Health officials, confronted with a shocking increase in heroin abuse, are developing a clearer picture of who is becoming addicted to this drug and why. The results may surprise you.
The biggest surge is among groups that have historically lower rates of heroin abuse: women and white (non-Hispanic) Americans. They tend to be 18-25 years old, with household incomes below $20,000. "In addition, persons using heroin are abusing multiple other substances, especially cocaine and opioid pain relievers," says a report published Tuesday by the Centers for Disease Control and Prevention.
All told, more than half a million Americans used heroin in 2013, according to the report. That represents a nearly 150 percent increase since 2007.
Men still outnumber women, but that gap is narrowing. And 96 percent of heroin users said they'd used other drugs within the past year.
In 2013 alone, more than 8,200 Americans died of heroin overdoses. Most of them took that as a deadly combination with other drugs — most often cocaine. The death toll has skyrocketed in recent years. It's up from 1,800 in 2001, according to a report from the National Institute on Drug Abuse.
"As a doctor who started my career taking care of patients with HIV and other complications from injection drugs, it's heartbreaking to see injection drug use making a comeback in the U.S.," says Dr. Tom Frieden, head of the CDC. He unveiled the report in a phone briefing.
Those stark facts define the challenge that health officials face. The epidemic isn't just a problem of inner city "shooting galleries" and a dead end for the down-and-out. To a considerable extent, Frieden says the heroin "crisis" is growing out of prescription drug abuse, especially opioid painkiller use. People who abuse painkillers are 40 times more likely to abuse or be dependent on heroin, the study finds.
"It's really a one-two punch," Frieden said.
First, he says, the widespread use of opiate painkillers has primed people for heroin addiction. These drugs and heroin have essentially the same active ingredient. The second punch is that heroin is increasingly available, and often far cheaper than prescription painkillers. Frieden estimates that heroin is available on the street at one-fifth the cost of prescription pain pills.
This problem calls for a comprehensive response — one that recognizes the changing demographics of heroin use, says the CDC report, which is co-authored by Christopher Jones at the Food and Drug Administration along with colleagues from the CDC.
Frieden said "an urgent all-society response" is needed. It would include:
- Tracking the use of prescription painkillers and making sure doctors only prescribe them as necessary.
- Providing treatment to individuals who are addicted to these drugs.
- Cracking down on smuggling and street sales of heroin, to drive up the price and discourage abuse.
- Increasing the use of naloxone, a drug that can be injected into someone with a heroin overdose to reduce the risk of death.
RENEE MONTAGNE, HOST:
The U.S. is in the midst of a heroin epidemic. The government's latest estimates find that more than half a million Americans abused heroin in 2013. That's a sharp increase from just a few years ago, documented in a new report looking at the changing face of this deadly addiction. NPR's Richard Harris has more.
RICHARD HARRIS, BYLINE: Set aside your stereotypes of who's shooting up heroin. Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, says that picture has changed rapidly since as recently as 2007.
TOM FRIEDEN: The largest increases were among women, non-Hispanic whites and others - groups that have historically had lower rates of heroin use.
HARRIS: Though men are still the heaviest users, the number of women taking this drug has doubled. Most are young with low incomes. A study in the CDC's publication Vital Signs looks at what's driving that change.
FRIEDEN: It's really a one-two punch.
HARRIS: First, it's being driven by people who have gotten hooked on prescription pain pills. These opioids have essentially the same active ingredient as heroin.
FRIEDEN: And second, there's an increase in the supply and accessibility and a decrease in the cost of heroin.
HARRIS: Frieden says the street price for heroin is one-fifth of what it costs to buy pain pills. So what's to be done? For one thing, Frieden says law enforcement should really go after heroin supplies. Limiting supply will raise the price and discourage some people from taking the drug. Doctors also need to think carefully about the severe risks of prescribing painkilling pills in the first place.
FRIEDEN: A few doses and someone can have a life of addiction. A few pills too many and someone can die from overdose.
HARRIS: Frieden is calling for a broad effort involving doctors, law enforcement and health officials to bring what he calls the heroin crisis under control. Richard Harris, NPR News. Transcript provided by NPR, Copyright NPR.