Heroin Use Soars in State, Study Says
Drugs: Related hospital admissions have increased 70% in recent years;
most costs are paid by public. Southern California counties report fastest
rate
of growth.
By THOMAS H. MAUGH II, Times Medical Writer

After remaining stable through most of the 1980s, heroin use in
California, as measured by heroinrelated admissions to
hospitals, has surged to recordhigh levels during this decade,
according to a study released today.
Spurred by cheaper, purer heroin and the mistaken perception
that snorting or smoking the drug does not lead to addiction, the
surge in opiate use led to 70% more admissions in 1995 than in
1991, according to the Public Statistics Institute in Irvine.
Throughout the state, the total cost of such admissions in 1995 was
more than $320 million, most of it paid by the public.
"An old drug is back causing new problems," said Dr. Alex
Stalcup, medical director of the New Leaf Treatment Center in
Concord.
The fastest rate of growth occurred in Orange, San Bernardino,
Santa Barbara and Ventura counties, but overall usage remained
highest in Northern California, especially San Francisco, the study
found.
The admission rate for Los Angeles County was about the same
as the state average. The majority of admissions throughout the
state was among middleaged baby boomers, but admissions of
young adults increased as well.
"This is the first quantitative look at how heroin is making a
comeback," said psychologist M. Douglas Anglin of the UCLA
Drug Abuse Research Center. "It is consistent with anecdotes I
have heard from other researchers."
"This is pretty compelling information," said Andy Mecca,
director of the California Department of Alcohol and Drug
Programs. "We had a decade of success in the 1980s, a 50%
reduction in drug use, and look what is happening now. . . . I'm very
concerned."
The study confirms a national trend previously reported by the
Pulse Check studies, conducted twice yearly by the White House
Office of National Drug Control Policy, which are based in part on
information from police departments in 11 urban areas. Those
studies have shown an increase in heroin use.
The private institute performs contract research on health issues,
primarily for health care organizations and the insurance industry.
The study was not funded by the state, but the results have been
reported to it. The trends in the report confirm the state's own
unpublished data, Mecca said.
The growth in heroin use has received much less attention than
the growth in other drugs, such as methamphetamine, said James K.
Cunningham, research director of the institute and lead author of the
report. But the new data, he said, shows that heroin affects virtually
every age group, every ethnic group and most every region of
California.
"Heroin's lower profile may make it a more insidious problem"
than cocaine or methamphetamines, Cunningham said. "Hopefully,
these new data will be a wakeup call."
Why do people use heroin?
"Ingestion of heroin produces nevertobeforgotten pleasure,"
said Stalcup, a coauthor of the report. It activates what are known
as reward/pleasure centers in the brain.
"But heroin produces too much pleasure," much more than is
associated with a good meal or having sex, he added. "Thus heroin
becomes more appealing than the normal activities that one pursues
to relieve pain and gain pleasure."
But heroin use frequently leads to hospitalization, often caused
by overdoses, impurities in the drug or contaminated injection
equipment. Complications of continued use include opiate
poisoning, abdominal pain, hepatitis, chest pain, fever, convulsions,
coma, abscesses on the limbs, pneumonia, inflammation of the lining
of the heart, depression and blood poisoning.
The report notes several reasons for increased heroin use. To
begin with, world production jumped 85% between 1987 and
1995, rising to 4,157 metric tons. Accompanying that production
increase was a price decrease, a 50% drop to an estimated $1,272
per gram of pure heroin.
The lower price has made heroin more accessible as well. Many
dealers who traditionally sold only cocaine now sell both drugs.
Some, in fact, offer heroin, which is a depressant, as a way to come
down from the stimulant effects of cocaine or speed.
* * *
The purity of heroin on the street has also increased, from
14.2% in 1985 to 48.8% in 1994, according to the report. Higher
purity facilitates smoking or snorting by making it possible to get
high without injecting the drug, and it produces a more intense, or
"better," high. But it also accelerates the tolerance processwhich
leads to the need for increased amounts of the drug to achieve a
given euphoric effectand increases the likelihood of an overdose.
Cunningham, Stalcup and their colleagues used data from the
California Hospital Discharge Data System, which has tracked all
hospital admissions in the state since 1983, a total of more than 35
million admissions. They identified all admissions coded by the
hospitals as heroin or opiaterelated, dividing the state's 51
counties into 21 regions.
They found that there were 22,099 such admissions in 1995, at
an average cost of $7,805. Only 19.3% of the admissions were
covered by private insurance.
San Francisco County had the greatest number of admissions,
314 per 100,000 residents. Its rate was nearly three times higher
than in any other region and four times the state average of 66.6 per
100,000. The rate was 70.1 per 100,000 in Los Angeles County,
59.5 in Orange County, 46.6 in San Bernardino County and 48.5 in
Ventura/Santa Barbara.
Last year, the rate of admissions jumped 38% in Orange
County, 37.7% in Ventura/Santa Barbara and 28.7% in San
Bernardino County, compared to a 10% increase in Los Angeles.

* * *

Heroin's Hold
Heroinrelated hospital admissions in California have climbed
70% since 1991 after several years of stability.
Why the increased use?
* Production of heroin has nearly doubled.
* The price has dropped by half.
* Purity has tripled.
* Mistaken perception persists that snorting or smoking is not
addictive.

Where is Heroin Use Most Prevalent?
* The Bay Area has the highest use. San Francisco County, had
314 admissions per 100,000 population in 1995, compared to the
statewide average of 66.6. Alameda County had 97; Contra Costa
County had 91

Where is Heroin Use Increasing?
* The greatest increase in hospital admissions was in Southern
California. Orange County had 59.5 admissions 100,000, and the
largest increase, 38%; Ventura/Santa Barbara counties had 48.5, a
37.7% increase; San Bernardino County had 46.6, a 28.7%
increase; Los Angeles County had 70.1 a 10% increase.
Source: Public Statistics Institute

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