Heroin use increasing at alarming rate; health care providers can help

Heroin doesn’t discriminate. It’s an equal-opportunity taskmaster, ensnaring more and more men and women of all ages, races, and income levels. If there is still a war against drugs, then heroin is winning.

Beating it will require a corresponding, coordinated, all-out retaliation from government, organizations and individuals at all levels of society. That’s the conclusion from a recent report from the Centers for Disease Control and Prevention (CDC).

“Heroin use is increasing at an alarming rate in many parts of society, driven by both the prescription opioid epidemic and cheaper, more available heroin,” said CDC Director Thomas Frieden, MD, MPH.

Staggering Statistics

The CDC’s analysis, published in the July 7 Morbidity and Mortality Weekly Report, notes alarming trends in both heroin use and heroin addiction:

• Heroin use increased 63% from 2002 through 2013 in the United States. This increase occurred among a broad range of demographics, including men and women, most age groups, and all income levels. But in young adults (ages 18-25), heroin use more than doubled in the same time period.

• The gaps between men and women, low and higher incomes, and people with Medicaid and private insurance have all narrowed in the past decade. Some of the greatest increases occurred in demographic groups with historically lower rates of heroin use: women, people with private insurance, and people with higher incomes. But rates of abuse or dependence continue to remain highest among whites, men, 18-to-25 year-olds, city dwellers, people with an annual household income less than $20,000, Medicaid recipients, and the uninsured.

• In terms of heroin abuse and dependence, an estimated 517,000 Americans reported heroin addiction in 2013—an increase of nearly 150% since 2007.

• Not only are people abusing heroin, they are also abusing multiple other substances, especially cocaine and prescription opioid painkillers. Nearly all people who used heroin (96%) also used at least 1 other drug. Most (61%) used at least 3 other drugs.

• As heroin use has increased, so have heroin-related overdose deaths, which nearly quadrupled between 2002 and 2013. More than 8,200 people died of heroin-related overdose in 2013 alone.

“To reverse this trend we need an all-of-society response—to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses, and work with law enforcement partners like DEA to reduce the supply of heroin,” Dr. Frieden stated.

The Heroin-Opioid Connection

"In only 10 years, heroin use has more than doubled among people who abused or were dependent on prescription opioid painkillers. In fact, in this study, the strongest risk factor for heroin abuse or dependence was abuse or dependence on opioid painkillers,” said Debra Houry, MD, MPH, Director of the National Center for Injury Prevention and Control.

Indeed, people who are addicted to prescription opioid painkillers are 40 times more likely to have heroin abuse or dependence, the CDC’s report noted. Accordingly, the report addressed the question of whether efforts to curb opioid prescribing—intended to restrict access to prescription opioids—have fueled heroin use and overdose.

Not so, the investigators concluded. In fact, heroin use and prescription opioid abuse seem to go hand in hand.

“Let me put it more clearly,” Dr. Frieden said. “Approving [curbing] practices for prescription opiates is part of the solution, not part of the cause of the heroin problem.”

The CDC report cites a recent analysis that found that decreases in prescription opioid overdose death rates were not tied to increases in heroin death rates; in fact, increases in heroin overdose death rates were actually associated with increases in prescription opioid overdose death rates.

In addition, a study examining trends in overdose hospitalizations found that increases in opioid pain reliever hospitalizations predicted an increase in heroin overdose hospitalizations in subsequent years. “Thus, the changing patterns of heroin use and overdose deaths are most likely the result of multiple, and possibly interacting, factors,” the CDC report stated.

What Can Be Done?

"Everyone has a role to play—states, public health, health care providers, families, communities, and law enforcement,” Dr. Frieden said.

Dr. Houry added, “To respond to this epidemic, we have to do two things: Ensure appropriate prescribing and use of opioid painkillers to keep at-risk people from starting heroin, and expand treatment and recovery for those already abusing or dependent on opioid painkillers or heroin.”

State agencies can play a key role by improving access and insurance coverage for medication-assisted treatment for opioid use disorders, and expanding access and training for naloxone administration to reverse overdoses, the CDC report said.

“Health care providers can also play an important role by following best practices for responsible prescribing to reduce abuse or dependence, understanding that there's a risk and a benefit to every medication,” Dr. Frieden said. “And for prescription opiates, the risks are very palpable. A few doses and someone can have a life of addiction. A few pills too many, and someone can die from overdose.”

He also spoke directly to people who are addicted or may become addicted: “Seek help, because treatment works."

Additional information is available at the CDC’s website.