Heroin

1. Estimated Prevalence of Heroin Use in the US

"An estimated 808,000 people aged 12 or older in 2018 used heroin in the past year (Figure 10), which corresponds to about 0.3 percent of the population (Figure 14). The estimate of past year heroin use in 2018 was higher than the estimates for most years between 2002 and 2008, but it was similar to the estimates in 2009 to 2017.

"Aged 12 to 17
"In 2018, less than 0.1 percent of adolescents aged 12 to 17 were past year heroin users (Figure 14). This percentage represents about 10,000 adolescents who used heroin in the past year. The estimate of past year heroin use among adolescents in 2018 was lower than the estimates for most years in 2002 to 2014, but it was similar to the estimates in 2015 to 2017. About 0.1 to 0.2 percent of adolescents used heroin in any year from 2002 to 2017.

"Aged 18 to 25
"Among young adults aged 18 to 25 in 2018, 0.5 percent were past year heroin users (Figure 14). This percentage represents 157,000 young adults who used heroin in the past year. The percentage of young adults in 2018 who were past year heroin users was similar to the percentages in 2002 to 2010 and from 2015 to 2017, but it was lower than the percentages in 2011 through 2014 (ranging from 0.7 to 0.8 percent).

"Aged 26 or Older
"In 2018, an estimated 0.3 percent of adults aged 26 or older were past year heroin users (Figure 14). This percentage represents 641,000 adults in this age group who used heroin in the past year. The percentage of adults aged 26 or older in 2018 who were past year heroin users was similar to the percentages in 2013 to 2017, but it was slightly higher than the percentages in most years from 2002 through 2012 (ranging from 0.1 to 0.2 percent)."

Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
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2. Key Factors Underlying Increasing Rates of Heroin Use and Opioid Overdose in the US

"A key factor underlying the recent increases in rates of heroin use and overdose may be the low cost and high purity of heroin.45,46 The price in retail purchases has been lower than $600 per pure gram every year since 2001, with costs of $465 in 2012 and $552 in 2002, as compared with $1237 in 1992 and $2690 in 1982.45 A recent study showed that each $100 decrease in the price per pure gram of heroin resulted in a 2.9% increase in the number of hospitalizations for heroin overdose.46"

Wilson M. Compton, M.D., M.P.E., Christopher M. Jones, Pharm.D., M.P.H., and Grant T. Baldwin, Ph.D., M.P.H. Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. N Engl J Med 2016; 374:154-163. January 14, 2016. DOI: 10.1056/NEJMra1508490
http://www.nejm.org/doi/full/1...

3. Factors in the Transition from Prescription Opiate Use to Heroin Use

"Multiple studies that have examined why some persons who abuse prescription opioids initiate heroin use indicate that the cost and availability of heroin were primary factors in this process. These reasons were generally consistent across time periods from the late 1990s through 2013.34-41 Some interviewees made reference to doctors generally being less willing to prescribe opioids as well as to increased attention to the issue by law enforcement, which may have affected the available supply of opioids locally.38,40"

Wilson M. Compton, M.D., M.P.E., Christopher M. Jones, Pharm.D., M.P.H., and Grant T. Baldwin, Ph.D., M.P.H. Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. N Engl J Med 2016; 374:154-163. January 14, 2016. DOI: 10.1056/NEJMra1508490
http://www.nejm.org/doi/full/1...
http://www.nejm.org/doi/pdf/10...

4. Efficacy of Heroin-Assisted Treatment

"Over the past 15 years, six RCTs [Randomized Controlled Trials] have been conducted involving more than 1,500 patients, and they provide strong evidence, both individually and collectively, in support of the efficacy of treatment with fully supervised self-administered injectable heroin, when compared with oral MMT, for long-term refractory heroin-dependent individuals. These have been conducted in six countries: Switzerland (Perneger et al., 1998); the Netherlands (van den Brink et al., 2003); Spain (March et al., 2006); Germany (Haasen et al., 2007), Canada (Oviedo-Joekes et al., 2009) and England (Strang et al., 2010).

"Across the trials, major reductions in the continued use of ‘street’ heroin occurred in those receiving SIH [Supervised Injectable Heroin] compared with control groups (most often receiving active MMT). These reductions occasionally included complete cessation of ‘street’ heroin use, although more frequently there was continued but reduced irregular use of ‘street’ heroin, at least through the trial period (ranging from 6 to 12 months). Reductions also occurred, but to a lesser extent, with the use of a range of other drugs, such as cocaine and alcohol. However, the difference between reductions in the SIH group and the various control groups was not as great (compared with major reductions in the use of ‘street’ heroin)."

European Monitoring Centre for Drugs and Drug Addiction, "EMCDDA INSIGHTS No. 11: New heroin-assisted treatment: Recent evidence and current practices of supervised injectable heroin treatment in Europe and beyond" (Luxembourg: Publications Office of the European Union, April 2012), doi: 10.2810/50141, p. 11.
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5. Description of Heroin

"Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as 'black tar heroin.'"

National Institute on Drug Abuse, DrugFacts: Heroin (Rockville, MD: US Department of Health and Human Services, Revised March 2010), last accessed Jan. 12, 2013.
http://www.drugabuse.gov/publi...

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