The Empirical Status of Heroin Use Among Women in the United States, 2002-2020

Background and Purpose. Recent trends show both heroin use and overdose death rates have been increasing in the United States. Between 2002 and 2013, there was a 100% increase in women’s heroin use prevalence rates, while the increase was only 50% among men. Even though the prevalence of heroin use is greater among men, women have a greater susceptibility to cravings, more relapse episodes, and more co-occurring health and social problems than men, suggesting possible contributing factors to the disproportionate increase in heroin use among women. Using national data from the National Survey of Drug Use and Health (NSDUH) collected between 2002 and 2021, we sought to examine trends in heroin use in the age and sociodemographic subgroups of women in the United States. In addition, we aimed to investigate potential heroin-specific, behavioral health, and risk-behavioral correlates of heroin use among women.

Methods. Using the 2002–2021 NSDUH data, we conducted logistic regression to examine the linear trend and the psycho-social-behavioral correlates of heroin use among women.

Results. Between 2002 and 2021, the proportion of U.S. women who used heroin increased from .08% in 2002-2005 to .27% in 2018-2021, representing a 237.5% increase (AOR = 1.09, 95% CI = 1.06-1.12). Heroin use increased in all age groups, and the 26-44 age group, with the most rapid increase, surpassed the 18-25 age group after 2018 to be the age group with the highest heroin use prevalence. Significant upward trends were found in most sociodemographic subgroups, with the largest overall percent changes found among non-Hispanic White women, women having household income less than $49,999, women with a college degree, divorced/separated/widowed women, women with health insurance coverage, and women in rural areas. While the prevalence of smoking heroin was lower than sniffing and needle injection among women heroin users, it increased significantly with an overall 76.17% change from 29.71% (2002-2005) to 52.35% (2018-2021) (AOR=1.08, 95% CI=1.02-1.13).

Conclusion and Implications. We found that heroin use prevalence among U.S. women of non-reproductive age (aged 45 and older) demonstrated a significant upward trend, a 333% increase between 2002 and 2021. The heroin use trend within the women of reproductive age group also differed by age. Young adult women’s (ages 18-25) heroin use prevalence had been consistently increasing and was the highest among all age groups before 2016. We also observed significant increases in heroin use trends across most of the examined sociodemographic subgroups, particularly, non-Hispanic White women, women with low family incomes, and divorced/separated/widowed women. Heroin use prevention and treatment interventions may need to be tailored to the specific needs of these at-risk populations. For example, interventions targeting trauma, mental health issues, and/or social isolation may be particularly helpful in preventing/reducing heroin use among divorced/separated/widowed women. U.S. Women’s heroin use is a growing public health concern, and further research is needed to monitor the trend of heroin use among women in the United States.