Titre : | The changing face of heroin use in the United States: A retrospective analysis of the past 50 years (2014) |
Auteurs : | T. J. CICERO ; M. S. ELLIS ; H. L. SURRATT ; S. P. KURTZ |
Type de document : | Article : Périodique |
Dans : | JAMA Psychiatry (Vol.71, n°7, July 2014) |
Article en page(s) : | 821-826 |
Note générale : | News & Analysis: Kuehn B.M. Driven by prescription drug abuse, heroin use increases among suburban and rural whites. JAMA, 2014;312(2): p. 118-119. |
Langues: | Anglais |
Discipline : | EPI (Epidémiologie / Epidemiology) |
Mots-clés : |
Thésaurus géographique ETATS-UNISThésaurus mots-clés ETUDE RETROSPECTIVE ; HEROINE ; ABUS ; OPIOIDES ; INITIATION ; PRESCRIPTION MEDICALE ; PROFIL SOCIO-DEMOGRAPHIQUE ; MESURES QUANTITATIVES ; MESURES QUALITATIVES ; TYPE D'USAGE |
Résumé : |
ENGLISH:
Importance: Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. Objective: To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin. Design, Setting, and Participants: Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview. Main Outcomes and Measures: In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids. Results: Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants' Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the "high" produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids. Conclusion and Relevance: Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas. FRANÇAIS : Cette étude rétrospective analyse les évolutions démographiques liées à la consommation d'héroïne aux Etats-Unis eu égard à ce qu'elle était il y a cinquante ans. Le profil de l'usager qui en émerge est celui d'un habitant de petites villes ou des régions non urbaines appartenant aux classes moyennes, la consommation ne touchant plus spécifiquement les minorités urbaines comme dans les années 1960. Par ailleurs, les premières expériences de consommation sont plus tardives. Une hypothèse avancée par les auteurs est la disponibilité plus précoce aujourd'hui d'opioïdes sous prescription médicale et les détournements possibles associés. La consommation d'héroïne pouvant apparaître par la suite comme moins onéreuse, plus accessible, plus facile à injecter que les opioïdes sur prescription de type OxyContin. Puisqu'il ne s'agit pas d'une étude de cohorte et parce que l'échantillon a été construit à partir d'individus sous traitement (les usages récréatifs n'ayant pas été inclus), les auteurs insistent sur les limites de ces résultats tout en soulignant leur valeur indicative dans le cadre d'une réflexion épidémiologique. [Actualités des addictions] |
Domaine : | Drogues illicites / Illicit drugs |
Refs biblio. : | 38 |
Affiliation : | Department of Psychiatry, Washington University in St Louis, St Louis, Missouri, USA |
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