The Rise and Rise of Heroin

Data just released by the Centers for Disease Control reveal that 2014 marked the first year on record in which the total number of deaths caused by heroin reached five figures, at 10,754. This was more than 2008, 2009, and 2010 combined. In response to these worrying numbers, we have graphed figures from multiple government agencies to look for the causes behind America’s growing heroin epidemic.

One of the clearest signs that the use of heroin in recent years has escalated to epidemic proportions comes from the law enforcement agencies that witness its devastating effects on individuals and communities on a daily basis.

Once a year, the Drug Enforcement Administration (DEA) – as part of its National Drug Threat Assessment – asks more than 1,200 police forces across the nation which drug poses the greatest threat to the people they serve and protect.¹ The graph above shows that the threats posed by methamphetamine and marijuana have remained relatively constant over the past eight years, while cocaine has decreased every year, from 40% of agencies saying it posed the greatest threat in 2007 to 7% in 2015. But as the dangers from cocaine decreased, the menace of heroin multiplied, going from 8% in 2007 to 38% in 2015. And in almost every year, heroin’s ascent was mirrored by an increased threat from controlled prescription drugs. These include powerful opioid analgesics – painkillers such as OxyContin and Vicodin – which have similar effects on the body as heroin.

We can see one of the reasons so many law enforcement agencies have reported an increased threat from heroin by looking at data from the National Seizure System.²

Heroin seizures in the U.S. increased 81.5% between 2010 and 2014, and in 2015, 53% of police forces said that the availability of heroin was moderate or high in their areas. Moreover, nearly two-thirds said they felt that heroin availability and demand were increasing. The growing totals above aren’t just due to a few large seizures skewing the numbers either. The average size of each heroin seizure has been increasing year-on-year, from 0.86 kilograms in 2010, to 1.74 kilograms in 2014.¹ This abundance of heroin across the country can, of course, mean only one thing: an abundance of people using it.

Using data from the National Survey on Drug Use and Health (NSDUH), we graphed the number of people who used heroin or a non-medical psychotherapeutic for the first time in the past 12 months for each year from 2002 to 2014. As we saw earlier, these two substances (non-medical psychotherapeutics being part of the aforementioned “controlled prescription drugs” category) have posed a greater threat in recent years. Above, we can see why. More and more people have been trying heroin for the first time each year: In 2002, 117,000 people tried it, but in 2014, the number was 81% higher, at 212,000 (an average of 600 new people every day).³

It’s a somewhat different story for non-medical psychotherapeutics, though. 2004 saw the highest number of initiates (2.8 million) in the time period covered above, but since then the yearly number of new users has dropped. 2013 saw the lowest total in the last 13 years, at 2 million, and in 2014 there were marginally more at 2.1 million. On its face, fewer people using strong prescription drugs in non-medical ways seems like good news. In reality, though, what it amounts to is more people using heroin instead of opioid painkillers. We can examine this trend by specifically looking at people who said that they abused or had a dependence on heroin and pain relievers in the past year.

The graph above shows two connected trends. First, the number of people with heroin abuse/dependence in the past year has been increasing since 2004. Second, the number of people abusing heroin and painkillers in the past year has been increasing as well. In fact, unlike isolated heroin abuse – which between 2004 and 2010 fluctuated somewhat – the numbers of those abusing both heroin and painkillers, for the most part, been increasing every year. In 2004, only 15% of people who had heroin abuse/dependence problems in the past year also had concurrent painkiller abuse/dependence issues. In 2013, 62% had both. To be sure that there is a definite link between painkillers and heroin, and that the connection isn’t merely due to heroin users increasingly abusing a range of different drugs that just happens to include painkillers, we can compare abuse rates across a variety of illicit substances.

The graph above compares how people who used heroin in the past year also used four other illicit substances. It shows that past-year heroin users varied in their rates of use for alcohol, marijuana, and cocaine (which have all risen and fallen over the 10 years covered), but when it comes to opioid pain relievers, the trend has only moved in one direction: up. In fact, the percentage of people who used heroin and opioid pain relievers in the past year more than doubled between 2002–2004 and 2011–2013.⁴

The connection between heroin and painkillers is made clearer by an NSDUH study that examined data from 2002 to 2011. It found that heroin use was 19 times higher among people who had previously abused pain-relieving controlled prescription drugs. It also found that, while the percentage of people abusing painkillers then moving to heroin was fairly low (3.6%), they represented 79.5% of new heroin initiates.⁵ The connection makes sense. After all, prescription painkillers and heroin are both opioids, which means that users are not choosing between two completely different types of drugs. They are in fact choosing between two variations of the same drug, based on factors like availability and price. As regulations controlling opioid painkillers have tightened in recent years, they have become more expensive and less available. Certain companies have also changed their pill formulations in ways that make them harder to break up and abuse. These factors, and others, have resulted in people turning to the other main opioid option: heroin.⁶ The result of this is more people suffering the consequences of heroin use. We only have to turn back to the National Survey on Drug Use and Health to see what some of those consequences are.

Given what a powerfully addictive substance heroin is, users of the drug differ from non-users in certain dramatic ways. We have compared past-year heroin users with non-heroin users across 20 measures that highlight some of the biggest differences between these two types of people. The first category shown in the graphic above is Other Drugs Used in the Past Year. These figures reiterate something we’ve already covered: Heroin users are very likely to use other drugs too. For instance, 12.4% of non-heroin users reported using marijuana in the previous year. For heroin users, it’s 80.4%. Perhaps even more dramatically, 59.9% of heroin users also used cocaine, compared with only 1.6% of non-heroin users.

Taking heroin, let alone other hard drugs, takes a toll on the body. 29.9% of non-heroin users said they had been treated in an E.R. in the last year. For heroin users, it was 56.9%. Heroin users were also 6.4 times more likely to say they had ever had hepatitis, and 2.3 times more likely to say they had HIV/AIDS. On the subject of HIV, in trawling through the data, we checked what percentage of past-year heroin users said that the last needle they used had been used by someone else. The figure has fluctuated over the years, but not much. In 2004, 26% said someone else used their last needle before them. In 2006, the number had risen to 34.9%. In 2013, it was down to 21.3% (still a very worrying 1 in 5). Also, 1 in 5 said that someone else used their last needle after them. These numbers provide some explanation for why intravenous drug users are at such high risk of contracting serious illnesses. The UCLA Dual Diagnosis Program estimates that up to 89% of injectable substances sold on the street contain at least one pathogen, such as bacteria or fungi.⁷ Of course, the most serious outcome of using heroin is death. And, as we saw at the start, fatalities caused by heroin are at an all-time high. Here, they are compared with some other common causes of death.

In 2014, the heroin overdose rate was higher than the HIV death rate for the first time since 1999 (and quite possibly ever – the CDC data only go back to ’99). Deaths caused by opioid analgesics (prescription painkillers like OxyContin) also have been rising in recent years, although nowhere near as sharply as heroin has since 2010, thanks to so many people choosing heroin over painkillers. Nevertheless, the opioid analgesic death rate was higher in 2014 than HIV and homicides. And if we group all drug-induced deaths together, the rate skyrockets so much that, in 2014, it was higher than HIV, homicides, falls, alcohol, all firearm deaths, all suicides, Parkinson’s disease, and even transport accidents. And of all these causes, it’s heroin that has seen the highest percentage difference between 2004 and 2014. Heroin deaths have risen 385.7%.⁸ Here’s how the 10,754 that occurred in 2014 were distributed across the country, shown per 100,000 residents.

The state with the highest heroin overdose rate in 2014 (excluding five states for which data weren’t available) was Ohio.⁸ In 2014, 2,482 Ohioans died of drug-related causes, 1,177 of which involved heroin. In a recent “60 Minutes” special about Ohio’s heroin problem, Mike DeWine, Ohio Attorney General, said that it is the “worst epidemic” he has seen in his 45-year career, and its impact is being felt in “every part of Ohio.” He also said that 75 percent of people addicted to heroin started with opiates, which may explain why Ohio ranked 14th-highest for opiate-related overdoses in 2014 (750 million pain pills were prescribed in Ohio in 2014).⁹

West Virginia, which was second-highest for heroin overdoses, was first for opiate overdoses. In October 2015, President Obama traveled to Charleston, West Virginia – which The New York Times described as a “hotbed of one of the deadliest epidemics in American history”¹⁰ – to speak about the problem that is plaguing the nation: particularly the difficulties so many people have had finding treatment for their opiate addictions. The wait time for federally funded rehab is currently as long as 18 months in Maine, a month in Florida, and several weeks in Massachusetts.¹¹ This is a serious problem, especially given the fact that when people join rehab waiting lists, they will only tolerate four weeks on average before dropping off.

In the face of impossible-to-ignore and ever-rising figures, more light than in the past is being shed on the dark problem of heroin abuse, addiction, and overdose. There is also an increasing awareness of painkillers acting as a gateway to heroin (the highly publicized death of actor Philip Seymour Hoffman was reportedly caused by a heroin overdose, which itself was precipitated by a problem with prescription pills).¹² Turning the heroin mountain into a molehill won’t be easy, though, given that half a million Americans are now addicted to it.¹³ However, adopting certain key strategies, such as prioritizing treatment over punishment and emphasizing a preventative approach to tackling the problem (such as catching the abuse of painkillers before it transitions into a heroin addiction) are important first steps.

As public awareness grows concerning the separate issues of both heroin addiction and prescription opiate abuse – and, indeed, the startling interplay between the two – the undeniable need for adequate treatment and prevention strategies remains. Heroin.net works to provide site visitors with information about heroin abuse and various heroin treatment options. Search our national heroin rehabilitation directory, or call 1-888-496-8059 Who Answers? to speak with a caring recovery advisor about treatment that could save your life or that of someone you love struggling with a heroin addiction.

Sources & References

Used throughout: National Survey on Drug Use and Health via http://www.icpsr.umich.edu/icpsrweb/ICPSR/series/64

1. 2015 National Drug Threat Assessment – http://www.dea.gov/docs/2015%20NDTA%20Report.pdf

2. National Heroin Threat Assessment Summary, 2015 – http://www.dea.gov/divisions/hq/2015/hq052215_National_Heroin_Threat_Assessment_Summary.pdf (Page 4)

3. Risk and Protective Factors and Initiation of Substance Use: Results from the 2014 National Survey on Drug Use and Health – http://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR4-2014%20(1)/NSDUH-DR-FRR4-2014.htm

4. Vital Signs: Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013 – http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a3.htm

5. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States – http://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm

6. U.S. National Library of Medicine – https://www.nlm.nih.gov/medlineplus/news/fullstory_155391.html

7. http://www.medscape.com/viewarticle/468419_3

8. CDC Wonder – Multiple Cause of Death, 1999–2014 – http://wonder.cdc.gov

9. http://www.cleveland.com/open/index.ssf/2015/10/ohios_heroin_epidemic_gets_nat.html

10. http://www.nytimes.com/2015/10/22/us/politics/obama-curb-drug-overdose.html

11. http://www.nbcnews.com/storyline/americas-heroin-epidemic/road-back-officials-addicts-face-long-rehab-waits-n421661

12. http://news.sky.com/story/1219150/philip-seymour-hoffman-died-from-drugs-mix

13. http://www.drugabuse.gov/about-nida/noras-blog/2014/06/what-can-we-do-about-heroin-overdose-epidemic

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