 vs spring

2001)?

The marijuana sales scene has remained relatively stable since the last Pulse Check

report. Only a few changes are reported, with no discernible regional trends:

Baltimore, MD:

Los Angeles, CA:

Honolulu, HI, and

New York, NY: 

Miami, FL:

New York, NY:

Portland, ME: 

Washington, DC:

➤ Marijuana sellers are increasingly younger, according to the law

enforcement source.

➤ The use of electronic equipment, including cell phones, in marijuana sales has increased, according to the law enforcement source.

➤ According to law enforcement sources, ecstasy sold with marijuana

is new this reporting period.

➤ The law enforcement source reports that marijuana grown indoors

and hydroponically is increasing, perhaps due to drought in the

region.

➤ According to the epidemiologic source, as marijuana, especially

hydroponically grown marijuana, continues to be available, new

brand names have appeared.

➤ The law enforcement source states that marijuana sellers are

becoming more organized and the amount sold has increased.

➤ The epidemiologic source states that marijuana’s presence on the

drug market has increased.

Exhibit 5. 

How is marijuana referred to in different regions of the country?

WEST

Grass, ragweed,

skunkweed, good s--t,

ditch weed, BC bud,

ganga, dope, pot, bud,

blunt

Hydro, Mary

Jane, weed,

green

MIDWEST NORTHEAST

SOUTH

Grass, loose shake, weed, dope,

bud, smoke, texas tea, purple haze,

arizona, elo, hydro, dro, pellet, beef

and broccoli (hydro + pellet), trees,

$ signs, 8 ball, hershey’s 

kisses, horseheads, marijuana leaf

Grass, gungie, weed, smoke, cabbage, broccoli, hay, bud, dank,

herb, mota, blunt, dope, thirteen, mary jane, trees, joint, junt,

green acres, kine, schwag, gree, dosier, chronic, green, red bud,

bubbleberry, gold bu, hydro, teak, ink, clover, ragweed, ditchweed, kryptonite, kryppy, crippie, regs, skunk, killer, reefer, KD,

kindbud, blueberry, white widow, northern lights, mota

Kona gold, ditch weed, kuai

electric, Maui wowie, bud,

pakalolo (crazy tobacco),

chronic, grass, weed

Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents
MARIJUANA

page 60 Pulse Check: November 2001

Similarly, according to 8 of 14 

epidemiologic and ethnographic

respondents, marijuana sellers 

typically sell other drugs, including

crack cocaine in five cities (Denver,

Detroit, New Orleans, New York, and

St. Louis), heroin in four cities

(Baltimore, Denver, New York, and

St. Louis), powder cocaine in two

cities (Denver and New York), and

methamphetamine in Denver. In

Memphis, any drug available may be

sold with marijuana. In St. Louis,

many dealers, especially those affiliated with gangs, run a “one-stop shop,”

selling heroin, crack, and marijuana,

as reported in earlier sections.

Do marijuana sellers use their

own drug? As reported in the last

Pulse Check, according to nearly all

law enforcement and epidemiologic

respondents, marijuana sellers are

very likely to use the drug. Only the

Denver and Honolulu epidemiologic

sources report that marijuana sellers

are not very likely to use the drug. 

Are street-level marijuana 

sellers involved in other crimes?

Nearly all law enforcement, epidemiologic, and ethnographic respondents

view marijuana sellers as not very

likely or somewhat likely to be

involved in other crimes, although

law enforcement respondents generally report higher crime levels than

their epidemiologic counterparts. The

most common type of other crime

associated with marijuana sellers is

nonviolent criminal acts, such as

property damage and burglary.

Additionally, gang-related crimes are

mentioned in nine cities (Baltimore,

Birmingham, Detroit, El Paso,

Honolulu, Los Angeles, Memphis, St.

Louis, and Washington, DC), violent

crimes are mentioned in five

(Baltimore, Los Angeles, Memphis,

St. Louis, and Washington, DC), and

prostitution is mentioned in three

(Baltimore, El Paso, and Memphis). 

Where is marijuana sold?

According to law enforcement, epidemiologic, and ethnographic respondents, marijuana sales are widespread.

Most (14 of 21) law enforcement

respondents report that marijuana is

sold in all areas of cities (central, suburban, and rural), four (in Chicago,

Columbia [SC], Honolulu, and

Washington, DC) report that it is sold

mostly in central city areas, and three

(in Baltimore, Los Angeles, and New

Orleans) report that it is sold in central city and suburban areas. Similarly,

four epidemiologic sources (in

Birmingham, Denver, St. Louis, and

Washington, DC) report that marijuana is sold in all areas of cities, four

(in Baltimore, Honolulu, New York,

and Portland [ME]) report that it is

sold primarily in the central city, and

two (in Chicago and Detroit) report

its sale in the central city and suburbs.

Additionally, suburban areas are the

primary sales location in Sioux Falls,

and rural areas are in El Paso, according to epidemiologic sources.

Marijuana is sold both indoors and

outdoors, according to all (21) law

enforcement sources; epidemiologic

respondents tend to agree. According

to law enforcement respondents, 

marijuana is sold in a wide variety of

specific settings, most commonly

streets and inside cars (mentioned by

all sources), public housing developments, private residences, around 

junior high and high schools, and 

in nightclubs. Epidemiologic and

ethnographic sources agree that 

marijuana is sold in a wide variety 

of settings, most commonly private

residences and streets.

MARIJUANA: THE USERS

How old are marijuana users?

(Exhibit 6) As reported in the last

Pulse Check issue, adolescents (13–17

years) outnumber the young adult

(18–30 years) and older adult (>30

years) user groups in eight Pulse

Check cities: Baltimore, Columbia

(SC), Denver, El Paso, Los Angeles,

New Orleans, Portland (ME), and

Sioux Falls (according to epidemiologic and ethnographic respondents).

Adolescents and young adults are

equally likely to be the predominant

user group in Seattle. Young adults,

however, are named as the largest

group of marijuana users in eight

cities: Billings, Birmingham, Chicago,

Memphis, Miami, Philadelphia, St.

Louis, and Washington, DC. Older

adults are mentioned only in Detroit

(where they equal young adults as the

predominant user group), in Honolulu (where all three groups are

equally represented), and in Boston.

Since the last Pulse Check reporting

period, the Memphis and Los Angeles

sources note a slight increase among

young adults, and the Boston source

notes an emerging adolescent group,

with an age of initiation typically

between 14 and 16 years. A longer

term trend is noted in Birmingham,

where the young adult group has

been steadily increasing for the past

decade, in tandem with a decrease in

crack use.

In the majority of non-methadone

programs, the clients most likely to

use marijuana are young adults.

Preadolescents, however, are named

as the predominant marijuana user

group in two non-methadone treatment programs (in Baltimore and

Portland [ME]), and adolescents are

named in another three programs (in

Chicago, Columbia [SC], and Sioux 
MARIJUANA

Pulse Check: November 2001 page 61

Falls). In the Los Angeles and Seattle

programs, marijuana-using clients are

equally likely to be adolescents and

young adults. Older adults are named

as the predominant group in the

Denver program, they equal young

adults in the El Paso and Philadelphia

programs, and they equal both

younger groups in the St. Louis 

program. The Columbia (SC) nonmethadone treatment source notes

that the age of first use has become

lower since the last Pulse Check

reporting period.

Marijuana-using clients in methadone

programs tend to be older than those

in non-methadone programs: older

adults are named as the predominant

marijuana users in Chicago, Honolulu,

Los Angeles, and Washington, DC, as

well as in one of the Boston programs.

How have marijuana users changed across the country (fall 2000 vs spring 2001)?

According to epidemiologic and ethnographic sources....

Several increases are noted 

in various age groups: 

An increase in female marijuana

users is noted in two cities:

Racial/ethnic distributions have

shifted in a few cities: 

Drug use patterns have changed in

a few cities:

According to treatment sources...

➤ Novice use of marijuana has remained relatively stable, but increases are reported in one methadone program (in Portland, ME) and in

four non-methadone programs: in Billings, MT; Boston, MA; Columbia, SC; and New Orleans, LA.

➤ Columbia, SC: The non-methadone treatment source notes an increase in Blacks and Hispanics, an increase in females, and a lower

age of first use.

➤ Honolulu, HI: The methadone treatment source notes a decline in the number of marijuana/drug combinations.

➤ Boston, MA: Adolescents (13–18 years) are an emerging group.

➤ Detroit, MI: Young adults (18–30 years) have been increasingly using marijuana, so that they

now equal older adults (>30 years) as the groups most likely to use the drug. Moreover, 

adolescents have been emerging as a user group.

➤ Los Angeles, CA: Adolescents constitute the largest user group, but young adults have increased

slightly.

➤ Memphis, TN: Young adults (18–30 years), the predominant marijuana user group, have

increased even more.

➤ Sioux Falls, SD: Adolescents constitute the largest user group, but the number of preadolescent

users (<13 years) has increased.

➤ Washington, DC: Young adults (18–30 years) constitute the largest user group, but older adults

(>30 years) have increased. 

➤ New Orleans, LA

➤ Philadelphia, PA

➤ Memphis, TN: White marijuana users have increased.

➤ Sioux Falls, SD: An increase in marijuana use among middle school students (sixth through

eighth grades) is reported among recent immigrants from Ukraine, Russia, and various African

tribes. This large new population base bears watching for other emerging drug issues, especially

among those of student age.

➤ Washington, DC: Increasing use is noted among Hispanics, but that group is still 

underrepresented relative to the general population.

➤ Birmingham, AL: Marijuana is most commonly smoked in joints. Blunts are becoming passé.

➤ Memphis, TN, and New Orleans, LA: While joints remain the most common vehicle for 

smoking marijuana, use of blunts has increased.

➤ Honolulu, HI: The combination of marijuana and PCP is a recent development.

➤ Philadelphia, PA: A new practice, still rare, is reported: crushing and sprinkling the diverted

prescription drug Xanax® (alprazolam) onto marijuana.
MARIJUANA

page 62 Pulse Check: November 2001

Both young adults and older adults are

the predominant marijuana users in

the El Paso and Portland (ME) 

programs. Only in the Birmingham

program are young adults, exclusively,

named as the group most likely to use

marijuana. In the second Boston

methadone program, marijuana users

are equally likely to be adolescents,

young adults, and older adults. The

Pulse Check source at that program

elaborates that methadone clients generally have been chronic marijuana

users since their adolescence, and that

marijuana tends to be the one drug

they don’t give up—sometimes using it

daily, sometimes several times a day. 

Are there any gender differences

in who uses marijuana? According

to epidemiologic and ethnographic

sources, males are more likely than

females to use marijuana in all but

five Pulse Check cities. In Boston,

Chicago, Portland (ME), Sioux Falls,

and Washington, DC, males and

females are equally likely to do so.

Further breakdowns by age, however,

show different gender distributions.

In Detroit, for example, older marijuana users tend to be males, but the

emerging adolescent group appears

evenly split between the genders.

Since the last Pulse Check reporting

period, an increase in female marijuana users has been noted in New

Orleans and Philadelphia.

In the treatment population, more

than in the population described by

epidemiologic and ethnographic

sources, both genders are equally likely to use marijuana. Such is the case

in 11 non-methadone programs: in all

five cities in the West, in both Sioux

Falls programs, and in Memphis,

Philadelphia, Portland (ME), and

Washington, DC. Males predominate

in the remaining nine programs

where this information was provided.

In the Columbia (SC) program, where

males are the predominant marijuana

users, females have increased since

the last Pulse Check reporting period.

Similarly, in methadone treatment

programs, marijuana users are more

likely to be evenly split between the

two genders (as reported in Chicago,

Honolulu, Los Angeles, New Orleans,

Portland [ME], and one of the Boston

programs) than to be primarily males

(as in Birmingham, El Paso, Washington, DC, and the second Boston 

program).

Is any racial/ethnic group more

likely to use marijuana? As noted

in the last Pulse Check issue, the 

marijuana problem cuts across all

racial/ethnic groups. Nine epidemiologic and ethnographic respondents

(in Billings, Birmingham, Chicago, El

Paso, Philadelphia, Portland [ME], St.

Louis, Seattle, and Sioux Falls) report

that racial/ethnic distributions are

fairly representative of their respective cities’ populations. White users

are more prominent in the Midwest

(in Detroit, Sioux Falls, and St.

Louis), in the West (in Billings,

Denver, Los Angeles, and Seattle),

and in Memphis, Miami, and

Portland. The Los Angeles epidemiologic source adds that Whites, who

now trail Hispanics in Los Angeles’

general population distribution, are

nevertheless the most likely to use

marijuana. In Birmingham, Whites

and Blacks are equally likely to use

marijuana. Blacks are more likely

than other racial/ethnic groups to use

marijuana in six cities: Baltimore,

Chicago, Columbia (SC), New

Orleans, Philadelphia, and

Washington, DC. In Honolulu, Asians

are the likeliest to use marijuana, but

they are underrepresented relative to

the general population. While

Hispanics are not Philadelphia’s

largest marijuana-using population,

they are overrepresented relative to

the general population. The only

racial/ethnic shift reported by epidemiologic/ethnographic sources

since the last Pulse Check reporting

period is an increase in White 

marijuana users in Memphis.

Why do methadone clients take

marijuana?

According to a Boston treatment source,

methadone clients sometimes use marijuana daily, sometimes several times a

day, for several possible reasons: 

% To potentiate the methadone

% To temper their heroin cravings

% As a sleep aid, to counter the impact

methadone sometimes has on sleep

Exhibit 6.

What age group is most likely to

use marijuana?

Note: In some cities, more than one age group

is named.

Epidemiologic/

Ethnographic

Sources

(N=20)

NonMethadone

Treatment

Sources

(N=19)

Methadone

Treatment

Sources

(N=10)

Preadolescents

(<13 years)

Adolescents

(13–17 years)

Young Adults

(18–30 years)

Older Adults

(>30 years)

0 0

Number of Respondents 18

17

16

15

14

13

12

11

10

9

8

7

6

5

4

3

2

1

0
MARIJUANA

Pulse Check: November 2001 page 63

Similarly, reports from treatment

sources show how the marijuana

problem touches all racial/ethnic

groups. According to non-methadone

treatment sources, marijuana users

are predominantly Whites in 9 programs (in Billings, Columbia [SC], El

Paso, Los Angeles, Memphis,

Philadelphia, Portland [ME], Seattle,

and Sioux Falls), Blacks in 11 programs (in Baltimore, Birmingham,

Detroit, El Paso, Los Angeles,

Memphis, Miami, New Orleans, New

York, Philadelphia, and Washington,

DC), Hispanics in 4 programs (in

Chicago, El Paso, Los Angeles, and

Philadelphia), and Asians in 2 programs (in Honolulu and Los Angeles).

(Sources in El Paso, Los Angeles,

Memphis, and Philadelphia list more

than one group as predominant.) The

Columbia non-methadone treatment

source notes an increase in Black and

Hispanic marijuana users since the

last Pulse Check.

According to methadone treatment

sources, Whites are the predominant

marijuana users in four programs (in

Boston, Honolulu, Los Angeles, and

New Orleans), Blacks in three (in

Birmingham, Chicago, and Washington, DC), Hispanics in three (in El

Paso, Los Angeles, and New Orleans),

and Asians in the Honolulu program.

(The Honolulu and New Orleans

sources list more than one group.)

Is any socioeconomic group

more likely to use marijuana? As

with race/ethnicity, marijuana use

knows no socioeconomic bounds.

Epidemiologic and ethnographic

sources report that all SES groups are

represented relatively evenly among

marijuana users in six Pulse Check

cities: Denver, Detroit, Honolulu,

New Orleans, Portland (ME), and St.

Louis. Middle SES groups are more

likely to use marijuana in seven cities

(Billings, Chicago, El Paso, Los

Angeles, Memphis, Miami, and Sioux

Falls), and low SES groups are named

in five (Baltimore, Columbia [SC],

New York, Philadelphia, and

Washington, DC). The Birmingham

source names both low and high SES

groups as the most likely to use marijuana, and the Seattle source names

low to middle SES groups. No

changes are reported since the last

Pulse Check reporting period.

Non-methadone treatment sources,

however, paint a somewhat different

picture. The majority (in 15 cities)

report that marijuana-using clients in

their programs are likely to come

from low SES backgrounds. Only two

(in Denver and Sioux Falls) name the

middle SES group, and another two

(in El Paso and Los Angeles) name

both the low and middle SES groups.

St. Louis is the only Pulse Check city

where marijuana-using clients are

equally likely to come from all three

(low, middle, and high) SES groups.

According to methadone treatment

sources, low SES groups predominate

in five programs, middle SES groups

in two, and both low and middle SES

groups in one (Boston); New Orleans

is the only city where all three SES

groups are named.

Where do marijuana users tend

to reside? (Exhibit 7) As reported in

the last Pulse Check, marijuana users,

more so than other drug users, reside

“everywhere”—a term used by

numerous sources to refer to central

city, suburban, and rural places of residence. Specifically, epidemiologic

and ethnographic sources report all

three locations in nine Pulse Check

cities: Birmingham, El Paso, Miami,

and New Orleans in the South;

Detroit and St. Louis in the Midwest;

and Denver, Honolulu, and Seattle in

the West. Suburban residences are

more predominant in Billings, Los

Angeles, and Sioux Falls, and both

suburban and central city residences

are reported in Boston and Chicago.

central city residences are more commonly reported in the Northeast (in

New York, Philadelphia, and—along

with rural areas—in Portland [ME])

and the South (in Baltimore, Columbia [SC], Memphis, and Washington,

DC). Since the last Pulse Check, the

El Paso epidemiologic source notes an

increase in marijuana users living in

rural areas. That shift, however, is

probably not due to new use: more

likely, it is because more outreach

efforts are reaching those areas. 

Marijuana users in non-methadone

treatment programs are likely to live

in central city areas, as reported in 12

Pulse Check cities (New York and

Philadelphia in the Northeast;

Baltimore, Birmingham, El Paso,

Miami, New Orleans, and Washington, DC, in the South; Chicago and

Detroit in the Midwest; and Billings,

Denver, and Los Angeles in the West).

They are likely to reside in the suburbs in Columbia (SC), El Paso,

Portland (ME), and Seattle, while

rural areas predominate in both Sioux

Falls programs. Only in Honolulu and

St. Louis are clients likely to live in

all three types of locations.

According to responding methadone

treatment sources, marijuana users in

six programs reside predominantly in

central city areas (in Birmingham,

Boston, Chicago, El Paso, Portland

[ME], and Washington, DC), those in

Los Angeles live in both central city

and suburban areas, and those in a second Boston program live in the suburbs. All three types of locations are

named in Honolulu and New Orleans.
MARIJUANA

page 64 Pulse Check: November 2001

How do marijuana users wind up

in treatment? (Exhibit 8) The vast

majority (17 of 21) of non-methadone

treatment sources report that marijuana clients at their programs come

mainly from court or criminal justice

referrals. These findings differ from

those in the last Pulse Check in two

ways. First, during the last reporting

period, the number of marijuana

clients exceeded crack and heroin

clients in court or criminal justice

referrals, whereas during the current

period, heroin and crack clients have

slightly surpassed marijuana clients in

this type of referral. Second, the proportions of clients with criminal justice

referrals have increased for all three

drugs: from less than 50 percent of

responding sources during the last

reporting period to more than 80

percent during the current period.

These percentages should be viewed

with caution because the numbers

involved are relatively small and

because we cannot generalize Pulse

Check findings to the general treatment population. That said, these

findings make sense in light of the

growing legislative trend toward

diverting misdemeanor drug abusers

out of law enforcement and into

treatment. 

Comparatively few non-methadone

treatment sources list referral sources

other than courts or the criminal justice system. Only four list alcohol or

drug abuse health care providers (in

Memphis, Philadelphia, Portland

[ME], and Washington, DC), three

name individual referrals (in El Paso,

Memphis, and Washington, DC),

another three name school referrals

(in Baltimore, Chicago, and Columbia

[SC]), two name employer referrals

(in Honolulu and Washington, DC),

and only one (in Memphis) lists other

health care providers.

How do marijuana users take

marijuana? Joints seem to be the

most common vehicle for smoking

marijuana, as reported by the vast

majority of epidemiologic and ethnographic respondents. However, blunts

(hollowed-out cigars filled with marijuana) are more common than joints

in Baltimore and Philadelphia, and

they are nearly as common as joints

in Birmingham, but they are reportedly becoming passé in that city. In

some cities, different subgroups of

marijuana users prefer different 

vehicles for smoking marijuana. In

Boston, for example, central city 

residents tend to use blunts, while

suburban residents tend to use joints.

Similarly, in St. Louis, Blacks who live

in the central city tend to use blunts.

Increases in blunt use are reported in

Memphis and New Orleans, although

in the latter city they are not referred

to by that term. Pipes and “bongs”

are other vehicles for smoking 

marijuana, as reported in Denver,

Miami, and Seattle.

Non-methadone treatment sources

report blunts as the predominant

vehicle more often than epidemiologic and ethnographic sources. Such

is the case in nine programs: in

Baltimore, Chicago, Columbia (SC), El

Paso, Honolulu, New Orleans, Seattle,

Sioux Falls, and Washington, DC.

Exhibit 7.

Where are drug users most likely

to reside?

Marijuana

Powder

Cocaine

Crack Heroin

Sources: Epidemiologic and ethnographic

respondents

Note: Some respondents list two areas per city.

Rural Areas

Suburbs

Central City

All Areas

0 0 0

Number of Respondents (N=21) 20

19

18

17

16

15

14

13

12

11

10

9

8

7

6

5

4

3

2

1

0

Exhibit 8.

How are different drug users referred to treatment?

Sources: Non-methadone treatment respondents

Alcohol/Drug Abuse

Health Care Provider

Court/Criminal Justice

Marijuana

(N=21)

Heroin

(N=17)

0

IndividualSchool Employer Health

Care

Provider

Percent

0 0 0

100

90

80

70

60

50

40

30

20

10

0

Crack

(N=20)
MARIJUANA

Pulse Check: November 2001 page 65

Additionally, marijuana users in

Birmingham, Boston, Los Angeles,

Memphis, and the second Sioux Falls

program are equally likely to use blunts

and joints. Joints are more common in

Billings, Detroit, Miami, New York,

Philadelphia, and Portland (ME). Most

clients in Denver, and some in Los

Angeles and Sioux Falls, tend to smoke

marijuana in pipes.

Eight out of nine methadone treatment respondents report that their

clients smoke marijuana in joints (in

Boston, Chicago, El Paso, Honolulu,

Los Angeles, New Orleans, Portland

[ME], and Washington, DC). In a 

second Boston program, however,

marijuana smokers are equally likely

to use joints, blunts, and bongs.

What other drugs do marijuana

users take? (Exhibit 9) According

to epidemiologic and ethnographic

sources, marijuana users often also

use crack, sometimes sequentially and

sometimes in combination, particularly

throughout the Northeast (in Boston,

New York, and Philadelphia), the

South (in Birmingham, Columbia [SC],

El Paso, Memphis, and Washington,

DC), and the Midwest (in Chicago,

Detroit, and St. Louis). Powder cocaine

is sometimes used with marijuana in

Memphis, Miami, and Philadelphia.

The Boston ethnographic source hears

occasional reports about marijuana

being mixed with both heroin and

cocaine, but has not personally

observed such cases. As that source

notes, “Heroin users tend not to use

marijuana because they have to be on

their toes too much.” In Philadelphia,

some users occasionally crumble and

sprinkle the diverted prescription

drug alprazolam (Xanax®) onto 

marijuana; others sometimes mix

honey into marijuana to add flavor

and “slow the burn.” In Miami, 

marijuana is taken with ecstasy, and

in Memphis, marijuana is laced with

methamphetamine or amphetamine—

a combination that has increased

since the last reporting period. PCP

lacing or dipping is reported in

Boston, Chicago, Honolulu, New

Orleans, New York, Philadelphia, and

Washington, DC. The PCP combination in Honolulu is a recent development. Elsewhere in the West, the only

other drugs mentioned are embalming

fluid in Seattle, and club drugs (ecstasy, LSD, and GHB) in Los Angeles.

Marijuana users in several nonmethadone treatment programs also

take crack. Such reports, like those of

epidemiologic and ethnographic

sources, occur in the South (in 

Miami, New Orleans, and

Washington, DC) and in the Midwest

(in Detroit and Sioux Falls). Unlike

epidemiologic and ethnographic

reports, no crack use is noted in the

Northeast, but two reports emanate

from the West (in Billings and

Seattle). Marijuana clients in

Birmingham, Chicago, Columbia

(SC), El Paso, and Los Angeles use

powder cocaine. The Birmingham

source notes that sometimes the dealer laces the marijuana with cocaine,

but with the user’s knowledge. PCP

use is noted among marijuana clients

in Billings, Chicago, Memphis,

Miami, Portland (ME), and

Washington, DC. In Billings and

Chicago, embalming fluid is sometimes added to the marijuana-PCP

mixture. Embalming fluid is also

mentioned in Birmingham, where

some clients soak marijuana in the

substance. Marijuana clients in

Billings and Sioux Falls sometimes use

methamphetamine. Heroin is mentioned only in Philadelphia and St.

Louis, but the St. Louis source notes

that “Most marijuana users don’t use

anything else but alcohol. On the

other hand, most hardcore drug users

also smoke marijuana.”

Sources: Epidemiologic, ethnographic, and treatment provider respondents

Marijuana: First drug of abuse?

According to the Los Angeles epidemiologic source, “Marijuana is not always

the precursor to other drug use: now, it

sometimes follows club drug use. Some

‘rave kids’ start by using GHB, then

move on to ecstasy, and subsequently

end up using marijuana. Some of 

these users have never even smoked

cigarettes.”

Exhibit 9.

What are some slang terms for drug combinations involving marijuana? 

Marijuana combined 

with what drug Slang Term City

Marijuana + crack Oolies Boston

Coolies New York

Diablitos or turbos Philadelphia

Worties Washington, DC

Marijuana dipped in same Elo New York

water used to cook crack

Marijuana + powder cocaine Primos Chicago, El Paso, Los Angeles

Marijuana + PCP Wets New York, Philadelphia

Love boat Philadelphia
MARIJUANA

page 66 Pulse Check: November 2001

In methadone treatment programs,

some marijuana clients use crack in

Chicago, Los Angeles, and New

Orleans. The El Paso source notes

that some dealers lace marijuana with

heroin or cocaine but that the users

are not aware of this practice until

they are tested at the clinic. The

Honolulu source notes a decline in

the number of combinations.

Where and with whom is marijuana used? As reported in the last

Pulse Check, many epidemiologic and

ethnographic sources use the word

“everywhere” to describe the settings

and contexts of marijuana use. Of 20

sources who discussed this question,

11 report that users are equally likely

to smoke the drug both indoors and

outdoors, 12 assert that users tend to

use it in groups or among friends,

and 9 report that users are equally

likely to smoke marijuana both in

public and in private. Solo use and

group use are equally likely in eight

cities. For example, in Boston, users

report smoking marijuana while alone

as a sleep aid or sexual stimulant.

However, in no city does any source

report that solo use is predominant.

The specific settings are as varied as

the possibilities—from concerts in

Philadelphia to the workplace in St.

Louis, from festivals in Denver to

outside supermarkets and shopping

malls in El Paso, from before and

after raves in Miami to around junior

high and high schools in 10 Pulse

Check cities.

Similarly, non-methadone treatment

sources frequently report that 

marijuana users are equally likely to

smoke the drug indoors and outdoors, and the majority reports that

users tend to smoke the drug in

groups or among friends. These

sources, however, are about equally

divided on the question of public 

versus private use: clients in Baltimore, Billings, Chicago, Columbia

(SC), Honolulu, New York, and

Washington, DC, tend to smoke 

marijuana in public; clients in

Birmingham, Detroit, Memphis,

Miami, New Orleans, Portland (ME),

St. Louis, and Sioux Falls tend to do

so in private; and clients in Denver,

El Paso, Los Angeles, and Seattle are

equally likely to smoke marijuana in

public and in private.

Marijuana users in methadone 

programs, however, have much more

discrete use patterns than their counterparts in non-methadone treatment.

In the majority of reporting programs,

users prefer to smoke marijuana

indoors rather than outdoors, and in

private rather than in public. These

clients, however, still retain the social

aspect of marijuana use: no methadone treatment sources report that

solo use is predominant over use in

groups or among friends.

MARIJUANA: THE COMMUNITY

What is the impact of and 

community reaction to the marijuana problem?

% Billings, MT: A new media 

campaign, targeting both parents

and youth, focuses on marijuana and

alcohol. The campaign is converting

existing ONDCP printed matter into

locally relevant messages. Efforts are

underway to similarly access and

localize ONDCP’s Media Campaign

messages. Several other recent 

community prevention efforts

include the following: parent seminars; services to under-privileged,

high-risk youth, such as mentor 

programs at Boys’ and Girls’ Clubs;

and programs that focus on Native

American youth. It is too early to

assess the impact of these efforts,

and grant applications are currently

being made to sustain them.

% Hawaii: After an 8-month halt, the

Big Island’s Operation Green

Harvest marijuana eradication

effort was reinstated in April 2001.

The epidemiologic source predicts

that the amount of “local grow”

will go back down, but that this

decline will affect the amount of

marijuana exported, not the

amount consumed locally. Hawaii

also has a “Weed and Seed” 

program, similar to many States’

“Drug Free Zones,” with stiff 

sentences for drug arrests 

around schools.

% Sioux Falls, SD: The local school

district is promoting a parent education program that supports zero

tolerance for all drugs. The effort

includes letters to parents and billboards about communicating with

their children. Anecdotal reports

from parents so far suggest that the

program is having a positive

impact. Additionally, the area has

recently completed its first full year

of a school-based drug testing 

program partially funded by the

school system. Under this program,

parents can sign up their children

in advance for random testing and

agree to have conversations with

them about drugs; alternatively,

parents can request one-time tests

as they feel necessary. Students

from the first category are testing

positive at significantly lower 

levels than those from the second

category. Thus, apparently, the 

parent-child conversations are 

having an impact, and it is possible

that students are using the testing

as an excuse not to use the drug.
METHAMPHETAMINE

Pulse Check: November 2001 page 67

METHAMPHETAMINE: 

THE PERCEPTION

How do Pulse Check sources

perceive the methamphetamine

problem in their communities,

and have their perceptions

changed? Only three sources in 

two cities (both western) consider

methamphetamine the most widely

used drug in their communities: the

law enforcement source in Billings

and the epidemiologic and nonmethadone sources in Honolulu.

Additionally, nine sources in five

cities (all western) consider methamphetamine the second most widely

used drug: in Billings (the epidemiologic and non-methadone treatment

sources), Denver (the non-methadone

treatment source), Honolulu (the law

enforcement source), Los Angeles (the

non-methadone treatment source),

and Sioux Falls (the law enforcement, 

epidemiologic, and methadone and

non-methadone treatment sources).

Since the last Pulse Check reporting

period, no changes were reported in

the perceptions of methamphetamine

as the most or second most widely

abused drug.

More sources report methamphetamine as contributing to the most

serious consequences in their communities than report methamphetamine as

the most widely used drug. Thirteen

sources in four cities (Billings, Denver,

Honolulu, and Sioux Falls) report

methamphetamine as contributing to

the most serious consequences. The

Memphis law enforcement source is

the only one to report methamphetamine as the drug contributing to the

second most serious consequences.

Again, since the last Pulse Check, no

changes were reported in the perceptions of methamphetamine as the drug

of abuse contributing to the most or 

second most serious consequences.

METHAMPHETAMINE: THE DRUG

How available is methamphetamine across the country?

(Exhibit 1) Nearly two-thirds (25 of

42) of law enforcement, epidemiologic, and ethnographic sources report

methamphetamine as somewhat or

widely available in their communities,

and availability varies widely by

region. In the West, it considered

widely available by nearly every

respondent (in Billings, Denver, Los

Angeles, Honolulu, and Seattle); in

the Midwest, it ranges from not very

available (in Chicago) to widely available; in the South, it ranges from not

very to widely available; and in the

Northeast, it is not very or not available, according to nearly every

respondent. 

Exhibit 1.

How available is methamphetamine across the 21 Pulse Check cities?

According to epidemiologists and ethnographers... (N=19)*

According to law enforcement sources... (N=21)

Widely Available Somewhat Available

Not very Available Not Available

*The epidemiologic and ethnographic sources in Columbia and El Paso did not provide this

information.
METHAMPHETAMINE

page 68 Pulse Check: November 2001

Has methamphetamine availability changed? (Exhibit 2) Since

the last reporting period, methamphetamine availability increased or

remained stable according to all law

enforcement, epidemiologic, and

ethnographic respondents, with the

exception of the law enforcement

source in Philadelphia and the epidemiologic source in Boston, who

report availability declines. Similar to

the last Pulse Check, most increases

occurred in the South, Midwest, and

West, although the percentage of

western sources reporting increases

this reporting period is lower than

the percentage reporting increases

last period (50 versus 86 percent).

What type of methamphetamine is available? Locally

produced methamphetamine is

slightly more available than

methamphetamine produced in

Mexico, according to law

enforcement, epidemiologic, and

ethnographic respondents. “Ice,”

nearly 100 percent pure methamphetamine, is not very available in

most cities, except in Honolulu,

where it is widely available according

to both the law enforcement and 

epidemiologic sources. 

According to most law enforcement,

epidemiologic, and ethnographic

sources (in Billings, Columbia [SC],

Denver, El Paso, Memphis, Portland

[ME], St. Louis, and Sioux Falls) most

available methamphetamine is produced in “box labs,” small, mobile,

clandestine labs often located in rural

areas. Additionally, methamphetamine

labs run by large operations in Mexico

and California produce some of the

methamphetamine available in Denver,

Detroit, Los Angeles, Philadelphia,

Seattle, and Washington, DC. 

The manufacturing processes used to

produce methamphetamine differ by

region. In the Midwest, the “Nazi

method” (involving ephedrine or 

pseudoephedrine, lithium, and anhydrous ammonia) is most often used. In

the South and West, both the “coldcooking method” (involving ephedrine,

red phosphorus, and iodine crystals)

and the Nazi method are used. In

Philadelphia, the “P2P (phenyl-2-

propanone) method” (producing a

lower purity methamphetamine) is

most often used. According to the law

enforcement source in Seattle, locally

produced methamphetamine is purer

than methamphetamine produced in

Mexico.

Since the last reporting period,

methamphetamine labs have increased

in several Pulse Check cities, including

Detroit, Memphis, Portland (ME), St.

Louis, and Sioux Falls. Local box labs

or local clandestine labs have

increased in Denver, Los Angeles,

Memphis, Portland (ME), Sioux Falls,

and Seattle. The Portland law

enforcement source states that an

increasing number of people, 

typically from the Southwest, are

beginning to create methamphetamine labs in that city.

The Denver law enforcement

source reports that methamphetamine produced by the

Nazi method is increasing. The

Seattle law enforcement source

states that although the number

of local box labs has increased, law

enforcement officials focus their

efforts on the large labs. The

Memphis law enforcement source

states that more amphetamine is

being produced than methamphetamine, and the Denver epidemiologist

reports that dietary supplements are

often used in the methamphetamine

production process. 

What are methamphetamine

prices and purity levels across

the country? (Exhibit 3) Reported

gram prices (the most common unit

of methamphetamine sold) vary 

widely: $100 in the Northeast

(Boston and Philadelphia reporting),

$80–$175 in the South, $330 in

Chicago, and $20–$300 in the West. 

Exhibit 2.

How has methamphetamine 

availability changed 

(fall 2000 vs spring 2001)?*

L Law enforcement respondents

E Epidemiologic/ethnographic respondents

*The Baltimore, Columbia (SC), El Paso,

Memphis, New Orleans, and Portland (ME)

epidemiologic/ethnographic sources did not

provide this information.

Billings, MTL

Birmingham, ALL

Chicago, ILL

Columbia, SCL

Denver, COL

Detroit, MIE

Honolulu, HIL

Memphis, TNL

Portland, MEL

Seattle, WAL,E

Sioux Falls, SDL

Washington, DCL,E

Baltimore, MDL

Billings, MTE

Birmingham, ALE

Boston, MAL

Chicago, ILE

Denver, COE

Detroit, MIL

El Paso, TXL

Honolulu, HIE

Los Angeles, CAL,E

Miami, FLL,E

New Orleans, LAL

New York, NYL,E

Philadelphia, PAE

Sioux Falls, SDE

St. Louis, MOL,E

Philadelphia, PAL

Boston, MAE
Between fall 2000 and spring 2001,

prices remained relatively stable,

except in Memphis, where prices

declined slightly according to the law

enforcement source, and in Chicago,

where prices increased according to

the law enforcement source. 

Methamphetamine purity levels,

reported by only seven sources, vary

widely, ranging from 15–35 percent

in Los Angeles to 90–95 percent in

Memphis. Since the last reporting

period, purity levels changed in 

several cities: according to the law

enforcement source in Denver and

Los Angeles, purity increased, 

possibly because high-purity methamphetamine produced in local labs by

the Nazi method has replaced lower

purity methamphetamine produced in

Mexico. Similarly, the law enforcement source in Seattle states that the

purity of methamphetamine produced

in Mexico decreased because it has

been diluted with methylsulfonyl

methane (MSM) and that locally 

produced methamphetamine is often

of higher purity.

How is methamphetamine

referred to across the country?

(Exhibit 4) Across the country,

methamphetamine is often referred to

as “meth,” “speed,” “crank,” and

“crystal.” Other slang terms vary by

region and tend to be based on the

color or consistency of the available

methamphetamine, such as “clear,”

“glass,” “yellow girl,” and “cinnamon.” Often terms are based on 

production methods: “bathtub meth”

refers to methamphetamine 

manufactured in bathtubs, and

“Christmas tree meth” refers to 

green methamphetamine produced

using Drano® crystals.

Exhibit 4. 

How is methamphetamine referred to in different regions of the country?

METHAMPHETAMINE

Pulse Check: November 2001 page 69

Exhibit 3. 

How much does methamphetamine cost in 16 Pulse Check cities?

Boston, MA $100 NR NR 

Philadelphia, PA $100 NR <25 

Portland, ME NR $1,400 40 

Birmingham, AL $120 $1,800 NR 

Columbia, SC $175 NR NR 

Memphis, TN $90–$110 NR 90–95 

Miami, FL $80–$100 NR NR 

New Orleans, LA $100–$150 NR NR 

Washington, DC $140 NR NR 

Chicago, IL $330 NR NR 

Detroit, MI NR $500–$2,000 20–25 

Sioux Falls, SD NR $800–$1,000 NR 

Denver, CO $80–$125 NR 20–90 

Honolulu, HI $200–$300 NR NR 

Los Angeles, CA $80–$100 NR 15–35 

Seattle, WA $20–$60 $350–$650 75–95 

City Gram price Ounce price Purity (%)

Northeast Midwest West South

Sources: Law enforcement, epidemiologic, and ethnographic respondents

Hydro, dro, 

8 ball, OZs,

elbows, half

elbows

Ice, peanut butter, glass, anhydrous, soap,

fire, nazimeth, bathtub meth, CR, chemical,

california, spackle, getgo, white crosses,

speckled birds, yellow jackets, christmas

trees, black beauty, poppers, pink hearts,

(also known by the color of the substance:

red, black, brown, white, white rock, pink)

Ice, blade, snow, christmas tree meth, holiday

meth, cinnamon (pink), X’s and O’s, hugs and

kisses, sugar, good glass, hydro, rice krispy

Glass, baggies,

window, yellow

girl

Sources: Law enforcement, epidemiologic, ethnographic, and treatment respondents

WEST

MIDWEST

NORTHEAST

SOUTH

Clear, cloud,

ice, batu,

shabu
METHAMPHETAMINE

page 70 Pulse Check: November 2001

How is methamphetamine 

packaged? According to law

enforcement, epidemiologic, and

ethnographic respondents, methamphetamine is most commonly packaged in plastic sandwich or zipper

bags, as reported in the last Pulse

Check. Additional types of packaging

vary widely: it is packaged in folded

paper in Detroit, El Paso, Los

Angeles, and Memphis; small coin

zipper bags in El Paso, Honolulu, and

Washington, DC; tied-off corners of

plastic bags in St. Louis and Sioux

Falls; cellophane or plastic wrap with

duct tape in Denver and Los Angeles;

vials in Miami and Seattle; and balloons in Denver. It is sold loose in

rock form, like crack, in Birmingham,

St. Louis, and Seattle. Few sources 

in the Northeast responded to this

question, in keeping with the lower

availability in that region; the widest

variety of packaging was reported in

the West, corresponding to the wider

availability in that region.

METHAMPHETAMINE: 

THE SELLERS

How are street-level methamphetamine sellers organized?

According to law enforcement, 

epidemiologic, and ethnographic

respondents, methamphetamine sellers are predominantly independent in

the Midwest, mostly independent in

the Northeast (except in Philadelphia,

where biker and organized crime

groups are the predominant sellers),

and both independent and organized

in the South and West. According to

the epidemiologist in St. Louis, the

affiliation of methamphetamine distributors depends on the source:

independent sellers distribute locally

produced methamphetamine, and

organized sellers distribute Mexican

methamphetamine. In Honolulu, 

sellers are fairly independent with

two to three “runners,” and some are

affiliated with Mexican nationals. 

How is street-level methamphetamine sold? According to law

enforcement, epidemiologic, and

ethnographic respondents, methamphetamine is sold using a variety of

methods. The most common are

hand-to-hand sales through acquaintance networks. Many sales also

involve beeper or cell phone technology (as reported in 12 cities), and in

7 cities (Billings, Birmingham,

Denver, Honolulu, Memphis,

Philadelphia, and St. Louis), deliverytype services are used. 

How old are street-level

methamphetamine sellers? Law

enforcement, epidemiologic, and

ethnographic respondents across the

Nation report methamphetamine 

sellers as predominantly young adults

(18–30 years), with a few exceptions:

according to four sources (the law

enforcement sources in Los Angeles,

Memphis, and Sioux Falls, and the

epidemiologic source in St. Louis),

sellers are evenly split between young

adults and adults (>30 years), and

according six sources (the law

enforcement sources in Baltimore,

Columbia [SC], Philadelphia, Portland

[ME], and St. Louis, and the Billings

epidemiologic source), they are 

mostly adults.

What other drugs do street-level

methamphetamine sellers sell?

Similar to reports in the last Pulse

Check, most (13 of 22) law 

enforcement, epidemiologic, and

ethnographic respondents agree that

methamphetamine sellers do not 

typically sell other drugs, but all

respondents in the West (5 of 5)

report that methamphetamine sellers

do sell other drugs, namely heroin,

crack and powder cocaine, and 

marijuana. Additionally, methamphetamine sellers often sell cocaine or

ecstasy in Memphis, ecstasy in Miami,

and powder cocaine and club drugs

(including ecstasy, GHB, and ketamine) in Washington, DC. 

Do street-level methamphetamine sellers use their own drug?

Most law enforcement, epidemiologic, and ethnographic respondents (15

of 23) report that street-level

methamphetamine sellers are very

likely to use the drug, as reported in

the last Pulse Check. Reported levels

of likeliness to use the drug are highest among western sources. According

to the St. Louis epidemiologist, independent sellers are very likely to use

the drug, but organized sellers are not

very likely to use the drug. 

Are street-level methamphetamine sellers involved in other

crimes? (Exhibit 5) According to

most law enforcement, epidemiologic,

and ethnographic respondents,

methamphetamine sellers continue to

be somewhat involved or very likely

to be involved in other crimes, most

commonly domestic violence, nonviolent crimes, and other violent crimes.

Furthermore, methamphetamine sellers who are organized are reported as

more likely to be involved in other

crimes than those who are independent. Methamphetamine sellers seem

particularly involved in domestic violence: according to 34 law enforcement and epidemiologic respondents,

methamphetamine sellers account for

44 percent of the domestic violence

among drug sellers, compared with

only 24 percent for crack cocaine

sellers, 20 percent for powder cocaine

sellers, and 9 percent for heroin sellers.
METHAMPHETAMINE

Pulse Check: November 2001 page 71

Where is methamphetamine

sold? (Exhibit 6) The geographic

location of methamphetamine sales

varies widely by region. In the West,

except for Honolulu (where sales

occur in the central city), respondents

agree that sales occur in all areas of

the city: suburban, rural, and central.

In the Midwest, respondents cite

mostly rural areas for methamphetamine sales, except in Chicago, where

suburbs are mentioned. In the

Northeast, rural areas are mentioned

by the law enforcement sources in

Boston and Portland (ME), and all

areas are mentioned in Philadelphia.

Epidemiologists in the Northeast did

not respond to this question. In the

South, sales settings vary: all areas are

mentioned in Birmingham; suburbs

are mentioned in Columbia (SC) and

Exhibit 5.

In what other crimes are illicit drug sellers involved, by different drugs,

across Pulse Check sites?

Sources: Law enforcement, epidemiologic, and ethnographic respondents

Methamphetamine

Heroin

Crack

Powder cocaine

Marijana

Domestic

violence

(N=34)

44%

Violent

crimes

(N=75)

Gang-related

crimes

(N=60)

Nonviolent

crimes

(N=96)

Prostitution

(N=44)

Exhibit 6.

Where is methamphetamine sold and used across 18 Pulse Check cities?*

Private Raves Public Play- Shop- Around Hotels/ Total

Resi- Private Inside Night- Con- Hous- College grounds/ ping Crack Super- Motels #

City Streets dences Parties Cars Clubs certs ing Campus Parks Malls Houses markets Settings

Sell Use Sell Use Sell Use Sell UseSell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use

Boston, MA !!! ! ! ! ! 6 1

Philadelphia, PA !! !! ! ! ! 4 3

Portland, ME ! 1 NR

Birmingham, AL ! !! 3 NR

Columbia, SC ! 1 NR

El Paso, TX !!! ! ! ! ! ! ! ! 1 9

Memphis, TN ! !! ! ! !! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! 12 10

Miami, FL !! ! !! 3 2

Washington, DC !! ! ! ! ! !! ! 4 5

Chicago, IL !! ! ! ! ! 1 5

Detroit, MI !!! ! ! 1 4

St. Louis, MO ! !! ! !! ! ! 6 2

Sioux Falls, SD ! !! ! !! ! !! ! ! 8 3

Billings, MT ! !! ! ! !! ! ! ! ! ! ! ! ! ! 12 4

Denver, CO !!!! ! !! ! ! !! !!! ! ! ! 9 8

Honolulu, HI ! ! ! !! ! ! ! ! ! ! ! ! ! 12 2

Los Angeles, CA !!!! ! ! ! ! 2 6

Seattle, WA ! !! ! ! !! ! ! ! ! ! ! ! 8 6

Sources: Law enforcement, epidemiologic, and ethnographic respondents

*For sales settings law enforcement, epidemiologic, and ethnographic sources responded, except for the following: the law enforcement sources in

Baltimore, Chicago, Detroit, New Orleans, and New York, and the epidemiologic sources in Baltimore, Billings, Birmingham, Boston, Columbia (SC), El

Paso, Los Angeles, New Orleans, New York, Philadelphia, Portland (ME), and Seattle. For users settings, epidemiologic and ethnographic 

sources responded, except for the sources in Baltimore, Birmingham, Columbia (SC), New Orleans, New York, and Portland (ME). West South Northeast Midwest
METHAMPHETAMINE

page 72 Pulse Check: November 2001

El Paso; the central city is mentioned

in Memphis and Washington, DC;

and suburbs and the Miami Beach

area are mentioned in Miami.

All law enforcement, epidemiologic,

and ethnographic respondents in the

West report that outdoor and indoor

sales are equally common. In the

other three regions, indoors sales are

generally more common than outdoors sales, but several respondents

(in Birmingham, Memphis, Philadelphia, Sioux Falls, and Washington,

DC) report that outdoor and indoor

sales are equally common. The most

frequently mentioned specific sales

settings, according to law enforcement, epidemiologic, and ethnographic respondents, continue to be

private residences, followed by 

nightclubs and bars, private parties,

and inside cars.

METHAMPHETAMINE: THE USERS

How have novice methamphetamine treatment clients changed

between fall 2000 and spring

2001? Most (9 of 15) nonmethadone treatment respondents

report that the number of novice

methamphetamine users in treatment

(defined as any drug treatment client

who has recently begun using

methamphetamine) is stable, with a

few exceptions: novice users

increased in Billings, Denver, El Paso,

and Sioux Falls; they declined in

Portland (ME) and among adolescents

in Honolulu. Methadone treatment

sources did not provide information

on methamphetamine users or

methamphetamine treatment clients.

How old are methamphetamine

users? (Exhibit 7) As reported in the

last Pulse Check, the predominant age

of methamphetamine users varies by

city, according to 15 epidemiologic

and ethnographic sources, with most

(8) reporting young adults (18–30

years) as the predominant users (in

Chicago, El Paso, Los Angeles,

Memphis, Miami, St. Louis, Sioux

Falls, and Seattle). Additionally, four

respondents (in Billings, Denver,

Philadelphia, and Washington, DC)

cite adults (>30 years) as the predominant methamphetamine users,

two (in Birmingham and Detroit) cite

both young adults and adults, and the

Honolulu source cites adolescents and

young adults. Based on regions, no

patterns in the age of methamphetamine users emerged. Most (8 of 12)

non-methadone treatment providers

concur that methamphetamine users

are predominantly young adults. 

Are there any gender differences

in who uses methamphetamine?

According to most (11 of 15) 

epidemiologic and ethnographic

respondents, methamphetamine users

are predominantly male, as reported

in the last Pulse Check. Only three

sources (in Billings, Los Angeles, and

Sioux Falls) report methamphetamine

users as split evenly between genders,

and only in El Paso are methamphetamine users primarily females. By contrast, most (8 of 12) non-methadone

treatment respondents report that

males and females are equally likely

to use methamphetamine; the remaining sources report that users tend to

be males.

Then and Now:

How have methamphetamine user characteristics changed (fall 2000 vs

spring 2001)?

According to epidemiologic and ethnographic sources, methamphetamine user 

characteristics have changed in several areas:

➤ Billings, Detroit, and Washington, DC: Although adults (>30 years) are the 

predominant users, young adults (18–30 years) are cited as emerging user groups.

➤ Sioux Falls: Pre-adolescents (<13 years) are cited as an emerging user group.

➤ Detroit and Honolulu: Most methamphetamine users are male, but female

methamphetamine users have increased. 

➤ Los Angeles: Hispanics and Asian/Pacific Islanders are increasingly using 

methamphetamine.

➤ Washington, DC: Hispanics are cited as an emerging methamphetamine user

group.

➤ Los Angeles and Honolulu: Methamphetamine users who reside in suburban

areas have increased. 

➤ St. Louis: Methamphetamine users who reside in central city and suburban areas

are emerging groups. 

➤ Honolulu, El Paso, and St. Louis: Injecting as a route of methamphetamine

administration is increasing.
METHAMPHETAMINE

Pulse Check: November 2001 page 73

Is any racial/ethnic or socioeconomic group more likely to use

methamphetamine? As reported in

the last Pulse Check, methamphetamine users tend to be Whites and

overrepresented compared with the

general population, according to 

nearly all (17 of 19) epidemiologic and

ethnographic sources. In Billings, they

are split evenly between Whites and

Native Americans, and in Honolulu,

they are be split evenly between

Whites and Asian/Pacific Islanders.

Most non-methadone treatment

respondents agree with their epidemiologic and ethnographic counterparts. 

Methamphetamine users continue to

be of low or middle SES, with 7 of 16

epidemiologic and ethnographic

sources reporting them as having low

SES backgrounds and 9 reporting

them as being middle SES. All (12)

non-methadone treatment respondents concur with epidemiologic

sources that users tend to be of low

or middle SES. 

Where do methamphetamine

users tend to reside? Depending

on the region, the residences of

methamphetamine users vary widely.

According to epidemiologic and

ethnographic sources, most methamphetamine users reside in suburban

and rural areas in the Midwest; in

central city areas in the Northeast;

and in rural areas, suburbs, and 

central city areas in the South and

West. Most non-methadone treatment

respondents agree with their 

epidemiologic counterparts.

How do most methamphetamine

users take the drug? Route of

administration for methamphetamine

varies widely, according to epidemiologic and ethnographic sources. Most

(3 of 4) responding sources in the

West (in Denver, Los Angeles, and

Honolulu) report smoking as the predominant route of administration, but

the Seattle epidemiologic source

reports oral ingestion as the predominant route. Snorting predominates in

three non-western areas (Chicago,

Memphis, and Washington, DC), oral

ingestion predominates in Miami, and

smoking is most common in Sioux

Falls and New York. In Philadelphia

and Birmingham, snorting and 

injection are mentioned, in El Paso

injection and oral ingestion are mentioned, and in Detroit, snorting and

oral ingestion are mentioned.

According to the Los Angeles and 

St. Louis epidemiologic sources,

methamphetamine users often switch

routes of administration. Most nonmethadone treatment respondents

agree with their epidemiologic counterparts about predominant route of

administration.

What other drugs do methamphetamine users take?

Methamphetamine users take a 

variety of other drugs, according to

epidemiologic and ethnographic

respondents, and as reported in the

last Pulse Check. The most common

Exhibit 7. 

What age group is most likely to use methamphetamine?*

Adolescents (13–18) Young Adults (18–30) Adults (>30)

Philadelphia, PAE,N Philadelphia, PAN

Portland, MEN

Columbia, SCN Birmingham, ALE,N Birmingham, ALE

El Paso, TXE,N Washington, DCE

Memphis, TNE

Miami, FLE 

Sioux Falls, SDN Chicago, ILE Detroit, MIE

Detroit, MIE

St. Louis, MOE,N

Sioux Falls, SDE,N

Honolulu, HIE Billings, MTN Billings, MTE

Los Angeles, CAN Denver, COE

Denver, CON

Honolulu, HIE,N

Los Angeles, CAE,N

Seattle, WAE,N

E Epidemiologic/ethnographic respondents N Non-methadone treatment respondents 

*Notes: Epidemiologic sources did not respond in Baltimore, Columbia (SC), New Orleans, and

Portland (ME); non-methadone treatment sources did not respond in Baltimore, Boston,

Chicago, Detroit, Honolulu, Memphis, Miami, New Orleans, New York, Seattle, and

Washington, DC. If respondents cited methamphetamine users as evenly split between two age

groups, that respondent is listed under both age groups. Two non-methadone treatment sources

from Sioux Falls responded.

How do methamphetamine users

wind up in treatment? 

Courts and the criminal justice system

are the most common referral sources

for clients entering treatment for methamphetamine addiction, according to

non-methadone treatment respondents.

Individual referrals follow closely as the

second most common referral source.

Northeast South Midwest West
METHAMPHETAMINE

page 74 Pulse Check: November 2001

drugs used in combination with

methamphetamine are marijuana (in

Birmingham, Detroit, Los Angeles,

Memphis, Philadelphia, and St. Louis)

and ecstasy (in Miami and Washington, DC). Non-methadone treatment

sources agree that marijuana is often

used in combination with methamphetamine, as reported in Billings,

Denver, Los Angeles, Philadelphia, 

St. Louis, and Sioux Falls. 

Where and with whom do

methamphetamine users take

the drug? (Exhibit 6) According to

nearly all (17 of 27) epidemiologic,

ethnographic, and non-methadone

treatment respondents, methamphetamine is generally used indoors and in

private. Methamphetamine use is

most often a group activity, according

to the vast majority (21 of 27) of

those respondents. Additionally, the

Detroit and Seattle epidemiologic

sources and the Philadelphia and

Honolulu non-methadone treatment

sources report that most methamphetamine users take the drug both

alone and in groups; the Miami and

Los Angeles epidemiologic sources

report that most use the drug alone.

The most frequently mentioned user

settings, according to epidemiologic

and ethnographic respondents are 

private residences, followed by 

private parties and nightclubs. Other

common use settings include inside

cars and raves and concerts, similar to

those reported as sales settings.

Moreover, respondents in the South

and West report more user settings

than those in other regions. Nonmethadone treatment respondents

also report private residences as the

most common setting for methamphetamine use, followed by private

parties, inside cars, and parks and

playgrounds.
CLUB DRUGS

Pulse Check: November 2001 page 75

ECSTASY AND OTHER CLUB DRUGS

The last two issues of Pulse Check

addressed “club drugs” as a special

topic because of reports that these

drugs were increasingly available and

that the number of users increased.

The continuing growth of the club

drug problem, particularly ecstasy, has

warranted the addition of a club

drugs section to the report. 

This broad category of drugs includes

the following:

! Ecstasy (methylenedioxymethamphetamine, or MDMA), a synthetic,

psychoactive substance with 

stimulant and mild hallucinogenic

properties, is the most widely 

available of club drugs and often

used in pill form.

! Gamma hydroxybutyrate (GHB) is

a central nervous system depressant

usually sold as an odorless, colorless liquid in water bottles. GHB

precursors, gamma butyrolactone

(GBL) (a chemical used in many

industrial cleaners) and 1,4 butanediol (1,4 BD), convert into GHB in

the body and have been sold as

nutritional supplements in health

food stores and over the Internet,

often in powder or capsule form.

Because the effects of GHB precursors are similar to those of GHB,

many Pulse Check sources do not

distinguish between GHB and its

precursors.

! Ketamine is a prescription 

anesthetic with hallucinogenic and

dissociative properties and marketed for human use, but primarily for

veterinary use. Ketamine can be

used in liquid or powder form.

! Rohypnol (flunitrazepam) is a 

benzodiazepine, no longer marketed

in the United States but legally 

prescribed in Mexico and other

countries. It has been involved in

numerous drug-assisted rapes, but

its most common abuse pattern is

episodic use by teenagers and

young adults as an “alcohol 

extender” and disinhibitory agent. 

! Nitrous oxide is an inhalant often

referred to as laughing gas.

! Lysergic acid diethylamide (LSD)

(“acid”) is a hallucinogen, most

commonly distributed on blotter

paper and taken orally.

The club or rave experience typically

involves music, dancing, and socializing and usually lasts through the

night. Club drugs are commonly 

combined with one another and with

other illicit drugs or alcohol. As

reported in the last Pulse Check,

treatment sources had less first-hand

knowledge of club drug activity than

the law enforcement, epidemiologic,

and ethnographic sources, indicating

that club drug users have not entered

treatment in large numbers. It is

important to note that the amount of

information received from Pulse

Check sources was much greater for

ecstasy than for other club drugs.

Although these drugs are categorized

as club drugs, the settings and contexts

of their use are expanding to include

venues other than nightclubs and

raves. Moreover, Pulse Check sources

continue to suggest that White nonHispanics are no longer the exclusive

sellers and users of the drugs. An

increasing number of Pulse Check

sources report that ecstasy is being

sold with heroin and powder and

crack cocaine and that ecstasy users

are also using these other illicit drugs.

Just as Pulse Check continues to track

club drug activity due to concern

about increased availability and use,

Federal efforts to combat club 

drugs (ecstasy in particular) include

enacting new Federal sentencing

guidelines for ecstasy (MDMA) and

ecstasy-like substances (including

Exhibit 1. 

Where are club drugs emerging?

GHB*

GHB,

ketamine*

GHB,

Rohypnol,

designer

amphetamines*

Sources: Law enforcement, epidemiologic, ethnographic, and non-methadone treatment

respondents; methadone treatment sources did not provide information on club drugs.

*Additional club drugs reported as emerging

Ecstasy reported as emerging since last reporting period

No club drugs reported as emerging since last reporting period
methylenedioxyamphetamine [MDA]

and paramethoxyamphetamine

[PMA]). The new guidelines, effective

November 1, 2001, will increase the

prison term for the sale of 200 grams

of ecstasy (about 800 pills) from 15

months to 5 years, and the penalty

for sale of 8,000 pills will also rise

from 41 months to 120 months (similar to that of powder cocaine). Pulse

Check will continue to track ecstasy

and club drug activity and, as new

laws are established, will report

changes, if any, in the sale and use of

club drugs. 

ECSTASY AND OTHER CLUB

DRUGS: THE PERCEPTION

How do Pulse Check sources

perceive the ecstasy problem in

their communities? Ecstasy is not

considered the most widely abused

drug by any law enforcement, epidemiologic, ethnographic, or treatment source, but it is considered the

second most widely abused drug by

sources in four cities (Billings,

Honolulu, Memphis, and Miami), an

increase from only one source (the

Memphis law enforcement source)

during the last reporting period.

Additionally, the law enforcement

source in Billings is the only source to

report it as the drug contributing to

the second most serious consequences.

No other source reports ecstasy as

contributing to the most or second

most serious consequences in their

communities, and no other club drugs

were mentioned as such.

What club drugs are emerging in

Pulse Check communities?

(Exhibit 1) Although not currently

considered the drug contributing to

the most serious consequences in any

city, ecstasy is reported as an emerging drug of abuse by 25 Pulse Check

sources in most cities (15 of 21)

across the Nation, with no regional

patterns evident. Other club drugs

mentioned as emerging include GHB

in Denver, Los Angeles, and Honolulu; diverted ketamine in Denver;

and Rohypnol (flunitrazepam) and

designer amphetamines distributed as

samples at raves in Los Angeles. In

only six cities (Billings, Birmingham,

Chicago, El Paso, New Orleans, and

Washington, DC) are club drugs not

reported as emerging this reporting

period. In four of those cities

(Chicago, El Paso, New Orleans, and

Washington, DC), club drugs were

reported as emerging last reporting

period, suggesting that these are now

established drugs of abuse in those

communities. 

ECSTASY AND OTHER CLUB

DRUGS: AVAILABILITY, SLANG,

AND COMBINATIONS

How available are club drugs in

Pulse Check communities?

(Exhibit 2) Nearly identical to reports

in the last Pulse Check, ecstasy 

remains the most available of club

drugs, with more than 90 percent (38

of 42) of law enforcement, epidemiologic, and ethnographic sources

reporting it as widely or somewhat

available. Only three sources deem

ecstasy as not very available: the 

epidemiologic sources in Billings and

New Orleans and the law enforcement source in El Paso. Availability of

club drugs is not based on regional

patterns. 

As reported in the last Pulse Check,

GHB follows ecstasy as the most

available club drug, reported as widely or somewhat available by 40 percent (17 of 42) of respondents. GHB

is described as not available in only

three cities: Denver, El Paso, and

Portland (ME). As reported in the last

Pulse Check, cities where wide availability is reported are predominantly

in the West or South: Billings,

Birmingham, Denver, Los Angeles,

Miami, New Orleans, and (in the

Northeast) New York. 

CLUB DRUGS

page 76 Pulse Check: November 2001

Exhibit 2.

How available are club drugs across the 21 Pulse Check cities?

Sources: Law enforcement, epidemiologic, and ethnographic respondents

70

60

50

40

30

20

10

0

Ecstasy

Widely Available Not Available or Not Very Available

Percent Somewhat Available

GHB Ketamine Rohypnol

No Response

(N=42)
CLUB DRUGS

Pulse Check: November 2001 page 77

Diverted ketamine is considered

somewhat or widely available by 29

percent (12 of 42) of law enforcement, epidemiologic, and ethnographic sources, a lower percentage

than that reported in the last Pulse

Check. It is not available in three

western areas (Billings, Denver, and

Honolulu), El Paso, and Sioux Falls.

Rohypnol remains the least available

of the club drugs, with 19 percent of

law enforcement, epidemiologic, and

ethnographic sources reporting it as

somewhat or widely available. Three

(in Los Angeles, New Orleans, and

New York) report Rohypnol as widely

available, five report it as somewhat

available (in Boston, Detroit, El Paso

by both sources, and Seattle), and the

rest report it as not or not very available. No regional patterns based on 

ketamine or Rohypnol availability 

are apparent.

How has club drug availability

changed? (Exhibit 3) According to

all law enforcement, epidemiologic,

and ethnographic sources who discussed this question (38 of 42), 

ecstasy availability increased or

remained stable between fall 2000

and spring 2001, with 64 percent (27

sources) reporting increases, and 29

percent reporting stable trends. As

with availability trends for other club

drugs, no regional patterns emerged.

GHB availability continues to show

mixed trends, according to 42 law

enforcement, epidemiologic, and

ethnographic sources: 24 percent

report increases (in Birmingham,

Billings, Chicago, Denver, Memphis,

New Orleans, Portland [ME], Sioux

Falls, and Washington, DC, according

to both sources), 12 percent report

declines (in Columbia [SC], Detroit,

Honolulu, Miami, and St. Louis), and

most report availability as stable.

Ketamine availability increased

according to sources in Chicago,

Columbia, New Orleans, New York,

Portland, and Washington, DC;

declined according to sources in

Honolulu and Miami; and remained

stable according to remaining 

respondents. Rohypnol availability

shows mostly stable trends, with few

exceptions: the law enforcement

sources in New Orleans and Portland

report increases, and declines are

reported in Birmingham, El Paso,

Honolulu, and Miami. 

How are club drugs and their

combinations referred to across

the country ? (Exhibit 4) Slang

terms for ecstasy are similar across

the Nation. It continues to be generally referred to as “X,” although “E”

and “roll” are also used. The practice

of taking ecstasy is often referred to

as “rolling.” Ecstasy is often referred

to by its design or the shape of the

pill: for example, it is called “shamrock” in St. Louis because pills may

be clover shaped and “Buddha” in

Memphis because pills may be

stamped with a Buddha design. Other

ecstasy terms vary by locality, and

many terms are new this reporting

period, suggesting increasing ecstasy

availability and use.

GHB continues to be referred to as

“G” and ketamine as “K” or “special

K.” Rohypnol is typically referred to

as “roofies” and “rochas” where

available. Other terms for these drugs

vary by locality, with no particular

regional patterns. Use of particular

combinations of club drugs varies by

city and highlights that multisubstance use or “cafeteria-style use”

remains common among club 

drug users.

ECSTASY: THE DRUG

What form does ecstasy come

in? (Exhibit 5) According to law

enforcement, epidemiologic, and

ethnographic sources, the tablet form

of ecstasy remains, by far, the most

available, followed by powder and

liquid forms. Powder ecstasy is widely

available according to sources in

Boston, Memphis, and Portland

Exhibit 3.

Has club drug availability changed across the 21 Pulse Check cities (fall

2000 vs spring 2001)?

Sources: Law enforcement, epidemiologic, and ethnographic respondents

100

90

80

70

60

50

40

30

20

10

0

Up Stable

Percent

Down No response

Ecstasy GHB Ketamine Rohypnol

(N=42)
CLUB DRUGS

page 78 Pulse Check: November 2001

(ME); it is somewhat available

according to sources in seven other

areas (Baltimore, Birmingham,

Columbia [SC], Los Angeles, Miami,

Philadelphia, and Washington, DC);

and it is not or not widely available

elsewhere. The epidemiologic source

in Sioux Falls regards liquid ecstasy as

somewhat available, and the epidemiologic source in El Paso regards it as

widely available. All other respondents report liquid ecstasy as not very

or not available.

As reported in the last Pulse Check and

according to law enforcement, epidemiologic, and ethnographic sources,

ecstasy tablets are white or colored,

and many are pressed with designs and

logos that change periodically. The

variety of designs or logos on ecstasy

tablets reported has increased dramatically since the last Pulse Check.

Designs on ecstasy tablets common

across the country include “E,” 

“mitsubishi,” “mercedes,” “playboy,”

and cartoon characters. Other designs

differ according to city. In Columbia

(SC), where a variety of stamped

tablets are available, some are home

pressed. According to the law enforcement source in Denver, designs on

ecstasy seized at raves vary widely, 

but designs on ecstasy seized in large

shipments are the same. 

How is street-level ecstasy 

packaged? Overwhelmingly, law

enforcement, epidemiologic, and

ethnographic sources agree that ecstasy tablets are not typically packaged,

but sold as loose (or “naked”) pills.

Additionally, in Denver, El Paso,

Miami, and Portland (ME), pills are

packaged in plastic bags; in Birmingham and Denver, they are packaged

in prescription bottles; in Billings and

Honolulu, they are packaged in 

Exhibit 4. 

How are ecstasy and ecstasy combinations referred to across Pulse Check

cities? 

Drug or drug combination Slang term City

Ecstasy Tabs Memphis, New Orleans, 

and St. Louis

The bean, beans Birmingham, Denver, 

and Miami

Beads, ills, and illy Denver

Candy, shamrock St. Louis

Buddha, eenie greenie, Memphis

Rolanda, and wafers

Dice Columbia

Disco biscuits Birmingham

Sky Portland

Tuna, X-Files Washington, DC

Two ecstasy pills Double stacks Chicago

Thick ecstasy pills Double stacks Memphis

The use of more than one Stacking St. Louis

ecstasy tablet at a time

The use of more than one Piggybacking St. Louis

ecstasy tablet sequentially

Ecstasy (adulterated Speedies Sioux Falls

with amphetamine)

Ecstasy (adulterated Snackies Sioux Falls

with mescaline)

Ecstasy + LSD Candy flipping Chicago, Denver, and 

Philadelphia (new term 

and practice in this city)

Ecstasy + LSD Trolling Miami

Ecstasy +LSD or Flipping Boston

psilocybin mushrooms

Ecstasy + GHB, keta- E sitting, sitting E St. Louis

mine, or nitrous oxide

Ecstasy + ketamine Matrix Chicago

Ecstasy + PCP Pikachu Washington, DC

(combined in a pill) (also the logo on the pill) 

Ecstasy + psilocybin Hippie flipping Chicago

mushrooms

Ecstasy + Xanax® Zanybar Miami

(alprazolam)

Ecstasy + Viagra® Hammerheading Miami

(sildenafil citrate) X's and O's

GHB Liquid X, liquid E Boston, Chicago, Denver

Funk, holy water Denver

Gamma New Orleans

G juice St. Louis

Scoop Birmingham

Water Sioux Falls

Ketamine Cat Columbia, Memphis, 

Washington, DC 

Cat food, kitty, vitamin K Denver

In the K-hole (use of ketamine) Boston

Thunder Columbia

Sources: Law enforcement, epidemiologic, ethnographic, and treatment provider respondents

Note: A term in bold face indicates that it is reported as new to the respondent's community since

the last reporting period.
CLUB DRUGS

Pulse Check: November 2001 page 79

plastic coin bags; in New Orleans,

they are packaged in plastic logoemblazoned coin bags, similar to

powder cocaine packaging; in St.

Louis, they are packaged in cigarette

boxes; in Philadelphia, they are

strung on necklaces; and in Seattle,

they may be concealed in the ends of

glow necklaces. 

What are street-level ecstasy

prices across the country?

(Exhibit 6) The most commonly

reported unit of ecstasy sold is one

tablet (approximately 100–150 milligrams according to the Miami law

enforcement source and 150–250

milligrams according to the Seattle

law enforcement source), selling at

$12.50–$38 in the Northeast,

$20–$30 in the Midwest, $18–$50 in

the South, and $20–$45 in the West.

Between fall 2000 and spring 2001,

according to law enforcement, 

epidemiologic, and ethnographic

sources, prices remained stable, with

one exception: according to the law

enforcement source in Chicago,

prices increased. Other units of ecstasy sold in Pulse Check cities include

small tablets (50–150 milligrams) for

$10–$20 apiece in Seattle, one jar of

100 pills for $3,000 in Sioux Falls,

and wholesale units at $6–$18 in

New York and $7–$8 in Miami. 

What adulterants are added to

ecstasy? (Exhibit 7) Similar to 

the last reporting period, law 

enforcement, epidemiologic, and

ethnographic sources report that

ecstasy may be adulterated with 

other stimulants or may contain no

MDMA. Additionally, according to

the epidemiologic source in New

York, powder cocaine has been sold

as powder ecstasy.

Exhibit 5.

How are ecstasy pills labeled in reporting Pulse Check cities?

City Label

Boston, MA Mercedes, mitsubishi, and playboy

Philadelphia, PA Michelin and mitsubishi

Portland, ME E, various numbers

Columbia, SC Diamonds, elephants, mickey mouse, and mercedes

El Paso, TX E

Memphis, TN Arrowheads, cartoon characters, flintstone characters, ladybugs, mercedes, teletubbie characters, and VW beetle 

Miami, FL Cartoon characters

New Orleans, LA Mitsubishi, rolex

Washington, DC E, animals, pikachu (contains PCP)

Chicago, IL Ferrari

Detroit, MI Butterflies, fish, and mitsubishi

St. Louis, MO Clovers, mitsubishi, playboy, and statue of liberty

Sioux Falls, SD Mitsubishi, nike, suns

Denver, CO Cartoon characters, clovers, and stars

Honolulu, HI Happy faces, suns, pooh bear, mickey mouse

Sources: Law enforcement, epidemiologic, and ethnographic respondents

Note: A logo in bold face indicates that it is reported as new to the respondent's community since

last reporting period.

Exhibit 6.

How much does a pill (one dose)

of ecstasy cost in 17 Pulse Check

cities?*

City Price

Boston, MA $20–$35 

New York, NY $12.50–$38 

Philadelphia, PA $20–$35 

Portland, ME $25

Birmingham, AL $20–$35

Columbia, SC $20–$35

Memphis, TN $20–$35

Miami, FL $20–$50

New Orleans, LA $25–$35 

Washington, DC $18–$30

Chicago, IL $20–$30 

Detroit, MI $25–$30 

Sioux Falls, SD $30

Denver, CO $20–$25

Honolulu, HI $25–$45

Los Angeles, CA $20–$30

Seattle, WA $20–$30 

Sources: Law enforcement, epidemiologic,

and ethnographic respondents

*Law enforcement, epidemiologic, and 

ethnographic respondents in Baltimore,

Billings, El Paso, and St. Louis did not 

provide this information. Northeast South Midwest West

Northeast South Midwest West

Exhibit 7.

What other substances might be

contained in ecstasy tablets?

City Adulterant 

Boston, MA Amphetamines, ketamine, 

LSD, paramethoxyamphetamine (PMA), PCP 

Denver, CO Cocaine, heroin, 

strychnine 

Memphis, TN Depressants, heroin, 

methamphetamine

Miami, FL PMA 

Philadelphia, PMA

PA

St. Louis, PCP (sold as ecstasy and 

MO referred to as “space”) 

Sioux Falls, Amphetamine, mescaline

SD 

Washington, Methamphetamine, PCP

DC (tablets with pikachu 

designs) 

Sources: Law enforcement, epidemiologic,

and ethnographic respondents

Note: An adulterant in bold face indicates 

that it is reported as new to the respondent’s

community since the last reporting period.
CLUB DRUGS

page 80 Pulse Check: November 2001

ECSTASY: SALES

Who sells ecstasy? Young adults

are the predominant street-level 

ecstasy sellers, according to most (20

of 29) law enforcement, epidemiologic, and ethnographic respondents.

Five sources (in Birmingham, Denver,

New Orleans, St. Louis, and Sioux

Falls) report ecstasy sellers as evenly

split between young adults and 

adolescents, and four (in Baltimore,

Boston, Memphis, and Seattle) report

sellers as primarily adolescents. A

summary of ecstasy drug market 

characteristics appears in exhibit 11

at the end of this section.

Street-level ecstasy sellers tend to be

independent, according to most (19

of 30) law enforcement, epidemiologic and ethnographic respondents.

Five respondents report ecstasy as

organized, and five claim that ecstasy

sellers are evenly split between being

independent and organized, with

organized sellers more involved in

raves and nightclub sales than

independent sellers. For example, 

in Denver and Portland (ME), 

“house dealers” at raves may be in

charge of ecstasy sales, with their

“runners” distributing drugs to individual buyers; in Miami, organized

sellers in clubs tend to be connected

with drug trafficking; and in Los

Angeles, sellers tend to be affiliated

with organized crime. In Columbia

(SC) and Denver, independent sellers

are college students or those who

have access to the college scene. 

Pulse Check sources discuss the

wide range of MDMA purity in

ecstasy tablets:

! Boston, MA: According to the law

enforcement source, a lot of phony

ecstasy is available, and local manufacturers simply use pill molds to make

them. The epidemiologic source

agrees and states that ecstasy purity

fluctuates wildly, though it may be

more consistent for buyers who find

regular dealers.

! Los Angeles, CA: Ecstasy pills 

containing adulterants, referred to as

“bunk pills,” are common, but the 

epidemiologic source reports that they

are no longer seeing pills containing

paramethoxyamphetamine (PMA).

! St. Louis: According to the epidemiologic source, ecstasy tablet dosage

varies greatly due to inconsistent 

production methods.

! Washington, DC: It is becoming 

harder to obtain pure MDMA tablets,

according to the epidemiologic source.

Then and Now:

How have street-level ecstasy sales changed between fall 2000 and

spring 2001?

Ecstasy seller 

populations are

expanding:

New seller groups

include various

ethnicities in the

Northeast and

Blacks in the

South in five

Pulse Check

cities:

Ecstasy sales 

settings have 

also expanded in

cities across the

country:

➤ Los Angeles, CA: The law enforcement source states that the 

number of independent ecstasy sellers has increased. 

➤ Memphis, TN: According to the law enforcement source, ecstasy

sellers are expanding to include more high school students.

➤ St. Louis, MO: According to the epidemiologic source, more 

adolescents are becoming involved with ecstasy sales, and now

about equal numbers of adolescents and young adults sell the drug.

➤ Birmingham, AL

➤ Columbia, SC

➤ Memphis, TN

➤ New York, NY

➤ Philadelphia, PA

➤ Birmingham, AL: The law enforcement source reports that bars

and nightclubs are now catering to underage youth. Bars typically

have a “rave night” once a week, where no alcohol is sold, but

where customers are selling marijuana and ecstasy.

➤ Portland, ME: Law enforcement sources report an increase in the

number of local raves.

➤ St. Louis, MO: Ecstasy is now more prevalent in high schools and

is expanding from raves to schools and from central city areas to

suburbs, according to the epidemiologic source.

➤ Washington, DC: According to the law enforcement source, 

ecstasy is increasingly sold on the street.
CLUB DRUGS

Pulse Check: November 2001 page 81

Are ecstasy sellers involved in

other crimes? Most law enforcement respondents (13 of 19) report

that street-level ecstasy sellers are not

typically involved in other crimes.

Reports of “somewhat” or “very likely” involved in other crimes are given

by six respondents (in Baltimore,

Detroit, Portland (ME), Memphis,

Miami, and New Orleans). Furthermore, ecstasy dealers are not typically

involved in violence, according to 16

of 17 respondents. Only the Baltimore source associates violent crimes

with ecstasy sellers. Other crimes

associated with ecstasy sellers include

drug-assisted rape in Baltimore,

Denver, Los Angeles, and Memphis;

domestic violence in Baltimore, 

gang-related activity in Honolulu;

and prostitution (users prostituting

for the drug) in Birmingham.

Epidemiologic and ethnographic

respondents report that ecstasy dealers are less involved in other crimes

than do the law enforcement sources.

Most (seven of eight) epidemiologic/

ethnographic respondents report

those selling ecstasy are “not at all”

or “not very likely” to be involved in

other crimes. Similar to the Baltimore

law enforcement response, according

to the epidemiologic source, ecstasy

sellers are somewhat likely to be

involved in other crimes in that city.

Other crimes reported by epidemiologic and ethnographic sources are

typically nonviolent crimes, although

ecstasy sellers are reported to be

involved in prostitution and violent

crimes in Baltimore and gang-related

crimes in Memphis. 

Do ecstasy sellers use their own

drug? Similar to information in the

last Pulse Check, nearly all (25 of 27)

law enforcement, epidemiologic, and

ethnographic respondents believe that

ecstasy sellers are somewhat or very

likely to use the drug. Only in

Baltimore (by the epidemiologic

source) and Miami (by the law enforcement source) are ecstasy 

sellers reported as not very likely 

to use the drug. 

Where is street-level ecstasy

sold? (Exhibit 8) According to 20

law enforcement respondents, ecstasy

sales take place in a wide variety of

areas, mostly central cities and 

Sources: Law enforcement, epidemiologic, and ethnographic respondents

*For sales settings law enforcement, epidemiologic, and ethnographic sources responded, except for the following: the law enforcement source in El Paso

and Seattle and the epidemiologic source in Billings, Columbia (SC), El Paso, Los Angeles, Honolulu, New Orleans, Philadelphia, Portland (ME), Sioux

Falls, and Seattle. For users settings, epidemiologic and ethnographic sources responded, except for the sources in Billings, Boston, and St. Louis. 

Exhibit 8. Where is ecstasy sold and used across the 21 Pulse Check cities?*

Raves/ Night- College Private Shop- The Play- Total

Con- clubs/ Cam- Residen- Private Inside Around ping Inter- Public grounds/ #

City Streets certs bars puses ces Parties Cars Schools Malls net Housing Parks Settings

Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Sell Use Sell Use Sell Use

Boston, MA # ### # 5 NR

New York, NY # # # ## # # # # ## # # # # 9 6

Philadelphia, PA # # ## # 3 2

Portland, ME # ## #### 4 3

Baltimore, MD # # # ## # # # ## # # # 9 4

Birmingham, AL # # ## # # # # # 6 3

Columbia, SC # # ## # ## 4 3

El Paso, TX ## # # # # # # NR 7

Memphis, TN # # # ## # # # # ## # # # # # 10 6

Miami, FL # # # ## # # # # # # # # 10 3

New Orleans, LA # ### # # # # # # # # # 12 1

Washington, DC # # # ## # # # # # # # 8 4

Chicago, IL # # ## # # # # ## 5 5

Detroit, MI # ## # # #### # # 8 3

St. Louis, MO ## # # # # # # 8 NR

Sioux Falls, SD ### # ## # # 5 3

Billings, MT ## ## # ## ## 9 NR

Denver, CO ### # ## # # # # ## # # # # # 8 9

Honolulu, HI # # # ## # # # # # # # # # 11 2

Los Angeles, CA # ## # # # # 3 5

Seattle, WA # ## # NR 4

West South Northeast Midwest
CLUB DRUGS

page 82 Pulse Check: November 2001

suburbs. Law enforcement sources in

six cities (Columbia [SC], Denver,

New York, Philadelphia, Portland

[ME], and Washington, DC) report

ecstasy sales in all areas of the cities.

Similarly, according to epidemiologic

and ethnographic respondents, the

locations of ecstasy sales vary widely,

occurring mostly in central city and

suburban areas.

Raves and concerts, nightclubs and

bars, college campuses, private residences, private parties, and inside

cars remain the primary settings for

ecstasy sales as reported by law

enforcement, epidemiologic, and

ethnographic sources. Reinforcing the

widespread availability of ecstasy,

common sales settings also include

schools, streets, shopping malls, and

the Internet. Less common settings

include public housing developments

in Miami, New Orleans, and Sioux

Falls; playgrounds or parks in New

Orleans and Honolulu; hotels and

motels in Columbia (SC); and many

types of social gatherings, regardless

of setting, in Baltimore. 

How is street-level ecstasy sold?

Ecstasy sales typically involve handto-hand sales through acquaintance

networks, according to most (24 of

29) law enforcement, epidemiologic,

and ethnographic respondents.

Additionally, beepers or cell phones

are used in 10 cities (Baltimore,

Billings, Chicago, Detroit, Honolulu,

Memphis, Miami, New Orleans, St.

Louis, and Washington, DC).

According to law enforcement

respondents, the drug is distributed

by delivery-type services in five cities

(Baltimore, Birmingham, Memphis,

New Orleans, and St. Louis), and it is

sold via the Internet in four cities

(Detroit, Honolulu, Memphis, and

New Orleans). Conversely, epidemiologic and ethnographic respondents

do not report the use of delivery-type

services or the Internet for ecstasy

sales. According to the Memphis law

enforcement source, ecstasy transactions are conducted via introductions;

that is, sellers are introduced to

potential buyers by a liaison or 

mutual acquaintance who can vouch

for the seller.

What other drugs do ecstasy

dealers sell? According to most (12

of 18) law enforcement respondents,

ecstasy sellers also tend to sell other

drugs. By contrast, according to most

(6 of 8) epidemiologic and ethnographic respondents, ecstasy sellers

do not typically sell other drugs.

Other drugs sold by ecstasy dealers,

Ecstasy sales and user settings: A

closer look

The numbers of different ecstasy sales

settings and user settings mentioned

tend to be larger in the southern and

western cities, possibly indicating wider

availability and use in those regions. 

Ecstasy sales settings tend to overlap

with user settings in most cities, but 

typically more settings are mentioned

for sales than for use. 

Then and Now:

What other drugs are sold or used with club drugs (fall 2000 vs spring 2001)?

Perhaps the most disturbing changes in ecstasy and club drugs activity since the last

reporting period are reports in several cities that they are sold and sometimes used with

other drugs of abuse, such as heroin and cocaine:

Los Angeles:

Memphis, TN:

Miami, FL: 

New York, NY:

Portland, ME: 

Washington, DC: 

➤ Club drugs are becoming the entry point for use of other drugs,

such as marijuana, as noted by the epidemiologist. Many “rave

kids” in that city start using GHB as part of the “water bottle syndrome,” and then move to ecstasy use, followed by marijuana use.

➤ The epidemiologic source warns that ecstasy sellers are beginning

to sell heroin and powder and crack cocaine. The sale of other

illegal drugs by ecstasy dealers may be related to the increasing

numbers of young ecstasy users using other drugs of abuse.

➤ According to the law enforcement source, ecstasy sellers tend to

deal in many drugs, including heroin, powder and crack cocaine,

and marijuana. As reported in the last Pulse Check, the law

enforcement source states that heroin and ecstasy sold and used

in combination at raves may be a ploy to attract new heroin users.

The doses of heroin used in combination with ecstasy are small

enough to have little effect; therefore, the user may perceive

heroin as harmless. 

➤ Ecstasy is sold with other illicit drugs now because selling ecstasy

can be extremely lucrative, according to the law enforcement

source. Moreover, polydrug sales involving ecstasy are the 

norm, and ecstasy is actually becoming a currency of trade for

other drugs.

➤ The law enforcement source reports an increase in polydrug sales

involving ecstasy.

➤ Crack cocaine dealers on the street, according to the law 

enforcement source, are increasingly selling ecstasy.
CLUB DRUGS

Pulse Check: November 2001 page 83

according to law enforcement, 

epidemiologic, and ethnographic

sources, include other club drugs

(especially GHB, ketamine, and LSD),

heroin, powder and crack cocaine,

marijuana, methamphetamine (where

it is available), and other diverted

prescription drugs. The Philadelphia

law enforcement sources states that

LSD is often sold as an ecstasy 

substitute. 

ECSTASY: THE USERS

How has the number of novice

ecstasy users in treatment

changed? (Exhibit 9) According to

most (9 of 15) non-methadone treatment respondents, the number of

novice ecstasy users in treatment

(defined as any drug treatment client

who has recently begun using ecstasy)

has increased since the last reporting

period, with the remaining respondents reporting stable trends. Only

one methadone treatment source (in

Boston) responded to the question,

reporting an increasing number of

novice ecstasy users in treatment.

Who uses ecstasy? Similar to

information in the last Pulse Check,

ecstasy users tend to be young (13–30

years), evenly split between genders,

White, and of middle to high SES,

according to epidemiologic, ethnographic, and non-methadone treatment sources. In general, methadone

treatment sources did not provide

information about club drug users.

Of 17 epidemiologic and ethnographic respondents, most (15) report

that ecstasy users are predominantly

White, and of these, most (13) report

that Whites are overrepresented compared with the general population in

their cities. Only in Baltimore are

Blacks the predominant ecstasy users,

but they are underrepresented 

compared with the general population in that city. In El Paso, Hispanics

are the predominant ecstasy users, at 

proportions about equal to that of the

general population. Most ecstasy

users range from middle to high SES,

according to 18 epidemiologic 

and ethnographic sources, with 2

exceptions: in Baltimore, predominant

users are of low SES, and in Portland

(ME), ecstasy users are distributed

somewhat evenly among all SES categories. A summary of ecstasy users and

use characteristics appears in Exhibit

12 at the end of this section.

Then and Now: 

How has ecstasy use changed (fall 2000 vs spring 2001)?

Parallel to the expansion of ecstasy sales and seller populations, ecstasy use is expanding

to new users groups and new settings in some Pulse Check areas:

Adolescent ecstasy

users are increasing

in number, according to epidemiologic

and ethnographic

sources in seven

sites across the

country:

Ecstasy use is

expanding to nonWhite and Hispanic

populations: 

Ecstasy use is

expanding to new

settings and 

contexts in several

sites: 

➤ Columbia, SC

➤ Los Angeles, CA

➤ Memphis, TN

➤ Miami, FL

➤ St. Louis, MO

➤ Sioux Falls, SD

➤ Washington, DC

➤ Los Angeles, CA

➤ Honolulu, HI 

➤ Memphis, TN

➤ Miami, FL

➤ Boston, MA: Settings for new ecstasy users include streets, public housing developments, and cars, according to the

methadone treatment source. 

➤ Denver, CO: According to the non-methadone treatment

source, new ecstasy user settings include supermarkets and

nightclubs. 

➤ Miami, FL: Ecstasy use is moving from a specific event or place

to more common daily use, and some users are beginning to use

the drug alone and in private, according to the epidemiologic

source. Additionally, private residences, around schools, and

private parties were added to the list of user settings.

Furthermore, according to the law enforcement source, as

ecstasy activity has skyrocketed, the popularity of ecstasy use 

at raves has shifted to private parties.

➤ St. Louis, MO: The epidemiologic source states that, in the

past, ecstasy use was confined to raves and dance clubs in the

central city, but use has moved into the suburbs and into new

settings, paralleling increases in adolescent use.

➤ Sioux Falls, SD: According to the epidemiologic source, more

indoor raves are taking place in the area, with increasing 

advertising and promoting.
CLUB DRUGS

page 84 Pulse Check: November 2001

Non-methadone treatment provider

respondents (12) agree with epidemiologic and ethnographic sources and

report that ecstasy users in treatment

tend to be adolescents and young

adults, with the Honolulu source

reporting the emerging group of

ecstasy users in treatment as mostly

preadolescents. Also similar to

reports by epidemiologic sources,

most (8 of 13) treatment respondents

state that ecstasy users in treatment

are split evenly between genders, and

most (8 of 13) report ecstasy users in

treatment as predominantly Whites

and overrepresented or about 

proportionate to the general 

population. Although most treatment respondents (9 of 12)

state that ecstasy users in

treatment are predominantly of

middle SES, two (in Memphis

and Billings) report them as predominantly of low SES, and the 

Los Angeles source reports them 

as of both low and middle SES.

Additionally, in three cities (Boston,

New Orleans, and Seattle), emerging

ecstasy users in treatment are predominantly of low SES.

Where do ecstasy users tend to

reside? According to 18 epidemiologic and ethnographic respondents,

locations of ecstasy users’ residences

differ by region. For example, in the

Northeast, ecstasy users reside predominantly in central cities (except in

Philadelphia, where they reside in

both the central city and suburbs); in

the West, they reside predominantly

in central cities and suburbs; in the

South, they reside in central cities,

rural areas, and suburbs; and in the

Midwest, they reside predominantly

in suburbs (except in Chicago, where

they reside in both the central city

and suburbs). 

Where and in what contexts do

ecstasy users tend to use the

drug? (Exhibit 8) Similar to settings

for ecstasy sales, settings for ecstasy

use, in descending order of the most

frequently mentioned by law enforcement, epidemiologic, and ethnographic respondents, include raves,

nightclubs, private parties, private

residences, and college campuses.

Since the last reporting period, several new user settings have been added

to the list, including playgrounds and

parks, public housing developments,

shopping malls, streets, inside cars,

and around schools. Ecstasy use

occurs predominantly indoors, according to epidemiologic and ethnographic

sources. All 18 respondents report that

ecstasy is predominantly used in

groups or among friends, but in

Miami, ecstasy users are beginning 

to use the drug alone and in private. 

How is ecstasy used and what

other drugs do ecstasy users

take? Predominant route of administration among ecstasy users remains

oral, according to epidemiologic,

ethnographic, and non-methadone

treatment respondents. Additionally,

in Miami and St. Louis, some users

are beginning to snort or inject the

drug; in New Orleans, it is mixed in

beverages; and in Birming-ham

and Washington, DC, it is dissolved in hot beverages. 

Ecstasy continues to be used

in combination with other

drugs, including other club drugs

(such as LSD, psilocybin mushrooms, GHB, ketamine, and nitrous

oxide) across the country; marijuana

in the South, West, and Philadelphia;

methamphetamine in the West, Memphis, Washington, DC, and Chicago

(where the practice is rare); heroin in

Memphis, Miami, and St. Louis; powder cocaine in Memphis and Seattle;

and diverted prescription depressants

in Miami. “Candy flipping,” the use of

ecstasy and LSD, was mentioned in

several areas: Chicago, Denver, 

Hono-lulu, Memphis, Miami,

Philadelphia, and Washington, DC. 

In Los Angeles and Miami, Viagra®

(sildenafil citrate) is used with ecstasy.

Exhibit 4 lists slang terms for club

drug combinations. 

According to non-methadone treatment respondents, the most common

club drug combination is ecstasy and

marijuana. Emerging combinations

include ecstasy and diverted OxyContin® (a time-release, high-dosage

Exhibit 9. 

Has the number of novice ecstasy

users in treatment changed (fall

2000 vs spring 2001)?* 

Sources: Non-methadone treatment 

respondents 

*Sources in Baltimore, Birmingham, 

Chicago, Detroit, Los Angeles, New Orleans,

and Washington, DC, did not provide this

information; Billings has two non-methadone

treatment respondents.

Billings, MT

Boston, MA

Columbia, SC

Denver, CO

Honolulu, HI

Memphis, TN

Portland, ME

Seattle, WA

Sioux Falls, SD

Miami, FL

New York, NY

Philadelphia, PA

Sioux Falls, SD

St. Louis, MO
CLUB DRUGS

Pulse Check: November 2001 page 85

formulation of oxycodone) in Boston;

ecstasy and LSD in Columbia (SC);

and ecstasy and high-purity methamphetamine (“ice”) or cocaine in

Honolulu.

OTHER CLUB DRUGS: THE DRUGS

What are the common forms of

GHB, ketamine, and Rohypnol,

and how are they packaged? The

most common form of GHB available

is liquid, typically clear, as reported

by law enforcement, epidemiologic,

and ethnographic respondents.

Additionally, a powder form of the

drug is somewhat available in New

Orleans and Los Angeles. GHB as a

liquid is packaged in a variety of ways

depending upon locality. Common

packaging includes plastic bottles

(typically water, sports drink, or soda

bottles) in Birmingham, Chicago,

Columbia (SC), Detroit, Los Angeles,

Memphis, Miami, New Orleans, and

St. Louis; eyedropper bottles in

Chicago, Los Angeles, and Miami;

and vials (glass or plastic) in Billings,

Boston, Miami, Philadelphia, St.

Louis, and Washington, DC. GBL and

1,4 BD (GHB precursors) are available in some areas, including Boston,

Los Angeles, Miami, New Orleans,

and Sioux Falls. Many respondents

do not distinguish between GHB and

its precursors.

Diverted ketamine is available predominantly in liquid and powder

forms, according to responding law

enforcement, epidemiologic, and

ethnographic sources. It is typically

bought and sold as a liquid and taken

orally or converted into powder for

snorting. Additionally, the liquid form

is injected in Boston, Detroit, and

Washington, DC; the drug is available

in pill form in Los Angeles and New

York; and the liquid form is poured in

drinks in Boston. Ketamine is illegally

sold primarily by the plastic bag as a

powder or by the vial as a liquid.

Furthermore, according to the

Columbia (SC) law enforcement

source, sellers transfer ketamine from

prescription vials into plain vials to

avoid connection with the pharmacy or

veterinary office from which it was

stolen. The Memphis law enforcement

source states that ketamine powder is

sold in foil or in folded paper, and the

New Orleans law enforcement source

reports that liquid ketamine is sold in

plastic soda or sports drink bottles.

Ketamine is sold in powder form if it is

used in clubs and raves in Washington,

DC, and in liquid form if it is to be

delivered outside of the District,

according to the law enforcement

source. 

Rohypnol is available in pill form,

according to respondents in all areas

where it is available, and is sold as

loose pills, except in New Orleans

(according to the law enforcement

source), where it is packaged in plastic

bowls or small plastic bags. 

How much are GHB, ketamine,

and Rohypnol across the country? (Exhibit 10) Where 

available, GHB sells primarily as a

liquid by the dose, with a dose usually comprising bottle capfuls or drops.

One dose (a “shot” or “swig”) costs

$5–$20 in Pulse Check cities.

Additionally, in Birmingham, dealers

are putting GHB in water guns, and

users are paying for it by the squirt.

In Miami, candy, typically lollipops, 

is dipped in GHB and sold. In 

In several Pulse Check cities

Viagra® has recently been reported as sold or used with ecstasy.

! Honolulu: Viagra® (sildenafil citrate)

is sold with ecstasy or GHB at raves.

! Miami: Viagra® used in combination

with ecstasy is referred to as “X’s and

O’s” or “hammerheading.” 

! Los Angeles: Viagra® is often used

with ecstasy. 

Ecstasy users in treatment: A 

closer look

The most common treatment referral

sources for ecstasy users in treatment,

according to 13 non-methadone treatment respondents, are health care

providers (in Billings, Columbia [SC],

Denver, and Miami), court or criminal

justice referrals (in Denver, Miami, St.

Louis, and Sioux Falls), and secondary

school referrals (in Denver, Los Angeles,

and St. Louis). The non-methadone

treatment source in St. Louis comments

that most ecstasy users in treatment who

were referred by schools were sent to

treatment because they were caught with

marijuana on school property. Similarly,

according to the Boston methadone

treatment source, another drug besides

ecstasy, typically abuse of diverted OxyContin®, tends to be the primary reason

an ecstasy user is in treatment. According to the non-methadone source in

Columbia, ecstasy users in treatment initially claim to be addicted to drugs other

than ecstasy, but clients often later reveal

that ecstasy tends to be their primary

drug of use. 

Six of 10 non-methadone treatment

respondents (in Denver, Honolulu,

Memphis, Portland [ME], St. Louis, and

Sioux Falls) report that ecstasy clients

typically use the drug one to two times

per week, three respondents (in Los

Angeles, Miami, and Sioux Falls) report

that ecstasy clients use one to two times

per month, and the source in Columbia

(SC) reports that they use three to four

times per week. In Honolulu, the frequency of ecstasy use among adolescent

clients has increased since the last

reporting period.
CLUB DRUGS

page 86 Pulse Check: November 2001

Columbia (SC), a product containing

GHB (liquid Verve®) was given away

as a promotional item in a nutritional

supplement store. In Miami, a 32

ounce bottle of GBL or 1,4 BD sells

for $40–$70. Reported prices for

GHB have remained stable since the

last reporting period, except in Los

Angeles, where they have dropped

due to increased availability. 

The prices for diverted ketamine vary

based on the form of the drug and

unit available. Prices have remained

stable since the last reporting period,

with two exceptions: increases due to

decreasing availability are reported in

Los Angeles and Portland (ME).

Rohypnol prices are reported in only

five cities (Chicago, El Paso, Los

Angeles, Memphis, and New Orleans)

and range widely (from $1 to $25),

but have not changed since the last

reporting period. 

OTHER CLUB DRUGS: THE SALES

Who sells other club drugs, and

how and where are they sold?

(Exhibit 11) According to most law

enforcement, epidemiologic, and

ethnographic respondents, GHB, 

ketamine, and Rohypnol sellers and

sales characteristics are similar to

those of ecstasy, with a few differences, as shown in Exhibit 11. 

OTHER CLUB DRUGS: THE USERS

Who uses GHB, ketamine, and

Rohypnol and where are the

drugs used? (Exhibit 12) Regardless

of the specific drug and similar to

seller characteristics, club drug user

characteristics are similar, with a few

key differences noted in Exhibit 12. 

Exhibit 10.

How much do GHB, diverted ketamine, and Rohypnol cost?

Most Common

City Unit Sold Price

GHB

Birmingham, AL 1 ounce $60

Boston, MA Capful $5

Chicago, IL Capful $15–$20

Denver, CO Capful $5–$10

New York, NY 1 gram $30

Los Angeles, CA Capful (one shot) $5–$20

Memphis, TN Capful $20

Miami, FL One swig or hit $5–$10

New Orleans, LA Capful $15–$20

Philadelphia, PA One vial (one dose) $10–$20

Washington, DC Thimbleful $10

Ketamine

Boston, MA 1-ounce bottle of liquid $50

Chicago, IL One bag of powder $10–$20

Columbia, SC 1⁄2-ounce liquid vial $125

Denver, CO One dose $25

Detroit, MI 100 milligrams of liquid NR

Los Angeles, CA One pill NR

0.2 grams of powder $20

Memphis, TN 0.1 gram of powder $10

Miami, FL One vial $40

New Orleans, LA 0.35-gram bag of powder $15–$20

New York, NY One pill $40–$50

Philadelphia, PA One liquid vial $10–$20

Portland, ME 0.3-gram bag $40

Washington, DC 1/8 gram of powder $20 

150-milligram bag $25

Rohypnol

Chicago, IL One pill $5

El Paso, TX One pill $1–$5

Los Angeles, CA One pill $6–$10

Memphis, TN One pill $5–$10

New Orleans, LA One pill $15–$25

Sources: Law enforcement, epidemiologic, and ethnographic sources
CLUB DRUGS

Pulse Check: November 2001 page 87

With what other drugs are GHB,

ketamine, and Rohypnol used?

Club drug combinations include GHB

with alcohol across the country; with

ecstasy in Chicago, Los Angeles,

Miami, and Seattle; with marijuana 

in Birmingham and Miami; and with

ketamine in Denver. Ketamine is

combined with ecstasy in Chicago,

Miami, and Washington, DC; with

marijuana in Detroit and Miami; with

LSD in Chicago; and with methamphetamine in Birmingham. Rohypnol

is combined with marijuana in

Birmingham and Miami, LSD and

ecstasy in Miami, heroin and powder

cocaine in El Paso, where the speedball effect (in this case, Rohypnol, a

depressant, and cocaine, a stimulant)

is reported to “soften the fall when

users are coming down from the high.” 

Then and now:

How have GHB, ketamine, and Rohypnol sales and users changed (fall 2000 vs spring 2001)?

Changes among GHB 

and Rohypnol sellers are

reported by law enforcement sources in a few 

Pulse Check cities:

GHB use has expanded to

new user groups in several

Pulse Check sites, according to epidemiologic and

ethnographic sources:

Ketamine and Rohypnol

use and user characteristics

have changed in several

Pulse Check cities, according to epidemiologic and

ethnographic sources: 

➤ Birmingham, AL, and New Orleans, LA: More races and ethnicities are involved in selling GHB. 

➤ Los Angeles, CA: The number of independent GHB and Rohypnol sellers increased.

➤ Washington, DC: GHB has recently been seized with methamphetamine, suggesting that they may be

produced at the same clandestine labs.

➤ Los Angeles, CA, and Memphis, TN: Adolescent users increased.

➤ Sioux Falls, SD: A group of high school boys has emerged as users.

➤ Los Angeles, CA: An emerging group of high SES users is reported. 

➤ Miami, FL: Emerging groups include Blacks and central city dwellers. Emerging groups tend to be evenly split between the genders. 

➤ New Orleans, LA: Homosexual males are now the primary GHB users.

➤ Boston, MA: Although ketamine is used predominantly at private residences, the emerging group of

users tends to use the drug in nightclubs and bars. 

➤ Miami, FL: Adolescents are an emerging ketamine user group.

➤ Washington, DC: Young adults are the most likely age group to use ketamine, but adolescents are a

growing user population. The drug is usually snorted, but injecting has increased.

➤ Birmingham, AL, and Memphis, TN: Rohypnol use declined.

➤ Los Angeles: Rohypnol use increased. 

➤ Sioux Falls, SD: Adolescents are an emerging Rohypnol user group.
CLUB DRUGS

page 88 Pulse Check: November 2001

Exhibit 11.

What are the predominant characteristics of club drug sellers?

Variable Ecstasy GHB Ketamine Rohypnol

Age 18–30 years 13–30 years 13–30 years 13–30 years

Organization Independent Independent NR NR

Sales method Hand-to-hand through acquaintance networks NR NR

Likeliness to be Not likely Not likely, with the Not likely, with the Somewhat likely especially

involved with other exception of drug- exception of vet- especially drug-assisted rape

crimes or violence assisted rape erinary clinic thefts and nonviolent crimes

to obtain the drug

Likeliness to use Somewhat or very likely Somewhat likely Somewhat or Not very likely

the drug very likely

Indoors or outdoors Indoors and outdoors Indoors Indoors Indoors

Most common settings Raves/concerts, nightclubs, college campuses, and Private parties Raves

private residences and parties, but vary widely and nightclubs

Likeliness to be sold Somewhat likely, especially Somewhat likely, espe- NR NR

with other drugs with other club drugs cially with other club

and some major drugs drugs and marijuana 

Other NR Precursors sold at health NR NR

food and vitamin stores 

or gyms

Sources: Law enforcement, epidemiologic, and ethnographic respondents

Sources: Law enforcement, epidemiologic, and ethnographic respondents

Exhibit 12.

What are the predominant characteristics of club drug users?

Variable Ecstasy GHB Ketamine Rohypnol

Age 13–30 years 13–30 years 13–30 years 13–30 years

Gender Evenly split Male Male Male

Race/ethnicity Whites and over- Whites and over- Whites and over- Whites and overrepresented represented represented represented

SES Middle to high Middle Middle Middle

Indoors or outdoors Indoors Indoors Indoors Indoors

Context In groups/among friends In groups/among friends In groups/among friends

Most common settings Raves/concerts, nightclubs, and private residences and parties, but vary widely

Likeliness to be Very likely, especially with other Likely, especially with 

combined with club drugs, heroin, powder and Likely, especially with ecstasy marijuana

other dugs crack cocaine, and marijuana

Other characteristic Students NR NR Around the Mexican border,

users tend to be Hispanic

and overrepresented
SPECIAL TOPIC: SYNTHETIC OPIOIDS

Pulse Check: November 2001 page 89

SPECIAL TOPIC: SYNTHETIC 

OPIOIDS

This Pulse Check’s special topic discusses the illegal diversion and abuse

of synthetic opioids. The topic was

selected after several respondents providing information for the last Pulse

Check issue expressed concern about

the diversion and abuse of synthetic

opiates, with several specifically citing

OxyContin®. The category synthetic

opioids was used for the current special topic as it includes a wide range

of prescription pain medication, and

ONDCP was interested in learning to

what extent such medications were

being diverted and abused. However,

while respondents were asked about

the diversion and abuse of synthetic

opiods in general for this Pulse

Check, sources who discussed this

emerging issue specifically cited the

diversion and abuse of one particular

prescription opiate, OxyContin®. As

a result, the bulk of this section refers

specifically to OxyContin®. 

OxyContin® (oxycodone hydrochloride controlled-release) tablets are

prescribed to patients suffering from

severe persistent pain—a legitimate

medical need. However, concern has

increased about the diversion and

abuse of OxyContin® and other analgesics in some areas of the country.

The manufacturer, Purdue Pharma,

has been working proactively with

law enforcement and the medical

community to provide education on

the appropriate use of OxyContin®

and has recently launched a pilot

campaign in several cities to warn

youth about the dangers of prescription drug abuse. This special topic

section presents findings on the 

diversion and illegal use or abuse of

OxyContin® as reported by Pulse

Check sources, not on legitimate 

medical use by patients who use these

products at the direction of their

physicians.

OxyContin® is the trade name for a

high-dose, 12-hour-time-release form

of oxycodone, an opoid analgesic,

often prescribed for relief from

chronic pain and taken orally. Oxycodone is also the active ingredient in

other schedule II prescription drugs,

such as Percodan®, Percocet® and

Tylox®; however, OxyContin®

contains a higher concentration of

oxycodone (currently 10-, 20-, 40-,

and 80-milligram tablets are available) than similar pain relievers. 

Since the drug became available in

1996, there have been reports on the

diversion and abuse of OxyContin®,

especially in rural areas of Northeastern and Southeastern States, such

as Kentucky, Maine, Maryland,

Pennsylvania, Virginia, and West

Virginia, and in rural areas of Ohio.

OxyContin® is often referred to by

the media as “hillbilly heroin” or

“poor main’s heroin” for its heroinlike effects and for the initial abuse 

of the drug in low SES rural areas.

These terms, however are misnomers

because it is more expensive than

heroin when bought illicitly and

because its abuse has moved from

only lower SES rural areas to include

metropolitan areas in 2001.

Reports of crimes committed in order

to obtain OxyContin® (such as 

pharmaceutical burglaries, home 

invasions, and prescription fraud) 

and negative health consequences

(including deaths, overdoses requiring

emergency department visits, and

addiction requiring treatment)

increased through 2000 and 2001.

Although the nonmedical use of

OxyContin® was rare in 2000, the

most recent (2000) National

Pulse Check sources reflect mixed views on the accuracy of media attention:

Although most responding Pulse Check sources believe that the media has portrayed the

diversion of OxyContin® accurately in their communities, several sources believe that the

media has either underplayed or overemphasized the problem. For example, the New

Orleans law enforcement source states, “The media hasn’t given it (diverted Oxy-Contin®)

much media time, but it is a big problem.” The Baltimore non-methadone source, the

Memphis epidemiologic source, and the Philadelphia non-methadone source agree that the

media has underplayed the problem in their communities. However, two sources in

Portland (ME) (law enforcement and methadone treatment) state that initially the media

underplayed the problem, but that now it is addressed adequately. They also believe that

media attention has helped prompt legislation to make it harder to forge prescriptions. 

By contrast, many sources (the law enforcement source in Birmingham and Washington,

DC; the epidemiologic sources in Boston, New Orleans, Philadelphia, Seattle, and Sioux

Falls; and the non-methadone source in Sioux Falls) believe that the media has overemphasized the problem. Several admit that the reason the media might be emphasizing the

problem is that “such drugs are very addictive.” However, the opinion of several sources

is that not only has the media overplayed the problem of diverted synthetic opiates like

OxyContin® in their communities, but also they have helped encourage abuse. For

example, the Boston epidemiologic source states, “Large amounts of media coverage

have probably led to increased use by alerting opiate addicts to a possible market....it

has probably increased illicit (OxyContin®) sales.” The Portland (ME) epidemiologic

source reports that the intense press coverage is accurate for the area, but that media

attention “may have increased the value of illicit OxyContin®; it may have increased the

desire to obtain it.”
SPECIAL TOPIC: SYNTHETIC OPIOIDS

page 90 Pulse Check: November 2001

Household Survey on Drug Abuse

(NHSDA) shows a significant increase

(p<0.01) in the number and 

percentage of lifetime nonmedical 

use of OxyContin® since 1999.

Finally, the most recent data from

emergency department mentions of

the synthetic opiate, oxycodone, which

includes OxyContin®, Percocet®,

Percodan®, and Tylox®, increased 68

percent (from 6,429 to 10,825)

between 1999 and 2000, according to

the Drug Abuse Warning Network

(DAWN). 

In summer 2001, increased reports of

abuse of the drug and related crimes

prompted the FDA to strengthen

warnings and precautions in the 

labeling of the product. Purdue

Pharmaceuticals undertook a number

of activities aimed at reducing diversion and abuse, including issuing a

warning in the form of a letter distributed widely to physicians, pharmacists,

and other health care professionals,

and the suspension of sales of the

strongest formulation of the tablet

(160 milligrams). 

This Pulse Check special section 

corroborates increased levels of

OxyContin® diversion and abuse and

finds that its diversion and abuse are

reported as highest in the Northeast

and eastern parts of the South and

lowest in the Midwest. Furthermore,

sources who provided demographic

information about OxyContin®

abusers and sellers were mostly from

the Northeast and (to a lesser extent)

the Southeast, highlighting that it is

not yet a large problem in the West

and Midwest. This section also supports reports that although OxyContin® diversion and abuse occur

mostly in rural areas, they have also

recently emerged in metropolitan

areas (especially those in the

Northeast and Southeast), such as

Baltimore, Boston, Denver, Detroit,

Miami, Philadelphia, St. Louis, and

Washington, DC.

OXYCONTIN®: THE PERCEPTION

How serious a problem is

OxyContin® abuse and diversion

in Pulse Check cities? (Exhibit 1)

Nearly one-third (32 of 83) of Pulse

Check sources (law enforcement, epidemiologic, ethnographic, methadone

treatment, and non-methadone 

treatment) perceive OxyContin®

diversion or abuse as a somewhat

serious or very serious problem in

their communities, 23 percent (19)

perceive it as not a very serious 

problem, 20 percent (17) perceive it

as not a problem, and 18 percent (15)

did not respond to the question.

Sources in the Northeast perceive

OxyContin® diversion and abuse as a

more serious problem than in other

Exhibit 2.

How has the perceived OxyContin® problem changed since the last 

reporting period, by U.S. region?

Exhibit 1.

How much of a problem is OxyContin® diversion and abuse, by U.S. region?

Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone

treatment repondents

40

35

30

25

20

15

10

5

0

Northeast

(N=17)

Total

(N=83)

South

(N=30)

Midwest

(N=16)

West

(N=20)

Not Very Serious

Percent No Response

Not a Problem Very Serious

Somewhat Serious

0

Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone

treatment respondents

70

60

50

40

30

20

10

0 Northeast

(N=17)

South

(N=30)

Midwest

(N=16)

West

(N=20)

Less Serious

No Response

Percent

No Longer of Concern More Serious

Stable

0 0 0 0 0

Total

(N=83)

0 0
SPECIAL TOPIC: SYNTHETIC OPIOIDS

Pulse Check: November 2001 page 91

regions, with 35 percent of those

sources reporting it as a very serious

problem and 24 percent reporting it

as a somewhat serious problem.

Seventeen percent of sources in the

South report the problem as very 

serious, and 27 percent report it as

somewhat serious. By contrast, only

10 percent of western sources report

it as very serious and 25 percent as

somewhat serious; and finally, no

midwestern sources report it as very

serious and only 13 percent report it

as somewhat serious.

How has the perceived problem

changed between fall 2000 and

spring 2001? (Exhibits 2 and 3)

Nearly half (37 of 83) of Pulse Check

sources perceive OxyContin®

diversion and abuse as escalating in

their communities since the last

reporting period, and no sources

report the problem as declining. As

with perceived levels of seriousness,

increases in OxyContin® diversion

and abuse are largest in the Northeast, with 65 percent of sources

reporting increases. Increases were

lowest in the Midwest, with 31 percent of sources reporting increases.

Moreover, among sources who report

the diversion and abuse of OxyContin® as a very serious problem 

(in Billings, Birmingham, Boston,

Columbia [SC], Honolulu, Miami,

New Orleans, Philadelphia, and Portland [ME]), all report an intensification

of the perceived problem except in

Honolulu, where it remained stable

since the last reporting period. 

Where is OxyContin® abuse

emerging across the country?

(Exhibit 4) More sources (law enforcement, epidemiologic, ethnographic,

and methadone and non-methadone

treatment) report OxyContin® as the

emerging drug of abuse in their 

communities than any other drug this

reporting period. For example, 31 of

84 sources in most (14) Pulse Check

cities report OxyContin® as an emerging drug of abuse, compared with 25

sources in 15 cities who report ecstasy

as an emerging drug of abuse. By stark

contrast, in the last Pulse Check,

OxyContin® was reported as the

emerging drug of abuse only by the

epidemiologic source in Portland (ME).

During this reporting period, more

sources in northeastern and southern

(especially southeastern) cities report

OxyContin® as an emerging drug of

abuse than in cities elsewhere. 

Exhibit 3.

How serious a problem is OxyContin® diversion and abuse in Pulse Check

cities and how has the problem changed (fall 2000 vs spring 2001?)*

*Information was not provided by law enforcement sources in Los Angeles, St. Louis, and Seattle;

epidemiologic sources in Chicago, El Paso, and Honolulu; methadone treatment sources in Detroit,

Los Angeles, Miami, New Orleans, and New York; and non-methadone treatment sources in Los

Angeles, Memphis, Sioux Falls, and Washington, DC.

Boston, MAE,M

Philadelphia, PAN

Birmingham, ALL

Baltimore, MDE,N

El Paso, TXN

Chicago, ILL

Detroit, MIE

St. Louis, MOE,N

Billings, MTE

Denver, COE,M

New York, NYL

Columbia, SCN

Memphis, TNL

New Orleans, LAN

Washington, DCM

Detroit, MIL 

New York, NYE,N

Baltimore, MDL

Columbia, SCL

El Paso, TXL,M

Chicago, ILM,N

Detroit, MIN

Sioux Falls, SDE,N

Billings, MTE

Denver, COL,N

Honolulu, HIN

(among adolescents)

Seattle, WAE,N

Not a problem

Not very serious

Boston, MAN

Portland, MEN

Birmingham, ALE

Columbia, SCL

Miami, FLL,N

Washington, DCL,E

Sioux Falls, SDL

Billings, MTL

Honolulu, HIL,M

Los Angeles, CAE

Philadelphia, PAE,M

Birmingham, ALM

Memphis, TNE

St. Louis, MOM

Seattle, WAM

Boston, MAL,M

Philadelphia, PAL

Portland, MEL,E,M

Birmingham, ALN

Columbia, SCM

Miami, FLE

New Orleans, LAL,E

Billings, MTN

Honolulu, HIN

(adult care)

Very serious Somewhat serious

L

Law enforcement respondents

E

Epidemiologic and ethnographic respondents

MMethadone treatment respondents

N

Non-methadone treatment respondents
SPECIAL TOPIC: SYNTHETIC OPIOIDS

page 92 Pulse Check: November 2001

OXYCONTIN®: THE DRUG

How available is diverted

OxyContin®? (Exhibit 5) Across the

country, more than two-thirds (18 of

26) of law enforcement, epidemiologic,

and ethnographic respondents in 12

cities (Billings, Birmingham, Boston,

Chicago, Detroit, Honolulu, Miami,

New Orleans, Philadelphia, Portland

[ME], Seattle, and Washington, DC)

report diverted the OxyContin®

as somewhat or widely available. 

Furthermore, most (17 of 23) respondents report increased availability of

the diverted product since the last

reporting period, 5 report it as stable,

and only 1 (the Portland [ME] epidemiologic source) reports declining

availability. In general, sources in the

Northeast report higher levels of

diverted OxyContin® than those 

elsewhere.

How is diverted OxyContin®

referred to across the country?

(Exhibit 6) Diverted OxyContin® is

most often referred to as “oxy” or

“OC’s,” according to law enforcement, epidemiologic, ethnographic,

and methadone and non-methadone

treatment respondents. Additionally,

the pills are referred to as “blues” in

Miami, “forties” and “horse pills” in

Boston, and “O’s” in Philadelphia. 

Exhibit 4. 

Where is the diversion and abuse of OxyContin® emerging?

L

Law enforcement respondent

E

Epidemiologic/ethnographic respondent

MMethadone treatment respondent

NNon-methadone treatment respondent

OxyContin® reported as emerging since last reporting period

OxyContin® not reported as emerging since last reporting period

Exhibit 5.

How available is diverted OxyContin® in 17 Pulse Check cities, and how has availability changed (fall 2000 vs

spring 2001)?* 

Law enforcement sources Epidemiologic and ethnographic sources

No Not Not very Somewhat Widely No Not Not very Somewhat Widely

City response available available available available Change response available available available available Change

Boston, MA ! ↑ ! ↔

New York, NY ! ↔! NR

Philadelphia, PA ! ↑ ! NR

Portland, ME ! ↑ ! ↓

Baltimore, MD ! NR ! ↔

Birmingham, AL ! ↑ ! ↑

Memphis, TN ! NR ! NR

Miami, FL ! ↑ ! ↑

New Orleans, LA ! ↑ ! NR

Washington, DC ! ↑ ! ↑

Chicago, IL ! ↑ ! NR

Detroit, MI !↔ ! ↔

Sioux Falls, SD ! ↑ ! NR

St. Louis, MO ! NR ! ↑

Billings, MT ! ↑ ! NR

Honolulu, HI ! ↑ ! ↑

Seattle, WA ! ↑ ! NR

*Sources did not provided information in Columbia (SC), Denver, El Paso, and Los Angeles. West South Northeast Midwest
SPECIAL TOPIC: SYNTHETIC OPIOIDS

Pulse Check: November 2001 page 93

DIVERTED OXYCONTIN®: SALES

How is OxyContin® diverted and

sold illicitly? According to law

enforcement sources, OxyContin® is

diverted in a variety of ways within

Pulse Check communities, including

fraudulent prescriptions, “doctor

shopping,” legitimately obtained pills

sold illicitly, and pharmaceutical robberies. The most common way to

divert the drug (as reported in

Billings, Boston, Honolulu, New

Orleans, Philadelphia, Portland [ME],

Sioux Falls, and Washington, DC) is

through filling fraudulent prescriptions: diverted OxyContin® sellers

either make their own prescription

forms or steal blank prescription pads

and write their own prescriptions to

obtain the drug. Another frequently

reported method of diverting OxyContin® (as reported in Boston,

Detroit, New Orleans, Philadelphia,

and Portland) is doctor shopping:

people, posing as patients, fake legitimate pain to numerous doctors, and

doctors prescribe the drug. Often,

people who doctor shop use some of

the pills obtained through the prescriptions. Patients who obtain and

use the drug legitimately, as prescribed by doctors for pain, but sell

some of the pills illicitly, are also frequently mentioned by sources (in

Birmingham, Boston, Detroit, and

Washington, DC). Pharmaceutical

robberies are mentioned in Billings,

Boston, New Orleans, and Portland

(ME). Additionally in Portland (ME),

where armed robberies of pharmacies

for OxyContin® have increased 

drastically, doctors and pharmacy

employees have been involved in

OxyContin® theft and may help 

plan the robberies. Also in that city,

home invasions of clients who have

legitimately filled OxyContin® prescriptions have been reported, with

the suspicion that pharmacists are

involved in obtaining patient information. Finally, in New Orleans, some

shipments of the drug are thought to

come via U.S. mail from Mexico. 

Except in Boston and Miami, epidemiologic and ethnographic sources did

not provide information about the

sources of diverted OxyContin®.

According to the Boston epidemiologic

source and in agreement with the law

enforcement source in that city, low

SES patients with legal OxyContin®

prescriptions sell some of the pills 

illicitly. In Miami, organized diversion

efforts are conducted by dealers who

recruit patients from substance abuse

treatment and mental health facilities.

Dealers drive these patients in vans to

doctors who prescribe OxyContin®.

After the prescriptions have been 

written and filled, patients return to

the vehicles, give most of the pills to

the dealers, and keep a few pills for

themselves. Dealers often target and

recruit methadone and other treatment

clients because of their vulnerability to

addiction. 

Once OxyContin® is diverted, it is

sold hand-to-hand, mostly through

acquaintance networks, according to

law enforcement respondents.

Additionally, beepers and deliverytype services are used to distribute

the drug illicitly in Billings, Boston,

Honolulu, and New Orleans.

What are diverted OxyContin®

prices across the country, what

are the most common units sold,

and how is it packaged? (Exhibit 7)

Diverted OxyContin® costs $1 per

milligram in most cities where law

enforcement, epidemiologic, and

ethnographic sources responded (in

Boston, Chicago, Miami, and

Philadelphia). In Billings, prices are

$1–$1.50 per milligram, and in

Washington, DC, they are $1–$2 per

milligram. 

The most common pill unit of 

diverted OxyContin®, according to

law enforcement, epidemiologic,

ethnographic, and treatment sources,

is the 40-milligram tablet, followed

by the 20- and 80-milligram tablets.

Interestingly, methadone and nonmethadone treatment sources report

higher milligram units (typically 80

milligrams) sold than their law

enforcement and epidemiologic 

counterparts. 

According to eight of nine law

enforcement, epidemiologic, and

ethnographic respondents (in

Baltimore, Boston, Detroit, Miami,

Philadelphia, Portland [ME], and

Washington, DC), diverted

OxyContin® is sold as loose pills.

Additionally, law enforcement respondents in Boston and Portland (ME)

report that it is sold in prescription

bottles, and the Billings law enforcement source reports that it is sold in

small zipper coin bags.

Exhibit 6.

How is diverted OxyContin®

referred to in Pulse Check cities?

Slang 

Term City

Oxy Billings, Boston, Detroit, 

Honolulu, Philadelphia, 

Portland (ME), 

Washington, DC 

OC’s Birmingham, Boston, 

Miami, Portland (ME)

Oxy-cotton Memphis, Philadelphia 

Blues Miami 

Forties, 

horse pills Boston 

O’s Philadelphia 

Sources: Law enforcement, epidemiologic,

ethnographic, methadone treatment, and 

non-methadone treatment respondents
SPECIAL TOPIC: SYNTHETIC OPIOIDS

page 94 Pulse Check: November 2001

How often is diverted OxyContin®

available? According to the Portland

(ME) law enforcement and epidemiologic sources and the New Orleans law

enforcement source, for the past year,

OxyContin® has been available continually on the illicit drug market. By

contrast, according to epidemiologic

sources in Birmingham and Washington, DC, and the law enforcement

source in Honolulu, the drug has

been available on the illicit drug 

market only periodically. Other

respondents claim that the drug is so

new to the illicit drug market that

they cannot assess whether the drug is

available continually or periodically.

Who sells diverted OxyContin®?

According to all (nine) responding

law enforcement sources, diverted

OxyContin® sellers are independent.

The law enforcement sources in New

Orleans, Portland (ME), Seattle, and

Washington, DC, add that they tend

to be heroin addicts or often associate

with heroin users. 

According to law enforcement, 

epidemiologic, and ethnographic

respondents in Billings, Honolulu,

Memphis, Philadelphia, and

Washington, DC, diverted OxyContin®

sellers tend to be adults (>30 years).

Young adults (18–30 years) predominate in two cities: Birmingham 

and Portland (ME). Furthermore,

according to the New Orleans law

enforcement source, participants in

the club scene are starting to become

involved with the sale and use of

diverted OxyContin®.

What other drugs do diverted

OxyContin® dealers sell?

According to all law enforcement,

epidemiologic, and ethnographic

respondents (11 of 11), diverted

OxyContin® dealers sell other drugs,

most commonly heroin (as reported

in Baltimore, Boston, Honolulu, New

Orleans, Portland [ME], and Washington, DC) and other diverted 

prescription drugs, especially other

opiates (as reported in Honolulu,

New Orleans, Philadelphia, Portland

[ME], and Washington, DC). Diverted OxyContin® dealers also sell

cocaine in Baltimore, and marijuana

and methamphetamine in Billings. 

Do diverted OxyContin® sellers

use the drug? According to seven

of eight law enforcement respondents

(in Birmingham, Honolulu, New

Orleans, Philadelphia, Portland [ME],

Sioux Falls, and Washington, DC),

OxyContin® sellers are somewhat or

very likely to use the drug. Three 

epidemiologic sources responded to

the question: the Portland and

Washington, DC, respondents agree

with their law enforcement counterparts that OxyContin® sellers are

very likely to use the drug, but the

Memphis respondent cites sellers as

not very likely to use the drug.

In what types of other crimes

are diverted OxyContin® sellers

involved? According to most law

enforcement, epidemiologic, and

ethnographic respondents (8 of 12),

sellers of diverted OxyContin® are

somewhat or very likely to be

involved in other crimes, including

the following: nonviolent crimes in

Billings, Boston, New Orleans,

Portland (ME), and Washington, DC;

violent crimes in Honolulu and

Portland; prostitution in Boston and

Portland; and gang-related crimes in

Portland, where crimes involving

diverted OxyContin® have increased

according to the law enforcement

source. Only by respondents in

Birmingham, Memphis, and Philadelphia are diverted OxyContin® sellers

regarded as not involved in other

crimes. 

Where is diverted OxyContin®

sold? (Exhibit 8) Diverted OxyContin® is sold in the central city

and rural areas, according to most

law enforcement and epidemiologic

respondents. However, suburbs are

the predominant sales locales in

Philadelphia, and the drug is sold

throughout all areas of Boston and

Portland (ME). According to the 

law enforcement source in Washington, DC, most sales occur in the 

central city, but the buyers reside in

the suburbs. 

According to law enforcement, 

epidemiologic/ethnographic, and

treatment respondents, diverted

OxyContin® is sold most often in

private residences, followed by streets

and around methadone treatment

clinics. The reported number of

diverted OxyContin® sales settings is

highest in Boston and New Orleans.

Exhibit 7.

What are the most commonly sold

units of diverted OxyContin®?

City Most common unit 

sold (in milligrams) 

Boston, MA 10, 40 

Philadelphia, PA 20, 40, 80 

Portland, ME 20, 40, 80, 160 

Baltimore, MD 20, 40 

Birmingham, AL 80 

Columbia, SC 40, 80 

Miami, FL 20 

Washington, DC 20, 40 

Detroit, MI 40, 80 

St. Louis, MO 40 

Billings, MT 20, 40 

Honolulu, HI 20, 80 

Sources: Law enforcement, epidemiologic,

ethnographic, methadone treatment, and nonmethadone treatment respondents Northeast South Midwest West
SPECIAL TOPIC: SYNTHETIC OPIOIDS

Pulse Check: November 2001 page 95

OXYCONTIN®: THE ABUSERS

How has the number of novice

OxyContin® treatment clients

changed? (Exhibit 9) According to

most (12 of 16) methadone and nonmethadone treatment respondents,

the number of novice users of diverted OxyContin® in treatment (defined

as any drug treatment client who has

recently begun using diverted

OxyContin®) has increased since the

last reporting period, mainly in the

South. The remaining respondents

reporting stable trends.

Who abuses OxyContin® and

where do they reside? (Exhibits

10 and 11) This section refers to

those who abuse diverted

OxyContin®, not those who are 

prescribed the drug for a legitimate

medical need. Most OxyContin®

abusers are young adults (18–30

years) or adults (>30 years), 

according to most epidemiologic,

ethnographic, and methadone and

non-methadone treatment respondents. However, according to the 

epidemiologic and methadone treatment sources in Portland (ME) and

the epidemiologic source in Miami,

adolescent (13–17 years) and young

adult abusers are increasing.

Males are the predominant OxyContin® abusers, according to most 

(5 of 9) epidemiologic and ethnographic respondents (in Baltimore,

Detroit, Memphis, Miami, and

Philadelphia). However, males and

females are equally likely to abuse 

the drug in Birmingham, Columbia

(SC), Portland (ME), and Washington,

DC. Treatment respondents agree that

males are the predominant users or

that they are evenly split between the

genders. Females predominate, 

however, in treatment programs in

Baltimore, St. Louis, and two Western

cities (Billings and Denver).

Whites are the predominant OxyContin® abusers and are overrepresented compared with the general

population, according to nearly all

epidemiologic and ethnographic

respondents. Blacks, however, are the 

predominant abusers and overrepresented in Baltimore and Washington,

DC. Most treatment respondents

agree that Whites predominate as

OxyContin® abusers. Additionally,

Exhibit 8.

Where is diverted OxyContin® sold and abused across 17 Pulse Check cities?*

Private Meth- Night- Around Play- Con- Shop- Total

Resi- Public Inside Crack Private adone clubs/ Super- College grounds/ certs/ ping #

Streets dences Housing Cars Houses Parties Clinics Bars Markets Campus Parks Raves Malls Settings

City Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use Sell Use

Boston, MA ! ! ! ! ! ! ! ! ! !! ! ! ! !! ! 13 4

Philadelphia, PA !! ! ! ! ! !! ! ! 2 7

Portland, ME !! !! ! 3 2

Baltimore, MD !!!! ! ! !! ! 5 4

Birmingham, AL !! ! 1 2

Columbia, SC ! NR 1

Memphis, TN ! ! NR 2

Miami, FL !! ! NR 3

New Orleans, LA !! ! ! !! !! ! !! 11 NR

Washington, DC !!!! ! ! !! ! 4 5

Detroit, MI ! NR 1

St. Louis, MO !!! ! ! ! ! NR 7

Billings, MT ! ! ! !! ! ! ! ! ! ! ! 2 10

Denver, CO ! NR 1

Honolulu, HI !! ! ! 4 NR

Seattle, WA !! ! ! ! NR 5

Sources: Law enforcement, epidemiologic, ethnographic, and methadone and non-methadone treatment respondents

*For sales settings seven law enforcement sources responded (in Billings, Birmingham, Boston, Honolulu, New Orleans, Philadelphia, Portland [ME],

and Washington, DC) and three epidemiologic and ethnographic sources responded (in Baltimore, Boston, Portland [ME], and Washington, DC). For

users settings, nine epidemiologic and ethnographic sources responded (in Baltimore, Detroit, Memphis, Miami, Philadelphia, Portland [ME], St.

Louis, and Washington, DC), seven methadone treatment sources responded (in Boston, Columbia [SE], Denver, Portland [ME], St. Louis, Seattle

and Washington, DC), and eight non-methadone treatment sources responded (in Billings, Birmingham, Baltimore, El Paso, Miami, Philadelphia,

Portland [ME] and St. Louis). West South Northeast Midwest
SPECIAL TOPIC: SYNTHETIC OPIOIDS

page 96 Pulse Check: November 2001

Whites from rural areas are increasingly abusing the drug, according to

the epidemiologic sources in

Birmingham and Washington, DC.

Most OxyContin® abusers are of low

or middle SES, according to nearly all

epidemiologic, ethnographic, and

methadone and non-methadone 

treatment respondents. Additionally,

according to treatment respondents,

OxyContin® abusers in the Northeast

are more likely to be of low SES than

those in other regions.

The locations of OxyContin® abusers’

residences vary by city, according to

epidemiologic and ethnographic

respondents: in Baltimore, Philadelphia, and Washington, DC, they reside

in central city areas; in Detroit,

Birmingham, and Memphis, they

reside in rural areas and the suburbs;

and in Columbia (SC) and Miami, they

reside in the suburbs. Most treatment

respondents concur with their 

epidemiologic counterparts. 

Where and in what contexts do

OxyContin® abusers tend to use

the drug? (Exhibit 8) Most OxyContin® abusers use the drug indoors

and in private, according to all (eight

of eight) epidemiologic respondents

(in Baltimore, Birmingham, Detroit,

Memphis, Miami, Philadelphia,

Portland (ME), and Washington, DC).

Treatment respondents agree that

diverted OxyContin® is primarily

used indoors and in private, but the

Birmingham non-methadone source

cites both indoor and outdoor use

because, “you can take a pill anywhere.” According to the epidemiologic sources in Memphis, Philadelphia,

and Washington, DC, they primarily

use the drug in groups or among

friends, but in Baltimore, Miami, and

Portland (ME), most use the drug

alone. By contrast, most (8 of 12)

treatment respondents (in Billings,

Birmingham, Columbia (SC), Denver,

Portland (ME), St. Louis, and Washington, DC) report that most OxyContin®

abusers take the drug alone. 

The most frequently mentioned 

settings for abuse of diverted OxyContin®, according to epidemiologic,

ethnographic, and non-methadone

and methadone treatment respondents, are private residences, followed

by public housing developments,

inside cars, and private parties. Other

common settings include streets (in

Baltimore, Billings, Philadelphia, and

Washington, DC), nightclubs and bars

(in Billings, Boston, Philadelphia, and

St. Louis), and concerts and raves (in

Boston, Miami, and St. Louis). 

Exhibit 9.

How has the number of novice

OxyContin® treatment clients

changed (fall 2000 vs spring

2001)?

MMethadone treatment respondents

NNon-methadone treatment respondents

Notes: Billings has two non-methadone

treatment sources. 

OxyContin® users in treatment:

Referral sources, education, and

employment

The most common referral sources for

OxyContin® treatment clients, according to methadone and non-methadone

treatment respondents, are individual

referrals (in Baltimore, Birmingham,

Boston, Columbia [SC], Denver, Miami,

Philadelphia, Portland [ME], St. Louis,

Seattle, and Washington, DC), followed

by courts or the criminal justice system

(in Philadelphia, Portland [ME], and 

St. Louis) and health care providers (in

Billings, El Paso, and Portland). According to the Denver methadone source,

doctors are a common referral source:

doctors who have been prescribing

OxyContin® to their patients for pain

refer them to treatment when they believe

their patients may have an addiction. 

Nearly all (14 of 17) treatment respondents report that most OxyContin®

abusers have a high school education.

Only the methadone source in Seattle

and the methadone and non-methadone

sources in Philadelphia report that most

OxyContin® users have less than a high

school education. The employment status of OxyContin® abusers varies widely

according to treatment respondents, with

most reporting full-time employment or

unemployment. Additionally, the nonmethadone source in El Paso reports that

most are retired or disabled, and the

methadone treatment source in Boston

reports that most are unemployed due to

chronic pain.

OxyContin® abuse among health

care professional and adolescents...

Only 5 of 23 epidemiologic, ethnographic, and methadone and non-methadone

treatment respondents (in Baltimore,

Billings, Portland (ME), St. Louis, and

Seattle) report health care professionals as

involved in OxyContin® abuse. 

Seven respondents in six cities report

OxyContin® abuse among opioid-naïve

adolescents (in Billings, Boston, Detroit,

Miami, Portland (ME), and St. Louis). 

Baltimore, MDN

Billings, MTN,N

Birmingham, ALN

Boston, MAM

Columbia, SCM

El Paso, TXN

Miami, FLN

Portland, MEM,N

St. Louis, MON

Washington, DCM

Denver, COM

Philadelphia, PAM,N

Seattle, WAM
SPECIAL TOPIC: SYNTHETIC OPIOIDS

Pulse Check: November 2001 page 97

How is OxyContin® taken, and

what other drugs do OxyContin®

users take? Unlike those with a

legitimate medical need for OxyContin® who injest the pill orally by

swallowing it whole, OxyContin®

abusers seek to deactivate the timerelease formula by injecting, chewing,

or snorting the crushed pill or tablet

to achieve rapid release and absorption of oxycodone, according to 

epidemiologic and ethnographic

respondents. Injection (by crushing

the pill, dissolving it in water or

cooking it, and typically injecting it

through cotton balls or cotton pads—

hence, its street name “oxycotton”) is

reported in seven cities (Baltimore,

Birmingham, Detroit, Portland [ME],

Philadelphia, St. Louis, and Washington, DC). The diverted drug is taken

orally (often chewed) in three cities

(Memphis, Miami, and Philadelphia),

and it is crushed and snorted in

Columbia (SC) and Detroit. Unlike

epidemiologic and ethnographic

respondents, treatment sources overwhelmingly (16 of 20 respondents)

cite oral ingestion as the predominant

mode of OxyContin® administration

by hardcore drug users. Injecting the

drug is only mentioned by the Billings

non-methadone treatment source, and

snorting crushed pills is mentioned

only by three sources: the methadone

treatment source in Boston and the

methadone and non-methadone

sources in Portland (ME). According

to the epidemiologic source in

Washington, DC, oral ingestion of 

the drug is increasing. 

Few epidemiologic, ethnographic, or

treatment respondents report other

drugs used in combination with

diverted OxyContin®, and most

drugs mentioned are other prescription drugs that have been diverted.

For example, benzodiazepines are

taken in combination with OxyContin® in Baltimore, Boston,

Columbia (SC), Philadelphia, and

Seattle. Other diverted prescription

opiates are combined with OxyContin® in Billings (Percocet®,

meperidine [Demerol®] or morphine),

Philadelphia® (Percocet®), and Miami

(hydrocodone [Vicodin® or Lorcet®],

or carisoprodol [Soma®]). Heroin is

used with diverted OxyContin® in

Boston, Billings, and St. Louis, and

crack in Billings and Philadelphia. In

Boston, diverted OxyContin® is sometimes used with ecstasy to assuage the

effects of ecstasy.

Several sources report that OxyContin® abusers have previously

used drugs other than opiates.

According to the law enforcement

source in Billings, methamphetamine

users who are unable to obtain

methamphetamine or are looking for

a more sustained high may begin

using diverted OxyContin®, and

according to the Boston methadone

treatment source, OxyContin® users

tend to have already experimented

with marijuana and sometimes

cocaine.

How often do OxyContin®

abusers use the drug? Most

OxyContin® abusers take the drug at

least daily, according to most (11 of

15) treatment respondents (in

Birmingham, Boston, Columbia [SC],

Denver, Philadelphia, Portland [ME],

St. Louis, and Washington, DC). The

methadone treatment sources in

Boston and Philadelphia report that

OxyContin® abusers begin using the

drug occasionally or on weekends,

but they often quickly progress to

daily use. 

How is heroin related to

OxyContin® abuse? 

According to many Pulse Check sources,

heroin users often abuse diverted

OxyContin®, mostly as a heroin 

substitute. Seven respondents (the law

enforcement sources in New Orleans

and Philadelphia; the epidemiologic

source in Miami, the methadone treatment sources in Philadelphia and Seattle;

and the non-methadone treatment

sources in Birmingham and St. Louis)

report that heroin users often replace

heroin with diverted OxyContin®, 

especially when heroin is scarce. Four

respondents (the Portland (ME) law

enforcement source, the Boston

methadone treatment source, and the

Billings and St. Louis non-methadone

treatment sources) state that diverted

OxyContin® may be used in combination with heroin to enhance the effects

of heroin. And the methadone treatment

sources in Columbia (SC) and Washington, DC, report that heroin users often

take illegally obtained OxyContin® to

“tide them over” until their next dose of

heroin or methadone. 

By contrast, in Chicago, the diversion

and abuse of other prescription opiates

abuse continues to be low because 

heroin is readily available and less

expensive there. Sources also point out

that many OxyContin® abusers use the

drug exclusively. For example, in

Birmingham, most OxyContin® abusers

use the drug rather than heroin or other

diverted prescription drugs because they

believe it is more potent. And the law

enforcement source in Boston reports

that most Oxy-Contin® abusers do not

use heroin, but that they may start to use

heroin if they are unable get their

OxyContin® “fix.”
SPECIAL TOPIC: SYNTHETIC OPIOIDS

page 98 Pulse Check: November 2001

Exhibit 11.

Who abuses diverted OxyContin®, according to methadone and non-methadone treatment respondents?

Race/Ethnicity; representation 

Treatment compared with the Socioeconomic

City source Age Gender general population Status Residence

Boston, MA Methadone Adults (>30) Split evenly White; equal Low Suburbs

Philadelphia, PA Methadone Young adults Split evenly White; NR Low Central city

(18–30)

Non-methadone Young adults Split evenly White, Black, Hispanic; equal Low Central city

Portland, ME Methadone Young adults Split evenly White; NR Low and middle Central city

Non-methadone Adults Male White; NR Low Rural

Baltimore, MD Non-methadone Young adults Female White; underrepresented High Central city

Birmingham, AL Methadone Young adults Male White; equal Middle Suburbs

Non-methadone Young adults Split evenly White; equal Low and middle Suburbs

Columbia, SC Methadone Young adults Male White; equal Middle Rural

El Paso, TX Non-methadone Adults Male White, Black, Hispanic; equal All Central city 

and suburbs

Miami, FL Non-methadone Adults Split evenly White; overrepresented Middle Suburbs

New Orleans, LA Non-methadone Adults Male White; NR Middle Central city

Washington, DC Methadone Adults Male White, Black; NR Low Central city

St. Louis, MO Methadone Young adults Split evenly Multi-racial; NR Middle Suburbs and 

central city

Non-methadone Young adults Female White; NR Middle Suburbs

Billings, MT Non-methadone Young adults Female White; NR Low Suburbs

Denver, CO Methadone Adults Female White; NR Middle Suburbs

Honolulu, HI Non-methadone Adults Male Asian/Pacific Islander; NR Middle Suburbs

Seattle, WA Methadone Adults Split evenly White; equal Low Central

South West Northeast Midwest

Exhibit 10.

Who abuses diverted OxyContin®, according to epidemiologic and ethnographic respondents?

Race/Ethnicity; representation

compared with the general Socioeconomic

City Age Gender population Status Residence

Philadelphia, PA Young adults (18–30) Male White; underrepresented Low Central city

and adults (>30)

Portland, ME Young adults Split evenly White; equal Low All

Baltimore, MD Adults Male Black; overrepresented Low Central city

Birmingham, AL Adolescents (13–17) Split evenly White; overrepresented Low and middle Suburbs and rural areas

Columbia, SC Young adults Split evenly White; equal Middle Suburbs

Memphis, TN Young adults Male White; overrepresented Middle Suburbs and rural areas

Miami, FL Adults Male White; overrepresented Low Suburbs

Washington, DC Adults Split evenly Black; overrepresented Low Central city 

Detroit, MI Young adults Male White; overrepresented Middle and high Suburbs and rural

and adults areas

South Northeast Midwest
APPENDIX 1: METHODOLOGY

Pulse Check: November 2001 page 99

APPENDIX 1: METHODOLOGY

How were the sites selected?

(See map in the Introduction) A total

of 21 sites were studied for this issue

of Pulse Check, including a new site

not studied in the last (Mid-Year 2000)

issue: Baltimore, MD. Baltimore was

included at the request of the Office

of National Drug Control Policy

(ONDCP) because of concerns about

its unique problems involving heroin

and cocaine. We selected the other 20

sites using Census Bureau regions and

divisions with a goal of achieving

geographic and demographic diversity. In addition, we made an effort to

select sites in areas with special drug

abuse problems of national concern.

More specifically, we applied the following methodology in selecting sites.

We purposely selected the most 

populous States in the four census

regions: New York in Region I

(Northeast Region); Texas in Region

II (South Region); Illinois in Region

III (Midwest Region); and California

in Region IV (West Region). In three

of these States, we selected the most

populous metropolitan areas: New

York City, Chicago, and Los Angeles.

In Texas, however, we selected El

Paso—a known high trafficking area

with particularly high levels of unemployment, population growth, and

poverty—because of its proximity to

the United States border with Mexico. 

We included four rural States, one per

census region. (Rural States are

defined by the Census Bureau as

those in which 50 percent or more of

the State's population reside in census-designated rural areas.) The four

rural sites selected are as follows:

! Region I (Northeast): Portland,

ME—Of the three rural States in

the Northeast Region (including

New Hampshire and Vermont),

Maine has the only Atlantic coastline and shares the longest border

with Canada. It also includes an

ONDCP-designated High Intensity

Drug Trafficking Area (HIDTA).

Portland is Maine's most populous

metropolitan area.

! Region II (South): Columbia, SC—

The three other rural States in the

South census region are Kentucky,

Mississippi, and West Virginia.

However, South Carolina's location

along a major drug trafficking corridor makes that State a strategic

choice. Recent cocaine seizures in

Columbia further highlight its

strategic importance.

! Region III (Midwest): Sioux Falls,

SD—Sioux Falls is the most populous metropolitan area within the

Midwest Region's two rural States

(North Dakota and South Dakota).

! Region IV (West): Billings, MT—

Montana is the only census-designated rural State in the West

Region, and Billings is its most

populous metropolitan area.

The remaining 12 sites were selected

to ensure that the entire list included

at least 2 sites from each of the 9

Census Bureau divisions (East North

Central, Mountain, Middle Atlantic,

New England, Pacific, South Atlantic,

South East Central, South West

Central, and West North Central).

Additional selection criteria included

population density, representation of

racial/ethnic minorities, and emphasis

on high drug trafficking areas. 

Applying these criteria resulted in the

final selection of the following 21

Pulse Check sites:

Baltimore, MD

Billings, MT

Birmingham, AL

Boston, MA

Chicago, IL

Columbia, SC

Denver, CO

Detroit, MI

El Paso, TX

Honolulu, HI

Los Angeles, CA

Miami, FL

Memphis, TN

New Orleans, LA

New York City, NY

Philadelphia, PA

Portland, ME

St. Louis, MO

Seattle, WA

Sioux Falls, SD

Washington, DC

How do the 21 sites vary 

demographically? Appendix 2

highlights the demographic diversity

of these 21 sites. For example, their

population density per square kilometer ranges from a sparse 18.6 in

Billings, MT, to a crowded 2,931.6 in

New York City. Their unemployment

rates range from a 1.7 low in Sioux

Falls, SD, to a 9.4 high in El Paso,

TX. The racial/ethnic breakdowns in

the 21 sites further exemplify their

diversity: White representation ranges

from 30.9 percent in Honolulu, HI,

to 97.8 percent in Portland, ME;

Black representation ranges from 0.5

percent in Billings, MT, to 42.4 percent in Memphis, TN; and Hispanic 

representation ranges from less than 1

percent in Birmingham, AL, and

Portland, ME, to 75.4 percent in El

Paso, TX.
APPENDIX 1: METHODOLOGY

page 100 Pulse Check: November 2001

What other data are available at

the 21 selected sites? Information

from other national-level data sources

will be useful for framing, comparing,

corroborating, enhancing, or explaining the information obtained for Pulse

Check. The following data sources,

listed in Appendix 3, are available in

nearly every site: ONDCP's past Pulse

Check reports; the National Institute

on Drug Abuse (NIDA) Community

Epidemiology Work Group (CEWG);

the Substance Abuse and Mental

Health Services Administration

(SAMHSA) Drug Abuse Warning

Network (DAWN); and the National

Institute of Justice (NIJ) Arrestee Drug

Abuse Monitoring (ADAM) program. 

Who are the Pulse Check

sources, and how were they

selected? Consistent with previous

issues, the information sources for

Pulse Check were telephone 

discussions with 4 knowledgeable

individuals in each of the 21 sites: 1

ethnographer or epidemiologist, 1

law enforcement official, and 2 treatment providers. Excluding the new

Baltimore recruits, the vast majority

of the 42 epidemiologists, ethnographers, and law enforcement sources

who reported for this issue of Pulse

Check were the same, or associated

with the same agencies, as those who

reported for the previous issue.

Ethnographers and epidemiologists

were recruited based on several possible criteria: past participation in the

Pulse Check program; membership in

NIDA's CEWG; research activities in

local universities; or service in local

community programs. We recruited

law enforcement officials by contacting local police department narcotic

units, Drug Enforcement Administration (DEA) local offices, and HIDTA

directors. 

To identify treatment sources for the

previous (Mid-Year 2000) issue of

Pulse Check, we randomly selected

providers from the 1998 Uniform

Facility Data Set (UFDS), a listing 

of Federal, State, local, and private

facilities that offer drug abuse and

alcoholism treatment services. For

this purpose, we excluded facilities

that reported more than 50 percent

of their clientele as having a primary

alcohol abuse problem, served a 

caseload of fewer than 100 clients, or

provided only prevention or detox

services. We then divided the remaining facilities into two groups—

methadone and non-methadone 

treatment facilities—in order to 

capture two client populations whose

demographic characteristics and use

patterns often differ widely. We

selected one from each of these two

categories of programs for each of the

20 selected sites. Because Billings,

MT, and Sioux Falls, SD, have no

UFDS-listed methadone treatment

facilities, we selected two nonmethadone facilities in those sites.

For this issue of Pulse Check, in order

to preserve continuity, we retained all

available treatment sources who

reported for the last issue. Additionally, to ensure regular reporting for

the future, any treatment provider

who was unavailable to participate

was replaced via purposeful, rather

than random, selection based on consultation with experts in the field.

Altogether, we recruited 43 treatment

sources: 20 methadone providers (2

from Boston, and 1 from each of the

other Pulse Check sites except for

Billings and Sioux Falls), and 23 nonmethadone providers (1 from each

Pulse Check site plus extra sources

from Billings and Sioux Falls to compensate for their lack of methadone

representation). 

Thus, a total of 85 sources were 

identified and recruited, and we 

successfully obtained information for

this Pulse Check issue from 83 of

them: a response rate of 98 percent.

The nonresponding participants were

the methadone treatment providers

from Baltimore and Memphis. A full

list of responding sources appears in

Appendix 4.

What kind of data were collected, and how? For each of the 83

responding sources, we conducted a

single telephone discussion lasting

about 1 hour. We asked sources to

explore with us their perceptions of

the change in the drug abuse situation

between spring 2000 and fall 2001.

We discussed a broad range topic

areas with these individuals, as 

delineated in Appendix 5. Not 

surprisingly, ethnographic and 

epidemiologic sources seemed to be

very knowledgeable about users and

patterns of use; they were somewhat

knowledgeable about drug availability; and they were less informed about

sellers, distribution, and trafficking

patterns. Treatment providers had a

similar range of knowledge, but they

generally focused on the specific populations targeted by their programs.

Some providers, however, were able

to provide a broader perspective

about the communities extending

beyond their individual programs.

Among the three Pulse Check source

types, law enforcement officials

appeared to be most knowledgeable

about drug availability, trafficking

patterns, seller characteristics, sales

practices, and other associated 

activities; they were, understandably,

less knowledgeable about user groups

and characteristics. 
APPENDICES 2 AND 3: SITE DEMOGRAPHICS AND OTHER DATA SOURCES

Pulse Check: November 2001 page 101

*Small = <300,000

persons; Medium =

300,000–1 million

persons; Large = 1

million–5 million persons; Extra Large =

>5 million persons

1

Includes Worcester,

Lawrence, Lowell,

Brockton MA-NH

2

Includes

Washington, DCMD-VA-WVA

3

Includes Los

Angeles-Long

Beach

4

Includes Seattle,

Bellevue-Everett, WA

a

1999

b

1998

c

1997

d

1990–1999

Note: Shaded boxes

indicate that selected

city is in a rural State.

SOURCE: 2001

County and City

Extra: Annual Metro,

City, and County

Data Book, Tenth

Edition. Eds: Gaquin,

D.A., and Littman,

M.S. Washington,

DC: Bernan Press

APPENDIX 2: POPULATION DEMOGRAPHICS IN THE 21 PULSE CHECK SITES

Race Percenta Violent Percent PopulaMSA American Asian Crime/ Persons Unem- tion Percent

Size* Indian and 100,000 Under18 ploy- Density/ PopuPulse Check (S, M, Eskimo Pacific Percent Popu- Below Pov- ment Square lation

Site L, X) White Black Aleut. Islander Hispanica lationb erty Levelc Rate KMa Changed

Boston, MA1 X 89.9 6.0 .2 3.9 5.7 505 15.2 3.1 353.3 3.8

New York City, NY X 61.3 28.9 .4 9.3 25.6 1,037 32.9 6.2 2,931.6 1.9

Philadelphia, PA-NJ L 76.5 20.1 .2 3.2 4.7 667 17.1 4.1 495.7 .6

Portland, ME S 97.8 .8 .3 2.6 2.0 730 16.6 4.0 368.7 4.6

Baltimore, MD L 69.1 28.0 .3 .6 .8 581 19.4 3.1 110.9 8.9

Birmingham, AL M 70.4 28.9 .2 .6 .8 581 19.4 3.1 110.9 8.9

Columbia, SC M 68.7 29.6 .2 1.5 2.1 868 19.2 2.5 136.8 13.8

El Paso, TX M 94.5 3.4 .5 1.5 75.4 668 38.6 9.4 267.5 18.6

Memphis, TN L 56.3 42.4 .2 1.2 1.3 1,081 21.4 3.6 141.9 9.7

Miami, FL L 77.6 20.4 .3 1.8 57.4 1,532 29.6 5.8 432.0 12.3

New Orleans, LA L 62.6 34.9 .3 2.2 5.2 918 26.4 4.4 148.2 1.6

Washington, DC2 L 67.7 25.3 .3 6.7 7.6 537 12.8 2.6 281.1 12.2

Chicago, IL X 75.8 19.3 .2 4.6 14.8 NA 17.2 4.1 610.5 8.1

Detroit, MI L 74.9 22.6 .4 2.0 2.5 870 19.1 3.5 433.3 4.9

Sioux Falls, SD S 96.9 0.8 1.5 0.8 0.9 252 11.4 1.7 45.8 18.1

St. Louis, MO-IL L 80.8 17.6 .2 1.3 1.5 NA 16.4 3.7 155.2 3.1

Billings, MT S 95.5 .5 3.3 .6 3.3 187 16.8 4.0 18.6 12.2

Denver, CO L 89.8 6.2 .8 3.1 14.9 385 13.4 2.4 203.2 21.9

Honolulu, HI M 30.9 3.6 .5 65.0 7.4 268 14.8 4.9 556.4 3.4

Los Angeles, CA3 X 74.8 11.2 .6 13.4 44.4 1,027 30.5 5.9 887.3 5.3

Seattle, WA4 L 84.7 4.7 1.3 9.3 4.3 419 11.7 3.4 203.7 14.8

West Midwest South Northeast

APPENDIX 3: NATIONAL-LEVEL DATA SOURCES AVAILABLE IN THE 21

PULSE CHECK SITES

1

High Intensity Drug Trafficking Area of the

Drug Enforcement Administration (DEA)

2

Community Epidemiology Work Group of

the National Institute on Drug Abuse (NIDA)

3

Drug Abuse Warning Network of the

Substance Abuse and Mental Health

Services Administration (SAMHSA)

4

Arrestee Drug Abuse Monitoring program 

of the National Institute of Justice (NIJ)

Note: Shaded boxes indicate that selected

citiy is in a rural State.

Pulse Check Site HIDTA1 State CEWG2 DAWN3 ADAM4

Boston, MA ! !!

New York, NY ! ! !!

Philadelphia, PA ! !!

Portland, ME !

Baltimore, MD ! !!

Birmingham, AL ! !

Columbia, SC

El Paso, TX ! !

Memphis, TN !

Miami, FL ! ! !!

New Orleans, LA ! ! !!

Washington, DC ! ! !!

Chicago, IL ! ! !!

Detroit, MI ! ! !!

Sioux Falls, SD !

St. Louis, MO ! !!

Billings, MT

Denver, CO ! ! !!

Los Angeles, CA ! ! !!

Honolulu, HI ! !

Seattle, WA ! ! !!

West Midwest South Northeast
APPENDIX 4: PULSE CHECK SOURCES

page 102 Pulse Check: November 2001

Pulse Check Site Epidemiology/Ethnography Law Enforcement 

Baltimore, MD James Peterson Richard Hite

Johns Hopkins University Baltimore Police Department

School of Public Health 

Billings, MT Ernesto Randolfi, Ph.D. Scott Forshee

Montana State University at Billings City/County Special Investigations Unit

Department of Health and Physical Education 

Birmingham, AL Foster Cook Sergeant T.E. Thrash

University of Alabama Birmingham Police Department Vice and Narcotics Division

Boston, MA George Arlos Lieutenant Francis W. Armstrong, Jr.

Substance Abuse Treatment Boston Police Department

and Prevention Services Drug Control Division

Chicago, IL Larry Ouellet, Ph.D. Chicago Police Department

University of Illinois at Chicago Organized Crime Division, Narcotic

School of Public Health and Gang Investigations Section

Columbia, SC Dennis Nalty, Ph.D. Columbia Police Department

Department of Alcohol and Organized Crime and Narcotics Unit 

Other Drug Abuse Services

Denver, CO Bruce D. Mendelson, M.P.A. Curt Williams, B.S.

State Treatment Needs Assessment Contract Denver Police Department

Colorado Department of Human Services

Alcohol and Drug Abuse Division 

Detroit, MI Richard F. Calkins Southeast Michigan HIDTA

Michigan Department of Community Health

Division of Substance Abuse Quality and Planning

El Paso, TX Tessa Hill, M.A. Jeff Cole

Aliviane, Inc. El Paso Police Department, Narcotics Unit 

Honolulu, HI D. William Wood, Ph.D., M.P.H. Lieutenant Mike Moses

University of Hawaii Narcotics, Vice Division

Department of Sociology Honolulu Police Department 

Los Angeles, CA Richard Rawson, Ph.D. Criminal Intelligence Group

University of California, Los Angeles Los Angeles Police Department

Integrated Substance Abuse Programs (ISAP) 

Memphis, TN Randolph Dupont, Ph.D. Fred Romero

Department of Psychiatry Memphis Police Department

University of Tennessee Vice Narcotics Unit 

Miami, FL James N. Hall Prefers anonymity 

Up Front Drug Information Center 

New Orleans, LA Gail Thornton-Collins Lieutenant Commander Bruce Adams

New Orleans Health Department Narcotics Major Case Section

New Orleans Police Department 

New York, NY John A. Galea, M.A. Drug Enforcement Administration

New York State Office of Alcoholism New York Division 

and Substance Abuse Services 

Street Studies Unit 

Philadelphia, PA Samuel J. Cutler Drug Enforcement Administration

Philadelphia Behavioral Health System Philadelphia Field Division

Coordinating Office for Drug Divisional Intelligence Group 

and Alcohol Abuse Programs

Portland, ME Nate Nickerson, R.N., M.S.N. George Connick

Public Health Division, Augusta Field Office/ Maine Drug Enforcement Agency 

Department of Health and Human Services

City of Portland 

Seattle, WA Thomas R. Jackson, M.S.W. Steve Freng

Evergreen Treatment Services High Intensity Drug Trafficking Area 

Sioux Falls, SD Prairie View Prevention Services Jerry Mundt & Lieutenant Doug Barthell 

Sioux Falls Police Department

Narcotics Division 

St. Louis, MO James M. Topolski, Ph.D. Detective Leo Rice

Missouri Institute of Mental Health St. Louis Police Department

Narcotics Division 

Washington, DC Alfred Pach, Ph.D., M.P.H. Sergeant John Brennan

National Opinion Research Center Washington, D.C. Police Department

Major Narcotics
APPENDIX 4: PULSE CHECK SOURCES

Pulse Check: November 2001 page 103

Pulse Check Site Non-Methadone Treatment Methadone Treatment 

Baltimore, MD Ruth Daiker Nonrespondent

Jones Falls Community Corporation 

Billings , MT Mona Sumner Illegal in the State of Montana

Rimrock Foundation 

Deena Vandersloot

South Central Mental Health Center

Journey Recovery Program

Birmingham, AL Eleanor D. Powers Bill Garrett, M.P.H.

Program prefers anonymity University of Alabama 

Birmingham Substance Abuse Program 

Boston, MA Jim Sweeney Joanne Swindell

Gavin House CAB Health and Recovery Services

Patrick Griswold

NCIA 

Chicago, IL Del Larkin Terrie Matthes

Association House of Chicago Cornell Interventions

Columbia, SD Bryan Fox Jim Van Frank

Palmetta Baptist Medical Center Columbia Metro Treatment Center 

Denver, CO Tim McCarthy Pamela J. Manuele, RN, BSN, ANPC, CCJS

Arapahoe House Comprehensive Addiction Treatment Services

Detroit, MI Renaissance West Community Health Services Octavius Sapp, C.A.C.

City of Detroit, Department of Human Services

Drug Treatment 

El Paso, TX Armando Salas Julie Renteria, L.V.N.

Aliviane Men’s Residential Facility El Paso Methadone Maintenance

and Detox Treatment Center 

Honolulu, HI Andy Anderson Lisa Cook

Hina Mauka Recover Center Drug Addiction Services of Hawaii 

Los Angeles, CA Mari Radzik, Ph.D. Wynnell Domeniguez

Substance Abuse Treatment Program West Los Angeles Treatment Program 

Division of Adolescent Medicine 

Children’s Hospital of Los Angeles 

Memphis, TN Sharon Davis Nonrespondent

Frayser Family Counseling Center 

Miami, FL Michael Miller Prefers anonymity

The Village South, Inc. 

Addiction Treatment Center 

New Orleans, LA Eleanor Glapion DRD Clinic

New Orleans Substance Abuse Clinic 

Bronx, NY Narco Freedom Eugenia Curet, Ph. D.

Adult Service Clinic

The New York Presbyterian Hospital 

Philadelphia, PA C. Joseph Schultz, M.Ed. Peter A. Demaria, Jr., M.D., FASAM

Northeast Treatment Department of Psychiatry and Human Behavior

Jefferson Medical College 

Portland, ME Stephen Leary Discovery House Maine

Milestone Foundation, Inc. 

Seattle, WA Ramona Graham Victoria Evans

Center for Human Services Therapeutic Health Services 

Sioux Falls, SD Robin Erz, CCDCIII

Turning Point Alcohol and Drug Center Illegal in the State on South Dakota 

Keystone Treatment Center 

St. Louis, Missouri Mike Morrison Chris Johnson

Bridgeway Counseling DART 

Washington, D.C. Prefers anonymity LaTonya Sullivan

Umoja Treatment Center 
APPENDIX 5: DISCUSSION AREAS

page 104 Pulse Check: November 2001

APPENDIX 5: DISCUSSION AREAS BY SOURCE TYPE*

Topic L E M N 

SNAPSHOT 

How serious is the current illegal drug problem in your community? !!!!

How has the illegal drug problem changed in your community? !!!!

THE PERCEPTION 

What is the most commonly abused drug in your community during the current reporting period? !!!!

Second most commonly abused drug? What drug is related to the most serious consequences? 

Second most serious consequences? Is any new problem drug appearing in your community? 

What was the most commonly abused drug in you community during the last reporting period? !!!!

Second most commonly abused drug in your community? What drug was related to the most 

serious consequences last reporting period? Second most serious consequences? 

THE DRUG** 

How available is the drug in your community (for each drug, asks about various forms)? ! !

How has availability changed? ! !

What are the most common and second most common units of sale and corresponding standard units of the drug? !!!!

What is the purity range for the drug during the current reporting period? During the last reporting period? ! !

What is the price range during the current reporting period? During the last reporting period? ! !

What is the source for your price and purity information? ! !

Why have price and purity changed or why have they remained stable? ! !

What are the street names, and are any of these new this reporting period? !!!!

What types of packaging are used, and are any of these new this reporting period? ! !

Are labels or brand names used? If yes, please list and indicate if any are new this reporting period. ! !

Are there any adulterants? If yes, please list and indicate if any are new this reporting period. !!!!

Have there been any changes in street names, packaging, labels, or adulterants since the last reporting period? ! !

If yes, please describe. 

THE SALE** 

How is the drug manufactured, processed, or grown? ! !

What is the source country or point of origin? ! !

What are the transshipment cities? ! !

What is the point of entry? ! !

What is the final destination city or region? ! !

Have there been any changes in manufacturing process or trafficking since the last reporting period? ! !

If yes, please describe. 

What is the predominant affiliation of local, street-level sellers? ! !

How likely are sellers to use their own drugs? ! !

How involved in other crimes are sellers? ! !

In what type of other crimes are sellers involved? ! !

Have there been any changes in seller characteristics since the last reporting period? If yes, please describe. ! !

Are there any new sellers groups this reporting period? If yes, please describe. ! !

What is the geographical area where most street-level sales of the drug occur? ! !

Is the drug sold mostly indoors, outdoors, or evenly split between both? ! !

In what settings is the drug sold? ! !

How is the drug sold? ! !

Are other drugs sold by this type of dealer? If yes, please list the drugs. ! !

Have any of the drugs sold with this drug changed since the last reporting period? If yes, please describe. ! !

What are any other distinctive features of the drug scene in your area? ! !

Have any of the drug scene characteristics changed since the last reporting period? If yes, please describe. ! !

(special

section

only)
APPENDIX 5: DISCUSSION AREAS

Pulse Check: November 2001 page 105

THE USERS: Predominant characteristics** 

L E M N 

What is the predominant age range of the drug users? !!!

What is the predominant gender? !!!

What is the predominant racial/ethnic group? Is this group underrepresented, overrepresented, !!!

or about equal compared with the general population in your area? 

What is the predominant socioeconomic position? !!!

What is the most common geographical residence? !!!

What is the predominant route of administration? !!!

What are the drugs commonly taken in combination with this drug, including any street names for the !!!

combination or practice? 

Is the drug used mostly indoors or outdoors? !!!

Is the drug used mostly in public or in private? !!!

Is the drug used mostly alone or in groups/among friends? !!!

What are the common settings for the use of this drug? !!!

What are the unusual settings or contexts for the use of this drug? !!!

What is the most common referral source? ! !

What is the predominant education level? ! !

What is the most common frequency of use? ! !

What is the predominant employment status? ! !

THE USERS: New or emerging users** 

How did the number of new or emerging users change since the last reporting period? If increased, !

repeat the first 12 questions under “the users: predominant characteristics” for the new/emerging user group. 

How did the number of novice users in your program change since the last reporting period? ! !

If increased, repeat all questions under “the users: predominant characteristics” for the novice user group. 

METHADONE DIVERSION/TREATMENT 

To what extent is there a methadone diversion problem from treatment programs in your community? !

How has the diversion problem changed since the last reporting period? !

Is illegal methadone transported into your community from other areas? !

Who has been selling diverted methadone? !

How is it sold? !

Who has been buying diverted methadone? !

What is the availability of methadone treatment in your community? !

How has treatment availability changed since the last reporting period? !

What is the capacity of public methadone treatment? Private methadone treatment? !

How has the capacity of public methadone treatment changed since the last reporting period? !

Private methadone treatment?

COMMUNITY CONTEXTS 

Were there substantial changes or issues involving (treatment availability or waiting time, drug-related hospital ! !

medical emergencies, drug-related deaths, large drug seizures, targeted law enforcement policy directives or 

initiatives, community policing, new sentencing practices, new joint task forces, new legislation, new community 

education or prevention programs, new public service campaigns, drug-related news events, other)? 

If yes, please describe. 

How did medical, political, criminal, or societal changes or issues (listed above) impact your community’’s ! !

overall drug abuse problem? 

Have drug-related consequences (HIV/AIDS, hepatitis C, liver cirrhosis, drug-related automobile accidents, ! !

high-risk pregnancy, drug overdoses, alcohol DTs, tuberculosis, other) increased, decreased, or remained 

stable since the last reporting period? If changed, explain. 

Have any of the psychiatric comorbidity diagnoses (conduct disorder, psychosis, mood disorders, suicidal ! !

thoughts/attempts, other) increased, decreased, or remained stable as a concern among your clients since 

last reporting period? If changed, explain. 

Do any potential barriers (limited slot capacity, lack of trained staff to treat comorbid clients, ! !

violent behavior among presenting clients, age restrictions, other) prevent your program from serving all 

individuals who seek treatment? If yes, explain. 
APPENDIX 5: DISCUSSION AREAS

page 106 Pulse Check: November 2001

COMMUNITY CONTEXTS (continued)

L E M N 

Have any factors (law enforcement referral patterns, waiting lists, treatment funding slot capacity, ! !

access to treatment at other local programs, program outreach, media attention, availability, purity, 

overdoses just prior to treatment, withdrawal just prior to treatment, adulterants, route of administration, 

other drugs used concurrently, other drugs used by clients, other) contributed to increases or decreases in 

your program’’s number of admissions related to any specific drug? If yes, describe. 

Have any legal issues (nonviolent offenses, violent offenses, gang-related activity, prostitution, ! !

drug-assisted rape, domestic violence, DUI/DWI, other) increased or decreased as concerns among your 

clients since the last reporting period? If yes, describe. 

TREATMENT BACKGROUND 

What is your program’s maximum capacity? ! !

What is your current enrollment? ! !

Does your program’s clientele reflect the population of your local community? If no, please describe. ! !

SPECIAL TOPIC: SYNTHETIC OPIOIDS

All the above topics in “the drug,” “the sale,” and “the users: predominant characteristics” section were discussed about diverted/abused

synthetic opioids (specify). In addition, the following topics were discussed: 

L E M N 

How serious is the problem in your community? !!!!

How has the problem in your community changed since the last reporting period? !!!!

What are the sources of illicit distribution of the drug? ! !

Are there a substantial number of impaired health care professionals using the drug in your community? !!!

If yes, explain. 

Is the drug continually on the illicit drug market or does it emerge periodically? ! !

Is there prevalence for opioid-naive adolescents in your community? If yes, explain. !!!

Are highly tolerant or experienced opioid abusers using? If yes, explain. !!!

Is the drug used to replace heroin, used with heroin, or is its use not associated with heroin use? !!!

Is the user population in your community new this reporting period? !!!

In your opinion, has the media overemphasized, underplayed, or reflected accurately the problem !!!!

in your community? 

Have there been any related health consequences, comorbidity/dual diagnoses, barriers to treatment, ! !

or legal issues related to the drug’s abuse? 

L

Law enforcement

E

Epidemiologic/ethnographic

MMethadone treatment

NNon-methadone treatment 

*Please note that for the methadone and non-methadone treatment interviews, “community” was replaced with “program.”

**Respondents were asked about heroin, crack cocaine, powder cocaine, methamphetamine, marijuana, ecstasy, GHB, ketamine, Rohypnol, 

hallucinogens (specify), and any other drugs (specify) for each of the discussion areas.