Rates of heroin use and heroin use disorder rose dramatically between 2001-2002 and 2012-2013, and the trend was greatest among the white population. The rise among white individuals could be tied to the opioid epidemic, because nonmedical opioid also rose disproportionately in that group, according to research published online March 29.

The findings come from an analysis of 43,093 people who responded to the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), and 36,309 respondents to the 2012-2013 NESARC-III.

Photo of heroin, and hypodermic needle, and a spoon PaulPaladin/thinkstock
Overall prevalence of lifetime heroin use increased from 0.33% in 2001-2002 to 1.61% in 2012-2013, as did the rate of lifetime heroin use disorder (0.21% vs. 0.69%), reported Silvia S. Martins, MD, PhD, of the department of epidemiology at Columbia University, New York, and her associates. While the rates of heroin use among white and nonwhite individuals were comparable in 2001-2002 (0.34% vs. 0.32%), the rates had increased substantially more among white individuals by 2012-2013 (1.90% vs. 1.05% among nonwhites; P less than .001) (JAMA Psychiatry. 2017 Mar 29. doi: 10.1001/jamapsychiatry.2017.0113).

In addition, Dr. Martins and her associates found a significant rise in the number of white heroin users who had started nonmedical prescription opioid (NMPO) use before heroin (35.83% to 52.83%; P =.01). In contrast, the percentage of nonwhite individuals who started off with NMPO use dropped from 44.12% to 26.20% (P = .04).

The increase in heroin use was larger among individuals at less than 100% of the poverty level (0.44% to 2.42%; P less than .001), as well as among people with education levels of less than high school (heroin use, 0.41% to 2.01%; P = .03; heroin use disorder, 0.24% to 0.87%; P = .08) and among those with no more than high school education (heroin use, 0.39% to 2.15%; P =.003; heroin use disorder, 0.29% to 1.11%; P = .003). The absolute values of the findings may be inexact, because the methods of the two surveys differed slightly. In addition, the investigators did not include homeless and incarcerated individuals.

Based on their analysis, Dr. Martins and her associates offered strategies aimed at addressing the crisis. “To curb the heroin epidemic, particularly among younger adults, collective prevention and intervention efforts may be most effective,” they wrote. “Promising examples include expansion of access to medication-assisted treatment (including methadone hydrochloride, buprenorphine hydrochloride, or injectable naltrexone hydrochloride), educational programs in schools and community settings, overdose prevention training in concert with comprehensive naloxone hydrochloride distribution programs, and consistent use of prescription drug–monitoring programs that implement best practices by prescribers.”

NESARC and NESARC-III were funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. The authors received funding from several sources, including the National Institute on Drug Abuse, the New York State Psychiatric Institute, and the J. William Fulbright and the Colciencias doctoral scholarships. One of the study authors, Deborah S. Hasin, PhD, was a principal investigator on a study that was funded by InVentiv Health Consulting, which pool funds from nine pharmaceutical companies.