Heroin Rising: the Resurgence of Heroin and Opiate Abuse Eryck Kratville Chief, Heroin Interdiction Team Office of the Special Narcotics Prosecutor for the City of New York

Heroin: A Growing Problem… again 2007 – 2014: 145% increase in heroin use nationwide 2007 – 2014: 174% increase in heroin addiction nationwide Just under 1,000,000 Americans used heroin sometime in 2014 More than 500,000 Americans were addicted to heroin in 2014 Source: Substance Abuse and Mental Health Services Administration 2014 report

Heroin: A Growing Problem… again Particular problem: Americans 18-25 In 2007, one American 18-25 addicted to heroin for every five addicted to cocaine (61k v. 300k) By 2014, four Americans 18-25 addicted to heroin for every three addicted to cocaine (152k v. 114k) Source: Substance Abuse and Mental Health Services Administration 2014 report

Source: Substance Abuse and Mental Health Services Administration 2014 report

Heroin Epidemic Takes New Shape 1960’s / 1970’s Today Urban, poor users Suburban, rural, middle class users Drug injected Drug snorted, smoked Gateway: Marijuana Addictive Pills Source: Bridget Brennan, 2015 NYPTI Lecture

Precursor: Abuse of Legal Drugs

Precursor: Abuse of Legal Drugs About 1/3 of opioid pill addicts become addicted to heroin Doesn’t matter if originally used pills for medical or recreational reasons Average of three years from first pill to first use of heroin (median) Heroin: cheaper and more accessible than pills Source: Study presented at RxStat meeting 9/17/15.

Precursor: Abuse of Legal Drugs WARNING SIGNS High-dose opioid pills (>= 10mg oxycodone) Nasal inhalation of pills Physical dependence (withdrawal) Reduced heroin stigma in social circles Source: Study presented at RxStat meeting 9/17/15.

The Overdose Epidemic (New York City) 2000 – 2013: over 10,000 overdose deaths due to opioid abuse Heroin overdose rate has more than doubled since 2010 Nearly 80% of all drug overdoses in NYC involved opioid pills or heroin, more than half involved heroin Source: 1 – Bridget Brennan 2015 NYPTI lecture; 2,3 – RxStat meeting 9/17/15

NYC: 2010 –11 Heroin Death Rates Source: Bridget Brennan 2015 NYPTI lecture

NYC: 2012-13 Heroin Death Rates Source: Bridget Brennan 2015 NYPTI lecture

The Overdose Epidemic: Naloxone Naloxone – Can prevent overdose deaths, EASY TO LEARN NYS Dept. of Health website can direct you to training programs and free kits In 2014, more than 400 overdose deaths were prevented with naloxone administered by Suffolk County Police Source: RxStat meeting 9/17/15

The Increasing Heroin Supply Heroin seizures in the US increased 87% over the past five years Doses are tiny: a single kilogram of heroin can be broken down into as many as 50,000 single-use glassines Source: 1 – Bridget Brennan 2015 NYPTI lecture

The Increasing Heroin Supply

New York Mexico DR Colombia

Source: Office of the Special Narcotics Prosecutor

Methods of Concealment: Banana Leaves (2010) Source: Office of the Special Narcotics Prosecutor

Methods of Concealment: Container Crate of Sofas (2012) Source: Office of the Special Narcotics Prosecutor

Methods of Concealment: Coffee Beans (2013) Source: Office of the Special Narcotics Prosecutor