"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
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
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.