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, 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, 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.

If you look at raw numbers, the evidence looks 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, 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 dangerous substitution effects
but 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.” 

[Thanks to Robert Woolley for the NPR link.]