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Abuse

Heroin has overtaken cocaine as the drug of choice among users entering Massachusetts treatment centers. Primary heroin admissions account for the largest percentage by far of illicit drug admissions in Greater Boston and the state. Thirty-four percent of admissions to drug treatment centers in Boston in the first three quarters of FY1999 used heroin or other opiates in the month prior to admission, up from 32 percent in FY1998 and 28 percent in FY1997. This rise followed 2 years of stability (29% in FY1995, 28% in FY1996). Admissions for heroin or other opiates for the first three quarters of FY1999 were lower only than those for alcohol (59%); they were higher than powdered and crack cocaine admissions (31%) for the second straight year, and were significantly higher than those for marijuana (14%) and all other drugs combined (9%). The percentages and patterns for the remainder of Massachusetts were similar: 31 percent of admissions reported using heroin or other opiates in the month prior to admission, up from 29 percent in FY1998, 25 percent in FY1997 and FY1996, 23 percent in FY1995, and 21 percent in FY1994. Admissions for heroin and other opiates were lower only than those for alcohol (57%); they were higher than powdered and crack cocaine (22%) for the third straight year, and were significantly higher than marijuana (18%) and all other drugs combined (10%).

According to DAWN data, ED heroin/morphine mentions in Boston viewed as a percentage of total drug mentions were second to cocaine mentions every year during the 1990s except in 1998 when they fell to a close third behind marijuana/hashish. The percentage of heroin/morphine mentions rose in 1995, rose again in 1996, and remained stable in 1997 and 1998, a total increase of approximately 3 percent. Total ED heroin/morphine mentions were relatively constant from 1995 through the first half of 1999, as well. The patterns of heroin use in Boston appear to parallel other areas of the country. Since 1996, Boston has ranked either eighth or ninth in heroin/morphine mentions per 100,000 population among the 21 cities nationwide from which DAWN reports data.

Chart 1. Emergency Department Mentions, Boston 1990-1998

Cocaine    Heroin/morphine      Marijuana/hashish
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Source: Drug Abuse Warning Network, Emergency Department Data, 1990-1998.

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Heroin overdoses have become a significant problem in Massachusetts. The Boston Medical Center reports that heroin-related overdoses are on the rise,¹⁴ and police data and news reports from other cities in Massachusetts indicate that overdoses have increased statewide. The city of Lynn experienced notable increases in the number of heroin overdose deaths prior to 1999. Thirty fatal and 206 nonfatal overdoses were recorded in Lynn from 1996 to late 1999, and the rate of deaths from heroin was twice the city's homicide rate in 1999. In the Merrimack Valley, the death rate from heroin has remained steady since 1992, except for a spike in 1995 when "bad" heroin was known to be circulating in the area. Law enforcement indicates that Lynn, South Boston, and Worcester are the three areas in the eastern half of Massachusetts with the greatest heroin overdose problem. In general, there are at least four explanations why heroin overdoses occur: (1) heroin is often mixed with toxic additives including scopolamine and ketamine; (2) purity is variable and unpredictable; (3) users often co-use benzodiazepines, synthetic opiates, cocaine, or alcohol; and (4) users who have recently left heroin treatment have a lower tolerance for the drug.

Among admissions to state-funded substance abuse treatment centers in the first three quarters of FY1999 reporting heroin as their primary drug, 88 percent reported using at least one other drug in the month prior to treatment. This rate of polysubstance use among primary heroin users was higher than for users of any other primary drug. The most common secondary drug reported was alcohol (32%), followed by cocaine (17%). Polydrug heroin users admitted to treatment centers in Boston in 1998 and 1999 reported using heroin with benzodiazepines (e.g., Valium, Xanax), synthetic opiates, cocaine, and alcohol.

According to the Massachusetts DPH, substance abuse treatment centers in Boston provided the following data for admissions in the first three quarters of FY1999 who reported heroin or opiates as their primary drug:

• 73 percent were male, marginally higher than any of the previous 4 years.
  
• 48 percent were Caucasian, 24 percent were African American, 23 percent were Hispanic, and 5 percent were other races/ethnicities, percentages consistent with the previous 3 years.
  
• 42 percent were aged 30 to 39, 28 percent were 19 to 29, and 24 percent were 40 to 49, percentages consistent with the previous 4 years.
  
• 91 percent earned less than $10,000 per year, a percentage consistent with the previous 4 years, and 28 percent were homeless, a percentage consistent with the previous 2 years.
  
• 21 percent had some involvement with the criminal justice system, a percentage consistent with the previous 3 years.
  
• 20 percent reported a mental health problem, a percentage consistent with the previous 2 years.

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Heroin does not appear to be a popular drug among youths in Massachusetts. Only 3.8 percent of Massachusetts high school students assessed by the 1999 Youth Risk Behavior Surveillance survey reported ever using heroin, a lower percentage than for any other drug surveyed (marijuana, inhalants, cocaine, methamphetamine, and steroids). (See Chart 2.) The patterns of use were similar in Boston, but the user percentages were markedly lower: heroin still ranked last, but only 1.4 percent reported ever using heroin. (See Chart 3.) Most adolescents in focus groups reported little use or awareness of heroin compared to marijuana, diverted prescription drugs, LSD (lysergic acid diethylamide), and MDMA. However, the Bureau of Substance Abuse Services reports that statewide, the percentage of heroin users aged 18 or younger entering treatment rose from 4 percent in FY1992 to 13 percent in the first three quarters of FY1999.

Chart 2. Massachusetts High School Student Drug Use

Marijuana  Inhalants  Cocaine  Methamphetamine  Steroids  Heroin
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Source: U.S. Department of Health and Human Services, Centers for Disease Control, Youth Risk Behavior Surveillance-United States 1999.

Chart 3. Boston High School Student Drug Use

Marijuana  Inhalants  Cocaine  Methamphetamine  Steroids  Heroin

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Source: U.S. Department of Health and Human Services, Centers for Disease Control, Youth Risk Behavior Surveillance-United States 1999.

Among admissions to state-funded substance abuse treatment centers in the first three quarters of FY1999 reporting heroin as their primary drug, 63 percent preferred injection, 33 percent snorting, and 4 percent other methods of administration. The cities in northeastern Massachusetts report high rates of heroin injection, too, including Boston where injection was reported as the method of administration in 73.3 percent of heroin ED mentions in 1998. Some reporting indicates that heroin injection in Massachusetts has dropped and heroin smoking and snorting has risen, including among youths; however, treatment providers point out that users commonly progress from smoking and snorting to injection because a smaller amount of injected heroin provides the same high. Most users taking advantage of needle exchange programs in Boston are traditional users who have injected heroin for many years. However, exchange programs in Cambridge and Northampton (western Massachusetts) have seen an increase in younger heroin injectors.

Injection drug use accounted for 36 percent of new AIDS (Acquired Immune Deficiency Syndrome) cases reported between May 1 and October 31, 1999, the highest proportion for any category of AIDS transmission.

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DEA reports a significant increase in the availability of heroin in Massachusetts. The number of documented heroin distribution offenses in Massachusetts rose 11 percent in 1999 to 395, and the number of documented heroin trafficking offenses rose 32 percent to 108. The number of documented heroin possession offenses dropped 4 percent to 153. Most heroin in New England is of South American origin, although Southeast Asian and Southwest Asian heroin were the most common in the early 1990s. Heroin is the top priority for the U.S. Attorney's Office in Boston. Law enforcement tries to target repeat offenders in the state, especially those with two prior convictions, who can be sentenced to 12 or more years in prison according to state drug laws.

Law enforcement in Massachusetts and throughout New England reports a significant increase in the availability and purity of heroin. Heroin purity levels in Massachusetts range from 50 percent to 90 percent. DEA's Domestic Monitor Program (DMP) indicates that the average purity of South American heroin in Boston in 1999 was 57.7 percent at the street level, down for the second straight year following levels of 66.4 percent in 1997 and 61.4 percent in 1998.¹⁵ However, purity levels in Boston far exceeded the national average every year from 1991 to 1999. Retail-level heroin purity averaged 67.5 percent from April to June 1999, second highest on the East Coast for that period. Street-level heroin more than 90 percent pure is available in Boston and Lawrence, although 60 percent or more is the average. Analyses of several heroin exhibits seized in Lynn in 1998 revealed purity near 90 percent.¹⁶

As the purity of heroin has increased, the prices have dropped. Heroin sold for $3,000-$5,000 per ounce (28.3 grams) from October 1998 to March 1999. Prices then dropped to $2,500-$3,100 per ounce from April to September 1999. Gram quantities now cost $90-$125, half-grams sell for $60 or more, and glassine bag¹⁷ prices range from $4 to $30 with the purity often over 60 percent and sometimes as high as 90 percent. Bundles (10 glassine bags) cost $50-$200, and bricks (100 glassine bags) cost $200-$1,000. Springfield law enforcement authorities report prices of $100,000 per kilogram at 80 percent pure, and Lowell authorities report prices of $88,000 per kilogram at 80 percent pure (all figures stable over the past year). Prices in Lawrence and Lowell are reported to be "extremely low"; glassine bags sell at the street level for $5-$11, with $8 being the average price.

Heroin trafficking, distribution, and use are strongly associated with violent crime in Massachusetts. Some heroin traffickers and distributors commit violent acts while protecting or expanding their market area, others when stealing heroin or protecting their heroin from being stolen. Traffickers and distributors engage in "turf wars" and commit robberies because heroin is an extremely valuable black-market commodity. Some abusers act violently when stealing money or property that they need to buy heroin for personal use. Heroin use often causes physical or psychological dependence, and addicts without money often steal to support their drug habit. Law enforcement in Massachusetts reports a strong link between the trafficking and abuse of heroin and property crimes, including breaking and entering and shoplifting. Some violence in Massachusetts could also be drug-enhanced reactions by users under the influence of heroin's psychoactive effects. Although opiate consumption tends to temporarily inhibit violent behavior, withdrawal often results in exaggerated aggressive and defensive behavior.

There have been no reports of opium cultivation or heroin production in Massachusetts, although heroin is commonly "milled" (broken down from kilograms into user quantities) in places where wholesale activity occurs. Currently, most heroin in New England is of South American origin; Southeast Asian and Southwest Asian heroin, the most common in the early 1990s, are not often seen in Massachusetts. Some Southeast Asian heroin arrives by air from Europe. In September 2000, law enforcement seized approximately 22 pounds of Southwest Asian (Pakistani) heroin arriving at Logan International Airport from Islamabad, but such a seizure is an anomaly in type of heroin and size. All heroin tested by the DMP in Massachusetts in 1999 from which a signature could be derived originated in South America.¹⁸ DEA reports that Mexican black tar heroin is not commonly seen in Massachusetts either.

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The Greater Boston area--including the nearby cities of Lawrence, Lowell, and Lynn--is Massachusetts' primary regional distribution center for heroin transportation. Colombian and Dominican wholesalers arrange for the transportation of multihundred kilogram amounts of heroin into the metropolitan area and supply the heroin markets in northeastern and southeastern Massachusetts.¹⁹ Colombian wholesalers operate at the highest levels of Greater Boston's heroin trade, coordinating and controlling networks that bring in the greatest amounts of heroin and limiting their exposure and risk by hiring Dominican and other ethnic criminals to do the actual transportation for them. Many Dominican wholesalers operate independently of Colombian organizations, transporting large, but probably lesser, quantities of heroin into Greater Boston from their own sources outside the state. Most law enforcement investigations involve Dominican organizations, which law enforcement finds easier to penetrate than Colombian organizations. The U.S. Attorney's Office says its heroin cases usually involve individuals, whereas its cocaine cases usually involve organizations. Transporters generally choose to carry a kilogram or less of heroin at a time, rather than risk being caught in possession of a large amount of heroin, but in rare cases, they organize multikilogram shipments.

Worcester and Holyoke are secondary regional distribution centers for heroin transportation activity. Wholesalers arrange for the transportation of large quantities of heroin into these cities from sources outside the state and supply the heroin markets in central and western Massachusetts. Dominican wholesalers dominate transportation activity in Worcester and Holyoke; Puerto Rican wholesalers are involved to a lesser degree. Less heroin is transported into Worcester and Holyoke than Greater Boston because the population and drug markets in and near these cities are smaller. Law enforcement in Worcester reports that wholesalers arrange for the transportation of bulk heroin into the area, usually in amounts less than a kilogram. The wholesalers mill heroin into user quantities, package it in glassine bags they often obtain from New Jersey, and stamp the bags with marketing logos using stamps they buy locally. Law enforcement in western Massachusetts reports that there are indicators wholesalers might transport bulk quantities of heroin into Holyoke and mill it there. One investigation identified a suspect who was believed to be stamping glassine bags of heroin for another drug distributor in Holyoke, and a second investigation identified a suspect who was believed to have access to "uncut" (bulk) heroin in Holyoke. However, seizures in Holyoke usually amount to less than a "stack" or "brick" of heroin (approximately 1/300th of a kilogram).

The nearby cities of Providence and Hartford also serve as regional distribution centers outside the state for transporting heroin to Massachusetts' markets.²⁰ Organizations in New York City supply most of the heroin in Massachusetts, and some heroin is transported directly from New York City to local distributors and users in Massachusetts. However, most heroin reaches those markets by way of intermediate wholesalers in Greater Boston (en route to northeastern and southeastern Massachusetts), Providence (to southeastern and central Massachusetts), Worcester (to central Massachusetts), Hartford (to central and western Massachusetts), or Holyoke (to western Massachusetts). Proximity determines where local distributors and users go for supply: they will travel to New York City or any of these regional distribution centers, whichever is the closest, to obtain heroin.

The Colombian organizations obtain most of their heroin from organizations in Jackson Heights, New York, a Colombian-dominated area of Queens, and the Dominican organizations obtain the bulk of their supply from organizations in Washington Heights, New York, a Dominican-dominated area of Manhattan. Some wholesalers in Greater Boston also probably have direct supply routes from foreign locations in the Caribbean and South America by virtue of Boston's large port and international airport.²¹ Wholesalers in Holyoke and Worcester do not appear to have direct supply routes from foreign locations in the Caribbean or South America, probably because there are no ports or international airports in or near these cities.²² Past reporting also indicates some heroin is transported into Massachusetts from Montreal, Quebec; Vancouver, British Columbia; California; and possibly from Pennsylvania and Florida.

Most traffickers transport heroin to Massachusetts along major highways in privately owned, borrowed, or leased vehicles and livery vans--which often are outfitted with hidden hydraulic compartments--and via public transportation (buses, trains, commercial air carriers) and express delivery services. Buses run every hour or two between Springfield and New York City, and a livery service runs between the cities about once an hour. Interstate highways connect Massachusetts with five bordering states: New Hampshire (I-–95 and I-93), Vermont (I-91), New York (I-90), Connecticut (I-91, I-84, and I-395), and Rhode Island (I-95, I-295, and I-195). Interstate 95 also provides a direct connection to all major cities on the East Coast--most importantly New York City--and the Canadian border. Massachusetts has an extensive system of state highways that connect urban and rural areas, and a well-developed public transportation system in Boston provides easy access to communities in the eastern part of the state.

As outlined in the Overview section, drugs potentially are transported to Massachusetts by both air and maritime means. Some heroin is brought to Massachusetts by couriers traveling on commercial air flights into Logan International Airport in Boston, and other heroin might be shipped into smaller airports near Springfield, Worcester, and New Bedford, although law enforcement does not report any activity or seizures. Law enforcement task forces regularly monitor Logan and Bradley International Airports, but interdiction efforts at Worcester Municipal Airport and New Bedford Regional Airport are minimal. Heroin is probably transported to the state by maritime means as well. USCS documents no heroin seizures at Massachusetts seaports from mid-1995 through April 2000 and estimates there have been only one or two significant interdictions since the early 1980s, but interdiction efforts at those ports are minimal. The air threat is greater than the maritime threat for heroin because the small quantities of heroin needed to supply the Massachusetts market are transported more quickly by air couriers than by ship.

Massachusetts also serves as a staging area or interim transportation point for heroin being transported north. Lawrence and Lowell, north of Boston, are distribution centers for northern New England and Canada. Maine, New Hampshire, and Vermont are supplied with heroin chiefly by drug groups in northeastern Massachusetts, particularly in Lawrence and Lowell. DEA reports some evidence of heroin transportation to Vermont and Maine from western Massachusetts as well. USCS intelligence also suggests that drugs are transported from New York City through New England to Canada. Because drug penalties in Maine, New Hampshire, and Vermont are stricter than in Massachusetts and because U.S. Attorneys there are more likely to prosecute violators in cases involving smaller amounts of drugs, Massachusetts-based distributors generally do not travel to northern New England with drugs. Low-level retailers and users in Maine, New Hampshire, and Vermont usually come to Massachusetts to obtain their supply. Reportedly, most of these people are lower-income Caucasians.

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In Greater Boston, the state's primary regional distribution center, Colombian DTOs operate at the highest levels of the heroin trade, and Dominican trafficking organizations and distribution groups are believed to constitute 80 to 90 percent of the middle and lower levels. Past reporting indicates the involvement of Asian criminal organizations in the wholesale heroin trade, but the Asian drug trafficking threat ranks much lower than that posed by Colombian and Dominican organizations. In Lawrence and Lynn, Dominican distribution groups are active down to the street level. Some Puerto Rican criminal groups distribute drugs at the street level in these two cities, and Caucasian distributors are involved in Lynn. In East Boston, many ethnic criminal groups distribute drugs at the street level. Hispanic criminal groups dominate retail sales in South Boston and northern Dorchester, and African American and Hispanic criminal groups are the most active in Roxbury. In southern Dorchester and Hyde Park, farther south, Caucasian retailers predominate.

In Holyoke and Worcester, the state's secondary regional distribution centers, Dominican organizations control the wholesale market, and other groups that they supply dominate the street level including Asian, Puerto Rican, and Jamaican criminal groups and street gangs, independent local groups, and perhaps Nigerian, Guatemalan, Cuban, or other ethnic criminal groups. Dominican groups sell heroin at the retail level in these cities as well. Colombian organizations are rarely involved in these cities.

Command and control exists within wholesale organizations and retail groups, but not between or among them; those associations are exclusively buyer-seller business relationships. Law enforcement often refers to Dominican DTOs in particular as "loosely knit," meaning that organizational roles are not rigidly defined, as in some DTOs and distribution groups, and that the people who perform certain functions may vary significantly from one operation to the next. This method of organization creates difficulties for law enforcement, which must identify and target members of an organization that has an ever-changing look.

Heroin is milled, packaged into glassine bags, and stamped with marketing logos in New England by wholesalers, who in past years purchased premilled, prestamped heroin in New York and transported it to New England in glassine bags ready for sale at the street level. Distributors in Lawrence usually package heroin in heat-sealed bags, and those in Lynn generally seal bags with twist-ties or package heroin in cellophane. In Massachusetts, some wholesalers and retailers sell only heroin, but many others sell both heroin and cocaine. Open-air markets for these drugs exist, but only small amounts of drugs and money change hands there. Most drug sales are consummated off the street in stores, malls, or supermarkets, or in cars or private residences. Distributors often live in one residence, store drugs in a second, and distribute drugs out of a third.

DTOs and retail groups often use tight security measures to thwart law enforcement efforts. Dominican criminals, in particular, are extremely adept at operational security and countersurveillance. Their use of radio transceivers, alarm systems, police scanners, miniature video cameras, and other high-tech equipment to detect and monitor the activities of law enforcement is common. Dominican criminals are ingenious at constructing false compartments in buildings and vehicles to hide drugs, money, and firearms, and at installing intricate electronic and manual traps to protect their property and goods. Vehicle traps often contain sizable quantities of drugs.

According to an NDIC report, Dominican drug organizations are difficult for law enforcement to penetrate and dismantle for several other reasons. First, group members do their best to keep business within the family as much as possible. They are extremely insular and wary of outsiders. Second, they routinely disguise their identities by obtaining false identification papers from sources in the United States or the Caribbean. Law enforcement authorities can only positively identify such individuals through fingerprinting. Third, most Dominican criminals avoid lavish lifestyles that would attract attention. Adopting a low-profile existence allows them to blend easily into the metropolitan scene. Fourth, Dominican distributors usually reside in the United States for only 2 or 3 years, after which they return to the Dominican Republic to live in luxury. They are apt to flee back to the Dominican Republic immediately if they think law enforcement is targeting them.

Massachusetts' drug distributors use cell phones, pagers, and pay phones (dialing with phone cards) to communicate with fellow distributors, arrange shipments, and set up meetings with buyers. More and more, traffickers also are communicating with one another over the Internet, which is too expansive for law enforcement to monitor easily.

Drug distributors almost invariably pay for drugs with cash, often receiving them on full or partial consignment and repaying their suppliers after the drugs are sold. They launder profits by reinvesting proceeds in their organizational infrastructure or by sending money out of the state or country via bulk cash shipments or electronic wires. Dominican DTOs are known to wire vast amounts of illegal drug profits from Massachusetts to the Dominican Republic, amounting to millions of U.S. dollars annually. Targeting these money transactions is difficult for law enforcement.

Drug trafficking in other Massachusetts cities, towns, and rural areas is less sophisticated, and distribution markets are open to independent entrepreneurs and gangs. According to responses to a 2000 NDIC survey, gangs that law enforcement identifies as the most significant in their area are involved in drug trafficking in northeastern (Suffolk, Middlesex, and Essex Counties), central (Worcester County), and southeastern (Bristol County) Massachusetts. Of the survey respondents that listed specific drug types, all except those from Lynn and Worcester indicated one or more of the most significant gangs in their area distribute heroin.

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End Notes

14. According to the Community Epidemiologic Work Group's Epidemiologic Trends in Drug Abuse, Advance Report (December 1999), the Boston Medical Center reported 179 heroin overdoses during the 3-month period March to May 1999. No baseline of past years is provided in the report.
15. The DMP is a retail-level heroin purchase program that identifies purity, price, and source of origin. The purity calculation for 1999 was based on 38 samples that ranged from 0.8 percent to 93.0 percent. The median for these 38 samples was 57.1 percent, similar to the average (mean) of 57.7 percent.
16. As previously mentioned, Lynn experienced notable increases in the number of heroin overdose deaths prior to 1999.
17. Glassine bags typically contain one user dose of heroin.
18. The DMP tested 38 samples and determined 25 were of South American origin. The place of origin for the other 13 samples was not identified.
19. Some law enforcement authorities believe there are more drugs in Lawrence and Lowell than in Boston. These cities are said to have a larger Dominican population, and they occasionally serve as supply cities for the drug markets in Boston, Bedford, and other eastern Massachusetts cities.
20. Pawtucket, Woonsocket, and Warwick, cities near Providence, sometimes serve as supply areas for heroin.
21. Colombian organizations are more likely to have these international supply connections than Dominican organizations. If these connections do exist, Boston deserves designation as a national hub, not merely a regional distribution center, but that link requires more research to substantiate. 
22. As previously mentioned, international flights out of Bradley International Airport near Springfield actually connect to foreign destinations through other U.S. cities.

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