"Cheese" is a heroin-based recreational drug that came to the attention of the media inside and outside"US-Teenager riskieren mit "Cheese" ihr Leben." Der Spiegel. Sunday July 15, 2007. the United States after a string of deaths among adolescents in Dallas, between 2005 and 2007. As of 2012 the drug use was now among older people who were teenagers around the period the drug was first discovered.Pantazi, Andrew. "‘Cheese’ mostly in check for now, but has grown up with its users." The Dallas Morning News. December 29, 2012. Retrieved on November 7, 2013.
Cheese is a combination of drugs, made by combining heroin with crushed tablets of certain over-the-counter cold medication, such as Tylenol PM. Such cold medications contain acetaminophen (paracetamol), the active ingredient in Tylenol, and the antihistamine diphenhydramine, the active ingredient in Benadryl. Cheese samples obtained in north Dallas contained between 2% and 8% heroin, in contrast to the 30% commonly found in black tar heroin. Users commonly take the powder by insufflation ("snorting") rather than by intravenous injection. This mixture is also known as "Tylenol With Smack", by analogy to the Tylenol With Codeine series.
Due to the high concentrations of non-opiate substances relative to the diamorphine content of the drug, abuse and overdose of cheese are more dangerous than pure-form opiate overdoses. Emergency personnel must address the overdose effects of each component of the drug, since the contents and concentrations of each component vary widely among batches they must wait for either the completion of the toxicology report to begin treatment or wait for the effects of each drugs overdose to manifest. The acetaminophen content of the drug induces severe, irreversible damage to the liver when taken in high doses for long periods of time. Very high doses of acetaminophen are capable of producing acute liver failure and death within hours, and patients who survive this acute phase of the toxicity generally require dialysis and eventually a liver transplant. Due to the many methods of preparation a user can not know how much acetaminophen is in any given batch and therefore can not reliably determine a safe dose. A dose of the last batch which produced no toxic effects may produce lethal effects in the next batch.
Emergence
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,Donna Leinwand, Texas schools battle 'starter heroin', USA Today, April 26, 2006 some police agencies and the Dallas Independent School District (DISD) dubbed the mixture "starter heroin." 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."Cheese" May 2006 (), WhiteHouseDrugPolicy.gov On February 24, 2007, United Press International reported that DISD would increase drug-sniffing dog patrols in order to eliminate Cheese from its schools."Dallas schools turn to drug-sniffing dogs," United Press International, Feb. 24, 2007 As of mid-2007, police records for the northwest quadrant of Dallas showed almost daily arrests for and confiscations of the drug.Sergio Chapa. "Stores stop selling medicines that contain 'cheese' ingredient," Al Día, July 17, 2007.
According to Dallas school district authorities, Hispanic teenagers are the demographic group most frequently charged with possession of the drug;Dallas Morning News | News for Dallas, Texas | Latest News Hispanics also constitute a majority (60 percent) of all DISD students.Kent Fischer. "Superintendent is big on change," The Dallas Morning News, July 16, 2007. 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.Anna Schecter, "Update: $2 Heroin 'Cheese' Spreads to Fourth Grade," The Blotter, ABC News, Feb. 1, 2007
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. 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. Kim Horner, "Local kids falling victim to heroin mix: Rehab programs surprised to see 'babies' among clients," The Dallas Morning News, November 18, 2006
Newsweek posted an article about Cheese, titled "Stopping a Kid Killer," in 2007."Stopping a Kid Killer," Newsweek at The Daily Beast. May 20, 2007. Retrieved on September 6, 2011. Jack Schafer, a columnist for Slate, criticized the Newsweek article; Schafer believes that the Newsweek article does not adequately explain the process of creating Cheese and did not use scientists as sources.Schafer, Jack. "Newsweek's Cheesy Drug Story," Slate Jane C. Maxwell, a senior research scientist of the Gulf Coast Addiction Technology Transfer Center at The University of Texas at Austin, stated in "“Cheese” Heroin: Status as of May 2, 2007" that she believes that the effect of Cheese could increase due to media reporting aspects such as "unsubstantiated numbers" and "sensationalistic emphasis" regarding "new highs" and "schoolboy drugs," leading to copycat outbreaks.Maxwell, Jane C. "'Cheese' Heroin: Status as of May 2007," Gulf Coast Addiction Technology Transfer Center, University of Texas at Austin, May 2, 2007. Retrieved August 26, 2007.
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. 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."Dallas Stores Pull Medicine Containing 'Cheese' Ingredient," ABC News, July 18, 2007. 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.
The Dallas Morning News unofficially reported that arrests for Cheese in DISD decreased. The district performed 71 arrests for Cheese in the 2006-2007 school year. During the 2007-2008 school year from August to December the district performed 17 arrests. The number of children seeking treatment for use of Cheese remained steady. The paper reported that usage of Cheese spread from the northwest Dallas area and into areas outside of Dallas County. Deputy Chief Julian Bernal, the commander of the narcotics division of the Dallas Police, said that he encountered more White and Black teenagers using the drug. Michelle Hemm, the director of the Phoenix Academy of Dallas, believes that Cheese arrests decreased because users took more care to conceal the drugs or did not bring the drugs to schools for fear of detection."'Cheese' heroin arrests falling in Dallas school district," The Dallas Morning News
Production methods
According to a 14-year-old girl being treated at the Phoenix Academy, water is added to the heroin.ABC News. Cheese: The Heroin for Kids, slide 3 The watered-down heroin, often called "monkey juice," is mixed with Tylenol PM tablets.ABC News. Cheese: The Heroin for Kids, page 4 The makers of Cheese heat the mixture to remove excess water, resulting in the final product.ABC News. Cheese: The Heroin for Kids, slide 5
Deaths 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.
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 Karen 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. 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."Kim Horner, "Mesquite family unable to save teen from drugs: Seeking help, family found only dead ends", The Dallas Morning News, December 31, 2006 The death was also notable because Mesquite is located northeast 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;Rebecca Lopez, "Mom speaks out after 'cheese' claims son's life," WFAA-TV (Dallas, Texas), Feb. 21, 2007 his brother stated that the boy had previously survived an overdose of the same drug.Anna Schecter, "Who Killed Oscar Gutierrez?",The Blotter, ABC News, Feb. 28, 2007. 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 Corvallis party when he was offered "cheese" and that the boy had not tried drugs before that he was aware of."Police: Boy, 15, Found Dead," KXAS-TV, April 4, 2007."Muere otro estudiante por drogas: Estudiaba en la escuela Molina de Dallas," ["Another student dies from drugs: He studied at Dallas' Molina school"], Univision KUVN-TV, April 4, 2007 (in Spanish) Martín Martínez. "Padre de joven víctima aconseja a familias vigilar a menores," ["Father of young victim advises families to keep watch over minors"] Diario La Estrella, April 4, 2007 (in Spanish)Sergio Chapa."Family believes teen's death may be tied to 'cheese' heroin,"The Dallas Morning News, April 4, 2007 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.Sergio Chapa."Una lección llena de dolor" ["A lesson filled with pain"], Al Día, May 1, 2007 (in Spanish) 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.Jason Trahan. "'Cheese' heroin claims 18th school-age victim," The Dallas Morning News, April 24, 2007.
Spring/summer 2007: Old deaths examined, new deaths occur