THE SENTINEL: Cheese: Starter Heroin for Youth

The epidemic of substance abuse and addiction continues to grow in America. Tragically, the methods are increasing and the age of abusers is decreasing. According to an April 26, 2007 USA report, "Cheese" is being served not only in high schools but even in middle schools in Texas.

While it may sound harmless, "Cheese" is a toxic mix of heroin and Tylenol PM. Young people find "Cheese" particularly appealing since it is only $2.00 a "bump" Like cocaine, it is snorted and is highly addictive.

[Reprinted from the Gulf Coast Addiction Technology Center Website – http://www.utexas.edu/research/cswr/gcattc/]

"Cheese" Heroin: Status as of May 2, 2007
By Jane C. Maxwell, Ph.D.
Senior Research Scientist
Gulf Coast Addiction Technology Transfer Center
The University of Texas at Austin

The media has been reporting on "Cheese" heroin for about a year. It was reported in the June 2006 Texas Drug Trends report to NIDA's Community Epidemiology Work Group and it has been described in DEA's microgram. "Cheese heroin" is Black Tar heroin which has been turned into brown heroin powder by mixing the Tar with Tylenol PM^®, which is acetaminophen and diphenhydramine (such as Benedryl^®). Diphenhydramine has traditionally been used as a "cut" to turn Tar into powder, but there seems to be no explanation why "Cheese" heroin contains the more expensive Tylenol PM^® rather than the generic diphenhydramine.

Deaths. Because each county has its own medical examiner or justices of the peace to sign death certificates, there is no realtime centralized reporting of death data. The press has published various numbers, and the Dallas County Medical Examiner at the end of March, 2007, reported no deaths in 2005 involving heroin+diphenhydramine+acetaminophen. There were two deaths involving this combination of drugs in 2006, and none as of the end of March, 2007. The Dallas Medical Examiner is reexamining the death data to determine the number of deaths involving heroin and other substances.

Poison Control Center Cases. The Texas Poison Control Centers data on human exposure to heroin, acetaminophen, and diphenhydramine in combination show one case in 1998, four in 2001, one in 2002, two in 2003, one in 2004, none in 2005, and 10 in 2006. Between 1998 and 2005, the age range was 1736, average 21.6 years. and during this period, there was one case in Dallas and one in adjoining Cooke County. The other cases were spread around the state in Corpus Christi, Amarillo, and Lubbock. The exposure reason for seven of the 19982005 cases was intentional, suspected suicide. The 10 cases in 2006 were all in Dallas and ages ranged from 1348. Average was 21.1 years, but six of the cases were teenagers, with a 13 year old, two 14 year olds, one 15, and one 16. Seven of the 2006 cases were male. Eight of the 10 cases were intentional abuse.

In 2007, four cases had been reported to poison control centers through March (reporting may be incomplete). Of these, ages ranged from 1118, average of average age of 14.5. Two of the cases were from Dallas, one from Denton County, and one from Hockley County, which is west of Lubbock. Three of four cases were males. Intentional abuse was the exposure reason for the four cases to date in 2007. No deaths were reported in any of the poison control center cases between 1998 and March, 2007.

Inhaling/"Snorting" Heroin. A rumor has persisted for years that "if you inhale heroin, you will not get addicted." This is untrue, and in Texas, the average lag between first inhaling of heroin and entrance to treatment is seven years. Mexican black tar may be sticky like roofing tar or hard like coal. The most common route of administration of black tar is injection. Mexican brown powder may be either a powdered heroin produced in Mexico, or it may be black tar that has been turned into a brown powder by local dealers or users by adding a diluent. Because of its oily, gummy consistency, special steps are required to convert the heroin into a powder that can be inhaled. Diluents ("cuts") can include dormin, mannite (mannitol), lactose, Benedryl^®, Nytol, baby laxative, vitamin B, and coffee creamer. Tar heroin can be frozen, the "cut" added, and then pulverized or ground into a powder in a coffee grinder or with mortar and pestle. It can also be dried out on a plate over the stove or under a heat lamp prior to pulverizing. Because brown powder is diluted, it is reported to be preferred by novices and users who fear overdoses.

The newspapers have reported use of “Cheese heroin” with “Monkey Juice,” which is also called Agua de Chango or Monkey Water. This is a mix of heroin with water that is then drawn up in a syringe (with or without needle) and shot it up the nose, or used with a nose dropper. This method has been common among young users for over a decade.

America's substance abuse problem must be fought on many fronts. Law enforcement, educators, corporations and especially parents must join forces to take back our communities from the drug abuse that continues to unleash its destructive force.

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