Heroin Use Statistics: Rates, Overdose & Trafficking

April 18, 2022

Table of Contents

Heroin use is an enormous problem throughout the U.S. The 2015 National Survey on Drug use and Health found that almost 5.1 million people reported some degree of heroin use.[1] The 2021 Monitoring the Future Survey noted that 0.2% of 8th grade children reported having used heroin in the prior 12 months. 0.1% of 10th graders, and 0.1% of 12 graders said the same.[3] From 2018 to 2019, overdose deaths where heroin use was a factor increased by 6%.[3] This was a sevenfold increase from the number of heroin-implicated overdose deaths in 1999. In the United States, almost 33% of all deaths as a result of opioid misuse involved heroin.

What Is Heroin?

Heroin is cultivated from the resin (the naturally occurring sap) of poppy plants. In poppies, the sap is called opium. To make heroin, the sap is refined to produce morphine, and then further refined to produce heroin. Heroin is typically injected into a vein (although smoking and snorting heroin are also common forms of administration). Intravenous use is favored because the effects of heroin are felt more immediately and powerfully. Administration through the bloodstream reaches the brain far quicker than administration through the lungs or nose. When heroin enters the body, the chemical compounds rapidly bind to specific receptor sites in the brain.[12] This induces immediate feelings of pleasure, comfort, and reward. The latter effect is one of the key drivers in what makes heroin use so addicting. 

Injecting heroin requires some paraphernalia for the process: a source of heat (like a candle or a lighter) to liquify the heroin, a spoon to hold the liquid form, a belt or shoelace to tie around the arm to make the vein stand out, and a hypodermic needle for the injection.

Heroin Use Across the United States

The National Institute on Drug Abuse noted that heroin is one of the most, if not the most, drug-related public health issue in the United States.[4] In Vermont, for example, heroin use increased by 250% in just four years between 2000 and 2014.[5] Local news in New Jersey calculated that if all people addicted to heroin in the state were put together, there would be enough of them to make up the fourth largest city in the most densely populated state in the country.[6]In 2018, opioids were responsible for 20% of the deaths among Americans ages 24 to 35.[7] Native American tribes across the country fear losing so many of their people to heroin use disorder, that many traditions and cultures may be irreplaceably lost.[8] 

So many people have died from heroin that organ donations have actually increased because of the death toll.[9] Similarly, the death toll has caused a decline in the average American life expectancy.[10] CBS News reported that the spread of heroin in the country has killed more people in a single year (2016) than the number of soldiers who died in the Vietnam War as well as the number of people who died in car crashes in that same year.[11]

Gender Differences in Heroin Use

How does heroin use differ between men and women? In 2020, the PLOS ONE journal looked at some of the differences. 

After studying 109 active female drug users, they found that most women who took heroin had experienced emotional or psychological damage, usually at the hands of a male partner. Serious physical injury was also a factor in such cases.[15] 

Almost half the women had suffered sexual abuse. More than a quarter had exchanged sexual access for heroin or for money with which to buy heroin. This last finding was especially noted among women who injected heroin. 

Other research has found that women generally use smaller amounts of heroin than men and for less time. They tend to be less likely than men to inject heroin, preferring to smoke or snort the drug, except in certain cases when they might be seeking to trade sex for heroin. Women who do this have identified social pressure and encouragement from their sexual partners as their reasons).[16] 

Women are at greater risk than men for a fatal overdose during the first few years of their time injecting heroin for reasons that are still not clear. One idea is that women who inject heroin might be more likely than men to also be using prescription drugs at the same time, and the toxic interactions might prove fatal. 

As part of that, women who do not overdose within the first few years of their intravenous heroin use are more likely than men to survive for many years after. 

A 2015 Medscape review found that rates of heroin use in the previous year were higher among men than women, but also that heroin use across different demographics was experiencing a “significant increase.”[18] 

Such has been the prevalence of heroin trafficking and use that the traditional gaps in use rates between groups, like men and women, low-income people and higher income people, and Medicaid and people on private insurance, have all narrowed since 2010. The findings are based on notable shifts in the demographics of people entering heroin addiction treatment, spurred in large part by opioid manufacturers flooding the consumer painkiller market with fast-acting prescription opioids and illicit drug rings capitalizing on the incessant demand for more opioids.

Additionally, people using heroin are also on average likely to be misusing other substances, such as cocaine and prescription opioid painkillers.

How Does Heroin Get to the US?

Traditionally, heroin has been smuggled into the United States from four sources: Southeast Asia, Southwest Asia, Mexico, and Colombia.[19] More recently, illicit laboratories in China use online networks on the dark web to deliver heroin, fentanyl and other opioids to distributors in the United States, where the drugs are quickly disseminated.[20] 

Despite China criminalizing the production of fentanyl in 2019, vendors in that country have continued to sell synthetic opioids (and the chemicals used to make them) directly to customers in the U.S, sometimes cutting out the traffickers in the middle. The vendors use “a complex network of corporate entities” and intricate shipping methods to get past customs inspections.

Heroin Use in the COVID-19 Pandemic

In February 2022, the American Medical Association released a brief warning that America’s opioid epidemic was “continuing to worsen,” driven in large part by the health care and economic disruptions caused by the COVID-19 pandemic.[13] In almost every state, every state, from Alaska to Florida, and the District of Columbia, local health departments noted a spike in opioid-related fatalities since the spread of the COVID-19 virus. This may in part be due to isolation leading to the halting or discontinuation of many  caused widespread increases in anxiety and fear, and cut many people off from formalized treatment and their recovery groups. Treatment facilities. Social isolation is hypothesized to have increased loneliness, depression, and anxiety, all of which are common triggers for heroin addicts to misuse. 

Even before the pandemic’s effects on heroin use were known, NBC News reported that the United States had experienced a record 74,000 overdose deaths from April 2019 to March 2020, the same period of the official start of the pandemic in the U.S.[14]. The Associated Press found  that overdose deaths in nine states outpaced death counts from the same time period in just the previous year. Connecticut, for example, had a 19% higher overdose death count compared with the same time frame from 2019. Colorado had a 20% increase, and Kentucky had a 30% increase.

Heroin Treatment Statistics

Heroin use disorder treatment primarily involves Medication for Addiction Treatment (MAT) to break the body’s physical dependence on heroin with counseling to help people move away from the psychological hold of the drug.[21]

Up to 66% of individuals experience relapse. This can be due to many factors. Relapse is not treatment failure; it is often part of the long-term recovery process. In 2009, the Journal of Studies on Alcohol and Drugs reported that 79% of patients who got therapy and counseling, in addition to Medication for Addiction Treatment, showed positive rates of reduction in their substance misuse compared to patients who only received medication.[23] Ultimately, people who use heroin can find the support they need to stop in these treatment programs. With the right assistance, they are able to achieve milestones like healthier relationships, a good career, and a happier future.

Addiction cannot be cured, and managing addiction is a complex, active process that is challenging for everyone in treatment.[22] But with ongoing support, particularly with MAT, it can be effectively managed [22].

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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  1. Results From the 2015 National Survey On Drug Use and Health: Detailed Tables. Substance Abuse And Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf. 2016. Accessed March 2022.
  2. Changes in US Lifetime Heroin Use and Heroin Use Disorder: Prevalence From the 2001-2002 to 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2612444. May 2017. Accessed March 2022.
  3. Monitoring the Future. National Institute on Drug Abuse. http://monitoringthefuture.org/data/21data/table2.pdf. 2021. Accessed March 2022.
  4. Heroin Overdose Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/deaths/heroin/index.html. 2021. Accessed March 2022.
  5. What Is the Scope of Heroin Use in the United States? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/heroin/scope-heroin-use-in-united-states. June 2018. Accessed March 2022.
  6. Shumlin Lifts Veil on Heroin Abuse In Vermont. Boston Globe. https://www.bostonglobe.com/opinion/editorials/2014/01/11/governor-shumlin-lifts-veil-heroin-abuse-vermont/HGUkQlogvVtxZC2C1YiZfL/story.html. January 2014. Accessed March 2022.
  7. Welcome to Herointown, New Jersey's 4th-Largest City. NJ.com. https://www.nj.com/news/page/welcome_to_herointown_new_jerseys_4th_largest_city.html. 2015. Accessed March 2022.
  8. Another Shocking Opioid Statistic. The Atlantic. https://www.theatlantic.com/health/archive/2018/06/another-shocking-opioid-statistic/561671/. June 2018. Accessed March 2022.
  9. Native Americans: Opioid Epidemic Killing Off Indian Tribes. The Washington Times. https://www.washingtontimes.com/news/2018/apr/16/native-americans-opioid-epidemic-killing-indian-tr/. April 2018. Accessed March 2022.
  10. The U.S. Opioid Crisis Is So Devastating, It's Made More Organs Available for Transplant. Gizmodo. https://gizmodo.com/the-u-s-opioid-crisis-is-so-devastating-its-made-more-1826053571. May 2018. Accessed March 2022.
  11. Opioid Crisis Trims U.S. Life Expectancy, Boosts Hepatitis C: CDC. Reuters. https://www.reuters.com/article/us-usa-healthcare-cdc/u-s-life-expectancy-fell-in-2016-as-opioid-overdoses-surged-cdc-idUSKBN1EF1TF. December 2017. Accessed March 2022.
  12. Drug Overdoses Killed More Americans Last Year Than the Vietnam War. CBS News. https://www.cbsnews.com/news/opioids-drug-overdose-killed-more-americans-last-year-than-the-vietnam-war/. October 2017.  Accessed March 2022.
  13. How Does the Opioid System Control Pain, Reward and Addictive Behavior? European College of Neuropsychopharmacology. www.sciencedaily.com/releases/2007/10/071014163647.htm. October 2007.  Accessed March 2022.
  14. Issue Brief: Nation’s Drug-Related Overdose and Death Epidemic Continues to Worse. American Medical Association. https://www.ama-assn.org/system/files/issue-brief-increases-in-opioid-related-overdose.pdf. February 2022. Accessed March 2022.
  15. Overdose Deaths Appear to Rise Amid Coronavirus Pandemic in U.S. NBC News. https://www.nbcnews.com/health/health-news/overdose-deaths-appear-rise-amid-coronavirus-pandemic-u-s-n1244024. October 2020. Accessed March 2022.
  16. Gender-Based Vulnerability in Women Who Inject Drugs in a Harm Reduction Setting. PLOS ONE. https://doi.org/10.1371/journal.pone.0230886. March 2020. Accessed March 2022.
  17. Public Stigma Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution Theory and the Familiarity Hypothesis. Frontiers in Public Health. https://www.frontiersin.org/articles/10.3389/fpubh.2021.652876/full.  April 2021. Accessed March 2022.
  18. Vital Signs: Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. Medscape. https://www.medscape.com/viewarticle/847823. Accessed March 2022.
  19. Heroin in Brown, Black and White: Structural Factors and Medical Consequences in the US Heroin Market. International Journal of Drug Policy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704563/. October 2008. Accessed March 2022.
  20.  ‘We Are Shipping to the U.S.': Inside China's Online Synthetic Drug Networks. NPR. https://www.npr.org/2020/11/17/916890880/we-are-shipping-to-the-u-s-china-s-fentanyl-sellers-find-new-routes-to-drug-user. November 2020. Accessed March 2022.
  21. National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment. American Journal of Public Health. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302664. August 2015. Accessed March 2022.
  22. Lapse and Relapse Following Inpatient Treatment of Opiate Dependence. Irish Medical Journal. https://pubmed.ncbi.nlm.nih.gov/20669601/. June 2010. Accessed March 2022.
  23. Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials. Journal of Studies on Alcohol and Drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696292/. July 2009. Accessed March 2022.

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