Research paperImpact of South American heroin on the US heroin market 1993–2004
Introduction
In the United States (US), heroin users suffer persistently high rates of drug-related harm. Heroin-related emergency department visits have been rising. Between the years 1995 and 2002, the number of heroin-related emergency department visits increased 34% nationwide (SAMHSA, 2003). In a number of cities, heroin-related overdose deaths have risen dramatically (Fernandez, Hackman, McKeown, Anderson, & Hume, 2006; Oxman, Kowalski, Drapela, Gray, & Fafara, 2000; Solet, Hagan, Nakagawara, Plough, & Ball, 2000). Several major cities experience hundreds of overdose deaths every year (Bryant et al., 2004, SAMHSA, 2005). Bacterial complications from injection drug use are also increasing. Injection-related soft tissue infection was a leading cause of medical or surgical admission at one large county hospital (Ciccarone et al., 2001) and hospitalisations for endocarditis are increasing (Cooper et al., 2007). Injection drug users experience much chronic illness as well; they now constitute the majority of new hepatitis C infections (Wasley, Miller, & Finelli, 2007).
What changed about US heroin consumption to make it more dangerous? Analyses of heroin market trends may facilitate an understanding of these changes. As economists have repeatedly demonstrated a relationship between the price of an item and demand for it, that a similar relationship exists between heroin price, consumption and associated dangers, seems probable (Caulkins & Reuter, 1996). Moreover, a major goal of drug supply control efforts is to increase the street price of a drug by shifting the supply curve; this in turn reduces the quantity demanded by consumers as the market reaches a new equilibrium. (For a primer on illicit drug economics, see Moore et al., 2005.)
Illicit drug consumers adjust their purchase behaviours in response to price fluctuations (Bretteville-Jensen & Biørn, 2003; Grossman & Chaloupka, 1998). The ways and extent to which price influences heroin purchase and consumption are additionally affected by gender and whether or not the consumer also deals drugs (Bretteville-Jensen, 1999). A model of drug price effects showed drug purity-adjusted price fluctuations to predict more than 95% of the variation in drug-related emergency department visits (Caulkins, 2001). An economic study of data from 21 US cities found a significant inverse relationship between purity-adjusted heroin price and emergency episodes (Dave, 2006).
Some of the increase in heroin-related emergency department (ED) visits may be attributable to rising heroin purity. A study of epidemic level heroin-related deaths between 1979 and 1982 in Washington, DC, found that street heroin purity was significantly associated with overdose deaths (Ruttenber & Luke, 1984). An Australian study, conducted at 2-week intervals over a 2-year period, found a significant relationship between average heroin purity and number of overdose deaths (Darke, Hall, Weatherburn, & Lind, 1999).
The US Drug Enforcement Agency (DEA) maintains several administrative databases of heroin acquisitions. These include the Domestic Monitor Program (DMP), the Heroin Signature Program and System to Retrieve Information from Drug Evidence II (STRIDE). The DMP collects data from street-level heroin purchases made by undercover DEA agents in a number of major US cities, with the explicit goal of monitoring heroin trends. The Heroin Signature Program is responsible for determining the relationship between chemical composition and country of origin such that each heroin-producing region is associated with a specific chemical “signature.” The DMP and other DEA programs then utilize these signatures (US Department of Justice: National Drug Intelligence Center, 2000; US Drug Enforcement Administration, 1996a). In contrast to the DMP, STRIDE is a forensic database from street-level and larger scale seizures of all drugs, not solely heroin, to support enforcement and judicial proceedings (Office of National Drug Control Policy, 2004, US Drug Enforcement Administration, 1998).
These programs greatly inform any attempt to understand historical and current trends in the US heroin market. Prior to 1990, the Heroin Signature Program and DMP data reveal the top three sources of heroin to the US market as Southwest Asia (SWA), Southeast Asia (SEA), and Mexico (US Drug Enforcement Administration, 2000a). SEA and SWA heroin historically captured the largest share of the global market (UNODC, 2007, US Department of Justice, 2007), while heroin from Mexico has significant distribution only in the US (Bucardo et al., 2005, US Drug Enforcement Administration, 2000b). In the early 1990s, seizure and intelligence data revealed entry of a novel heroin – sourced from Colombia – that appeared to be poised for rapid expansion in the US (US Drug Enforcement Administration, 1993).
We examined DEA DMP data on price and purity for all four sources of heroin coming into the US from 1993 to 2004 for up to 20 metropolitan statistical areas (MSAs). While heroin market trends are reported by governmental agencies, this report represents an independent analysis of US heroin price and purity trends and the effects of Colombian-sourced heroin on the US heroin market.
Section snippets
Methods
The DEA designs, funds and executes the DMP to track the US retail heroin market. The DMP makes undercover, street-level heroin purchases. They compile price information and analytic data of the purity, chemical signature, composition, adulterants and diluents for each purchase. (The chemical signature identifies the heroin's region of origin, as determined by the Heroin Signature Program.) Although useful for drug supply and demand studies in general, we did not use STRIDE data for several
Results
Over all cities and years, the cluster-adjusted mean price for heroin was 1.09 (se =0.12) US dollars ($) per milligram-pure (mg-pure). Seattle had the highest mean price at $4.68 per mg-pure, while San Diego had the lowest mean price at $0.22 per mg-pure. Table 1 lists the mean price, maximum price and minimum price for each MSA along with the years that those prices occurred. With the exception of San Francisco, each MSA's maximum price was recorded before the minimum price. The smallest change
Discussion
During the 12 years studied, street-level heroin in the US became significantly less expensive. In the US cities sampled, the price of heroin declined 60–89%, with an overall yearly decrease of $.26 per mg-pure. These changes are significantly related to the introduction of new Colombian-sourced heroin. National market share of Colombian heroin grew by approximately 7% per year during the period of study. For each 10% increase in Colombian heroin market share, a corresponding $0.13 per mg-pure
Acknowledgements
The authors acknowledge the US Drug Enforcement Administration for the principal data used in this report. Dr. Ciccarone also thanks Dr. Philippe Bourgois for his mentorship and guidance in the development of this research. The authors thank the Drug Use Research Group (DURG) and the Qualitative Investigations into Drug Use Seminar (QUIDUS), both at UCSF, for reviewing aspects of this research. Finally, we acknowledge the editorial contributions of Dr. Clarissa Kripke at UCSF.
Funding for this
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