The Changing Face of Heroin Use in the United States A Retrospective Analysis of the Past 50 Years
The Changing Face of Heroin Use in the United States A Retrospective Analysis of the Past 50 Years
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DOI：
10.1001/jamapsychiatry.2014.366
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发表时间：
2014-07-01
期刊：
影响因子：
25.8
通讯作者：
Kurtz, Steven P.
中科院分区：
文献类型：
--
作者：
Cicero, Theodore J.;Ellis, Matthew S.;Kurtz, Steven P.
重要提示：在过去的几年里，有一些主流媒体报道海洛因的滥用已经从低收入的城市地区和大量的少数民族人口迁移到更富裕的郊区和农村地区，主要是白色population.Objective：检查这些轶事报道的真实性，并确定滥用处方阿片类药物和滥用海洛因之间的关系。使用混合方法，我们分析了（1）来自一项正在进行的研究的数据，自我管理的调查，以收集全国范围内接受海洛因使用/依赖初步诊断（DSM-IV）的药物滥用治疗方案患者过去药物使用模式的回顾性数据（n = 2797）和（2）来自完成结构化访谈的患者子集（n = 54）的非结构化定性访谈的数据。除了关于人口统计和目前居住地点的数据外，我们使用交叉表评估了滥用开始十年的流行率，（1）首次使用阿片类药物（处方阿片类药物或海洛因），（2）性别，（3）种族/民族和（4）首次使用时的年龄。受访者表示，在一个开放式的格式，为什么他们选择海洛因作为他们的主要药物和他们使用的处方阿片类药物之间的相互关系。结果：约85%的寻求治疗的患者接近完成调查的关键线人的患者计划这样做。在20世纪60年代开始使用海洛因的受访者主要是年轻男性（82.8%;平均年龄16.5岁），他们滥用的第一种阿片类药物是海洛因（80%）。然而，最近的使用者是年龄较大（平均年龄为22.9岁）的男性和女性，居住在城市较少的地区（75.2%），他们是通过处方药（75.0%）接触类阿片的。白人和非白人在20世纪80年代之前开始使用的人中占同等比例，但在过去十年中开始使用的受访者中有近90%是白色。虽然海洛因产生的“快感”被描述为选择海洛因的一个重要因素，但它之所以经常被使用，是因为它比处方类阿片更容易获得，而且便宜得多。我们的数据显示，在过去的50年里，接受治疗的海洛因使用者的人口构成发生了变化，海洛因的使用已经从市中心，从以少数群体为中心的问题转变为具有更广泛地理分布的问题，主要涉及居住在大城市地区以外的20多岁的白色男性和女性。
IMPORTANCE: Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations.OBJECTIVE: To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin.DESIGN, SETTING, AND PARTICIPANTS: Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview.MAIN OUTCOMES AND MEASURES: In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids.RESULTS: Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants' Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids.CONCLUSION AND RELEVANCE: Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.