Fatal heroin overdoses doubled in the United States from 2010 to 2012, according to a report published online Oct. 2 in the Morbidity and Mortality Weekly Report.
In a representative sample of 28 states, heroin deaths climbed from 1,779 to 3,635, a rate increase from 1.0 to 2.1 per 100,000 population. Meanwhile, deaths from prescription opioids fell from 10,427 to 9,869, a decrease from 6.0 to 5.6 per 100,000 population (MMWR 2014;63:849-54).
In Northeastern states, fatal heroin overdoses increased 211.2%. Southern states had an increase of 180.9%, Midwestern states an increase of 62.1%, and Western states an increase of 90.7%, based on state health department data.
The report did not give numbers for individual states, only regions, but it did note that Kentucky reported a 279% increase in heroin deaths from 2010 to 2012, and Ohio had an increase of approximately 300% from 2007 to 2012.
The investigators found no statistically significant relationship between the increase in heroin deaths and the decrease in prescription opioid fatalities. However, they noted that about 75% of heroin users report using prescription opioids first, then switching to heroin, a cheaper, more readily available alternative that gives a more potent high.
Others have reported that young adults are sometimes unaware that prescription pain pills are opioids and that their abuse can slip into heroin use. Particularly hard hit communities have reduced opioid fatalities by getting that message out through education campaigns, and also by distributing intranasal naloxone kits to the people most likely to need them: first responders, family members, and opioid abusers who might need to rescue a friend (See, for example, BMJ 2013;346:f174.).
“State policies that increase access to naloxone, a drug that can reverse potentially fatal respiratory depression in persons who have overdosed from either OPRs [opioid pain relievers] or heroin, or policies that reduce or eliminate penalties when someone reports an overdose, are potentially useful strategies” to counter the problem, said the investigators, led by Rose A. Rudd, a statistician at the Centers for Disease Control and Prevention.
Also, “efforts to prevent expansion of the number of OPR users who might use heroin when it is available should continue [including] screening for substance abuse, urine testing for drug use, and referral to substance abuse treatment. The use of prescription drug monitoring programs can address inappropriate opioid prescribing and further prevent OPR abuse,” they said.
In 2012, 25- to 34-year-olds had the highest heroin fatality rate; OPR fatalities were highest in those aged 45-54 years. Non-Hispanic whites had the highest rates for both. Men were four times more likely than women to die from a heroin overdose, but only slightly more likely to die from prescription pain pills.
“Heroin overdose death rates increased significantly for both sexes, all age groups, all census regions, and all racial/ethnic groups other than American Indians/Alaska Natives,” the investigators noted.
Meanwhile, from 2010 to 2012 pain pill overdoses declined significantly in men, people under 45 years old, those who live in the South, and non-Hispanic whites. They increased in people aged 55-64 years.
The MMWR is published by the Centers for Disease Control and Prevention.