Purchase and Use Patterns of Heroin Users at an Inner-city Emergency Department

Brigitte M. Baumann, Cooper University Hospital
Anthony Mazzarelli, University of Medicine and Dentistry of New Jersey
Jaclyn Brunner, University of Medicine and Dentistry of New Jersey
Michael E. Chansky, University of Medicine and Dentistry of New Jersey
Nicole Thompson, University of Medicine and Dentistry of New Jersey
Edwin D. Boudreaux, University of Massachusetts Medical School

Abstract

BACKGROUND: Many consider heroin abuse a problem of the inner city, but suburban patients may also be at risk.

OBJECTIVE: To characterize the demographics and purchase/use patterns of heroin users in an inner-city emergency department (ED).

METHODS: The study was conducted in one of the most impoverished and crime-ridden cities in the United States. Demographics and substance use habits of ED patients were prospectively collected. Patients who were<18 years of>age, cognitively impaired, or did not speak English were excluded. Participants were further categorized as homeless, inner-city, and suburban residents.

RESULTS: Of 3947 participants, 608 (15%) used an illicit substance in the past year, with marijuana (9%) and cocaine (6%) the most commonly used. Heroin ranked third, used by 180 (5%) participants, with 61% male, 31% black, and 20% Hispanic. There were 64 homeless, 60 suburban, and 56 inner-city heroin users. The most common route of use was injection (68%), with the highest rate in the homeless (84%). The majority of homeless and inner-city users bought (73%, both groups) and used (homeless 74%, inner city 88%) in the inner city. Of suburban users, 58% purchased and 61% used heroin in the inner city. Prescription narcotic use was more common in homeless (20%) and suburban (23%) heroin users than in inner-city users (9%) (p<0.001).

CONCLUSIONS: Heroin is the third most commonly used illicit substance by ED patients, and a significant amount of inner-city purchase and use activity is conducted by suburban heroin users.