(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.
"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"
"In 2016, a total of 67,265 persons died of drug-induced causes in the United States (Tables 5, 6, 8, and I–1). This category includes deaths from poisoning and medical conditions caused by use of legal or illegal drugs, as well as deaths from poisoning due to medically prescribed and other drugs. It excludes deaths indirectly related to drug use, as well as newborn deaths due to the mother's drug use. (For a list of drug-induced causes, see Technical Notes.)
"It is important to note that, contrary to alcohol, benzodiazepines and nicotine, opioids do not have teratogenic potential (3). Thus, special attention needs to be paid to dependence and abuse of legal substances and prescription drugs that can have severe consequences for the foetus and newborn, such as foetal developmental disorders or sudden infant death syndrome (Fetal Alcohol Spectrum Disorders Center for Excellence, 2013; McDonnell-Naughton et al., 2012)."
"Untreated opiate dependence in pregnant women is associated with many environmental and medical factors that contribute to poor maternal and child outcomes. Illicit opioid consumption is associated with a sixfold increase in obstetric complications such as low birth weight, toxaemia, third trimester bleeding, malpresentation, puerperal morbidity (2), foetal distress and meconium aspiration.
Data Limitations Make Estimating Demographics of Heroin Users in the US Difficult: "The prevalence of heroin use is extremely difficult to estimate despite the fact that harm to society associated with heroin marketing and use is substantial. A disproportionate number of heroin users are part of the nonsampled populations in general prevalence surveys (persons with no fixed address, prison inmates, etc.) Also, heroin users are believed to represent less than one half of one percent of our total population, making heroin usage a relatively rare event.
"The present study determined participants’ satisfaction with received treatments in the first North American RCT [Randomized Controlled Trial] to provide injectable diacetylmorphine or hydromorphone compared to oral methadone for the treatment of long-term, treatment resistant, opioiddependency. At 3 and 12 months, participants were satisfied with the treatment received during the study period, although satisfaction was greater for those randomized to receive injectable treatments.
"Our results on the cost-effectiveness of diacetylmorphine are consistent with those of an economic analysis based on data from two Dutch heroin-assisted treatment trials,21 despite differences in the design of the Dutch trials and the North American Opiate Medication Initiative, and the time horizon and analytic design of the economic analyses.
"Other Highlights – Younger Heroin Users:
"Overall, the number of PWID per 10,000 persons aged 15–64 years varied from 31 to 345 across MSAs [Metropolitan Statistical Areas], median 104.4 (mean 127.4; standard deviation 66.7; percentile range 76–162) in 1992 and from 34 to 324 across MSAs, median 91.5 (mean 103.6; standard deviation 56.4; percentile range 61–125 ) in 2007 indicating an overall decline in PWID prevalence across MSAs.