Recent literature suggests a relationship between the decline in prescription opioid misuse and the rise in heroin abuse in the United States—essentially misusers of prescription opioids shift to abusing heroin, with accessibility and cost often triggering the transition.  A recent study reported on the validity of these shifting trends, including if regional differences existed.  Treatment centers participating in a larger research program (see manuscript’s supplemental appendix) were asked to identify individuals receiving treatment for a primary diagnosis of opioid abuse.  These individuals (over 18 years old) were asked to self-report their abuse of prescription opioids and/or heroin the month prior to entering treatment.  The investigators collected data from 2008-2014, and for each year, classified respondents (n=15,227) into one of three groups: misuse of prescription opioids only, abuse of heroin only, or abuse of both prescription opioids and heroin.  Indeed, from 2010-2014, national data demonstrates the decline in prescription opioid misuse with a coincident rise in heroin abuse.  However, throughout the same time period, the concurrent use of heroin and prescription opioids also increases.  Moreover, this study identifies regional differences in these trends.  For example, for the first time in 2014, concurrent heroin and prescription opioid abuse surpassed misuse of only prescription opioids in the Northeast. Take Away:  While tracking trends of prescription opioid misuse and heroin abuse remain important, recent literature suggests we must also track the concurrent abuse of heroin and prescription opioids.  Moreover, our prevention efforts must reflect this changing landscape of opioid abuse.

Citation: Cicero et. al.  (2015) Shifting Patterns of Prescription Opioid and Heroin Abuse in the United States. New England Journal of Medicine, 373:18, 1789-1790.