Importance Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. Objective To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin. Design, Setting, and Participants Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary ( DSM-IV ) diagnosis of heroin use/dependence (n?=?2797) and (2) data from unstructured qualitative interviews with a subset of patients (n?=?54) who completed the structured interview

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Opioid abuse is reaching epidemic proportions in the United States. The consequences of opioid abuse and dependence include emergency department visits, premature death, HIV, hepatitis, criminal activity, lost workdays, and economic costs that in the United States exceed $56 billion annually. Agonist maintenance is the most efficacious treatment for opioid dependence and dramatically reduces morbidity, mortality, and spread of infectious disease

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More than 38, 000 Americans died by suicide in 2010, the most recent year for which we have national data. This makes suicide, once again, the tenth leading cause of death for all ages; the second leading cause of death for young adults ages 25 to 34. 1 Despite changes in recent decades that might reasonably have been expected to reduce suicide rates—increased awareness about mental disorders, the availability of treatment, and community-based public health efforts aimed directly at preventing suicide—U.S.

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Importance Although substance use disorders (SUDs) are prevalent and associated with adverse consequences, treatment rates remain low. Unlike physical and mental health problems, treatment for SUDs is predominantly provided in a separate specialty sector and more heavily financed by public sources. Medicaid expansion under the Patient Protection and Affordable Care Act has the potential to increase access to treatment for SUDs but only if an infrastructure exists to serve new enrollees

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Director’s Blog In a visit to a mental asylum in 1912 you would have seen many patients with “general paresis.” The word “paresis” is Latin for weakness. General paresis was a form of psychosis with delusions, hallucinations, and memory problems often of rapid onset and thought to be due to a general constitutional weakness. At least that was the explanation until 1913, when general paresis was shown to be caused by syphilitic infection of the brain

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Director’s Blog Today, on World Suicide Prevention Awareness Day, an updated National Strategy for Suicide Prevention is being released amidst a public health landscape that has changed thanks in part to the focus brought to suicide by the first national strategy issued 11 years ago. Since the first version was issued, the Suicide Prevention Lifeline was established, Federal and State legislation has been passed that advances suicide prevention planning and programming, and the Suicide Prevention Resource Center was established, among other efforts.

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Director’s Blog Let’s start with some good news. Over the past few decades in the United States, we have seen dramatic reductions in mortality due to coronary artery disease (an over 60 percent reduction, with 1.1 millions deaths averted each year), AIDS (a 40 percent reduction, with over 30,000 deaths averted each year), and stroke (a 30 percent reduction, with over 20,000 deaths averted each year). Indeed, last month AIDS was declared a chronic disease, recognizing that a young person who becomes infected with HIV will likely survive for decades and die of other causes

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