Heroin Death Rate Doubles in 28 States in 2 Years

Ricki Lewis, PhD

October 03, 2014

Deaths attributed to heroin overdose surged in 28 states from 2010 to 2012, according to a report published in the October 3 issue of the Morbidity and Mortality Weekly Report. At the same time, more than twice as many people died from overdoses of prescription opioid drugs, although the death rate fell somewhat.

About three quarters of new heroin users report prior prescription opioid drug abuse. Heroin is much cheaper and more accessible than prescription opioid drugs, yet it is chemically similar. The study aimed to track the trend and quantify the problem.

In response to states and cities reporting increases in deaths from heroin overdose in recent years, Rose A. Rudd, MSPH, from the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues asked state health departments for data on mortality from any drug overdose, covering the period from 2008 to 2012. They analyzed information from 28 states, representing 56% of the US population.

From 2010 to 2012, the death rate from heroin overdose in participating states increased from 1.0 to 2.1 per 100,000. The increases equally affected both sexes and occurred in all age groups, all census regions, and all racial/ethnic groups except American Indians/Alaska Natives. In no state did heroin death rate decrease.

During the same period, the death rate from prescribed opioid drug overdose decreased from 6.0 per 100,000 in 2010 to 5.6 per 100,000 in 2012, yet still remained considerably higher than that from heroin. Five states reported increases in prescription opioid death rates, seven had decreases, and 16 states had no change. Decreases in opioid death rates were not associated with increases in heroin-related death rates.

"The findings in this report indicate a growing problem with heroin overdoses superimposed on a continuing problem with [opioid pain reliever] overdoses," the investigators conclude. They call for more rigorous efforts at preventing overdose from all opioids, including heroin, such as substance abuse screening and urine testing when prescribing opioids.

The study had several limitations. The data may not represent the United States as a whole. In 22% of cases, death certificates did not specify which drug caused overdose. Certificates that listed "morphine" may have been interpreted as either heroin or prescribed opioids. For 2012, five states reported deaths that happened only in-state, and six states reported provisional data. Racial misclassifications may have obscured some data.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2014;63:849-854. Full text

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