Vital Signs: Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013

BACKGROUND: Heroin use and overdose deaths have increased significantly in the United States. Assessing trends in heroin use among demographic and particular substance-using groups can inform prevention efforts. METHODS: FDA and CDC analyzed data from the National Survey on Drug Use and Health and National Vital Statistics System reported during 2002–2013. Trends in heroin use among demographic and substance using groups were compared for 2002–2004, 2005–2007, 2008–2010, and 2011–2013. A multivariable logistic regression model was used to identify characteristics associated with heroin abuse or dependence. RESULTS: Annual average rates of past-year heroin use increased from 1.6 per 1,000 persons aged ≥12 years in 2002–2004 to 2.6 per 1,000 in 2011–2013. Rates of heroin abuse or dependence were strongly positively correlated with rates of heroin-related overdose deaths over time. For the combined data years 2011–2013, the odds of past-year heroin abuse or dependence were highest among those with past-year cocaine or opioid pain reliever abuse or dependence. CONCLUSIONS: Heroin use has increased significantly across most demographic groups. The increase in heroin abuse or dependence parallels the increase in heroin-related overdose deaths. Heroin use is occurring in the context of broader poly-substance use. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Further implementation of a comprehensive response that targets the wider range of demographic groups using heroin and addresses the key risk factors for heroin abuse and dependence is needed. Specific response needs include reducing inappropriate prescribing and use of opioids through early identification of persons demonstrating problematic use, stronger prescription drug monitoring programs, and other clinical measures; improving access to, and insurance coverage for, evidence-based substance abuse treatment, including medication-assisted treatment for opioid use disorders; and expanding overdose recognition and response training and access to naloxone to treat opioid pain reliever and heroin overdoses.