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America's Top 5 Street Drugs

The 2011 data just came in—and there are some surprising new names and rankings on the list.

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Brown-bagging it out on the mean streets of America. photo via

By Jeff Deeney

02/07/12

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New England loves heroin. Philly puffs mad blunts. West Virginia’s hooked on pills, and California’s tweaking. Everybody everywhere is getting drunk.

Coming up with a definitive list of 2011's most popular street drugs is complicated. If you go by just the sheer number of users, you get a different outcome from what you get if you calculate the size of the social costs of certain drugs that are abused in lesser numbers. Consider that many big boozers like to mix their drink with whatever other drugs they can lay their hands on. Not surprisingly, many die because they downed their Oxys or Xanies (paging Ms. Whitney Houston) with a row of stiff drinks. It’s hard to say which drug in the mix pulled the trigger. 

Meanwhile, there’s yet to be a single death reported from acute THC intoxication even as droves of weed smokers arrive at drug treatment centers seeking help. Does this make weed a public menace on par with heroin? Not a lot of people smoke PCP, but those who do catch more serious charges when they get arrested than other drug abusers (fighting with cops is a popular dusthead pastime) and cost society a lot of money in hospital fees when they jump from windows without medical insurance thinking they can fly.

In addition, availability drives markets, making it impossible to claim that one drug has a greater inherent draw. A lot of hillbillies would surely choose real heroin over prescription painkillers, but the pure, cheap, potent dope that has Southies nodding off in Boston doesn’t make its way across the Appalachians. Oregonians might do more coke if there were more around, but meantime most seem content with the ample supply of meth.

Just-released 2011 treatment data, including criminal justice reports like the Department of Justice's Drug Market Analyses, the most recent TEDS (Treatment Episode Data Set), and local confidential sources allow us to compile a thumbnail sketch of America’s top five get-highs. The big news is that while they may be the usual suspects, they are not at all in the order you might expect.

1. Weed

There’s a lot of controversy surrounding the fact that marijuana is the number one street drug right now. Treatment admissions for marijuana abuse, especially to outpatient programs, are through the roof. You can’t walk two blocks in any large city without seeing a kid on a corner smoking a lit blunt in broad daylight like it’s already legal, but pot is also easy to score in America's most remote rural areas, where it competes mainly with alcohol as the high of choice. High-potency herb is more ubiquitous than ever before, and those seeking treatment for habitual use are some of the youngest admissions in the entire system.

As the older crowd of heavy drinkers gets sober or dies off, bank on weed becoming America’s most popular drug of both casual use and chronic abuse.

Look at the trend in my home state of Pennsylvania. In 2009 treatment admissions in Philly for marijuana abuse edged out those for alcohol, 25.7% compared to 23%. By contrast, in 1992 marijuana comprised only 7% of treatment admissions statewide, whereas alcohol was 38%; in 2000, pot was up to 14.6%, booze down to 24.4%. Do these statistics suggest a more general trend in drug consumption? Perhaps. 

As the older crowd of heavy drinkers gets sober or dies off, bank on weed becoming America’s most popular drug of both casual use and chronic abuse—a prospect that large numbers of Americans have no problem with. According to a recent survey, as much as 71% of those polled in Massachusetts support marijuana decriminalization. More than ever, the public dismisses the "gateway" myth about Mary Jane. In fact, marijuana legalization advocates point to the drop in the numbers of cocaine abusers—as kids increasingly pick up the bong instead of an 8-ball—as a major positive in addiction-related harm reduction. 

Yet, as the Drug Enforcement Agency frequently reminds us, the marijuana trade isn’t driven by a bunch of fuzzy old Deadheads; there’s a lot of money in weed—an estimated annual $120 billion worth—and ruthless Mexican drug traffickers feed much of America’s voracious appetite for buds.

Critics of prevailing "Drug War" policies argue that legalization could effectively shut down this black market. In addition, as the criminal justice system has become more involved, via drug courts and probation stipulations, in determining who gets drug treatment in lieu of incarceration, more and more potheads who don’t really need treatment are filling the slots—an underreported aspect of the much-hyped jump in pot admissions. On the flip side, many addiction professionals who work with “forensic” clients steered into addiction treatment by the courts cite the epic consumption of pot some users self-report (15 to 20 blunts daily). Frequently contributing to, if not caused by, such high levels of chronic weed intake are co-occurring mental health disorders, certainly a legitimate, if often unmet, treatment need.

In terms of knowing what’s out there to sample, the justice department does us the favor of serving up a kind of menu-by-location with their annual drug market analyses. Northern California looks to be a smoker's heaven with a slew of “indoor grow sites” producing “high potency” weed. Philly gets “good quality Mexican,” while Chicago is singing the blues, trying to get by and stay high on “commercial grade” dirt buds.

As for the Obama administration's rampant raids on medical-marijuana suppliers: a boondoggle resulting in monumental waste of money? Or a long-overdue intervention for abusers of a drug with an underestimated capacity for harm? Marijuana use (and treatment for its abuse) are touchy subjects, dear readers. Argue it out in the comments section.

2. Meth

Crystal methamphetamine addicts constituted 45,457 cases of addiction treatment in the state of California in 2010—more than the state's combined number of alcoholics and heroin admissions. In Oregon law enforcement crackdowns in 2007 on pseudoephedrine, meth’s widely available chemical precursor, resulted in a brief lull in meth-related arrests, but those numbers began climbing again all too soon.

Meth is an ugly business, toxic to make and use at home resulting in massive social costs like increased foster-care placements for children of addicts and dealers. In addition, murderous Mexican drug cartels finally figured out that meth could be as profitable as smuggling cocaine, conveniently manufacturing the drug in their own laboratories instead of being the middle man for South American coke traffickers.

For all the gaunt, gap-toothed mug shots favored by the national media, meth remains mainly a problem of America’s new Wild West. There were fewer than 250 cases each of meth-addiction treatment admissions in New Jersey, Pennsylvania and Massachusetts in 2010. On the East Coast, meth is a blip; outside the gay club scene you rarely encounter Tina, as the boys on the dance floor have affectionately dubbed her. But ice's popularity rises as you travel west, ticking up to 10% of treatment admissions in Missouri and crossing the Rockies at a high altitude to become 20% of admissions in Nevada, where the drug fuels the eternal bacchanal of other addictions on the Vegas strip.

3. Alcohol

Just as the dudes with the rainbow cascade of keychains hanging out of their ass pockets at the Narcotics Anonymous clubhouse are wont to remark, booze is a drug. In fact, plain, old-fashioned alcohol has been fucking so many people up in so many ways for so many years that its destructiveness would seem to exceed a mention as newsworthy on a list of the year's top street drugs. Plus, being legal and all, booze is not, technically speaking, a "street" drug, although its sleek and sexy advertisements on billboards from coast to coast suggest otherwise.

But King Alcohol will not be denied, ranking a strong second in large urban centers both in terms of treatment admissions and, more important, in percentage of drug-related deaths. In Philly, liquor has in recent years become very much of a street drug in another sense as well, as the City of Brother Love struggles with a “nuisance bar” problem that has pushed up its murder rate. The inner-city bar culture resembles the old frontier-saloon scene, except that now gun-strapped hustlers are partying after their crack-corner work shifts and getting into drunken arguments that escalate to shootouts.

Last year, after nine people—nine!—were shot outside a club with a bad street rep, Mayor Nutter declared, “We’re not putting up with this crap anymore,” and set to waging war against booze-fueled street violence.

Of course, the substance is deadly enough without a bullet hastening the end. It often seems like the most underappreciated drug fact is the role alcohol plays in the entire gamut of drug-related deaths; in 2010 in Philly alcohol was present in 23% of such deaths—nearly as many as cocaine. Arrests for public inebriation and drunk driving were also up. Even in Philly’s poorest neighborhoods alcohol remains the most common drug of abuse, especially with older substance abusers in whom it exacts hellish tolls such as chronic health problems and homelessness.

Remember that episode of The Wire focused on how liquor is killing as many people in East Baltimore as crack? Of course you don’t—David Simon didn’t write it—and that’s a shame because while crack and heroin claim most of the glam press, John Barleycorn may, in the long run, be even more hazardous—same as it ever was.

4. Pills

That’s right, just “pills"—no fine distinctions here between oxycodone and hydrocodone. The fact is that on the streets, where formal knowledge of psychopharmacology is often at a low ebb, black-market pharmaceuticals that came in pallet loads off a truck or bottled from the pharmacy shelves are largely seen as a monolithic category separate from “street” drugs that were cooked and bagged at someone’s kitchen table.

Over the past two decades specific sections of some cities have grown up to accommodate the traffic in pharmaceuticals; my own old stomp in North Philadelphia—"Pill Hill"—was set away from the more violent heroin and crack corners so Oxy addicts could cop in relative safety. Oxys weren’t the only product trading at Pill Hill; Percs and Endos (percocet), Xanies (Xanax), Pins (Klonopin) and even Suzie Q (the antipsychotic drug Seroquel) were abundant and readily available at a 24/7 open-air drug market at the corners of 17th and Jefferson streets until recently when gentrification moved into the neighborhood.

Of course, pill abuse has swept the entire nation, as the incidence of treatment for prescription drug addiction has skyrocketed, doubling, tripling and more over the past 20 years. The ongoing meteoric rise in social costs associated with pharma narcs puts pills ahead of the remaining street drugs of abuse in this survey; dope and coke are, in many ways, so last century. 

The DoJ considers CPDs (controlled prescription drugs) “the primary drug threat” in its most recent drug-market analysis of Appalachia, handily outpacing the abuse of locally cooked meth. That Rx drug abuse has yet to subside from the hysteria-inducing levels of, say, 2002 has recently spawned a new round of “Oxy epidemic” news stories, pitting enforcement-oriented pols and the families of overdosed drug addicts against civil libertarians (and the medical and pharma lobbies) arguing that legitimate pain patients suffer unnecessarily when given a bad name by crazed gun-toting drug-store cowboys knocking over the local CVS for a sack full of Vicodin.

The ongoing meteoric rise in social costs associated with pharma narcs puts pills ahead of dope and coke, which are, in many ways, so last century.

5. Heroin and Cocaine

How to choose between these two old stand-bys of the street drug world for the final spot on our list? Neither high has the same allure as in the '70s, '80s or '90s. Cocaine, especially, has lost its disco-era luster; fiscal austerity imposed by the financial collapse seems to have driven many casual coke snorters to cheaper alternatives like weed. There’s also an “older-sibling effect”—kids who observed the devastating impact of the crack epidemic on the inner city grew up to prefer comparatively harmless blunts to the dime rocks that put them in foster care. This trend is reflected in nationwide data; the count of current cocaine users has dropped off hugely from 2.6 million in 2003 to 1.6 million in 2010.

Yet coke and junk remain a presence in the nation's inner cities, especially on the East Coast—for example, ranking third and fourth respectively in total treatment admissions in Philadelphia only behind marijuana and alcohol. And both are still very risky ways to get high, ranking first and third in drug-related deaths.

Heroin use was especially Russian Roulette-like during the fentanyl outbreak of 2006, when a batch of bags containing the superpotent, respiratory depressing anesthetic instead of heroin left a trail of dead addicts in Philly, New York and New Jersey. The DoJ calls heroin the “most significant drug threat” in Boston, overburdening law enforcement and public health resources. In addition, officials are predicting that in big-city markets where heroin is available in unlimited quantities and more expensive painkillers less so, today’s Oxyheads will be tomorrow’s dopefiends, setting off an addiction bomb that spikes new heroin users through the roof.

(Dis)Honorable Mention:

Levamisole: You may have first read about it in 2009 after a coke-addled DJ AM turned up dead with a bunch of it in his system. As of 2011, this animal deworming chemical had found its way into 82% of all American coke as a cutting agent. Ominously, the Coroner’s Office in Philadelphia found levamisole in 29% of corpsed-out coke users in 2010, raising the distinct possibility that levamisole is so prevalent in autopsied stiffs less because of its prevalence in the overall drug supply than some lethal properties of its own.

Media-stirred fears that the toxic substance would spawn hordes of undead-looking New York bar-scene casualties with their noses rotted off have proven overblown, but seriously, who wants this nasty shit in their body? Yet if you insist on blowing casual lines at certain dance clubs to keep the party going, odds are that right now you do whether you like it or not.

PCP: Phencyclidine garners little attention in drug discussions because on paper the war on PCP appears to have been won; a mainstream party drug in the '70s, angel dust resulted in astronomical numbers of regular young users. But psychosis horror stories about people getting dusted and then flaying and feeding their own faces to the family dog eventually drove the numbers down to near vanishing. Except that PCP never actually vanished; its diminished user base became tightly concentrated in very poor black and Latino inner-city neighborhoods, where smoking “wet” has recently increased in popularity.

A dramatic 10% of all Washington, DC, parolees test positive for the drug; in Philly, 12.5%. The social costs associated with widespread use of this long-lasting anesthetic are astonishing; expensive psych unit stays, long-term hospital care for grievous physical injuries, ongoing treatment for chronic psychotic disorders and jail stays for violent public behavior are par for the course for a regular smoker of “dippers”—blunts or cigarettes dipped in liquid PCP and let dry.

From street corners where users and dealers meet to buy and sell the dope they take, to bars where they party, to the treatment centers they land in after the sun has risen and the cold chill of reality has set in, there you have it: The Fix’s Top 5 Street Drugs of 2011. If you can’t take none of them, best odds are to stick with number one, though who could fault you for the judicious use of number three, thereby joining in our national pastime. For more adventurous readers, let us ex-junkies remind you that the rest are best approached with great caution and used only in moderation—let’s not see you or anyone you love on next year’s statistics list.

Jeff Deeney is a Philadelphia social worker and a writer who is in recovery. His column, "Street Beat," runs biweekly in the The Fix.

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