A recent article published by Medical Xpress and authored by Caitlin Kizielewicz examined historical trends in heroin initiation in the U.S. and how these patterns have changed over time. Moreover, the article discussed the findings of a new study published in the peer-reviewed journal Addiction, which demonstrated that heroin initiation patterns changed significantly after the late 1990s, following nearly two decades of stability.
As part of the study, researchers evaluated data from 1.7 million individuals who responded to general population surveys over a period spanning over forty years. Specifically, the results showed that heroin initiation that occurred after 2000 was significantly different in magnitude and character from initiation in the late 1970s through mid-1990s. The study found that changes in heroin initiation began soon after the expansion of opioid prescribing and before restrictions on prescription opioids, suggesting that rising deaths from illegal opioids cannot be explained solely by policies limiting opioid prescriptions.
Moreover, the results of the study show that heroin initiation was rare before the late 1960s, peaked in 1972, declined, and remained stable until the mid-1990s before rising again sharply through the early 2010s. Over time, a growing proportion of users reported misusing prescription opioids before starting heroin, and initiation increasingly occurred among older adults, with those over 40 representing a much larger share of new users in recent years.
“Self-reported heroin initiation after 2000 differed in magnitude and character from that of the late 1970s through mid-1990s,” said study author Bishu Giri, a data scientist specializing in natural language processing and an alumnus of Carnegie Mellon University, in an interview with Medical Xpress. “Changes began before dates that are commonly associated with restrictions on opioid prescribing. This appears consistent with a view that ‘trading down’ from prescription opioid misuse to consumption of illegally manufactured opioids did not occur only after implementation of policies to reduce the prescribing of opioids.”
The authors have also noted that survey data may underestimate heroin use because some individuals may not respond or may underreport their use, particularly those with more severe substance use problems. As a result, the identified trends likely reflect individuals with less severe use, though these patterns may still parallel broader initiation trends that lead to more problematic use.
