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JAMA Psychiatry. 2014 Jul 1;71(7):821-6. doi: 10.1001/jamapsychiatry.2014.366.

The changing face of heroin use in the United States: a retrospective analysis of the past 50 years.

Author information

1
Department of Psychiatry, Washington University in St Louis, St Louis, Missouri.
2
Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida.

Abstract

IMPORTANCE:

Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations.

OBJECTIVE:

To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin.

DESIGN, SETTING, AND PARTICIPANTS:

Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (nā€‰=ā€‰2797) and (2) data from unstructured qualitative interviews with a subset of patients (nā€‰=ā€‰54) who completed the structured interview.

MAIN OUTCOMES AND MEASURES:

In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids.

RESULTS:

Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants' Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids.

CONCLUSION AND RELEVANCE:

Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.

PMID:
24871348
DOI:
10.1001/jamapsychiatry.2014.366
[Indexed for MEDLINE]

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