The Changing Face of the Heroin Epidemic

The New York City Department of Health and Mental Hygiene (DOHMH) recently released data indicating that the death toll from heroin overdose in the city is continuing to rise. New York City saw 420 people fatally overdose on heroin in 2013, accounting for the highest absolute and population-adjusted rates since 2003, and data indicate that heroin use is spreading to new areas of the city. Whereas the majority of heroin overdoses used to be “almost exclusively central Brooklyn, South Bronx, east Harlem…overlapp[ing] with New York City’s highest-need neighborhoods,” now the profile of an average user has shifted to white, higher income New Yorkers, as well as older Hispanic users in the Bronx.

The situation in New York is similar to what is happening across the country, and the epidemic is affecting not only urban, but also suburban and rural areas. Heroin users often begin by using prescription opioid pills that deliver similar effects, but then shift to heroin, which provides a “better high” for less money. In recent years, authorities have increasingly begun monitoring opioid prescriptions, as well as cracking down on rogue pain clinics and pill dealers, thereby drying up the supply of pills. All told, these factors have contributed greatly to the rise in heroin use across a myriad of populations.

In response to this tragic overdose epidemic, the New York City Police Department has begun outfitting police officers with naloxone, a medication that reverses the effects of an overdose from both heroin and opioid pills. This move follows similar initiatives taking place in the suburbs of Boston, New Mexico, and New Jersey. Further, the Food and Drug Administration has approved a device called Evzio earlier this year that will allow family members to administer a dose of naloxone during an emergency overdose situation prior to contacting EMS.

However, in addition to these essential crisis response strategies, what is clear now more than ever is that our communities must invest in drug prevention, education and treatment activities in order to meet the needs of our neighbors experiencing substance use issues.  

Two possible solutions with demonstrated effectiveness include:

  • Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence based practice with public health roots that can be utilized in primary care centers, hospital emergency rooms, trauma centers, and other community based settings to intervene early with at-risk substance users before more severe consequences occur.
  • Recovery Coaching, a form of strength-based supports for persons in or seeking recovery from alcohol and other drugs, and other addictions. One young adult recovery program in Massachusetts that utilized recovery coaches as part of their approach to recovery saw an 83% reduction in admissions to rehabilitation facilities after one year in the program, and emergency room admissions amongst those in the program went from 30% over the course of a year to 2%.

What other strategies are you using to prevent and/or reduce drug overdoses? Have you seen these same trends occurring in your community?