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Abstract #163266

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Daniel Ciccarone, MD, MPH¹, Allison Kraus¹, and George Jay Unick, PhD, MSW². (1) Family and Community Medicine, University of California San Francisco, 500 Parnassus Ave., MU-3E, Box 0900, San Francisco, CA 94143, 415-514-0275, ciccaron@fcm.ucsf.edu, (2) Department of Psychiatry, University of California San Francisco, 2727 Mariposa St. Suite 100, San Francisco, CA 94110

Background: The past two decades have seen a dramatic increase in heroin-related overdose deaths (HOD) in the United States. This analysis considers heroin purity, price and source region in an explanatory model.

Methods: The average standardized price ($/mg pure) and purity (% by weight) of heroin from 1990 to 2002 was from obtained from US Drug Enforcement Agency retail purchase data for 23 urban areas. HOD were recorded from Centers for Disease Control Wonder data from years 1990-1998 for 9 major US urban areas. Cities with < 20 HOD/year were excluded. Random Effect Regression Models adjusting for clustering in urban areas were estimated to predict price and purity over time and HOD as a function of price and purity controlling for CDC estimates of IDU population size.

Results: Over the 12 study years, heroin price decreased 79% (p<0.001) and the purity increased 47% (p<0.001). In the 9 urban areas with available HOD data, price (p<0.001) and purity (p=0.03) were both associated with increased overdoses controlling for IDU population size.

Conclusions: These data reveal trends to historically low-cost, highly pure heroin in many US cities. These trends appear associated with the concurrent heroin-related overdose epidemic. These changes correspond to Colombian drug-lords' entrance into, and rapid domination of, the US heroin market. Interdiction efforts, which should reduce drug supply and raise prices by restricting drug flows across our borders, have largely failed and may indeed have produced paradoxical results. Resources should be diverted instead to domestic substance treatment and overdose prevention programs.

Learning Objectives:

• 1. Characterize trends in United States retail heroin markets
• 2. Examine effects of heroin price and purity on concurrent heroin overdose deaths

Keywords: Injecting Drug Use, Substance Abuse

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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