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Demographics of heroin users shifted since the 1960s

Heroin users of today are predominately white men and women aged in their late 20s living outside of large urban areas vs. heroin users from the 1960s, who were predominately young urban men, according to recent study findings published in JAMA Psychiatry.

Theodore J. Cicero, PhD, of the department of psychiatry at Washington University in St. Louis, and colleagues evaluated 2,797 adults with a heroin use/dependence diagnosis entering treatment centers from the Survey of Key Informants’ Patients (SKIP) study as well as another 54 adults with a heroin use/dependence diagnosis from the Researchers and Participants Interacting Directly (RAPID) study. Researchers sought to determine the relationship between prescription opioid and heroin abuse.

Theodore J. Cicero

Of the SKIP study participants, 75.2% reported currently living in small urban or nonurban areas rather than in large urban areas.

Any kind of substance abuse in the past month was reported by 98.5% of all participants while 86.4% used heroin once a day and 66% abused prescription opioids at the same time as heroin in the 30 days before treatment.

When asked when abuse began, 88 SKIP participants reported their use began in the 1960s compared with more than 1,600 in the 21st century. However, of those who began to abuse opioids in the 1960s, more than 80% said they started abuse with heroin vs. 75% in the 21st century who began with prescription opioids.

Of SKIP participants who began abuse in the 1960s, 82.8% were men, whereas the ratio of men to women was nearly equal by 2010. Also, in 2010, 90.3% of users were white.  

Ninety-eight percent of participants from the RAPID study reported the “high” from heroin as their reason for use, and ease of inhalation or injection determined use in 31.7%. Heroin cost and ease of attainment was a reason for use for 94% of RAPID participants.

“Today’s heroin addicts are not the ‘dirty junkies’ that was the public perception decades ago, but are now main stream males and females, generally middle class, who began their opioid careers with prescription drugs, such as oxycodone, Vicodin, and Percocet, and then graduated to heroin,” Cicero told Healio.com. “Often they resorted to heroin as a cheaper alternative to their drug of choice, a prescription opioid. As such, physicians need to realize that some of the patients they least suspect to have a heroin use problem may indeed have one and they should be treated accordingly.”

Theodore J. Cicero, PhD, can be reached at Box 8134, 660 S. Euclid Ave., St. Louis, MO 63110; email: cicerot@wustl.edu.

Disclosure: Cicero and another researcher report serving as consultants on the scientific advisory board of the nonprofit postmarketing surveillance system RADARS.