Premium
The relationship between US heroin market dynamics and heroin‐related overdose, 1992–2008
Author(s) -
Unick George,
Rosenblum Daniel,
Mars Sarah,
Ciccarone Daniel
Publication year - 2014
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12664
Subject(s) - heroin , medicine , drug overdose , population , demography , psychiatry , poison control , emergency medicine , environmental health , drug , sociology
Abstract Background and Aims Heroin‐related overdose is linked to polydrug use, changes in physiological tolerance and social factors. Individual risk can also be influenced by the structural risk environment including the illicit drug market. We hypothesized that components of the US illicit drug market, specifically heroin source/type, price and purity, will have independent effects on the number of heroin‐related overdose hospital admissions. Methods Yearly, from 1992 to 2008, M etropolitan S tatistical A rea (MSA) price and purity series were estimated from the US D rug E nforcement A dministration data. Yearly heroin overdose hospitalizations were constructed from the Nationwide Inpatient Sample. Socio‐demographic variables were constructed using several databases. N egative binomial models were used to estimate the effect of price, purity and source region of heroin on yearly hospital counts of heroin overdoses controlling for poverty, unemployment, crime, MSA socio‐demographic characteristics and population size. Results Purity was not associated with heroin overdose, but each $100 decrease in the price per pure gram of heroin resulted in a 2.9% [95% confidence interval (CI) = 4.8%, 1.0%] increase in the number of heroin overdose hospitalizations ( P = 0.003). Each 10% increase in the market share of C olombian‐sourced heroin was associated with a 4.1% (95% CI = 1.7%, 6.6%) increase in number of overdoses reported in hospitals ( P = 0.001) independent of heroin quality. Conclusions Decreases in the price of pure heroin in the United States are associated with increased heroin‐related overdose hospital admissions. Increases in market concentration of C olombian‐source/type heroin is also associated with an increase in heroin‐related overdose hospital admissions. Increases in US heroin‐related overdose admissions appear to be related to structural changes in the US heroin market.