National Drug Intelligence Center   New England High Intensity Drug Trafficking Area Drug Market Analysis 2009   April 2009

Abuse

The abuse of heroin and controlled prescription opioids is the primary drug abuse problem in the HIDTA region, according to various drug abuse indicators. According to NDTS 2009 data, 65 of 104 state and local law enforcement agency respondents in the NE HIDTA region report that the diversion and abuse of CPDs are high in their areas.

Opioid-related inquiries accounted for 39 percent of all substance abuse-related nonemergency information calls from healthcare professionals and the general public to the Northern New England Poison Center (NNEPC) hotline from 2006 through 2008. Most of the opioid-related calls to the NNEPC, which serves Maine, New Hampshire, and Vermont, involved oxycodone (43%) and hydrocodone (28%) issues.

Heroin was the primary drug reported in calls to the substance abuse help line in Boston; heroin-related issues accounted for 32 percent of incoming calls during 2007 (the latest year for which such data are available), according to the Boston Public Health Commission (BPHC). The abuse of heroin accounted for 33.3 percent of the emergency department (ED) reports or mentions in Boston from January through June 2007, according to BPHC data.

The percentages of ED mentions reported for other drugs were 45.0 percent for marijuana, 42.1 percent for cocaine, and 0.7 percent for methamphetamine. Moreover, the abuse of heroin contributed to an increasing percentage of drug-related deaths in Connecticut, accounting for approximately 22 percent of drug-related deaths in 2006, 23 percent in 2007, and 29 percent in 2008, according to the Connecticut Medical Examiner's Office.8 During 2008, the youngest decedent in Connecticut whose death was attributed to a heroin-related overdose was 17 years old; the oldest heroin-related overdose decedent was 66. Additionally, according to data from the Treatment Episode Data Set (TEDS), the number of heroin-related treatment admissions to publicly funded facilities in the region exceeded admissions for all other illicit substances combined from 2003 through 2007, the latest year for which such data are available. (See Table 5.)

Table 5. Drug-Related Treatment Admissions to Publicly Funded Facilities in the New England HIDTA Region, 2003-2007

Source: Treatment Episode Data Set.

TEDS data also indicate that the number of other opiate-related treatment admissions in New England nearly doubled from 7,135 in 2003 to 13,475 in 2007. Furthermore, drug treatment facilities in Boston reported increases in heroin and other opiate-related primary treatment admissions in the age 19 to 29 category and among Caucasians during fiscal year (FY) 2007. The treatment facilities also reported that the proportion of past year injection drug use among heroin and other opiate-related admissions reached 83 percent, the highest level reported in Boston in the last 10 years, according to the BPHC.

Controlled prescription opioid abusers are fueling the heroin abuse problem in the NE HIDTA region. According to area treatment providers, a rising number of controlled prescription opioid abusers (particularly adolescents and young adults) have switched to heroin abuse because heroin is more affordable and potent. For example, a noteworthy increase in the number of heroin overdose incidents occurred in the Wilmington/Billerica, Massachusetts, area near the end of 2008. Most of the victims, who were either teens or in their early twenties, had previously abused controlled prescription opioids and transitioned to heroin, according to law enforcement officials. A spike in fatal heroin overdoses in southeastern Connecticut in early 2008 was attributed to heroin that had been distributed by members of a local street gang, according to law enforcement officials. The average retail price for one 80-milligram tablet of OxyContin ranges from $65 to $80 in Boston, while 1 gram of SA heroin sells for approximately $100. Law enforcement officials report that the prices for heroin sold by the bag are low in some parts of Connecticut because of the wide availability of the drug.

Many heroin abusers in the region are "functional heroin abusers;" they hold jobs, have families, attend school, and participate in community events. Moreover, many heroin abusers from the northern New England states are commonly viewed by law enforcement and public health officials as "day trippers" because they drive to the Lowell/Lawrence and Hartford/Springfield areas to purchase heroin on a daily basis. They often ingest or inject a portion of the heroin while driving back to their home state and typically sell a portion of their purchase to other abusers to defray costs associated with their addiction.

There is a distinct relationship between heroin and controlled prescription opioid abuse in New England; in addition to controlled prescription opioid abusers who often switch to heroin use, former heroin abusers are abusing the synthetic opioids methadone and buprenorphine, which are addiction treatment drugs, according to substance abuse treatment providers. The abuse of methadone contributes to a significant number of drug-related deaths in New England states. The presence of methadone was noted in 25 of 117 drug-related deaths in New Hampshire during 2008. In 2007 (the latest year for which such data are available) methadone was the drug mentioned most often in drug-related deaths in Maine (40%) and Vermont (25%), and methadone contributed to many others throughout the entire region, including 13 percent of the drug-related deaths reported in Connecticut. Moreover, the NNEPC reports that the hotline received more than 3,600 methadone-related information calls from 2006 through 2008. Public health officials in Maine and New Hampshire attribute the high number of methadone-related deaths to the removal of OxyContin as a preferred drug from state health plans; the drug was removed because of its high abuse potential. Physicians are now compelled to prescribe methadone for chronic pain relief and, as a result, abusers, who typically obtain drugs through fraud, theft, or doctor-shopping, are acquiring and abusing methadone more frequently than OxyContin, their previous drug of choice. These abusers, who are seeking an OxyContin-type high--which is physiologically unattainable from methadone--sometimes use excessive amounts of the drug and accidentally overdose. Reported use of buprenorphine is increasingly common among heroin users, who use it primarily to avoid withdrawal or to self-manage their addiction by reducing their cravings for opioids, according to New England substance abuse treatment providers.

Public health data reveal the diversion and abuse of other CPDs throughout the region. For instance, law enforcement officials report that some heroin addicts in the region who are undergoing treatment for opioid dependence with drugs such as methadone, Suboxone, and Subutex or benzodiazepines such as Klonopin (clonazepam) sell a portion of the drugs that they are prescribed and use the proceeds to purchase heroin. Law enforcement officials further report that some individuals on fixed incomes sell a portion of their CPDs, often obtained through publicly funded programs, to supplement their income. Benzodiazepines and benzodiazepine-like products were the drugs cited second most frequently in terms of the number of nonemergency information calls to the NNEPC hotline from 2006 through 2008. Moreover, law enforcement officials in Maine report that some distributors of diverted CPDs provide abusers with free samples of benzodiazepines when the abusers obtain controlled prescription opioids; some distributors offer the free samples as a marketing technique in an attempt to entice these abusers to use controlled prescription benzodiazepines to avoid the common withdrawal symptoms that are often associated with the abuse of controlled prescription opioids.

Illicit drug abusers in the NE HIDTA region are unwittingly being exposed to illicit substances they do not intend to ingest, primarily through their use of synthetic drug tablet/capsule combinations, which are increasingly available in the region. Some synthetic drug tablets available in the region are represented as MDMA by distributors but actually contain methamphetamine, or methamphetamine and MDMA in combination. Public health officials report that MDMA and methamphetamine combinations may produce greater adverse neurochemical and behavioral effects than either drug alone, thus placing abusers at greater risk. Some synthetic drug tablets/capsules available in the region may also contain multiple substances and various combinations of ingredients such as MDMA, MDA, and methamphetamine. Some cocaine abusers in the region have also been exposed to illicit substances used by distributors as cutting agents to stretch cocaine supplies and increase profits. (See text box.)

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Illicit Finance

Illicit drug proceeds generated in the NE HIDTA region typically are laundered by traffickers through bulk cash and monetary instrument smuggling, money services businesses (MSBs), depository institutions, front companies, casinos, securities and futures instruments, and the purchase of real property and expensive consumer goods. Wholesale-level traffickers transport drug proceeds in bulk, either in the form of cash (U.S. and foreign currency) or monetary instruments, to Canada or Mexico for eventual repatriation; they generally transport the proceeds in private vehicles or tractor-trailers.

They also transport bulk proceeds to New York City to be combined with other drug proceeds for eventual transport to southwestern states, Mexico, South America, or the Dominican Republic. Traffickers also ship drug proceeds through the U.S. mail, via package delivery services, and aboard commercial aircraft. Wholesale-level traffickers operating in the HIDTA region use personal and business accounts to launder drug proceeds through depository institutions, a segment of the New England financial industry which ranked second in the number of Suspicious Activity Reports (SARs) that were filed from 2003 through 2007. However, depository institutions ranked first in the number of Suspicious Activity Reports (SARs) that were filed in New England during the first half of 2008. Wholesale-level traffickers also launder drug proceeds through MSBs, typically by electronic wire transfers of funds to associates outside the HIDTA region or to domestic and international bank accounts owned by the trafficker or money brokers. MSBs ranked first in the number of SARs that were filed by the New England financial industry every year from 2003 through 2007; however, MSBs ranked second in the number of SARs that were filed during the first half of 2008. U.S. postal inspectors seized 57 parcels and nearly $1.5 million in cash that had been mailed from New England to various locations from 2007 through 2008; most of the seized parcels that contained currency were destined for California and Puerto Rico.

Midlevel and retail traffickers operating in the region often launder proceeds by commingling them with legitimate funds generated in cash-intensive area businesses such as clothing, music, and convenience stores; restaurants; tanning and nail salons; travel agencies; and used car dealerships. Additionally, retail drug distributors often purchase real estate, expensive clothing, jewelry, high-end consumer electronics, and automobiles with the proceeds from illegal drug sales. Some traffickers also use unscrupulous members of the financial and legal professions to launder drug proceeds in the New England region.

Footnote

8. The mortality percentages that are listed may be understated because they include only incidents in which heroin was mentioned as contributing to a drug-related death; the percentages may exclude incidents in which heroin was involved and the pathologist listed the cause of death as multiple drug toxicity.

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