title: Observed transition from opioid analgesic deaths toward heroin.
abstract: BACKGROUND
  In the United States, overdose mortality from controlled substances has increased over the last two decades, largely involving prescription opioid analgesics. Recently, there has been speculation on a transition away from prescription opioid use toward heroin, however the impact on overdose deaths has not been evaluated.
  
  
  METHODS
  Time series study of North Carolina residents, 2007 through 2013. Monthly ratio of prescription opioid-to-heroin overdose deaths. Non-parametric local regression models used to ascertain temporal shifts from overdoses involving prescription opioids to heroin.
  
  
  RESULTS
  There were 4332 overdose deaths involving prescription opioids, and 455 involving heroin, including 44 where both were involved (total n = 4743). A gradual 6-year shift toward increasing heroin deaths was observed. In January, 2007, for one heroin death there were 16 opioid analgesic deaths; in December, 2013 there were 3 prescription opioid deaths for each heroin death. The transition to heroin appears to have started prior to the introduction of tamper-resistant opioid analgesics. The age of death among heroin decedents shifted toward younger adults. Most heroin and opioid analgesic deaths occurred in metropolitan areas, with little change between 2007 and 2013.
  
  
  CONCLUSIONS
  The observed increases in heroin overdose deaths can no longer be considered speculation. Deaths among younger adults were noted to have increased in particular, suggesting new directions for targeting interventions. More research beyond vital statistics is needed to understand the root causes of the shift from prescription opioids to heroin.
authors.affiliation: Injury Prevention Research Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 500, Campus Box 7505, Chapel Hill, NC 27599-7505, USA. Electronic address: nabarund@gmail.com.
authors.forename: Nabarun
authors.initials: N
authors.lastname: Dasgupta
authors.affiliation: CDC/CSTE Applied Epidemiology Fellowship, N.C. Department of Health and Human Services, Injury Epidemiology and Surveillance Unit, Division of Public Health, 1915 Mail Service Center, Raleigh, NC 27699-1915, USA. Electronic address: kathleen.creppage22@gmail.com.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Creppage
authors.affiliation: N.C. Department of Health and Human Services, Injury Epidemiology and Surveillance Unit, Injury Violence Prevention Branch Chronic Disease and Injury Section, Division of Public Health, 1915 Mail Service Center, Raleigh, NC 27699-1915, USA. Electronic address: anna.austin@dhhs.nc.gov.
authors.forename: Anna
authors.initials: A
authors.lastname: Austin
authors.affiliation: Injury Prevention Research Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 500, Campus Box 7505, Chapel Hill, NC 27599-7505, USA. Electronic address: cringwal@email.unc.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ringwalt
authors.affiliation: Injury Prevention Research Center, University of North Carolina at Chapel Hill, 137 East Franklin Street, Suite 500, Campus Box 7505, Chapel Hill, NC 27599-7505, USA. Electronic address: kay.sanford@gmail.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sanford
authors.affiliation: N.C. Department of Health and Human Services, Injury Epidemiology and Surveillance Unit, Injury Violence Prevention Branch Chronic Disease and Injury Section, Division of Public Health, 1915 Mail Service Center, Raleigh, NC 27699-1915, USA. Electronic address: scott.proescholdbell@dhhs.nc.gov.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Proescholdbell
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D002423:Cause of Death / Q000639:trends*; D062787:Drug Overdose / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D003932:Heroin / Q000506:poisoning*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000401:mortality
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin
keywords: Epidemiology; Heroin; Opioid analgesics; Overdose; Poisoning