"Cheese" is a heroin-based recreational drug that came to the attention of the media inside and outside the United States after a string of deaths among adolescents in Dallas, between 2005 and 2007. As of 2012 the drug use is now among older people who were teenagers around the period the drug was first discovered.
Cheese is a combination of drugs, made by combining heroin with crushed tablets of certain over-the-counter cold medication, such as Tylenol PM. Such cold medications contain acetaminophen (paracetamol), the active ingredient in Tylenol, and the antihistamine diphenhydramine, the active ingredient in Benadryl. Cheese samples obtained in north Dallas contained between 2% and 8% heroin, in contrast to the 30% commonly found in black tar heroin. Users commonly take the powder by insufflation ("snorting") rather than by intravenous injection. This mixture is also known as "Tylenol With Smack", by analogy to the Tylenol With Codeine series.
Due to the high concentrations of non-opiate substances relative to the diamorphine content of the drug, abuse and overdose of cheese are more dangerous than pure-form opiate overdoses. Emergency personnel must address the overdose effects of each component of the drug, since the contents and concentrations of each component vary widely among batches they must wait for either the completion of the toxicology report to begin treatment or wait for the effects of each drugs overdose to manifest. The acetaminophen content of the drug induces severe, irreversible damage to the liver when taken in high doses for long periods of time. Very high doses of acetaminophen are capable of producing acute liver failure and death within hours, and patients who survive this acute phase of the toxicity generally require dialysis and eventually a liver transplant. Due to the many methods of preparation a user can not know how much acetaminophen is in any given batch and therefore can not reliably determine a safe dose. A dose of the last batch which produced no toxic effects may produce lethal effects in the next batch.
Emergence
The drug made many news headlines when it appeared in several public middle and high schools in Dallas, Texas. The United States Drug Enforcement Administration, some police agencies and the Dallas Independent School District (DISD) dubbed the mixture "starter heroin." The district handled fifty-four property cases and found twenty-four felony offenses involving "cheese" between August 15, 2005 and March 1, 2006, at eleven schools. On February 24, 2007, United Press International reported that DISD would increase drug-sniffing dog patrols in order to eliminate Cheese from its schools. As of mid-2007, police records for the northwest quadrant of Dallas showed almost daily arrests for and confiscations of the drug.
According to Dallas school district authorities, Hispanic teenagers are the demographic group most frequently charged with possession of the drug; Hispanics also constitute a majority (60 percent) of all DISD students. By February 1, 2007, usage of Cheese was reported in the fourth-grade level at several elementary schools; By February 2007, Monty Moncibais, a detective of the Dallas Police Narcotics Division, noted 71 cheese-related arrests in children aged 10 through 16.
Dallas-area treatment centers have noted that the drug's growing use has led to a lowering in the age of teens admitted to their programs. From a typical clientele of 15- to 17-year-olds admitted under court order, one Dallas-area center noted it had begun to admit 11, 12, and 13-year-olds voluntarily or at a parent's request.
Newsweek posted an article about Cheese, titled "Stopping a Kid Killer," in 2007. Jack Schafer, a columnist for Slate, criticized the Newsweek article; Schafer believes that the Newsweek article does not adequately explain the process of creating Cheese and did not use scientists as sources. Jane C. Maxwell, a senior research scientist of the Gulf Coast Addiction Technology Transfer Center at The University of Texas at Austin, stated in "“Cheese” Heroin: Status as of May 2, 2007" that she believes that the effect of Cheese could increase due to media reporting aspects such as "unsubstantiated numbers" and "sensationalistic emphasis" regarding "new highs" and "schoolboy drugs," leading to copycat outbreaks.