Bushra Griffith
Cheese heroin is a highly addictive opioid drug that is a combination of Mexican black tar heroin and crushed over-the-counter sleep medication tablets such as Tylenol PM, which contains diphenhydramine HCl. This deadly mixture has been encountered in several areas, most notably in Dallas, Texas, where it has contributed to numerous overdose deaths since 2005, including that of an 18-year-old high school senior, Karen Becerra, in 2006.
| Characteristics | Values |
|---|---|
| Ingredients | Mexican black tar heroin, diphenhydramine, Tylenol PM tablets, hydrochloride salts, diamorphine, water |
| Appearance | Tan-colored powder |
| Packaging | Single-use small plastic "baggies" |
| Methods of Consumption | Injection, snorting, smoking |
| Side Effects | Withdrawal symptoms such as headaches, chills, nausea, vomiting, muscle pains, spasms, and anxiety |
| Overdose Symptoms | Respiratory depression, ineffective or shallow breathing, brain damage, death |
| Prevalence | First discovered in 2005 in Dallas, Texas, United States; prevalent among young Hispanic individuals |
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What You'll Learn
Mexican black tar heroin
The abuse of cheese heroin has been a particular concern in Dallas, Texas, where it has contributed to numerous overdose deaths, especially among young Hispanics. The drug was first discovered in Thomas Jefferson High School in August 2005, and since then, there have been reports of daily arrests and confiscations in the northwest quadrant of Dallas. The outbreak in Dallas has been described as a "mini-epidemic," with health officials seeing children as young as 9 or 10 years old suffering from heroin withdrawal symptoms.
Cheese heroin is easily accessible to children and teens due to its low cost, and its use has spread beyond Dallas to other areas. The side effects of cheese heroin are similar to those of regular heroin, but the addition of central nervous system depressants like Tylenol PM and diphenhydramine HCL increases the risk of respiratory depression and overdose. Treatment officials have noted that young adults abusing heroin may also abuse diphenhydramine-based medications to prolong their heroin high.
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Crushed Tylenol PM tablets
Cheese heroin is a highly addictive illicit drug that can be ingested in a variety of ways, including injection, snorting, and smoking. It is a combination of Mexican black tar heroin and crushed Tylenol PM tablets. The Tylenol PM tablets are central nervous system depressants that contain diphenhydramine HCl and acetaminophen. The addition of these tablets to the mix heightens the risk of respiratory depression and overdose.
Tylenol PM is an over-the-counter sleep medication that can be purchased at a low cost, making cheese heroin easily accessible to children, teens, and young adults. The drug typically appears as a tan-coloured powder that may be snorted using a tube, straw, or ballpoint pen. It is packaged and sold in small plastic baggies.
The process of making cheese heroin involves heating the watered-down heroin, often called "monkey juice," mixed with crushed Tylenol PM tablets to remove excess water. This results in a clumpy powder containing a highly purified mixture of heroin and diphenhydramine. The purification process can be further enhanced by titrating the solution with a weak to intermediate base.
The abuse of cheese heroin has been a particular concern in Dallas, Texas, where it contributed to numerous overdose deaths as early as 2005. The drug was initially spread in middle and high schools in the area, with users as young as 9 or 10 years old experiencing withdrawal symptoms and requiring medical attention. The outbreak in Dallas predominantly affected young Hispanics, which was unprecedented as typically, older white individuals were more associated with inhaling heroin.
Due to the varying methods of preparation, users cannot determine a safe dosage of cheese heroin. This uncertainty, coupled with the drug's addictive nature, has led to a cycle of abuse and withdrawal that has impacted young individuals in particular. The side effects of cheese heroin include headache, chills, nausea, vomiting, muscle pains, spasms, and anxiety.
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Diphenhydramine HCl
Cheese heroin is a combination of Mexican black tar heroin and over-the-counter pain relievers or sleep medication that contain diphenhydramine HCl. This mixture is heated to remove excess water, resulting in a final product that is a tan-coloured powder. Diphenhydramine HCl is an antihistamine that is often found in over-the-counter sleep medication, such as Tylenol PM. When added to heroin, it can increase the risk of respiratory depression and overdose.
The addition of diphenhydramine HCl to heroin creates a highly addictive and dangerous drug. Diphenhydramine HCl is a central nervous system depressant, which means it slows down brain activity. When combined with heroin, which is also a central nervous system depressant, the effects are amplified, leading to a heightened risk of respiratory depression and overdose. Respiratory depression refers to ineffective or shallow breathing, which can prevent an individual from getting enough oxygen and can lead to brain damage or death.
The abuse of cheese heroin, particularly among young people in Dallas, Texas, has led to numerous overdose deaths and has been described as a "mini-epidemic". Health officials in Dallas have reported seeing children as young as 9 or 10 years old suffering from the effects of withdrawal from cheese heroin. The drug is cheap and easily accessible to children and teens, which has contributed to its widespread abuse in the area.
To address the problem of cheese heroin abuse, some stores in the Dallas area have stopped selling products containing diphenhydramine HCl, while others have placed these products behind the prescription drug counter and require customers to show identification before purchasing. Additionally, education programs have been implemented in schools, and there has been an increase in arrests of heroin dealers in schools and neighbourhoods. Despite these efforts, the abuse of cheese heroin remains a significant concern, highlighting the need for effective prevention, treatment, and recovery support services.
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Water
The specific method involves taking #4 powder heroin and crushed diphenhydramine tablets and combining them with water. This mixture is then heated to remove excess water, resulting in a clumpy powder. This powder is the final product, often referred to as "monkey juice."
The addition of water serves a critical function in the production process. By dissolving the heroin and diphenhydramine in water, the drug makers can effectively mix the ingredients, ensuring a more uniform and consistent product. This step enhances the drug's potency and makes it easier to consume.
The use of water also facilitates the filtration process. After dissolving the active ingredients in water, the solution is passed through a micron filter. This filtration step helps remove any unwanted cuts, binders, or fillers, resulting in a purer form of the drug.
Additionally, water plays a role in the optional final step of converting the cheese heroin into a salt form. After filtering, the highly pure heroin-DPH mixture is added to a water solution and carefully treated with hydrochloric, acetic, or citric acid. This process yields up to 99.9% pure "cheese" heroin in its salt form. The water used in this step is then evaporated, leaving behind the potent and harmful drug in its final powder form.
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Injection, snorting, smoking
Injection, snorting, and smoking are some of the most common methods of opioid use. Each method is associated with unique health risks. Injection opioid use, for instance, can lead to several fatal and disabling conditions, including HIV and HCV infection, endocarditis, osteomyelitis, and skin and soft tissue infections. The CDC recommends that people who inject opioids get vaccinated for Hepatitis A and B and get tested for Hepatitis B and C. The sharing of tubes, straws, and other nasal insufflation equipment during snorting can also increase the risk of HIV and hepatitis C transmission. Snorting opioids can further irritate and rupture the small blood vessels in the nose, leading to nasal pain, nosebleeds, and the destruction of nasal cells or tissue, resulting in holes in the nasal septum.
Smoking opioids is a popular method because it causes the drug to take effect almost immediately and does not carry the stigma associated with injecting. However, both injecting and smoking opioids increase the risk of overdose compared to ingestion. By 2022, smoking was the most common route of use among fatal overdoses, and the number of states with ≥10% smoking rates had increased from 2 to 27 between 2000 and 2021.
National trends in the United States indicate a recent decrease in injection and a rise in smoking and snorting since 2000. Injection peaked in 2014 (69.9%) and decreased to 52.2% in 2021, while snorting increased from a low of 24.9% in 2014 to a peak of 36.4% in 2021. Smoking rates have also been steadily rising, from 2.5% in 2005 to a peak of 11.4% in 2021.
Geography plays a role in ROA preferences, with increased smoking in the western US and increased snorting in the eastern US. These shifts in ROA preferences have public health implications, including a rise in smoking-related fatal overdoses and a potential reduction in injection-specific morbidity.
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Frequently asked questions
Cheese heroin is a combination of Mexican black tar heroin and crushed Tylenol PM tablets.
Mexican black tar heroin is a form of heroin that is black and sticky. It is made from morphine, which is a natural substance taken from the opium poppy plant.
Tylenol PM is an over-the-counter sleep medication that contains diphenhydramine HCl.
Cheese heroin typically appears as a tan-colored powder that may be snorted with a tube, straw, or ballpoint pen.
