A Closer Look at Heroin Use

Students have long seen heroin as one of the most dangerous drugs. Discover the trends in use, risk, disapproval, and availability among students in grades 8, 10, and 12.

From Monitoring the Future national survey results on drug use, 1975-2015: Overview, key findings on adolescent drug use, this piece was written by the principal investigators and staff of the Monitoring the Future project at the Institute for Social Research, the University of Michigan, under Research Grant R01 DA 001411 from the National Institute on Drug Abuse. 

For many decades, heroin—a derivative of opium—was administered primarily by injection into a vein. However, in the 1990s the purity of available heroin reached very high levels, making other modes of administration (e.g., snorting, smoking) practical alternatives. Thus, in 1995 we introduced questions that asked separately about using heroin with and without a needle to determine whether noninjection use explained the upsurge in heroin use we were observing. The usage statistics presented on the next page are based on heroin use by any method, but data on the two specific types of administration are provided in the tables at the end of this report.

Trends in Use

The annual prevalence of heroin use among 12th graders fell by half between 1975 and 1979, from 1.0% to 0.5%. The rate then held amazingly steady until 1994. Use rose in the mid- and late-1990s, along with the use of most drugs; it reached peak levels in 1996 among 8th graders (1.6%), in 1997 among 10th graders (1.4%), and in 2000 among 12th graders (1.5%), suggesting a cohort effect. Since those peak levels, use has declined, with annual prevalence in all three grades fluctuating between 0.7% and 0.9% from 2005 through 2010. Since then, annual prevalence in the three grades combined has declined, from 0.8% to 0.4% in 2015.

Because the questions about use with and without a needle were not introduced until the 1995 survey, they did not encompass much of the period of increasing heroin use. Responses to the new questions showed that, by then, about equal proportions of all 8th-grade users were taking heroin by each method of ingestion, and some—nearly a third of users—were using both means. At 10th grade, a somewhat higher proportion of all users took heroin without a needle, and at 12th grade, the proportion was higher still. Much of the increase in overall heroin use beyond 1995 occurred in the proportions using it without injecting, which we strongly suspect was true in the immediately preceding period of increase as well. Likewise, much of the decrease since the recent peak levels has been due to decreasing use of heroin without a needle. In 2012 there were significant decreases in use of heroin without a needle for 8th and 12th graders, and very slight declines since then in 8th and 10th grades.

Use with a needle has fallen considerably in all three grades since the mid-1990s; annual prevalence in 2015 stood at 0.2%, 0.2%, and 0.3%, respectively, including significant declines in 8th and 10th grades from the 2014 to 2015 prevalence levels. The proportional declines are greatest in the lower grades.

Perceived Risk

Students have long seen heroin to be one of the most dangerous drugs, which helps to account for both the consistently high level of personal disapproval of use (see below) and the quite low prevalence of use. Nevertheless, perceived risk levels have changed some over the years. Between 1975 and 1986, perceived risk gradually declined, even though use dropped and then stabilized in that interval. Then there was a big spike in 1987 (when perceived risk for cocaine also jumped dramatically), where it held for four years. In 1992, perceived risk dropped to a lower plateau again, presaging an increase in use a year or two later. Perceived risk rose in the latter half of the 1990s, and use leveled off and then declined. Perceived risk of use without a needle rose in 8th and 10th grades between 1995 and 1997, foretelling an end to the increase in use. Note that perceived risk has served as a leading indicator of use for this drug as well as a number of others. During the 2000s, perceived risk has been relatively stable.

Disapproval

There has been little fluctuation in the very high levels of disapproval of heroin use over the years, though it did rise gradually between 2000 and 2010. The small changes that have occurred have been generally consistent with changes in perceived risk and use.

Availability

The proportion of 12th-grade students saying they could get heroin fairly easily if they wanted some remained around 20% through the mid-1980s. It then increased considerably from 1986 to 1992 before stabilizing at about 35% from 1992 through 1998. From the mid- to late-1990s through 2014, perceived availability of heroin declined gradually but substantially in all three grades. It leveled in 2015.

Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975-2015: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.