'CHEESE' CRISIS RUNS DEEP

Drug Spreading Faster, Farther Than Previously Thought

As many as 17 Dallas County teenagers have died since 2005 from
overdoses of the popular new form of heroin known as "cheese" - the
most visible sign yet that more youths are caught in the grip of a
growing crisis.

The Dallas Morning News worked with the Dallas County medical
examiner's office to examine toxicology results from hundreds of
autopsies and found more than four times as many cheese heroin deaths
as previously reported.

Cheese heroin deaths already rival the Plano-area crisis of the
1990s, in which at least 20 youths overdosed on black-tar heroin in a
period of about three years.

The current Dallas County problem also reaches far beyond the mostly
Hispanic cluster of northwest Dallas campuses where the drug was
first identified by Dallas school police almost 20 months ago, and
the deaths are almost evenly split between Hispanic and white youths.

"It definitely surprises me," said Zachary Thompson, director of
Dallas County Health and Human Services, who serves on a regional
cheese task force made up of more than a dozen health, government,
school and police agencies.

"We've had this drug in the community for some time and didn't
recognize it," Mr. Thompson said. "It flew under the radar of all of
us. The cheese heroin has been the most instantly addictive and
deadliest drug .. that we have seen since the crack cocaine epidemic."

Sabina Stern, Collin County's substance abuse program coordinator
since 1991, said the Dallas cheese heroin epidemic is following the
same script as the Plano black-tar heroin crisis a decade ago. "It's
so frightening," she said. "Those 17-year-olds dying now were 7 a
decade ago when all that was happening here. They were little guys.
They didn't get the message. And with the influx in people from other
cities and other states, there are thousands of Dallas families that
never knew heroin was a big deal up here."

The Findings

Toxicology results from accidental overdoses among youths 18 and
younger were examined going back to the beginning of 2005. The News
then tracked down families and friends of the victims to get a more
detailed picture of those who died.

Among the findings:

. There were at least 22 fatal drug overdoses. Of those, 18 were
heroin-related.

. Seventeen heroin victims also had diphenhydramine in their system -
a key ingredient of Tylenol PM and other over-the-counter nighttime
cold medicines commonly used to make cheese. Friends, family members
or police directly confirmed 11 of those deaths as cheese-related.

. Cheese heroin-related deaths seem to be rising in Dallas County. In
2006, 11 teenagers overdosed on heroin-diphenhydramine by itself or
in combination with other drugs such as cocaine or methamphetamine.
In 2005, five died.

. About half the victims since 2005 had Hispanic surnames, and the
rest were white. No black youths 18 and under are known to have died
from the drug, according to county records. Two of the 17
heroin-diphenhydramine overdoses were girls.

. While several of the deaths have been of students in northwest
Dallas, cheese heroin teen deaths have also occurred in Cockrell
Hill, Coppell, Garland, Grand Prairie, Mesquite and West Dallas.

The epicenter of the growing cheese problem remains the Dallas
Independent School District. The News reported last week that arrests
for the heroin mix are up more than 80 percent so far this school year at 122.

There were at least six cheese heroin-related deaths among DISD
students in 2006 compared with at least two in 2005.

The Suburbs

Most suburban districts say the drug hasn't overrun their campuses - yet.

Garland had one cheese heroin death.

"It has made its presence known, but it's not an epidemic here," said
Reavis Wortham, a Garland school district spokesman. He said district
officials are "keeping an eye out for increased usage, and they're
talking to the kids. We're trying to warn them away from it."

Mesquite also had one cheese heroin death.

Ian Halperin, Mesquite school district spokesman, said his district
is on the watch for signs of growing use of cheese heroin in the community.

"While we have seen very few cases of it in the Mesquite schools, we
are working very close with the Mesquite police department to make
sure we are educating ourselves and our parents," Mr. Halperin said.

Other suburban districts are just now becoming aware of the growing
cheese heroin problem.

Paul Lupia, Coppell school district's director of student services,
said he has not received any information from local police
departments or principals of students discovered using cheese.

Tests show at least two Coppell students died with cheese heroin in
their systems.

Grand Prairie police Sgt. Alex Bielawski, supervisor of the school
resource officers, said the drug hasn't turned up in Grand Prairie.

"Some of our officers have talked to kids who said they've heard of
it," he said. "But all it takes is the right kid to declare it the
'cool drug,' for that to change, but right now, we don't see it."

At least one Grand Prairie student has died of a cheese heroin overdose.

No cheese deaths have been reported outside Dallas County.

Cheese Discovered

Dallas school police first identified cheese around the beginning of
the 2005-06 school year. The tan powdered mixture sells for as little
as $2 a dose and can be easily smuggled into schools, where it is
typically snorted, sometimes in class.

Authorities now admit they were slow to respond because they had
difficulty identifying the heroin in the powdered mixture that more
and more kids were caught possessing and using.

Nine months later, in May, Dallas school police distributed a
bulletin describing cheese in great detail and noting that the drug
had cropped up at nearly a dozen secondary campuses "and may be in
other schools not yet identified."

The cheese-related death a month later of Karla Becerra, an
18-year-old Pinkston High School senior from West Dallas, touched off
a media firestorm, as Dallas appeared to be the only place in the
U.S. that was besieged by this combination of heroin and Tylenol PM.

Attention waned, but cheese heroin was back in the spotlight after
the February death of Oscar Gutierrez, a 15-year-old eighth-grader at
Marsh Middle School in northwest Dallas. Countless parent and school
meetings followed, as did a huge increase in cooperation between
state and federal law enforcement to jail the adult heroin dealers
supplying the "mixers" making the cheese concoction.

The latest unconfirmed death is that of Fernando Cortez Jr., a
15-year-old Molina High School student from Oak Cliff whose family
said he had been doing cheese heroin. Fernando was found dead the
morning of March 31 on a couch at the home of the grandfather of his
sister's boyfriend on Sylvia Drive in Far East Dallas.

A relative told police that the night before, Fernando was
"staggering when he was walking as if he was high or intoxicated."
His father blames the school, where he believes his son obtained the drug.

Toxicology tests are pending and could take weeks.

What Can Be Done

Dallas County Commissioner Ken Mayfield, who spearheaded the creation
of a regional cheese heroin task force, said the top priority in the
fight against cheese heroin is getting more treatment beds for young addicts.

He said the county is exploring converting some of its overflow jail
space into treatment facilities and is seeking about a half-million
dollars in state and federal aid to pay for more beds. "We can come
up with some funding locally as well. We'll do what we need to," he said.

Other priorities are getting more retailers to put nighttime cold
medicine behind counters and holding more public awareness rallies.

Knowing that the number of deaths far outpaces what was previously
attributed to cheese heroin adds to the urgency.

"We're working as hard as we can," he said. "We've got young people
succumbing to this. ... It doesn't matter where they come from. The
federal and state government will have to pony up money to combat
this problem."

Echoing Plano's Crisis

The chemical makeup of cheese is virtually identical to what was
killing some of the victims of the Plano-area crisis of a decade ago.
Some users injected heroin, while others became hooked on chiva -
black-tar heroin typically cut, or mixed, with Dormin, a sleep aid
that also contained diphenhydramine.

"What happened 10 years ago is kids up here heard about chiva, they
could snort it, they liked how it made them feel, they didn't realize
it was heroin," said Ms. Stern, Collin County's drug program
coordinator. "That's what's happening now" in Dallas County. "It's
small amounts of heroin, mixed with something to counteract the side
effects. And who's mixing it? Kids. They don't know anything about
dosage. It's the same thing."

Federal prosecutors eventually put more than a dozen heroin dealers
thought to be linked to the Plano outbreak behind bars, some for
life. Now, Plano has a narcotics detective who investigates all
overdoses, fatal or not, to track trends.

In Dallas, the U.S. Drug Enforcement Administration is heavily
involved in tracking down heroin suppliers with Dallas and DISD police.

Collin County found a way to draw attention to its problem in a way
that Dallas must now learn.

"We found out really quickly that numbers meant people sat up and
listened," Ms. Stern said. "The higher the number, the bigger the impact."

Why here and now?

Speculation abounds about why northwest Dallas is where cheese seems
to have started and taken the greatest toll. Some say that it's
because the heroin traffickers are mostly Mexican, who are supplying
the young Hispanics who crush the nighttime cold tablets, mix them
with the black-tar heroin and then peddle it at their own schools.

Perpetuating the spread of the drug, some believe, is a fear among
most illegal immigrants of speaking out to authorities for fear of
deportation. Language barriers stymie the free flow of information
between parents and their teachers.

The number of cheese-related deaths has been difficult to determine,
largely because the Dallas County medical examiner's office doesn't
routinely track drug deaths with its aging computer system. Also, law
enforcement doesn't normally compare notes on overdoses, and in
Dallas, overdose cases that go straight to the hospital don't usually
involve police.

Adding to the confusion is the difficulty in counting the cheese
deaths, which is necessary to assess the scope of the problem and
come up with solutions, authorities say.

Some toxicologists suggest that the mere presence of diphenhydramine
coupled with heroin isn't concrete evidence that cheese was what the
victims took before dying, pointing to the lack of Tylenol PM's other
ingredient, acetaminophen.

But the pain reliever acetaminophen can metabolize out of the
victims' bodies quicker than the rest of the ingredients, said Dr.
Jeffrey Barnard, Dallas County's chief medical examiner. Also, he
noted that acetaminophen could be present in the victims' bodies at
levels below the testing range.

"Acetaminophen has a pretty short half-life," said Elizabeth Todd,
head of toxicology for the Dallas County medical examiner's office
and a UT Southwestern associate professor. She said people who
overdose on heroin often fade away slowly, giving acetaminophen a
chance to be absorbed in their bodies.

There also are variations on the original recipe for cheese. Law
enforcement says youths now are mixing heroin with other
over-the-counter nighttime cold medicines with diphenhydramine,
instead of just Tylenol PM.

Susan Dalterio, a pharmacology and drug education expert at the
University of Texas at San Antonio who frequently consults with the
DEA, said that toxicology results showing heroin and diphenhydramine
in a dead teenager point to cheese heroin.

"The idea that you're going to be doing heroin while you are asleep
from an allergy medicine doesn't fit," she said. "If it's there with
diphenhydramine on top of the heroin, I would certainly say it's a
presumptive cheese death."

She also doesn't think that the most deadly part of cheese is the
heroin. Diphenhydramine is a powerful hallucinogen when taken in
high-enough doses and is a well-documented killer on its own.

"I think people are ignoring that diphenhdyramine is a significant
contributor," Dr. Dalterio said. "This is not just starter heroin.
This is starter heroin with a hallucinogenic kick. Heroin doesn't
give you the walking dreaming effects."

There is no consensus about why diphenhydramine has long been a
popular additive to heroin.

"Some theories are that it cures runny noses associated with heroin
use, that it somehow enhances the high, that it's a depressant that
makes you drowsy so that you don't have some of the ill effects of
coming down off it," Dr. Todd said.

Dallas ISD teachers have reported being told to look out for kids
with runny noses as a sign of heroin use.

The Victims

Some Dallas County teens who have died from cheese heroin since 2005
were experienced drug users who had just been through treatment
programs. Others were novices who didn't know their limits. Most died
in their sleep after a night of partying and were discovered by family members.

Many of the parents who lost children to cheese heroin said they want
to share their stories to prevent other deaths.

Cindy Hill isn't that optimistic.

After her 17-year-old son, Garrett, died in January 2005 from a
cheese heroin overdose, the North Dallas mother took a job at
Millwood Hospital in Arlington, which treats youths with mental
illnesses and drug addictions.

"I tell them about my son," she said. "But these kids don't deal in
reality. Kids have no fear of these drugs and don't think that they
can die from this."