The heroin uptick: Is it a crisis?
Across the nation, officials are sounding an alarm about heroin use. The U.S. attorney general calls it an "urgent public health crisis," and television news routinely describes it as an epidemic.
Sure, there is evidence that people hooked on prescription painkillers are moving to cheaper heroin when their legal pills runs out.
But is it truly an epidemic? A number of experts question that and suggest something else may be at play: a new demographic of heroin users who are increasingly white, suburban or rural, middle-class, and largely female.
"We have a syndrome in this country: When you have a young white woman at risk, it makes national headlines," said Roseanne Scotti, state director of the New Jersey Drug Policy Alliance.
"There's no doubt [heroin has] gotten more attention since it's become an issue that's perceived as affecting people in the suburbs," Scotti added. "But for more than 20 years, it hasn't been an issue. People died of overdoses all the time. It never got any news coverage, none at all."
Lawrence Payne of the Drug Enforcement Administration says: "If you look at heroin abuse over the entire population, it's an extremely small number. But the spike in the growth is significant and alarming."
In the 1960s, first-time heroin users were typically members of a minority, under 17 years old, male, and from the inner city.
Now, heroin users are 90 percent white men and women whose gateway drug was a prescription painkiller. They tend to be in their early 20s and live in the suburbs or rural areas, concluded a study last month in the journal JAMA Psychiatry.
Law enforcement officers on the front lines say that they have seen the spike in heroin use and that the drug is more widespread than at any time in recent memory. Lt. Charles Jackson of the Philadelphia Police narcotics squad calls heroin "the new crack."
"You see more younger people using heroin today than you'd ever imagine," he said. "Now it's something that's common."
The peril cries out for good statistics. And there lies the problem. The available numbers are surprisingly out of date.
Public health officials express frustration and agree there really are no good numbers when it comes to heroin use.
In 2010, heroin overdoses in the United States killed 3,038 people, the federal Centers for Disease Control and Prevention reported last year. The CDC is expected to release more current data this month. Unfortunately, researchers say, the data will be three years old and usable only as an historical snapshot.
"Our reporting systems are a mess," said Theodore J. Cicero, a psychiatry professor at Washington University in St. Louis, whose retrospective analysis in JAMA Psychiatry examined 50 years of heroin use in the U.S. "It's hard to get a figure on what the number of users is. We just don't know."
Cicero and other addiction specialists said that without up-to-date data, creating an effective policy to attack the use of heroin is profoundly difficult.
According to the National Institute on Drug Abuse (NIDA), nearly a half-million people were addicted to heroin in 2012. But the number could be far higher, Cicero said.
Indeed, there is wide agreement on one thing: Opioid painkillers, such as oxycodone, were overprescribed for years, leading many to become addicted.
An estimated 2.1 million people in the U.S. abused prescription painkillers in 2012, NIDA found, most of whom lived in the suburbs and had access to health insurance that originally paid for the drugs, making them affordable. But many of the legal prescriptions ran out. Heroin use began to spike as the government cracked down on pill mills and OxyContin was reformulated to keep users from snorting it.
"Now they're using [heroin] as a default drug," Cicero said of the 2,700 addicts he surveyed for the JAMA study.
Prescription painkillers killed 16,651 people in 2010, four times the number of deaths attributed to heroin.
Those drugs are "the bridge to heroin," said Jeanmarie Perrone, director of medical toxicology in the emergency medicine department at the Hospital of the University of Pennsylvania.
Perrone said she had seen more heroin overdoses in her ER. But they are dwarfed by the number of prescription painkiller overdoses.