Drug use in Miami-Dade County, Florida

South Florida's heroin epidemic is now characterized by dramatic increases in hospital emergency department visits, heroin-induced deaths, the highest street purify in local history, and novice, noninjecting abusers representing more than one-third of primary heroin treatment admissions. The number of casualties in Miami's heroin epidemic of the 1990s rivals the consequences of the local cocaine and crack epidemic at ifs peak a decade ago. While cocaine consequences still dominate local drug problems, their levels have stabilized or declined. Yet heroin is feeding a quieter and subtler Epidemic, which has not affected the public consciousness as did the cocaine crisis in the late 1980s. Other drug use is an important factor in the initiation of heroin use. Methylenedioxymethamphetamine (MDMA) pills are now called "rolls" and their use is called "rolling," referring to the swing from stimulant to depressant effects. Many users believe that rolls contain a little bit of heroin to cut the stimulating effects of amphetamine-type drugs that have replaced MDMA in most of the tablets. Gamma-hydroxybutyrate (GHB) and its analogs are widely abused, increasingly by adolescents, and are associated with several deaths in south Florida. Marijuana consequences continue to mount among youth even though fewer report its use.