Today’s Heroin Users Mostly White, Suburban and Initiated Through Prescription Pain Pills

Theodore J. Cicero, PhD Professor, Vice Chairman for Research Department of Psychiatry Washington University in St Louis St Louis, Interview with:
Theodore J. Cicero, PhD
Professor, Vice Chairman for Research
Department of Psychiatry
Washington University in St Louis
St Louis, Missouri

MedicalResearch: What are the main findings of the study?

Dr. Cicero: Heroin users nowadays are predominantly white men and women in their late 20s living outside large urban areas who were first introduced to opioids through prescription drugs compared to the 1960s when heroin users tended to be young urban men whose opioid abuse started with heroin.

MedicalResearch: Were any of the findings unexpected?

Dr. Cicero: While a higher population of white heroin users was anticipated, the fact that they made up 90% of new users in the past decade was a greater shift than we had expected to see.  In our qualitative interviews, their description of heroin being cheaper and more readily available made the drug a practical choice.  However, these interviews also made it apparent that the stigma once associated with heroin as a “dirty” drug for “junkies” is no longer the prevailing norm.  As one individual noted:  “I knew I liked it [heroin] above all else, and once I had a drug dealer it became almost too easy to get, I had access to money because I am an upper middle class… we weren’t really looked at as being addicts because everyone thinks heroin addicts are all homeless, shady looking, dirty junkies.”

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Cicero: One of the biggest shifts from heroin use in the 1960s to today is that most people in the past decade were initiated into heroin through prior use of prescription opiate analgesics.  Considering the large population of patients receiving opiate medications and the relative percentage of those that develop opiate abuse/dependence with their medications, the risk is actually very low that one would progress to heroin.  However, careful monitoring of medications, particularly by both doctors and parents of teens and young adults, is necessary to identify misuse early on.

In addition, treatment centers and physicians in suburban and rural areas that may not have a lot of prior experience treating heroin-related issues should be prepared for increases in individuals seeking treatment for heroin addiction.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Cicero: Future research will need to focus on the demand side of addiction, particularly what the motivations are for people using drugs.  Supply-side policies have made strides in cracking down on prescription opiate diversion.  However, this seems to have driven a number of people directly to other, more dangerous drugs such as heroin.  To use the balloon analogy; if you squeeze one end of a balloon, the other side gets bigger.  If you restrict the supply for certain drugs, people will simply substitute the drugs they once used with other drugs.  More research is needed in understanding why individuals use drugs in the first place, and developing treatment and prevention efforts based on this knowledge will be a stronger force in helping people end their drug abuse habits, as opposed to supply-side efforts alone.


The Changing Face of Heroin Use in the United States
A Retrospective Analysis of the Past 50 Years

Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. Published online May 28, 2014. doi:10.1001/jamapsychiatry.2014.366.


Last Updated on November 4, 2015 by Marie Benz MD FAAD