In just two years, deaths from heroin overdoses doubled in the U.S., according to a new report (PDF) from the Centers for Disease Control and Prevention.
In a survey of 28 states, the agency found the death rate increased from 1.0 to 2.1 per 100,000. At the same time, deaths from heroin’s prescription counterparts, opioid pain relievers like hydrocodone and oxycodone, declined from 6.0 per 100,000 in 2010 to 5.6 per 100,000 in 2012.
These fatal drug overdoses are more than twice as common with prescription opioids than heroin, but the gap between the two has narrowed in recent years. In 2008, 1,786 people died from heroin overdoses in the states surveyed. By 2012, the number of those deaths jumped to 3,635. And 9,869 people died from prescription opioids in 2012, a decrease from 2011, back to 2008 levels. Deaths from both make up 57 percent of total drug overdose deaths.
The main force behind the surge seems to be a cocktail of availability, potency, and cost, said Dr. Samuel Ball, president of CASAColumbia, a research organization that focuses on addiction.
While prescription pills can go for $40 each, a small bag of heroin can sell for around $10.
Heroin overdose deaths from 2010 to 2012 increased in every single subgroup examined in the CDC report. Death rates doubled for men and women, increased for all people of all ages, doubled for whites and Hispanics, and nearly doubled for blacks. Prescription opioid death rates dropped 12.4 percent in men and were unchanged in women, declined for people younger than 45 years old, and increased for those aged 55—64, who might have an easier time obtaining and affording prescriptions.
Regionally, the largest heroin overdose deaths between 2010 and 2012 were concentrated in the northeast and the south, areas that saw spikes of 211 percent and 181 percent, respectively. Opioid prescription death rates declined only in the south.
Around three-quarters of addicts get started on opioids through prescription drugs, according to a study published in JAMA Psychiatry this year. Users said they turned to heroin not only because it produced a similar high but because it was cheaper and more readily available.
The study concluded, “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.”
This new data reflects the deadliness of that change.
Facing a flood of emergency room visits and deaths from opioids in recent years, federal and state agencies have worked to curb their over-prescription and abuse.
Many states have enacted legislation—from prescription drug monitoring programs to treatment guidelines—to combat the growing abuse and number of overdoses.
In August, the Drug Enforcement Administration called hydrocodone combination drugs like Vicodin “some of the most addictive and potentially dangerous prescription medications available,” and announced its plan to reclassify them into a category that restricts a prescription to 90 days.
Though the message of the CDC report is clear—prescription opioid overdose and related heroin overdoses are a problem—the silver lining, if there’s one to be found, is that this data doesn’t take into account the potential impact of newly available medication. An injectable drug, naloxone or Narcan, that was approved by the FDA just this year can reverse a opioid overdose by restoring breathing. In many areas, including Rhode Island, where heroin deaths have reached epidemic proportions and continue to rise, naloxone can be purchased without a prescription at Walgreens and CVS.
“It is hoped that the public health, medical, and public safety communities will provide extensive training in the use of Narcan by medical personnel, first responders, family members, and individuals experiencing opioid addiction,” Dr. Ball, of CASAColumbia said.
Also not reflected in this data is a possible link between medical marijuana and decreased opioid overdose deaths. A recent study published in the Journal of the American Medical Association found that states with medical marijuana laws had an opioid overdose death rate 25 percent lower compared with states where marijuana for medical purposes remained illegal.