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Heroin Overdose Data

Heroin is a semi-synthetic, highly addictive opioid that is made from morphine, a substance taken from opium poppy plants, and can produce intense feelings of euphoria.

Heroin Use

The use of heroin has been increasing in recent years among men and women, most age groups, and all income levels. Some of the greatest increases have occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes.1 In 2017, nearly 494,000 people in the United States (12-years old or older) reported using heroin in the past year, which is an estimated rate of 0.2 per 100 persons.2 And in 2015, 81,326 emergency department visits occurred for unintentional, heroin-related poisonings in America, which is an estimated rate of almost 26 per 100,000 people.3

Risk Factors

Past misuse of prescription opioids is the strongest risk factor for starting heroin use, especially among people who became dependent upon or abused prescription opioids in the past year. This indicates that widespread opioid exposure and increasing rates of opioid addiction have played a major role in the growth of heroin use.

  • In 2013, more than nine in 10 people who used heroin also used at least one other drug. 1
  • Among new heroin users during 2000 to 2013, approximately three out of four report having misused prescription opioids prior to using heroin.4

Heroin-Related Overdose Deaths

As heroin use has increased, so have heroin-related overdose deaths:

  • During 2017, over 15,000 people died from drug overdoses involving heroin in the United States, a rate of almost 5 deaths for every 100,000 Americans.6
  • Heroin-related overdose deaths increased five-fold from 2010 to 2017.5
  • From 2016-2017, heroin overdose death rates remained stable.6
  • In 2017, males aged 25-44 had the highest heroin death rate at 14.8 per 100,000, which was a decrease of -4.5% from 2016.

Statistically significant changes in drug overdose death* rates involving heroin§ by select states,¶ United States, 2016 to 2017.** Note: Rate comparisons between states should not be made due to variations in reporting across states.

*Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14.

† Rates shown are for the number of deaths per 100,000 population. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.

§ Drug overdose deaths, as defined, that have heroin (T40.1) as contributing causes.

Analyses were limited to states meeting the following criteria: For states with very good to excellent reporting, ≥90% of drug overdose deaths mention at least one specific drug in 2016, with the change in drug overdose deaths mentions of at least one specific drug differing by no more than 10 percentage points (pp) between 2016 and 2017. States with good reporting had 80% – <90% of drug overdose deaths mention of at least one specific drug in 2016, with the change in the percentage of drug overdose deaths mentioning at least one specific drug differing by no more than 10 percentage points between 2016 and 2017. States included also were required to have stable rate estimates, based on ≥20 deaths, in at least two drug categories (i.e., opioids, prescription opioids, synthetic opioids other than methadone, heroin).

**Absolute rate change is the difference between 2016 and 2017 rates. Percent change is the absolute rate change divided by the 2016 rate, multiplied by 100. Statistically significant at p<0.05 level. Nonoverlapping confidence intervals based on the gamma method were used if the number of deaths was <100 in 2016 or 2017, and z-tests were used if the number of deaths was ≥100 in both 2016 and 2017. Note that the method of comparing confidence intervals is a conservative method for statistical significance; caution should be observed when interpreting a nonsignificant difference when the lower and upper limits being compared overlap only slightly.

2015-2016 Overdose Map

  • Large central metro—Counties in metropolitan statistical areas of 1 million or more population that:
    • Contain the entire population of the largest principal city
    • Have their entire population contained in the largest principal city
    • Contain at least 250,000 inhabitants of any principal city
  • Large fringe metro—Counties of 1 million or more population that did not qualify as large central metro counties.
  • Medium metro—Counties of populations of 250,000 to 999,999.
  • Small metro—Counties of populations less than 250,000.
  • Micropolitan—Counties in micropolitan statistical areas that have a population of at least 10,000 but less than 50,000.
  • Noncore—Nonmetropolitan counties that did not qualify as micropolitan.

Categories of 2013 NCHS Urban-Rural Classification Scheme for Counties (https://www.cdc.gov/nchs/data_access/urban_rural.htm)

Age-adjusted death rates for heroin are plotted above by urbanization classification of residence for 2016 to 2017. Rates increased significantly for large central metro (5.7) and decrease forlarge fringe metro (-4.9%) and medium metro (-6.1%) areas. The rates did not change significantly for small metro, micropolitan, and noncore areas. The heroin overdose death rate remained stable in the United States overall from 2016 to 2017, with a total of 15,482 deaths in 2017. Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug overdose deaths, as defined, that have heroin (T40.1) as a contributing cause. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.7

Data Table

County Urbanization Level 2016 Rate 2017 Rate
United States 4.9 4.9
Large Central Metro 5.3 5.6
Large Fringe Metro 6.1 5.8
Medium Metro 4.9 4.6
Small Metro 3.7 3.6
Micropolitan 3.6 3.3
Noncore 2.6 2.4

2015-2016 Urbanicity

Heroin Overdose Death Rates.  Age-adjusted deaths per 100,000 population for heroin from 2014 to 2015, by census region of residence. Northeast*: 3,461 deaths in 2015. 5.1 in 2014, 6.3 in 2015. Midwest*: 3,959 deaths in 2015, 2.4 in 2014, 3.2 in 2015. South*: 3,722 deaths in 2015, 2.4 in 2014, 3.2 in 2015. West*: 1,847 deaths in 2015, 2.2 in 2014, 2.4 in 2015. United States*: 12,989 deaths in 2015, 3.4 in 2014, 4.1 in 2015. SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://wonder.cdc.gov/. *Statistically significant at p<0.05 level.
  • Large central metro—Counties in metropolitan statistical areas of 1 million or more population that:
    • Contain the entire population of the largest principal city
    • Have their entire population contained in the largest principal city
    • Contain at least 250,000 inhabitants of any principal city
  • Large fringe metro—Counties of 1 million or more population that did not qualify as large central metro counties.
  • Medium metro—Counties of populations of 250,000 to 999,999.
  • Small metro—Counties of populations less than 250,000.
  • Micropolitan—Counties in micropolitan statistical areas that have a population of at least 10,000 but less than 50,000.
  • Noncore—Nonmetropolitan counties that did not qualify as micropolitan.

Categories of 2013 NCHS Urban-Rural Classification Scheme for Counties (https://www.cdc.gov/nchs/data_access/urban_rural.htm)

Age-adjusted death rates for heroin are plotted above by urbanization classification of residence for 2015 to 2016. Rates increased significantly for all areas – large central metro (20.5%), large fringe metro (22.0%), and medium metro (14.0%), small metro (15.6%), micropolitan (12.5%), and noncore (23.8%) areas. The heroin overdose death rate also increased in the United States overall—a statistically significant 19.5% increase from 2015 to 2016, with a total of 15,469 deaths in 2016. Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug overdose deaths, as defined, that have heroin (T40.1) as a contributing cause. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.7

References

    1. Jones CM, Logan J, Gladden RM, Bohm MK. Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. MMWR 2015; 64(26):719-725.
    2. Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
    3. Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report 2. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.
    4. Cicero TJ, Ellis MS, Surratt, HL. The Changing Face of Heroin Use in the United States. A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry 2014; 71(7):821-826.
    5. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics. 2018.
    6. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. Morb Mortal Wkly Rep. ePub: 21 December 2018.
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