Heroin and prescription drugs are different opiates affecting different parts of U.S., Globe notes

Stories about an increase in opiate addiction and opiate deaths, growing concerns in rural areas, are missing the fact that opiates are made up of two distinct categories—heroin and prescription painkillers, Evan Horowitz reports for The Boston Globe. "Reacting to these very different epidemics with a set of policies focused on 'opioids' may ultimately prove inadequate, even counterproductive. Because heroin and prescription opioids are killing different people, in different ways, across different parts of the country."

"Heroin deaths are largely concentrated across New England and the Midwest, and heroin victims tend to be young men in their 20s and early 30s," Horowitz writes. "By contrast, prescription opioids are killing people all across the country, especially people aged 45-54 and including a substantial number of women. Perhaps most critical, a Globe anaylsis of death certificates compiled by the Centers for Disease Control shows a marked shift towards heroin, which once contibuted to less than 15 percent of opioid overdose deaths and now accounts for nearly 40 percent." (Globe map: Prescription opioid deaths per every 100,000 people in 2014)

Prescription opioid deaths, led by a rise in popularity of OxyContin, increased by 300 percent from 1999 to 2010, Horowitz writes. During that same time heroin deaths increased from .7 deaths per every 100,000 people to 1 death per every 100,000 people. But from 2010 to 2014, heroin deaths tripled, partly due to cheaper heroin and a concentrated effort by law enforcement to crack down on prescription drug abuse. Heroin deaths are far more rare in states such as Oklahoma, Kansas, Idaho and Wyoming, where "less than one in five opioid-related deaths stem from heroin." (Globe map: Heroin deaths per every 100,000 people in 2014)

"Prescription drug overdoses are most common among middle-aged Americans, 45-54, who account for about 25 percent of all prescription opioid deaths," Horowitz writes. "When you add in 55-64 year olds, you capture nearly half of all overdoses from prescription drugs. With heroin, the situation is reversed. It’s the 25-34 year olds who suffer most, with an overdose rate vastly higher than any other age cohort. This complicates the familiar story of opioid abuse, where people get hooked on prescription drugs before shifting to heroin. For young people, this may indeed be a real risk. One 2012 study suggested that 3-4 percent of opioid addicts do make the switch to heroin. But this doesn’t seem to be happening among older Americans. For that age group, the prescription drugs themselves are the big risk."