title: The changing face of heroin use in the United States: a retrospective analysis of the past 50 years.
abstract: OBJECTIVE
  Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations.
  
  
  OBJECTIVE
  To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin.
  
  
  METHODS
  Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview.
  
  
  METHODS
  In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids.
  
  
  RESULTS
  Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants' Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids.
  
  
  CONCLUSIONS
  Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.
authors.affiliation: Department of Psychiatry, Washington University in St Louis, St Louis, Missouri.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Cicero
authors.affiliation: Department of Psychiatry, Washington University in St Louis, St Louis, Missouri.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Ellis
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida.
authors.forename: Hilary L
authors.initials: HL
authors.lastname: Surratt
authors.affiliation: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kurtz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006306:Health Surveys / Q000639:trends; D006556:Heroin Dependence / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008913:Minority Groups; D055553:Prescription Drugs / Q000009:adverse effects* / Q000191:economics; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D014505:Urban Population; D055815:Young Adult
chemical_list: D055553:Prescription Drugs