The number of heroin users in the U.S. has grown by nearly 300,000 over a decade, with a corresponding 90% increase in the rate of heroin abuse, according to a new report by the Centers for Disease Control and Prevention.
The report, based on data from the National Survey on Drug Use and Health and the National Vital Statistics System, shows a dramatic rise in heroin use, abuse, and overdose deaths between 2002 and 2013.
In the most recent survey data from 2013, nearly three in every 1,000 Americans said they used heroin in the previous year. That’s a 62% increase from a decade ago, which translates to hundreds of thousands of new heroin users, the CDC researchers said. In all, the report found that more than half a million people used heroin in 2013, an increase of nearly 150% since 2007.
So what’s behind the massive surge in heroin use? It really comes down to supply and demand:
- First, opiate painkillers such as Vicodin and OxyContin have become less available and more expensive. As the DEA cracks down on pill mills and places even stricter regulations on painkillers, fewer people are able to obtain the drugs through a prescription, resulting in a dwindling supply for the illicit market. This, in turn, is making painkillers harder to find and much more expensive. Many drug companies have also made their pills harder to crush and snort. Consequently, some people were already hooked on pills began to turn to heroin, which has a similar effect on the brain as opiate painkillers.
- Second, heroin has become more widely available, and it’s cheap (and potent). Despite a decades-long war on drugs, the U.S. Justice Department’s National Drug Intelligence Center says that heroin “remains widely available in many U.S. drug markets,” with ” increasing [availability] in some areas.” And according to a 2013 review of drug surveillance databases, the price of heroin (and other illicit drugs) has fallen by more than 80% over the last two decades, while the purity and potency have risen by an average of over 60%. This suggests that global efforts to combat illegal drugs “have failed to curb supply,” the researchers concluded. Today, prescription opiates sell for about $1 per milligram, “so a 60-milligram pill will cost $60,” CNN reports. “You can obtain the equivalent amount of heroin for about one-tenth the price.”
As science writer David DiSalvo points out, the sharp increase in heroin use has overlapped with a decrease in pain killer abuse. The number of new non-medical users of pain killers dropped from 2.2 million in 2002 to 1.9 million in 2012. Meanwhile, the number of new heroin users rose by 300,000 during that same time period. The reason for this shift is clear, DiSalvo writes, and it comes down to basic economics:
Illegally obtained prescription pain killers have become more expensive and harder to get, while the price and difficulty in obtaining heroin have decreased. An 80 mg OxyContin pill runs between $60 to $100 on the street. Heroin costs about $9 a dose. Even among heavy heroin abusers, a day’s worth of the drug is cheaper than a couple hits of Oxy.
Notably, heroin use has increased across nearly all demographic groups, even among those who have historically had some of the lowest rates of use. For instance, heroin use has doubled among women and non-Hispanic white people.
“With that increase we are seeing a dramatic rise in deaths,” said CDC director Dr. Tom Frieden. According to the CDC report, the rate of death by heroin overdose nearly quadrupled between 2002 and 2013, with 8,200 people dying in 2013.
How heroin affects the brain
When someone injects, snorts, or smokes heroin, the brain converts it into morphine. Morphine binds to molecules on cells located throughout the brain and body called opioid receptors, which affect how we perceive pain and rewards.
This explains the surging sense of euphoria that many people feel when they inject the drug straight into the bloodstream, which is the fastest route of administration. After the initial “rush,” the skin gets flushed and warm, the arms and legs start to feel heavy, and thinking slows.
Because we also have opioid receptors in our brain stem — the body’s main control center that is in charge of automatic processes such as blood pressure and breathing — overdosing on heroin can slow and even stop breathing, leading to brain damage, coma, and/or death.
Heroin is particularly easy to overdose on; since the potency and purity can change dramatically, users have no idea how much they are putting in their bodies. This is reflected in the new CDC data. With an estimated 500,000 heroin users and more than 8,000 deaths in 2013, that means nearly 1 in 50 people who use heroin in any given year can expect to die from it.