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									   D rug and A lcohol S ervices I nformation S ystem



   The DASIS Report                                                                                                                April 26, 2007




Heroin—Changes In How It Is
Used: 1995-2005

T
        he National Survey on Drug Use                                        used the drug for the first time.1 Routes of
        and Health (NSDUH) estimates that                                     administration for heroin include inhalation,
        379,000 Americans aged 12 or older                                    injection, smoking, and other means such as
used heroin in 2005, including 108,000 who                                    oral ingestion. Prior DASIS reports indicated
                                                                              increased inhalation among primary heroin
                           In Brief                                           admissions to substance abuse treatment
                                                                              during the 1990s, but also suggested that users
   ● The proportion of primary heroin                                         may have progressed from inhalation to injec-
         admissions who injected the drug
         declined from 69 percent in 1995 to 63
                                                                              tion during that time.2 Similarly, this report
         percent in 2005, while the proportion of                             shows a trend toward inhalation versus injec-
         primary heroin admissions who inhaled                                tion, although the proportion of users who
         the drug increased from 27 percent in                                inhaled the drug has been fairly stable since
         1995 to 33 percent in 2005                                           2001, at about one third.
   ● The proportion of admissions for which                                       Trends in heroin treatment admissions can
         medication-assisted opioid therapy                                   be monitored with the Treatment Episode
         was planned fell from 55 percent of
                                                                              Data Set (TEDS), an annual compilation of
         primary heroin injection admissions
         in 1995 to 31 percent in 2005, but                                   data on the demographic characteristics and
         remained stable at around 30 percent                                 substance abuse problems of those admit-
         of primary heroin inhalation admissions                              ted to substance abuse treatment, primarily
                                                                              at facilities that receive some public funding.
   ● From 1995 to 2005, the proportion of
         primary heroin admissions—whether                                    TEDS records represent admissions rather
         inhalation or injection admissions—                                  than individuals, as a person may be admitted
         receiving ambulatory treatment                                       to treatment more than once during a single
         decreased, while the proportions                                     year.3 This report compares trends in primary4
         admitted to residential/rehabilitation                               heroin inhalation and injection admissions
         treatment or detoxification increased
                                                                              between 1995 and 2005.

The DASIS Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA).
All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of
this report or other reports from the Office of Applied Studies are available on-line: http://www.oas.samhsa.gov. Citation of the source is appreciated.
For questions about this report please e-mail: shortreports@samhsa.hhs.gov.
DASIS REPORT: HEROIN—CHANGES IN HOW IT IS USED: 1995-2005                                                                 April 26, 2007




Heroin Treatment                               Figure 1. Primary Heroin Admissions, by Race/Ethnicity and
                                               Route of Administration: 1995 and 2005
Admissions
                                                         100
Annual admissions to substance abuse
treatment for primary heroin abuse                              26                  24                             24
                                                                                                 27
increased from 228,000 in 1995 to                         80
254,000 in 2005; however, the propor-
                                                                                                                   12
tion of primary heroin admissions                         60                                     20                        Other




                                               Percent
remained steady at about 14 to 15                                                   44                                     Hispanic
                                                                47
percent of all admissions. Between                                                                                         Black
                                                          40                                                               White
1995 and 2005, inhalation and injection
accounted for at least 94 percent of                                                                               61
                                                                                                 50
annual primary heroin admissions.                         20
                                                                25                  30
    In every year from 1995 to 2005,
most TEDS admissions for primary                           0
                                                               1995                2005        1995               2005
heroin addiction injected the drug.                                   Inhalation                      Injection
However, the proportion of primary
heroin admissions who injected the drug     Source: 2005 SAMHSA Treatment Episode Data Set (TEDS).

declined from 69 percent in 1995 to 63
percent in 2005 (despite an 8 percent
                                               Figure 2. Primary Heroin Admissions, by Age Group and Route of
increase in the number of such admis-
sions over this time period). Although         Administration: 1995 and 2005
inhalation has remained the second                       100
most frequent route of administration,                          8
                                                                                                 18
the proportion of primary heroin                                                    26                             24
                                                          80
admissions who inhaled the drug
increased from 27 percent in 1995 to 33
                                                                55                                                         45 or
percent in 2005.                                          60
                                               Percent




                                                                                                                   40      Older
                                                                                    52           64                        30-44
                                                          40                                                               Younger
Demographics                                                                                                               than 30

The racial/ethnic composition of                          20    37                                                 36
primary heroin injection and inhalation                                             22           18
admissions to substance abuse treatment
changed between 1995 and 2005.                             0
                                                               1995                2005        1995               2005
During this time, the general increase in
                                                                      Inhalation                      Injection
the proportion of White primary heroin
admissions was observed for both heroin     Source: 2005 SAMHSA Treatment Episode Data Set (TEDS).
inhalation admissions (from 25 to 30
percent) and heroin injection admissions    were younger than 30 years of age at             71 to 48 percent) for injection admissions
(from 50 to 61 percent) (Figure 1). Over    admission in 1995; by 2005, this propor-         and by 5 percentage points (from 59 to
the same time period, the proportion of     tion increased to 36 percent.                    54 percent) for inhalation admissions
admissions who were Black declined for                                                       (Figure 3). Necessarily, the proportion of
both heroin inhalation admissions (from                                                      primary heroin admissions using other
47 to 44 percent) and heroin injection      Service Setting                                  service settings—residential/rehabilita-
admissions (from 20 to 12 percent).                                                          tion or detoxification—rose sharply for
                                            From 1995 to 2005, the proportion of
    There was also a shift in the age at    primary heroin admissions—whether                injection admissions, and less dramati-
admission of primary heroin injection       inhalation or injection admissions—              cally for inhalation admissions.
versus inhalation admissions. In 1995,      receiving ambulatory treatment
37 percent of primary heroin inhala-        decreased, while the proportions admit-
tion admissions were younger than 30        ted to other service settings increased.5
                                                                                             Prior Treatment
years of age at admission; by 2005, this    Specifically, from 1995 to 2005, the              The proportion of primary heroin
proportion decreased to 22 percent          proportion of primary heroin admis-              injection admissions entering substance
(Figure 2). In contrast, 18 percent of      sions receiving ambulatory treatment             abuse treatment for the first time was
primary heroin injection admissions         decreased by 23 percentage points (from          relatively steady from 1995 to 2004,
April 26, 2007                                                                                        DASIS REPORT: HEROIN—CHANGES IN HOW IT IS USED: 1995-2005


                                                                                                                  inhalation admissions (Figure 4).6 While
   Figure 3. Primary Heroin Admissions, by Service Setting and                                                    heroin inhalation admissions were
   Route of Administration: 1995 and 2005                                                                         consistently less likely than heroin injec-
                                                                         Ambulatory                               tion admissions to have methadone or
                 80
                                                            71           Residential/Rehabilitation               buprenorphine included as part of their
                                                                         Detoxification                           treatment plan, this difference narrowed
                      59                                                                                          in recent years. The proportion of
                 60                      54                                                                       admissions for which medication-
                                                                              48
                                                                                                                  assisted opioid therapy was planned fell
      Percent




                 40                                                                        37                     from 55 percent of primary heroin injec-
                                                      32                                                          tion admissions in 1995 to 31 percent
                                  29
                                                                                                                  in 2005, but remained stable at around
                                                                        20
                 20                            14                                   15                            30 percent of primary heroin inhalation
                           12                                                                                     admissions.
                                                                  9

                                                                                                                  End Notes
                  0
                           1995                2005              1995               2005                          1
                                                                                                                      Substance Abuse and Mental Health Services
                                  Inhalation                            Injection                                     Administration, Office of Applied Studies.
                                                                                                                      (2006). Results from the 2005 National Survey
Source: 2005 SAMHSA Treatment Episode Data Set (TEDS).                                                                on Drug Use and Health: National findings
                                                                                                                      (NSDUH Series H-30, DHHS Publication No.
                                                                                                                      SMA 06-4194). Rockville, MD, tables G.3, G.28.
                                                                                                                  2
                                                                                                                      Substance Abuse and Mental Health Services
   Figure 4. Medication-assisted Opioid Therapy among Primary                                                         Administration, Office of Applied Studies
   Heroin Admissions, by Route of Administration: 1995-2005                                                           (Rockville, MD), The DASIS report: Heroin—
                                                                                                                      changes in how it is used (July 20, 2001) and
                                                                                                                      Heroin—changes in how it is used: 1992-2002
                                                                                                                      (December 17, 2004).
                 60                                                                      Injection                3
                                                                                                                      In 2005, TEDS collected data on 1.8 million
                                                                                         Inhalation
                                                                                                                      admissions to substance abuse treatment
                 50                                                                                                   facilities. Four States and jurisdictions (AK, DC,
                                                                                                                      NM, and WY) did not submit data for 2005.
                                                                                                                  4
                                                                                                                      The primary substance of abuse is the main
                 40                                                                                                   substance reported at the time of admission.
       Percent




                                                                                                                  5
                                                                                                                      Service settings are of three types: ambulatory,
                 30                                                                                                   residential/rehabilitative, and detoxification.
                                                                                                                      Ambulatory settings include intensive outpatient,
                                                                                                                      non-intensive outpatient, and ambulatory
                 20                                                                                                   detoxification. Residential/rehabilitative settings
                                                                                                                      include hospital (other than detoxification),
                                                                                                                      short-term (30 days or fewer), and long-term
                 10                                                                                                   (more than 30 days). Detoxification includes 24-
                                                                                                                      hour hospital inpatient and 24-hour free-standing
                                                                                                                      residential.
                  0                                                                                               6
                                                                                                                      Federal treatment standards for the use of
                      1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005                                          methadone or buprenorphine in opioid treatment
                                                                                                                      programs is regulated by SAMHSA under 42
                                                                                                                      CFR Part 8, as administered by the Center for
Source: 2005 SAMHSA Treatment Episode Data Set (TEDS).
                                                                                                                      Substance Abuse Treatment (CSAT). The use of
                                                                                                                      buprenorphine in office-based treatment
                                                                                                                      became possible under the Drug Addiction
varying between 18 and 20 percent                          while that proportion increased among                      Treatment Act of 2000 (DATA 2000—21 U.S.C. §
before increasing to 23 percent in 2005.                   primary heroin inhalation admissions                       823(g)(2)), also as administered by CSAT. TEDS
                                                                                                                      collects data on whether, at the time of
However, the proportion of primary                         (from 10 to 14 percent).                                   admission, the use of such regulated opioids
heroin inhalation admissions entering                                                                                 was planned as part of treatment. TEDS
                                                                                                                      included levo-alpha acetyl methadol (LAAM) as
treatment for the first time decreased                                                                                 one of these regulated opioids through 2003, but
from 33 percent in 1995 to 29 percent                      Opioid Treatment                                           as of 2004 only includes methadone and
                                                                                                                      buprenorphine. Although LAAM is still a legal
in 2005.                                                   The proportion of primary heroin                           opioid treatment option, it is no longer on the
                                                                                                                      market due to cardiac side effects. Data to
     Admissions with five or more prior                     injection admissions planning medication-                  confirm that the plan was implemented and
                                                           assisted opioid therapy—using metha-                       methadone or buprenorphine was used are not
admissions showed a different trend                                                                                   available.
than admissions entering treatment                         done, levo-alpha acetyl methadol
for the first time. From 1995 to 2005,                      (LAAM), or buprenorphine—as part                       Suggested Citation
the proportion of admissions with five                      of substance abuse treatment declined
                                                                                                                  Substance Abuse and Mental Health Services
or more prior admissions decreased                         from 1995 to 2005. In contrast, the                    Administration, Office of Applied Studies. (April 26,
slightly among primary heroin injection                    proportion planning such therapy                       2007). The DASIS Report: Heroin—Changes In
                                                                                                                  How It Is Used: 1995-2005. Rockville, MD.
admissions (from 32 to 30 percent),                        remained relatively stable among
                                              this list please e-mail: shortreports@samhsa.hhs.gov.
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    Research Findings from SAMHSA’s 2005 Drug and Alcohol Services Information System (DASIS)


Heroin—Changes                                                The Drug and Alcohol Services Information System (DASIS) is an inte-
                                                              grated data system maintained by the Office of Applied Studies, Substance
                                                              Abuse and Mental Health Services Administration (SAMHSA). One
                                                              component of DASIS is the Treatment Episode Data Set (TEDS). TEDS is

In How It Is                                                  a compilation of data on the demographic characteristics and substance
                                                              abuse problems of those admitted for substance abuse treatment. The
                                                              information comes primarily from facilities that receive some public funding.
                                                              Information on treatment admissions is routinely collected by State admin-

Used: 1995-2005                                               istrative systems and then submitted to SAMHSA in a standard format.
                                                              TEDS records represent admissions rather than individuals, as a person
                                                              may be admitted to treatment more than once. State admission data are re-
                                                              ported to TEDS by the Single State Agencies (SSAs) for substance abuse
                                                              treatment. There are significant differences among State data collection
                                                              systems. Sources of State variation include completeness of reporting,
● The proportion of primary heroin admissions who             facilities reporting TEDS data, clients included, and treatment resources
   injected the drug declined from 69 percent in 1995 to      available. See the annual TEDS reports for details. Approximately 1.8 mil-
                                                              lion records are included in TEDS each year.
   63 percent in 2005, while the proportion of primary
                                                              The DASIS Report is prepared by the Office of Applied Studies, SAMHSA;
   heroin admissions who inhaled the drug increased           Synectics for Management Decisions, Inc., Arlington, Virginia; and by RTI
   from 27 percent in 1995 to 33 percent in 2005              International in Research Triangle Park, North Carolina (RTI International is
                                                              a trade name of Research Triangle Institute).

● The proportion of admissions for which medication-          Information and data for this issue are based on data reported to
                                                              TEDS through February 1, 2006.
   assisted opioid therapy was planned fell from 55 per-
                                                                                  Access the latest TEDS reports at:
   cent of primary heroin injection admissions in 1995                          http://www.oas.samhsa.gov/dasis.htm
   to 31 percent in 2005, but remained stable at around
                                                                              Access the latest TEDS public use files at:
   30 percent of primary heroin inhalation admissions                         http://www.oas.samhsa.gov/SAMHDA.htm

● From 1995 to 2005, the proportion of primary heroin                       Other substance abuse reports are available at:
                                                                                     http://www.oas.samhsa.gov
   admissions—whether inhalation or injection admis-
   sions—receiving ambulatory treatment decreased,                          U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
                                                                            Substance Abuse and Mental Health Services Administration
   while the proportions admitted to residential/rehabili-                  Office of Applied Studies
   tation treatment or detoxification increased                              www.samhsa.gov

								
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