Need for Treatment
According to the National Survey on Drug Use and Health (NSDUH), in 2003 more than 1.5 million people were dependent on or abused opioid analgesics and heroin.
1
(NOTE: Other studies estimated the size of the heroin-dependent population in the United States to be roughly 4 to 5 times that documented by NSDUH, raising the total opioid-dependent/abusing population to 2.2 to 2.4 million people.1,2)
Opioid Analgesics—A Growing Presence
Between 1990 and 2001, the number of first-time users of opioid analgesics for nonmedical purposes grew by 330% to include almost 2.5 million people.1
New Nonmedical Use of Opioid Analgesics
Among Persons Ages 12 and Older1 |
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Emergency department mentions of opioid analgesics likewise grew over a similar period (1994-2002), including:
- 450% rise in oxycodone mentions3
- 170% rise in hydrocodone mentions3
Opioid Misuse—Changing Profile
Opioids' tacit migration into the cultural mainstream has put new populations at risk, as evidenced by the rising volume of younger users2,4:
- 44% of new nonmedical use of opioid analgesics in 2001 was by people younger than 18 years1
- Opioid analgesic treatment admissions among 18- to 25-year-olds have more than doubled since 19935
Frequency of Opioid Analgesic Admissions
Among Persons Ages 18-255 |
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The increased use of opioids among females is indicative of that group's new risk4,6:
- Women accounted for 55% of new nonmedical use of opioid analgesics in 20011
- Between 1995 and 2002, the likelihood of a woman needing emergency medical care due to opioid analgesic abuse doubled7
Heroin—Hitting Closer to Home
Heroin use has now extended into many communities where, until recently, it was virtually unheard of.3,8,9 Even as heroin use tapers in larger metropolitan areas, use in the suburbs is rising steadily.4,8,10
Heroin's popularity is driven by its low cost and significantly improved purity—up to 95% pure in some high-traffic areas.3,4,8,11 (Heroin was less than 5% pure on average during the 1960s and 70s.)11 This increased quality heightens heroin's attractiveness to new users, because10:
- High purity heroin has made smoking and intranasal use feasible alternatives to intravenous administration10
- These more casual routes of administration appeal to new and recreational users, approximately 60% of whom have never injected (injection remains the preferred administration route among older users)4,10-12
- Many new users mistakenly believe that inhaled heroin is less addictive3,11
Barriers to Treatment
In 2002, opioid analgesics accounted for 2.4% of all substance abuse treatment admissions, but 16% of all substance abuse emergency department visits.5,7
Overall, opioid dependence accounted for 18% of all substance abuse treatment admissions in 2001, exceeding cocaine admissions for the fifth consecutive year.13
This figure is believed to understate the magnitude of the opioid dependence problem, because:
- The stigma attached to opioid dependence can be so overwhelming that thousands of patients every year choose to continue using opioids rather than risk possible exposure by receiving treatment1,14
- 20% of patients who wanted help for substance abuse in 2001 did not pursue treatment because of their fear of being stigmatized1
- Less than 25% of opioid-dependent individuals receive any form of treatment14
As a result of these and other factors, at least 1.2 million opioid-dependent patients in the United States are believed to be untreated at present.15
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References
| 1. |
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2003 national survey on drug use and health: national findings. Rockville, Md: Department of Health and Human Services, SAMHSA, Office of Applied Studies; 2004. NSDUH Series H-25, DHHS Publication No. SMA 04-3964. |
| 2. |
SAMHSA. The DAWN Report: oxycodone, hydrocodone, and polydrug use, 2002. July 2004. Available at: http://oas.samhsa.gov/2k4/oxycodone/oxycodone.cfm. Accessed September 30, 2004. |
| 3. |
Stancliff S. Buprenorphine and the treatment of opioid addiction. The PRN Notebook. 2004;9:28-32. |
| 4. |
Community Epidemiology Work Group (CEWG). Advance report of findings presented at the 53rd CEWG meeting. Available at: www.drugabuse.gov/
PDF/CEWG/AdvReport1202.pdf. Accessed September 30, 2004. |
| 5. |
SAMHSA. Quick Statistics from the Drug and Alcohol Services Information System. Available at: wwwdasis.samhsa.gov/webt/tedsweb/
tab_year.choose_year_web_table?t_state=US. Accessed October 19, 2004. |
| 6. |
Partnership for a Drug-Free America. Prescription Medication Abuse. Available at: www.drugfreeamerica.org/Templates/Prescription_Abuse.asp?ws=PDFA&vol=1&grp=Kids. Accessed August 10, 2004. |
| 7. |
SAMHSA. The DAWN Report: narcotic analgesics, 2002 update. September 2004. Available at: dawninfo.samhsa.gov/pubs_94_02/shortreports/files/
DAWN_tdr_na2002.pdf. Accessed October 19, 2004. |
| 8. |
Klein A. Young and hooked: pure, cheap heroin luring more North Jersey teens. New Jersey Record. May 2, 2004:A-1, A-14-A-15. |
| 9. |
National Institute on Drug Abuse. Research Report series: heroin abuse and addiction. Printed October 1997. Reprinted September 2000. Available at: www.nida.nih.gov/ResearchReports/Heroin/Heroin.html. Accessed September 30, 2004. |
| 10. |
Epstein JF, Gfroerer JC. Heroin abuse in the United States. Office of Applied Studies, SAMHSA website. Available at: www.oas.samhsa.gov/NHSDA/Treatan/treana11.htm. Accessed July 29, 2004. |
| 11. |
California Department of Alcohol and Drug Programs. Fact sheet: facts and figures on youth heroin use. July 2004. Available at: www.adp.cahwnet.gov/FactSheets/
Facts_and_Figures_on_Youth_Heroin_Use.pdf. Accessed September 30, 2004. |
| 12. |
Fiellin DA, O'Connor PG. Office-based treatment of opioid-dependent patients. N Engl J Med. 2002;347:817-823. |
| 13. |
SAMHSA. Treatment Episode Data Set. 2001 Highlights. Available at: wwwdasis.samhsa.gov/teds01/TEDS2K1High.htm. Accessed August 12, 2004. |
| 14. |
Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004. |
| 15. |
Lucas GM. Buprenorphine in primary HIV care clinics: a big pill to swallow. The Hopkins HIV Report. 2004;16:5-7. |
