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CDC Vital Signs: Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013

Heroin use and overdose deaths have increased significantly in the United States. Assessing trends in heroin use among demographic and particular substance-using groups can inform prevention efforts.

FDA and CDC analyzed data from the National Survey on Drug Use and Health and National Vital Statistics System reported during 2002–2013. This report summarizes their findings.

During 2002–2013, heroin overdose death rates nearly quadrupled in the United States, from 0.7 deaths to 2.7 deaths per 100,000 population, with a near doubling of the rates from 2011–2013 (1).

Data from the National Survey on Drug Use and Health (NSDUH) indicate heroin use, abuse, and dependence have increased in recent years. In 2013, an estimated 517,000 persons reported past-year heroin abuse or dependence, a nearly 150% increase since 2007 (2).

During 2002–2011, rates of heroin initiation were reported to be highest among males, persons aged 18–25 years, non-Hispanic whites, those with an annual household income <$20,000, and those residing in the Northeast (3).

However, during this period heroin initiation rates generally increased across most demographic subgroups (3). Most heroin users have a history of nonmedical use of prescription opioid pain relievers (3–5), and an increase in the rate of heroin overdose deaths has occurred concurrently with an epidemic of prescription opioid overdoses.

Although it has been postulated that efforts to curb opioid prescribing, resulting in restricted prescription opioid access, have fueled heroin use and overdose, a recent analysis of 2010–2012 drug overdose deaths in 28 states found that decreases in prescription opioid death rates within a state were not associated with increases in heroin death rates; in fact, increases in heroin overdose death rates were associated with increases in prescription opioid overdose death rates (6).

In addition, a study examining trends in opioid pain reliever overdose hospitalizations and heroin overdose hospitalizations between 1993 and 2009 found that increases in opioid pain reliever hospitalizations predicted an increase in heroin overdose hospitalizations in subsequent years (7).

Thus, the changing patterns of heroin use and overdose deaths are most likely the result of multiple, and possibly interacting, factors…

[CDC, MMWR, vol. 64, early release, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0707a1.htm?s_cid=mm64e0707a1_w ]
Christopher M. Jones, PharmD, Joseph Logan, PhD, R. Matthew Gladden, PhD, et al.
MMWR Morb Mortal Wkly Rep 2015;64(Early Release):1-7