Prevalence, correlates and patterns of heroin use among young adults in the United States
Introduction
The prevalence of heroin use, abuse, and dependence in the US has seen a considerable increase over the past decade (Jones, Logan, Gladden, & Bohm, 2015). Data from the National Survey on Drug Use and Health (NSDUH) show a significant increase in the total number of past-year heroin users in 2013 from 2002 to 2008 (Lipari & Hughes, 2015). In 2013, about 460 people aged 12 or older initiated heroin use each day (Lipari & Hughes, 2015). Furthermore, from 2010 through 2012, there was a doubling in death rate of people aged 12 or older due to heroin overdose (Hedegaard, Chen, & Warner, 2015). In fact, the age-adjusted rate for drug poisoning deaths involving heroin in people aged 12 or older nearly quadrupled from 0.7 deaths per 100,000 in 2000 to 2.7 deaths per 100,000 in 2013 (Hedegaard et al., 2015).
The significant increase in heroin use in the US has been driven mostly by the population of young adults (18 to 25 years). Data from the NSDUH indicate that the rate of heroin initiation in young adults was approximately two to seven times higher than the initiation rates in adolescents (12 to 17 years) and older adults (26 to 49 years), from 2002 to 2011 (Muhuri, Gfroerer, & MC, 2013). Additionally, in 2013, young adults (18 to 25 years) in the US had the highest prevalence rate of past year heroin use (7.0 per 1000) compared to adolescents (12 to 17 years) and older adults (≥ 26 years) with prevalence rates of 1.0 and 2.0 per 1000, respectively (Lipari & Hughes, 2015). A comparison of the prevalence rates of past-year heroin use between 2002 to 2004 and 2011 to 2013 among adolescents (12 to 17 years), young adults (18 to 25 years) and older adults (≥ 26 years) revealed that young adults experienced the greatest increase in rates [108.6% (i.e., 3.5 to 7.3 per 1000)] compared to adolescents [−11.1% (i.e., 1.8 to 1.6 per 1000)] and older adults [58.3% (i.e., 1.2 to 1.9 per 1000)] (Jones et al., 2015). Moreover, from 2000 through 2013, young adults had the highest increase in the rate of drug-poisoning deaths involving heroin (Hedegaard et al., 2015). Rates increased 4.9-fold from 0.8 to 3.9 per 100,000 for young adults, and for older adults (25 to 44 years), the rate increased 4.2-fold from 1.3 to 5.4 per 100,000. Likewise, for those aged 45 to 64 years, rates increased 3.8-fold from 0.8 to 3.0 per 100,000.
Despite the burden of heroin use in the population of young adults, there is a paucity in research examining correlates and patterns of heroin use in this population. A substantial body of literature has examined heroin use, abuse and dependence in the general population and have reported correlates of heroin abuse and dependence such as residence in large urban areas, annual household income of less than $20,000, having no health insurance or having Medicaid, and past-year abuse or dependence on alcohol, marijuana, cocaine, or opioid pain relievers (Jones et al., 2015). However, there is evidence to suggest that among young adults, the decision to use a drug is based on a rational appraisal process, rather than a passive reaction to the context in which a substance is available (Boys et al., 2000, Boys et al., 2001). Correlates of heroin use among young adults may therefore differ from the general population. Furthermore, many of the studies which examined heroin use among young adults have been limited to subsamples of the US population and as such, cannot be nationally generalized. Pugatch, et al. examined heroin use among young adult heroin users in detoxification facilities in Rhode Island (Pugatch, Strong, Has, et al., 2001). Due to restriction of the study sample to heroin users in treatment facilities in the state, findings from the study cannot be generalized to young adult heroin users in the US. Similarly, Perry and Duroy, in an exploratory study examined differences between adolescent and young adult heroin users and their non-heroin-using peers in a long-term, step-down therapeutic community (Perry & Duroy, 2004). Findings from this study were also limited by the inability to generalize them to US adolescents and young adults. Thus, examining the correlates, patterns and attitudes of heroin use among a nationally-representative sample of young adults is warranted. Improving the understanding of heroin use, abuse, and dependence in the population of young adults by identifying correlates, patterns and attitudes of heroin use can help tailor prevention and treatment efforts in the population of young adults. This study aims to (1) determine the lifetime, past-year and past-month prevalence of heroin use among young adults in the US from 2011 to 2013, (2) describe patterns and attitudes towards heroin use among US young adults, and (3) identify correlates of lifetime, past-year and past-month heroin use among young adults in the US.
Section snippets
Data source and study participants
This study combined data from the 2011 to 2013 National Survey of Drug Use and Health (United States Department of Health and Services, 2011, United States Department of Health and Services, 2012, United States Department of Health and Services, 2013). The NSDUH is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) to measure prevalence and correlates of drug use among members of the noninstitutionalized US civilian population aged 12 or older.
Results
The study population comprised of approximately equal proportion of male and female young adults (49.9% vs 50.1%) (Table 1). Over half of the study sample were NH Whites (56.6%), unmarried (88.4%), fully employed (52.0%) and had private health insurance (55.4%). The majority of the study population (85.7%) resided in metropolitan county areas and over a third (34.4%) had household income of $50,000 and above.
Discussion
In this study sample, 7.3 per 1000, 3.3 per 1000 and 18.4 per 1000 young adults used heroin during the past year, past month and at some time during their lives, respectively. The prevalence rates of heroin use were similar to those reported for young adults in other nationally-representative studies for the period between 2011 and 2013 (Lipari and Hughes, 2015, Johnston et al., 2014). Consistent with recent nationally-representative studies, the prevalence of heroin use in the current study
Conclusion
This study demonstrates that fewer than 2% of young adults in the US reported ever using heroin, and 82% of those reported no use in the past month. It also shows a shift towards heroin use among young adults in higher SES groups. Young adults who used non-prescribed opioid pain relievers and other illicit drugs, smoked cigarettes and were arrested and booked for breaking the law, had the greatest odds of using heroin. In addition, young adult heroin users initiated heroin use at an early age
Role of funding sources
Authors report no funding sources.
Contributors
Drs. Ihongbe and Masho designed the study. Dr. Ihongbe conducted the statistical analysis and wrote the first draft of the manuscript. Dr. Masho conducted manuscript preparation and review. All authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflict of interest.
Acknowledgments
None.
References (35)
- et al.
Early-onset drug use and risk for drug dependence problems
Addictive Behaviors
(2009) - et al.
Levels and correlates of polydrug use among heroin users and regular amphetamine users
Drug and Alcohol Dependence
(1995) - et al.
Patterns and correlates of alcohol use amongst heroin users: 11-year follow-up of the Australian treatment outcome study cohort
Addictive Behaviors
(2015) Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002–2004 and 2008–2010
Drug and Alcohol Dependence
(2013)- et al.
Initiation into prescription opioid misuse amongst young injection drug users
International Journal of Drug Policy
(2012) - et al.
“Every ‘never’ I ever said came true”: Transitions from opioid pills to heroin injecting
International Journal of Drug Policy
(2014) - et al.
Heroin use in adolescents and young adults admitted for drug detoxification
Journal of Substance Abuse
(2001) Diagnostic and Statistical Manual of Mental Disorders
(1994)- et al.
Drugs Decisions: A Qualitative Study of Young People
(2000) - et al.
Understanding reasons for drug use amongst young people: A functional perspective
Health Education Research
(2001)
2013 National Survey on Drug Use and Health: Methodological Resource Book
Wide-ranging Online Data for Epidemiologic Research (WONDER)
Abuse-deterrent formulations and the prescription opioid abuse epidemic in the United States: Lessons learned from OxyContin
JAMA Psychiatry
Effect of abuse-deterrent formulation of OxyContin
The New England Journal of Medicine
The changing face of heroin use in the United States: A retrospective analysis of the past 50 years
JAMA Psychiatry
The Life of the Heroin User: Typical Beginnings, Trajectories and Outcomes
National drug threat assessment summary 2014
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