Drug Policy

How Many Daily Heroin Users Are There in the U.S.? Somewhere Between 60,000 and 1 Million. Maybe.


According to the National Survey on Drug Use and Health (NSDUH), about 620,000 Americans used heroin in 2010. But according to a new report commissioned by the Office of National Drug Control Policy, something like 1.5 million Americans were "chronic heroin users" that year. That group includes anyone who has consumed heroin on four or more days in the previous month.

This dramatic discrepancy results from the report's attempt to count heroin users missed by NSDUH, whether because they did not respond honestly, because they did not respond at all, or because they were not part of the household population sampled by the survey. To adjust for such undercounting, Beau Kilmer and eight other drug policy analysts at the RAND Corporation rely mainly on data from the Arrestee Drug Abuse Monitoring Program (ADAM), which includes urinalysis as well as a survey. Because it focuses on arrestees, ADAM is more likely than NSDUH to identify heavy drug users. But its sample, unlike NSDUH's, is not nationally representative, so Kilmer and his colleagues must perform a series of calculations to convert ADAM numbers into total male arrestees testing postive for heroin and divide those users by frequency of use. Then they add estimates for men who were not arrested as well as for women and teenagers, based partly on NSDUH and information about overdoses, emergency room episodes, and treatment admissions.

The RAND researchers convert their estimate of heroin users into estimates of total consumption and spending. They use similar methods to estimate the size of the cocaine, methamphetamine, and marijuana markets. In the case of marijuana, a drug for which NSDUH seems to be a better guide, Kilmer et al. rely mainly on numbers from that survey, inflated by 25 percent and supplemented by ADAM data for respondents with criminal records. It is an impressive, headache-inducing feat, but one that is subject to "great uncertainty" because of the assumptions involved and the limits of the data, as the authors repeatedly acknowledge. "In many cases," they say, "the extent of the uncertainty cannot be bounded or quantified." They do not really know, for example, "the extent to which one can trust arrestees' self-reports about their spending on illegal drugs" or "how to extrapolate just ten urban areas' arrest records to the country as a whole." 

The RAND estimate for frequent heroin users is much higher than the one reported by NSDUH. In a recent USA Today op-ed piece, Kilmer and one of his collaborators, Jonathan Caulkins, say "estimates from the 2010 NSDUH suggest there were only about 60,000 daily and near daily heroin users"—i.e., people who used heroin on 21 or more days in the previous month. They argue that "the real number is closer to 1 million."

Yet whether you look at NSDUH data or at the RAND estimates, the trend from 2000 through 2010 looks similar. "Heroin consumption remained fairly stable throughout the decade," Kilmer et al. write, "although there is some evidence of an increase in the later years." They note that "there was a steady increase in the amount of heroin seized within the United States and at the southwest border from 2007 through 2010," but they caution that seizure levels may reflect enforcement efforts and traffickers' tactics rather than consumption. The RAND estimates of heroin consumption indicate "essentially no change" from 2000 to 2010. The report does not cover the two subsequent years, when NSDUH reported an increase in the number of past-month heroin users, from 239,000 in 2010 to 335,000 in 2012.

The trends for the other drugs are also similar to what the NSDUH data suggest. "Multiple indicators are consistent with an increasing trend in meth consumption over the first half of the decade and a subsequent decline through 2008," Kilmer et al. write. "From 2002 to 2010, the amount of marijuana consumed in the United States likely increased by about 40 percent while the amount of cocaine consumed in the United States decreased by about 50 percent." Throughout the period covered by the report, estimated annual spending on the four drugs in the United States totaled about $100 billion, although the breakdown changed substantially. "In 2000," say the RAND researchers, "much more money was spent on cocaine than marijuana; in 2010 the opposite was true."

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  1. No alt-text for the Man With the Golden Arm? Really??

    1. “The neck, will ya let go of the neck… let go of the neck!”

  2. But according to a new report commissioned by the Office of National Drug Control Policy, something like 1.5 million Americans were “chronic heroin users” that year. That group includes anyone who has consumed heroin on four or more days in the previous month.

    Four days or more in a month? By that standard, there are probably more chronic masturbators in America than heroin users.

    1. 4 times a month is ‘chronic’?

      Who the fuck comes up with this shit?

      I’ve drank beer on 4 occasions in the last 4 days. I must be e a real monster.

      1. A beer a day? That sounds like Gradual Binge Drinking (GBD) to me.

        [big red stamp] ALCOHOLIC

        1. Well, don’t worry, I’m sure that Obamacare is going to save me in the end.

          1. Not sure about “save” but the “in the end” part of ACA is true.

            Bend over.

  3. That 1.5mm number for chronic users sounds really high to me. That’s in the neighborhood of 1 out of every 200 people, which strikes me as incredible.

    1. More heroin addicts than lawyers!

      1. Well to be fair, people have a much higher opinion of junkies.

        1. As well they should. You’re far more likely to be materially harmed by a lawyer than by a heroin addict, especially if you’re talking about indirect harm.

          1. Yeah, I’d estimate my odds of being robbed by a lawyer at about 2 million x times the odds of being robbed by a junkie looking to get money for his next fix.

            1. Lawyers fucked you with Obamacare, which, of course, is named after a lawyer. Bet that’s harmed you some already this year.

              1. I might be among the more fortunate in that my rates didn’t go up that much. But the rise in the deductible is a real punch in the nuts, since my wife and I are in our 50s now and even though we are both pretty healthy now, you know, you start to worry. I don’t know if anyone escaped that.

                1. My deductible doubled, all while my premiums went up significantly. TVs and computers get cheaper and better, mortgages, higher ed, and health insurance skyrocket and get worse. What makes that happen, anyway?

                  1. What makes that happen, anyway?

                    George Bush and the Kochtopus, of course.

                    The meddlings of all benevolent government had nothing to do with it.

                    1. Got me there.


                    2. Kochtobush bound in cheneys. That’s when it’s most dangerous.

    2. Check your privilege. Maybe all of the heroin users are in places where cishet white males don’t tend to hang out.

      Or maybe they’re all cishet white males which is why the police aren’t arresting them.

      I forget why you should check your privilege, exactly. I only remember the “you should” part.

      1. I forget why you should check your privilege, exactly

        You didn’t forget why, you just said because you’re a white male. Are you on drugs, white boy? If so, then check your privilege twice.

        1. I would think that drugs would open the door for “I have a disease”, which would allow me to tell the able-bodied to check their privilege.

          1. The drug (not alcohol because you know, that’s not a drug) treatment industry hasn’t got off the ground yet. Now that CO and WA will allow us to create some disease victims that can’t be thrown into a cage for the profit of the prison industrial complex, we can get some crony bucks flowing for the drug treatment industry.

      2. Cishet? Is that cis-heterosexual? Or is the het from “heteronormative?” Or het from “hetman?”

  4. “In 2000,” say the RAND researchers, “much more money was spent on cocaine than marijuana; in 2010 the opposite was true.”

    You have a bull market, you buy cocaine; you have a bear market, you buy marijuana.

    1. Well, I hope that the RAND researchers didn’t get their data from the police. You know, those guys who typically value 6 straggly looking pot plants at 1 million dollars street value?

      1. Don’t forget the dirt – gotta weigh it roots and all to get the ‘true’ street value.

  5. Whatever. Good enough for government statistics.

  6. If they are just going to guess, why gather any data?

    “How many herion users are there.”

    “Er, 60,000?”

    “No, no. Way to few to keep our phony baloney jobs afloat. Guess again.”

    “50 million?”

    “No one would believe that. Someone get one of those octopuses that pick Superbowl winners.”

    1. From the studio that brought you Sixty Million Uninsured. . . .

    2. You just don’t understand how science works.

      1. I do:

        1. Ask a question
        2. Do background research on whether people will pay you for answering the question in some way
        3. Construct a hypothesis that gets you the most grant money
        4. Find data that supports your cash-garnering hypothesis
        5. Draw a conclusion and build a political consensus around your conclusion
        6. Communicate your results and ostracize those that dare disagree with you

      2. Science is just underdeveloped magic. I learned that from Arthur C. Clarke or something.

        1. Did you get the invite to the alumni panel in April?

          1. I got something about a roadtrip. I don’t actually read much that they send me because it’s usually not interesting. Was it a paper invite or an email one?

            1. Email, or maybe LinkedIn. They probably didn’t send one to you because of the beard.

              1. They probably didn’t send one to you because of the beard.

                She’s my roommate not a fake girlfriend…

                1. Uh huh. Whatever you say, dude.

                  1. She’s not! I swear I’m not a breeder. Nobody believes me…

                    *weeps into bud light while watching sunday football*

                    1. Whatever Het-boy. How many days a week are you even in the gym, like three? I bet your towels aren’t even designer!

                    2. I only go to the gym to cruise the saunas!

    3. I love this. Well, we’ve got it pinned down within two orders of magnitude. Oh, great. So somewhere between 1 in 35000 adults and 1 in 200. Great.

  7. They note that “there was a steady increase in the amount of heroin seized within the United States and at the southwest border from 2007 through 2010,” but they caution that seizure levels may reflect enforcement efforts and traffickers’ tactics rather than consumption.

    I’m pretty sure that “a steady increase in the amount of heroin seized” is indisputable evidence that less heroin is being consumed, you jackasses. It’s simple logic – the more the cops seize, the less there is for drug users. It’s proof that the WOD is working! (And the same evidence the cops have always used for demonstrating what a fine job they’re doing fighting drug use.)

    1. But, simultaneously, its *also* evidence that drug producers are stepping up production, flooding our streets with product. So we need to give the drug-warriors more money either way.

  8. Still here waiting for the high school vending machines full of heroine.

    1. ” Yo Sully! Lend me an extra quarter, I wanna grab me a quick Jane Eyre between class”

      1. Oh, fuck. Keynesian theory in Economics. I’m gonna need a double shot to get through.

  9. “Hi, I’m from the government, and I’m here to ask you about your illegal drug use.”

    Who the fuck is going to answer that truthfully?

  10. There is another reason the Jews don’t want to speak to loudly against intermarriage: they don’t want the Stuff White People Like to see it. The typical Stuff White People Like is convinced that if he is a good shabbos goy, if he does what the Jews tell him, if he believes what the Jews tell him, if he acts against the interests of his own people and for the interests of the Jews, if he adopts religiously the Stuff White People Like culture, he will be allowed to be an honorary Jew, he will get that job in finance and, perhaps most importantly, have access to that pretty Jewess, so that he can raise children who are genetically part-Jewish, solidifying his position in the hostile elite. But no matter how good a shabbos goy he is, he can’t change his blood. If the Jews deny him the opportunity at intermarriage, he might start to question the Stuff White People Like.

    1. ^THIS is what happens when you’re left on your own to do too much heroin.

    2. What the fuck was that?

    3. I see.

      So, what you’re saying is, A Jewish Girl dumped you?

      Yes, that happens.

      1. That actually did happen, but that’s not why I’m antisemitic, I was antisemitic before that.

        1. The very picture of a self-hating anti-semite!

    4. Shit, that’s all it takes? Where do I sign up?

      Do you get to pick the pretty Jewess or is one selected for you?

      1. PROJECT MONARCH has been cloning Mila Kunis-es for about 30 years. So you have a choice between that model or the slightly older Natalie Hershlag Portman model.

        1. I would have preferred an Emmy Rossum, but I’m still in.

        2. I’m already circumcised, will that get me a test drive of a Portman model?

  11. Damn beboppin’ hopheads, with their goofballs and zoot suits, jitterbugging to that wild music.

    This country’s going to Hell in a handcart.

    1. Hoolishenanigans!

  12. Who really cares? I sure don’t. History has proven you cannot legislate morality. After 60 years and billions of dollars spent losing the war on drugs. It’s time to leave people to their own devices.

  13. It seems to me that you don’t generate the billions of dollars per year in drug war profits unless you have millions of users. The drug war isn’t fueled by that dirty trailer park down the road. It’s fueled by millions of ordinary Americans who use illegal substances. We like to think it’s someone else, certainly not my little baby, or my uncle, or my brother… That sentiment is what has fueled the drug war for decades. The reality is that poor people rarely get high, because doing so costs money and isn’t an option for them.

    I have a friend who was a heroin addict and dealer. Apparently heroin use is quite common, with scores of white collar workers on maintenance(basically using a little here and there to keep from getting sick and feel normal).

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