The numbers are startling - in 2015, 52,404 people died from drug overdoses according to the U.S. Centers for Disease Control and Prevention. Sixty-three percent of those deaths involved an opioid.
More people die from drug overdoses than from guns or car accidents. At the peak of the AIDS epidemic in 1995, 43,115 people in the United States died from the disease.
Furthermore, since 1999, the number of overdoses from prescription opioids like oxycodone and hydrocodone, as well as illicit drugs like heroin, have quadrupled. In fact, heroin now accounts for one in four overdose deaths in the United States.
Now, a new study in the journal JAMA Psychiatry looks beyond the total number of overdose deaths to get a better picture of how heroin use patterns have changed since 2001. Since then, the number of people who have used heroin has increased almost five-fold, and the number of people who abuse heroin has approximately tripled.
The greatest increases in use occurred among white males.
Heroin use on the rise
The authors evaluated the responses of 79,402 individuals, as collected from the 2001-2002 and the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions, a longitudinal study conducted by the National Institutes of Health to evaluate alcohol and drug use and abuse. While heroin use between whites and non-whites was fairly similar in the 2001-2002 results, at 0.34% and 0.32% respectively, by 2012-2013 the percentage of whites who had used heroin jumped to 1.90%. Just 1.05% of non-whites in 2012-2013 used heroin. Heroin use also increased significantly among those with a high school education or less, as well as those who lived at less than 100% of the federal poverty line.
The authors of the new report write "these trends are concerning because increases in the prevalence of heroin use and use disorder have been occurring among vulnerable individuals who have few resources to overcome problems associated with use."
According to a 2016 Surgeon General's report on alcohol, drugs and health, only one in 10 of those with a substance use disorder receive any treatment.
"The good news is that among all drugs of abuse, heroin and opioids have by far the best treatment medications available. Methadone and buprenorphine have proven effectiveness data, they not only reduce the chances of dying from an opioid overdose by 50%, they support people being in recovery from their addiction and reduce health care costs and improve a wide array of other outcomes," said Caleb Banta-Green, an associate professor of health services at the University of Washington. Banta-Green was not involved in the study.
Starting with prescription drugs
The study also confirmed the idea that many heroin users start by using prescription opioids like oxycodone and hydrocodone. Approximately one-third of all white heroin users reported using prescription drugs for non-medical purposes in 2001-2002. By 2013 more than half of all white heroin users started by initially using prescription drugs. For non-whites, the number of people who started by using prescription drugs before heroin actually dropped in the same time frame.
An accompanying editorial by Bertha Madras, a psychologist at McLean Hospital in Massachusetts and former deputy director in the White House's Office of National Drug Control and Policy pointed to the shift in treating pain as a major factor in understanding the current crisis. She noted that in the past two decades, the number of opioid prescriptions has risen three-fold.
"This shift in practice norms was fueled by acceptance of low quality evidence that opioids are a relatively benign remedy for managing chronic pain," she wrote. "These vast opioid supplies created a risk for diversion, opioid misuse and disorder, and overdose death."
The study did not find any significant difference when looking at what age groups were using heroin, but heroin dependency and addiction was significantly higher for those below the age of 45 than those above. That should be a cause of concern, said Banta-Green, who noted that one of the costs of overdoses and abuse to society is lost productivity.
A county-by-county study released Wednesday by the Robert Wood Johnson Foundation, calculated that drug overdose deaths resulted in a 778 years of potential life lost for every hundred thousand people. This report also found that most of the increase in premature deaths in 15- to 44-year-olds is due to drug overdoses. And while no community is immune to this crisis, suburbs, which used to have the lowest rates of premature deaths from drug overdoses now have the highest rates.
The authors of the longitudinal study note that "heroin use appears to have become more socially acceptable among suburban and rural white individuals, perhaps because its effects seem so similar to those of widely available [prescription opioids]."
The findings of these new reports are in line with earlier research over the past two decades about increasing heroin and opioid overdoses. "The trend isn't a surprise - the takeaway is what matters. Heroin use disorder is a serious medical condition with which individuals are likely to struggle for the rest of their life. We need to give them the tools they need to survive and thrive," said Banta-Green.
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