Street Watch: Notes of a Paramedic: Black Jack

I did three heroin ODs on one shift last week. Another medic did four in a shift the day before. Lots of OD calls going out. All three of these ODs used the same brand. Black Jack. For years, dealers in the Northeast have been branding their supply, stamping or printing it on the glassine envelopes the heroin is sold in. While many areas of the country get their heroin in small balloons made from the tips of latex gloves or torn off shopping bags, in Hartford (which is supplied from the New York I-95 route) it is almost always sold in the small glassine bags. One bag $5. A bundle of ten bags - $50. Black Jack is evidently pretty strong as there seems to be a big demand for it, and it is knocking people down. The more deadly, the greater the appeal. That is why many of the brands promote the idea of danger.

Big dealers take a kilo of heroin and cut it down, mixing it 50/50 with baking soda. It is enough to fill 25,000 glassine envelopes, which are usually prestamped with the brand, before being distributed along the chain.

I have heard that dealers make the first batch extra strong to create a demand, and then slowly cut its strength. When I was in medic school there was brand on the streets called Tango and Cash, named after the Sylvester Stallone/Kurt Russell movie cop duo. It was laced with Fentanyl and caused enough death and furor on the Hartford streets to earn mention in the New York Times.

Toxic Heroin Has Killed 12, Officials Say

Lacing heroin with Fentanyl seems to en vogue again, as it is mentioned in most articles that deal with upswings in ODs. On one scene, a bystander noted that the heroin must have had Fentanyl in it as his buddy was an experienced user, and was not normally felled by such a small amount.

One of the overdoses was a woman who does a $100 dollars worth of heroin a day. Two bundles. She Oded in the bathroom of a doctor's office where she had brought her mother for an appointment. They were able to wake her with stimulation, though she would nod back off if you left her alone. She decided to clean out her pocketbook while we checked her out. She tossed a crack pipe and several empty Black Jack envelopes, one of which she gave to me. She wore a skimpy top for such a large woman. She had numerous tattoos on her arms. Her pocketbook was filled with condoms. She told me she had gotten into heroin five years ago when she found out her boyfriend was cheating on her. She was very sad she said and wanted escape.

Looking at the Black Jack stamping on the envelope, I had an idea to collect empty heroin bags as a sort of an urban art collection. I thought of all the brand names I had heard over the years. Atom Bomb. 9/11. Empire. New World. Isis. Obama Care. I could drive around Hartford, attempting not to buy heroin, but the empty bags. No, no, I don't want the heroin, please pour it out, or sniff it yourself, I just want the empty bag. Gotta any Monkey Man? No, I don't need 357, I have that one. I Goggled the topic and found I had been beaten to the punch. Graham MacIndoe, an ex-junkie included photos of heroin bags in All In, Buying In to the Drug Trade, his memoir of addiction. Then there is Dequincey Jynxie ( a pseudonym), who at one point had a collection of over 3,000 bags before she threw them out. For awhile, she was the go to expert on heroin bag labeling. She even ran a web site Jynxie's Natural Habitat where she had posted photographs of various branded bags and rated them them in three categories, Rush (Strength of Drug) Legs (How Long it Lasts) and Count (How much You get for the Price).

I went to the blog, and looked at the stamps and read some of the reviews. Here is what a reader wrote about Ace of Hearts.

'Best product I have come across in the neighborhood in a while! This connect was formerly slingin' something called Public Enemy #1 for some time which wasn't terrible, but this is far superior. No name or letter on the bag, just an image of an Ace of Hearts (which I suspect is preprinted (ie not stamped). A bit pricey at $100/bun, but a very consistent product nonetheless."

When I went to the blog site, the first thing that caught my eye was an entry titled The Future of Jynxie.

As many of you have already guessed, I've decided it is no longer feasible to continue this blog. This is because with Jynxies death I am permanently logged out of the main administrative account, meaning I can only post myself, can't invite authors, and can't change the format or administer this blog in the way it needs to keep it running smoothly.

The post was by Eve, who often co-posted with Jynxie, and had taken over maintenance of the blog as Jynxie went through recovery and tried to move on to something different in her life. I assumed Jynxie must have died of an overdose, but with a little more digging I found out she did not die of a heroin overdose, but had left the market several months before and moved to Oklahoma to work in her boyfriend's family business. There, she and her boyfriend were murdered, and their house set on fire with their bodies in it in an as yet unsolved homicide. It also turns out she was an IVY League graduate and artist, who had once had her work displayed at the Museum of Modern Art. She was also a designer for Old Navy.

Check out some of these names listed on her blog: DOA, Just Do it with the Nike label, Jim Jones.Little Debbie, Versaci, True Blood, America's Most Wanted, Double Dragon, Dark Night, Walking Dead, Level 9, Overdose, Godzilla, Rihanna, Dead End, Zombie, Four of a Kind, BioShock, Life Support, Powerball, Medusa, OMG, Lights Out, 007, Kill Bill, Breaking Bad, 24K, Got Milk?, Lacoste Knockout, Ace of Hearts, Happy Hour, Red Butterfly, Hell Boy, Toy Story, Oblivion, War Horse, Venom, Bring A Friend, No Parking, 9mm, Bada Bing.

I read a recent article on the net about how drug dealers in Philadelphia put NBA MVP Stephen Curry's picture on their heroin bags. If you were a sports memorabilia collector, how much would you pay for Kobe Bryant's first NBA basketball card? How much would you pay for a limited edition empty heroin bag with his picture on it?

Philadelphia drug dealers stamping image of NBA star Steph Curry on heroin bags

When the actor Phillip Seymour Hoffman was found dead, there were empty glassine envelopes near his body stamped with the Ace of Hearts and Ace of Spades. Intrepid reporters found Jynxie's Heroin blog and reported on the reviews for the batch, which I mentioned above.

The woman who gave me the empty Black Jack bag, nodded off again in the ambulance. We put an ETCO2 cannula on her and watched her ETCO2 slowly rise to the 70s. We ended up giving her 0.02 Narcan IV. Yes, 0.02, not 0.2. The deal with Narcan is you only want to give enough to keep them from hypoventilating, but not necessarily wake them up. That is often a hard line to walk. Often if you wake them up with vigorous stimulation, they will fall back asleep and once asleep, they start hypoventilating. This woman was very nice and did not want to upset her dose at the same time, I did not want her to hypoventilate, and I knew while I could keep her roused all the way to the hospital, I would likely get tired of constantly hitting her in the triage line to keep her breathing nor would I feel comfortable leaving her in a room to fall back into hypoventilation once we left her. The 0.02 Narcan given as two 0.01 pushed five minutes apart seemed to do the trick. I delivered it by putting 0.1 mg in a 10 cc flush. Next time I think I will put 1 mg in a 100 cc bag and just run a slow as needed drip. This is the type of dosing that is traditionally used in hospitals for patients who hypoventilate post sedation.

The other two Black Jack patients that day were both men. One in his 40's who had a new heart valve(within the last month) and said he was just using for the first time again after his operation and this was just as a one-time deal. We hear that alot. Before we got to him, his buddy gave him the city's home remedy, ice in the pants. He needed IN Narcan from us as his respirations were 1-2 a minute. Again, we experimented. Giving 0.5 mg in each nare with a plan to wait five minutes while bagging before giving him the rest. This is the Maine guideline. It worked great and he was breathing and talking to us in about four minutes with no signs of withdrawal. He agreed to come with us to the hospital. While on scene, I made sure to teach his friend how to do IN Narcan, and he promised he would go down to the health clinic and get one of the kits they handed out. What about the ice in the pants? he asked. You don't need to do that, I said. Just give Narcan. Okay, he said, I'm going to go down there this afternoon.

The last victim drove his car into a parked car, and was so out of it, the police had to break the window out with a window punch to pull him out of the car. He was pale as can be when we got there, but talking. We got him in the ambulance and he said he did not want to go to the hospital. He wanted to drive home. We explained his car was totaled but he did not believe us. He was in his twenties. The cop came over and gave him a stern lecture on how the streets would eat up a skinny white kid like him from the suburbs. He told the cop this was the first time he had used heroin. On the way to the hospital, he admitted to us, he had been using for ten years. He started recreationally using stolen pain pills from his friend's parents when he was 15. We didn't have to give him narcan, but we talked to him about the drug. He said he carried a Narcan kit in his glove compartment.

I have a set of questions I ask all heroin users (if they will answer. Post Narcan patients tend to be very quiet and withdrawn). How did they get started? How many times have they been to rehab? Do they have Narcan handy or do their friends and families? I think now I will start asking them what their top five brands of heroin are of all-time?

Just playing around, if I was a heroin distributor, here are some of the brands I might think about starting:

OJ, Ebola, Double-Barrell, Roulette, 911,Tombstone, Smackdown. Zika, DNR.

Yesterday, during a downtime between calls, my partners and I decided we would drive to a park near drug area and see if we could find any empty bags with labels on them. Here's what we found in a little over 15 minutes of looking along the edge of the parking lot:

Black Jack, Call of Duty, Focus, Adidas, El Chapo, Worldstar, Chief, Headphones(just a design), Compton, Avengers, Money Bags, Avatar. We also found one with a weird red design and a few that were indistinguishable. Only Black Jack was multi-colored, several had fancy designs, others just a stamped name. It had rained hard that morning, so the bags were damp and some muddy. There were also lots of unlabeled bags. We found some that were colored pink, others light blue. In some cases we found the same brand clustered together. I don't know how long the bags had been there, some -- the clustered ones were likely fresh (an addict does a quick bundle and tosses the wrappers out the car window). Some of the others could have been there for months. It was hard to go two feet without finding an empty bag of one kind or another. Some people hunt Pokemon. We hunted empty heroin bags.