New rules: Heroin and hydrocodone

Heroin Drug Trafficking Map, DEA

Heroin use is on the increase in the United States. It has been theorized that this is due to more stringent efforts to decrease the availability of oxycodone, resulting in those with a dependence on the drug turning to heroin as a cheap and plentiful replacement. The question is: What has been going on worldwide in the cultivation and distribution of heroin that could make this so?


As is true for most drugs, availability often influences use. Alcohol is the most obvious example. It is available virtually every day all day in the United States. Only 31 % of people in the United States abstain from drinking and the rate of alcohol use disorders is 7.4%. In contrast in Egypt, a predominantly Muslim country where use of alcohol is not a cultural norm and availability is limited, 95% of people abstain from alcohol and only 0.2% of the population has a current alcohol use disorder.

Where is heroin coming from and how available is it? To get a handle on this we can look at what is exported, from where, and how frequently it is used in the countries it ends up in.

Getting opiates from one place to another is a well-organized and lucrative operation. It is believed that the drug-trafficking of opiates is worth 55-65 billion dollars a year with most of the profit going to the global traffickers who facilitate transport of opiates from the production areas to the end-user.

There are three areas that supply most of the opiates for this large underground economy: Afghanistan, South-East Asia (mostly Myanmar) and Latin America (Mexico and Columbia). Most distinctly, Afghanistan is by far the largest producer, accounting for at least 80-90% of the world illicit opium production over the last few years.

The majority of heroin that enters the United States comes from Mexico and Latin America with a much smaller amount coming from Afghanistan through European and African channels. Recently, there have also been reports of a small proportion of heroin coming from Afghanistan through India to the U.S.


Heroin demand is distributed throughout the world. It has become more available than opium gradually over the last century. Opium use, however, has historically been found to be predominate in Asia and continues to have important markets in Iran, India and Pakistan.

Opioid (opium, morphine, heroin and hydrocodone) use has increased throughout the world with the main increase taking place in the United States. It is estimated that between 28.6 and 38 million people globally have used heroin and prescription pain killers in the last year.

Of all the illicit opioids (opium, morphine and heroin), most people use heroin. Heroin can be smoked, snorted or injected. When injection is used as the primary route of administration it can lead to chronic health issues through exposure to blood-borne diseases such as HIV and Hepatitis C. Heroin is believed to be the most potentially lethal of all illicit drugs due to variations in the purity of the drug and resumption of injection use after a period of abstinence when tolerance to the drug is at a lower threshold.

The Russian Federation and Europe account for one-half of global heroin use. The Russian Federation is estimated to have the highest national consumption. The United Kingdom, Italy, France and Germany have the highest rates of consumption in Europe. The heroin distributed in Europe and the Russian Federation is believed to come almost exclusively from Afghanistan opium.

Comparatively speaking, data suggests that heroin consumption in the United States (20 metric tons) is about a fourth of that which is consumed in Europe. Latin America consumes 5 mt and Canada 1.3 mt of heroin annually.

Back in the USA

Presently, illicit prescription opioids are much more often used than is heroin in the United States. There are concerns that any barriers to the availability of prescription opioids could lead to increases in heroin use. There is already evidence that this has been the case as stricter controls have been implemented.

Most recently, as of October 6, 2014, the FDA has rescheduled all hydrocodone combination products from schedule III to schedule II of the Controlled Substances Act. This allows for much more restrictive prescribing practices which will limit availability of hydrocodone for many people. Given that the Community Epidemiology Work Group (CEWG) operating under the auspices of National Institute on Drug Abuse (NIDA) has reported that heroin continues to be one of the most significant drug abuse concerns across all monitored regions of the United States, the prospect of tightening controls while there is increased heroin availability could be a very lethal combination as those with an opioid dependence turn to a cheaper and less predictable alternative.

Community Epidemiology Work Group. January 2014. Epidemiologic trends in drug abuse: Proceedings of the Community Epidemiology Work Group, Highlights and Executive Summary. National Institute of Drug Abuse. Retrieved from

Federal Register. Vol. 79, No. 163. Friday, August 22, 2014. Rules and Regulations. Drug Enforcement Administration
21 CFR Part 1308 [Docket No. DEA–389]. Retrieved from

United Nations Office on Drugs and Crime. (2010). World drug report 2010. Retrieved from

United Nations Office on Drugs and Crime. (2012). World drug report 2012. Retrieved from

United Nations Office on Drugs and Crime. (2014). World drug report 2014. Retrieved from

4 thoughts on “New rules: Heroin and hydrocodone

  1. Thanks for the update Kathleen! I really did not know much about heroin. It’s interesting how people use prescription drugs as alternatives for the same effects as heroin. Thanks for the education.

    Take care,

  2. Hi Kathleen,

    I love visiting your blog because I learn so much from it. Thanks for this information you have compiled because I had no idea how prescription drugs were leading into heroin. When I had major surgery, I was on vicodin. I knew the dangers of it, but it was needed for the pain. I took it sparingly and dealt with pain most of the day. It made me so fuzzy I rather have the pain.

    Prescription drugs are given out like candy! Thank goodness the FDA is stepping up. Thanks so much for keeping me posted!


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