The Heroin Epidemic, in 9 Graphs

The Heroin Epidemic, in 9 Graphs

By Dr. Fourkan Ali

The White House released a plan this week to pour $5 million into combating heroin use and trafficking. The plan followed months of warnings from the Centers of Disease Control and Prevention about the explosion in heroin use in the U.S.

Presidential candidates have also spoken out on the issue. Hillary Clinton has called the heroin and methamphetamine addiction a "quiet epidemic" and held roundtables to discuss the issue with voters. Rand Paul has spoken repeatedly about the racial aspect of the war on drugs and said that he would change minimum sentencing laws if elected.Chris Christie has enacted reforms in his home state of New Jersey, saying he favored treatment instead of imprisonment, and calling drug addiction a disease that "can happen to anyone from any station in life."

In the last decade, heroin abuse has skyrocketed. The rate of heroin-related overdose deaths increased 286 percent between 2002 and 2013 . In 2002, 100 people per 100,000 were addicted to heroin but that number had doubled by 2013.

COURTESY CDC

The CDC says males, non-hispanic whites, 18- to 25-year-olds and people living in large metropolitan areas are at the most risk for heroin addiction, which covers most of the U.S. Heroin addiction spans all ages, races, genders, incomes, insurance statuses and locations.

The problem of substance abuse touches many areas of public policy, from border security to the health system and criminal justice. The rise may have been spurred partially by an increase in supply: the amount of heroin seized at the border with Mexico quadrupled by 2013 from the 2000s, making the drug cheaper in the U.S. and more pure. During 2008-2011, there were about 1.1 million emergency department visits for drug poisoning each year, or 35.4 visits per 10,000 people.

Abuse has increased most drastically in the Midwest. 

Age-adjusted rates for drug-poisoning deaths involving heroin, by census region: United States, 2000, 2007, and 2013
COURTESY CDC

Who Abuses Heroin?

The average user of heroin has changed drastically in the last decade. In 2000, black Americans aged 45-64 had the highest death rate for drug poisoning involving heroin. Now, white people aged 18-44 have the highest rate. The share of people who say they have used heroin in the past year is actually decreasing for non-whites. Heroin has taken hold of the white suburbs, which has prompted more attention for what is now being called a " health problem." 

Rates for drug-poisoning deaths involving heroin, by selected age and race and ethnicity groups: United States, 2000 and 2013
COURTESY CDC

The heroin epidemic is hitting young adults more than other age groups. The use among Americans aged 18-25 increased 109 percent from 2002-2004 and 2011-2013. For Americans 26 and older, it increased 58 percent.

Rates for drug-poisoning deaths involving heroin, by selected age groups: United States, 2000–2013
COURTESY CDC

Emergency department visit rates for drug poisoning, by age: United States, 2004–2007 and 2008–2011

COURTESY CDC

Although people aged 18 to 25 are more at risk for heroin use, according to the CDC, on average, heroin is a drug for slightly older adults probably because it is perceived as being more risky (rightly so) and because most heroin users have used other drugs in the past. Nine in 10 people who use heroin use it with at least one other drug, most with at least three other drugs. 

Although heroin is perceived by teenagers as the most dangerous drug, the share of 12 to 17-year-olds who perceive the drug as very risky has declined slightly since 2002, according to the results of a 2013 survey by the U.S. Department of Health and Human Services. Teens also say it is the most difficult to obtain with the share of teens saying heroin is fairly or very easy to obtain declining from 15.8 percent in 2002 to 9.1 percent in 2013.

But prescription drug abuse is the bigger epidemic.

Heroin abuse is tightly tied to prescription drug abuse. Almost half of people addicted to heroin are also addicted to painkillers. People are 40 times more likely to be addicted to heroin if they are addicted to prescription painkillers. Abuse of prescription painkillers is incredibly common — one in 20 Americans age 12 and older reported using painkillers for non-medical reasons in the past year. While it's true that heroin abuse has skyrocketed in the last years, prescription drug abuse is more common. The number of overdose deaths from prescription pain medication is larger than those of heroin and cocaine combined. 

Age-adjusted rates for drug-poisoning deaths, by type of drug: United States, 2000–2013
COURTESY CDC

By 2011-2013, painkiller dependence among heroin users was more common than alcohol, marijuana or cocaine dependence.

Annual average percentage of past-year heroin users* with past-year selected substance abuse or dependence, by time interval — United States, 2002–2013
COURTESY CDC

One of the main differences between the two issues is that while the issue of heroin is intertwined with border security, the abuse of prescription drugs is largely the fault of our own health system. Enough painkillers were prescribed by American doctors during one month in 2010 to medicate every American around the clock for an entire month.

A majority of those who take prescription pain medicine for non-medical reasons get them free from a friend or relative. In nearly 85 percent of those cases, the friend or relative obtained them from one doctor. One in five users obtain prescriptions themselves from one doctor.

States have more ability to increase the monitoring of prescription drugs, identify people showing signs of problematic use earlier, and stop inappropriate prescriptions of painkillers (which can lead to abuse and then, abuse of heroin). 

While some have warned that a crackdown on prescription drug abuse will only spur more abuse of heroin, one analysis of death rates in 28 states found that while heroin overdose rates were associated with an increase in overdose rates for prescription medication, a decrease in the prescription drug rate was not associated with an increase in the death rate for heroin. Still, more research is needed to combat both issues. 

Sources: US NEWS