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Case Report

The Emergence of "Coachella" Heroin in the Midwest

Roopa Sethi, MD; Joey Luvisi, BA; Kyle Ahonen, DO; and Thomas Irwin, MM

Published: July 18, 2019

Case Report Header

The Emergence of "Coachella" Heroin in the Midwest

The opioid epidemic is receiving extensive attention in the popular press, online social media, and public policy and is largely attributed to a rise in nonmedical use of prescription opioids.1 This case report highlights a dangerous new way some people are consuming heroin.

Case Report

The patient is a 20-year-old white man with a past history of excessive alcohol use. In the past 6 months, he started using heroin. He describes the consistency of heroin as like black tar. He snorts the heroin by mixing it with something dry to make it powder. He described putting the heroin, a B12 vitamin, and a nickel into an old pill bottle; shaking it vigorously for about 1 minute; and pouring it out onto a flat surface. The nickel breaks the heroin and vitamin apart. The heroin would then be in a powdered form that could be snorted. This form of the drug is popularly called "Coachella" heroin. He said that the name Coachella was taken directly from the music festival (the Coachella Valley Music and Arts Festival is held in April in Indio, California)2 because "It is difficult to shoot up at Coachella" and easier to snort something. He said the powder is named after the flavor of whatever it was mixed with, such as "strawberry Coachella" if mixed with a strawberry-flavored vitamin. He stated that this form of heroin has gained popularity in the Midwest region as well.


Heroin comes in several forms including white heroin, brown heroin, liquid heroin, and black tar heroin. Originally, it is derived from the poppy plant. The seedpod is filled with raw opium in a sap-like consistency. The opium sap is extracted and allowed to dry. This brown or black substance is then converted to morphine through an extraction and filtering process. Ammonia, calcium hydroxide, and charcoal are used to filter the opium into a morphine base. It is then heated with acetic acid to create heroin. Various types of heroin are made through further chemical additions, heating, and filtering.3,4

White heroin is a powder and considered the purest form but is often cut with white additives, such as sugar, flour, or cornstarch. It is difficult to obtain and expensive, as it requires more effort and expertise to produce. White heroin has high melting and boiling points, so it is most commonly injected rather than smoked. Brown heroin is a low-grade heroin that often contains many impurities and comes as a powder that is often smoked. Black tar heroin comes in hard rocky or tacky forms rather than a powder. It is usually the least expensive type of heroin and can be smoked or melted. When black tar heroin is melted, it is called liquid heroin, thus allowing it to be packaged in everyday containers such as eye droppers.3,4

The snorted black tar heroin mentioned in this case report highlights yet another variation of heroin and the importance of staying up-to-date with drug trends as clinicians. While using heroin intranasally is not a new phenomenon, the technique of breaking down black tar heroin into powdered form to use in that fashion is a relatively new development.

When one considers that 11% of youths aged 12-17 years old said it would be easy to obtain heroin in a 2010 report by the Substance Abuse and Mental Health Services Administration,5 heroin use is a problem that is unlikely to go away soon.

Published online: July 18, 2019.

Potential conflicts of interest: None.

Funding/support: None.

Patient consent: The patient was very willing for everyone to know that this is the new heroin in the Midwest, and the case has been de-identified to protect anonymity.


1.Manchikanti L, Helm S 2nd, Fellows B, et al. Opioid epidemic in the United States. Pain Physician. 2012;15(3 suppl):ES9-ES38. PubMed

2.Coachella Arts and Music Festival information website. Available at Accessed October 12, 2018.

3.Zerell U, Ahrens B, Gerz P. Documentation of a heroin manufacturing process in Afghanistan. Bull Narc. 2005;57(1-2):11-31. PubMed

4.Mars SG, Ondocsin J, Ciccarone D. Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency. Harm Reduct J. 2018;15(1):26. PubMed CrossRef

5.Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Substance Abuse and Mental Health Services Administration website. Accessed July 13, 2018.

aDepartment of Psychiatry and Behavioral Sciences, Kansas University Medical Center, Kansas City, Kansas

bUniversity of Kansas School of Medicine, Kansas City, Kansas

*Corresponding author: Roopa Sethi, MD, Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 (

Prim Care Companion CNS Disord 2019;21(4):18l02394

To cite: Sethi R, Luvisi J, Ahonen K, et al. The emergence of "Coachella" heroin in the midwest. Prim Care Companion CNS Disord. 2019;21(4):18l02394.

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