An overview of heroin trends in New York City: past, present and future.

Heroin abuse has been a long-standing problem in the United States, especially in New York City, which is a major heroin trafficking center and home to the largest population of heroin addicts in the country. As a consequence, New York City is also the major center for methadone treatment. Over time, however, the heroin problem seems to have changed in terms of demographic characteristics of abusers, as well as heroin purity, its associated health consequences, modes of use, and other drug patterns. Past and present heroin-involved events for New York City are examined, with some projection about the future of the heroin problem. To identify these changes, a variety of indirect indicators of heroin abuse are analyzed. These indirect indicators include admissions to New York City heroin treatment programs, as well as heroin-involved deaths, arrests and emergency room episodes, and heroin purity levels. Additionally, a recent study of heroin abusers in New York City yielded patterns of heroin use and estimates of heroin prevalence. The salient results indicate that, over time, Hispanics have become the predominant user group, the population of abusers is an aging cohort, heroin purity levels have risen dramatically, and intranasal use has become more prominent than injecting. The findings have important consequences for prevention, treatment, and programs that target special populations.