Heroin Use Soars in State, Study Says

After remaining stable through most of the 1980s, heroin use in California, as measured by heroin-related admissions to hospitals, has surged to record-high levels during this decade, according to a study released today.

Spurred by cheaper, purer heroin and the mistaken perception that snorting or smoking the drug does not lead to addiction, the surge in opiate use led to 70% more admissions in 1995 than in 1991, according to the Public Statistics Institute in Irvine. Throughout the state, the total cost of such admissions in 1995 was more than $320 million, most of it paid by the public.

“An old drug is back causing new problems,” said Dr. Alex Stalcup, medical director of the New Leaf Treatment Center in Concord.

The fastest rate of growth occurred in Orange, San Bernardino, Santa Barbara and Ventura counties, but overall usage remained highest in Northern California, especially San Francisco, the study found.

The admission rate for Los Angeles County was about the same as the state average. The majority of admissions throughout the state was among middle-aged baby boomers, but admissions of young adults increased as well.

“This is the first quantitative look at how heroin is making a comeback,” said psychologist M. Douglas Anglin of the UCLA Drug Abuse Research Center. “It is consistent with anecdotes I have heard from other researchers.”

“This is pretty compelling information,” said Andy Mecca, director of the California Department of Alcohol and Drug Programs. “We had a decade of success in the 1980s, a 50% reduction in drug use, and look what is happening now. . . . I’m very concerned.”

The study confirms a national trend previously reported by the Pulse Check studies, conducted twice yearly by the White House Office of National Drug Control Policy, which are based in part on information from police departments in 11 urban areas. Those studies have shown an increase in heroin use.

The private institute performs contract research on health issues, primarily for health care organizations and the insurance industry. The study was not funded by the state, but the results have been reported to it. The trends in the report confirm the state’s own unpublished data, Mecca said.

The growth in heroin use has received much less attention than the growth in other drugs, such as methamphetamine, said James K. Cunningham, research director of the institute and lead author of the report. But the new data, he said, shows that heroin affects virtually every age group, every ethnic group and most every region of California.

“Heroin’s lower profile may make it a more insidious problem” than cocaine or methamphetamines, Cunningham said. “Hopefully, these new data will be a wake-up call.”

Why do people use heroin?

“Ingestion of heroin produces never-to-be-forgotten pleasure,” said Stalcup, a co-author of the report. It activates what are known as reward/pleasure centers in the brain.

“But heroin produces too much pleasure,” much more than is associated with a good meal or having sex, he added. “Thus heroin becomes more appealing than the normal activities that one pursues to relieve pain and gain pleasure.”

But heroin use frequently leads to hospitalization, often caused by overdoses, impurities in the drug or contaminated injection equipment. Complications of continued use include opiate poisoning, abdominal pain, hepatitis, chest pain, fever, convulsions, coma, abscesses on the limbs, pneumonia, inflammation of the lining of the heart, depression and blood poisoning.

The report notes several reasons for increased heroin use. To begin with, world production jumped 85% between 1987 and 1995, rising to 4,157 metric tons. Accompanying that production increase was a price decrease, a 50% drop to an estimated $1,272 per gram of pure heroin.

The lower price has made heroin more accessible as well. Many dealers who traditionally sold only cocaine now sell both drugs. Some, in fact, offer heroin, which is a depressant, as a way to come down from the stimulant effects of cocaine or speed.

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The purity of heroin on the street has also increased, from 14.2% in 1985 to 48.8% in 1994, according to the report. Higher purity facilitates smoking or snorting by making it possible to get high without injecting the drug, and it produces a more intense, or “better,” high. But it also accelerates the tolerance process--which leads to the need for increased amounts of the drug to achieve a given euphoric effect--and increases the likelihood of an overdose.

Cunningham, Stalcup and their colleagues used data from the California Hospital Discharge Data System, which has tracked all hospital admissions in the state since 1983, a total of more than 35 million admissions. They identified all admissions coded by the hospitals as heroin- or opiate-related, dividing the state’s 51 counties into 21 regions.

They found that there were 22,099 such admissions in 1995, at an average cost of $7,805. Only 19.3% of the admissions were covered by private insurance.

San Francisco County had the greatest number of admissions, 314 per 100,000 residents. Its rate was nearly three times higher than in any other region and four times the state average of 66.6 per 100,000. The rate was 70.1 per 100,000 in Los Angeles County, 59.5 in Orange County, 46.6 in San Bernardino County and 48.5 in Ventura/Santa Barbara.

Last year, the rate of admissions jumped 38% in Orange County, 37.7% in Ventura/Santa Barbara and 28.7% in San Bernardino County, compared to a 10% increase in Los Angeles.

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Heroin’s Hold

Heroin-related hospital admissions in California have climbed 70% since 1991 after several years of stability.

Why the increased use?

* Production of heroin has nearly doubled.

* The price has dropped by half.

* Purity has tripled.

* Mistaken perception persists that snorting or smoking is not addictive.

Where is Heroin Use Most Prevalent?

* The Bay Area has the highest use. San Francisco County, had 314 admissions per 100,000 population in 1995, compared to the statewide average of 66.6. Alameda County had 97; Contra Costa County had 91

Where is Heroin Use Increasing?

* The greatest increase in hospital admissions was in Southern California. Orange County had 59.5 admissions 100,000, and the largest increase, 38%; Ventura/Santa Barbara counties had 48.5, a 37.7% increase; San Bernardino County had 46.6, a 28.7% increase; Los Angeles County had 70.1 a 10% increase.

Source: Public Statistics Institute