Heroin-Related Deaths on the Rise

Heroin’s popularity is starting to creep into demographic groups that historically had lower rates of use and related deaths.

Annual average rates of heroin use have increased from 1.6 per 1000 individuals from 2002 to 2004, to 2.6 per 1000 from 2011 to 2013, according to a new study from the US Centers for Disease Control and Prevention (CDC) and the FDA.

In 2013 alone, 517,000 individuals reported that they had used heroin—a 150% increase since 2007.

Heroin-related deaths have also climbed, as the rate of fatal overdoses nearly quadrupled between 2002 and 2013.

In an exclusive interview with Pharmacy Times, lead study author Christopher M. Jones, PharmD, MPH, senior advisor at the FDA’s Office of Public Health Strategy and Analysis, said that pharmacists are critical players in identifying patients at risk for overdose and those who may be addicted to prescription opioids, which can lead to heroin abuse.

In fact, the researchers discovered that those who use prescription opioids are 40 times more likely to use heroin. The odds of heroin abuse or dependence were highest among those who had abused or become dependent on opioids or cocaine.

“For people who are addicted to prescription opioids or heroin, pharmacists can serve as a resource for connecting them with evidence-based substance abuse treatment services and help to manage medications they may be receiving as part of their addiction treatment,” Dr. Jones said.

State prescription drug monitoring programs (PDMPs) can serve as useful tools to help pharmacists recognize these patients, Dr. Jones noted. He also said pharmacists can get involved in community efforts to curb drug problems.

“[Pharmacists have been] partnering with community coalitions, the medical community, and others to help educate the public about this important public health crisis,” he explained.

In the study, almost all of those who used heroin also reported using at least 1 other drug in the past year, and 61% had used at least 3 other drugs. These findings are especially relevant, given that fatal overdoses most often include multiple drugs, the researchers noted.

The most stereotypical heroin users were non-Hispanic white men, aged 18 to 25 years, making less than $20,000 a year, and who were Medicaid recipients or uninsured. However, the study found that heroin use was becoming more popular among individuals with private insurance, those with higher incomes, and women. In fact, heroin use among women has doubled.

To address the theory that efforts to curb prescription opioid abuse have led to greater numbers of heroin users, the researchers cited an analysis of 2010 to 2012 fatal overdoses in 28 states that showed decreases in prescription opioid deaths were not associated with increases in heroin-related deaths. Rather, the data demonstrated a link between increases in fatal heroin overdose rates and fatal prescription opioid overdose rates.

Another study found that hospitalizations related to opioid use predicted a spike in heroin overdose hospitalizations down the road.

“Thus, the changing patterns of heroin use and overdose deaths are most likely the result of multiple, and possibly interacting, factors,” the researchers said.

In a Drug Enforcement Administration (DEA) press release, CDC Director Tom Frieden, MD, MPH, added that cheaper and more accessible heroin is contributing to the problem.

“To reverse this trend, we need an all-of-society response—to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses, and work with law enforcement partners like the DEA to reduce the supply of heroin,” Dr. Freiden stated.

Dr. Jones also highlighted how pharmacists are providing the overdose antidote naloxone to patients.

“We have really seen pharmacists take a leading role in efforts to expand access to naloxone,” he told Pharmacy Times. “This includes expanding access to all individuals who are likely to respond to an overdose, including caregivers or family members of patients receiving opioids.”

Pharmacists have been granted greater legal authority over naloxone dispensing in the past year.

In May, the Kentucky Board of Pharmacy passed an emergency regulation permitting pharmacists to dispense the overdose antidote without a prescription. California pharmacists have also been allowed to dispense naloxone this way since January 1, 2015.

Some other interventions that the researchers suggested include reducing inappropriate prescribing of opioids and developing stronger prescription drug monitoring programs. They also posited that greater access and insurance coverage for evidence-based substance abuse treatment could make a difference.

The data in the study came from the National Survey on Drug Use and Health and the National Vital Statistics System.