Cheese: an old drug in a new wrapper

Area of Science:

• Public Health
• Substance Abuse Research
• Adolescent Health

Background:

• An outbreak of "cheese" heroin, a substance containing diphenhydramine and acetaminophen, emerged in Dallas around 2004.
• The outbreak primarily affected Hispanic immigrant youth, who were initially inhaler users at risk of transitioning to injection drug use.

Purpose of the Study:

• To investigate the "cheese" heroin outbreak among youth in Dallas.
• To understand the social factors, strengths, and deficits of the affected youth population.
• To monitor the outbreak's progression and inform response strategies.

Main Methods:

• Utilized multiple data sources: surveys, emergency department data, law enforcement records, treatment program data, coroner reports, and interviews.
• Collected data from users and key informants to gain comprehensive insights.

Main Results:

• Overdose deaths peaked in 2006, followed by peak survey responses in 2007 and treatment admissions in 2008 among heroin users under 20.
• Hispanic youth in treatment reported fewer problems and were more family-supported than Anglo counterparts.
• Treatment completion rates were low (53%), with 60% of Hispanic youth having prior treatment; cocaine and/or benzodiazepines were involved in 32% of adolescent heroin deaths.

Conclusions:

• Multiple data sources facilitated rapid identification and monitoring of the "cheese" heroin outbreak.
• Treatment retention and readmission were significant issues, with cultural factors like immigration status and language posing barriers.
• Emphasized the critical role of completing treatment as an inhaler to prevent transitioning to injection drug use.