The image of the heroin user is changing, according to researchers who say the great majority are now white men and women who mostly live outside the cities.
Their study, published in JAMA Psychiatry, tracked data from almost 2,800 heroin users and found that first-time users are now generally older than those who began taking the drug in the 1960s. About 90 percent are white, according to the study, and 75 percent now live in non-urban areas.
The research also confirmed a link between the rise of opioid abuse and the growing use of heroin that had been noted in earlier studies. Heroin use has jumped 80 percent to 669,000 users from 2007 to 2012, according to the National Survey on Drug Use and Health, after being relatively stable since 2000.
Heroin “is not confined to inner-city areas,” said Theodore Cicero, the lead author and vice chairman for research at Washington University School of Medicine in St. Louis, Missouri. “It’s now a main stream problem.”
The uptick in usage is attributed to users waning off of prescription opioids and turning to heroin because it’s cheaper and more readily accessible than prescription drugs, the researchers said in their report.
After widespread prescription drug abuse in the 1990’s, prices for prescription drugs have surged. Companies have also made the pills more difficult to manipulate, leading users to choose heroin as an alternative even though it carries a lot of risk, Cicero said in a telephone interview.
“It doesn’t have the safety of a prescription drug,” Cicero said. Because heroin is often cut with other chemicals, and injected through non-sterile solutions, users are prone to infections that can be fatal as well as deadly overdoses.
“There’s a lot of interest in how whites are getting so many opioids,” said Meghan Ralston, harm reduction manager for the Drug Policy Alliance. “That reflects what research shows -- that blacks and minorities are not even prescribed opioids at the same rates.”
The study found most people who began using the drug in the last decade were 23-years-old on average. That compares with the 1960’s, the researchers wrote, when users were 16-years-old on average.
The majority of heroin users surveyed in the study, 94 percent, said that if there were given the choice, they would prefer prescription pills to heroin.
Cicero said it’s likely that most people are using the drug as self-medication to treat depressive tendencies. Knowing this, better mental health and depression treatments in schools and communities could curb rates of heroin use.
He is now studying whether there’s a correlation between depression and drug abuse, Cicero said.
Vermont is one state among several in the U.S. seeing a surge in heroin addiction in rural areas, with a 260% increase in people receiving treatment since 2000, according to the governor’s office. The number of deaths from heroin overdose almost doubled in 2013 from a year earlier.
Surging addiction is in part due to a “depressed economy, loss of hope, and challenges with just getting by day-to-day,” said Harry Chen, Commissioner of the Vermont Department of Health. He said it has hurt the “Vermont way of life” through its impact on families, communities, and health-care spending.
“We’re trying to approach it comprehensively,” Chen said in a telephone interview.
Drug enforcement officials have in the past been prone to attack the problem only from the supply side, the study author, Cicero, said.
“Comprehensive policy would address both a demand and a supply side,” he said. “We need some emphasis on why are people using these drugs, and why they find them attractive.”