title: The Textures of Heroin: User Perspectives on "Black Tar" and Powder Heroin in Two U.S. Cities.
abstract: Since the 1990s, U.S. heroin consumers have been divided from the full range of available products: east of the Mississippi River, Colombian-sourced powder heroin (PH) dominates the market while, to the west, Mexican-sourced "black tar" (BTH) is the main heroin available. By conducting qualitative research in two exemplar cities, Philadelphia (PH) and San Francisco (BTH), we compare users' experiences of heroin source-types, markets, health consequences, and consumption preferences. The strict division of heroin markets may be changing with novel forms of powder heroin appearing in San Francisco. Our researchers and interviewees perceived vein loss stemming from the injection of heroin alone to be a particular problem of BTH while, among the Philadelphia sample, those who avoided the temptations of nearby cocaine sales displayed healthier injecting sites and reported few vein problems. Abscesses were common across both sites, the Philadelphia sample generally blaming missing a vein when injecting cocaine and the San Francisco group finding several explanations, including the properties of BTH. Consumption preferences revealed a "connoisseurship of potency," with knowledge amassed and deployed to obtain the strongest heroin available. We discuss the reasons that their tastes take this narrow form and its relationship to the structural constraints of the heroin market.
authors.affiliation: a Qualitative Project Director, Heroin in Transition, Department of Family and Community Medicine , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Mars
authors.affiliation: b Visiting Professor of Anthropology and Social Medicine, Director , Center for Social Medicine and Humanities and Semel Institute of Neuropsychiatry, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles , CA , USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bourgois
authors.affiliation: c Paul and Daisy Soros New American Fellow , Harvard University , Boston , MA , USA.
authors.forename: George
authors.initials: G
authors.lastname: Karandinos
authors.affiliation: d Department of Anthropology , Columbia University , New York , NY , USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Montero
authors.affiliation: e Professor of Family and Community Medicine, Department of Family and Community Medicine , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ciccarone
mesh_terms: D000038:Abscess / Q000139:chemically induced / Q000453:epidemiology; D000328:Adult; D005260:Female; D003932:Heroin / Q000009:adverse effects* / Q000737:chemistry; D006556:Heroin Dependence / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D012495:San Francisco / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*; D014652:Vascular Diseases / Q000139:chemically induced / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003932:Heroin
keywords: Connoisseurship; USA; drug markets; heroin; heroin purity; injection drug use