Dope at discount: Public health consequences of historically low-cost and pure heroin in the United States, 1990 – 2004

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.