View attachment 38156 Heroin use is reaching into new communities – addicting more women and middle-class users – as people hooked on prescription painkillers transition to cheaper illegal drugs, a new report shows. The rate of heroin use doubled among women over a decade, according to the study released Tuesday by the Centers for Disease Control and Prevention, which compared data from the three-year period between 2002 to 2004 with data from 2011 to 2014. Heroin use also grew by 60% among those with annual household incomes of at least $50,000 -- close to the median household income in the United States. Heroin use grew by 62.5% among those with private insurance, an indication that the users are employed and more financially secure. The report shows that heroin addiction can affect anyone, said Leana Wen, Baltimore City Health Commissioner and an emergency medicine physician. "I can tell you from my experience in the ER that you cannot predict this addiction, any more than you can predict who has diabetes," Wen said. "We see addiction in all walks of life, from 60-year-olds to teenagers, in people of all races, in men and women." Most new heroin users are young white men with low incomes. But CDC directorThomas Frieden said he's alarmed that the reach of heroin is expanding -- a trend that could make it harder to fight the epidemic. "We're seeing big increases across the country and in almost all demographic groups," Frieden said. An estimated 517,000 people used heroin or were dependent on it in 2013, a nearly 150% increase since 2007, the CDC study found. Drug dealers import far more heroin into the United States now than in past years, according to the Drug Enforcement Administraton. Federal agents seized about 4,840 pounds at the southwest border in 2013, four times the amount seized annually from 2000 to 2008. About 75% of new heroin users first became hooked on prescription opiates, a class of morphine-like drugs that includes OxyContin and Vicodin, before turning to heroin, the CDC found. "Prescription opiates have become a gateway drug," Frieden said. There's no evidence that painkiller addicts switch to heroin because doctors are prescribing fewer opiates or because painkillers are harder to get, Frieden said. The biggest increases in heroin use are in communities where opiate use remains high. Many people switch to heroin because it's cheaper, Frieden said. For a heavy user, a day's supply of OxyContin – two 80 milligram pills – can cost up to $160. A day's worth of heroin costs just $40, the DEA said. As heroin addiction deepens, many users turn to needles for a more intense high. That rise in injection drug use has fueled a new set of public health problems, including an HIV outbreak in rural Indiana and a resurgence of hepatitis C nationwide, Frieden said. Growing heroin use is also leading to an increase in the number of babies born addicted to the drug and an increase in overdoses. The rate of fatal heroin overdoses nearly quadrupled from 2000 to 2013. In 2013, more than 8,200 people died from opiate overdoses, the CDC said. Drug and alcohol overdoses kill more people in Baltimore than homicide – with nearly one overdose death a day, Wen said. In Baltimore, overdose deaths have risen 23% in the past year, Wen said. Heroin today can be particularly dangerous because some drug dealers cut it with fentanyl, an opiate commonly used for post-surgical pain that can be up to 50 times more powerful than heroin and up to 100 times stronger than morphine, according to the DEA. While some dealers divert fentanyl from hospitals and doctor's offices, criminals also make the drug themselves in illegal labs. Fentanyl-laced heroin is claiming lives around the country. In Baltimore, deaths linked to fentanyl-laced heroin have spiked by 178% over the past year, Wen said. Thirty-nine people in Baltimore city died from the fatal combination from January to March. The city is distributing fliers warning of the overdose risk. In New Hampshire, four people died from fentanyl overdose within a two-month period, the New Hampshire State Laboratory reported In New Jersey, 80 people died from fentanyl in the first six months of the 2014 fiscal year, the DEA reported. In Pennsylvania, about 200 people died from fentanyl overdose over 15 months, the DEA reported. To reduce heroin use, doctors should be more careful about prescribing painkillers, Frieden said. The CDC offers grants of up to $1 million to states to fund treatment and prescription drug monitoring programs, which aim to prevent people from amassing large amounts of addictive medicines by visiting multiple doctors or pharmacies. Although the CDC approved grants to 34 states for the monitoring programs, it had money to fund only 17. Boosting this program's budget could help many more people, Frieden said. "We have to stop increasing the number of people who are primed and susceptible to heroin," Frieden said. The country also should help more people access treatment, Frieden said. Wen said she'd like to see more communities train people to use naloxone, a drug that can reverse opiate overdoses. The drug is now available in a nasal spray, making it easy for family members and first responders to use. "We can turn this around, but it will take a lot of work and all of society working together," Frieden said.