The dynamics of heroin spread in endemic neighborhoods.

To explore the social dynamics of heroin spread in endemic neighborhoods, a research team conducted interviews with active addicts in two inner-city black neighborhoods in Chicago. Unlike epidemic neighborhoods in which heroin often spreads outward from only a few new users to other members of a friendship group, we found that in these "old dope" neighborhoods there were multiple initiators and multiple, discrete heroin outbreaks not connected with one another. Furthermore, the majority of initiators did not appear to be in the experimental stage but were chronic addicts who ranged in age from their early twenties to middle age. These findings suggest that in endemic neighborhoods, where heroin is continuously available and there are multiple addict initiators, treatment outreach efforts directed only at new, young users would be unlikely to halt further heroin spread. To effectively reduce incidence and prevalence of heroin addiction, it may be necessary to eliminate the entire neighborhood copping area--chronic addicts as well as new addicts--a much more formidable task for a community addiction-control program.