The Tiny Numbers Behind the 'Heroin Epidemic'

The other day I noted that, despite the talk of "soaring" and "skyrocketing" heroin use in the wake of Philip Seymour Hoffman's death, the percentage of the population consuming the drug remains very low. In 2012, the most recent year for which data are available from the National Survey on Drug Use and Health (NSDUH), 0.3 percent of respondents reported that they had used heroin in the previous year, up from 0.2 percent in 2011. One commonly heard explanation for the increase is that a crackdown on nonmedical use of prescription painkillers made them more expensive and harder to get, driving users of drugs like OxyContin to heroin. Here is how NPR puts it in a story that aired yesterday:

When you talk to people who use heroin today, almost all of them will tell you that their opioid addiction began with exposure to painkillers, says Dr. Andrew Kolodny, chief medical officer for the Phoenix House Foundation and president of Physicians for Responsible Opioid Prescribing.

"The main reason they switched to heroin is because heroin is either easier to access or less expensive than buying painkillers on the black market," he says....

As patients became addicted, doctors began cutting back their prescriptions, drug companies agreed to make the pills less snortable, and states created registries of patients who doctor-shopped for prescriptions.

Experts say that's when heroin suppliers stepped in to fill the void.

The NSDUH data (below) provide some support for that theory. Between 2011 and 2012, the share of respondents reporting past-month use of OxyContin fell by 50 percent, while the share reporting past-year use of heroin rose by 50 percent. Then again, the rate for past-year use of OxyContin remained steady (as did the rate for past-month use of heroin), while past-year and past-month use of all prescription opioids rose. The last time past-year heroin use rose—between 2007 and 2008, when it doubled from 0.1 percent to 0.2 percent—painkiller use did fall, but past-month OxyContin use rose, while past-year OxyContin use remained steady.

NSDUH dataNSDUH data

If you look at raw numbers, the evidence seems similarly mixed. The number of past-month heroin users rose from 281,000 to 335,000 between 2011 and 2012, while the number of past-month OxyContin users fell from 434,000 to 358,000, which is consistent with the hypothesis that some people switched from OxyContin to heroin. Between 2007 and 2008, however, the number of past-month heroin users rose from 153,000 to 213,000, while the number of past-month OxyContin users also rose, from 369,000 to 435,000. 

Assuming that heroin is substituting for opioids like OxyContin, that is probably not a desirable development, since a black-market product is much less predictable and therefore more dangerous than a legal, pharmaceutical-quality drug. Yet Kolodny, the addiction specialist who says increased restrictions on painkillers are driving up heroin use, argues that the solution is...more restrictions on painkillers. That's a bad idea not just because of potentially harmful substitution effects but also because attempts to prevent nonmedical users from obtaining opioids inevitably hurt patients who need the drugs to relieve pain.

Notice, by the way, that past-month heroin use—a necessary but not sufficient requirement for addiction—has held steady at 0.1 percent for a decade. The raw numbers have increased (from 166,000 in 2002 to 335,000 in 2012), but not enough to kick the rate up a tenth of a percentage point. That fact helps put into perspective the numbers behind what NPR describes as a "heroin epidemic." 

Addendum: Kolodny contacted me to clarify that he wants to prevent new cases of addiction by encouraging more- careful prescribing practices and putting hydrocodone combination products such as Vicodin in a more restrictive category (Schedule II rather than Schedule III), while simultaneously increasing access to treatment for current addicts.

[Thanks to Robert Woolley for the NPR link.]

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  • Killaz||

    Yeah, but when a famous person dies, his life is worth like a million commoners. Add that, someone so talented, and so young, it's as if 150 million Americans are shooting up every day.

    Also, fried chicken.

  • ||

    Way to NutraSweet the link, dope. If we needed another NutraSweet we'd get him to take a huge dump and then there would be two of him.

  • Killaz||

    Ah, shit. Notepad++ autofill and then paste and dump works everywhere else but here.

  • Killaz||

  • Sevo||

    Plain old links work everywhere.
    http://reason.com/blog/2014/02.....de#comment

  • Killaz||

    But, I wanted to make it pretty.

  • ||

    You can never be pretty! Accept it!

  • Sevo||

    Killaz|2.5.14 @ 1:37PM|#
    "But, I wanted to make it pretty."

    Well, since there are mirrors in the Sevo bathroom, I've long ago given up on 'pretty'.

  • SugarFree||

    I'm working on it.

  • ||

    Eat more meat. And corn. And laxatives.

  • Killaz||

    Shooting out of Sugarfree's butt, wouldn't that actually create a scag bile bomb?

  • ||

    How are those things different?

  • Killaz||

    Well, one blows up when you poke it, and the other just screams for more.

  • CampingInYourPark||

    ...attempts to prevent nonmedical users from obtaining opioids inevitably hurt patients who need the drugs to relieve pain.

    Why can't people just take a swig of whiskey and bite down on a leather belt like the good old days?

  • Killaz||

    Good old days that whiskey would actually be laudanum.

  • pan fried wylie||

    "Whisky Plus"

  • Snark Plissken||

    The original Whiskey Sour.

  • Paul.||

    What happened to Phillip Seymour Hoffman?

  • NSA Corey||

    He was getting nosy about surveillance.

  • GILMORE||

    He was great in Capote

  • NSA Corey||

    a movie that was not filmed in the US of A!

  • GILMORE||

    OMG are you suggesting he was Canadian?

  • GILMORE||

    ....Nine....

  • ||

    He was overrated, and then he was overdosed. It happens.

  • waffles||

    But isn't he more overrated after the overdose?

  • ||

    I don't know, I'm kind of overwhelmed by the overrating after the overdose. Let's just throw the whole thing overboard.

  • Sevo||

    Who?

  • Killaz||

    PSH, or the guy with one too many names so he gets abbreviated. Serves him right.

  • Sevo||

    There was a huckster peddling stereos in SF years ago; Steven David Matthew. 'Low down payment, terms, etc'.
    Don't play poker with a guy named Doc and never trust anyone with three first names.

  • PD Scott||

    Oh, like it's my fault some people take a perfectly decent geographically/tribally based last name and use it for a first name!

  • waffles||

    Heath Ledger

  • ||

    The nerdy kid in the Breakfast Club.

  • EDG reppin' LBC||

    Philip Michael Thomas?

  • GILMORE||

    DEAR ZOG PSH IS NOW AN OFFICIAL TOPIC LINK @ H&R

    PSH is now the official mascot of H&R.
    WWPSHD? Shoot smack and die! eerrhhhhhaaahgggggggggssshh.

    I don't know why, but this came to mind=
    http://www.youtube.com/watch?v=s2-LEBc2sO8

  • ||

    BLOODHOUND GANG BITCHES

    Man I love that show. Did everyone get that, or was it just those of us who got WGBH out of Boston and WNET out of New York?

  • EDG reppin' LBC||

    We got it in Indianapolis.

  • Sevo||

    We recently had a 200% increase in bums in our neighborhood! There was one for a long period of time and then the population exploded!

  • ||

    They're reproducing, like tribbles. You need some Klingons to frighten them into not mating, or something.

  • sarcasmic||

    What did tribbles eat?

  • ||

    Romulans, I think. It's all a little hazy.

  • sarcasmic||

    I don't recall Kirk having a stash of Romulans in every cupboard on the ship, but I could be wrong.

  • SugarFree||

    They were all poisoned by gorging on tainted corn, so human starches at a minimum.

    SPOILER ALERT

  • Pro Libertate||

    GMO wheat.

  • sarcasmic||

    Whenever I see people use percentages instead of numbers I assume they're misleading.

  • Killaz||

    You are right about that 87% of the time, but if you need to convert those numbers for whatever reason, percentages are really helpful.

  • ||

    Everything I know about heroin I learned from Phil Anselmo. Who also started with painkillers.

  • John||

    Everything I learned, I learned from Keith Richards. He is still alive. He must know something.

  • hotsy totsy||

    Keith just celebrated his 30th wedding anniversary with Patti Hansen. They have two grown daughters. He sounds pretty stable.

  • Francisco d Anconia||

    PSH = The new Lou Reed

  • John||

    I think the "take a trend number and draw it off to infinity and write about the coming 'epidemic' or 'explosion'" is the laziest for of issue journalism there is. And since people are stupid enough to believe it, it will never die.

    This should go without saying so I will say it anyway. Society has self correcting mechanisms. Being a heroin junkie is not a very appealing lifestyle to many people. So there is a natural limit of the total number of junkies in the world and it is pretty low and generally pretty close to the number of actual junkies. There will be no heroin epidemic.

  • sarcasmic||

    There will be no heroin epidemic.

    But, but, but heroin is contagious!

  • John||

    You can get it from a toilet seat.

  • SugarFree||

    "I don't care how carefully you cleaned it, I'm not snorting coke off a toilet seat."

  • John||

    But the high is so much better dude.

  • sarcasmic||

    Fifteen years ago I would have.

  • sarcasmic||

    When I tried it it was a dealer taking advantage of my being too drunk to fight him off, not a toilet seat.

    And somehow I didn't turn into a junkie.

    The high was great. Too great. I will never touch the stuff again.

  • John||

    You mean you have chosen not to be a drug using degenerate sarcasmic? That is impossible!! Drugs make people irrational.

  • sarcasmic||

    The fact that I knew a guy who OD'd might have had something to do with it.

  • John||

    It is almost as if people learn from the mistakes of others or something.

  • sarcasmic||

    Sucks because he was a really nice guy. Dave was his first name. Don't remember his last name. All the other junkies I knew were worthless pieces of shit. But the nice guy had to die while all the assholes lived.

  • KDN||

    But the nice guy had to die while all the assholes lived.

    That seemed to be the end result in Trainspotting, too.

    My cousin was a heroin addict for about 15 years. Physically, he's none the worse for wear. He also might be the biggest piece of shit I know. I think there's a pattern here.

  • waffles||

    We can't have people learning from mistakes. People must be protected from the consequences of their own decisions.

  • Snark Plissken||

    I tried it a few times didn't find it that amazing, perhaps it didn't jive with my biochemistry, or maybe because I was also drinking.

  • ||

    Stop saying that word! You're just infecting everyone!

  • SweatingGin||

    How can you say that?!! By 2040, everyone in the country will be on heroin!

  • Ted S.||

    I think the "take a trend number and draw it off to infinity and write about the coming 'epidemic' or 'explosion'" is the laziest for of issue journalism there is.

    http://xkcd.com/605/

  • John||

    Extrapolation, the one subject in statistics class journalists didn't sleep through.

  • Francisco d Anconia||

    If you were to post that over at Salon, what percentage would get it?

  • Mongo||

    The Mplx paper today has an article where a record number of heroin deaths were recorded in the county last year (I'm not linking to it as I don't want my post marked spam and that just pisses me off).

    Anyway, officials aren't sure if it's because the dope has fentanyl or other crap in it.

  • Mongo||

    http://www.startribune.com/opi.....94421.html

    54 deaths last year as compared with 8 in 2010.

    They're coming up with something called 'Steve's Law' (snicker).

    The ed cartoonist today in the same paper has - wait for it - the Grim Reaper holding a scythe with a syringe instead of the blade! (snicker)

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