Epidemiology of Opioid Abuse and Dependence
Heroin is the most commonly abused drug of this class. The 2000 National Household Survey obtained information on nonmedical use of analgesics and heroin separately. For heroin, the survey showed that 1.3% of the population had used in their lifetime; in the adolescent groups, 0.6% of 16- to 17-year-olds had used in their lifetime, but by age 18 to 20 the percentage was the same as in the adult population, 1.3%. When the data for nonmedical use of opioid pain relievers are examined, particularly in adoles-cent populations, the numbers are more alarming, with 12.4% of 16- to 17-year-olds having used these agents and 15.8% of 18- to 20-year-olds. It is unclear what proportion of the users met crite-ria for dependence or abuse since diagnoses were not part of the Household Survey (National Household Survey, 2000).
Heroin addiction has traditionally been associated with large urban areas, especially those in the northeast and mid-Atlantic states
In spite of significant increases in resources that are committed to stop the supply, the purity, and availability of heroin for sale to ad-dicts “on the street” have increased markedly during the last several years. This increase in purity and availability is probably a significant contributor to the increase that has recently occurred in opioid-related emergency room visits and applications for methadone treatment. There also appears to have been an increase in the abuse of prescrip-tion opioids, mainly in nonurban areas. Oxycodone and hydrocodone containing products have traditionally been the main prescription opioids of abuse. Attention has recently focused on oxycontin, a long-acting formulation of oxycodone that contains doses up to 80 mg/tablet. Though the slow absorption of this medication is unlikely to result in abuse when taken as prescribed, addicts have discovered that the tablets can be crushed, freeing much of the oxycodone which can then be inhaled or injected to produce a potent euphoria.