How Have the Demographics of Heroin Use Changed Over Time?

In recent months, both public health officials and news outlets have widely reported an increase in the number of people using the highly addictive opioid drug heroin. However, most reports on this subject have not taken advantage of detailed demographic information (racial/ethnic background, age, gender, etc.) to look closely at population segments most likely to use the drug. In a study published in May 2014 in the American Medical Association journal JAMA Psychiatry, researchers from two U.S. universities used information from an ongoing project called the Survey of Key Informants’ Patients (SKIP) Program to explore how the heroin-using population in the U.S. has changed over time.

How Many People Use Heroin?

Nationwide figures on how many people use heroin are available from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), which gathers information on all forms of substance use in the U.S. through an annual project called the National Survey on Drug Use and Health (NSDUH). As of mid-2014, figures from the latest reported version of this project cover the year 2012. In that year, approximately 335,000 teenagers and adults across the country used heroin at least once in the average month. In addition, approximately 669,000 teens and adults used the drug at least once in a year’s time. Roughly 156,000 people initiated heroin intake at some point in 2012. On average, a person beginning use of the drug was 23 years old.

It’s critical to note that the National Survey on Drug Use and Health does not include information on the heroin use of people who are homeless or incarcerated in a jail or prison. In a report presented in February 2014 to the White House Office of National Drug Control Policy, researchers from the RAND Corporation supplemented data from the NSDUH with data gathered from the Arrestee Drug Abuse Monitoring Program, a now-defunct project that specifically looked at the drug use rates of people under arrest or incarcerated across America. These researchers concluded that, in 2010 (the last year of a decade-long study period), there were probably about 1.5 million people in the U.S. who qualified as chronic heroin users.

The Survey of Key Informants’ Patients Program

The Survey of Key Informants’ Patients Program is an ongoing project that uses anonymous information gathered from 125 public and private substance treatment facilities across the U.S. to analyze a number of factors related to the use of heroin and other opioid drugs and medications. Factors under consideration include which opioid substance a given user prefers, how often a user takes an opioid drug or medication per month, how old a person was when opioid intake began and how often a person has used an opioid substance in their lifetime. The SKIP questionnaire also includes detailed demographic information for each participant. A small number of SKIP participants give up their anonymity and provide researchers with even more detailed personal information.

How Have the Heroin Demographics Changed?

In the study published in JAMA Psychiatry, researchers from Washington University in St. Louis and Nova Southeastern University used information gathered from SKIP between 2010 and 2013 to examine long-term trends in the demographics of heroin use in the U.S. All told, 2,797 SKIP participants identified themselves as primary heroin users during this span of time. The researchers supplemented the data drawn from the main pool of SKIP participants with more detailed data drawn from 54 project participants who relinquished anonymity.

Some study participants had first started taking heroin as far back as the 1960s, while others initiated intake of the drug at some point between the 1960s and present day. The researchers concluded that those individuals who initiated heroin use in the 60s were overwhelmingly male (82.8 percent) and had an average age between 16 and 17. Additional demographics of the average heroin user during that timeframe included having a non-white racial/ethnic background and living in an urban, inner-city environment. Over time, the demographics of users began to change. By the 1980s, many more women were taking heroin.  In addition, whites represented a much larger portion of the heroin-using population. By the 2000s, almost 90 percent of all new heroin users were white. In contrast to earlier decades, the average user had a much greater chance of living in a non-urban environment.

The authors of the study largely attribute the shift in heroin demographics to the rise and widespread popularity of prescription opioid medications such as hydrocodone (Vicodin, Lorcet) and oxycodone (OxyContin, Percocet). In line with other experts examining the role of these medications, they believe that people who begin by abusing prescription opioids can transition into heroin use because the drug is both easier to obtain and cheaper to use on a recurring basis.

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