When posed the question, “Who’s using heroin?” the answer may not be what one would expect. An epidemic of heroin use over the past five years crosses generational, socioeconomic and geographic boundaries to plague all areas of American culture. Heroin, once a drug primarily associated with aging inner-city addicts, has become popular among suburban and rural populations, and is used by adults and adolescents.

Because significant tolerance to respiratory depression develops quickly with continued use of heroin and is lost just as quickly during withdrawal, it is often difficult to determine whether a heroin death was an accident, suicide or murder.

The route of administration among heroin users entering treatment has been changing. In 1993, 74% of admissions for heroin abuse were injectors. By 1999, this had declined to 66%. There was an increase in admission for heroin inhalation for 23% in 1993 to 28% in 1999.

Often these heroin users are under the misconception that if they do not inject the drug they will not become addicted. Those who have entered rehab to recover from heroin addiction include every method of heroin user. Annual admissions to substance abuse treatment for primary heroin abuse increased from 228,000 in 1995 to 254,000 in 2005; however, the proportion of primary heroin admissions remained steady at about 14 to 15 percent of all admissions. Between 1995 and 2005, inhalation and injection accounted for at least 94 percent of annual primary heroin admissions.