Crack: The Perception

How do Pulse Check sources perceive the crack cocaine problem in their communities? Crack is considered the most commonly used drug in Pulse Check communities by 20 law enforcement, epidemiologic, ethnographic, and non-methadone treatment sources in 14 cities. As reported in the last Pulse Check issue, more than half of those cities are in the South (all eight Pulse Check sites in that region). The rest span the remaining regions: the Northeast (New York and Portland, ME); the Midwest (Chicago and Detroit); and the West (Los Angeles, and Seattle). Additionally, the Denver non-methadone treatment source considers both crack and powder cocaine as the most commonly used drugs. Further, crack is considered the second most commonly used drug by sources in Boston, Philadelphia, and St. Louis.

Crack is also named as the drug with the most serious consequences in Pulse Check communities by 29 of the 82 sources who provided this infor-mation. These sources span 14 cities, and again, more than half are in the South (all 8 Pulse Check sites). The rest span the remaining three regions: the Northeast (Boston and New York); the Midwest (Chicago, Detroit, and St. Louis); and the West (Los Angeles). Another two sources (in Baltimore and Philadelphia) name both crack and heroin as the most serious drug problem, while two name cocaine without differentiating between the two types. Crack is named as the drug with the second most serious consequences by 22 additional sources in 16 cities, and it is considered equal to other drugs (in causing the second most serious consequences) in another 5 cities: powder cocaine in Denver and Seattle; heroin in Baltimore and Los Angeles; and benzodiazepines in Philadelphia.

Has the perception of the crack problem changed between fall 2000 and spring 2001? One source in Memphis believes that crack has overtaken powder cocaine as the most commonly abused drug among hardcore users in the community. However, all other sources who list crack as the most commonly abused drug during the current period report a stable trend since the previous period. Similarly, all but two sources report a stable trend in crack as the drug with the most serious consequences in their communities. El Paso is one exception: that city's epidemiologic source believes that crack has been making inroads and is replacing heroin in terms of serious consequences. Memphis is the other exception, but in reverse: the non-methadone treatment source believes that powder cocaine has overtaken crack in this area.

CRACK: THE DRUG

How available is crack cocaine across the country? (Exhibit 1) More than three-quarters (32 of 42) of law enforcement, epidemiologic, and ethnographic Pulse Check sources who discussed this question consider crack to be widely available in their community. Only six sources give a"somewhat available" response: three in the West (Denver, Los Angeles, and Seattle); the two sources in Portland, ME; and one source in Chicago. And only three sources, in three different regions, consider it not very available: in Billings, El Paso, and Sioux Falls.

*The epidemiologic source in Columbia, SC, did not provide this information

Has crack availability changed? (Exhibit 2) Crack availability remained stable between fall 2000 and spring 2001, according to the majority of Pulse Check sources who discussed this question (17 of 20 law enforcement sources and 14 of 19 epidemiologic and ethnographic sources). Increased availability of crack is reported by only one law enforcement source (in Sioux Falls) and one epidemiologic source (in Seattle). Two law enforcement sources perceive a decline in crack availability (in Chicago and in Portland, ME), as do four epidemio-logic and ethnographic sources: two in the West (Denver and Los Angeles), one in the South (El Paso), and one in the Northeast (Portland).

^L Law enforcement respondents
^E Epidemiologic/ethnographic respondents
*The Columbia (SC) epidemiologic and the Memphis law enforcement sources did not provide this information.

What are crack cocaine prices across the country? (Exhibit 3) Crack tends to be sold in 0.1 and 0.2 gram rocks, which generally cost approximately $10 and $20, respec-tively, according to law enforcement, epidemiologic, and ethnographic sources. Gram prices tend to be approximately $100, but prices are as low as $24 in New York and as high as $250 in Honolulu. Purity levels are usually not reported. Nearly all prices are stable in comparison to the last Pulse Check reporting period. Two minor changes are reported: the Los Angeles law enforcement source reports some market fluctuation, resulting in a slight increase in the price of some rocks (0.2 gram); and the Seattle epidemiologic source reports a price decline for "kibbles and bits," a unit smaller than the standard rock size (not included in the chart), to $5.

MOST COMMON STREET UNIT						1 GRAM
City		Unit	Size	Price	Purity	Price	Purity
	Boston, MA	"jum" (small rock)	0.1 gm	$10	NR	NR	NR
	New York, NY	bag	NR	$3–$10	NR	$24–$30	58%
		"eightball"	1/8 oz	$20	58%	NR	NR
		rock	NR	$7–10	58%
	Philadelphia, PA	rock	0.05–0.1 gm	$5–$10	80%	NR	NR
	Portland, ME	rock	NR	$80	75%	NR	NR
		"100-rock"	0.5 gm	$100	80%
	Baltimore, MD	vial	NR	$5–$10	NR	NR	NR
	Birmingham, AL	rock	0.2–0.5 gm	$10–$20	NR	$100	NR
	Columbia, SC	rock	0.2 gm	$20	NR	$100	NR
		"slab"	0.5 gm	$100	NR
	El Paso, TX	rock	0.25 gm	$20	NR	NR	NR
	Memphis, TN	rock	0.2 gm	$20	40–50%	$100	40–50%
	Miami, FL	rock	0.1 gm	$5–$20	80%	NR	80–90%
	New Orleans, LA	rock	0.25 gm	$10	NR	$40–$50	NR
	Washington, DC	"dimebag"	75 mg	$10	30–60%	$80–$100	NR
	Chicago, IL	rock	0.2 gm	$5–$20	NR	$123	NR
	Detroit, MI	rock	0.1 gm	$10	90%	$70–$125	90%
	Sioux Falls, SD	rock	0.3–0.5 gm	$50	NR	NR	NR
	Denver, CO	rock	0.1–0.2 gm	$20	70%	$100–$125	NR
	Honolulu, HI	rock	0.25 gm	$25–$35	70%	$100–$250	NR
	Los Angeles, CA	rock	0.2 gm	$20	NR	$80	NR
	Seattle, WA	"20 rock"	0.1–0.125 gm	$20	NR	$100	40–85%
		"40 rock"	0.2–0.25 gm	$40	NR

Sources: Law enforcement, epidemiologic, and ethnographic respondents
*Respondents in Billings and St. Louis did not provide this information.

How and where is crack cocaine made? Crack continues to be processed locally in most Pulse Check communities, as noted in the last issue. In Denver and Portland (ME), however, sources note that it is processed prior to arriving in the community, while in Washington, DC, crack may be processed locally or in New York. Baking soda continues to be the standard ingredient added to powder cocaine to convert it into crack. A few sources, however, mention the use of other adulterants. In New York, for example, the ethnographic source reports vitamin B₁₂ and lidocaine. Vitamin B₁₂ is also mentioned by the epidemiologic source in Memphis. The Baltimore ethnographic source notes different types of cooking solutions and ammonia as crack cocaine adulterants.

Do-it-yourself "chemistry"... The New York ethnographic source notes that "One crack user told a researcher that while a lot of crack is available it is better to buy your own powder cocaine and cook it yourself " (rather than buy ready-made crack)" if you want to get your money's worth. These people refer to themselves as 'chemists.'" Crack by bus... According to the El Paso epidemiologic source, street outreach workers report that some individuals regularly travel by bus between Los Angeles and El Paso for personal reasons and, in the process, also transport crack. Thus, not all of El Paso's crack comes from across the border: some of the supply comes from California.

How is crack referred to across the country? (Exhibit 4) Slang names for crack seem particularly common in the South, with numerous names listed by law enforcement, epidemiologic, and ethnographic sources in all eight Pulse Check sites. The majority of the names listed for the Northeast come from Philadelphia. Few slang names are reported by sources in the Midwest and the West.

Sources: Law enforcement, epidemiologic, and ethnographic respondents

How is crack packaged and marketed? The New York ethnosgraphic source reports that small glassine bags and light plastic wrap knotted at both ends are replacing plastic colored vials as the preferred method of packaging crack cocaine. The Portland, ME, law enforcement source mentions a similar packaging: a plastic bag whose corner is knotted in "Dominican ties." Elsewhere, packaging remains relatively unchanged since the last Pulse Check reporting period. The most commonly reported packaging, as in the case of heroin, remains small plastic, cellophane, glassine, or coin bags, often the "zipper" type, particularly throughout the Northeast, the South, and the Midwest. In the West, however, that packaging is reported only in Honolulu. Other types of packaging are more common in that region: plastic or glass vials (as reported in Denver, Los Angeles, and Seattle); foldover bindles of plastic, paper, or magazine pages (as reported in Billings, Denver, Honolulu, Los Angeles, and Seattle); plastic wrap or cellophane (in Denver, Honolulu, and Los Angeles); foil (in Los Angeles and Seattle); plastic balloons (in Los Angeles); and just loose rocks (in Seattle). Loose rocks are mentioned most frequently in the South (Birmingham, Columbia, Memphis, Miami, New Orleans, and Washington, DC), but are also found in the Northeast (in Boston and New York) and the Midwest (Detroit and St. Louis). Baltimore is the only Pulse Check city outside of the West where sources report crack sold in vials. According to that city's ethnographic source, different neighborhoods use different colors on the crack vial tops for identification: "The vial tops are red on Monroe Street, but blue on East Baltimore...." Elsewhere in the South, the El Paso law enforcement source reports balloon packaging and paper diamond folds—similar to packaging found nearby in the West.

CRACK: THE SELLERS

How are crack cocaine sellers organized? According to law enforcement sources, crack sellers in all four Pulse Check cities in the Northeast operate independently. Recently, however, gangs have started taking over sales in New York. In the South, by contrast, sales structures vary: independent operations are reported in Baltimore, El Paso, Miami, and Washington, DC; both types of sales structures—independent and organized—are reported in Birmingham and New Orleans; and loosely organized structures or small networks are reported in Columbia (SC) and Memphis. Sales structures also vary in the Midwest: operations are organized in Chicago and (loosely) in Sioux Falls, while both independent and organized structures are reported in Detroit and St. Louis. Similarly, in the West, sales structures vary, from organized in Billings, Denver, and Seattle to independently run operations in Honolulu, to a mix of structures in Los Angeles.

By contrast, nearly all epidemiologic and ethnographic sources who provide this information report that crack sellers are affiliated with organized sales structures, such as gangs. As is the case with heroin, this seeming discrepancy might be explained by differing definitions of what constitutes an organized group.

Then and Now: How have crack sellers and sales changed across the country (fall 2000 vs spring 2001)? The crack sales scene has remained relatively stable since the last Pulse Check report. Only a handful of changes are reported, with no discernible regional trends:
Baltimore, MD; Birmingham, AL; Columbia, SC; and Memphis, TN:	Law enforcement sources note a tendency toward younger crack sellers.
Boston, MA:	Continuing a trend noted in the last issue of Pulse Check, crack sales are increasingly moving indoors, with more deliveries made via beeper orders. The Boston ethnographic source attributes this phenomenon to increased law enforcement efforts and to urban renewal.
Denver, CO:	Sales are starting to take place in the suburbs, according to the law enforcement source.
Los Angeles, CA:	The law enforcement source notes that electronic equipment, such as cell phones, continues to be increasingly involved in crack sales.
New York, NY:	The law enforcement source reports that gangs have recently started taking over sales.
St. Louis, MO:	According to the epidemiologic source, crack used to come into the area from Colombia through Mexico, but now more seems to be coming directly from Mexico.

How is street-level crack sold? Hand-to-hand crack sales are reported by law enforcement sources in every Pulse Check city, as noted in the last Pulse Check, and similar to the most common method for selling heroin. Sales involving beepers or cell phones are also quite common—reported by law enforcement sources in 16 cities: all four Pulse Check sites in the Midwest, all but one (Washington, DC) of the sites in the South, all but one (Seattle) in the West, and New York in the Northeast. Acquaintance networks are mentioned in 13 cities, and home delivery (which often also involves beeper or cell phone use) is mentioned in 11. Internet sales are reported in New York.

Epidemiologic and ethnographic sources, similarly, report that hand-to- hand sales are the most common (in 14 cities), followed by beeper/cell phone sales (in 10 cities), then by home delivery and acquaintance networks (in 7 cities each). In El Paso, crack is also reportedly sold over the Internet.

How old are street-level crack sellers? As reported in the last Pulse Check issue, young adults (18–30 years) continue to be the predominant crack sellers at the street level, according to law enforcement sources in nearly every city. Several exceptions, however, are noteworthy. In the Northeast, for example, older adults are more likely to sell crack in Philadelphia. In the South, adolescents are the primary sellers in Baltimore, while all three age groups (adolescents, young adults, and older adults) are equally likely to sell crack in Memphis. In the Midwest, both young and older adults are named as the primary crack sellers in Sioux Falls and St. Louis. And in the West, all three age groups are listed for Denver, while adolescents reportedly predominate in Seattle crack sales. In comparing the fall 2000 and spring 20001 reporting periods, four law enforcement sources—all in the South—note a tendency toward younger crack sellers: in Baltimore, Birmingham, Columbia (SC), and Memphis.

Epidemiologic and ethnographic sources concur that young adults are the most likely to sell crack, as reported in nearly every city where this information was provided. Five exceptions, however, are noted in the South and the Midwest: young adults and adolescents are equally likely to be the primary crack sellers in Birmingham and Detroit; young adults and older adults are equally likely in Memphis; and adolescents are considered the predominant seller group in Baltimore and Chicago. Adolescents are also noted, to a lesser extent, as sellers in other cities. In New York, for example, the ethnographic source reports that "some dealers in Manhattan are as young as 13."

What other drugs do crack dealers sell? (Exhibit 5) As reported in previous issues of Pulse Check, crack dealers are often polydrug sellers. In New York, law enforcement, epidemiologic, and ethnographic sources report that some dealers sell as many as four drugs in addition to crack. Other "one-stop shops," where dealers sell two or three drugs in addition to crack, are particularly common in the South (Birmingham, Columbia, and New Orleans) and the Midwest (Chicago, Detroit, and St. Louis); they are less commonly reported in the Northeast (Portland, ME) and the West (Billings and Seattle). Overall, marijuana is reported in 11 cities, followed by heroin (in 8 cities) and powder cocaine (in 7 cities). Methamphetamine is mentioned in only two western sites, and ecstasy is named only in New York. Eight law enforcement sources and three epidemiologic and ethnographic sources, however, report that crack sellers in their communities sell no other drugs.

City		Marijuana		Powder Cocaine		Heroin		Methamphetamine		Ecstasy		No Other Drugs Sold
		LE	E	LE	E	LE	E	LE	E	LE	E	LE	E
	Boston, MA
	New York, NY
	Philadelphia, PA
	Portland, ME
	Baltimore, MD
	Birmingham, AL
	Columbia, SC
	El Paso, TX
	Memphis, TN
	Miami, FL
	New Orleans, LA
	Washington, DC
	Chicago, IL
	Detroit, MI
	St. Louis, MO
	Sioux Falls, SD
	Billings, MT
	Denver, CO
	Honolulu, HI
	Los Angeles, CA
	Seattle, WA

Sources: Law enforcement (LE), epidemiologic, and ethnographic (E) respondents
*Epidemiologic sources in Billings, Columbia, El Paso, Denver, Honolulu, Los Angeles, Philadelphia, Portland, Seattle, Sioux Falls, and Washington, DC, did not provide this information

One-stop shopping... In some cities, such as St. Louis—as noted by that city's epidemiologic source—crack dealers affiliated with gangs are the ones most likely to run a "one-stop shop," selling multiple drugs.

Do crack sellers use their own drug? (Exhibit 6) In Miami, St. Louis, and Seattle, crack sellers usually do not use the product they sell, according to law enforcement sources. In all other Pulse Check sites, sellers are somewhat or very likely to use their own drug.

Epidemiologic and ethnographic sources, however, generally consider crack sellers as less likely to use their own drug. Only in Boston, El Paso, Memphis, New Orleans, and St. Louis do these sources describe crack dealers as very or somewhat likely to use crack themselves. The Boston ethnographic source adds that "nearly all users eventually sell" and that "older sellers are selling to make enough to 'hustle' their own crack," but that "a few of the dealers are younger, in gangs, and less likely to use." Nearly all the remaining epidemiologic and ethnographic sources who addressed this issue believe that crack sellers are not very likely to use crack. Furthermore, in Baltimore, the ethnographic source reports that sellers, who are predominantly adolescents, do not use crack.

What type of crimes are crack sellers involved in? All law enforcement sources consider crack sellers as somewhat or very likely to be involved in other criminal activity. The majority name both violent and nonviolent crimes (15 and 16 sources, respectively, out of 21). The most commonly mentioned crime is gang-related activity, as noted by 13 sources, heavily concentrated in the South (in Baltimore, Birmingham, Columbia, Memphis, New Orleans, and Washington, DC) and the West (in Denver, Honolulu, Los Angeles, and Seattle), and to a lesser extent in the Northeast (in Boston) and the Midwest (in Chicago and St. Louis). Prostitution is also mentioned frequently, again particularly in the South (Birmingham, Columbia, El Paso, New Orleans, and Washington, DC), and to a lesser extent elsewhere (Boston and Philadelphia in the Northeast; St. Louis in the Midwest; and Denver and Honolulu in the West). Domestic violence is noted in six cities (Baltimore, Birmingham, Boston, Denver, Memphis, and St. Louis). Other crimes specified include theft and burglary (in Billings and Chicago), robberies and shootings involving other dealers (in Columbia, SC), and money laundering (in Detroit).

Sources: Law enforcement, epidemiologic, and ethnographic respondents
*Law enforcement, epidemiologic, and ethnographic respondents in Baltimore, Billings, El Paso, and St. Louis did not provide this information.

Where is crack cocaine sold? (Exhibit 7) All but 6 of the 21 law enforcement sources agree that crack sales generally take place in central city areas. Five of those six exceptions are in the South. In Miami and New Orleans, crack is equally likely to be sold in central city and suburban areas. In El Paso, crack sales are more likely to occur in the suburbs. In Birmingham, Memphis, and—outside of the South—New York, crack is sold in a wide range of areas, including central city, suburban, and rural areas. The locations for crack sales remain the same since the last Pulse Check reporting period, except for Denver, where crack sales have expanded to suburban areas, according to the law enforcement source. Similarly, nearly every epidemiologic and ethnographic source who provided this information indicates that crack is sold primarily in central city areas. In Birmingham and El Paso, however, it is sold both in central city and rural areas. And in Detroit, crack is sold in central city, rural, and suburban areas.

Both outdoor and indoor sales occur across sites, with a few exceptions. According to law enforcement sources, outdoor sales are more common in Chicago and Philadelphia while indoor sales predominate in Baltimore. According to epidemiologic and ethnographic sources, indoor sources are more common in Detroit while outdoor sales predominate in Washington, DC.

The specific settings for crack sales, like for heroin sales, are varied. Public housing developments, cars, and crack houses are mentioned by law enforcement, epidemiologic, or ethnographic sources in nearly every city. Parties and schools are the next most common settings, followed by parks, private housing, and clubs. College campuses and raves are also mentioned in at least half the sites, while sales in shopping malls, outside supermarkets, and over the Internet are mentioned in some cities. Overall, several cities have a particularly wide range of crack sales settings.

Sources: Law enforcement, epidemiologic, and ethnographic respondents for seller settings Epidemiologic and ethnographic respondents for user settings
*The law enforcement sources in Sioux Falls, and the epidemiologic/ethnographic sources in Billings, Columbia, Los Angeles, and Seattle, did not provide seller setting information. The epidemiologic source in Columbia did not provide user setting information.

CRACK: THE USERS

How old are crack cocaine users? (Exhibit 8) Epidemiologic and ethnographic sources vary in their views of which age groups are most likely to use crack. Three (in Boston, Birmingham, and Detroit) consider both young adults (18—30 years) and older adults (older than 30 years) equally likely to use the drug, although in Birmingham, crack use among young adults has declined. Young adults are considered the primary user group in nine Pulse Check cities: Philadelphia in the Northeast; Baltimore, El Paso, and New Orleans in the South; St. Louis and Sioux Falls in the Midwest; and Billings, Honolulu, and Seattle in the West. Older adults are named in eight cities: Portland, ME, in the Northeast; Columbia, Memphis, Miami, and Washington, DC, in the South; Chicago in the Midwest; and Denver and Los Angeles in the West. In Washington, DC, however, while older adults remain the primary user group, use among younger adults is increasing. These findings differ from those in the last Pulse Check issue, when epidemiologic and ethnographic sources named older adults as the group likeliest to use crack in all but four cities (Birmingham, Honolulu, Los Angeles, and Sioux Falls).

All reporting Pulse Check treatment sources note that the age of crack users in treatment has remained stable. The non-methadone treatment providers are more likely to report younger adults (18—30 years) than older adults (>30 years) as the predominant crack users. Both age groups are considered equally likely to use crack in three cities: Birmingham, Memphis, and Philadelphia. The younger adult group is named in 11 cities: Boston and Portland in the Northeast; El Paso, Miami, New Orleans, and Washington, DC, in the South; Chicago and Detroit in the Midwest; and Honolulu, Los Angeles, and Seattle in the West. Older adults, exclusively, are named in only two cities: Baltimore and Denver. Most disturbingly, adolescents (younger than 18) are the largest crack-using group in the Columbia, SC, non-methadone program, and they share the dubious number-one spot with young adults in Los Angeles, and with older adults in Sioux Falls.

By contrast, crack-using clients in the methadone programs appear older than those in the non-methadone programs: nearly all responding Pulse Check sources in this category report that any clients who use crack tend to be in the older adult (>30 years) category. This finding, similar to findings about heroin-using clients, is not surprising because methadone maintenance tends to involve people who have been treated over a long period of time. The only exceptions are in Boston, Philadelphia, Columbia (SC), and New Orleans programs, where the younger adults outnumber the older adults among crack users in methadone maintenance.

	Adolescents (<18)	Young Adults (18–30)	Adults (<30)
		Boston, MAE,N,M	Boston, MAE,M
		Philadelphia, PAE,N,M	Philadelphia, PAN
		Portland, MEN	Portland, MEE
	Columbia, SCN	Baltimore, MDE	Baltimore, MDN
		Birmingham, ALE,N	Birmingham, ALE,N,M
		Columbia, SCM	Columbia, SCE
		El Paso, TXE,N	Memphis, TNE,N
		Memphis, TNN	Miami, FLE
		Miami, FLN	Washington, DCE,M
		New Orleans, LAE,N,M
		Washington, DCN
	Sioux Falls, SDN	Chicago, ILN	Chicago, ILE,M
		Detroit, MIE,N	Detroit, MIE,M
		St. Louis, MOE	St. Louis, MON
		Sioux Falls, SDE	Sioux Falls, SDN
	Los Angeles, CAN	Billings, MTE	Denver, COE,N
		Honolulu, HIE,N	Honolulu, HIM
		Los Angeles, CAN	Los Angeles, CAE,M
		Seattle, WAE,N	Seattle, WAME

^E Epidemiologic/ethnographic respondents ^N Non-methadone treatment respondents
^M Methadone treatment respondents

Then and Now: How have crack cocaine users changed across the country (fall 2000 vs spring 2001)? According to epidemiologic and ethnographic sources... Crack use has remained relatively stable since the last Pulse Check reporting period. Only a few changes are reported among young adults, among Hispanics, among women, and in where crack users reside:
Among young adults:	Birmingham, AL: Crack use has declined among young adults (18–30 years), who are now as likely to use the drug as older adults (>30 years). Washington, DC: Crack use has increased among younger adults, but older adults remain most likely to use the drug.
Among Hispanics:	Columbia, SC: A small increase in the number of Hispanics using crack reflects a similar increase in the overall population. The numbers, however, remain small. Philadelphia, PA: Hispanics, who are overrepresented among crack users, have increased in proportion since the last Pulse Check report.
Among women:	Columbia, SC: The percentage of females among crack users has been fluctuating during the past 12 months (between 38 and 56 percent), with no particular pattern. St. Louis, MO: While crack users are still predominantly males (approximately 60 percent), the number of female users has been increasing over the past 5 or 6 years.
Where crack users reside:	St. Louis, MO: With the mass exodus from the city into the surrounding counties over the past few years, the crack problem is becoming more concentrated among people of lower SES, who remain in the city. Washington, DC: Crack users continue to reside primarily in the central city, but increases are noted among suburban dwellers.
According to treatment sources...
Crack user demographic characteristics and use patterns have remained stable since the last Pulse Check reporting period, with only a few exceptions:	Novice use: Recent initiation of crack use by any drug treatment client has increased in only four non-methadone programs (in Billings, Memphis, Portland, and Sioux Falls) and one methadone program (in Columbia, SC). Female use: The Washington, DC, non-methadone provider notes an increase in females smoking crack.

Are there any gender differences in who uses crack? (Exhibit 9) According to the New York ethnographic source, females are the pre-dominant crack users in that city. Moreover, females and males are evenly split among crack users according to epidemiologic and ethnographic sources in nine Pulse Check cities: Chicago and Sioux Falls in the Midwest; Boston and Philadelphia in the Northeast; Baltimore, Columbia, Miami, and Washington, DC, in the South; and Seattle in the West. The remaining 11 epidemiologic and ethnographic sources report males as the predominant crack users in their respective cities. In St. Louis, while crack users are still predominantly males (approximately 60 percent), the number of female users has been increasing over the past 5 or 6 years.

What drugs do female users tend to take? The Boston ethnographic source comments that "females are more likely to use crack than IV drugs such as heroin and powder cocaine." Indeed, as Exhibit 9 shows, epidemiologic and ethnographic sources tend to consider females as equally or more likely than males to use crack, more so than any other illicit drug except ecstasy.

Non-methadone treatment sources, like epidemiologic and ethnographic sources, report an even gender split among crack-using clients in several Pulse Check cities: Philadelphia in the Northeast; Washington, DC, in the South; Sioux Falls and St. Louis in the Midwest; and Billings, Honolulu, Los Angeles, and Seattle in the West. Males are the predominant crack users among clients in the remaining non-methadone treatment programs. The only reported change is in Washington, DC, where more females are smoking crack than ever before.

Only four methadone treatment providers report males as predominant among crack users in their programs: in Birmingham, Boston, New Orleans, and Seattle. Both males and females are equally likely to use crack in another five methadone programs (in Boston, Columbia, Detroit, Los Angeles, and Washington, DC). Females comprise the majority of crack-using clients in the Chicago and Honolulu methadone programs. Eight methadone sources, however, did not supply breakdowns of their client population by gender.

Exhibit 9. Which genders are the predominant users of specific drugs in the 21 Pulse Check cities?

Source: Epidemiologic and ethnographic respondents

Back to Exhibits

Is any racial/ethnic group more likely to use crack? (Exhibit 10) According to epidemiologic and ethnographic sources, Blacks account for the largest proportion of crack users in 11 of the 21 Pulse Check cities, where they are overrepresented relative to the general population. In Birmingham, Blacks and Whites are equally likely to use crack, reflecting their distributions in the general population. El Paso has two distinct racial/ethnic groups of crack users: Blacks are the predominant sole crack users; but Hispanics are the most likely to use both crack and heroin. Whites are more likely than other racial/ethnic groups to use crack in seven cities and are overrepresented relative to the general population in three of those cities. Only two race/ethnicity changes are reported: in Philadelphia, Hispanics, who are overrepresented among crack users, have increased in proportion since the last report; and in Columbia, SC, a small increase in the number of Hispanics using crack (which remains small) reflects a similar increase in the overall population.

White crack users in Boston? "The majority of crack users are Black," states Boston's ethnographic source. "White crack users tend to be heroin addicts who are losing injectable surface veins."

According to Pulse Check treatment sources, Blacks are the predominant crack users among clients in 11 non-methadone programs but only 5 methadone programs. Whites account for the largest proportions of crack users at four non-methadone programs and six methadone programs. Blacks and Whites are split approximately evenly as the foremost crack users in the Columbia, SC, methadone program, while Blacks, Whites, and Hispanics are about equally represented at three non-methadone programs: in El Paso, Los Angeles, and Philadelphia. No racial/ethnic shifts are reported by any treatment sources since the last Pulse Check reporting period.

What is the most common socioeconomic background of crack users? Crack-using populations are predominantly in lower SES categories in all but 4 of the 21 cities, according to epidemiologic and ethnographic sources. In Honolulu and Sioux Falls, crack users are primarily middle SES; in Birmingham, they are both lower and middle SES; and in Detroit, users cross all SES categories. Treatment sources concur that crack users are generally found in the lower SES groups. The only exceptions are in Boston, Columbia (SC), Honolulu, Los Angeles, New Orleans, and Sioux Falls, where either the middle SES or both lower and middle SES groups are cited by treatment providers.

Exhibit 10. What racial/ethnic group is most likely to use crack?

	City	Crack
		E	N	M
	Boston, MA	Black	White	White
	New York, NY	NR	NR	NR
	Philadelphia, PA	Black	All	Black
	Portland, ME	White	White	NR
	Baltimore, MD	Black	Black	Black
	Birmingham, AL	Black/ White	Black	Black
	Columbia, SC	Black	White	Black/ White
	El Paso, TX	Black	All	NR
	Memphis, TN	White	Black	NR
	Miami, FL	Black	Black	NR
	New Orleans, LA	Black	Black	White
	Washington, DC	Black	Black	Black
	Chicago, IL	Black	Black	Black
	Detroit, MI	White	Black	Black
	St. Louis, MO	Black	Black	NR
	Sioux Falls, SD	White	Black	N/A
	Billings, MT	White	White/ American Indian	N/A
	Denver, CO	White	Black	Black
	Honolulu, HI	White	NR	White
	Los Angeles, CA	Black	All	White
	Seattle, WA	Black	White	White

Sources: Epidemiologic/ethnographic (E), non-methadone treatment (N), and methadone treatment (M) respondents Note: Shaded boxes indicate that a given drugusing population is overrepresented relative to that city’s general population. Not all sources, however, had this information available.

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Crack in St. Louis: Increasingly a lower SES problem... As the St. Louis epidemiologic source notes, "With the mass exodus from the city into the surrounding counties over the past few years, St. Louis' crack problem is becoming more concentrated among people of lower SES, who remain in the city."

Where do crack users tend to reside? Crack users reside primarily in central city areas, as reported by nearly all (18 of the 21) epidemiologic and ethnographic sources. In El Paso and Sioux Falls, however, crack users are more likely to reside in the suburbs, while in Detroit users reside throughout the area. While Birmingham's crack users reside primarily in the central city, the epidemiologic source notes that many users reside throughout small rural towns all over Alabama.

Similarly, all but three treatment sources report that the majority of crack users reside in central city areas. Two exceptions are in Sioux Falls, where crack users in the two non-methadone Pulse Check sites are more likely to live in rural areas. Seattle is the third exception, with crack users equally likely to reside in both central city and suburban locations. Additionally, smaller populations of crack users reside in the suburban and rural areas surrounding Honolulu and St. Louis, as reported by those cities' methadone and non-methadone treatment sources, respectively.

How do crack cocaine users wind up in treatment? As reported in the last Pulse Check issue, courts and the criminal justice system remain the most common referral sources for clients entering treatment for crack addiction, according to the responding treatment sources. Individual referrals, again, follow closely as the second most common referral source.

Then and Now: How have crack cocaine use patterns changed across the country (fall 2000 vs spring 2001)? According to epidemiologic and ethnographic sources...
Increased crack injection:	Baltimore, MD: Solid crack is sometimes cooked and injected, according to recent reports. Washington, DC: Crack is being injected with heroin and marijuana.
More drugs:	Philadelphia, PA: Crack users are taking a wider range of other drugs than before, including heroin, marijuana, ecstasy, and diverted prescription drugs such as alprazolam (Xanax ® ), diazepam, amitriptyline (Elavil ® ), and, most recently, oxycodone (OxyContin ® ).
Decline in crack houses:	Denver, CO: Crack houses have become less prominent, but this change is long term, rather than recent. St. Louis, MO: Crack houses have become less prominent, possibly because cell phones and beepers are increasingly used and because users know which blocks to drive down in order to make their "connections."
Increased public use:	Seattle, WA: Public smoking of crack has increased since the last report. Users are now equally likely to smoke the drug either in public or in private.

How do users take crack? Smoking, by far, remains the predominant route of crack administration in every Pulse Check city, according to all epidemiologic and ethnographic sources and nearly all treatment sources. The only exceptions are in three non-methadone treatment programs: in Boston, injecting equals smoking; in Memphis, snorting predominates; and in Sioux Falls, both snorting and smoking are common. Occasional crack injection is also mentioned by epidemiologic and ethnographic sources in Baltimore (where solid crack is sometimes cooked and injected), New Orleans (where crack is injected with heroin in speedballs), and Washington, DC (where it is injected with heroin and marijuana).

How frequently do users take crack? The majority of non-methadone treatment sources (15 of 21) report that crack users in their program tend to take the drug daily. Less frequent usage is reported in six programs, three of which are in midwestern Pulse Check cities: Chicago (four to seven times a week), Columbia (SC) (once to twice a month), Los Angeles (twice a month), Portland (ME) (three to four times a week), St. Louis (three to four times a week), and Sioux Falls (once to twice a month). In methadone programs, by comparison, usage frequency appears lower: only seven Pulse Check sources report daily crack usage by clients in their programs, while another seven report less than daily use. In Philadelphia, for example, some clients use crack daily, but binge use is more typical.

What other drugs do crack users take? Aside from alcohol, the substances most commonly consumed with crack—either sequentially or in combination—are marijuana and heroin. Marijuana is mentioned by epidemiologic, ethnographic, and treatment sources across the country: Philadelphia in the Northeast; Baltimore, Birmingham, Columbia, Miami, New Orleans, and Washington, DC, in the South; Detroit and St. Louis in the Midwest; and Denver, Honolulu, and Seattle in the West. Heroin is also mentioned by the same source categories in all four regions: Boston, New York, Philadelphia, and Portland in the Northeast; El Paso, Memphis, New Orleans, and Washington, DC, in the South; only Chicago in the Midwest; and Denver, Honolulu, and Los Angeles in the West.

The marijuana-crack combination (in a blunt) in Philadelphia is known as a "diablito" or a "turbo." That city's epidemiologic source also lists a variety of diverted prescription drugs abused by crack users, including alprazolam and diazepam (benzodiazepines); amitriptyline (an antidepressant); and oxycodone (the opiate in Percodan ® , Percocet ® , and OxyContin ® ). The New York ethnographic source similarly mentions the crack-diazepam combination, stating that "A woman in the Bronx told a researcher that when she cooked up her crack she would put 'a valium' in it. She said when she smoked this crack combination it felt like she was using heroin." New York users also combine crack with PCP, a practice known as cspace basing." Further south, alprazolam and diazepam are also commonly taken by crack users in Memphis, according to the epidemiologic source. In the West, three treatment sources—in Billings, Honolulu, and Los Angeles—report that crack users in their programs also abuse diverted benzodiazepines, such as diazepam and clonazepam. The Los Angeles methadone treatment source adds that some crack-using clients also abuse the diverted prescription muscle relaxant carisoprodol (Soma ® ).

Where and with whom is crack used? (Exhibit 7) Unlike crack sales, which occur both indoors and out-doors, crack use is more likely to take place indoors than outdoors (according to 12 out of 20 responding epidemiologic and ethnographic sources). Users also prefer to smoke crack in private, rather than public (13 out of 20 sources) and in small groups or among friends, rather than while alone (11 out of 20 sources).

Nearly all the remaining epidemiologic and ethnographic sources report that sales and use occur both indoors and outdoors and in both private and public locations. But sources in six cities (Baltimore, Los Angeles, Memphis, Miami, New York, and Portland) report that crack users tend to use their drug while alone, rather than in a group. The Baltimore ethnographic source explains that "crack users tend to smoke their drug alone, not in groups, because of the short duration of the high." Baltimore is also the only city where outdoor use is slightly more common than indoor use, but the ethnographic source notes a particularly wide range of use settings, including "abandominiums" (abandoned row houses) and fast-food restaurant bathrooms. Similarly, the El Paso epidemiologic source lists a particularly wide range of use settings. El Paso is also the only city where use in public places is more common than use in private locations.

Overall, a wide variety of specific settings are reported, with private residences most commonly mentioned, followed by crack houses and public housing developments. Crack houses, however, are becoming less prominent in some areas, such as Denver and St. Louis. Other venues mentioned, in descending order of frequency, include parties, cars, nightclubs, schools, and college campuses. The Honolulu epidemiologic source adds two other unusual crack use settings: adult video galleries, and hotel rooms.

Treatment sources concur that crack is usually used indoors, in private, and in small groups or among friends. Outdoor use is more common than indoor use in only two programs (the Boston and Columbia [SC] non-methadone programs), public use is more common than private use in only one (the Columbia non-methadone program), and solo use is more common than social use in only six programs (at the methadone programs Chicago, Detroit, New Orleans, and Washington, DC, and at the non-methadone programs in the Miami and Washington, DC). A treatment source in Honolulu points out that people tend to use crack in small groups and among friends in order to share costs and, when availability is low, to share the drug.

Indoor versus outdoor crack use in Boston... Outdoor use in Boston, while slightly less common than indoor use, is still wide-spread. As that city's ethnographic source points out, "crack is used outdoors more than other drugs because it's easier to 'do' without being seen." By contrast, a Boston treatment source states that "crack can't be used in public because of its dis-tinct odor." Crack houses on the decline... The St. Louis epidemiologic source notes a decline in crack houses, possibly because cell phones and beepers are increasingly used and because users know which blocks to drive down in order to make their "connections. The Denver epidemiologic source also reports a long-term decline in crack houses. Small-group versus private use... The Baltimore ethnographic source explains that ccrack users tend to smoke their drug alone, not in groups, because of the short duration of the high." A Honolulu treatment source points out, however, that group use is more economical: friends can share costs and, when availability is low, they can share the drug.