How to fight rising heroin and opiate use

Dana Eser Hunt, PhD, is a Principal Scientist with Abt Associates. Dr. Hunt has conducted research in the areas of crime and addictions for over 30 years. She is currently the principal investigator in the Arrestee Drug Abuse Monitoring (ADAM) annual survey funded by the Office of National Drug Control Policy.

The recent State of the State address by Vermont Governor Peter Shumlin sounded the alarm on the rampant opiate problem in his state, underscoring a coming tidal wave that researchers have been seeing for years: heroin is back, attracting a younger audience in suburbia and small towns.

I began studying heroin use during my doctoral work in Philadelphia in the 1970s, in the middle of what was known as a heroin epidemic. I witnessed the burgeoning heroin addict groups at that time: young men and women living in urban areas who were starting use in their mid-teens. Over the next few decades, I saw their struggle with addiction in treatment facilities and jails.

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Several years later, things began to change. My research took me to New York City in the 1980s to conduct a three-state ethnographic study of methadone treatment, and the majority of addicts were part of an aging group, carryovers from another time. What changed? Crack had arrived and heroin lost its appeal, especially to the young. The ever-present threat of HIV and all-out effort to stop injection of drugs by prevention and treatment communities made shooting heroin a less attractive option, particularly to novice users who were not yet addicted.

Unfortunately, the pendulum swung again. The 1990s brought the widespread availability of higher purity heroin that made snorting or smoking the drug possible. This shift produced an increasing number of users, including youth that appeared in national survey data in the mid-1990s. In the big cities, the increase in heroin use again faded somewhat as the new century began. In major hubs for heroin distribution, such as New York and Chicago, data from ER visits, treatment admissions and arrest records showed that heroin users were an aging group with fewer young recruits.

Over the last few years, research shows that heroin use in general and among new young users in particular is increasing in unlikely places.

The government’s Arrestee Drug Abuse Monitoring Program interviews and takes a urine sample from male arrestees in specified cities across the country within 48 hours of arrest. Data from this program show that in the years between 2000-2013, the proportion of arrestees 18-24 years old who test positive for heroin when they are arrested has increased by more than 20 percent in unlikely cities such as Minneapolis and Indianapolis. Places such as Upstate New York, rural New Hampshire, small towns in Vermont, Maine, and counties in the Midwest are starting to see a rise in heroin use in areas that historically were relatively untouched by the drug.

Reports of young users who are just starting down a path toward addiction in new areas and increased use in established areas are all too familiar. But where are they coming from and why heroin? For starters, many young users begin with prescription opiates commonly found in home medicine cabinets, move to the less expensive and, in many areas, more accessible heroin. These pharmaceuticals have high opiate content for therapeutic reasons, so when an abuser of the drugs moves to the cheaper and readily available heroin as a substitute, he/she is into a significant street habit needed to avoid withdrawal. And street availability also plays a role. Suburban police report that heroin is available in their towns, and urban departments report availability at an all-time high.

What can we do to stop this current cycle? Law enforcement always plays a role, but identifying and providing services to youth who are at risk, no matter where they live or what their socioeconomic status, is just as critical. We also need treatment that is specific to the problem, with providers who are specially trained to deal with narcotic addition and who are accessible to the young user.

Perhaps just as important: We must undo the collective amnesia about the damage heroin does to the youth and a belief that the readily available prescription opiates are somehow “not the same thing” as the more stigmatized heroin. Parents who may remember an earlier era must overcome the disbelief that their child or community could be involved with heroin. It is critical that we act before we have yet another generation of people struggling with heroin addiction.