CDC: Heroin surge tied to prescription opioids

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Heroin use has more than doubled in past decade among young adults aged 18 to 25 years
Figure 1: Heroin use is part of a larger substance abuse problem. Source: National Survey on Drug Use and Health (NSDUH), 2011–13

A new report from CDC links a rampant heroin addiction epidemic across the United States to the rise in people who are addicted to prescription opioids. Those individuals addicted to prescription opioids are 40 times more likely to be addicted to heroin, according to the findings. 


The report, which appeared in a Vital Signs report published in the CDC’s Morbidity and Mortality Weekly Report, found that heroin use has more than doubled in the past decade among young adults aged 18–25 years. While the increase has affected most demographic groups, the report said the greatest increases were occurring in groups with historically lower rates of heroin use, including women and people with private insurance and higher incomes. 


“Heroin use is increasing at an alarming rate in many parts of society, driven by both the prescription opioid epidemic and cheaper, more available heroin,” said CDC Director Tom Frieden, MD, MPH, in a prepared statement. “To reverse this trend, we need an all-of-society response—to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses, and work with law enforcement partners like DEA to reduce the supply of heroin.”


Despite the notion that less prescribing to help restrict prescription opioid access has fueled heroin use and overdose, the report said that a recent analysis of drug overdose deaths in 28 states from 2010 to 2012 found that decreases in prescription opioid death rates within a state were not associated with increases in heroin death rates—“in fact, increases in heroin overdose death rates were associated with increases in prescription opioid overdose death rates,” stated the report.


States, health care providers called to action


CDC is urging health care providers and states to lead efforts that can curb the growing epidemic, including addressing prescription painkiller addiction, increasing access to substance abuse treatment services, and expanding access to and training for administering naloxone to reduce opioid overdose deaths. 


The National Alliance of State Pharmacy Associations said it has seen more states implementing policies giving pharmacists prescriptive authority for naloxone. For example, California, Idaho, New Mexico, and Vermont have a statewide naloxone protocol or prescriptive authority for pharmacists, which also includes a very specific outline for educating pharmacists on naloxone administration. Similar bills have been proposed in North Dakota, Illinois, Ohio, Kentucky, and Connecticut. (See page 78 for more information.)


Naloxone is an opioid receptor antagonist at mu, kappa, and delta receptors that can reverse the effects of an opioid overdose if given in time. Additionally, there are three ways to administer naloxone: with a naloxone handheld auto-injector (Evzio—Kaléo) that was approved by FDA in 2014, an I.M. naloxone rescue kit, or an intranasal rescue kit. 


APhA supports laws and regulations that permit pharmacists to furnish opioid reversal agents to prevent opioid-related deaths due to overdose. 


Study method


The report was based on data that CDC and FDA analyzed from the 2002–2013 National Survey on Drug Use and Health, sponsored by the Substance Abuse and Mental Health Services Administration and the National Vital Statistics System. Using a multivariable logistic regression analysis, characteristics associated with heroin use disorders were identified, and heroin trends among demographic and substance-using groups were compared for 2002–04, 2005–07, 2008–10, and 2011–13. 


The study also found that roughly 96% of those who reported using heroin also reported using at least one other drug in the past year with more than 61% using at least three other drugs. Heroin-involved overdose deaths nearly doubled between 2011 and 2013, and more than 8,200 people died in 2013 alone. 


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