Typical heroin users often are middle-class people from the suburbs who started their addiction with prescribed painkillers. While heroin previously was used mostly by the urban poor, a new study indicates today it is commonly used by young, white suburban dwellers.

The study involved 9,000 patients from different treatment centers all over the United States. It showed that 90 percent of people using heroin were white, with an average age of 23. This is in contrast to the 1960s and 1970s when heroin became popular among young minority males who were city dwellers.

Signs of heroin moving from the city to the suburb and rural areas started in the 1990s, according to research published online May 28 in JAMA Psychiatry. The shift to the suburbs seems to be related to the abuse of hydrocodone (Vicodin), fentanyl (Duragesic) and oxycodone (OxyContin). These people were prescribed with the aforementioned medications and soon became addicted, but they could not afford to abuse the expensive drugs so they replaced it with heroin.

"For years, a lot of people in pain couldn't get adequate relief," said addiction expert Dr. Herbert Kleber from the Columbia University Medical Center and New York State Psychiatric Institute. "Then in the 1990s, there was a rebellion against that. Pain became the 'fifth vital sign' in medicine." More patients then received legitimate prescriptions. However, abuse of prescription painkillers and overdoses highly increased.

In the United States, prescription narcotics sales increased 300 percent from 1999 to 2008, while deaths caused by drug overdose tripled in the same period mainly due to prescribed narcotics. In the 1960s, 82.8 percent of people using heroin were males, but now an equal rate of males and females are seeking treatment. A little over 40 percent of heroin users in the '60s were white, while in 2010 the rate was 90.3 percent. The mean age of people seeking treatment rose from around 16 years old in the '60s to around 23 years old in 2010.

The people who need to be treated for specialized substance abuse are not receiving it. Only 10.8 percent of those who needed alcohol or drug abuse treatment received it from specialized facilities in 2012.

The Affordable Care Act and a mental health parity law from 2008 are expected to significantly expand the coverage of substance abuse treatments. Obamacare required benefits that new small-group and individual health plans must cover starting this year, and substance abuse is one of the expanded coverage areas.

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