August 27, 2009

Heroin and Other Opiate Admissions to Substance Abuse Treatment

Opiates, sometimes referred to as narcotics, are a group of drugs with analgesic and sedative effects. Although opiates are often manufactured and prescribed as medications, they can also be manufactured and obtained illegally. All opiates have a high potential for abuse. As substances of abuse, opiates are generally separated into two categories: (1) heroin and (2) opiates other than heroin, which consist almost entirely of prescription pain killers. While heroin and other opiates are similar in terms of their addictive qualities, the characteristics of the individuals receiving substance abuse treatment for these substances are very different. Understanding the similarities and differences in the characteristics of primary heroin admissions and admissions for other opiates may help treatment providers offer appropriate services and other support to this high-risk population.

Using the 2007 Treatment Episode Data Set (TEDS), this report compares secondary substances of abuse, prior treatment admissions, and demographic and socioeconomic characteristics of primary heroin admissions and admissions for other opiates.¹ As the primary substance of abuse, opiates accounted for 19 percent of all substance abuse treatment admissions (14 percent for heroin and 5 percent for other opiates) in 2007.

Approximately 65 percent of primary heroin admissions and 63 percent of other primary opiate admissions reported a secondary substance of abuse. The most commonly reported secondary substances of abuse among both types of admissions were cocaine, alcohol, and marijuana (Figure 1). Heroin admissions were almost three times as likely as admissions for other opiates to report cocaine as a secondary substance of abuse (51 vs. 18 percent). However, primary heroin admissions were less likely than admissions for other primary opiates to report marijuana (11 vs. 22 percent) or tranquilizers (4 vs. 13 percent) as secondary substances of abuse.

Admissions reporting primary heroin abuse were less likely than admissions reporting other primary opiate abuse to be first-time admissions (23 vs. 44 percent) (Figure 2). While the majority of admissions for both groups had at least one prior treatment admission, heroin admissions were nearly three times as likely as other opiate admissions to report five or more prior treatment admissions (26 vs. 9 percent, respectively).

Primary heroin admissions were older on average than other primary opiate admissions (36 vs. 32 years). Among heroin admissions, 45 percent were between the ages of 18 and 34 and 50 percent were between the ages of 35 and 54 (Table 1). In comparison, the majority of other primary opiate admissions were between the ages of 18 and 34 (62 percent) and one third (33 percent) were between the ages of 35 and 54.

Both heroin and other opiate admissions were more likely to be male than female. However, heroin admissions were less likely than other opiate admissions to be female (32 vs. 47 percent).

Primary heroin and other primary opiate admissions differed in their racial/ethnic composition. Heroin admissions were less likely to be non-Hispanic White (53 vs. 88 percent). However, heroin admissions were five times as likely as other opiate admissions to be Hispanic (22 vs. 4 percent) or non-Hispanic Black (22 vs. 4 percent).

Admissions for heroin abuse were less educated than admissions for other opiate abuse. Heroin admissions were more likely than admissions for other opiates not to have completed high school (36 vs. 25 percent) and less likely to have some education beyond high school (18 vs. 30 percent) (Table 2).² Heroin admissions were also less likely than other opiate admissions to be employed (16 vs. 29 percent) and more likely not to be in the labor force (47 vs. 33 percent).³

Opiate abuse continues to be a serious public health concern. In 2007, admissions for primary opiate abuse accounted for nearly one-fifth of all substance abuse admissions. The differences between heroin admissions and admissions for other opiates are notable, especially in regard to secondary substances of abuse, number of treatment admissions, and demographic characteristics. It is widely accepted that the most effective substance abuse treatment programs provide services that meet the specific individual needs of the client. Recognizing and understanding the differences between primary heroin admissions and other primary opiate admissions may help treatment providers design more effective opiate abuse treatment protocols.

¹ Other primary opiates include methadone, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.
² Education is evaluated only for admissions aged 18 or older.
³ Employment is evaluated only for admissions aged 16 or older.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (August 27, 2009). The TEDS Report: Heroin and Other Opiate Admissions to Substance Abuse Treatment. Rockville, MD.

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