Heroin Treatment Admission Information

Heroin users most often inject or inhale the drug. Admissions trend data suggest that many users begin using heroin in inhaled form, and switch to injecting the drug later in their lifetimes. Since the use of shared syringes is an important factor in the transmission of diseases such as HIV/AIDS and hepatitis, it is especially important to design effective heroin abuse treatment and prevention programs.

Understanding how heroin inhalation and injection admissions differ may help in formulating effective programs:

• Among primary heroin admissions, 95 percent either injected (62 percent) or inhaled (33 percent) the drug
• Primary heroin inhalation admissions were more likely to be Black (45 percent), while primary heroin injection admissions were more likely to be White (58 percent)
• Primary heroin injection admissions were more likely than inhalation admissions to be younger than 25 years of age (17 vs. 11 percent), but also more likely to be 45 years old or older (24 vs. 19 percent)

In 2002, heroin was reported as the primary substance of abuse for 15 percent of the 1.9 million admissions in the Treatment Episode Data Set (TEDS). The most common route of administration among primary heroin admissions was injection (62 percent), followed by inhalation (33 percent), smoking (2 percent), oral (2 percent), and other (1 percent). This report compares the characteristics of primary heroin admissions reporting the two major routes of administration, injection and inhalation.

Sex and Race/Ethnicity: There were no substantial differences between the sexes in the preferred route of administration; males comprised 67 percent of inhalation admissions and 69 percent of injection admissions. Primary heroin inhalation and injection admissions were quite different by race/ethnicity, however. Primary heroin inhalation admissions were more likely to be Black (45 percent), while primary heroin injection admissions were more likely to be White (58 percent) (Figure 1).

Figure 1.

Primary Heroin Admissions, by Route of Administration and Race/Ethnicity: 2002

Figure 2. Age

Primary heroin injection and inhalation admissions also had different age distributions. Injection admissions were more likely than inhalation admissions to be younger than 25 years of age (17 vs. 11 percent), but also more likely to be 45 years old or older (24 vs. 19 percent) (Figure 2).

Figure 2. Primary Heroin Admissions, by Route of Administration and Age Group: 2002

Figure 3. Census Region

Primary heroin injection admissions were more likely to be from the West than were inhalation admissions: 32 percent of injection admissions were from that region compared with 3 percent of inhalation admissions (Figure 3). However, primary heroin injection admissions were less likely than inhalation admissions to be from the Northeast (47 vs. 66 percent).

Figure 3. Heroin Admissions, by Primary Route of Administration and Region: 2002

L. Ron Hubbard and the Narconon program

Primary prescription and OTC drug treatment admissions were slightly more likely than all treatment admission to be first-time admissions (47 vs. 44 percent) and slightly less likely to have been in treatment five or more times previously (7 vs. 11 percent).

Routes of administration for primary heroin admissions differed by source of referral to treatment. While self/individual referrals were the most common referral type for both inhalation and injection admissions, the proportion was higher among injection admissions (65 vs. 59 percent) (Figure 4). Injection admissions showed a correspondingly lower proportion of criminal justice system referrals than inhalation admissions (12 vs. 16 percent).

Figure 4. Primary Heroin Admissions, by Route of Administration and Referral Source: 2002

History and Substances

Primary heroin injection and inhalation admissions did not differ noticeably in their treatment settings (ambulatory, detoxification, or rehabilitation / residential), but did differ in the number of prior treatment episodes. In particular, inhalation admissions were more likely to have no prior treatment episodes (26 vs. 20 percent) or one to four prior episodes (60 to 49 percent), while injection admissions were more likely to have five or more prior treatment episodes (31 vs. 14 percent). This pattern—injection admissions more likely to have lengthy treatment histories, inhalation admissions more likely to have no treatment history—may have been related to the greater proportion of older users among injection users noted above. Injection admissions were also more likely than inhalation admissions to have their treatment plan include methadone (39 vs. 32 percent)

Primary heroin injection and inhalation admissions showed no substantial differences in frequency of use, with about 81 percent of both groups reporting daily use.

Primary heroin inhalation and injection admissions were about equally likely to report some form of cocaine as a secondary substance (50 vs. 48 percent), although inhalation admissions were more likely to specifically report using smoked cocaine (crack) as a secondary substance (30 vs. 15 percent). Primary heroin inhalation and injection admissions also reported about the same percentages of secondary use of alcohol (27 vs. 25 percent) and opiates (7 vs. 8 percent). Primary inhalation admissions were more likely than injection admissions to report marijuana as a secondary substances (12 vs. 9 percent), but less likely than injection admissions to report stimulants (1 vs. 4 percent) or other substances (3 vs. 6 percent) as a secondary substance.