US - Heroin use up in all ages and social groups - deaths climbing almost 200% since 2008 - linkage to "great recession"?

[sharon sanders]

[h=1]Today?s Heroin Epidemic[/h]
http://www.cdc.gov/vitalsigns/heroin/index.html


More people at risk, multiple drugs abused



Language: English

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[h=4]On this Page[/h]

• Overview
• Problem
• Infographics
• What Can Be Done
• Issue Details

[h=3]Overview[/h] Heroin use has increased across the US among men and women, most age groups, and all income levels. Some of the greatest increases occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes. Not only are people using heroin, they are also abusing multiple other substances, especially cocaine and prescription opioid painkillers. As heroin use has increased, so have heroin-related overdose deaths. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people died in 2013. States play a central role in prevention, treatment, and recovery efforts for this growing epidemic.
[h=4]States can:[/h]

• Address the strongest risk factor for heroin addiction: addiction to prescription opioid painkillers.
• Increase access to substance abuse treatment services, including Medication-Assisted Treatment (MAT), for opioid addiction.
• Expand access to and training for administering naloxone to reduce opioid overdose deaths.
• Ensure that people have access to integrated prevention services, including access to sterile injection equipment from a reliable source, as allowed by local policy.
• Help local jurisdictions to put these effective practices to work in communities where drug addiction is common.

Want to learn more? www.cdc.gov/vitalsigns/heroin

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Heroin use more than doubled among young adults ages 18?25 in the past decade.
More than 9 in 10 people who used heroin also used at least one other drug.
45% of people who used heroin were also addicted to prescription opioid painkillers.






[h=3]Problem[/h] [h=4]Heroin use is increasing, and so are heroin-related overdose deaths.[/h] [h=5]How is heroin harmful?[/h]

• Heroin is an illegal, highly addictive opioid drug.
• A heroin overdose can cause slow and shallow breathing, coma, and death.
• People often use heroin along with other drugs or alcohol. This practice is especially dangerous because it increases the risk of overdose.
• Heroin is typically injected but is also smoked or snorted. When people inject heroin, they are at risk of serious, long-term viral infections such as HIV, Hepatitis C, and Hepatitis B, as well as bacterial infections of the skin, bloodstream, and heart.

[h=5]Who is most at risk of heroin addiction?[/h]

• People who are addicted to prescription opioid painkillers
• People who are addicted to cocaine
• People without insurance or enrolled in Medicaid
• Non-Hispanic whites
• Males
• People who are addicted to marijuana and alcohol
• People living in a large metropolitan area
• 18 to 25 year olds

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[h=3]Infographics[/h]
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[h=3]What Can Be Done[/h] [h=4]The Federal government is[/h]

• Providing educational training and resources to health care providers so they can make informed decisions and ensure the appropriate prescribing of opioid painkillers. This includes:
  • Developing prescribing guidelines for chronic pain.
  • Supporting the use of prescription drug monitoring programs (electronic databases that track the dispensing of certain drugs) as a routine part of clinical practice.
• Increasing access to substance abuse treatment services through the Affordable Care Act.
• Expanding use of Medication-Assisted Treatment (MAT).
• Supporting the development and distribution of the life-saving drug naloxone to reduce prescription opioid painkiller and heroin overdose deaths.
• Supporting the research, development, and approval of pain medications that are less prone to abuse.
• Improving surveillance to better track trends, identify communities at risk, and target prevention strategies.

[h=4]States can[/h]

• Address the strongest risk factor for heroin addiction: addiction to prescription opioid painkillers.
  • Make prescription drug monitoring programs timely and easy to use. Providers can analyze patient prescription drug history and make informed decisions before prescribing opioid painkillers.
  • Look at the data and practices of state Medicaid and worker's compensation programs to identify and reduce inappropriate prescribing.
• Increase access to substance abuse treatment services, including MAT for opioid addiction.
  • Work with Medicaid and other insurance companies to provide coverage for MAT.
  • Support adoption of MAT in community settings.
• Expand access to and training for administering naloxone to reduce opioid overdose deaths.
• Ensure that people have access to integrated prevention services, including access to sterile injection equipment from a reliable source, as allowed by local policy.
• Help local jurisdictions to put these effective practices to work in communities where drug addiction is common.

[h=4]Health care providers can[/h]

• Follow best practices for responsible painkiller prescribing to reduce opioid painkiller addiction, the strongest risk factor for heroin addiction:
  • Use prescription drug monitoring programs and ask patients about past or current drug and alcohol use prior to considering opioid treatment.
  • Prescribe the lowest effective dose and only the quantity needed for each patient.
  • Link patients with substance use disorders to effective substance abuse treatment services.
• Support the use of Food and Drug Administration approved MAT options (methadone, buprenorphine, and naltrexone) in patients addicted to prescription opioid painkillers or heroin.

[h=4]Everyone can[/h] Learn more about the risks of using heroin and other drugs.

• Learn how to recognize and respond to an opioid overdose.
• Get help for substance abuse problems: 1-800-662-HELP.

For more information on MAT and naloxone, visit SAMHSA at: www.samhsa.gov.

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[h=3]Issue Details[/h]

• Related Pages
• Other Sites
• Science Behind the Issue

• Vital Signs Issue details: Demographic and Substance Use Trends Among Heroin Users ? United States, 2002?2013, Morbidity and Mortality Weekly Report (MMWR)
• Vital Signs ? Today?s Heroin Epidemic [PODCAST - 1:15 minutes]
• Vital Signs ? Today?s Heroin Epidemic [PSA - 0:60 seconds]
• Vital Signs: Opioid Painkiller Prescribing: Where You Live Makes a Difference
• Vital Signs: Prescription Painkiller Overdoses: A Growing Epidemic, Especially Among Women
• Vital Signs: Prescription Painkiller Overdoses: Use and Abuse of Methadone as a Painkiller
• Vital Signs: Prescription Painkiller Overdoses in the US
• CDC Prescription Drug Overdose
• Common Elements in Guidelines for Prescribing Opioids for Chronic Pain
• Data Brief: Drug-poisoning Deaths Involving Heroin: United States, 2000?2013
• Press Release: Heroin overdose deaths increased in many states through 2012
• Prescription Drug Overdose Prevention for States

 

[Emily]

The rise in heroin use is a response to overuse of oxy and other opiates - that's why we see it in more affluent populations who have or had access to doctors, (as opposed to meth which is more common among the working class or poor.)

By Nancy Rommelmann
June 5, 2015 3:18 p.m. ET
...
OxyContin and heroin are very similar on a molecular level. Both are highly addictive; both transport the user to a rapturous state followed by a plunge into pain and sickness alleviated only by more of the drug. “Like no other particle on earth, the morphine molecule seemed to possess heaven and hell,” writes Mr. Quinones. For “Dreamland,” he spoke with “parents whose children were still alive, but who had shape-shifted into lying, thieving slaves to an unseen molecule.” He met teenage boys from dirt-poor ranchos around the Nayarit city of Xalisco who scrambled their way to Los Angeles’s San Fernando Valley to sell heroin. He spoke with addicts, past and present. And he learned how a single paragraph published in the New England Journal of Medicine in 1980 came to support a pharmaceutical industry intent on pushing as many opiates as doctors would prescribe and patients would take.

http://www.wsj.com/articles/the-grea...oom-1433531938

RICHARD D. OXLEY, North Kitsap Herald Reporter
Oct 11, 2013 at 7:00AM
...
The only other needle exchange available to the Kitsap region is a volunteer organization run by Monte Levine for the past 18 years. He too has noticed the jump.
“The spike started in the spring of 2011 and I believe it was in a reaction to the reformulation of pharmaceuticals,” Levine said. “Within a matter months the number people we served tripled.”
Pills and needles
Levine is not alone in his opinion about prescription pain medications.
“There was a change in the ’90s in this country and a bit of a head slap on how doctors had been under-medicating pain,” Freng said. “And the pendulum didn’t go to the middle, it went to the other side.”
...
Manufacturers of the prescription drugs, however, have reacted to the street use and have altered its makeup, making it less smokable. Providers have become more guarded as well, and the pills are now more difficult to access.
The combination of factors have led some to switch from the pill to heroin for an opiate high.
“The segue to heroin is usually from prescription opiates,” the 20-something Kitsap man said. “I don’t know anybody who went straight to pick up heroin as a habit. It’s usually a result of a dependency from prescription drugs. People become dependent on pills, for whatever reason, and they become addicted. It’s easy to make that transition to heroin.”
...

http://www.northkitsapherald.com/news/227295441.html#

Heroin Makes a Comeback
This Time, Small Towns are Increasingly Beset by Addiction, Drug-Related Crimes
By Zusha Elinson and Arian Campo-Flores
Updated Aug. 8, 2013 12:23 a.m. ET
..
The drug surfaced in the past two years and is spawning a new generation of addicts. The fatal overdose of a state trooper's son in May convulsed the town—especially when the two men arrested and charged with selling him heroin turned out to be a county official's sons. They pleaded not guilty in Kittitas County Superior Court and are awaiting trial.

http://www.wsj.com/articles/SB100014...40531575133750

Here's an article about the junky black tar heroin circulating in the US, (vs the cleaner white heroin Canadians get cheaply from Asia.):

Levine has noticed that while use has dramatically risen, the purity of the black tar has dropped.
“What we are getting is of very low purity,” he said. “This stuff smells like vinegar, it’s very acidic.”
The acidity can wreak havoc on a user’s veins.
“We are seeing a lot of vein damage,” Levine said. “The stuff is so weak it takes a large amount to get high from it once you have a tolerance built up.”
The acidic smell is likely the result of the black tar process, Rodriguez said.
“They adulterate it with some chemicals that give it that smell,” Rodriguez said.
The poor quality can take a toll on users, such as overdoses, and more.
“We are seeing young people under the age of 25 that are losing their legs because of their femoral vein being damaged,” Levine said.

• RICHARD D. OXLEY, North Kitsap Herald Reporter

http://www.northkitsapherald.com/news/227295441.html#

 

[Pathfinder]

Press Releases

RIDOH Monthly Overdose Death Data Show Spikes in Fentanyl-Related Deaths and Illicit Drug Overdose Deaths

Spike in Fentanyl-Related Overdose Deaths

The results of initial toxicology screens suggest that Rhode Island is experiencing a significant increase in accidental opioid overdose deaths that involve the synthetic drug fentanyl. Although the results of confirmatory tests are still pending, these initial screenings suggest that fentanyl could have been involved in approximately 60% of overdose deaths in March, April, and early May. This figure is a significant increase over the approximately 47% of fentanyl-related overdose deaths in 2015. Law enforcement, Rhode Island emergency departments, and outreach workers have reported similar increases in recent weeks and months.

The Dangers of Fentanyl, and Increased Need For Naloxone

Fentanyl is an opioid that is more powerful than heroin, and that is often added to heroin to make supplies more profitable. The addition of even slight traces of fentanyl to heroin, which is a lethal narcotic on its own, increases the deadliness of heroin significantly. Recent victims have reported using heroin without being told by their suppliers that it had been altered with fentanyl.

In working to communicate this warning to heroin users and first responders, the Rhode Island Department of Health (RIDOH) and the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) will also communicate that additional doses of naloxone are often needed when responding to fentanyl-related overdoses. In some instances, two or three doses of naloxone are needed. Naloxone is a medication that reverses an overdose, and is often carried by people with substance use disorders and their family members.

"People are injecting, swallowing, and snorting this drug without realizing that they are often breathing their last breaths. Unfortunately, fentanyl kills, and it kills quickly," said Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Island Department of Health (RIDOH). "In many instances, people don't know that they are taking fentanyl. If someone around you uses heroin or fentanyl, make sure you have naloxone, and if you think that someone around you is overdosing, call 911 as soon as possible. Every second counts."

Changing Trends in Rhode Island's Drug Overdose Crisis

Since 2012, there has been a 135% increase in illicit drug overdose deaths in Rhode Island, and a 34% decrease in prescription drug overdose deaths. In this time, the total number of drug overdose deaths has continued to rise steadily. In 2012, there were 182 drug overdose deaths in Rhode Island, compared to at least 257 in 2015.

The shifts in prescription and illicit drug overdose deaths may be due to a number of factors. During this time, we have seen growth in the global heroin market, and increases in the accessibility of synthetic and research chemicals, including fentanyl. The number of overdose deaths related to fentanyl has increased 15-fold since 2012.

The shifts in prescription and illicit drug overdose deaths also began roughly when more focused efforts were undertaken nationally to reduce the supply of prescription drugs. In Rhode Island, there was a 35% decrease in the number of Schedule 2 and Schedule 3 drugs prescribed between December 2011 and February 2016.

During tomorrow's monthly meeting of the Overdose Prevention and Intervention Task Force, Governor Gina M. Raimondo will release a detailed action plan developed to address the drug overdose crisis in Rhode Island. The meeting will take place at 11 a.m. at the Rhode Island Department of Administration (One Capitol Hill, Providence, RI 02908) in Conference Room 2A.

Strategies in the plan are all intended to address substance use disorders among people using both illicit and prescription drugs. These strategies include expanding access to medication-assisted treatment, increasing the number of peer recovery coaches in Rhode Island, and pushing naloxone into the community.

Related links

http://www.ri.gov/press/view/27491