Cheese (recreational drug)

  Cheese is a heroin-based recreational drug that surfaced in the United States in 2005 and came to the media's attention after a string of deaths among adolescents in the Dallas/Fort Worth Metroplex, in 2006 and 2007.

Cheese is formed by combining heroin with crushed tablets of certain over-the-counter cold medication, such as Tylenol PM. Such cold medications contain acetaminophen, the active ingredient in Tylenol, and the antihistamine diphenhydramine, the active ingredient in Benadryl and a common opiate potentiator.^[1] Cheese samples obtained in north Dallas contained between 2% and 8% heroin, in contrast to the 30% commonly found in black tar heroin.^[2][3] Users commonly take the powder by insufflation rather than by intravenous injection.

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Emergence of Cheese

The drug made many news headlines when it appeared in several public middle and high schools in Dallas, Texas. The United States Drug Enforcement Administration,^[4] some police agencies and the Dallas Independent School District (DISD) dubbed the mixture "starter heroin."^[5] The district handled fifty-four property cases and found twenty-four felony offenses involving "cheese" between August 15, 2005 and March 1, 2006, at eleven schools.^[6] On February 24, 2007, United Press International reported that DISD would increase drug-sniffing dog patrols in order to eliminate Cheese from its schools.^[7] As of mid-2007, police records for the northwest quadrant of Dallas showed almost daily arrests for and confiscations of the drug.^[8]

According to Dallas school district authorities, Hispanic teenagers are the demographic group most frequently charged with possession of the drug;^[2] Hispanics also constitute a majority (60 percent) of all DISD students.^[9] DISD Police, on April 18, 2006, identified the youngest known user of Cheese as a 13-year old. By February 1, 2007, usage of Cheese was reported in the fourth-grade level at several elementary schools; By February 2007, Monty Moncibais, a detective of the Dallas Police Narcotics Division, noted 71 cheese-related arrests in children aged 10 through 16.^[10]

Dallas-area treatment centers have noted that the drug's growing use has led to a lowering in the age of teens admitted to their programs^{[citation needed]}, although the United States Drug Enforcement Administration (DEA) asserted in 2006 that cheese usage was not increasing. From a typical clientele of 15- to 17-year-olds admitted under court order, one Dallas-area center noted it had begun to admit 11, 12, and 13-year-olds voluntarily or at a parent's request.^[11]

In mid-2007, a number of area stores opted either to remove Tylenol PM and similar products from their shelves or to move them to shelves within a pharmacist's view or control.^[8] The manager of a Fiesta Mart supermarket in northwest Dallas explained his store's policy shift regarding various diphenhydramine-containing products by saying local youths were stealing these items, adding, "We didn't want to be part of the problem or anybody dying," implying that the store also pulled the products to curb abuse.^[12] The manager stated that theft decreased after removing the products, and various local Carnival supermarkets and Walgreens pharmacies also voluntarily shifted the products to pharmacist-controlled or -monitored shelves.^[8]

Creation and marketing of cheese

Drug traffickers bring the raw black tar heroin into the country for consumption. In the United States, most traffickers ship tar heroin from Mexico.^[13]

Middlemen purchase the raw heroin from the traffickers and then sell the heroin to children at middle and high school campuses, according to drug counselors at the Phoenix Academy of Dallas.^[14]

According to a 14-year old girl being treated at the Phoenix Academy, water is then added to the heroin.^[15] The watered-down heroin, often called "monkey juice," is mixed with Tylenol PM tablets.^[16] The makers of Cheese heat the mixture to remove excess water, resulting in the final product.^[17]

The heroin in cheese remains an addictive substance, just like any adulterated form of heroin. Once a person is physically addicted, withdrawal symptoms may appear from 6 to 24 hours after the last dose of the drug.^[1] The link between physical dependence and addiction is partly psychological and sociological, and thus varies from person to person (and culture to culture), as has been documented in the work of Alfred Lindesmith, an Indiana University professor of sociology, and others.

Deaths attributed to cheese

Deaths directly attributable to this form of heroin are difficult to confirm because coroner's offices frequently do not have a method to track cause of death to one specific form of a drug. Centralized reporting of cheese heroin deaths does not exist in Texas since each county has its own official to sign death certificates.^[18]

2006: The first deaths are reported

Several of the deaths are notable due either to the publicity that followed or unusual circumstances of the case. One of the earliest published instances of a death attributed to cheese heroin was that of Karla Becerra, an 18-year-old high school senior found dead by her father in their West Dallas home on April 24, 2006. Police attributed her death to snorting cheese and drinking alcohol.^[2] On November 1, 2006, 17-year-old Keith Witherspoon died in nearby Mesquite; a story the following month in The Dallas Morning News profiled Witherspoon as "the first Dallas-area youth publicly known to have died of a heroin overdose since the 'cheese' concerns were raised."^[19] The death was also notable because Mesquite is located southeast of Dallas, indicating the problem had moved beyond its origins in the northwest quadrant of the city.

Early 2007: Deaths in younger populations

The first middle-school "cheese" death in published accounts was that of Oscar Gutierrez, a 15-year old eighth grader in northwest Dallas, who died February 18, 2007;^[20] his brother stated that the boy had previously survived an overdose of the same drug.^[21] Community rallies followed Gutierrez' death as parents and others urged the police and school district to become more active in fighting what was viewed as a growing problem. The death of Fernando Cortez Jr., a high school student, on March 31, 2007, led to further community activism. Initially this death was linked to cheese heroin based on the father's comments in press reports; the father said his son was at a Dallas party when he was offered "cheese" and that the boy had not tried drugs before.^{[22][23][24][25]} Cortez's father went on to become a speaker at community meetings within the school system, urging that parents keep closer watch over their children.^[26] On April 24, the same day toxicology results were announced confirming the link to cheese, police announced a family friend would be charged with murder for having mixed the drugs for Cortez.^[27]

Spring/summer 2007: Old deaths examined, new deaths occur

Between the time of Cortez Jr.'s death and the announcement of his toxicology tests in late April, The Dallas Morning News published the results of a lengthy analysis of autopsy results between 2005 and 2007, conducted in concert with the Dallas County medical examiner's office, which suggested that as many as 17 deaths among adolescents during that period were attributable to cheese heroin, not including the Cortez death. The conclusion was based in part on the presence of both heroin and diphenhydramine in the blood of the deceased; additionally, the families of 11 victims confirmed the deceased had used cheese heroin. Some toxicologists questioned the results due to the absence of acetaminophen. Other experts argued that acetaminophen has a shorter half-life and might have been metabolized by the body prior to death. Susan Dalterio, a University of Texas at San Antonio pharmacology expert, insisted that the combination was unlikely to be a coincidence, as a person sleepy from diphenhydramine would be unlikely to be abusing heroin at the same time.^[28] It is common for users of heroin, and other opioid drugs, to take diphenhydramine-containing medications to reduce two common side effects of opioid drugs: itchiness and nausea^{[citation needed]}.

On April 18, days after findings from the medical examiner's review were published, two more deaths occurred, though once again their connection to cheese heroin took weeks to be confirmed. The body of 18-year-old Keridma Godina was found on a porch in Balch Springs the day after her death;^[29] police charged two men immediately with abandoning the body, but were unable to make any drug-related charge when confirmation of the link to cheese came three weeks later. The death of 17-year-old Lauren Paulson of The Colony, was reported that same week, but was not linked to cheese heroin until late summer.^[30] In mid-May, the Dallas County medical examiner's office confirmed that two earlier teen deaths — one in January and another in April — were confirmed by toxicology tests as linked to cheese heroin; these additions brought the known toll at that time to 21 deaths among those 18 and under, not including the Paulson case.^[31]

Over the summer vacation months of 2007, the push against cheese heroin continued. Parents and police organized a June 30 march, Sen. John Cornyn visited the area as part of an anti-cheese campaign in early July, the director of the White House Office of National Drug Control Policy gave a press conference from Dallas ISD headquarters in August praising the district's efforts, and local stores pulled Tylenol PM and similar drugs from the shelves to make them less accessible.^{[32][33][34][35]} July also saw the addition of two more names to the list of deaths, as Paulson's death became the 22nd linked to the drug, and a 17-year-old member of a high school drill team died at Parkland Memorial Hospital eleven days after being found unconscious on the morning her group was to take its yearbook photo.^[36]

Autumn 2007: Deaths across north Texas

The spread of the drug to the outlying suburbs of Dallas was confirmed in September by the return of toxicology reports from the July 13 death of an 18-year-old student from McKinney, located northeast of Dallas in Collin County,^[37] and from two July deaths in nearby Tarrant County, one involving a 17-year-old male and the other, a 26-year-old male.^[38] Additional suburban deaths in September — in Irving to the west and Rockwall to the east — were believed to be linked to cheese heroin, though police cautioned toxicology reports would not likely be complete until November. The Tarrant County medical examiner's office announced on September 24 that a review of deaths in Tarrant County (west) and Denton County (north) showed an additional 15 deaths between 2004 and 2007 that appeared to be linked to "cheese," and Collin and Rockwall counties had reported one death each.^[39] These new figures brought the total number of deaths associated with cheese heroin in northern Texas to 40, a figure that included much older adults along with those age 18 and under.

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