Trends and characteristics of heroin overdoses in Wisconsin, 2003-2012.
BACKGROUND
Heroin abuse has increased substantially during the past decade in the United States. This study describes trends and demographic shifts of heroin overdoses and heroin-related fatalities in Wisconsin and contrasts these with prescription opioid overdoses.


METHODS
This study was cross-sectional using databases of emergency department (ED) visits, hospital admissions, and death certificates in Wisconsin, United States, during 2003-2012. Cases were Wisconsin residents treated for heroin or prescription opioid overdose, and residents who died of heroin-related drug poisoning. Primary measurements were rates over time and by geographic region, and rates and rate ratios for selected demographic characteristics.


RESULTS
During 2003-2012, age-adjusted rates of heroin overdoses treated in EDs increased from 1.0 to 7.9/100,000 persons; hospitalized heroin overdoses increased from 0.7 to 3.5/100,000. Whites accounted for 68% of hospitalized heroin overdoses during 2003-2007 but 80% during 2008-2012. Heroin-related deaths were predominantly among urban residents; however, rural fatalities accounted for zero deaths in 2003 but 31 (17%) deaths in 2012. Among patients aged 18-34 years, those hospitalized with heroin overdose were more often men (73.0% versus 54.9%), uninsured (44.2% versus 29.9%), and urban (84.3% versus 73.2%) than those with prescription opioid overdose. Rates of ED visits for heroin overdose in this age group exceeded rates for prescription opioid overdose in 2012 (26.1/100,000 versus 12.6/100,000 persons, respectively).


CONCLUSIONS
An epidemic of heroin abuse is characterized by demographic shifts toward whites and rural residents. Rates of heroin overdose in younger persons now exceed rates of prescription opioid overdose.
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Wisconsin Division of Public Health, 1 West Wilson Street, Room 150, Madison, WI 53703, United States. Electronic address: xdf5@cdc.gov.
Jon
J
Meiman
Wisconsin Division of Public Health, 1 West Wilson Street, Room 150, Madison, WI 53703, United States. Electronic address: Carrie.Tomasallo@dhs.wisconsin.gov.
Carrie
C
Tomasallo
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, CDC El Paso Quarantine Station, 601 Sunland Park Drive, Suite 200, El Paso, TX 79912, United States. Electronic address: LBP4@cdc.gov.
Leonard
L
Paulozzi
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000506:poisoning*; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000453:epidemiology* / Q000401:mortality*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D003932:Heroin / Q000506:poisoning*; D006556:Heroin Dependence / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014922:Wisconsin / Q000453:epidemiology; D055815:Young Adult
D000701:Analgesics, Opioid; D003932:Heroin
Heroin; Mortality; Overdose; Prescription opioids; Wisconsin