       Document 0163
 DOCN  M9630163
 TI    Heroin epidemics revisited.
 DT    9603
 AU    Hughes PH; Rieche O; Institute for Research in Psychiatry, T.G.H.
       University; Psychiatry Center, University of South Florida, Tampa 33613,
       USA.
 SO    Epidemiol Rev. 1995;17(1):66-73. Unique Identifier : AIDSLINE
       MED/96051454
 AB    This paper reviewed heroin use data from the US government's
       epidemiologic monitoring system for substance abuse. The monitoring
       system has multiple components, i.e., the Drug Abuse Warning Network of
       reporting emergency rooms (9), annual surveys of high school and
       post-high school youth (3, 4), annual National Household Surveys of
       Substance Abuse (7, 8, 50), Drug Use Forecasting (51), the Community
       Epidemiology Work Group (52), and law enforcement systems not reviewed
       here. These monitoring systems should identify any major increase in
       heroin incidence in this country relatively early. This is important,
       because the early stages of heroin epidemics are often hidden from
       society, and the epidemics are already full-blown by the time health and
       other agencies become aware of the size of the affected population and
       are required to respond. The hidden or underground nature of heroin
       epidemics is caused by 1) the need of each user to hide an illegal
       activity and 2) the delay between the time when heroin is first used and
       the onset of physical dependence and other adverse consequences, which
       bring new heroin addicts to the attention of treatment and enforcement
       systems. Despite an epidemiologic surveillance system which should
       rapidly identify large-scale heroin spread in this country, our
       treatment and law enforcement systems are not organized to respond
       rapidly to contain an epidemic. Substance abuse treatment services are
       not structured for rapid expansion and contraction based on fluctuating
       need. Apart from HIV prevention programs, we do not have outreach teams
       attached to treatment programs that could quickly identify local
       outbreaks and involve new heroin abusers in treatment (10).(ABSTRACT
       TRUNCATED AT 250 WORDS)
 DE    Adolescence  Adult  Aged  Cross-Sectional Studies
       Diacetylmorphine/SUPPLY & DISTRIBUTION  *Disease Outbreaks  Drug and
       Narcotic Control/LEGISLATION & JURISPRUD  Female  Heroin
       Dependence/*EPIDEMIOLOGY/PREVENTION & CONTROL  Human  HIV
       Infections/PREVENTION & CONTROL/TRANSMISSION  Incidence  Male  Middle
       Age  Population Surveillance  Risk Factors  Substance Abuse,
       Intravenous/EPIDEMIOLOGY/PREVENTION & CONTROL  United
       States/EPIDEMIOLOGY  JOURNAL ARTICLE  REVIEW  REVIEW, MULTICASE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

