Heroin

Diamorphine

Prevalence of "High Risk" Opioid Use in Norway

"High-risk opioid users are a heterogeneous group that includes marginalised drug users with long-standing ‘careers’ of heroin use, as well as socially included persons who became addicted to opioids through excessive consumption of prescribed pharmaceuticals. The description of high-risk opioid use does not include stable patients in opioid substitution treatment (OST) or others using pharmaceutical opioids in accordance with a doctor’s prescription. Patients in OST who misuse prescribed drugs or other opioids than the prescribed one(s) shall be included, however.

The Burden of Opioid-Related Mortality in the United States

"Over the 15-year study period, 335,123 opioid-related deaths in the United States met our inclusion criteria, with an increase of 345% from 9489 in 2001 (33.3 deaths per million population) to 42,245 in 2016 (130.7 deaths per million population). By 2016, men accounted for 67.5% of all opioid-related deaths (n = 28,496), and the median (interquartile range) age at death was 40 (30-52) years.

Retail Price of Heroin in the US, Canada and the UK

According to the United Nations Office on Drugs and Crime:

In the United States in 2015 (the most recent year for which data are available), the retail price of black tar heroin ranged from $20 to $300 per gram; the retail price of South American heroin ranged from $25 to $400 per gram; and the retail price of southwest Asian heroin ranged from $120 to $300 per gram.

In Canada in 2014 (the most recent year for which data are available), the retail price of opium ranged from $43 to $55.90 per gram; and the retail price of heroin ranged from $154.80 to $300.90 per gram.

Wholesale Price of Heroin in the US and Around the World

According to the United Nations Office on Drugs and Crime:

In the United States in 2015 (the most recent year for which data are available), the wholesale price of black tar heroin ranged from $12,000 to $100,000 per kilogram; the wholesale price of South American heroin ranged from $10,000 to $100,000 per kilogram and the price of southwest Asian heroin ranged from $50,000 to $85,000 per kilogram.

In Mexico in 2015 (the most recent year for which data are available), the wholesale price of heroin was $35,000 per kilogram.

Changes in Synthetic Opioid Involvement in Overdose Deaths in the US and Involvement of Other Drugs in Combination

"Among the 42 249 opioid-related overdose deaths in 2016, 19,413 involved synthetic opioids, 17,087 involved prescription opioids, and 15,469 involved heroin. Synthetic opioid involvement in these deaths increased significantly from 3007 (14.3% of opioid-related deaths) in 2010 to 19,413 (45.9%) in 2016 (P for trend <.01). Significant increases in synthetic opioid involvement in overdose deaths involving prescription opioids, heroin, and all other illicit or psychotherapeutic drugs were found from 2010 through 2016 (Table).

Use of Cannabis as a Response to the Overdose Crisis

"The opioid epidemic is a public health crisis that is at least partially driven by harms associated with POM [Prescription Opioid Medication] use. States are passing laws allowing use of MC [Medical Cannabis] and patients are using MC, but currently there is little understanding of how this influences POM use or of MC-related harms. This literature review provides preliminary evidence that states with MC laws have experienced reported decreases in POM use, abuse, overdose, and costs.

Opioid-overdose laws association with opioid use and overdose mortality

"Results
"By 2014, 30 states had a naloxone access and/or Good Samaritan law. States with naloxone access laws or Good Samaritan laws had a 14% (p = 0.033) and 15% (p = 0.050) lower incidence of opioid-overdose mortality, respectively. Both law types exhibit differential association with opioid-overdose mortality by race and age. No significant relationships were observed between any of the examined laws and non-medical opioid use.

Association of Opioid Overdose Laws with Opioid Use and Mortality

"• Naloxone access laws that ease restrictions on naloxone possession and distribution are associated with a 20% reduction overdose deaths among African-Americans.
"• Good Samaritan laws, providing immunity from prosecution for those calling emergency services, are associated with broad reductions in overdose deaths, reducing overdose deaths by 13% overall.
"• None of these harm reduction measures result in increase in opioid or heroin use.

Deaths in 2016 in the US Attributed to Drug Overdose

"• In 2016, there were more than 63,600 drug overdose deaths in the United States.

"• The age-adjusted rate of drug overdose deaths in 2016 (19.8 per 100,000) was 21% higher than the rate in 2015 (16.3).

"• Among persons aged 15 and over, adults aged 25–34, 35–44, and 45–54 had the highest rates of drug overdose deaths in 2016 at around 35 per 100,000.

"• West Virginia (52.0 per 100,000), Ohio (39.1), New Hampshire (39.0), the District of Columbia (38.8), and Pennsylvania (37.9) had the highest observed age-adjusted drug overdose death rates in 2016.

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