Heroin use is increasing in Washington State, especially among young people, a development that suggests the drug could become more common in the rest of the country, according to researchers at the University of Washington's Alcohol and Drug Abuse Institute.
Washington was one of the first states to toughen its laws regarding the prescription of commonly-abused opiates such as oxycodone, requiring patients who wanted the drugs to see pain-management specialists and requiring random drug tests for certain patients to make sure the painkillers are being used properly.
The effect of those laws, says Caleb Banta-Green a researcher at the university who previously served as President Obama's senior science adviser at the Office of National Drug Control Policy, has decreased the number of people who have abused prescription opiates but pushed up demand for heroin in the state.
"We were either progressive or regressive with that aggressive effort to reign in opiate prescribing before a lot of the country," Banta-Green says. "It shows if you enact these laws, you get some of the intended effects – high school sophomores have significantly decreased the rate at which they're abusing prescription opiates, but people are also diverted to heroin."
In the state, the number of drug tests from criminal suspects sent to the state crime lab that have tested positive for heroin jumped from 842 cases in 2007 to 2,251 in 2012, a 167 percent increase. Researchers in the state are still optimistic that the stricter opiate laws will eventually be unequivocally beneficial for the state, because first-time users are more likely to first become addicted to prescription painkillers rather than start with heroin.
It's a problem that has the White House's attention. The 2013 National Drug Control Strategy notes that "heroin use appears to be increasing, particularly among younger people outside of metropolitan areas."
The National Survey on Drug Use and Health found that there were 620,000 past-year heroin users in 2011, compared with 373,000 in 2007. But prescription drug overdoses are also up nationwide – in 2010, prescription pain killers were involved in 16,600 overdose deaths, more than four times as many as in 2000.
"We know that people go from prescriptions to heroin," Banta-Green says. "If they're not getting initially exposed, that's a good thing."
According to Banta-Green, heroin has slowly become a problem outside of urban areas, moving from large cities such as Seattle into smaller suburbs and towns statewide – a problem the state experienced with crystal meth in the 1990s. Banta-Green thinks that development can be explained by stricter prescription drug laws as well. Much of the state's heroin is impure "black tar" heroin from Mexico, which is imported the same way crystal meth is. Laws that made it difficult for American meth manufacturers to purchase the ingredients necessary (including pseudophedrine, a decongestant) to make the drug led Mexican cartels to take over.
"Meth used to be manufactured all across the state, but then with precursor laws, it moved across the border," Banta-Green says. "Well guess what, [Mexican cartels] also have access to heroin and cocaine."
"Prescription drugs created the demand for heroin, meth has provided the supply line," he adds.
Other states, such as Florida, New York and Oregon have also enacted tougher prescription painkiller regulations, and anecdotally, some other states have seen an uptick in heroin abuse after painkiller crackdowns.