May 17, 2001 -- Injection drug use has declined steadily in America's inner cities, but New Jersey's public health officials have detected a disturbing new trend. Since 1993, the use of injectable heroin and cocaine has increased -- raising concerns about spread of HIV and other infections.
And the increased use was in young adults outside the urban areas -- a group not previously thought to be at high risk, says the new CDC study.
"We found an increase in injection heroin use in younger age groups -- 18 to 25 -- in all ethnic groups across the state," says lead author Anna Kline, PhD, director of research in the division of addiction services of the New Jersey Department of Health. "We also noticed an expansion into the suburbs and rural areas."
In her study, Klein looked at data on persons admitted to New Jersey addiction outpatient treatment centers who reported using injectable drugs from 1992 to 1999. She also analyzed data on users of injectable heroin and cocaine from 1980 to the early 1990s. The numbers of injectable users declined from the 1980s through the early 1990s, says Kline.
In 1995 the trend shifted, with 43% of patients reporting use in 1993 compared with 45% in 1999. The largest increases were among those 18 to 25 years old, says Kline. That number rose from 22% in 1993 to 46% in 1999.
Total numbers of injectable drug users increased substantially among suburban/rural residents from 1993 to 1999 while it declined among urban residents.
"Quite bluntly, that can't be good news," says George DiFerdinando, MD, deputy commissioner for the New Jersey Department of Health and Senior Services. DiFerdinando is a co-author of the CDC study.
But can local drug use patterns give an idea of what's going on nationally?
"Not really," says DiFerdinando. "To a surprising extent, drug use patterns can be very local or even regional. Methamphetamine is extremely popular in other parts of the country, but we haven't had too much of that problem in New Jersey. We have a substantial problem with ecstasy while some parts of country don't."
It's the age group that he's most concerned about, DiFerdinando tells WebMD.
"We see it in this study and others -- high-risk behaviors in the 18- to 25-year-old group have greatly increased. The message isn't getting through. We have to keep pushing the prevention message with the same intensity that we did at the beginning of the HIV epidemic 15 years ago. It was a crisis atmosphere, and we felt we had to do everything possible."
Not all experts agree with the CDC data. In fact, national studies show that since 1995 heroin use in young adults -- 19- to 29-year-olds -- has remained "amazingly constant," says Lloyd Johnston, PhD, principal investigator of the Monitoring the Future study from the University of Michigan Institute for Social Research. His studies are funded by grants from the National Institute on Drug Abuse, an arm of the National Institutes of Health.
Johnston has tracked drug use for the past 25 years among adolescents, college students, and young adults across the country, Johnston tells WebMD.
"We're quite good at looking at the nation as a whole," says Johnston. "We don't show any change since 1995 in heroin use in young adults -- 19- to 29-year-olds. But our data is of high school graduates -- some 85% of the population. The other 15% may be the heavier heroin users. Our absolute estimates are undoubtedly low, but I think we're picking up the trends. And I don't see any trends of that sort."
Another major source -- the National Household Survey on Drug Abuse -- also shows no increase in heroin use among the 18 to 25 age group, says Johnston. "In fact, they show a decrease in that population."
Main message from her study, says Kline: "The need for a redirection of prevention efforts," she tells WebMD. "We have been placing a lot of preventive dollars for HIV/AIDS into the urban areas and not so much into the suburbs."
Also, the message needs to target younger kids, says Howard Simon, spokesperson for Partnership for a Drug-Free America. "If you're talking about 18- to 25-year-olds, you're not talking about new drug users. They've probably been using for a while. We like to look at the next group coming up, the 12- to 17-year-olds."
Too true, says Maggie Jenkins, director of Mainstream Kansas City Inc., a drug treatment facility for women in Johnson County, Kan.
"I've had 13-, 14-, 15-year-old girls with [skin and muscle] infection ... from a dirty needle," Jenkins tells WebMD. "They have to have the muscle in their arm removed; they go through hell with that. We need to get the message to them better. Kids just haven't gotten the message about sharing dirty needles. They figure if they both use same needle, then it's a clean needle. It's still a dirty needle."