When “Glee” TV star Cory Monteith died last year at age 31 after a heroin overdose, the tragedy was underscored by an element of disbelief.
He was young, affluent and white — the exact opposite of the stereotype of an inner-city user. Drug abuse experts had to expend considerable effort to explain that, in fact, Monteith was the new face of heroin.
“He is what a heroin user looks like,” Caleb Banta-Green, a University of Washington research scientist who specializes in drug abuse, emphasized at the time.
Philip Seymour Hoffman's overdose death brought another wave of shock.
Now comes a new analysis, published in the journal JAMA Psychiatry, which confirms that there’s been a dramatic shift in the demographics of heroin use in the United States.
In the 1960s, the typical user was an inner-city teenager, likely as not a minority, whose habit started with heroin. Fifty years later, new heroin users in America are more likely to be white suburban men and women in their 20s who get hooked on prescription opiates and then turn to heroin because it’s cheaper and easier to get.
“Our typical image of a heroin user is a ‘dirty junkie,’” said lead study author Theodore J. Cicero, a professor of psychiatry at Washington University School of Medicine in St. Louis. “This is not the current heroin user.”
Cicero and his colleagues analyzed data from an ongoing study that included nearly 2,800 heroin addicts entering substance abuse treatment in centers across the U.S. In addition, they conducted intensive interviews with 54 addicts about their experiences and motivations related to using heroin.
In the 1960s, nearly 83 percent of users were boys and men, with a median age of 16.5, who lived in urban areas and started using heroin as their first opiate, the study found.
Before the 1980s, whites and other races were equally represented. But in the last decade, nearly 90 percent of new heroin users were white. New users now are typically older, with a mean age of 23, and they start their addiction with prescription narcotics like Oxycontin, only to progress to heroin.
“This has become a mainstream problem,” Cicero said. “This is now affecting white children living in the suburbs."
That’s clear to Dr. Jason Jerry, a professor of psychiatry and psychology at the Cleveland Clinic, who treats heroin patients. He wasn’t involved in the new study, but he said it accurately underscores the shift he’s seen. “The crackdown in prescription narcotics has pushed more people over to heroin,” he said.
To be sure, prescription opiates cause 16,600 deaths a year, according to federal figures. That compares to about 3,000 deaths a year from heroin. But as U.S. Attorney General Eric Holder noted in March, heroin overdose deaths climbed by 45 percent between 2006 and 2010, flagging what he called “an urgent and growing public health crisis.”
Cynics might suggest that surging heroin use and rising numbers of overdoses have only drawn such high-profile attention because it's becoming a middle-class issue, Cicero noted. "When it was an inner-city problem among minorities, it wasn't a problem," he said.
The new study should serve as a caution to those who still view heroin use — and opiate addiction — through the lens of old stereotypes. For instance, parents of teenagers should monitor prescription painkillers carefully and keep them away from kids because such early use can easily escalate, the experts said.
“The typical path to heroin nowadays starts with prescription narcotics,” Jerry said.