Prescription drug abuse drives heroin use increases among suburban, rural whites

Dr CiceroHeroin use has become pervasive in all sectors, inner cities, suburbs and rural areas. It is no longer an isolated problem, according to a study published in JAMAPsychiatry.

Theodore J. Cicero, PhD, professor of psychiatry at Washington University in St Louis, and his colleagues found that heroin users are increasingly likely to be white, from nonurban areas and to have previously abused prescription pain drugs.

Cicero and colleagues used standardized surveys of 10,000 people entering treatment and detailed qualitative interviews with a subset of these individuals to address the drugs they had used in the last 30 days and the motivation for such use. 

“Our studies show that heroin abuse, once a problem with male minority populations in inner cities [1960 to 1970], has  migrated to suburban and rural locations where it is now pervasive in predominately [>90%] white, middle- to upper-class young males and females in their mid-20s,” Cicero said.

Prior to the 1980s, heroin users were roughly equally divided between white and minority groups, the authors noted.

“Most importantly, today most heroin abusers were introduced  to opioids through abuse of prescription opioid drugs, such as OxyContin, Percocet, and Vicodin first and then graduated to heroin, often as a cheaper and more readily accessible alternative than their prescription opioid of choice,” he said. “The latter have grown more expensive while heroin has become cheaper.”

“As the use of prescription opioid analgesics has increased over the years so too has diversion to illicit channels where they are used for non-therapeutic purposes [eg, to get high],” said Dr Cicero. “As research moves forward it will be important to define those individuals most at risk to develop opioid abuse problems.”