Injection Drug Use in the United States M. Fe Caces Office of National Drug Control Policy Executive Office of the President Washington, DC 20503 Presentation at the Treatment Demand Indicators Expert Meeting European Monitoring Centre on Drugs and Drug Addiction Lisbon, Portugal September 24, 2013
Overview Data sources: Estimates of Injection Drug Use Prevalence Estimates of Injection Drug Use Incidence among Persons with HIV Treatment Data Linkage of injection heroin use with non-medical pain reliever use
Injection Drug Use Estimates 1,520,054 estimated number of injection drug users (IDU) in the United States in 2007 Prevalence varies widely by location: in 2007, major metropolitan statistical areas (MSA) range from 34 to 324 IDUs per 10,000 population; median among MSAs is 95.1 per 10,000 Variability between subgroups: Prevalence increased among non-hispanic Blacks; declined among Hispanics prevalence increased among youth, from 90-100 per 10,000 population in the early 1990s to >120 in 2006-2007 Source: TempalskiB, PougetER, Cleland CM, Brady JE, Cooper HLF, et al. (2013) Trends in the Population Prevalence of People Who Inject Drugs in US Metropolitan Areas 1992 2007. PLoS ONE 8(6): e64789. doi:10.1371/journal.pone.0064789. 9/2013
United States National Estimates of People Who Inject Drugs, by Index, 1992 2007 Tempalski B, Pouget ER, Cleland CM, Brady JE, et al. (2013) Trends in the Population Prevalence of People Who Inject Drugs in US Metropolitan Areas 1992 2007. PLoS ONE 8(6): e64789. doi:10.1371/journal.pone.0064789 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0064789
New HIV Infections Attributed to Injection Drug Use 1/2013 *Includes transmission categories Injection drug use and Male-to-male sexual contact and injection drug use. Source: Prejean, et al. Estimated HIV Incidence in the United States, 2006-2009. PLoSONE 6(8): e17502. doi:10.1371/journal.pone.0017502 (August 2011) for 2006 estimate; CDC. Estimated HIV incidence in the United States, 2007-2010. HIV Surveillance Supplemental Report 2012 Vol. 17, No. 4 (December 2012) for 2007-2010 estimates.
Injected Drugs Heroin is the most commonly injected drug Seventy percent of primary heroin treatment admissions reported injection as the route of administration, and 25 percent reported inhalation Fourteen percent of primary non-heroin opiate admissions reported injection as the route of administration, while 62 percent reported oral route of administration Eleven percent of primary non-smoked cocaine admissions reported injection as their route of administration Twenty-two percent of primary methamphetamine/amphetamine admissions reported injection as the route of administration Source: Substance Abuse and Mental Health Services Administration, 2010 Treatment Episode Data Set (Data received through 10-10-2011). 9/2013
Mode of Administration among Heroin Treatment Admissions, Ages 12 or Older, 2010 Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (Data received through 10-10-2011). 9/2013
Percent Injecting among Heroin Treatment Admissions, Ages 12 or Older, 2000-2010 Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (Data received through 10-10-2011). 9/2013
Percent Injecting among Heroin Treatment Admissions, 2000-2010 Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (Data received through 10-10-2011). 9/2013
Heroin Treatment Admissions, By Route of Administration and Age Group, 2000-2010
Younger Injectors Route of administration of heroin was closely linked to age -injection increased among young adults; inhalation increased among those 45 and older. The proportion of injectors aged 20 to 34 among heroin admissions increased from almost 1 in 4 (24 percent) in 2000 to more than 2 in 5 (41 percent) in 2010. During the same period, the proportion of injectors aged 35 to 44 fell from 22 percent to 13 percent. Source: Substance Abuse and Mental Health Services Administration, 2010 Treatment Episode Data Set (Data received through 10-10-2011). 9/2013
Heroin Initiation among Non-Medical Users of Pain Relievers Findings from analysis of pooled data from the National Survey on Drug Use and Health conducted annually from 2002 through 2011 among persons aged 12 to 49: The vast majority of non-medical pain reliever (NMPR) users have not progressed to heroin use. Only 3.6 percent of NMPR initiates had initiated heroin use within the 5-year period following first NMPR use. However, the heroin incidence rate in the 12 months preceding interview was 19 times higher among those who reported prior non-medical pain reliever (NMPR) use than among those who did not (0.39 vs. 0.02 percent). Four out of five recent heroin initiates (79.5 percent) previously used NMPR. Source: Muhuri, PK, Gfroerer, JC and Davies, C. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States CBHSQ Data Review, Substance Abuse and Mental Health Services Administration (August 2013). 9/2013
Most opiate admissions are for heroin, with increasing admissions for other opiates or synthetics since 1999. Number of Primary Treatment Admissions, 1999 to 2010 450 000 400 000 350 000 Non-Rx methadone Other opiates/synthetics Heroin 300 000 250 000 200 000 150 000 100 000 50 000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 NOTE: Other opiates/synthetics excludes non-prescription methadone. 3/2013 Source: SAMHSA, Treatment Episode Data Set 2000-2010 (June 2012) and Treatment Episode Data Set 1999-2009 (April 2011).
Emergency Department Visits Involving Heroin or Non-medical Use of Narcotic Analgesics, 2004-2011 Source: Substance Abuse and Mental Health Services Administration, Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits (February 2013) and DAWN 2010 Emergency Department Excel Files National Tables (2012). 3/2013
Number of Deaths 3 500 3 000 2 500 2 000 1 500 1 000 Drug Poisoning Deaths Involving Heroin: United States, 1999 2010 % CHANGE 2006-10 + 45% 500 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 heroin* 1963 1843 1784 2092 2084 1879 2010 2089 2402 3041 3279 3038 Note: Not all drug poisoning deaths specify the drug(s) involved, and a death may involve more than one specific substance. The rise in 2005-2006 in opioid deaths is related to non-pharmaceutical fentanyl (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a1.htm). *Heroin includes opium. 2/2013 Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC 16 WONDER Online Database, released 2012. Extracted on February 11, 2013.
Drug Poisoning Deaths Involving Heroin United States, 1999 2010 Deaths per 100,000 Population 2,5 2,0 1,5 1,0 0,5 0,0 Age 40-55 Age 25-39 Age 15-24 Age 55-74 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: Centers for Disease Control and Prevention. Wide-ranging OnLineData for Epidemiologic Research(WONDER) Multiple Cause Mortality data. http://wonder.cdc.gov, extracted on March 11, 2013.