TY - JOUR
KW - Adolescent
KW - Adult
KW - Age Factors
KW - Female
KW - Health Surveys/trends
KW - Heroin Dependence/economics/epidemiology/ethnology
KW - Humans
KW - Interview, Psychological
KW - Male
KW - Minority Groups
KW - Prescription Drugs/adverse effects/economics
KW - Retrospective Studies
KW - Sex Factors
KW - Time Factors
KW - United States/epidemiology/ethnology
KW - Urban Population
KW - Young Adult
AU - T. J. Cicero
AU - M. S. Ellis
AU - H. L. Surratt
AU - S. P. Kurtz
A1 - 
AB - IMPORTANCE: Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. OBJECTIVE: To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin. DESIGN, SETTING, AND PARTICIPANTS: Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview. MAIN OUTCOMES AND MEASURES: In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids. RESULTS: Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants' Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids. CONCLUSION AND RELEVANCE: Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.
BT - JAMA Psychiatry
C5 - Opioids & Substance Use; Healthcare Disparities
CP - 7
CY - United States
DO - 10.1001/jamapsychiatry.2014.366
IS - 7
JF - JAMA Psychiatry
N2 - IMPORTANCE: Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. OBJECTIVE: To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin. DESIGN, SETTING, AND PARTICIPANTS: Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview. MAIN OUTCOMES AND MEASURES: In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids. RESULTS: Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants' Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids. CONCLUSION AND RELEVANCE: Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.
PP - United States
PY - 2014
SN - 2168-6238; 2168-622X
SP - 821
EP - 826
EP - 
T1 - The changing face of heroin use in the United States: a retrospective analysis of the past 50 years
T2 - JAMA Psychiatry
TI - The changing face of heroin use in the United States: a retrospective analysis of the past 50 years
U1 - Opioids & Substance Use; Healthcare Disparities
U2 - 24871348
U3 - 10.1001/jamapsychiatry.2014.366
VL - 71
VO - 2168-6238; 2168-622X
Y1 - 2014
ER -