Ciccarone Daniel
Department of Family and Community Medicine, University of California San Francisco, 500 Parnassus Avenue, MU-3E Box 0900, San Francisco, CA 94143-0900, USA.
Int J Drug Policy. 2009 May;20(3):277-82. doi: 10.1016/j.drugpo.2008.08.003. Epub 2008 Oct 21.
Heroin coming into the United States historically comes from three widely dispersed geographical regions: Southwest Asia, Southeast Asia and Mexico. A fourth source of US-bound heroin, from Colombia, originated in the early 1990s. The fact that the four heroin sources produce differing morphologies and qualities of heroin has not been critically examined. In addition, it is not well established how the contemporary competing dynamics of interdiction, or restriction of heroin flows across international boundaries, and neoliberal, e.g., global expansion of free trade, policies are affecting heroin markets. This paper will highlight changes in the US heroin market, including source trends, the political economy of the now dominant source and the resultant effects on the heroin risk environment by US region.
Using a structural and historical framework this paper examines two decades of secondary data sources, including government and drug control agency documents, on heroin flows together with published work on the political and economic dynamics in Latin America.
Co-occurring neoliberal economic reforms may have contributed to paradoxical effects of US/Colombian interdiction efforts. Since entering the US market, heroin from Colombia has been distributed at a much higher quality and lower retail price. An increasingly exclusive market has developed with Mexican and Colombian heroin gaining market share and displacing Asian heroin. These trends have had dramatic effects on the risk environment for heroin consumers. An intriguing factor is that different global sources of heroin produce substantially different products. Plausible associations exist between heroin source/form and drug use behaviours and harms. For example, cold water-soluble powdered heroin (sources: Asia, Colombia) may be associated with higher HIV prevalence in the US, while low-solubility "black tar" heroin (BTH; source: Mexico) is historically used in areas with reduced HIV prevalence. BTH is associated with soft tissue infections caused by Clostridium bacteria.
Source and type of heroin are structural factors in the risk environment of heroin users: source dictates distribution and type predicts practice. How specific types of heroin are used and with what risk is therefore distributed geographically. Continued flux in the heroin market and its effects on the risk environment for drug users deserves further attention.
历史上进入美国的海洛因来自三个广泛分布的地理区域：西南亚、东南亚和墨西哥。美国海洛因的第四个来源地是哥伦比亚，始于20世纪90年代初。这四个海洛因来源地所生产的海洛因在形态和质量上存在差异，这一事实尚未得到严格审视。此外，目前尚不清楚拦截（即限制海洛因跨国流动）与新自由主义政策（如自由贸易的全球扩张）之间相互竞争的动态关系是如何影响海洛因市场的。本文将重点介绍美国海洛因市场的变化，包括来源趋势、当前主要来源地的政治经济情况以及由此给美国各地区海洛因风险环境带来的影响。
本文采用结构和历史框架，研究了二十年的二手资料来源，包括政府和毒品管制机构的文件，内容涉及海洛因流动情况以及已发表的关于拉丁美洲政治和经济动态的研究。
新自由主义经济改革的同时出现可能导致了美国/哥伦比亚拦截行动产生自相矛盾的效果。自进入美国市场以来，来自哥伦比亚的海洛因以更高的质量和更低的零售价格进行分销。一个日益排他的市场已经形成，墨西哥和哥伦比亚海洛因获得了市场份额，取代了亚洲海洛因。这些趋势对海洛因消费者的风险环境产生了巨大影响。一个有趣的因素是，不同全球来源的海洛因产生的产品有很大差异。海洛因来源/形式与吸毒行为及危害之间可能存在合理关联。例如，冷水可溶的粉状海洛因（来源地：亚洲、哥伦比亚）可能与美国较高的艾滋病毒流行率相关，而低溶解度的“黑焦油”海洛因（BTH；来源地：墨西哥）在历史上用于艾滋病毒流行率较低的地区。BTH与梭状芽胞杆菌引起的软组织感染有关。
海洛因的来源和类型是海洛因使用者风险环境中的结构因素：来源决定分销，类型预测使用方式。因此，特定类型海洛因的使用方式及相关风险在地理上存在差异。海洛因市场的持续变化及其对吸毒者风险环境的影响值得进一步关注。
