Cheese (recreational drug)
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"Cheese" is a heroin-based recreational drug that came to the attention of the media inside and outside the United States after a string of deaths among
adolescents Adolescence () is a transitional stage of Developmental biology, physical and psychological Human development (biology), development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majo ...
in
Dallas Dallas () is the List of municipalities in Texas, third largest city in Texas and the largest city in the Dallas–Fort Worth metroplex, the List of metropolitan statistical areas, fourth-largest metropolitan area in the United States at 7.5 ...
, between 2005 and 2007. As of 2012 the drug use is now among older people who were teenagers around the period the drug was first discovered. Cheese is a combination of drugs, made by combining heroin with crushed tablets of certain
over-the-counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescr ...
cold Cold is the presence of low temperature, especially in the atmosphere. In common usage, cold is often a subjective perception. A lower bound to temperature is absolute zero, defined as 0.00K on the Kelvin scale, an absolute thermodynamic ...
medication, such as Tylenol PM. Such cold medications contain acetaminophen (paracetamol), the
active ingredient An active ingredient is any ingredient that provides biologically active or other direct effect in the diagnosis, cure, mitigation, treatment, or prevention of disease or to affect the structure or any function of the body of humans or animals. The ...
in
Tylenol Tylenol may refer to: * Paracetamol Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. At a standard dose, paracetamol only slightly decr ...
, and the
antihistamine Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provid ...
diphenhydramine Diphenhydramine (DPH) is an antihistamine and sedative mainly used to treat allergies, insomnia, and symptoms of the common cold. It is also less commonly used for tremor in parkinsonism, and nausea. It is taken by mouth, injected into ...
, the active ingredient in
Benadryl Benadryl is a brand of various antihistamine medications used to stop allergies, whose content varies in different countries, but which includes some combination of diphenhydramine, acrivastine, and/or cetirizine. It is sold by Johnson & Joh ...
. Cheese samples obtained in
north North is one of the four compass points or cardinal directions. It is the opposite of south and is perpendicular to east and west. ''North'' is a noun, adjective, or adverb indicating direction or geography. Etymology The word ''north ...
Dallas Dallas () is the List of municipalities in Texas, third largest city in Texas and the largest city in the Dallas–Fort Worth metroplex, the List of metropolitan statistical areas, fourth-largest metropolitan area in the United States at 7.5 ...
contained between 2% and 8% heroin, in contrast to the 30% commonly found in
black tar heroin Black tar heroin is a form of heroin that is sticky like tar or hard like coal. Its dark color is the result of crude processing methods that leave behind impurities. Despite its name, black tar heroin can also be dark orange or dark brown in ap ...
. Users commonly take the powder by
insufflation In religious and magical practice, insufflation and exsufflation are ritual acts of blowing, breathing, hissing, or puffing that signify variously expulsion or renunciation of evil or of the devil (the Evil One), or infilling or blessing with go ...
("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 Heroin, also known as diacetylmorphine and diamorphine among other names, is a potent opioid mainly used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt. Various white and brown ...
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 Dallas () is the List of municipalities in Texas, third largest city in Texas and the largest city in the Dallas–Fort Worth metroplex, the List of metropolitan statistical areas, fourth-largest metropolitan area in the United States at 7.5 ...
,
Texas Texas (, ; Spanish: ''Texas'', ''Tejas'') is a state in the South Central region of the United States. At 268,596 square miles (695,662 km2), and with more than 29.1 million residents in 2020, it is the second-largest U.S. state by ...
. 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 The Dallas Independent School District (Dallas ISD or DISD) is a school district based in Dallas, Texas ( USA). It operates schools in much of Dallas County and is the second-largest school district in Texas and the seventeenth-largest in the ...
(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 United Press International (UPI) is an American international news agency whose newswires, photo, news film, and audio services provided news material to thousands of newspapers, magazines, radio and television stations for most of the 20t ...
reported that DISD would increase drug-sniffing dog patrols in order to eliminate Cheese from its schools. 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 The term ''Hispanic'' ( es, hispano) refers to people, cultures, or countries related to Spain, the Spanish language, or Hispanidad. The term commonly applies to countries with a cultural and historical link to Spain and to viceroyalties forme ...
teenagers are the demographic group most frequently charged with possession of the drug;Dallas Morning News , News for Dallas, Texas , Latest News
/ref> Hispanics also constitute a majority (60 percent) of all DISD students.Kent Fischer

''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

''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

''The Dallas Morning News'', November 18, 2006
''
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'' posted an article about Cheese, titled "Stopping a Kid Killer," in 2007. 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. Jane C. Maxwell, a senior research scientist of the Gulf Coast Addiction Technology Transfer Center at
The University of Texas at Austin The University of Texas at Austin (UT Austin, UT, or Texas) is a public research university in Austin, Texas. It was founded in 1883 and is the oldest institution in the University of Texas System. With 40,916 undergraduate students, 11,075 ...
, 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 Copycat refers to a person who copies some aspect of some thing or somebody else. Copycat may also refer to: Intellectual property rights * Copyright infringement, use of another’s ideas or words without permission * Patent infringement, a v ...
outbreaks.Maxwell, Jane C
"'Cheese' Heroin: Status as of May 2007,"
Gulf Coast Addiction Technology Transfer Center,
University of Texas at Austin The University of Texas at Austin (UT Austin, UT, or Texas) is a public research university in Austin, Texas. It was founded in 1883 and is the oldest institution in the University of Texas System. With 40,916 undergraduate students, 11,07 ...
, 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 Fiesta Mart, L.L.C., formerly Fiesta Mart Inc., is a Latino-American supermarket chain based in Houston, Texas that was established in 1972. Fiesta Mart stores are located in Texas. The chain uses a cartoon parrot as a mascot. As of 2004 it ope ...
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 Walgreen Company, d/b/a Walgreens, is an American company that operates the second-largest pharmacy store chain in the United States behind CVS Health. It specializes in filling prescriptions, health and wellness products, health information, a ...
pharmacies also voluntarily shifted the products to pharmacist-controlled or -monitored shelves. ''
The Dallas Morning News ''The Dallas Morning News'' is a daily newspaper serving the Dallas–Fort Worth area of Texas, with an average print circulation of 65,369. It was founded on October 1, 1885 by Alfred Horatio Belo as a satellite publication of the '' Galvest ...
'' 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 The Dallas Police Department, established in 1881, is the principal law enforcement agency serving the city of Dallas, Texas. Organization The department is headed by a chief of police who is appointed by the city manager who, in turn, is hir ...
, said that he encountered more
White White is the lightest color and is achromatic (having no hue). It is the color of objects such as snow, chalk, and milk, and is the opposite of black. White objects fully reflect and scatter all the visible wavelengths of light. White o ...
and
Black Black is a color which results from the absence or complete absorption of visible light. It is an achromatic color, without hue, like white and grey. It is often used symbolically or figuratively to represent darkness. Black and white ...
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.


Production methods

According to a 14-year-old girl being treated at the Phoenix Academy, water is added to the heroin. The watered-down heroin, often called "monkey juice," is mixed with Tylenol PM tablets. The makers of Cheese heat the mixture to remove excess water, resulting in the final product. A more refined method for creating Cheese heroin is done by taking #4 powder heroin and crushed diphenhydramine tablets, and adding them to water such that the active ingredients dissolve into the solution. The solution is then filtered via a micron filter to remove all the cuts and binders/fillers, leaving the user with a solution of high purity diamorphine HCl and diphenhydramine hcl. The water is then evaporated off, yielding a clumpy powder containing a highly purified mixture of heroin and DPH. It can also be further purified by titrating the solution with a weak to intermediate base such as sodium carbonate or sodium hydroxide to freebase the diamorphine and DPH. This releases the bound hydrochloride salts on both the diamorphine and DPH, such that the HCl ions dissolve into the water while the heroin and diphenhydramine are freebased; this allows the molecules to precipitate out as the solution is titrated. The precipitates (heroin and DPH) are then collected, leaving behind all of the process waste. Lastly (and optionally) the super high purity (90%-99%) heroin-DPH mixture is added to a water solution and hydrochloric, acetic, or citric acid is carefully titrated to yield up to 99.9% pure "cheese" heroin in the salt form, which is again run through a micron filter and extracted to a powder via evaporation (water-soluble, and as such is the type used for injection and insufflation ROA's) otherwise this step is excluded and the Cheese is in a super pure base form (which can be efficiently smoked).


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, Texas, Mesquite; a story the following month in ''
The Dallas Morning News ''The Dallas Morning News'' is a daily newspaper serving the Dallas–Fort Worth area of Texas, with an average print circulation of 65,369. It was founded on October 1, 1885 by Alfred Horatio Belo as a satellite publication of the '' Galvest ...
'' 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

WFAA-TV (Dallas, Texas), Feb. 21, 2007
his brother stated that the boy had previously survived an overdose of the same drug. 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 Logan Michael Howatt., a high school student, on March 31, 2017, 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.
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 Chap
"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 Chap

["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

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, Texas, 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 toxicology, toxicologists questioned the results due to the absence of acetaminophen. Other experts argued that acetaminophen has a shorter half-life and might have been metabolism, 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.Jason Trahan
"'Cheese' crisis runs deep,"
''The Dallas Morning News'', April 15, 2007
It is common for users of heroin and other opioid drugs to take diphenhydramine-containing medications as an attempt to alleviate side effects resulting from histamine release induced by opioid administration, such as Itch, pruritus, as well as potentiate the sedative effects of the drug. 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, Texas, Balch Springs the day after her death;Jason Trahan
"Woman, 18, confirmed as 'cheese' victim,"
''The Dallas Morning News'', May 3, 2007
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, Texas, The Colony, was reported that same week, but was not linked to cheese heroin until late summer.Jason Trahan
"Girl, 17, apparently dies of overdose,"
''The Dallas Morning News'', April 21, 2007. Retrieved August 4, 2007.
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.Jason Trahan

''The Dallas Morning News'', May 9, 2007
Over the summer vacation months of 2007, the push against cheese heroin continued. Parents and police organized a June 30 March, John Cornyn, 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.Sam Hodges
"Parents, police march to promote awareness of 'cheese,'"
''The Dallas Morning News'', June 30, 2007.
Frank Trejo

''The Dallas Morning News'', July 7, 2007. Retrieved August 4, 2007.
Tawnell D. Hobbs

''The Dallas Morning News'', August 2, 2007.
Gary Reaves

WFAA-TV, July 18, 2007.
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.Sergio Chapa
"Dallas County's 23rd 'cheese' victim buried: Dallas: Drill team member, good student is 23rd to die in county,"
''Al Día'', July 12, 2007.


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, Texas, McKinney, located northeast of Dallas in Collin County, Texas, Collin County,Marissa Alani
"'Cheese' confirmed as cause of McKinney student's death,"
''The Dallas Morning News'', September 2, 2007.
and from two July deaths in nearby Tarrant County, Texas, Tarrant County, one involving a 17-year-old male and the other, a 26-year-old male.Debra Dennis
"Two confirmed as 'cheese' victims,"
''The Dallas Morning News'', September 21, 2007.
Additional suburban deaths in September — in Irving, Texas, Irving to the west and Rockwall, Texas, 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, Texas, Denton County (north) showed an additional 15 deaths between 2004 and 2007 that appeared to be linked to "cheese," and Collin County, Texas, Collin and Rockwall County, Texas, Rockwall counties had reported one death each.Associated Press
"Tarrant officials confirm 2 'cheese' heroin deaths,"
''The Dallas Morning News'', September 24, 2007.
These new figures brought the total number of deaths associated with cheese heroin in northern Texas to 40, a figure that included many older adults along with those age 18 and under.


References


Further reading


ABC News
gallery of Cheese seized by the Dallas ISD * Pantazi, Andrew.
‘Cheese’ heroin led Dallas 13-year-old to a life on the edge
" ''
The Dallas Morning News ''The Dallas Morning News'' is a daily newspaper serving the Dallas–Fort Worth area of Texas, with an average print circulation of 65,369. It was founded on October 1, 1885 by Alfred Horatio Belo as a satellite publication of the '' Galvest ...
''. 29 December 2012. Updated 30 December 2012. *Dave Montgomery
"Law enforcement worries 'cheese heroin' could spread,"
McClatchy Newspapers, July 18, 2007. * Maxwell, Jane C., PhD (Senior Research Scientist,
University of Texas at Austin The University of Texas at Austin (UT Austin, UT, or Texas) is a public research university in Austin, Texas. It was founded in 1883 and is the oldest institution in the University of Texas System. With 40,916 undergraduate students, 11,07 ...
Gulf Coast Addiction Technology Transfer Center).
“Cheese” Heroin: Status as of May 2, 2007

Archive
* Merlan, Anna.
In Suburban Dallas, Loosening "Cheese" Heroin's Deadly Grip
" ''Dallas Observer''. July 28, 2011. * Merlan, Anna.
Why Does Dallas Keep Forgetting About its Cheese-Heroin Problem?
''Dallas Observer''. May 21, 2012. *
Dallas Man Sentenced to a Total of 240 Months in Federal Prison for Role in Heroin Distribution Conspiracies
"

United States Department of Justice. November 5, 2013. * Tracy Sabo
"Deadly $2 heroin targets teens,"
CNN, June 12, 2007.