March 29, 2017
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Study links nonmedical opioid use, national increases in heroin use

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Heroin use and use disorder significantly increased from 2001 to 2012, particularly among white individuals. Notably, self-reported initiation of nonmedical opioid use before heroin use also increased during this time period among whites.

“Increases in serious consequences of heroin use, including overdoses, ED visits, and public drug abuse treatment, have led to widespread concerns about a heroin epidemic,” Silvia S. Martins, MD, PhD, of Columbia University, and colleagues wrote. “Although studies have addressed the link between use of prescription opioids and heroin, most information on trends in U.S. adult heroin use is indirect, obtained through studies of its sequelae.”

To assess changes in lifetime prevalence, patterns and associated demographics of heroin use and heroin use disorder from 2001 to 2013, researchers analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions for 2001 to 2002 (n = 43,093) and 2012 to 2013 (n = 36,309). Study participants had a mean age of 46.1 years.

Prevalence of heroin use (0.33% vs. 1.6%) and heroin use disorder (0.21% vs. 0.69%) significantly increased from 2001 to 2013 (P < .001).

Increase in prevalence of heroin use was significant among white participants (0.34% vs. 1.9%), compared with non-white participants (0.32% vs. 1.05%; P < .001).

Increases in heroin use disorder prevalence were more pronounced among white participants (0.19% vs. 0.82%; P < .001), those aged 18 to 29 years (0.21% vs. 1%; P = .01) and those aged 30 to 44 years (0.2% vs. 0.77%; P = .03), compared with non-white participants (0.25% vs. 0.43%) and older participants (0.22% vs. 0.51%).

DSM-IV heroin abuse was significantly more prevalent among heroin users in 2001 to 2002 (37.02%) than 2012 to 2013 (19.19%; P = .001).

Reported initiation of nonmedical use of prescription opioids before initiation of heroin use increased over time among white participants, from 35.83% in 2001 to 2002 to 52.83% in 2012 to 2013 (P = .01).

“Physicians’ prescriptions for chronic noncancer pain rose 3-fold and became the major source of opioids over the past 2 decades. This shift in practice norms was fueled by an acceptance of low-quality evidence that opioids are a relatively benign remedy for managing chronic pain,” Bertha K. Madras, PhD, of Harvard Medical School, wrote in an accompanying editorial. “These vast opioid supplies created a risk for diversion, opioid misuse and disorder, and overdose death. A proportion of prescription opioid misusers transitioned to illicit opioids, following contraction of prescription opioid supplies, and an expanding influx of potent, low-cost heroin and fentanyl analogs. The rise in overdose deaths catalyzed formation of federal and state policies to reduce supply, augment treatment, and distribute overdose medications. The current response remains inadequate until opioid deaths decline.” – by Amanda Oldt

Disclosure: Martins reports no relevant financial disclosures. Madras reports serving on the scientific advisory board of RiverMend Health, as a consultant for Guidepoint, and recently on a panel organized by the Vatican Pontifical Academy of Sciences (unfunded) titled “Narcotics: Problems and Solutions of this Global Issue.” Please see the study for a full list of relevant financial disclosures.