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
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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