It's cheap and available and more people are turning to it as prescription painkillers become more costly and difficult to obtain
Heroin, suspected of killing actor Philip Seymour Hoffman last weekend, has for years been a forgotten drug in the United States, overtaken by abuse of prescription painkillers.
Heroin-related deaths jumped 84 per cent in New York City from 2010 to 2012, according to a September 2013 report, while the number of heroin users seeking help on New York's Long Island in January rose to 767, far from the average 100 a month seen just five years ago by a local treatment centre. Officials in Pennsylvania, Vermont and Ohio report similar increases.
While inner cities have long battled heroin, law enforcement officials say they are seeing increasing seizures in suburban areas, and that in some communities the highest rate of overdose deaths are among older users, ages 45 to 54. This age group has long been tied to abuse of prescription painkillers. The dynamic, though, may be changing as tough, new federal laws have tightened access to those drugs.
"As people have less and less access to prescription opioids, heroin is the most viable alternative," said Sharon Stancliff, medical director of New York-based advocacy group Harm Reduction Coalition.
Hoffman, 46, who won an Oscar for his portrayal of Truman Capote in 2005, was found dead Feb. 2 in the bathroom of his New York City apartment with a needle in his arm, law-enforcement officials have said. The medical examiner is investigating the death as a possible drug overdose.
"The theory, demonstrated well with Philip Seymour Hoffman, is that when you have a period of forced abstinence through rehab, or when you go sober for a period of time, your body chemistry has changed and you can't handle it," said Jeffrey Reynolds, executive director of the Long Island Council on Alcoholism and Drug Dependence.
Heroin today is cheaper and more easily obtained than prescription painkillers, whose use has been limited by federal and state laws tightening doctor and patient access. A bag of heroin can sell for $10 while the equivalent amount of Vicodin costs $30, Reynolds said.
"If you shut down the supply and don't deal with demand, people turn to heroin," he said by telephone.
Across the U.S., heroin use increased 79 per cent from 2007 to 2012, with 669,000 people reporting they used the drug, according to the National Survey on Drug Use and Health released in 2013.
In the past two months, emergency room doctors at the Allegheny Health Network in Pennsylvania have seen visits related to heroin overdose more than double, said Thomas Campbell, chairman of emergency medicine for the Pittsburgh-based network that includes five hospitals.
Maryland and Vermont have also recorded increases in heroin use, officials there say. Vermont is facing "a full-blown heroin crisis," Gov. Peter Shumlin said in his Jan. 8 state of the state address, noting there were twice as many heroin overdose deaths in 2013 as in 2012.
While cities such as Baltimore have confronted heroin abuse for decades, police and U.S. Drug Enforcement Administration agents say they are seeing increasing seizures in mall towns and suburbs. In suburban Anne Arundel County, Maryland, police say they are seizing more drugs from what have traditionally been quieter areas of the county.
"We are seeing this in the central and southern parts of our county, and it's being used by middle class and upper middle class residents," said Kevin Davis, Anne Arundel's police chief.