No Longer an Inner City Problem: Today's Typical Heroin Users Are White People in the Suburbs

What does the typical heroin user look like? The answer has shifted dramatically in the past 50 years, according to a new study published in JAMA Psychiatry.

In the 1960s, heroin was used predominantly by men in cities—usuallyl in areas with large minority populations. They typically started in their late teens, and heroin was usually the first opioid they tried. Since then the picture has changed. Now heroin users start older, live in the suburbs, and are 90 percent white. The key to this shift is in another finding by the same study: while the heroin users of previous decades had not previously used other opioids, heroin users of the last decade typically got their start on prescription drugs.

The study authors explain:

“Part of this increase in heroin use and apparent migration to a new class of users appears to be due to the coincidental increase in the abuse of prescription opioids over the last 20 years, arguably accelerated by the release of OxyContin in the mid-1990s, which made large quantities of oxycodone hydrochloride readily available for inhalation and intravenous injection.”

What seems to have happened is that thousands of people—mostly white suburbanites—got the taste for opioids from OxyContin, Percocet and other prescription painkillers, and then simply shifted to the cheapest, most accessible source for their fix. Three quarters of the roughly 2,800 people surveyed for the study said that they tried prescription pain-killers before heroin:

“[T]here is now growing evidence that some prescription opioid abusers, particularly those who inhale or inject their drugs, graduate or shift to heroin, at least in part because it has become more accessible and far less expensive than prescription opioids.”

This pattern helps explain the sudden rise in heroin use in the U.S. After years of relative stability, heroin use rose steadily from 2007 to 2012, when it was estimated that there were 669,000 users in the U.S, according to the National Institute on Drug Abuse. This report estimated that the number of new users nearly doubled from 2006 (90,000) to 2012 (156,000).

The path many white suburb dwellers have taken from prescription painkillers to heroin shows the fraught relationship the U.S. has between legal drugs and illegal drugs. When they perform many of the same functions and one is cheaper and easier to find, can we blame patients for switching between them?

For a weekly roundup of AlterNet's top drugs stories, subscribe to our 'Drugs' newsletter here.