The demographics of heroin users have changed significantly in the past 50 years, with many young people attracted to the drug not only for the “high” it brings but because it is less expensive and easier to get than prescription painkillers.
“In the past, heroin was a drug that introduced people to narcotics. But what we’re seeing now is that most people using heroin begin with prescription painkillers such as OxyContin, Percocet or Vicodin, and only switch to heroin when their prescription drug habits get too expensive,” said Theodore J. Cicero, PhD, a professor of neuropharmacology in psychiatry at Washington University School of Medicine in St. Louis.
Cicero and his colleagues analyzed data gathered from more than 150 drug treatment centers across the United States. More than 9,000 patients dependent on narcotic painkillers, or opioids, completed the surveys from 2010 to 2013. Of those, almost 2,800 reported heroin as their primary drug of abuse.
“Our surveys have shown a marked shift in the demographics of heroin users seeking treatment over the past several decades,” said Cicero.
Respondents who began using heroin in the 1960s were predominantly young men in their teens living in urban areas, whose first opioid use was heroin (80%). Recent users are more likely to be white, older (average age almost 23 years) men and women living in suburban or rural areas. Three out of four were first introduced to opioids through prescription painkillers.
To get more detail about their use of heroin, the researchers zeroed in on 54 patients who participated in unstructured interviews.
Most got high with prescription opioid drugs that were acquired illegally Heroin became their drug of choice because it was cheaper than painkillers and more readily accessible. The introduction of “tamper resistant” opioid formulations, which make the drugs harder for abusers to crush or liquefy, was also a factor in their use of heroin.
“If you make abuse-deterrent formulations of these drugs and make it harder to get high, these people aren’t just going to stop using drugs,” said Cicero. “As we made it more difficult to use one drug, people simply migrated to another. Policymakers weren’t ready for that, and we certainly didn’t anticipate a shift to heroin.”
A recent study by the Substance Abuse and Mental Health Services Administration found that use of heroin nearly doubled in United States after a reformulated version of OxyContin was introduced in 2010.
“The price on the street for prescription painkillers, like OxyContin, got very expensive. It has sold for up to a dollar per milligram, so an 80 milligram tablet would cost $80. Meanwhile, they can get heroin for $10,” said Cicero.
Previous studies of heroin users in the 1960s and 1970s found that over 80% were young male minorities who lived in inner cities. Many began using the drug at about age 16.
“Our earlier studies showed that people taking prescription painkillers thought of themselves as different from those who used heroin,” Cicero said. “We heard over and over again, ‘At least I’m not taking heroin.’ Obviously, that’s changed.”
“The overdose deaths and hospitalizations are symptoms of a problem that we really need to deal with,” he said. “You can’t effectively treat people or prevent addiction unless you know why they are taking drugs, and we don’t really have a handle on that yet. Unfortunately, the problem with heroin is it’s the most powerful opiate ever created, and even if people think they are being careful, it can kill.”