title: The relationship between US heroin market dynamics and heroin-related overdose, 1992-2008.
abstract: OBJECTIVE
  Heroin-related overdose is linked to polydrug use, changes in physiological tolerance and social factors. Individual risk can also be influenced by the structural risk environment including the illicit drug market. We hypothesized that components of the US illicit drug market, specifically heroin source/type, price and purity, will have independent effects on the number of heroin-related overdose hospital admissions.
  
  
  METHODS
  Yearly, from 1992 to 2008, Metropolitan Statistical Area (MSA) price and purity series were estimated from the US Drug Enforcement Administration data. Yearly heroin overdose hospitalizations were constructed from the Nationwide Inpatient Sample. Socio-demographic variables were constructed using several databases. Negative binomial models were used to estimate the effect of price, purity and source region of heroin on yearly hospital counts of heroin overdoses controlling for poverty, unemployment, crime, MSA socio-demographic characteristics and population size.
  
  
  RESULTS
  Purity was not associated with heroin overdose, but each $100 decrease in the price per pure gram of heroin resulted in a 2.9% [95% confidence interval (CI) = 4.8%, 1.0%] increase in the number of heroin overdose hospitalizations (P = 0.003). Each 10% increase in the market share of Colombian-sourced heroin was associated with a 4.1% (95% CI = 1.7%, 6.6%) increase in number of overdoses reported in hospitals (P = 0.001) independent of heroin quality.
  
  
  CONCLUSIONS
  Decreases in the price of pure heroin in the United States are associated with increased heroin-related overdose hospital admissions. Increases in market concentration of Colombian-source/type heroin is also associated with an increase in heroin-related overdose hospital admissions. Increases in US heroin-related overdose admissions appear to be related to structural changes in the US heroin market.
authors.affiliation: University of Maryland, School of Social Work, Baltimore, MD, USA.
authors.forename: George
authors.initials: G
authors.lastname: Unick
authors.forename: Daniel
authors.initials: D
authors.lastname: Rosenblum
authors.forename: Sarah
authors.initials: S
authors.lastname: Mars
authors.forename: Daniel
authors.initials: D
authors.lastname: Ciccarone
mesh_terms: D000328:Adult; D003132:Commerce / Q000706:statistics & numerical data*; D062787:Drug Overdose / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D003932:Heroin / Q000737:chemistry / Q000191:economics / Q000633:toxicity; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D003932:Heroin
keywords: Heroin; heroin distribution; heroin overdose; heroin type; structural environmental risk