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Anaged care payment issues have impeded placement in appropriate treatment programs. Additional long-term management issues include regular attendance at 12-step meetings (Alcoholics Anonymous or Narcotics Anonymous), biweekly urine tests for drugs of abuse, attention to issues of dual diagnosis (group or family therapy), and reapproachment with family, school, and straight friends. Key words: drug abuse, heroin, chemical dependency, addiction. New heroin users include adolescents in ever-increasing numbers. In 1988 the mean age of heroin use in the United States was 27; in 1995, the mean age of self-reported heroin use was reduced to 19 years (Substance Abuse Report Newsletter 1997;28(23):2). According to data from the 1997 National Institute on Drug Abuse monograph Monitoring The Future, use of heroin by American high school 12th graders was 100% higher than it was in 1990-1996 (0.90 to 1.8%) and there has been a further increase in 1997 from to 2.1%.1 There has been a continuing increase in heroin use from 1996 through 1997 from 1.8% to 2.1%.1 Additional support for an increase in heroin use in the United States comes from analysis of recent survey data from California and Maryland. A 1996 survey revealed that 2.2% of California high school juniors had used heroin during the previous 6 months. This rate was double that of 1994 and represents a 10-year all-time high.2 A 1996 survey of high school students in Maryland showed a 35% increase in heroin use by 12th graders since 1994 (3.4% vs 2.2%) Maryland State Department of Education . Teenagers in the United States have ch clonidine snorting


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On in (Goldsmith users snorting sales areas ) into many off-street locations, some sales of both heroin and cocaine Table 1 (cont'd.) Ethnographers - Heroin City Purchase Purity Other Comments Amount Austin, TX Black tar: high Black tar is most plentiful but more (Maxwell) $150K kilo expensive. Colombian or South East Asian Columbian: heroin is rare but cheaper. Emerging drugs $85- include Rohypnol and over the counter 100K kilo ephedrine. San $60 gram high Heroin is inexpensive and high quality. Francisco, Black tar Greatest increase is among new young users, CA and powder some of whom combine it with methamphetamine. (Murphy) both available Atlanta, GA $50 1 8oz. 60-90% There has been the appearance of bag marking; (Sterk- also see snorters "speedballing" lines of Elifson) cocaine and heroin and some shift from crack to heroin. El Paso, TX variable, but gen The practice of "shabanging" or squirting (Ramos) erally high liquefied heroin into the nose continues among young users. New Yo

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clonidine snorting Mming clonidine snorting, or barking noises and progress to compulsive clonidine snorting, involuntary bouts of cursing. For no apparent reason and often in the midst of conversation clonidine snorting, some people with Tourette's syndrome may call out obscenities. Use of words related to feces (coprolalia) is common. These vocal outbursts are sometimes mistakenly thought to be intentional clonidine snorting, especially in children. Repetition of words immediately after hearing them (echolalia) is also common. People with Tourette's syndrome often have difficulty functioning and experience considerable anxiety in social situations. In the past clonidine snorting, they were shunned clonidine snorting, isolated clonidine snorting, or even thought to be possessed by the devil. Many people with the disorder develop impulsive clonidine snorting, aggressive clonidine snorting, and self-destructive behaviors; about half of the people develop obsessive-compulsive behavior. Children with Tourette's syndrome often have difficulty learning. Whether the disorder itself or the extraordinary stresses of living with the disorder cause these behaviors is unclear. Diagn.

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