Heroin Epidemic Expands Its Grip on America. medlineplus.gov.  March 29, 2017.Use of the narcotic grew 5-fold in a decade, helped by scourge of prescription painkiller abuse.Heroin use in the United States jumped fivefold over a decade, and young, white males are the epidemic’s most likely victims, a new study finds. One addiction specialist blamed the lax use of prescription opioid painkillers — narcotics such as Oxycontin, Percocet and Vicodin — for the surge in heroin use.

"A nation awash with prescription opioids has led to a large increase in addiction, overdose deaths and transition to heroin-fentanyl [a powerful synthetic opioid]," said Bertha Madras, a professor of psychobiology at Harvard Medical School. She wrote an editorial that accompanied the study.
The issue is so pressing that President Donald Trump plans to announce the formation of a commission to investigate the opioid epidemic in the United States on Wednesday. New Jersey Gov. Chris Christie will chair the commission. The Trump administration also named Richard Baum to serve as acting director of National Drug Control Policy.
Opioid overdose kills about 78 people a day in the United States. In 2015, more than 33,000 died of opioid overdoses, which was a record high, according to the U.S. Centers for Disease Control and Prevention.
The latest research only adds more troubling statistics on the trend.
In the study, Columbia University researchers surveyed more than 79,000 people and found the proportion of Americans using heroin jumped from less than 1 percent in 2001-2002 to nearly 2 percent in 2012-2013. The prevalence of heroin addiction increased threefold, from way below 1 percent to nearly 1 percent, the researchers reported.
And the increases have been seen most among the disadvantaged, according to lead researcher Dr. Silvia Martins. She is an associate professor of epidemiology at the Mailman School of Public Health at Columbia, in New York City.
"While heroin use is now more widespread among individuals of all social classes and among those with stronger bonds to social institutions, relative increases in heroin use and use disorder across time were greater among less educated and poorer individuals," Martins said.
These are concerning trends because increases are occurring among vulnerable people who have few resources to overcome the problems associated with heroin use, she added.
The increase in the prevalence of heroin is related to the prescription opioid epidemic, as people transition from painkillers to heroin, Martins explained. It is also related to availability, lower cost and the dangerous characteristics of heroin sold today.
"There is more heroin laced with fentanyl [a powerful synthetic narcotic] than in the past," Martins noted.
The researchers also found that the increase in the use of heroin was higher among whites, rising from about 1 percent in 2001-2002 to nearly 2 percent in 2012-2013. Among non-whites, it rose from less than 1 percent in 2001-2002 to just over 1 percent in 2012-2013.
Among white people, the path to heroin use often started with non-medical use of prescription opioid painkillers, rising from about 36 percent in 2001-2002 to nearly 53 percent in 2012-2013, the investigators found.
It’s estimated that about 80 percent of heroin users transitioned from prescription opioids, Martins added.
The findings were published online March 29 in the journal JAMA Psychiatry.
To curb the heroin epidemic — particularly among younger adults — prevention and intervention efforts may be most effective, including access to medication-assisted programs and overdose prevention programs, Martins suggested.
Madras offered this historical analysis of the heroin crisis: "The root causes of this sea change were triggered by two reports that opioids are safe for long-term management of non-cancer pain."
After these two papers were published, in 1980 and 1986, pressure from pain patients, financial interests and pain societies led to designation of pain as the fifth vital sign, she explained.
"We now have a vast increase in lamentable, preventable opioid addiction and overdose deaths not seen in our history," Madras said.
It doesn’t matters if an addictive drug is a legal medicine or an illicit drug, she pointed out. "This crisis has reinforced the view that reducing supply and demand are essential to national drug control policies," she said.
"There is a dire need for a national, effective campaign specific for different populations — such as the public, patients and physicians — on the life-threatening hazards of opioid-induced addiction and overdose and street heroin/fentanyl," Madras said.
"We must not lose any more people, many in the prime of their lives, to drug overdoses," she stated.
SOURCES: Silvia Martins, M.D., Ph.D., associate professor, epidemiology, Mailman School of Public Health, Columbia University, New York City; Bertha K. Madras, Ph.D., professor, psychobiology, department of psychiatry, Harvard Medical School, McLean Hospital, Belmont, Mass.; March 29, 2017, JAMA Psychiatry, online
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