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Comment & Response
March 11, 2019

Heroin Smoking is Not Common in the United States—Reply

Author Affiliations
  • 1Department of Neurology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
  • 2Neurocritical Care & Stroke Divisions, Department of Neurology, Case Western Reserve University, Cleveland, Ohio
JAMA Neurol. 2019;76(4):509. doi:10.1001/jamaneurol.2019.0194

In Reply We appreciate the correspondence. “Chasing the dragon” (CTD) has evolved from being a novelty in North America to an actively pursued form of heroin inhalation. Its linear dose-response association makes it a more effective method of heroin pyrolysis (typically reported as smoking).1 Consequently, in the 2015 Substance Abuse and Mental Health Services Administration dataset2 heroin inhalation comprised 99 901 of total admissions (24.9%, an increase from 76 884 [21.6%] in 2014), whereas smoking heroin involved 18 950 (4.7%, an increase from 17 051 [4.8%] in 2014). Additionally, those aged 20 to 34 years witnessed a rise in inhalation as the usual route of administration of 6 708 (21.8%) between 2014 and 2015. The self-administered character of substance use disorder interviews emphasizes the incongruence between systematic definitions of inhaled heroin routes and actual heroin administration practices in the community. Hence, it is necessary to measure CTD prevalence within the United States.1

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