Is the New Heroin Epidemic Really New? Racializing Heroin.

Heroin abuse as an outcome of the prior use of painkillers increased rapidly over the past decade. This "new epidemic" is unique because the new heroin users are primarily young White Americans in rural areas of virtually every state. This commentary argues that the painkiller-to-heroin transition could not be the only cause of heroin use on such a scale and that the new and old heroin epidemics are linked. The social marketing that so successfully drove the old heroin epidemic has innovated and expanded due to the use of cell-phones, text messaging and the "dark web" which requires a Tor browser, and software that allows one to communicate with encrypted sites without detection. Central city gentrification has forced traffickers to take advantage of larger and more lucrative markets. A second outcome is that urban black and Latino communities are no longer needed as heroin stages areas for suburban and exurban illicit drug distribution. Drug dealing can be done directly in predominantly white suburbs and rural areas without the accompanying violence associated with the old epidemic. Denial of the link between the new and old heroin epidemics racially segregates heroin users and more proactive prevention and treatment in the new epidemic than in the old. It also cuts off a half-century of knowledge about the supply-side of heroin drug dealing and the inevitable public policy measures that will have to be implemented to effectively slow and stop both the old and new epidemic.

Drug treatment clients and their community peers: how they differ.

Free-at-Last is a drug treatment program in East Palo Alto, California, a low-income predominantly African American community in Silicon Valley. In this research, a cohort of treatment clients was compared to a random sample of community residents. Both groups used drugs. Two-way analysis of variance was used to identify factors that predicted the number of drugs used, controlling for client or community sample status. Significant predictors turned out to be perception of race discrimination, ever selling drugs, contact with the police, the number of relatives who died suddenly as a juvenile, ever having thoughts of suicide, and marital status. Path analysis was used to show the relationship between predictors of the number of drugs used for treatment clients; a second path was done for community clients. By comparing each path analysis, we were able to show how treatment clients arrived at significantly higher drug use than peers in the community.

Comparison of HIV infection risk behaviors among injection drug users from East and West Coast US cities.

This study assessed whether behavioral differences explained higher human immunodeficiency virus (HIV) seroprevalence among injection drug users (IDUs) in three East Coast versus two West Coast cities in the United States. Sociodemographic, sexual, and injecting information were collected during semiannual face-to-face interviews. Baseline data from New York City; Baltimore, Maryland; and New Haven, Connecticut, were compared with data from Los Angeles, California, and San Jose, California. Among 1,528 East Coast and 1,149 West Coast participants, HIV sero-prevalence was 21.5% and 2.3%, respectively (odds ratio [OR] 11.9; 95% confidence interval [CI] 7.9-17.8). HIV risk behaviors were common among IDUs on both coasts, and several were more common among West Coast participants. Adjusting for potential risk factors, East (vs. West) Coast of residence remained highly associated with HIV status (adjusted OR 12.14; 95% CI 7.36-20.00). Differences in HIV sero-prevalence between East and West Coast cities did not reflect self-reported injection or sexual risk behavior differences. This suggests that other factors must be considered, such as the probability of having HIV-infected injection or sexual partners. Prevention efforts are needed on the West Coast to decrease HIV-associated risk behaviors among IDUs, and further efforts are also needed to reduce HIV incidence on the East Coast.

Death in the family and HIV risk-taking among intravenous drug users.

The objective of this study was to ascertain the relationship among intravenous drug users between high levels of HIV risk-taking and both (a) deaths of significant others experienced before age 15, and (b) unresolved mourning; 592 out-of-treatment intravenous drug users (71.4% male; mean age = 40.5), stratified as to zip code, were recruited in San Jose, CA, as part of a CDC multisite investigation of access to sterile needles and HIV infection. HIV serostatus tests were obtained and an individual, structured interview administered covering demographics, employment, mental health, HIV risk-taking behavior, family contacts/closeness, and family deaths/mourning. Multivariate analyses indicated that the extent of HIV risk-taking in adulthood was highly and positively related to (a) the number of close-family-member deaths participants experienced as youth, (b) the extent to which respondents effectively mourned sudden family losses, (c) the extent to which those lost were emotionally close to the respondent, and (d) whether or not the respondent attended the funerals of lost relatives. Canonical correlations between sets of death/mourning and HIV risk-taking variables were .55 for the total sample (p < .001) and .70 for the subsample who experienced early and sudden family deaths (p < .001). In both analyses, it made little difference if age and gender were partialed out. These findings give credence to the importance of (a) unexpected deaths experienced early in life, and (b) related, inadequate mourning, as factors in progressively higher adult HIV risk-taking. They suggest that treatment for such individuals and their families should involve grief work dealing with unresolved losses within the family of origin. In addition, prevention efforts may have to revise their modus operandi toward both more focused and more family-based methods of outreach and engagement.