According to the National Survey on Drug Use and Health (NSDUH), in 2016 about 948,000 Americans reported using heroin in the past year,1 a number that has been on the rise since 2007. This trend appears to be driven largely by young adults aged 18–25 among whom there have been the greatest increases. The number of people using heroin for the first time is high, with 170,000 people starting heroin use in 2016, nearly double the number of people in 2006 (90,000). In contrast, heroin use has been declining among teens aged 12–17. Past-year heroin use among the nation’s 8th, 10th, and 12th graders is at its lowest levels since 1991, at less than 1 percent in each grade level.6
It is no surprise that with heroin use on the rise, more people are experiencing negative health effects that occur from repeated use. The number of people meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for dependence or heroin use disorder increased dramatically from 214,000 in 2002 to 626,000 in 2016.1 The fifth and the current version of the DSM, DSM-5, no longer separates substance abuse from dependence, but instead provides criteria for opioid use disorder that range from mild to severe, depending on the number of symptoms a person has.7 Data on the scope and severity of opioid use disorder in the United States are not yet available for these new criteria.
FentanylFentanyl is a synthetic opioid that is 50 to 100 times more powerful than morphine. Recently, traces of fentanyl have been found in many other illegal drugs, including heroin. This is a public health concern because the strength of fentanyl makes overdosing more likely.
The impact of heroin use is felt all across the United States, with heroin being identified as the most or one of the most important drug use issues affecting several local regions from coast to coast. The rising harm associated with heroin use at the community level was presented in a report produced by the NIDA Community Epidemiology Work Group (CEWG). The CEWG is comprised of researchers from major metropolitan areas in the United States and selected foreign countries and provides community-level surveillance of drug use and its consequences to identify emerging trends.3
Heroin use no longer predominates solely in urban areas. Several suburban and rural communities near Chicago and St. Louis report increasing amounts of heroin seized by officials as well as increasing numbers of overdose deaths due to heroin use. Heroin use is also on the rise in many urban areas among young adults aged 18-25.8 Individuals in this age group seeking treatment for heroin use increased from 11 percent of total admissions in 2008 to 26 percent in the first half of 2012.