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Heroin Use Increasing in U.S. Population, Linked to Overdose Deaths, CDC Says

Heroin use has increased among men and women across most age groups and all income levels in recent years, according to the July 7 Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA). The report urges a 3-prong response, including preventing people from starting heroin use, treating heroin addiction, and using naloxone (Narcan) to prevent overdose deaths.

The CDC and FDA analyzed data from the National Survey on Drug Use and Health and the National Vital Statistics System reported during 2002-2013. Trends in heroin use among demographic groups were compared for 2-year time periods and a multivariate regression model was used to identify characteristics associated with heroin abuse or dependence.

The data summarized in Vital Signs is more fully described in the July 7 early edition of Morbidity and Mortality Weekly Report. The report states that the annual average rate of past-year heroin use increased from 1.6 per 1000 persons age 12 and older during 2002-2004 to 2.6 per 1000 during 2011-2013. In 2013 an estimated 517,000 people reported using heroin in the past year -- a nearly 150% increase since 2007.

The groups at highest risk for heroin abuse or dependence include non-Hispanic whites, men, people age 18 to 25, people with an annual household income less than $20,000, Medicaid recipients and the uninsured, and those residing in the Northeast U.S.

However, the greatest increases in heroin use were seen in groups with historically lower rates of use, including women and people with private insurance and higher incomes. As a result, the gaps between men and women, and between people with low and high incomes, have narrowed over the past decade.

Most people (96%) who use heroin also use other substances -- including 61% who use 3 or more other drugs -- and having a prescription opioid use disorder is the strongest risk factor for a heroin use disorder. The report notes that people who use prescription opioid painkillers are 40 times more likely to abuse or be dependent on heroin.

The rise in heroin use has been accompanied by an increase in heroin overdoses, with overdose deaths nearly quadrupling since 2002 and almost doubling just since 2011. The heroin overdose mortality rate rose from 0.7 to 2.7 deaths per 100,000 during the study period. In 2013 alone there were more than 8200 overdose deaths in the U.S.

An increase in the number of people injecting heroin also raises the risk of blood-borne infections transmitted via shared injection equipment, including hepatitis B virus, hepatitis C virus, and HIV, as well as bacterial infections.

"Heroin use is increasing at an alarming rate in many parts of society, driven by both the prescription opioid epidemic and cheaper, more available heroin," CDC director Tom Frieden stated in a CDC press release. "To reverse this trend we need an all-of-society response -- to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses, and work with law enforcement partners like DEA to reduce the supply of heroin."

The report outlines a comprehensive for responding to the increase in heroin use:

• Preventing people from starting heroin use, including improved painkiller prescribing practices to reduce abuse.
• Reducing heroin addiction, including expanded access to and insurance coverage of medication-assisted treatment combining opiate-substitution therapy (methadone or buprenorphine), naltrexone, and counseling and behavioral therapies.
• Reducing heroin overdose deaths by expanding awareness and availability of naloxone, which reverses the life-threatening effects of opioid overdose.

"We are working with federal, state and local partners to increase access to effective treatment, while reducing overdoses and other consequences of the opioid epidemic, including the spread of Hepatitis C and HIV," said Michael Botticelli, director of National Drug Control Policy. "It is not enough to simply reverse overdoses. We must also connect overdose victims and people struggling with prescription drug and heroin use disorders to treatment facilities and doctors that offer medication-assisted treatment."

7/9/15

References

CM Jones, J Logan, M Gladden, and MK Bohm. Vital Signs: Demographic and Substance Use Trends Among Heroin Users -- United States, 2002-2013. Morbidity and Mortality Weekly Report 64:1-7. July 7, 2015 (Early release).

CDC. Today’s Heroin Epidemic. CDC Vital Signs. July 7, 2015.

Other Source

CDC. New research reveals the trends and risk factors behind America’s growing heroin epidemic. Press release. July 7, 2015.