drug abuse trends in the akron-canton region · 2018. 11. 5. · klonopin® and xanax® as the most...

Surveillance of Drug Abuse Trends in the Akron-Canton Region

Page 8OSAM Drug Trend Report January-June 2013 7


OSAM Drug Trend Report January-June 2013 Page 17

Surveillance of Drug Abuse Trends in the State of Ohio

PORTAGE

CARROLL

SUMMIT

STARK

TUSCARAW AS

Ohio Substance Abuse Monitoring NetworkOSAM

Regional Epidemiologist: Joseph Cummins, MA,PCC-S,LIDC

Data Sources for the Akron-Canton Region

Thisregionalreportwasbaseduponqualitativedatacollectedviafocusgroupinterviews.Participantswereactiveandrecoveringdrugusersrecruitedfromalco-holandotherdrugtreatmentprogramsinPortage,Stark,SummitandTuscarawascounties.Datatriangu-lationwasachievedthroughcomparisonofpartici-pantdatatoqualitativedatacollectedfromregionalcommunityprofessionals(treatmentproviders,lawenforcementandpublichealthofficials)viaindividualandfocusgroupinterviews,aswellastodatasur-veyedfromtheStarkCountySheriff’sDepartment,theStarkCountyDayReportingProgramoftheStarkCountyCourtofCommonPleas,theSummitCountyJuvenileCourtandtheBureauofCriminalInvestigation(BCI)Richfieldoffice,whichservestheCleveland,AkronandYoungstownareas.Allsecond-arydataaresummarydataofcasesprocessedfromJulythroughDecember2012.Inadditiontothesedatasources,Ohiomediaoutletswerequeriedforin-formationregardingregionaldrugabuseforJanuarythroughJune2013.

Note:OSAMparticipantswereaskedtoreportondruguse/knowledgepertainingtothepastsixmonths(fromtimeofinterviewthroughpriorsixmonths);thus,currentsecondarydatacorrespondtothecur-rentreportingperiodofparticipants.

Drug Abuse Trends in the Akron-Canton Region

OSAM Staff:

R. Thomas Sherba, PhD,MPH,LPCC OSAMPrincipleInvestigator

Beth E. Gersper,MPA OSAMCoordinator

Nicholas J. Martt,MSW,LSW OSAMResearchAdministrator


OSAM Drug Trend Report January-June 2013Page 18

Indicator1 Ohio Akron-Canton Region OSAM Drug ConsumersTotalPopulation,2010 11,536,504 1,200,204 42

Gender(female),2010 51.2% 51.5% 57.1%

Whites,2010 81.1% 85.4% 85.7%

AfricanAmericans,2010 12.0% 9.4% 9.5%

HispanicorLatinoorigin,2010 3.1% 1.6% 14.6%

HighSchoolGraduationrate,2010 84.3% 86.3% 81.0%

MedianHouseholdIncome,2011 $45,803 $44,250 $11,000to$18,9992

PersonsBelowPovertyLevel,2011 16.3% 15.9% 50.0%3

1Ohio and Akron-Canton statistics are derived from the most recent US Census, and OSAM drug consumers were participants for this reporting period: January-June 2013. 2Participants reported income by selecting a category that best represented their household’s approximate income for 2012. Income status was unable to be determined for six participants due to missing data.3Poverty status was unable to be determined for six participants due to missing data.

6

1

18

15

23

14

12

32

19

8

16

1

33

6

5

7

8

16

0

17

17

8

3

14

8

16

1

24

18

0 5 10 15 20 25 30 35

Other Drugs***

Synthetic Marijuana

Sedative-Hypnotics

Prescription Stimulants

Prescription Opioids

Powdered Cocaine

Methamphetamine

Marijuana

Heroin

Ecstasy/molly

Crack Cocaine

Bath Salts

Alcohol

>$38,000

$30,000 to $38,000

$19,000 to $29,999

$11,000 to $18,999

<$11,000

Bachelor's degree or higher

Some college or associate's degree

High school graduate

Less than high school graduate

50s

40s

30s

20s

<20

Female

Male

Drug

s Use

d**

Hous

ehol

d In

com

eEd

ucat

ion

Age

Gen

der

*Notallparticipantscompletedforms;numbersmaynotequal42.**Somerespondentsreportedmultipledrugsofuseduringthepastsixmonths.***OtherdrugsrefertoDMT,LSD,psilocybinmushroomsandSeroquel.®

Akron-CantonRegionalParticipantCharacteristics

Age

Gend

erDr

ugs

Used

**Ho

useh

old

Inco

me

Educ

ation

Drug Consumer Characteristics* (N = 42)

Regional Profile


Page 8OSAM Drug Trend Report January-June 2013 Page 19



Historical SummaryDuringthepreviousreportingperiod(July–December2012),bathsalts,crackcocaine,heroin,marijuana,methamphetamine,prescriptionopioids,prescriptionstimulants,sedative-hypnotics,Suboxone®andsyntheticmarijuanaremainedhighlyavailableintheAkron-Cantonregion.IncreasedavailabilityexistedforheroinandSuboxone®.Dataalsoindicatedlikelyincreasedavailabilityformethamphetamineandsedative-hypnotics,adecreaseinavailabilityforecstasy,andalikelydecreaseinavailabil-ityforpowderedcocaine.

Alldatasourcesindicatedanincreaseinheroinavail-ability.CommunityplannersinStarkCountyreportedthatthecoronerdeclaredheroinoverdosesanepidemic.Treatmentprovidersattributedtheincreaseofheroinavailabilitytoincreaseddifficultyinobtainingprescrip-tionopioids.Participantscontinuedtonoteanincreaseinavailabilityanduseinmoreruralareasoftheregion.Brownpowderedheroinremainedthemostavailabletypeandintravenousinjectionremainedthemostcommonrouteofadministrationforthisdrug.However,participantsreportedthatitwasbecomingmoredifficulttobuyinjec-tionneedleswithoutaprescriptionatareapharmaciesandthatitwascommonforindividualstoshareneedles.Participantsnotedthattherewerenoneedleexchangeprogramsintheimmediatearea.

Participantsstatedthatasopiateusecontinuedtoin-crease,sodidtheavailabilityofSuboxone®.TheBCIRichfieldCrimeLabreportedprocessinganincreasednumberofSuboxone®casesduringthatreportingpe-riod.TreatmentproviderssaidthatthereseemedtobeademandforSuboxone®.TreatmentprovidersnotedthattherewerebillboardsadvertisingfreeSuboxone®intheregionandthatitwascommonforindividualswhowereprescribedSuboxone®toshareitwithfriends.

Participantsthroughouttheregioncommentedaboutthe“one-pot”or“shake-and-bake”formsofmethamphetamineasbeingprevalentintheregionandreportedthattheavailabilityofmethamphetaminehadincreasedduringthepreviousreportingperiod.Participantsnotedthatmethamphetaminewascheaperandeasiertomake.Theydescribedtypicalusersaswhite,fromworking/middle-tolower-classsocio-economically,“younger”andmoreoftenmale,thoughsometreatmentprovidersnotedanincreaseinuseamongfemales.

Manyparticipantsagreedthatitwaseasytofindaphy-sicianwhowouldprescribesedative-hypnotics,anditwasalsoeasytofindthesemedicationsonthestreet.ParticipantsandcommunityprofessionalsidentifiedKlonopin®andXanax®asthemostpopularsedative-hypnoticsintermsofillicituse.Participantsnotedthatopiateabuserstendedtousesedative-hypnoticsmorethanotheruserstohelpalleviatewithdrawalsymptoms.

Alldatasourcesindicatedadecreaseinecstasyavailabilityduringthepreviousreportingperiod.Treatmentprovidersnotedthatecstasyissometimesheardabout,butmostlyinthecontextofexperimentaluseamonghighschoolandcollegestudents.

Participantsfrommostgroupsintheregionreportedtheavailabilityofpowderedcocainehaddecreasedduringtheprevioussixmonths.Participantsidentifiedanumberofreasonsforthedecreaseinavailability,suchaspolicetargetingmajordealersofthedrugandtheinterceptionoflargeshipmentscomingintothecountry.

Participantsandcommunityprofessionalsreportedthatdespitelegislation,bathsaltsandsyntheticmarijuanacon-tinuedtobeavailableonthestreetfromdealersaswellasfrommanyconveniencestoresand“headshops.”However,lawenforcementnotedthatrecentlegislationhadcausedbathsaltsandsyntheticmarijuanatobefarlessavailableatretailstoresintheregionandthatthosestoreswhichdidsellthesedrugsweremuchmorediscreet.

Current TrendsPowdered Cocaine

Powderedcocaineishighlyavailableintheregion.Participantsmostoftenreportedthedrug’scurrentavailabilityas‘8’onascaleof‘0’(notavailable,impos-sibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewas‘5.’Participantcommentsoncurrentavailabilityofpowderedcocaineincluded: “It’s extremely available. I can make a phone call and get it in a half hour or less; Just as easy [toobtain] as heroin.” However,aparticipantnoted,“I have to go into the ‘hood [innercity] to find a dope boy [drugdealer] to get the powder [powderedcocaine] before it is cooked into crack [cocaine].”Treatmentprovidersmostoftenreportedthecurrentavailabilityofpowderedcocaineas‘8;’thepreviousmostcommonscorewas‘5.’Atreatmentprovidercom-mented, “Clients report they don’t struggle to find it.”



Lawenforcementmostoftenreportedcurrentavailabilityofpowderedcocaineas‘6.’Anofficercommented, “It’s out there, but you need to know the right people. A lot of cocaine dealers have converted to selling heroin.”

Collaboratingdataalsoindicatedthatpowderedcocaineisreadilyavailableintheregion.TheStarkCountyDayReportingProgramsaidthat22.1percentofitspositivedrugscreensduringthepastsixmonthswerepositiveforcocaine.Inaddition,mediaoutletsreportedoncocaineseizuresandarreststhisreportingperiod.TheOhioStateHighwayPatrolfound$100,000worthofcocainecon-cealedinashoeboxinacar’strunkduringatrafficstopinStarkCounty(http://statepatrol.ohio.gov/media.stm,Jan.30,2013).InAkron,agrandjuryindicted17peopleforconspiracytodistributecocaine,heroinandmarijuanainnortheastOhio(www.newsnet5.com,June25,2013).

Participants,treatmentprovidersandlawenforcementallreportedthattheavailabilityofpowderedcocainehasre-mainedthesameduringthepastsixmonths.Whilesomeparticipantsreportedthatdealersareswitchingtosellingotherdrugssuchasheroinandmethamphetamine,manyparticipantsreportedthatthedealersalsocontinuetosellpowderedcocaine.Oneparticipantdisclosed,“My guy [dealer]had both [heroinandcocaine], so it’s still easy to get [powderedcocaine].”BoththeBCIRichfieldCrimeLabandtheStarkCountySheriff’sofficereportedthatthenumberofpowderedcocainecasestheyprocesshasremainedthesameduringthepastsixmonths.

Mostparticipantsratedthecurrentqualityofpowderedcocaineas‘5’or‘6’onascaleof‘0’(poorquality,“garbage”)to‘10’(highquality);thepreviousmostcommonscorewas‘5.’Participantsreportedthatpowderedcocaineintheregioniscut(adulterated)withaspirin,babylaxative,babypowder,bakingsoda,creatineandvitaminB.TheBCIRichfieldCrimeLabreportedthatpowderedcocaineiscutwithcaffeine,levamisole(livestockdewormer)andlido-caine(localanesthetic).Severalparticipantscommentedonthevariablequalityofpowderedcocaine.Onepartici-pantstated,“If you buy it from old-timers, it’s pretty good … in the ‘hood, there’s a chance of being ripped off.”Anotherparticipantsaidheswitchedtomethamphetaminebe-causethequalityofpowderedcocainewasbad.Duringthepastsixmonths,participantsreportedthatthequalityofpowderedcocainehasgenerallydecreased.

Currentstreetjargonincludesmanynamesforpowderedcocaine.Themostcommonlycitedwere“blow”and“snow.”

Participantslistedothercommonstreetnamesof“girl,”“powder,”“ski”and“white.”Currentstreetpricesforpow-deredcocainewereconsistentamongparticipantswithexperiencebuyingthedrug,yetpricingcontinuestobedependentonquality:1/2gramsellsfor$50-80;agramsellsfor$70-100;1/16ounce(aka“teener”)sellsfor$90;1/8ounce(aka“eightball”)sellsfor$125-150.Participantsreportedthatitiscommontopurchasepowderedcocainebythe1/2gramorgram,withafewparticipantsnotingapricediscountiftheybuyagram.

Participantscontinuedtoreportthatthemostcommonwaytousepowderedcocaineissnorting.Outof10pow-deredcocaineusers,participantsestimatedthatsixwouldsnort,threewouldintravenouslyinjector“shoot,”andan-otheronewouldsmokethedrug.Participantsnotedthat“recreationalusers”moreoftenusepowderedcocainebysnorting,while“addicts”moreoftenintravenouslyinjectit.

Participantsdescribedtypicalusersofpowderedco-caineaswhiteandofmiddle-to-uppersocio-economicstatus.Oneparticipantdescribedusersas “upper class, white males, from the medical field – doctors [and]lawyers.” However,someparticipantsdisagreedandstatedthat,whilepowderedcocainewasmorecommonlyusedbyindividualswithhigheconomicmeansinthepast,anyonecouldbeausertoday.Aparticipantcommented, “It’s so accessible, anyone can be using cocaine. You don’t know. You have no clue who is using cocaine.”Treatmentprovidersgenerallyagreedthatpowderedcocaineuseismorecom-monamongwhites,andmorecommonamongindividu-alswhoare “more financially able.” Lawenforcementnotedthatapowderedcocaineusercanbeanyone.

Reportedly,powderedcocaineisusedincombinationwithalcohol,heroin,marijuanaandsedative-hypnotics.Itisreportedlyverycommontousepowderedcocainewithalcoholbecauseitallowstheusertodrinkforlongerperi-odsoftime.Alcoholandbenzodiazepinesusedincom-binationwithpowderedcocainehelpreducewithdrawalsymptoms,suchasjitters,asuserscomedownoffthestimulanthigh.Reportedly,heroiniscommonlyusedwithpowderedcocainebythoseusersseekingthe“speedball”(upanddown)effect.Participantsexplainedthatsmok-ingmarijuanawithpowderedcocainehelpstointensifythecocainehigh,producesaspeedballeffectandhelpsincomingdownfromcocaineuse.





Crack Cocaine

Crackcocaineremainshighlyavailableintheregion.Participantsmostoftenreportedthedrug’scurrentavail-abilityas‘10’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewasalso‘10.’Participantsagreed,makingcommentssuchas,“It’s extremely easy [togetcrackcocaine]; it’s everywhere.”Treatmentprovidersmostoftenreportedthedrug’scurrentavailabilityas‘9;’thepreviousmostcommonscorewasalso‘9.’Treatmentproviderscommentsoncurrentcrackcocaineavailabilityincluded:“You can get it anywhere you go; it’s around the corner … next door; I hear a lot more use of crackthan I do of powdered cocaine.”Lawenforcementmostoftenreportedthedrug’scurrentavailabilityas‘6;’thepreviousmostcom-monscorewas‘3.’Lawenforcementbelievedcrackcocainetobeabithardertofindthanotherdrugs.

Participantsreportedthattheavailabilityofcrackcocainehasremainedthesameorincreasedduringthepastsixmonths.Oneparticipantwhostatedanincreaseinavail-abilitycommented,“[Crackcocaine] is more addictive … it grabs you.”Someparticipantsalsomentionedanincreaseincrackcocainedealersintheregion:“It’s an open market, a lot more people are dealing it [crackcocaine].Dealers are making a fortune. Heroin dealers also sell crack; There’s more competition. Younger people are trying to sell it.”Treatmentprovidersandlawenforcementreportedthatavailabilityofcrackcocainehasremainedthesameduringthepastsixmonths.Treatmentproviderscommentedthatcrackcocainewasveryavailablesixmonthsago.“[Availabilityofcrackcocaine] it’s the same today, running right under heroin,”saidonetreatmentprovider.BoththeBCIRichfieldCrimeLabandtheStarkCountySheriff’sofficereportedthatthenumberofcrackcocainecasestheyprocesshasremainedthesameduringthepastsixmonths.

Mostparticipantsratedthecurrentqualityofcrackco-caineas‘6’onascaleof‘0’(poorquality,“garbage”)to‘10’(highquality);thepreviousmostcommonscorewas‘4.’Participantsreportedthatcrackcocaineintheregioniscutwithbakingsoda.Aparticipantcommentedonthevari-abilityofcrackcocainequalityintheregion:“Sometimes you get something great. Other times, it’s messed up.”Overall,participantsreportedthatthequalityofcrackcocainehasdecreasedduringthepastsixmonths.

Currentstreetjargonincludesmanynamesforcrackcocaine.Themostcommonlycitednameremains“hard.”

Participantslistedthefollowingasothercommonstreetnames:“butter,”“rock”and“work.”Currentstreetpricesforcrackcocainewereconsistentamongparticipantswithexperiencebuyingthedrug.Participantsreportedthat1/16ounce(aka“teener”)sellsfor$60-80,dependingonthequality;1/8ounce(aka“eightball”)sellsfor$80-120.Allparticipantgroupsnoted,however,thatitismostcom-montopurchasecrackcocaineby“pieces,”withsizesvary-ingdependingontheamountofmoneytheconsumerhastospend.Severalparticipantscommentedonthepracticeofpurchasingcrackcocainewithwhateveramountofmoneyausercanmuster:“It does not matter; you can buy a 5 [$5]piece [ofcrackcocaine]or a 10 [$10]piece. Any [amountof ]money, in general … even if you have a dollar.”

Whiletherewereafewreportedwaysofadminister-ingcrackcocaine,generally,themostcommonrouteofadministrationremainssmoking.Outof10crackcocaineusers,participantsreportedthatapproximatelyninewouldsmoke;andonewouldintravenouslyinjector“shoot”thedrug.

Althoughthemajorityofparticipantsnotedtherewerenotypicalcharacteristicsofacrackuser,acoupleofthepar-ticipantgroupsdescribedusersofcrackcocaineasmostoftenAfrican-Americanandresidinginlow-incomeareas.Aparticipantcommented,“It does not matter if you are rich or poor. It [crackcocaine]does not discriminate. I’ve seen old, kids, mayors, attorneys.”Treatmentprovidersreportedthatcrackcocaineuseismorecommonamongindividualswhohavelessmoneyandareunder-educated.Atreat-mentprovideradded,“Crack is less costly than powdered cocaine, so it’s more popular with people with lower incomes.”TreatmentprovidersalsonotedthatusersaremorelikelyAfrican-American.Lawenforcementreportedthatcrackcocaineusersaretypicallyinner-cityAfrican-Americans.

Althoughmostparticipantsreporteditismostcommontousecrackcocainebyitself,oneparticipantsaid,“A lot more people are using crack in combination with other drugs. It’s always a side dish, used with something else.”Reportedly,crackcocaineismostoftenusedincombinationwithalcohol,ecstasy,heroin,marijuana,prescriptionopioidsandsedative-hypnotics.Severalparticipantsmentionedthatalcohol,heroinandsedative-hypnoticsassistauserincomingdownfromthestimulanthighofcrackcocaine.Aparticipantexplained,“I would not shoot crack if I did not have heroin. I did not like the paranoid feeling. I liked the buzz, but I’d come down with heroin.”Concerningtheuseofprescriptionopioidswithcrackcocaine,aparticipant



said,“Some crack does not last long. Opiates keep them going until they can get more crack.”Onegroupreferredtothecombinationofecstasywithcrackcocaineas,“streetViagra®.”

Heroin

Heroinremainshighlyavailableintheregion.Participantsmostoftenreportedthecurrentoverallavailabilityofheroinas‘10’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);the

previousmostcommonscorewasalso‘10.’Aparticipantstated,“[Heroinis] as acces-sible as alcohol.”Participantsoftencomparedheroinavailabilitytootherdrugavailability:“Sometimes it’s easier to get heroin than it is marijuana; A lot easier to find [heroin]than scripts [prescriptionopioids]. You only get one or two scripts of pills a month, while heroin is unlimited.”Treatmentprovidersmostoftenreportedthedrug’scurrentavailabilityas‘10;’thepreviousmostcommonscorewas‘9.’Treatmentproviderscommentedon

theavailabilityandpopularityofheroin:“It’s the thing; It’s everywhere; It’s cheaper than pills [prescriptionopioids].”Atreatmentprovidershared,“A lot of clients say they are offered heroin before they even know what it is.”Lawenforce-mentmostoftenreportedthedrug’scurrentavailabilityas‘10;’thepreviousmostcommonscorewasalso‘10.’

Whilemanytypesofheroinarecurrentlyavailableintheregion,participantsreportedthatbrownpowderedheroinremainsthemostavailabletype.Lawenforce-mentagreed.TheBCIRichfieldCrimeLabalsoreportedbrownpowderedheroinasmostavailableintheregion.Participantsreportedtheavailabilityofblacktarherointobelow,ratingitsavailabilityas‘3’onascaleof‘0’(notavail-able,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget).Participantsstated,“Once in a while you come across black tar [heroin]; You have to go to Cleveland to get tar; it’s hard to get around here.”Lawenforcement,likewise,reportedtheavailabilityofblacktartobelow,explainingtheyencounteringittwiceduringthepastsixmonths.Treatmentprovidersdidnotreportspecificallyontypesofheroinbecause,asonestated,“Clients don’t talk about the specifics about type.”TheBCIRichfieldCrimeLabalsoreportedlowavailabilityofblacktarheroinintheregion.

Mediaoutletsintheregionreportedonheroinseizuresandarreststhisreportingperiod.TheSummitCounty

Sheriff’sofficereportedchargingalocalwomanintheher-oinoverdosedeathsoftwomen;themostrecentofthetwodeathsoccurredinDecember2012atamotelinthecityofGreen(www.wkyc.com,Jan.31,2013).ThePortageCountyDrugTaskForcearrestedtwoindividualsattheirhomeinParisTownship:oneforsolicitingandpossessionofheroinandtheotherforpromotingprostitutionandpermittingdrugabuse(www.wkyc.com,April19,2013).

Participantsreportedthattheavailabilityofbrownpow-deredheroinhasincreasedduringthepastsixmonths.Oneparticipantexplained:“Pharmacy companies switched [theformulaof ]oxy’s [OxyContin®]and other drugs. They gel up when you want to snort or shoot them.” Anothersaid,Pain pills are harder to get. Heroin is cheaper and stronger than pain pills.”Treatmentprovidersagreedthattheavailabilityofbrownpowderedheroinhasincreasedduringthepastsixmonthsduetothesamereasonsthatparticipantsgave.Lawenforcementreportedthattheavailabilityofbrownpowderedheroinhasremainedthesameduringthepastsixmonths.BoththeBCIRichfieldCrimeLabandtheStarkCountySheriff’sofficereportedthatthenumberofbrownpowderedheroincasestheyprocesshasincreasedduringthepastsixmonths.TheBCIRichfieldCrimeLabreportedthatthenumberofblacktarheroincasesitprocesseshasremainedthesame;theStarkCountySheriff’sofficedoesnottrackblacktarheroincases.

Mostparticipantsratedthecurrentoverallqualityofheroinas‘7’onascaleof‘0’(poorquality,“garbage”)to‘10’(highquality);thepreviousmostcommonscorewas‘6.’Participantsreportedthatbrownpowderedheroinintheregioniscutwithotheropiates(Dilaudid®orfentanyl),sedatives-hypnotics(phenobarbitalorXanax®),vitaminB-12,andasonestated,“anything that looks like it[heroin] and is water-soluble.”Participantsoftennotedthatthequalityofheroinvariesfromdaytoday.TheBCIRichfieldCrimeLabreportedthatthereare“not a lot of cutting agents”intheheroincasestheyprocess.Overall,partici-pantsreportedthatthequalityofheroinhasdecreasedduringthepastsixmonths.Participantsoftencommentedthatincreaseddemandhasresultedindealerscuttingherointogetmoresales/profitoutofthedrug.Apar-ticipantexplainedthatduetohighdemand,dealersarebringingmorelowerqualityheroininfromoutsidetheregion.Aparticipantreportedthatdemandforheroinishigh,saying,“They [dealers] can’t get enough of it. They go to Detroit to get it … it’s already stomped [adulterated]five times [beforeitreachestheregion].”





Currentstreetjargonincludesmanynamesforheroin.Themostcommonlycitednamesremain“boy”and“dogfood.”Othercommonstreetnamesforheroininclude:“brown,”“H,”“horse,”and“ron.”Participantsreportedthatbrownpowderedheroinisavailableindifferentquanti-ties:a“20bag”containingabout1/10gramsellsfor$20;a“50bag”containingbetween2/10–3/10gramsellsfor$50;1/2gramofsellsfor$60-100;agramsellsfor$100-150.Participantsreportedthatheroinisoftenpurchasedbyweight:“It [purchaseofheroin]depends on how much money you have at a time; It used to be stamps, bundles, or bags. Now it’s by the weight.”However,anumberofpartici-pantsreportedthatitismostcommontopurchase$50worth(aka“50bag”),butonemaypurchaseaslittleasa$20bag.Participantsdidnothaveinformationregardingthecurrentpricingforblacktarheroin.

Whiletherewereafewreportedwaysofusingheroin,generallythemostcommonrouteofadministrationre-mainsintravenousinjection(aka“shooting”).Participantsestimatedthatoutof10heroinusers,eightwouldintrave-nouslyinject;andtwowouldsnortthedrug.Aparticipantcommented,“Everybody goes to the needle.”

Participantsreportedobtainingneedlesfromseveralvenues.Whenpurchasingneedlesfrompharmacies,onehastopurchasealargeamountandoftenhastoprovideproofofprescription(fordiabeticmedication).Participantsreportedthatneedlescanalsobepurchasedfrommanyheroindealersfor$2each.Aparticipantgroupreportedonthepracticeofpurchasing“dogneedles”frompetstores,eventhoughtheyarelarger.Otherparticipantsreportedtakingneedlesfromrelativeswhoarebeingtreatedfordiabetes.AparticipantgroupinStarkCountyreportedthattherearepastorswhogiveneedlesoutaspartofdiseaseprevention.Participantsreportedthatshar-ingneedlescontinuestobeacommonpractice,makingcommentssuchas:“People reuse and share needles because they cannot get them readily; You will use someone else’s nee-dle before you snort it [heroin].” Participantswerenotawareofanyneedle-exchangeprogramswithintheregion.

Participantsdescribedtypicalusersofheroinaswhite,young(teens–20s)andfromlower-tomiddle-incomebrackets.Severalparticipantscommentedonheroinuseamongyoungergroups:“Age is getting lower; teens are using heroin; High schoolers … a lot more today, 15 and 16 years old. It keeps getting younger and younger.”Apar-ticipantsuggestedcocaineusersareswitchingovertoheroin:“Cocaine [quality]sucks, so they are doing heroin to

get the high.”Treatmentprovidersconsistentlyreportedthatheroinusersareoftenwhiteandyounger(early-tomid-20s/college-aged).Inaddition,atreatmentprovidergroupreportedthatheroinuseisincreasingamongyoungfemales.Lawenforcementreportedthatheroinuserscomefrom“all walks of life, inner city, suburbs,”andalsoreportedanincreaseinthenumberofteenagerswhoareusingheroin.

Reportedly,heroinisusedincombinationwithalcohol,crackandpowderedcocaine,marijuana,methamphet-amineandsedative-hypnotics.Crackandpowderedcocaineareusedforthe“speedball”effect.Marijuanausedincombinationwithheroinreportedly“makes you higher,”accordingtoaparticipant.Participantsidentifiedtheprac-ticeofusingheroinwithbenzodiazepinesas“the number one way to O.D. [overdose].”Overall,participantshadmixedopinionsregardingwhetheritismorecommontouseheroinbyitselfortouseitincombinationwithothersub-stancesinanattempttoincreasetheimpactofthedrug.

Prescription Opioids

Prescriptionopioidsaremoderatelytohighlyavailableintheregion.Participantsmostoftenreportedcurrentavailabilityofthesedrugsas‘6’onascaleof‘0’(notavail-able,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewas‘10.’ParticipantsidentifiedOpana®,Percocet®andVicodin®asthemostavailableandpopularprescriptionopi-oidsintermsofwidespreaduse.Participantsdiscussedavailabilityofspecificprescriptionopioids.Reportedly,Dilaudid®andfentanylavailabilityarelow.AparticipantinTuscarawasCountyreported,“[Fentanyl] it’s not easy to find, but when it is around, it’s very popular.”Reportedly,Vicodin®andPercocet®arereadilyavailablebutlowindemand.Participantsalsodiscussedthedifferenceandavailabilityofoldandnewformulaprescriptionopioids.TheyreportedtheoldformulationofOxyContin®OCasunavailable,andtheoldformulationofOpana®asstillavailable,thoughincreasinglydifficulttofind.Apartici-pantinTuscarawasCountystated,“Opana® is very popular around here.”

Treatmentprovidersmostoftenreportedthecurrentavailabilityofprescriptionopioidsas‘9;’thepreviousmostcommonscorewas‘8.’TreatmentprovidersidentifiedPercocet®andVicodin®asthemostpopularprescriptionopioidsintermsofwidespreaduse.Lawenforcement



mostoftenreportedcurrentavailabilityas‘7;’thepreviousmostcommonscorewasalso‘7.’Lawenforcementidenti-fiedOpana®,OxyContin®andRoxicet®asmostpopular.Mediaoutletsintheregionreportedonseizuresandar-reststhisreportingperiodinvolvingprescriptionopioids.TheOhioStateHighwayPatrolseizedecstasy,heroinandoxycodonepillsduringatrafficstopontheOhioTurnpikeinSummitCounty(www.wkyc.com,May16,2013).

Participantsreportedthattheavailabilityofprescriptionopioidshasdecreasedduringthepastsixmonths,attrib-utingthismainlyduetoformulationchangesthathavemadeprescriptionopioidsmoredifficulttoabuse.Thehighpriceofthesedrugswasalsocommonlynotedasareason.Treatmentprovidersdidnotagreeonwhethertheavailabilityofprescriptionopioidsincreasedorremainedthesame.Lawenforcementreportedthattheavailabilityofprescriptionopioidshasremainedthesame,thoughthereismoreattentionbeinggiventothem.Anofficerexplained,“Law enforcement has increased efforts, looking into prescription pill[opioid]abuse. Special task forces have been set up.”TheBCIRichfieldCrimeLabreportedthenum-berofprescriptionopioidcasesitprocesseshasgenerallyremainedthesameduringthepastsixmonths,withtheexceptionofanincreaseinUltram®casesandadecreaseinOxyContin®cases.

Reportedly,manydifferenttypesofprescriptionopioidsarecurrentlysoldontheregion’sstreets.Currentstreetpricesforprescriptionopioidswereconsistentamongpar-ticipantswithexperiencebuyingthedrugs.Participantsreportedthefollowingprescriptionopioidsasavailabletostreet-levelusers(Note:Whenreported,currentstreetnamesandpricesareindicatedinparentheses):Dilaudid®(aka“D’s;”4mgsellsfor$10-15;8mgsellsfor$20-25),mor-phine(100mgsellsfor$20),Opana®(aka“Os,”“pans”and“pandas;”40mg,aka“bigs,”sellsfor$80-100fortheoldfor-mulaand$15orhigherforthenewformula),OxyContin®(old formulation,aka““OCs”and“oxy’s;”80mgsellsfor$100;new formulation,aka“OP’s;”80mgoftensellsfor$20),Percocet®(aka“Ps”and“percs;”5mgsellsfor$3-5;10mgsellsfor$5-8),Roxicodone®(aka“blues”and“roxies;”30mgsellsfor$15-30)andVicodin®(aka“Vs”and“vics;”5mgsellsfor$3-5;7.5mgsellsfor$7;10mgsellsfor$7-8).

Inadditiontoobtainingprescriptionopioidsonthestreetfromdealers,participantscontinuedtoreportgettingthemfromdoctors,painclinics,families,friendsandanyonewhoisbeingtreatedwiththesemedications.Participantsalsooftenreportedthatdifferentmedications

aretradedandswappedtogetotherdrugs.Participantsoftencommentedonlegitimatepatientswhoselltheirprescriptions.Aparticipantshared,“I have a friend who gets scripts[prescriptions]for oxy’s, Percocet® and Vicodin®. She would take out so many for herself and sell the rest.”Anotherparticipantadmitted,“I stand outside the pharmacy and ask, ‘Do you want to let go of anything?’”Onefocusgroupdiscussedanetworkof“old-timers”whocanfindanyopi-ateonedesires.Aparticipantfromthatgroupsaid,“I can get any pill you want, any milligram. If they did not have it, they would get it and call me. I’d put in orders with them.”Treatmentprovidersagreedthattherearemanywaysforpeopletogetprescriptionopioids,noting: “doctor shop-ping, friends and relatives, on the street. Most [illicitusers]get them from people with prescriptions.”

Whiletherewereafewreportedwaysofconsumingprescriptionopioids,andvariationsinmethodsofusewerenotedamongtypesofprescriptionopioids,themostcommonroutesofadministrationareoralinges-tion,snortingandintravenousinjection(aka“shooting”).Participantsestimatedthatoutof10prescriptionopioidusers,fivewouldorallyingest,threewouldsnortandtwowouldintravenouslyinjectthedrugs.Inaddition,smokingwasmentionedbyaminorityofparticipants;thisrouteofadministrationforprescriptionopioidsisreportedlyrare.

Aprofileofatypicalillicituserofprescriptionopioidsdidnotemergefromthedata.Participantsnotedthatolderindividualstendtohavegreateraccesstoprescriptionopioids,whileindividualsofallagesusethem.Participantsobservedthatyoungerpeopleoftenobtainthesedrugsfromolderindividuals.Aparticipantexplained,“Older people are not seen as drug seeking, so doctors more read-ily prescribe these medications to this population.”Alawenforcementofficeragreed,commenting,“Even legitimate older people sell one or two [pills]just to get by … some pills sell for $40-80 a piece on the streets.”Treatmentprovidersalsoreportedthatuserstendtobeolderorknowolderpeoplewithailmentsandcangettheirmedications.Participantscommonlyreportedthatprescriptionopioidsare,“very popular [forabuse]across all lines; all races, all ages, all genders.”Treatmentprovidersreportedthattypi-calillicitusersofprescriptionopioidsaremorelikelytobewhitewithsomeincome(employed)tobeabletopayforthedrugs.SometreatmentprovidersnotedthatuseofprescriptionopioidsisincreasingamongAfrican-Americanmalesandwhitesuburbanadolescents.Lawenforcementdidnotreportatypicalillicituserofprescriptionopioids.Oneofficersaidthatauser“could be anybody.”





Reportedly,whenusedincombinationwithotherdrugs,prescriptionopioidsaremostoftencombinedwithalcohol,crackandpowderedcocaine,marijuana,meth-amphetamineandsedative-hypnotics.Theconsensusamongparticipantswasthatitismorecommontouseprescriptionopioidsincombinationwithotherdrugsthanitistousethembythemselves.Reportedly,alcoholandbenzodiazepineuseincreasestheeffectoftheprescrip-tionopioids.Stimulantssuchascocaineandmethamphet-amineareusedwithprescriptionopioidsbythoseseekingthe“speedball”effect.Severalparticipantsreportedusingprescriptionopioidswithmarijuanabecause,asonestated,“bothare downers … they make you feel more down, relaxed.”

Suboxone®

Suboxone®remainshighlyavailableintheregion.Partici-pantsreportedcurrentstreetavailabilityofSuboxone®as‘10’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewasalso‘10.’ParticipantssuggestedfraudulentuseofSuboxone®prescriptions:“People lie about their drug use … will get two or three [Suboxone®]pills a day and sell them; Many sell them[Suboxone®] to get what they really want[heroin].”

Treatmentprovidersmostoftenreportedthedrug’scurrentavailabilityas‘10;’thepreviousmostcommonscorewas‘7.’Atreatmentprovidercommented,“There is a market. People who are prescribed [Suboxone®]hold on to it and sell it.”However,treatmentproviderscommonlyre-portedthatindividualswhoseekSuboxone®,evenillicitly,oftendosoinanattempttogetoffheroinandtoavoidwithdrawal.Atreatmentprovidercommented,“[IllicituseofSuboxone®] it’s uncontrolled treatment. Providers [ofSuboxone®]are not doing their piece of getting them [pa-tients] off … keeping them accountable.”Lawenforcementreported,“I’ve seen it[Suboxone®] a few times. It’s getting into the [county] jail. People sneak it in [understamps] to help a person in jail who is in withdrawal.”

ParticipantsreportedthattheavailabilityofSuboxone®hasremainedthesameduringthepastsixmonths,whiletreatmentprovidersreportedthatavailabilityhasin-creased.TheBCIRichfieldCrimeLabreportedthenumberofSuboxone®casesitprocesseshasremainedthesameduringthepastsixmonths.

ParticipantsdidnotidentifyanycurrentstreetnamesforSuboxone®.StreetpricesforSuboxone®werevariableamongparticipantswithexperiencebuyingthedrug.Participantsreportedthattheypreferredtheless-availableSuboxone®8mgpillsoverthe8mgsublingualstrips:an8mgpillsellsfor$10-30;an8mgsublingualstripsellsfor$8-25.InadditiontoobtainingSuboxone®onthestreetfromdealers,participantsreportedgettingthedrugfromphysicians,treatmentagenciesandpeoplewithprescrip-tions.Aparticipantsaid,“You find a doctor who doesn’t require a [counselingortreatment]program.”Anotherpar-ticipantadmitted,“We’d lie about our drug use to get extras in order to make money. A friend of mine was prescribed 150 pills a month. She’d sell them to get heroin.”

Mostoften,participantsreportedtakingSuboxone®sublingually.Participantsestimatedthatoutof10illicitSuboxone®users,eightwouldsublinguallyusethestrips;betweenoneandtwowouldintravenouslyinjectthestrips,andsomewouldsnortthepills.AparticipantgroupalsomentionedthatSuboxone®stripsarecutandthenchewedbyusers.Further,itwasspecifiedthatSubutex®ismorelikelytobeintravenouslyinjectedduetoitspar-ticularformulationwithoutnaloxone.Participantswerealsoquicktonotethatboththepillsandthestripscanbeintravenouslyinjected.Nevertheless,thesealternativepracticeswerereportedtobefarlesscommon.

ParticipantsreportednodescriptoroftypicalillicitusersofSuboxone®.TreatmentprovidersreportedthatillicitSuboxone®usersaretypicallyyoung,white,employedandhavemedicalinsurance.

Reportedly,whenusedincombinationwithothersub-stances,Suboxone®isusedwithalcohol,crackandpow-deredcocaine,marijuanaandsedative-hypnotics.TheeffectofalcoholusewasreportedtobeintensifiedwhenusedwithSuboxone®.ParticipantsreportedusingotherdrugssuchasbenzodiazepineswithSuboxone®becauseasonestated,“You can’t get high on heroin [whiletakingSuboxone®], so it’s switch time.”Aparticipantexplainedthatthoseusingbenzodiazepinesoftenare,“seeking the same [opiate]high they were getting before.”Aparticipantgroupnoted,“Even though it [Suboxone®usewithbenzodiaz-epines] can be fatal, they still do it.”



Sedative-Hypnotics

Sedative-hypnotics(benzodiazepines,barbituratesandmusclerelaxants)remainhighlyavailableintheregion.Participantsmostoftenreportedcurrentavailabilityofthesedrugsas‘10’onascaleof‘0’(notavailable,impos-sibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewasalso‘10.’ParticipantsidentifiedAtivan®,Klonopin®,Valium®andXanax®asthemostpopularsedative-hypnoticsintermsofwidespreaduse.Participantscommented:“I could get them [sedative-hypnotics] anywhere, and I was highly addicted to them; Doctors are giving [prescribing]Ativan® to taper off Xanax®.”

Treatmentprovidersmostoftenreportedcurrentavailabil-ityofsedative-hypnoticsas‘8;’thepreviousmostcommonscorewas‘9.’TreatmentproviderscontinuedtoidentifyKlonopin®andXanax®asthemostpopularsedative-hypnoticsintermsofwidespreaduse.Treatmentproviderscommented:“[Sedative-hypnoticsare]not so much a ‘drug of choice,’ but they are available. People tend to use it episodi-cally, one or two times a month; If they are stressed, they take one of mom’s Xanax®.”Lawenforcementreportedcur-rentavailabilityas‘6’or‘7’andidentifiedXanax®asmostpopular.LawenforcementbelievedthatXanax®inparticu-larisreadilyavailable.Alawenforcementofficerstated,“There’s a lot of [Xanax®]prescriptions, and one is able to get it[Xanax®]from grandma’s or mom’s purse.”

Participantsreportedthattheavailabilityofsedative-hyp-noticshasincreasedduringthepastsixmonths.Apartici-pantstated,“I’ve noticed that because heroin has gone up, so have the benzos [benzodiazepines]. They go hand in hand. They [benzodiazepines]take the edge off when you are dope sick [inwithdrawal].”Treatmentprovidersandlawenforce-mentreportedthattheavailabilityofsedative-hypnoticshasremainedthesameduringthepastsixmonths.TheBCIRichfieldCrimeLabreportedthatthenumberofsedative-hypnoticscasesitprocesseshasremainedthesameduringthepastsixmonths,withtheexceptionofadecreaseinthenumberofSoma®cases.

Reportedly,manydifferenttypesofsedative-hypnoticsarecurrentlysoldontheregion’sstreets.Currentstreetpricesforsedative-hypnoticswereconsistentamongpar-ticipantswithexperiencebuyingthedrugs.Participantsreportedthefollowingsedative-hypnoticsasavailabletostreet-levelusers(Note:Whenreported,currentstreetnamesandpricesareindicatedinparentheses):Ativan®(aka“A’s”and“vans;”sellsfor$1permilligram;2mgsells

for$1.50-2),Klonopin®(aka“forget-a-pins”and“pins;”1mgsellsforunder$3),Xanax®(aka“busses,”“wagonwheels”and“xanies;”0.25mg,aka“footballs”and“peaches,”sellsfor50cents-$2.50;0.5mg,aka“greenfootballs,”sellsfor$2-3;1mg,aka“bluefootballs”and“blues,”sellsfor$2-4;2mg,aka“bars”or“logs,”sellsfor$5-7)andValium®(sellsforlessthan$1permilligram;5mgsellsfor$3).

Inadditiontoobtainingsedative-hypnoticsonthestreetfromdealers,participantsreportedgettingthemfromphysicians,psychiatrists,friendsandfamilymembers.Participantcommentsincluded:“I went to my doctor. He gave me anything I want. I told him I was trying to get off of alcohol; You can go to a doctor, tell him someone in your family died, say you’re depressed and he will give you Valium®.”Participantsalsoreportedthatitiscommonpracticeforpeoplewithprescriptionstosellthem.Apar-ticipantstated,“My 30-day script for Xanax® lasts five days. Then, the rest of the month, I am chasing it. Friends, family, they swap this for that.”

Whiletherewereafewreportedwaysofconsumingsedative-hypnotics,generally,themostcommonmethodsareoralingestionandsnorting.Participantsestimatedthatoutof10sedative-hypnoticusers,sevenwouldorallyingest;andthreewouldsnortthedrugs.Participantsreportedthatuserswilloftenchewthepills,oringestsub-linguallytogetthedrugintothesystemquicker.

Participantsdescribedtypicalillicitusersofsedative-hypnoticsaseitheryoung(teens–mid20s)orolder(overage40).Participantsreportedthatsedative-hypnoticuseiscommonwithopiateusersbecause“It helps take away [dope] sickness,”andcocaineusers“to come down from the buzz [stimulanthigh].”Treatmentprovidersreportedthattypicalillicitusersofsedative-hypnoticsaremostoftenwhite.SomeprovidersnotedthatveteranscomingbackfromtheMiddleEastcommonlyusesedative-hypnotics,aswellaspeoplewithmentalhealthissues.

Reportedly,whenusedincombinationwithotherdrugs,sedative-hypnoticsaremostoftencombinedwithalcohol,crackandpowderedcocaine,ecstasy,heroin,marijuanaandmethamphetamine.Accordingtoparticipants,seda-tive-hypnoticsare,“almost always part of a cocktail [mixofdrugs],”because,“If you take it by itself, you just fall asleep.”Participantsreportedthatsedative-hypnoticsintensifytheeffectofmarijuanaandheroin.Userscombineusewithcrackandpowderedcocaine,ecstasyandmethamphet-amineto“comedown”fromthestimulanthighofthose





drugs.Participantssaidthattheyusesedative-hypnoticswithalcoholto“intensifythehigh”producedbyalcohol.

Marijuana

Marijuanaremainshighlyavailableintheregion.Partici-pantsandcommunityprofessionalsmostoftenreportedthedrug’scurrentavailabilityas‘10’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewasalsounanimousat‘10.’Aparticipantstated,“People I know usually have some weed [marijuana]on them.”Therewasalsoconsensusamongparticipantsthatevenhighergradesofmarijuanaare“very easy to get, year round.”Atreatmentprovidercommented,“It used to be, ‘Thank God my kids are only using cigarettes, not other drugs.’ Now they say, ‘Thank God my kids are only using marijuana [andnototherdrugs].’”Anothertreatmentproviderreportedthatsevenoutof10clientstestpositiveformarijuanauponad-mission,butmarijuanaisoftennotthedrugofchoice.Lawenforcementcitedthreetypesofmarijuanaintheregion:“Mexicanskunkweed,”“B.C.bud”(fromBritishColumbia,describedashavingahighTHClevel)and“homegrown.”Theyreportedallthreetypesasreadilyavailable.

Collaboratingdataalsoindicatedthatmarijuanaisreadilyavailableintheregion.TheStarkCountyDayReportingProgramsaidthat58.5percentofitspositivedrugscreensduringthepastsixmonthswerepositiveformarijuana.Inaddition,theSummitCountyJuvenileCourtreportedthat19.2percentofalldrugscreensprocessedduringthepastsixmonthswerepositiveformarijuana.

Mediaoutletsintheregioncoveredanumberofmari-juanaseizuresandarreststhisreportingperiod.PoliceinAlliance(StarkCounty)arrestedamaninwhatwasbe-lievedtobethelargestmarijuana-growingoperationinAlliancepolicehistory,confiscating260marijuanaplantsatahome(www.wkyc.com,Feb.27,2013).AnAkronmanwassentencedonfelonydrug-traffickingchargesstem-mingfromanarrestinMarchwhenthemanwascaughtacceptingapackagecontainingfivepoundsofmarijuana(www.wkyc.com,June11,2013).ThePortageCountyDrugTaskForcemadetwoarrestsofindividualstraffickinginmarijuana,oneatamotelwhereseveralmarijuanaplantswerefoundandtheotheratahomeinKent(www.wkyc.com,June18,2013);andStarkCountylawenforcementre-portedseizing332poundsofmarijuanawithanestimatedstreetvalueof$500,000(www.wkyc.com,June27,2013).

Participantsandcommunityprofessionalsmostoftenre-portedthattheavailabilityofmarijuanahasremainedthesameduringthepastsixmonths.TheBCIRichfieldCrimeLabreportedthatthenumberofmarijuanacasesitpro-cesseshasremainedthesameduringthepastsixmonths.

Severalparticipantsexplainedthatthequalityofmari-juanadependsonwhethertheuserbuys“commercial weed”(low-tomid-grademarijuana)orhydroponicallygrown(high-grademarijuana).Participantsdescribed“commercial weed”asbeing“dark brownish-green,”dry,andcontainingstemsandseeds.Highergradesofmari-juanaweredescribedashaving“vibrant colors”(aka“bright green,”attimeswith“red hairs”anda“purple hue”),fluffy,sometimeswithcrystals,“strong smelling,”often“sticky”tothetouch.Participantsmostoftenreportedthecurrentqualityofmarijuanaas‘10’forhigh-grademarijuanaand‘7’forlow-grademarijuanaonascaleof‘0’(poorquality,“garbage”)to‘10’(highquality);thepreviousmostcom-monscoreswere‘10’forhigh-grademarijuanaand‘5’forlow-grademarijuana.Mostparticipantsreportedthattheywillusuallybuyhighergradesofmarijuana.Severaltreat-mentprovidersagreed,withonestating,“Young people are smoking higher potency marijuana.”

Currentstreetjargonincludescountlessnamesformarijuana,butthemostcommonlycitednameremains“weed.”Participantslistedthefollowingasothercom-monstreetnames:“mids,”“reggie,”“regular”and“swag”forcommercial-grade(lower-quality)marijuana;“dank”and“dro”forhigh-gradeorhydroponicallygrownmarijuana.Thepriceofmarijuanadependsonthequalitydesired;currentstreetpricesformarijuanawereconsistentamongparticipantswithexperiencebuyingthedrug.Participantsreportedcommercial-grademarijuanaasthecheapestform:ablunt(cigar)ortwojoints(cigarettes)sellsfor$10;1/8ouncesellsfor$15-25;1/4ouncesellsfor$35-45;andanouncesellsfor$100.Higher-qualitymarijuana(“hydro”)sellsforsignificantlymore:abluntortwojointssellsfor$15;1/8ouncesellsfor$40-60,1/4ouncesellsfor$80-100;andanouncesellsfor$200-350.Participantscommonlyreportedthatuserstypicallypurchasebetween1/8ounceand1/4ounceofmarijuanaatatimeandthatpricesvarydependingongeographicallocation.AparticipantfromTuscarawasCountynoted,“You can get more weed for $20 in Canton [StarkCounty] than you do for $20 around here.”

Whiletherewereseveralreportedwaysofconsumingmarijuana,themostcommonrouteofadministrationremainssmoking.Outof10marijuanausers,participants



reportedthatapproximatelyall10wouldsmokethedrug.Whilemarijuanacanalsobeconsumedbyeatingbakedgoods,participantscommonlyreportedthatthismannerofuseistheexception.Aprofileforatypicalmarijuanauserdidnotemergefromthedata.Participantsandcom-munityprofessionalsreportedthatmarijuanauseiscom-monamongallpopulationgroups.

Reportedly,marijuanaisusedincombinationwithjustaboutanyotherdrug.Manyparticipantgroupsnotedthatmarijuanais“used with everything.”Aparticipantexplained,“If I am using meth[methamphetamine], I’m going to smoke some weed. If I’m smoking coke, I’m going to smoke some weed. If I’m drinking [alcohol], I’m going to get me a blunt.”Itwasnotedthatthereareafewuserswhoonlysmokemarijuana,butitwasmorecommonlyreportedthatusersofanyotherdrugwillalsousemarijuana.Asatreatmentprovidernoted,“Anyone who uses any illegal drug is prob-ably using marijuana with it.”

Methamphetamine

Methamphetamineremainshighlyavailableintheregion.Participantscontinuedtomostoftenreportthedrug’scurrentavailabilityas‘10’onascaleof‘0’(notavailable,

impossibletoget)to‘10’(highlyavailable,extremelyeasytoget).Participantsreportedthatmethamphetamineisavailableinpowderedform.Aparticipantexplainedtheconsistency:“sometimes chunky, breaks down into powder.”Participantsagreedthatpreva-lenceofmethamphetamineishigh:“Pretty common; every day a meth [methamphet-amine]lab is being busted.”Participantsfromthroughouttheregioncommentedabouttheproductionof“one-pot”or“shake-and-bake”methamphetamine.Usersareproduc-

ingmethamphetamineinasingle,sealedcontainer,suchasatwo-litersodabottle.Byusingcommonhouseholdchemicals,alongwithammoniumnitrate(foundincoldpacks)andpseudoephedrine(typicallyfoundinover-the-countercoldandallergymedications),methamphetaminemanufacturers(aka“cooks”)canproducethedruginap-proximately30minutesatnearlyanylocationbymixingingredientsineasilyfoundcontainers.Thisformofmeth-amphetamineisincreasinglymoreavailableintheregion.Asoneparticipantcommented,“You don’t see old-school cooks. It takes too long – up to a week – and they need too many ingredients.”Anotherparticipantreported,“Around

here, there are still 24-hour cooks, but shake-and-bake is more popular.”Importedmethamphetamine(aka“crystalice”)reportedlyisveryhardtofind.

Treatmentprovidersmostoftenreportedthedrug’scur-rentavailabilityas‘8;’thepreviousmostcommonscorewas‘9.’Atreatmentprovidercommented,“So many people are making their own [methamphetamine].”Lawenforce-mentreportedthedrug’scurrentavailabilityas‘10;’thepreviousmostcommonscorewas‘4.’(Note:forthisreport,lawenforcementfromSummitCountywasinterviewed,whileinthepreviousreport,lawenforcementwasfromStarkCountyonly).Lawenforcementreportedthat90per-centofthelabsintheregionareinSummitCounty;theyalsoreportedthatinthepastyear,therehasbeenanaver-ageof39labsfoundbylawenforcementperquarteryear.Accordingtolawenforcement:“We don’t see red phospho-rous [“old-school”method]anymore, it’s all one-pot; anyone can make it now.”

Mediaoutletsintheregionreportedonanumberofmethamphetamineseizuresandarreststhisreportingpe-riod.AjuryfoundanAkronmanguiltyofmanufacturingmethamphetamineinalocalapartment(www.wkyc.com,Feb.6,2013).Streetsboro(PortageCounty)policearrestedtwopeopleatalocalmotelforpossessionofanounceofcrystalmethamphetamine(aka,“ice”or“glass”)withanap-proximatestreetvalueof$6,000;thiswasasignificantfindasthistypeofmethamphetamineisthoughttoberareintheregion(www.wykc.com,Feb.27,2013).Severalmethlabswerediscoveredintheregion:thePortageCountyDrugTaskForcediscoveredamethlabinaRavennaapart-mentcomplex(www.wkyc.com,March6,2013);inAkron,afive-year-oldchildwasremovedfromahomewhenamethlabwasdiscoveredinoneofthehome’sbedrooms(www.wkyc.com,March12,2013);andthePortageCountyDrugTaskForcebustedtwoadditionalmethlabs,arrest-ingfourpeople(www.wkyc.com,March28,2013).LawenforcementinSummitCountyreportedbusting11methlabs,puttingthecountyontrackforarecordnumberofmethlabbustsfor2013(www.wkyc.com,April30,2013).Brimfield(PortageCounty)policearrestedtwomenandtwoteensafterdiscoveringamobilemethlabnearI-76(www.wkyc.com,June8,2013).

Participantsreportedthattheavailabilityofmetham-phetaminehasincreasedduringthepastsixmonths.Participantsoftencommentedonthechangeofmanufactureasthereasonforincreasedavailability:“[Methamphetamine] it’s easy to make, and everyone is





making it. Teenagers are making it now; We went from a 24-hour cook, to ‘shake-and-bake’ in one hour; … get me two boxes of Sudafed®, and I will guarantee an eight-ball[1/8ounceofmethamphetamine].”Onegroupreportedanincreaseinthenumberofpeoplewhomakemethamphet-aminetosellit:“There’s a ton of money in making it[meth-amphetamine] … fast cash.”

Treatmentprovidersreportedthattheavailabilityofmeth-amphetaminehasremainedthesameduringthepastsixmonths,whilelawenforcementreportedthatavailabilityhasincreasedduringthepastsixmonths,primarilyduetoeaseofproduction.Themajorityofmethamphetaminelabbuststhroughouttheregionarereportedlythe“shake-and-bake”type;labsareoftenfounddiscardedalongtheroadorinvehicles,homesandmotels.TheBCIRichfieldCrimeLabsaidthenumberofmethamphetaminecasesitprocesseshasincreasedduringthepastsixmonths.

Participantsmostoftenratedthecurrentqualityofpow-deredmethamphetamineas‘10’onascaleof‘0’(poorquality,“garbage”)to‘10’(highquality);thepreviousmostcommonscorewas‘6.’However,qualityofpowderedmethamphetaminewassaidtovarywidely.Aparticipantstated,“It’s like heroin. You don’t know what you are going to get.”Anotherparticipantshared,“It’s a rough game out there. They [dealers]will sit with you and use some really good shit with you, then sell you some garbage.”Apartici-pantgroupreportedthatmethamphetamineisoftencutwithbathsalts.Participantsdidnotagreeonwhetherthequalityofmethamphetaminehasincreasedordecreasedduringthepastsixmonths.However,theydidagreethatthequalityof“shake-and-bake”methamphetamineisnotasgoodasredphosphorousmethamphetamine.

Currentstreetjargonincludesafewnamesformetham-phetamine.However,althoughtherehavebeenotherstreetnamesformethamphetaminementionedinpastreports,participantsduringthisreportingperiodonlymentioned“crystal.”Currentstreetpricesformethamphet-aminewereconsistentamongparticipantswithexperi-encebuyingthedrug.Participantsreportedthatagramofcrystalmethamphetaminesellsfor$120-160;agramofpowderedmethamphetaminesellsfor$80-110.However,aparticipantnoted,“If you make it [methamphetamine] yourself, it will cost you $20, and you will get four grams.”Participantsalsoreportedthatonecanpurchasea“vial”ofanunspecifiedamountofmethamphetaminefor$20;someparticipantsreportedthatthisisthemostcommonwaytopurchasethedrug.

Manyparticipantsreportedexchangingboxesofpseu-doephedrineformethamphetamine.Participantsnotedthatonecouldpurchasealimitedamountofmedicationcontainingpseudoephedrineeachmonthperstatelaw,andmanyparticipantsreporteddoingsototradeformethamphetamine,ortoselltoamethamphetaminecookformoneytobuytheirdrugofchoice.AparticipantexplainedexchangingSudafed®formethamphetamine:“You can get a quarter gram of meth [inexchange] for a box of Sudafed®.”AnotherparticipantexplainedhowtheyexchangeSudafed®formoney:“I would get Sudafed® … sell three boxes for $100 to support my heroin use.”

Whilethereareseveralwaysofusingmethamphetamine,themostcommonmethodremainsintravenousinjection.Outof10methamphetamineusers,participantsestimatedthatsixwouldintravenouslyinject,threewouldsnortandanotheronewouldsmokethedrug.However,participantsnotedthatimportedmethamphetamine(aka“crystalice”)isalmostalwayssmoked.

Participantsdescribedtypicalusersofmethamphetamineaswhite,male,middle-tolower-incomestatus,middle-agedoryounger.Inaddition,participantsoftennotedmethamphetamineuseascommonamongthosewhoworklonghours,includingseasonallandscapersandconstructionworkers,aswellastruckdrivers;andreport-edly,thedrugiscommonlyusedinthegaycommunity.Treatmentprovidersdescribedtypicalusersofmetham-phetamineaswhite,under-educatedandoftenoflowerincomebecause“it’s cheap.”Lawenforcementagreedthattypicalusersofmethamphetaminearemostoftenwhiteandoflowersocio-economicstatus.

Reportedly,methamphetamineisusedincombinationwithalcohol,bathsalts,heroin,marijuanaandsedative-hypnotics.Participantssaidthattheseotherdrugsaregenerallyusedtoassistwith“comingdown”fromthestimulanthighproducedbymethamphetamine.Apartici-pantexplained,“Some meth users are up for days and need something to calm them down.”Anotherparticipantshared,“I’d shoot meth [and]then come down with heroin.”Severalparticipantsalsoreportedthatitiscommontousemeth-amphetaminebyitself,notincombinationwithotherdrugs.Participantsexplained:“Meth makes other drugs inef-fectual; I used meth by itself. In fact, I quit drinking [alcohol] because of meth.”



Prescription Stimulants

Prescriptionstimulantsaremoderatelyavailableintheregion.Specifically,participantsreportedontheavailabil-ityofAdderall®.Participantswerenotconsistentinratingprescriptionstimulantavailability.Themostcommonscoreswerebetween‘3’and‘10’onascaleof‘0’(notavail-able,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewas‘10.’Aparticipantremarked,“If you want it [Adderall®]bad enough, you can find it, but you may need to knock on a few doors.”Participantsspokeabouttheneedtocallaroundtodifferentpharmaciesevenwhentheyhavealegiti-mateprescription,asmanypharmaciesarenotabletofillprescriptionsforAdderall®becausetheyhaverunout.Consequently,aparticipantsurmised,“The manufacturer is not making them readily available.”Lawenforcementmostoftenreportedcurrentavailabilityofprescriptionstimu-lantsas‘5.’TheBCIRichfieldCrimeLabreportedAdderall®andDexedrine®asavailableintheregion.

Participantsdidnotagreeonwhethertheavailabilityofprescriptionstimulantshasincreased,decreasedorremainedthesameduringthepastsixmonths.Someparticipantsreportedthatitismoredifficulttohavethesedrugsprescribedbyadoctor,commenting:“It used to be easy to get a prescription [forastimulant]. Now, you need to know the key words, like ‘paying attention;’ Doctors are being wiser, starting to drug test to make sure you are not on co-caine; People who are prescribed it [Adderall®] want to hang on to it.”However,oneparticipantsaid,“A doctor moved into the area who is writing scripts left and right. I found out about him in jail.”Communityprofessionalsdidnotreportonachangeofavailabilityforprescriptionstimulants.TheBCIRichfieldCrimeLabreportedthatthenumberofprescriptionstimulantcasesitprocesseshasremainedthesameduringthepastsixmonths.

Currentstreetjargonincludesafewnamesforprescriptionstimulants.Themostcommonlycitednameswere“addies,”“blues,”“legalmeth,”“speed”and“XRs.”Currentstreetpricesforprescriptionstimulantswereconsistentamongpartici-pantswithexperiencebuyingthedrug.Thefollowingpre-scriptionstimulantpriceswereprovidedbyparticipants:genericprescriptionstimulant20mgsellsfor$4;Adderall®30mgsellsfor$5-10;anentiremonth’sprescriptionsellsfor$100.

Inadditiontoobtainingprescriptionstimulantsonthestreetfromdealers,participantsreportedgettingthem

fromphysiciansandfamilymembersorfriendswhohavebeenprescribedthemedication.Aparticipantcom-mented,“I thieved from my son. I got hooked, went to my doctor and said I have ADD [attentiondeficitdisorder], got a script for 60 pills. Then, I’d use them in five days. Then I’d have to go buy them for $6 or $7 a pill.”Anotherparticipantadded,“If I wanted it [prescriptionstimulants], I would go to the high school, as so many kids are prescribed it, and are willing to sell it for cash.”Whiletherewereseveralreportedwaysofusingprescriptionstimulants,themostcommonmethodissnorting.Outof10illicitprescriptionstimulantusers,participantsestimatedthatninewouldsnort;andonewouldorallyingestthedrugs(eitherbyswallowingorchewingthem).

Participantsdescribedtypicalillicitusersofprescriptionstimulantsascollegestudents.Reportedly,truckdriversalsocommonlyusethedrug.Participantsstatedthatthesedrugsareusedincombinationwithalcohol,heroin,pre-scriptionopioidsandsedative-hypnoticstohelpto“comedown”fromtheeffectofthestimulant.

Bath Salts

Bathsalts(syntheticcompoundscontainingmethylone,mephedrone,MDPVorotherchemicalanalogues)remainavailableintheregion.Participantsmostoftenreported

thedrug’scurrentavailabilityas‘2’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewas‘10.’Aparticipantcommented,“You can’t get it[bathsalts]anymore.”Treatmentprovidersmostoftenreportedcurrentavailabilityas‘7.’Treatmentproviderscommented:“If they[users]cannot find heroin or meth, or are tired of heroin or meth, they will turn to bath salts; People that are using bath salts are not talk-ing about it.”Lawenforcementreportedthat

whilebathsaltsarestillavailableinsomestores,availabil-ityissomewhatscarce.

Participants,treatmentprovidersandlawenforcementreportedthattheavailabilityofbathsaltshasdecreasedduringthepastsixmonths.Participantcommentsinclud-ed:“You used to be able to buy it[bathsalts]on every corner until they outlawed it.”Atreatmentprovidercommented,“The conversation is going down, which means that either it [bathsalts]is going away, or they[clients]are afraid of it.”TheBCIRichfieldCrimeLabreportedthatthenumberof





bathsaltcasesitprocesseshasremainedthesameduringthepastsixmonths.

Participantsdidnotidentifyanystreetnamesforbathsalts,thoughonegroupnotedthatitiscurrentlybeingsoldintheregionwiththebrandname,“WhiteHorse.”Participantssharedtheirknowledgeandexperienceofpurchasingthedrug.Reportedly,bathsaltsmostoftensellfor$40-60pergram.However,thepricevaries,asonefocusgroupreported1/2gramsellsfor$35.Anothergroupsaidthatbathsaltsaresoldin“littlevials,”for$15,butdidnotreporthowmuchdrugeachvialcontains.

DespitelegislationenactedinOctober2011,severalpar-ticipantsnotedthatbathsaltsarestillsoldincertain“headshops,”convenientstoresandbeveragedrive-thrustores.However,participantsoftenreported:“Some [retailoutlets]won’t sell it[bathsalts] unless they know you; You have to know the name of what they call it, you can’t just ask for bath salts; You have to know the right ‘code word.’”Participantsdisclosed,“There’s only one place in Canton that still sells it [bathsalts], but it’s not worth it … poor quality ….”ParticipantsalsosaidthatonecandrivetoPennsylvaniaandpurchasebathsaltseasierthanobtainingitintheAkron-Cantonregion.Aparticipantgroupnoted,“If noth-ing else, [you]look it [bathsalts] up on the Internet, learn how to make it or order it online.”

Whiletherewereseveralreportedwaysofusingbathsalts,themostcommonmethodsareintravenousinjectionandsnorting.Participantsestimatedthatoutof10bathsaltusers,fivewouldintravenouslyinject,threewouldsnortandtwowouldsmokethedrug.

Aparticipantgroupdescribedtypicalusersofbathsaltsasbeingthesameascocaineusers,butotherwisenotypicalcharacteristicswereidentified.Reportedly,bathsaltsareusedincombinationwithalcohol,crackandpowderedcocaine,heroinandmethamphetaminetoeitherenhance/intensifytheeffectsoftheotherdrugs,ortoassistwith“comingdown”offofbathsalts.Participantsdidnotcom-mentastohowcommonitistousebathsaltswithotherdrugsasopposedastousingbathsaltsalone.

Synthetic Marijuana

Syntheticmarijuana(syntheticcannabinoids,aka“K2”and“Spice”)ismoderatelytohighlyavailableintheregion.Participantswerenotconsistentinratingitsavailability.

Mostcommonscoreswerebetween‘6’and’10’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget);thepreviousmostcommonscorewas‘10.’Similartobathsalts,partici-pantsreportedthatsyntheticmarijuanaisstillavailablein“headshops,”conveniencestores,beveragedrive-thrustoresandtattooparlors.However,thesevendorsaremorediscreetthantheyusedtoberegardingsales.Treatmentprovidersandlawenforcementdidnotratethecurrentavailabilityofsyn-

theticmarijuana.Previously,themostcommonscorewas‘6.’Treatmentprovidersnotedthatclientsrarelytalkaboutsyntheticmarijuana.Lawenforcementsaidthatthemajor-ityofsyntheticmarijuanatheyencounteris“homemade,”explainingthatuserspurchasetheingredientsthroughtheInternet:“When we [lawenforcement]find it [syntheticmarijuana], we have it tested to identify illegal components.”

Participantsreportedthattheavailabilityofsyntheticmarijuanahasremainedthesameordecreasedduringthepastsixmonths.Aparticipantnoted,“They [lawenforce-ment]are trying to outlaw it [syntheticmarijuana] and are cracking down on it.”Treatmentprovidersandlawenforce-mentreportedthattheavailabilityofsyntheticmarijuanahasdecreasedduringthepastsixmonths,althoughlawenforcementreported,“We still see it occasionally.”TheBCIRichfieldCrimeLabreportedthatthenumberofsyntheticmarijuanacasesitprocesseshasremainedthesamedur-ingthepastsixmonths.

Participantsreportedthatsyntheticmarijuanamaybesoldunderlabelslike“potpourri.”Reportedly,syntheticmari-juanasellsfor$5-10pergramandcanbepurchasedin1-,2-or3-grambags.Severalparticipantscommentedthat“headshops”aretheonlyplaceonecanpurchasesynthet-icmarijuanacurrently;whileotherparticipantscontinuedtoreportpurchasingthisdrugatconvenienceandbever-agedrive-thrustores.Theonlyrouteofadministrationreportedbyparticipantswassmoking.

Participantsdescribedtypicalusersofsyntheticmarijuanaasanyindividual,“being drug tested for their job or for probation.”Reportedly,syntheticmarijuanacanbeusedin



combinationwith“anything,”althoughparticipantsindi-catedthatitismostcommonlyusedbyitself.

Ecstasy

Ecstasy(methylenedioxymethamphetamine:MDMA,orotherderivativescontainingBZP,MDAand/orTFMPP)ishighlyavailableintheregion.Participantsmostoften

reportedthedrug’scurrentavailabilityas‘8’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget).Participantsreportedthatecstasyalmostexclusivelyisfoundinstripclubsoratraves(danceparties)andisnotcommonlyavailableonthestreets.Treatmentprovidersandlawenforcementdidnotratethedrug’scurrentavailability.Asonetreatmentpro-vidercommented,“No one talks about these [ecstasy]anymore.”Lawenforcementreport-edtheavailabilityasbeing,“hit and miss.”A

lawenforcementofficerstated,“As far as large amounts[ofecstasy], we don’t see it. On occasion we will get a big seizure, but other than that, it’s a few pills here and there.”

Participantsreportedthattheavailabilityofecstasyhasdecreasedduringthepastsixmonths.Aparticipantreasoned,“Harder drugs are taking over. Ecstasy people [users] are going to heroin.”Participantsalsoreportedthattherearefewerdealerssellingthedrug.Aparticipantstated,“Many of my ecstasy hooks[dealers]are in jail now.”TheBCIRichfieldCrimeLabreportedthatthenumberofecstasycasesitprocesseshasdecreasedduringthepastsixmonths.

Participantsdidnotreportanystreetnamesforecstasy.Currentstreetpricesforecstasywereconsistentamongparticipantswithexperiencebuyingthedrug.Participantsreporteda“singlestack”(lowdose)ecstasytabletsellsfor$10-15;a“doublestack”(highdose)sellsfor$20.Whiletherewereseveralreportedwaysofusingecstasy,themostcommonmethodisoralingestion.

Participantsdescribedtypicalusersofecstasyasindividu-alswhofrequentclubs.Lawenforcementdescribedthetypicalecstasyusersas,“young, party kids.”Participantsdidnotreportanyotherdrugsusedincombinationwithecstasy.

Other Drugs

Participantsandcommunityprofessionalslistedafewotherdrugsasbeingpresentintheregion,butthesedrugswerenotmentionedbythemajorityofpeoplein-terviewed:hallucinogens[lysergicaciddiethylamide(LSD)andpsilocybinmushrooms]and“lean”(promethazinewithcodeinetypicallymixedintoasoftdrink).

ParticipantscommentedontheavailabilityofLSD(aka“acid”),reportingittobe,“hard to find; not as common[aspsilocybinmushrooms].”NoparticipantreportedrecentexperienceusingLSD.Participantsreportedtheavailabil-ityofpsilocybinmushroomstobevariable.Aparticipantsaid,“If you are looking for it[psilocybinmushrooms], you can find it, but it’s seasonal.”Anotherparticipantcom-mented,“[Psilocybinmushroomsare]hard to find around here, only at festivals or people at festivals bring them home.”Participantssuggestedavailabilityofpsilocybinmush-roomshasdecreased,asonestated,“It used to be 24/7. Now, depends on the time of year.”OnlyonegroupinStarkCountyreportedhighavailability:“Shrooms [psilocybinmushrooms] are big around here.”StarkCountyparticipantsratedthecurrentavailabilityofpsilocybinmushroomsas‘8’onascaleof‘0’(notavailable,impossibletoget)to‘10’(highlyavailable,extremelyeasytoget).

Treatmentprovidersreportedthathallucinogenicdrugs(LSDandpsilocybinmushrooms)arenotveryavailable.Atreatmentprovidercommented,“[Hallucinogens] are one of the hardest things[drugs] to find, no one talks about these anymore.”Lawenforcementreported,“We don’t see [hal-lucinogens]much … mostly they’re mushrooms.”TheBCIRichfieldCrimeLabreportedthatthenumberofcasesofLSDandpsilocybinmushroomsitprocesseshasdecreasedduringthepastsixmonths.Participantsreportedthataquarterounceofpsilocybinmushroomssellsfor$50.Participantsreportedthatuseofpsilocybinmushroomsisverypopularamongmarijuanasmokers.Communityprofessionalssuggestedthathallucinogensareseenmoreatrockconcertsthanonthestreet.Atreatmentprovidercommentedthatuseismorecommonwith,“the older generation.”

Onetreatmentprovidergroupreportedontheuseof“lean.”Reportedly,theuseofthissubstanceispopularwithyouthandyoungadultsandalsoverycommonlyusedinthe“rapscene”andinthe“ravescene”asitispromotedbymanyrapartists.





ConclusionCrackcocaine,heroin,marijuana,methamphetamine,sedative-hypnoticsandSuboxone®remainhighlyavail-ableintheAkron-Cantonregion;alsohighlyavailableintheregionarepowderedcocaineandecstasy.Changesinavailabilityduringthepastsixmonthsincludein-creasedavailabilityforheroinandmethamphetamineanddecreasedavailabilityforbathsaltsandecstasy.Dataalsoindicatedlikelydecreasedavailabilityforsyntheticmarijuana.

Whilemanytypesofheroinarecurrentlyavailableintheregion,participants,lawenforcementandtheBCIRichfieldCrimeLabreportedbrownpowderedheroinasthemostavailableherointypeintheregion;allofthedatasourcesalsowereinconsensusonthelowavailabilityofblacktarheroinregionally.Respondentscontinuedtoattributetheincreasedavailabilityofbrownpowderedheroinduringthepastsixmonthstothereformulationofseveralpre-scriptionopioidsthatmadethemmoredifficulttoabuse,increaseddifficultyinobtainingprescriptionopioidsandthesignificantlycheaperpriceofheroin.However,partici-pantsreportedthatthequalityofheroinhasdecreasedduringthepastsixmonths.Participantsoftencommentedthatincreaseddemandhasresultedindealerscuttingheroinmoretotheirprofitmargin.

Participantsandcommunityprofessionalsconsistentlycommentedonthedecreasedageamongheroinusers.Treatmentprovidersconsistentlyreportedthatheroinusersareoftenwhiteandyounger(early-tomid-20s/collegeaged).Inaddition,atreatmentprovidergroupre-portedthatheroinuseisincreasingamongyoungfemales.Lawenforcementalsoreportedanincreaseinthenumberofteenagerswhoareusingheroin.

Participantscontinuedtoreportthecurrentavailabilityofmethamphetamineas‘10’(highlyavailable).Participantsagreedthattheprevalenceofmethamphetamineishigh.Mostoftheavailablemethamphetamineisthepowdered“shake-and-bake”type,whichislocallyproduced.Lawenforcementreportedthat90percentofthemethlabsintheregionareinSummitCounty;theyalsoestimatedanaverageof39labsfoundbylawenforcementperquarteryear.Importedmethamphetamine(aka“crystalice”)isreportedlyrarelyavailable.

Participantsandlawenforcementreportedthatmetham-phetamineavailabilityhasincreasedduringthepastsix

months,primarilyduetoeaseofproduction.Aparticipantgroupreportedanincreaseinthenumberofpeoplewhomakemethamphetaminetosellthedrug.Manypartici-pantsreportedexchangingboxesofpseudoephedrineformethamphetamine.Participantsnotedthatonecouldpurchasealimitedamountofmedicationcontainingpseu-doephedrineeachmonthperstatelaw,andmanypartici-pantsreporteddoingsototradeformethamphetamine,ortoselltoamethamphetaminecookformoneytobuytheirdrugofchoice.Typicalusersofmethamphetaminecontinuetobepredominatelywhite,male,middle-tolower-incomestatusandmiddleagedoryounger.

DespitelegislationenactedinOctober2011,participantsnotedthatbathsaltsandsyntheticmarijuanaarestillsoldincertain“headshops,”conveniencestoresandbever-agedrive-thrustores.However,thesevendorsaremorediscreetthantheyusedtoberegardingsales.Lawenforce-mentaddedthatwhilebathsaltsarestillavailableinsomestores,availabilityissomewhatscarce.ParticipantsnotedthatonecandrivetoPennsylvaniaandpurchasebathsaltseasierthanobtainingthedrugintheAkron-Cantonregion.Treatmentprovidersnotedthatclientsrarelytalkaboutsyntheticmarijuana.

ParticipantsandlawenforcementreportedthatsomeusersareturningtotheInternettolearnhowtomaketheirownsyntheticdrugs.Lawenforcementexplainedthatthemajorityofsyntheticmarijuanatheyencounteris“homemade.”Lawenforcementinformedthatuserspur-chasetheingredientsviatheInternet,andwhentheyfindsuspectedsyntheticmarijuana,theysendittobetestedforanyillegalcomponents.

Lastly,whileecstasyavailabilitywasthoughttoremainhighintheregion,participantsreportedthatavailabilityhasdecreasedduringthepastsixmonths.Inaddition,theBCIRichfieldCrimeLabreportedthatthenumberofecstasycasesitprocesseshasdecreasedduringthepastsixmonths.Participantsreportedthatecstasyisalmostexclusivelyfoundinstripclubsoratraves(undergrounddanceparties)andnotcommonlyavailableonthestreets.Participantsexplainedthattherearefewerdrugdealerssellingecstasy.Treatmentprovidersstatedthatclientsdonottalkaboutecstasyanymore,andlawenforcementdescribedecstasyavailabilityas“hitandmiss.”

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