The face of heroin use in the United States is changing dramatically. A study published in JAMA Psychiatry in late May found that compared with previous generations of heroin users, newer initiates are more likely to be older, to be white, to live in nonurban areas, and to have previously abused prescription painkillers (Cicero TJ et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2014.366 [published online May 28, 2014]).