Heroin use has dramatically increased across the U.S., spreading to groups it hadn't previously reached, and deaths from overdose have soared, according to a new federal report released Tuesday.
Heroin deaths nearly quadrupled in the decade between 2002 and 2013, the Centers for Disease Control and Prevention reports. Rates of abuse doubled among women and went up 50 percent among men during the same time period.
"Heroin use in the United States increased 63 percent from 2002 through 2013. This increase occurred among a broad range of demographics, including men and women, most age groups, and all income levels," the CDC says in its report, attributing much of the increase to users who started abusing prescription painkillers and then moved on to heroin.
"What's most striking and troubling is that we're seeing heroin diffusing throughout society to groups that it hasn't touched before," CDC director Dr. Tom Frieden told NBC News.
"We're seeing heroin affecting people in urban and rural areas, white, black and Hispanic, low middle and high income. We're seeing heroin diffusing throughout society but we can turn this around."
The reasons are complicated -- drug abuse overall is up, and more people are using prescription painkillers. Heroin is a cheap and more easily available alternative to these prescription drugs for people who become addicted to them.
"They are addicted to prescription opiates because they are essentially the same chemical with the same effect on the brain as heroin," Frieden told a news conference. "Heroin costs roughly 5 times less than prescription opiates on the street."
Not only that, but cheaper, purer heroin is coming into the United States. This makes it easier to overdose. "Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people died in 2013," CDC said.
The absolute numbers are still low — fewer than 1 percent of people abuse heroin, CDC said.
For the report, the Food and Drug Administration and the CDC analyzed data from the National Survey on Drug Use and Health from 2002-2013. This report captures thousands of Americans, but misses the military, homeless and prison populations. So it may actually understate the extent of the heroin abuse problem.
"Annual average rates of past-year heroin use increased from 1.6 per 1,000 persons aged 12 years or older in 2002-2004 to 2.6 per 1,000 in 2011-2013," the report reads.
"In 2013, an estimated 517,000 persons reported past-year heroin abuse or dependence, a nearly 150 percent increase since 2007," CDC added.
"During 2002-2013, heroin overdose death rates nearly quadrupled in the United States, from 0.7 deaths to 2.7 deaths per 100,000 population, with a near doubling of the rates from 2011-2013."
Heroin kills by causing slow and shallow breathing. Multiple drug use worsens the effect. "People often use heroin along with other drugs or alcohol. This practice is especially dangerous because it increases the risk of overdose," CDC said.
Heroin users also risk getting infections like HIV and hepatitis.
The report fits in with what other government agencies have been saying.
Last year, the Drug Enforcement Administration found a four-fold increase in heroin seizures along the southwest border since 2008, with 4,653 pounds being confiscated last year.
Frieden says law enforcement needs help stopping it. "The less accessible it is and the more difficult and the more expensive it is to get, the fewer people will use it," he said.
The Substance Abuse and Mental Health Services Administration has reported a steady increase in heroin abuse nationwide, with an estimated 669,000 American users in 2012.
And The Journal of the American Medical Association published a study in 2014 that showed heroin users are changing. While in past decades people from many races used heroin, 90 percent of people who began using in the past decade are white, and many live outside of major cities, the study found.
CDC and FDA found a similar pattern. "During 2002-2011, rates of heroin initiation were reported to be highest among males, persons aged 18-25 years, non-Hispanic whites, those with an annual household income more than $20,000, and those residing in the Northeast," CDC said.
"Most heroin users have a history of nonmedical use of prescription opioid pain relievers, and an increase in the rate of heroin overdose deaths has occurred concurrently with an epidemic of prescription opioid overdoses."
Users say they move to heroin after they get addicted to prescription drugs - often during legitimate use for a medical condition - and then their supply dries up.
And it's easy to get addicted to opiate painkillers, Frieden said.
"A few doses and someone can have a life of addiction. A few pills too many and someone can die from an overdose," he said.
But that's not the only reason heroin use is up.
"The highest rate was consistently found among users of cocaine; during 2011-2013, this rate was 91.5 per 1,000," CDC said.
"Past-year alcohol, marijuana, cocaine, and opioid pain reliever abuse or dependence were each significant risk factors for heroin abuse or dependence. Research has identified poly-substance use as a risk factor for overdose death; most overdose deaths involve multiple drugs."
CDC said states can do a lot more to help fight heroin abuse.
"Specifically, a focus on reducing opioid pain reliever abuse is needed," it said.
Drug registries, educating doctors and patients, and programs to help people avoid becoming dependent on pain medications can all help. Prescription drug monitoring programs help doctors identify potential abusers. "Providers can analyze patient prescription drug history and make informed decisions before prescribing opioid painkillers," CDC said.
Some policymakers have worried that tightening access to painkillers might drive addicts to heroin. But Frieden said that's not really true. "Improving prescribing practices for prescription opiates is part of the solution, not part of the cause, of the heroin problem," he said.
Some doctors may be overusing opiate painkillers, Frieden said.
"If someone has sever terminal pain from cancer, you absolutely want to provide pain relief," he said. The same goes fpr severe pain from, say, a car crash.
"For chronic, non-cancer pain, you really have to look at the risks and benefits," he added. "And the risks are very, very clear."
Alternatives include safer non-steroidal anti-inflammatory drugs such as ibuprofen; physical therapy and even ice, Frieden said.
Wider use of the rescue drug naloxone can also help reduce deaths, CDC said. Naloxone, also known by its trade name Narcan, works within minutes to reverse the effects of an overdose by sticking to brain cells and keeping the drug from getting in.
Erika Edwards and Bree Douglas contributed to this article.