Heroin use, long thought a problem stalking teens in poorer urban and inner city areas, is now more commonly seen affecting middle-class suburban white adults in their early 20s, a study indicates.
In a seismic shift in the demographics of heroin usage, most addicts today are white, wealthy and residing in desirable suburban enclaves, a study published in JAMA Psychiatry reports.
That shift, the researchers say, is likely linked to the increasing availability of and demand for prescription opioids -- painkillers.
Led by researchers at Washington University in St. Louis, the study analyzed data from more than 150 drug treatment centers around the U.S., where patients agreeing to take part in the survey were quizzed on their usage of heroin and of prescription opiate drugs.
The analysis allowed the researchers to correlate the decade in which patient began using opoids with some significant demographic data.
"The country has been abusing heroin since back in the 1940s," researcher Theodore Cicero says, "but at that time it was viewed as a dirty, low-class kind of drug."
By the decade of the 1960s and through the 1970s users were believed to consist mostly of minorities from impoverished backgrounds, and in fact a number of studies from the time characterized heroin as a strictly "inner-city" problem.
Not so, say the Washington University researchers.
Such characterizations were probably exaggerated, they say, since data shows that of people who began using heroin during the 1960s, only 45 percent were nonwhite, while 55 percent of them were white.
Studies of the 1970s probably had a "a tendency to overlook that [white] population, because no one expected to see [heroin abuse] there," Cicero says.
The new study confirms a heroin problem affecting white communities dates back at least four decades, and has been worsening ever since.
By the last decade, whites accounted for 90 percent of new heroin users, the researchers found.
Of the almost 2,800 heroin users in the study survey, 75.2 percent said their first experience with opioids was through prescription painkillers.
"In the past, heroin was a drug that introduced people to narcotics," Cicero says. "But what we're seeing now is that most people using heroin begin with prescription painkillers such as OxyContin, Percocet or Vicodin, and only switch to heroin when their prescription drug habits get too expensive."
Wealthy, white suburban adults more often have access to doctors and can obtain prescriptions for -- and eventually develop an addiction to -- the pharmaceutical opioids, he says.
Many of them eventually turn from prescription opioids to heroin because the drug, although illegal, is more affordable and can be obtained more easily.
Cicero says 94 percent of opioid users in his study reported turning to heroin because the prescription drugs were "far more expensive and harder to obtain."