Heroin use doubled among women and young adults ages 18 to 25, and more than doubled among non-Hispanic whites. Some of the highest increases were in groups with historically low rates of abuse: women, people with higher incomes and people who are privately insured.
"What is causing the increase? Our best information suggests two main reasons," CDC director Dr. Thomas Frieden told CNN. "First, more and more people are susceptible to heroin because they have been prescribed prescription opiates, like OxyContin. And the second reason is that heroin itself seems to be cheaper and more widely available."
The CDC's Vital Signs report
points to data from the Drug Enforcement Administration's National Seizure System for proof. After years of stable seizures of about 500 kilograms per year at the U.S.-Mexican border, the amount of heroin seized jumped sharply in 2013, to more than 2,000 kilograms. At the same time heroin availability went up, there was a "decline in price and an increase in purity."
"Let's make the analogy with tobacco, in which nicotine is a highly addictive drug. When the cost of tobacco goes up, use goes down," Frieden said. "When heroin becomes more accessible and less expensive, more people will use it, especially people who are primed for addiction because of prescription opiates."
The CDC report also showed that nearly everyone using heroin used at least one other drug, and most used at least three. People addicted to cocaine were 15 times more likely to also be addicted to heroin, while marijuana addicts had a threefold increase. Alcoholics were twice as likely to be addicted.
Those addicted to opioid painkillers were found to be 40 times more likely to be addicted to heroin.
"It's basically the same drug," Frieden said. "It operates in the brain in the same way. And if you're addicted to one, use of the other will temporarily relieve the craving from that addiction."
When a prescription opioid like OxyContin attaches to one of the opioid receptors found on nerve cells throughout the body, it reduces pain. Concurrently, the drug increases a "reward" chemical called dopamine
in the brain, which boosts feelings of pleasure, relaxation and happiness -- euphoria or a "high." Both the pain relief and the euphoria are highly addictive; the CDC calls prescription painkiller overdose
in the United States an "epidemic," especially among women
A January 2015 analysis in the New England Journal of Medicine showed that deaths from opioid addiction leveled off from 2006 to 2008 and then decreased slightly from 2009 thru 2013. The study said
the decrease could be due to crackdowns on "pill mills," new uncrushable pills, and the increase of local, state, and federal efforts to reduce doctor shopping and improve opioid prescriptions.
The study also discussed the link to the increase in heroin use.
The CDC's Vital Signs report calls for increased monitoring efforts by state governments and local health care providers to analyze patient history and track Medicaid and workers' compensation programs to stop unnecessary and inappropriate prescriptions.
"Before they prescribe an opioid for the first time, doctors really need to look at the risks and the benefits, particularly for chronic pain like back pain, neck pain, headaches," Frieden said.
"Really, does it make sense to give a prescription opiate for these conditions? What are the risks and what are the benefits? Well, we know the risks -- someone can get addicted for life and if they take a few too many pills, they can die. The benefits are really unproven for chronic, noncancer pain management."
Instead, the report said, health care providers can ask patients about past and current drug and alcohol use; prescribe only the lowest effective dose and quantity of pills for that patient's needs; and link patients who have abuse disorders to treatment services.
"To reverse this trend, we need an all-of-society response to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses and work with law enforcement partners like DEA to reduce the supply of heroin," Frieden said.
In a statement, Chuck Rosenberg, the DEA's acting administrator, said the agency will continue to work with the CDC.
"Approximately 120 people die each day in the United States of a drug overdose," Rosenberg said. "We will continue to target the criminal gangs that supply heroin, and we will work to educate folks about the dangers and to reduce demand. In this way, we hope to complement the crucial efforts of the CDC and our nation's public health agencies."