11. Risk of Heroin Dependence After Onset of Use

"When observed within approximately 1 to 12 months after heroin onset, an estimated 23% to 38% of new heroin users have become dependent on heroin. Rank-order correlation and post hoc exploratory analyses prompt a hypothesis of recently increased odds of becoming dependent on heroin.

"Seeking estimates for comparison, we found 3 published studies on how often heroin dependence was found among people who have used heroin at least once in their lifetime. The National Comorbidity Survey (1990-1992) estimate was 23% dependence rate (with a standard error [SE] of 5%); National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002) estimate (SE) was 28% (4%); and National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) estimate (SE) was 25% (2%).4,6 These 3 values yield a random-effects meta-analysis summary of 26%, with a 95% CI of 22% to 29%, which clearly overlaps this study’s overall finding of 23% to 38% of all participants becoming heroin dependent soon after first heroin use."

Rivera OJS, Havens JR, Parker MA, Anthony JC. Risk of Heroin Dependence in Newly Incident Heroin Users. JAMA Psychiatry. Published online May 30, 2018. doi:10.1001/jamapsychiatry.2018.1214

12. Trends in Prevalence of Current Heroin Use in the US

"The estimate of current heroin use in 2015 among people aged 12 or older was higher than the estimates in most years between 2002 and 2009, but it was similar to the estimates between 2010 and 2014 (Figure 8). However, even when there was a statistically significant difference between the 2015 estimate and prior years, the percentages were approximately the same, except for the estimate in 2014 (0.2 percent). For example, all of these estimates for current heroin use rounded to 0.1 percent. In 2014, the estimate of current heroin use was higher than in all previous years; however, the 2015 estimate does not provide strong support that the increase in 2014 signaled the start of a change in the trend. Future survey years will be useful for monitoring this trend.
"The estimate of past year heroin use in 2015 (0.3 percent) was also higher than the estimates for most years between 2002 and 2008, but it was similar to the estimates between 2009 and 2014 (Figure 9). This shift in heroin use among people aged 12 or older reflects changes in heroin use by adults aged 26 or older and, to a lesser extent, smaller increases in heroin use among young adults aged 18 to 25."

Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). pp. 10-11. Retrieved from

13. Mortality from Heroin Use

"The majority of drug deaths in an Australian study, conducted by the National Alcohol and Drug Research Centre, involved heroin in combination with either alcohol (40 percent) or tranquilizers (30 percent)."

Peele, Stanton, MD (1998), "The persistent, dangerous myth of heroin overdose," published in DPFT News (Drug Policy Forum of Texas), August, 1999, p. 5, from The Stanton Peele Addiction Website, last accessed Nov. 7, 2017.

14. Opioid Overdose Deaths in the US, 1999-2005

"There can be no doubt, however, that fatal opioid overdose, long a chronic health problem in the United States, is now a rapidly growing one.71 National surveillance data suggest that almost 83,000 Americans died from this form of overdose between 1999 to 2005, with over 16,000 fatalities in 2005 alone.72 Opioid overdose death has seen a sharp increase over the last decade, especially in the category of overdose from prescription medications.73 Because of gaps in the surveillance system, the actual figure is likely to be substantially higher."

Burris, Scott; Beletsky, Leo; Castagna, Carolyn; Coyle, Casey; Crowe, Colin; and McLaughlin, Jennie Maura, "Stopping an Invisible Epidemic: Legal Issues in the Provision of Naloxone to Prevent Opioid Overdose," Drexel Law Review (Philadelphia, PA: Earle Mack School of Law, Spring 2009), Vol. 1, Number 2, p. 284.

15. Heroin Toxicity or Overdose

"The main toxic effect is decreased respiratory rate and depth, which can progress to apnea. Other complications (eg, pulmonary edema, which usually develops within minutes to a few hours after opioid overdose) and death result primarily from hypoxia. Pupils are miotic. Delirium, hypotension, bradycardia, decreased body temperature, and urinary retention may also occur.
"Normeperidine, a metabolite of meperidine, accumulates with repeated use (including therapeutic); it stimulates the CNS and may cause seizure activity."

"Opioids," The Merck Manual for Health Care Professionals, Special Subjects: Drug Use and Dependence, Opioids (Merck & Co. Inc., last revised July 2008), last accessed Feb. 16, 2013.