Heroin Deaths Nearly Quadruple in a Decade, CDC Finds

Heroin use has soared in recent years, with death rates from the drug nearly quadrupling in the past decade, according to a new CDC study that blames much of this epidemic on the overuse of prescription painkillers.

While heroin use is highest among young men earning less than $20,000 a year, the drug has left its mark across every demographic group, based on a study released yesterday in advance of the Mortality and Morbidity Weekly Report.

CDC’s findings combine survey results the Substance Abuse and Mental Health Administration with death rates reported to the agency between 2002 and 2013. It found heroin overdoses rose from 0.7 deaths to 2.7 deaths per 100,000 of the population during this period.

However, the largest spikes in both heroin use and deaths have been very recent. In 2013, an estimated 517,000 people used heroin within the past year, a rise of 150% just since 2007. Those reporting heroin abuse or dependence doubled during the decade, with a 35.7% increase from 2008 to 2010.

While the estimates of heroin use are based on self-reported data, there are no questions about the rising number of deaths from the drug, which have gone up sharply since 2010. The 8257 heroin overdose deaths in 2013 were 4 times the number in 2006, but the death rate shot up from 1.4 per 100,000 people in 2011 to 2.7 per 100,000 just 2 years later.

Those using heroin for the first time are most likely to be white males, 18 to 25 years old, and living in the Northeast. However, the number of first-time heroin users increased across all ages, races, among men and women, and in every part of the country.

Link to prescription opioids. The most common thread among these new heroin users, according to CDC, is past use of an opioid painkiller, either with or without a prescription. Those who become addicted to painkillers often cross over to use heroin, a similar chemical, to duplicate the opioid effect. CDC found 45% of those who use heroin were addicted to painkillers.

According to the report, “An increase in the rate of heroin overdose deaths has occurred concurrently with an epidemic of prescription opioid overdoses.”

CDC Director Thomas Frieden, MD, told Modern Healthcare there’s a perception that curbing the availability of opioid prescriptions hastens a rise in heroin addiction, but research has found the opposite to be true.

In a recent analysis of 2010-2012 drug overdose deaths in 28 states, CDC found that decreases in opioid death rates were not associated with increases in heroin death rates. “In fact, increases in heroin overdose death rates were associated with increases in prescription opioid death rates,” the report states.

What’s more, a study of opioid painkiller use from 1993 to 2009 found that use of these drugs in hospital settings was a predictor of rising heroin overdose hospitalizations in the years that followed.

Overuse of prescription painkillers is not the only culprit, however. “Changing patterns of heroin use and overdose deaths are most likely the result of multiple, and possibly interacting, factors,” the report said, noting that 9 out of 10 who use heroin use at least 1 other drug, and overdose deaths often involve other drugs or alcohol.

More research is needed to understand the relationship between other drug use and heroin abuse among certain users, so that physicians can identify those at risk for heroin addiction, especially when prescribing painkillers.

Preventing abuse and addiction. Separately, CDC urged healthcare providers to use prescription monitoring programs, to ask patients about past or current drug use when prescribing opioid painkillers, and to use only the lowest dose necessary.

In 2014, a study in The American Journal of Managed Care sought to develop predictive models for possible opioid abuse. The study identified past substance abuse, a history of mental health treatment, and a diagnosis of hepatitis as risk factors.

CDC called on states to require prescription monitoring and take steps to make it easy for doctors to use. State Medicaid and worker’s compensation programs can provide local data to identify and combat overprescribing.

The agency said the federal government is developing prescribing guidelines for chronic pain, supporting the development of electronic databases to track opioid use, and increasing access to substance abuse and treatment through the Affordable Care Act.