Because of the overall high prevalence and marked increases in morbidity and mortality associated with nonmedical prescription opioids and heroin, addressing opioid use disorders is a public health priority in the United States.1
In 2014, 10.3 million persons reported using prescription opioids nonmedically (ie, using medications that were not prescribed for them or were taken only for the experience or feeling they caused).2 Emergency department visits involving misuse or abuse of prescription opioids increased nearly 3-fold between 2004 and 2011, from 198 126 to 556 551,3 and persons reporting substance abuse treatment linked to prescription opioids more than doubled between 2002 and 2014, from 360 000 to 772 000.4 Most concerning, prescription opioid overdose deaths more than quadrupled, from 4400 to 18 893 decedents between 2000 and 2014.5 Coinciding with the increases in prescription opioid abuse and overdose have been reports of increases in heroin use (including both injection and noninjection routes of administration) and heroin-related overdose deaths. Heroin use increased by 145% since 2007, with estimates of 914 000 people reporting heroin use in 2014, and heroin-related overdose fatalities more than quadrupled during this same period, from 2399 deaths in 2007 to 10 574 in 2014.2,5 The disproportionate increase in the rate of heroin overdose fatalities compared with increases in heroin use in the United States reflects in part the high purity of heroin sold in the United States as well as its mixture with fentanyl and its analogs.6