The number of new heroin users fell by more than half in 2017, according to the latest national drug survey, which was unveiled Friday.
“One of the most important findings,” said SAMHSA chief Elinore McCance-Katz in announcing the results in a webcast, “is the very steep decline in new users of heroin from 2016.” New initiates to that drug dropped from 170,000 to 81,000.
The National Survey on Drug Use and Health (NSDUH) is an annual survey of 67,500 Americans over the age of 12 from all 50 states and the District of Columbia. It’s performed by the federal Substance Abuse and Mental Health Services Administration.
The drop in new heroin users is important for two reasons. First, it holds out the hope of stemming the rising tide in heroin use. But second, it cuts against the argument that reducing the availability of prescription drugs is driving their users to switch to heroin.
“There’s been a claim that efforts to promote more cautious prescribing have caused a sudden shift to heroin. This new data helps debunk that narrative.”
“There’s been a claim that efforts to promote more cautious prescribing have caused a sudden shift to heroin,” writes Andrew Kolodny, MD, in an email. “This narrative can make a good news story. ‘Government tries to tackle a problem and inadvertently makes it worse.’ But it’s not true,” says Kolodny, who co-leads the Opioid Policy Research Collaborative at Brandeis University’s Heller School. “This new data helps debunk that narrative.”
The total prevalence of heroin use—886,000 people in 2017—has remained fairly stable since 2015, according to the report. That is more than double the number using it 2002, however.
As troubling as that rise in heroin use is, the heroin death rate has much more than doubled as a consequence. That’s because heroin has become much more lethal during the same period. Since 2010, its purity has increased and, since 2013, it has become common for dealers to lace heroin with illicit fentanyl. A cheap, synthetic opioid often imported from China, fentanyl is up to 50 times more powerful than heroin.
So while the number of people using heroin has doubled since 2002, the number of fatal overdoses from heroin has jumped 7.7 times over that period. It has rocketed from 2,013 fatalities to 15,594, according to data from the Centers for Disease Control and Prevention.
“Illicit opioid overdose deaths didn’t soar because of a sudden increase in the number of heroin users,” continues Kolodny. “Deaths soared because of a sudden increase in the dangerousness of the illicit opioid supply. It was the fentanyl, not the CDC guidelines,” he says, referring to the prescribing guidance announced in December 2015 and adopted in March 2016, which are are one factor that has helped bring down opioid prescribing levels.
The new NSDUH data on heroin use—showing a drop in new users and a leveling off in its prevalence—are consistent with the reductions in heroin overdose death seen in the most recent CDC data, as we noted earlier this month.
According to the CDC data—which track overdose deaths over rolling 12-month periods—fatalities from heroin have gently fallen in every reported period for the past seven straight months. Such deaths have fallen from 16,572 (for the year ending July 31, 2017) to 15,515 (for the year ending February 28, 2018—the last data available).
This series of declines—now adding up to a 6.4 percent drop in fatalities—follows at least three years of uninterrupted rises. (The CDC data are not final, but “provisional.” They are predictions that are adjusted retrospectively each month as new data come in. For more detail, see our previous article, which also discusses recent apparent declines in overdose deaths from all drugs; from all opioids; and from the most common prescription opioid pills.)
Regarding the opioid crisis, the new NSDUH data offer some other bases for cautious optimism. While McCance-Katz stressed that “we still have an epidemic,” the survey shows that the total number of opioid misusers dropped to 11.4 million, from 12.7 million two years earlier. Subtracting heroin users from that figure, misusers of prescription opioid pain relievers declined to 11.1 million from 12.5 million.
The survey does not ask opioid misusers how they were introduced to opioids. (A 2017 study of that question concluded that “nearly half” (47.1 percent) were “first exposed … through a prescription from their physician to treat pain.”) The NSDUH does inquire, however, where prescription opioid misusers obtained the drugs they most recently consumed.
In response, 36.6 percent said they got them from a doctor’s prescription, while 53.1 percent said they got them from a friend or relative (by gift, purchase, or theft). Of those who got them from a friend or relative, 83 percent said that the friend or relative got them from a doctor’s prescription.
“We still have a major problem with prescribers overprescribing pain medications to the point where people have enough of these drugs to share them or sell them to others.”
Reviewing that data, McCance-Katz concluded: “We still have a major problem in this country with prescribers overprescribing pain medications to the point where people have enough of these drugs to share them or to sell them to others.”
One other glimmer of positive news: McCance-Katz reported significant increases in the number of people receiving treatment for both opioid use disorder and heroin use disorder.
Still, however, that good news was dwarfed by bad news: 92.3 percent of people with substance use disorder are getting no treatment at all.
Looking beyond opioids, the survey’s other key headline was that marijuana use was “skyrocketing” among adults. That finding may not be very surprising, given the drug’s continuing legalization in ever-growing numbers of states. Despite the increasing use, moreover, levels of marijuana use disorder stood basically unchanged across all age groups since 2015, the report finds.
Clearly alarming, however, was the rising level of marijuana use reported among pregnant women. Use of marijuana during pregnancy is associated with “negative outcomes in pregnancy” and “very adverse outcomes” for the baby, McCance-Katz said, including “fetal growth restriction,” “hyperactivity,” and “deficits in cognitive function.”
Finally, methamphetamine and LSD both showed significant increases in use among adults 18-25. The use of meth was strongly concentrated in the Western and Midwestern states and Alaska, the report found.
As we noted earlier this month, methamphetamine—which is now often cut with fentanyl—is the drug subcategory currently showing for the most dramatic increases in overdose fatalities, according to the most recent CDC tallies. Fentanyl deaths also continue to march upward.
The NSDUH does not poll active-duty military people, long-term hospital residents, prison populations, and homeless shelters.