Abuse

National Drug Intelligence Center
Washington/Baltimore High Intensity Drug Trafficking Area Drug Market Analysis
June 2007

Heroin is the primary drug of abuse in Baltimore and can be purchased at numerous open-air drug markets in West and East Baltimore in either "raw" (high-purity) or cut form. Heroin abuse in Baltimore is cultural and intergenerational; most users and many dealers have parents and grandparents who are addicted to heroin. In Washington, D.C., the heroin trade is well entrenched; some local markets cater to the suburban trade, while others are frequented by well-established sellers and long-term addicts. Richmond also has a small heroin market that supplies long-term addicts with relatively high-purity heroin; the purity of this heroin indicates that it most likely is being obtained not in Washington or Baltimore but from a primary source area.

Maryland High School and College Students' Abuse of Heroin

The Montgomery County Police Department reports that high school and college students in that area are increasingly abusing heroin and that this abuse has led to one heroin-related death. These students do not purchase the heroin locally because there are no major heroin dealers in the county. Instead, students pool their money, drive to Washington, D.C., or Baltimore, purchase the heroin, and bring it back. The Montgomery County Police Department plans to focus investigative resources on the county over the coming months in order to combat the heroin threat there.

Source: Montgomery County Police Department.

According to DEA Heroin Domestic Monitor Program (HDMP) data, SA heroin is the principal type available in street-level heroin markets in Baltimore, Richmond, and Washington, D.C. Moreover, fourth-quarter fiscal year (FY) 2006 HDMP results show that the average heroin purity in Washington (7.6%) was much lower than that in Richmond (38.8%) and Baltimore (45%), as it has been for several years.

Fentanyl-Related Deaths in Maryland

In 2006 fentanyl was linked to at least 36 fatal overdoses in Maryland. Fentanyl is a synthetic opiate approximately 50 to 100 times more potent than heroin. Clandestinely produced fentanyl powder, heroin/fentanyl combinations and, to a lesser extent, cocaine/fentanyl combinations were distributed in the region. The introduction of fentanyl into the heroin market resulted in a health crisis for both users and law enforcement because any ingestion or absorption of the drug through the skin could result in a fatal overdose.

Source: Maryland State Office of the Chief Medical Examiner.

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Crack cocaine is abused by African American individuals primarily in inner-city areas of the HIDTA region. Powder cocaine is abused primarily by middle- to upper-middle-income individuals in metropolitan and suburban areas of the W/B HIDTA region. Nightclubs and bars in the affluent Georgetown area and newly renovated areas of Washington, D.C., reportedly are frequented by white-collar cocaine users. Powder cocaine is also one of many drugs available and used in the nightclub scene by suburban teens and young adults.

Methamphetamine abuse has been traditionally limited to the homosexual male community in the Washington, D.C., area; however, recent law enforcement reporting suggests that abuse may be extending to young rural and suburban users because of increasing availability of the drug. Increases in the availability of methamphetamine are apparent in the Richmond; Tidewater, Virginia; and northern Virginia areas.

MDMA available in the W/B HIDTA region generally is abused in combination with other substances, including alcohol, marijuana, cocaine, and club drugs. In some communities, however, law enforcement and medical authorities are now noting the abuse of MDMA with heroin or OxyContin. MDMA is mostly available in the college and university areas and is used mainly by youth in more affluent communities at clubs and rave parties.

The abuse of diverted pharmaceuticals in the W/B HIDTA region is emerging as a gateway for adolescents and young adults to abuse other drugs such as heroin, cocaine, or methamphetamine. Many initiates to drug abuse are inclined to begin with diverted pharmaceuticals rather than heroin, cocaine, or methamphetamine. Once addicted to prescription narcotics, abusers often switch to heroin because of the drug's higher availability and lower price. Similarly, abusers of prescription stimulants sometimes graduate to crack cocaine abuse, and treatment providers believe that abusers of prescription amphetamines, such as Ritalin (methylphenidate) or Adderall (dextroamphetamine), may begin to abuse methamphetamine as it becomes more available.

Prescription narcotics are the most commonly abused diverted pharmaceuticals in the W/B HIDTA region. Abuse patterns vary according to location: methadone and Valium are predominant in Washington, D.C.; methadone, Klonopin (clonazepam), and other benzodiazepines are mostly abused in the Baltimore area; and benzodiazepines, methadone, and hydromorphone are commonly abused in Richmond. Abuse of prescription narcotics, particularly OxyContin and Percocet (oxycodone) and Vicodin (hydrocodone), is increasing in Baltimore County. This increase may be the result of heroin users switching to prescription narcotics because they fear the intimidation tactics and violence that street-level heroin dealers often resort to during drug transactions.

Effects of Methadone Abuse Enhanced by Certain Pharmaceuticals

In April 2006 four individuals were arrested for shoplifting 12 boxes of Prilosec (Omeprazole) from a Queen Anne's County drugstore. Maryland drug task forces report an increase in thefts of Prilosec in Baltimore and Carroll County. Prilosec is believed to increase or intensify the high when taken in conjunction with methadone. Other drugs that are thought to intensify the effects of methadone include Goldenseal,^a Tagamet (cimetidine), Antabuse (disulfiram), Prozac (fluoxetine), and Zoloft (sertraline). However, these drugs, when taken in conjunction with methadone, may cause methadone-related toxicity, such as oversedation, respiratory depression, or overdose.

Source: Maryland State Police.

a. Goldenseal is a perennial herb in the buttercup family. It is often used as a multipurpose remedy, having different medicinal properties. However, it also contains potentially toxic alkaloid compounds and should be used with caution and not on a long-term basis.

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Drug-Related Crime

Drug-related violence, including robberies, thefts, and shootings, is increasing in the W/B HIDTA region. Of particular concern to law enforcement officials is a rise in the number of home invasions and stash house robberies occurring in Baltimore County. Much of this violence is related to dealers who distribute drugs in the city of Baltimore but live and maintain stash houses in Baltimore County, where they feel more insulated from law enforcement detection. The abuse of heroin and crack is also associated with domestic violence, including child neglect, child abuse, and spousal abuse. Some abusers also commit property crimes, such as burglary, forgery, fraud, and theft, to support their addictions

Despite the increase in drug-related violence, the number of homicides decreased in the region in 2006, particularly in Washington, D.C., and Prince George's County. Washington, D.C., reported 167 homicides, a decrease from 196 in 2005, and Prince George's County reported 134 homicides, compared with 462 in the previous year. The drop in the number of homicides is due in part to a combination of effective policing strategies, incarceration of violent offenders, economic development, and population shift. At least 23 of the 167 homicides in Washington, D.C., were drug-related, and many others were directly related to gang rivalries. Many of the homicides in Prince George's County involved young men who were shot inside the Capital Beltway area; many of these homicides were reportedly committed by members of MS 13. This street gang is the largest and fastest-growing gang in the W/B HIDTA region, and reports of the gang's involvement in drug distribution continue to surface. MS 13 has a presence in Washington, D.C., the Broadway area of Baltimore, Montgomery County, Prince George's County, and Fairfax County.

Medicaid-related fraud associated with the distribution and abuse of diverted pharmaceuticals is a problem in the W/B HIDTA region. The cities of Baltimore, Washington, D.C., and Richmond have large low-income populations that receive Medicaid benefits. Criminal groups in low-income areas steal, borrow, rent, or buy Medicaid cards from legitimate holders to fill counterfeit prescriptions, which are then sold on the street. This activity results in fraudulent billings to the Medicaid system, since single cards can be used to obtain multiple prescriptions, resulting in millions of dollars in annual costs to taxpayers. As a result of the huge illicit profit potential, law enforcement officials are concerned that cities in the region with large numbers of Medicaid recipients may emerge as local or regional sources for diverted pharmaceuticals, particularly OxyContin.

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