NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

injected in a “speedball.” These estimates were very
similar to the focus group responses throughout 2002.
In the autumn of 2004, crack users continued to report
frequent use in combination with 40-ounce bottles of
malt liquor, beer, wine, or other drugs, including alprazolam
(Xanax), marijuana, or heroin. Powder cocaine,
cigarettes, and methamphetamine were less frequently
mentioned as drugs used with crack.
Heroin/Morphine
According to the Drug Enforcement Administration’s
Domestic Monitor Program, the average street-level
purity of heroin in Philadelphia was 71.0 percent in
2001, 66.3 percent in 2002, 59.6 percent in 2003, and
53.0 percent in the first half of 2004 (based on only
70 percent of the samples analyzed). The authors
pose that a possible explanation for the aforementioned
increase in the average number of drugs in
mortality and hospital emergency departments since
2001 is the decreasing potency of the heroin available
at the retail/street level. With lower heroin purity,
users may perceive a need for more drugs to achieve
the desired effect.
Unweighted data accessed from DAWN Live! show
that heroin reports in hospital emergency departments
ranked third (behind cocaine and alcohol) among all
drugs in cases categorized as “seeking detox,” “overmedication,”
or “other” in the first half of 2004
(n=1,030) (exhibit 1). Among these patients, 65 percent
were male, 65 percent were White, 23 percent
were African-American, 9 percent were Hispanic, and
3 percent were not specified. Thirty-five to 44-yearolds
represented the plurality of these patients with 24
percent. The second largest group was 25–29-yearolds,
accounting for 19 percent.
Heroin was detected in 2,947 decedents from 1994
through June 2004, making it the second most commonly
detected drug in decedents (exhibit 2). For the
4-year period 1999 through 2002, positive heroin
toxicology reports occurred in 47 percent of all
deaths with the presence of drugs. In 2003 and the
first half of 2004, heroin was detected in only 25 and
27 percent, respectively, of all decedents with drugpositive
toxicology reports.
From 2000 through 2002, heroin alone was identified
in 14, 11, and 10 percent of the respective heroin toxicology
reports. In 2003 and the first half of 2004, heroin
alone was identified in 7 and 2 percent, respectively,
of the heroin toxicology reports. The combination
of heroin and cocaine was detected in 20, 19, and
17 percent of all decedents, respectively, from 2000
EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Philadelphia
through 2002, and only 10 percent of drug-positive
toxicology reports in 2003. Cocaine was detected in 47
percent of heroin toxicology reports in the first half of
2004.
In 2003 and the first half of 2004, heroin treatment
admissions ranked highest of all drugs mentioned as a
primary drug of abuse (exhibit 4). Heroin admissions
accounted for 22 percent of all admissions in 2002, 27
percent in 2003, and 28 percent in the first half of
2004. During 2003, 66 percent of all treatment admissions
for heroin, illegal methadone, and other opiates
were male; in the first half of 2004, 65 percent were
male (exhibit 6). In the first half of 2004, 62 percent
were White, 25 percent were African-American, 11
percent were Hispanic, and 2 percent were
Asian/other. Individuals who identified heroin as the
primary drug of abuse in 2003 used an average of 1.63
drugs; in the first half of 2004, the average was 1.61.
As depicted in exhibit 6, the preferred routes of administration
for heroin, illegal methadone, and other
opiates have been relatively stable among treatment
admissions. Within the “swallowed” route, the increasing
numbers that began in 2001 reveal that users
of pharmaceutically produced synthetic opiates entered
treatment.
Heroin treatment admissions data from the second
half of 1997 through the first half of 2004 revealed
that there was a slow, but steady decline in the percent
of heroin injectors entering treatment. It was
determined that the injection percentages were influenced
by an influx of relatively new users who entered
treatment for the first time prior to converting to
injection from intranasal use, which is characteristic
of new users. However, most heroin users make the
conversion to injecting prior to entering treatment for
the first time.
Urinalysis data of booked arrestees from Philadelphia’s
APPD in the first half of 2004 showed that 6.6
percent (n=1,655) of the 25,178 tested arrestees in the
sample were positive for opiates. Opiates were the
third most frequently detected drugs behind marijuana
and cocaine.
Key informants continued to report that the $10 bag of
heroin remained the standard unit of purchase. The
$10 bag usually yields one hit; $5 and $20 bags reportedly
remain available. According to the National
Drug Intelligence Center, the retail/street-level price
for heroin was $10–$20 per bag, $180–$250 per bundle,
and $65–$300 per gram in the first half of 2004.
Focus group participants in 2004 reported that the average
age of new users is 20. All groups since autumn
Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 185