Today’s Heroin Epidemic

More people at risk, multiple drugs abused

Overview

Heroin use has increased across the US among men and women, most age groups, and all income levels. Some of the greatest increases occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes. Not only are people using heroin, they are also abusing multiple other substances, especially cocaine and prescription opioid painkillers. As heroin use has increased, so have heroin-related overdose deaths. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people died in 2013. States play a central role in prevention, treatment, and recovery efforts for this growing epidemic.

States can:

Address the strongest risk factor for heroin addiction: addiction to prescription opioid painkillers.
Increase access to substance abuse treatment services, including Medication-Assisted Treatment (MAT), for opioid addiction.
Expand access to and training for administering naloxone to reduce opioid overdose deaths.
Ensure that people have access to integrated prevention services, including access to sterile injection equipment from a reliable source, as allowed by local policy.
Help local jurisdictions to put these effective practices to work in communities where drug addiction is common.

Want to learn more? www.cdc.gov/vitalsigns/heroin

Heroin use more than doubled among young adults ages 18–25 in the past decade.

More than 9 in 10 people who used heroin also used at least one other drug.

45% of people who used heroin were also addicted to prescription opioid painkillers.

Problem

Heroin use is increasing, and so are heroin-related overdose deaths.

How is heroin harmful?

Heroin is an illegal, highly addictive opioid drug.
A heroin overdose can cause slow and shallow breathing, coma, and death.
People often use heroin along with other drugs or alcohol. This practice is especially dangerous because it increases the risk of overdose.
Heroin is typically injected but is also smoked or snorted. When people inject heroin, they are at risk of serious, long-term viral infections such as HIV, Hepatitis C, and Hepatitis B, as well as bacterial infections of the skin, bloodstream, and heart.

Who is most at risk of heroin addiction?

People who are addicted to prescription opioid painkillers
People who are addicted to cocaine
People without insurance or enrolled in Medicaid
Non-Hispanic whites
Males
People who are addicted to marijuana and alcohol
People living in a large metropolitan area
18 to 25 year olds

Heroin Use Has INCREASED Among Most Demographic Groups

Heroin use has increased among most demographic groups. This chart shows the annual average rate of heroin use (per 1,000 people in each demographic group) for the combined years 2002 to 2004 and 2011 to 2013, and shows the percent increase between those time periods.

	2002–2004*	2011–2013*	Percent Change
Sex
Male	2.4	3.6	50%
Female	0.8	1.6	100%
Age, Years
12–17	1.8	1.6	--
18–25	3.5	7.3	109%
26 or older	1.2	1.9	58%
Race / Ethnicity
Non-Hispanic white	1.4	3	114%
Other	2	1.7	--
Annual Household Income
Less than $20,000	3.4	5.5	62%
$20,000–$49,999	1.3	2.3	77%
$50,000 or more	1	1.6	60%
Health Insurance Coverage
None	4.2	6.7	60%
Medicaid	4.3	4.7	--
Private or other	0.8	1.3	63%

*Annual average rate of heroin use (per 1,000 people in each group)

Heroin Addiction and Overdose Deaths are Climbing

Heroin addiction and overdose deaths are climbing. The x-axis category is years and runs from 2002 to 2013. The y-axis category is rate and runs from 0 to 3. The rates of heroin addiction and heroin-related overdose deaths are given in the table below. The heroin-related overdose death rate increased 286% from 2002 to 2013.

Year	Heroin Addiction (per 1,000 people)	Heroin-Related Overdose Deaths (per 100,000 people)
2002	1.0	0.7
2003	0.9	0.7
2004	1.2	0.6
2005	0.9	0.7
2006	1.2	0.7
2007	0.9	0.8
2008	1.2	1.0
2009	1.6	1.1
2010	1.4	1.0
2011	1.8	1.4
2012	1.9	1.9
2013	2.0	2.7

SOURCE: National Survey on Drug Use and Health (NSDUH), 2002-2013.

SOURCE: Multiple Cause of Death Files from the National Vital Statistics System, 2002-2013.

Heroin use is part of a larger substance abuse problem.

Nearly all people who used heroin also used at least 1 other drug. Most used at least 3 other drugs.

Heroin is a highly addictive opioid drug with a high risk of overdose and death for users.

People who are addicted to...

Alcohol are 2 times more likely to become addicted to heroin.

Marijuana are 3 times more likely to become addicted to heroin.

Cocaine are 15 times more likely to become addicted to heroin..

Prescription opioid painkillers are 40 times more likely to become addicted to heroin.

SOURCE: National Survey on Drug Use and Health (NSDUH), 2011-2013.

Responding to the Heroin Epidemic

Hand up icon, indicating a command to stop
- PREVENT People From Starting Heroin
  - Reduce prescription opioid painkiller abuse.
  - Improve opioid painkiller prescribing practices and identify high-risk individuals early.
Decreasing line graph icon
- REDUCE Heroin Addiction
  - Ensure access to Medication-Assisted Treatment (MAT).
  - Treat people addicted to heroin or prescription opioid painkillers with MAT which combines the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.
U-turn icon
- REVERSE Heroin Overdose
  - Expand the use of naloxone.
  - Use naloxone, a life-saving drug that can reverse the effects of an opioid overdose when administered in time.

SOURCE: CDC Vitalsigns, July 2015

What Can Be Done

The Federal government is

Providing educational training and resources to health care providers so they can make informed decisions and ensure the appropriate prescribing of opioid painkillers. This includes:
- Developing prescribing guidelines for chronic pain.
- Supporting the use of prescription drug monitoring programs (electronic databases that track the dispensing of certain drugs) as a routine part of clinical practice.
Increasing access to substance abuse treatment services through the Affordable Care Act.
Expanding use of Medication-Assisted Treatment (MAT).
Supporting the development and distribution of the life-saving drug naloxone to reduce prescription opioid painkiller and heroin overdose deaths.
Supporting the research, development, and approval of pain medications that are less prone to abuse.
Improving surveillance to better track trends, identify communities at risk, and target prevention strategies.

States can

Address the strongest risk factor for heroin addiction: addiction to prescription opioid painkillers.
- Make prescription drug monitoring programs timely and easy to use. Providers can analyze patient prescription drug history and make informed decisions before prescribing opioid painkillers.
- Look at the data and practices of state Medicaid and worker's compensation programs to identify and reduce inappropriate prescribing.
Increase access to substance abuse treatment services, including MAT for opioid addiction.
- Work with Medicaid and other insurance companies to provide coverage for MAT.
- Support adoption of MAT in community settings.
Expand access to and training for administering naloxone to reduce opioid overdose deaths.
Ensure that people have access to integrated prevention services, including access to sterile injection equipment from a reliable source, as allowed by local policy.
Help local jurisdictions to put these effective practices to work in communities where drug addiction is common.

Health care providers can

Follow best practices for responsible painkiller prescribing to reduce opioid painkiller addiction, the strongest risk factor for heroin addiction:
- Use prescription drug monitoring programs and ask patients about past or current drug and alcohol use prior to considering opioid treatment.
- Prescribe the lowest effective dose and only the quantity needed for each patient.
- Link patients with substance use disorders to effective substance abuse treatment services.
Support the use of Food and Drug Administration approved MAT options (methadone, buprenorphine, and naltrexone) in patients addicted to prescription opioid painkillers or heroin.