Sixty years ago, the typical heroin addict was a young black man who lived in the inner city and started using the drug when he was 16. Today, the typical heroin user is a mid-20s white man or woman who lives in the suburbs and started his or her habit by abusing prescription painkillers, such as OxyContin, according to a new analysis in JAMA Psychiatry.
"The pattern seems to have shifted entirely," said lead researcher Theodore Cicero, a professor at the Washington University School of Medicine in St. Louis. "It appears that, over time, the supply of prescription opioids became a little less abundant, the price rose, and the expense for a drug habit meant these people had to shift to something else."
Cicero and his colleagues analyzed data from 2,800 patients at more than 150 treatment centers nationwide. They found that 75 percent of today's heroin users were introduced to opioids through prescription drugs, compared with research findings from the 1960s that 80 percent of users started their habit with heroin.
The Centers for Disease Control and Prevention classified prescription-drug abuse as an epidemic a few years ago, but some addicts are shifting to heroin because it is cheaper and easier to get.
Meanwhile, the demographics of other drug users have remained relatively stable over time, with the exception of marijuana, Cicero said. Marijuana has become more pervasive, given the legalization of the drug in Colorado and Washington, and the availability of medical marijuana in a handful of other states. Meth continues to be a problem among the rural poor, he said, while cocaine has high use among young urban and suburban professionals.
"When [heroin] was in the cities, it was something we could ignore," Cicero said. "Now it's a problem of mainstream America. It's hit the middle class."
He says that the findings show that drug policy still must address the root of the problem: why people take drugs at all.