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For much of its horrific history, the deadly opioid epidemics that ravaged the Rust Belt and killed more than 350,000 Americans since 1999 were largely white.
This is changing rapidly as the plague spreads in major cities on the East Coast, according to a new study by a quartet of researchers led by Mathew Kiang of Stanford University and released Friday.
"Although opioid-related mortality has been stereotyped as a concentrated low-income rural phenomenon in the Appalachian and Midwestern states, it has rapidly spread, particularly in the eastern states," he said. reported the researchers in a study published in JAMA.
The result is "a wider range of affected populations, with the spread of the epidemic from rural areas to urban areas and a dramatic increase in opioid-related mortality observed in the black population."
For example, the opioid death rate in the District of Columbia, where almost half of the residents are black, has tripled each year since 2013.
Why is it spreading?
"Heroin," Kiang told NBC News.
27 PICTURES
Crisis of Opioids and Drugs in America
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Thrown needles are seen in a heroin encampment in the Kensington district of Philadelphia, Pennsylvania on April 7, 2017.
In North Philadelphia, the rail chasm, as we know, is the zero point of the opioid epidemic in Philadelphia. Nicknamed El Campanento by locals, the open-air drug market and its heroin encampment are built with gulch scrapped materials and populated by drug addicts looking for a hit. Heroin to control their dope or withdrawal symptoms. In one area, near the 2nd Avenue overpbad, empty envelopes for syringes cover the garbage as grbad
the used needles they once contained sting like thistles.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
NEW YORK, NY – JUNE 07: "Surfer" shoots heroin into a South Bronx park on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
NEW YORK, NY – JUNE 07: A man leans against the wall and appears to be under the influence of drugs on a South Bronx street on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
Washington, DC – Sept. 18: Family members of those who have died of an opioid overdose attend the "Fed Up! & # 39; Rally to end the opioid epidemic at the National Mall on September 18, 2016 in Washington, DC. Activists and family members gathered in the National Mall to visit the Capitol Building. Some 30,000 people die each year from addiction to the pain pill and heroin. Speakers called on Congress to provide $ 1.1 billion for the Addiction and Recovery Act, which Congress pbaded in July without funding. (Photo by John Moore / Getty Images)
NEW YORK, NY – JUNE 07: A man is leaning against a wall that appears to be under the influence of drugs on a South Bronx street on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
NEW YORK, NY – JUNE 07: Brian is smoking a synthetic drug called K2 on the street in the South Bronx on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
NEW YORK, NY – JUNE 07: "Surfer" shoots heroin into a South Bronx park on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
Washington, DC – September 18: Activists and family members of their loved ones who died during the opioid / heroin epidemic participate in a "Fed Up! Rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on lawmakers to fund the Addiction and Recovery Act, which Congress pbaded in July without funding. In the United States, some 30,000 Americans die each year from addiction to pain pills and heroin. (Photo by John Moore / Getty Images)
Lt. Patrick Glynn, a Mbadachusetts police detective in Quincy, received a nasal injection containing naloxone, a drug that prevented an overdose, at police headquarters in Quincy, Mbadachusetts on 13 June 2014. In 2002, Quincy (Mbadachusetts) became the first US city to comply with this standard. equipment of his police officers, who used it to remedy 275 overdoses, a significant number in a city of 93,000 inhabitants. The country's police forces are beginning to do the same. The state's program has now far surpbaded the only police force: it has trained some 25,747 people in Mbadachusetts to recognize the signs of opioid drug overdose and the administration of naloxone. June 13, 2014. REUTERS / Gretchen Ertl (UNITED STATES – Tags: DRUGS SOCIETY CRIMINAL LAW OF HEALTH)
A woman suspected of having acted under the influence of heroin showed weapons to the police on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
Accessories for smoking and injecting drugs are seen after being found during a police raid on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
Accessories for smoking and injecting drugs are seen after their discovery during a police raid on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
An injecting drug paraphernalia is seen after being found during a police raid on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
Jessica, a homeless heroin addict, is showing her own needlecraft kit, mixing cap and tourniquet in the Kensington neighborhood in Philadelphia, Pennsylvania on April 14, 2017.
In North Philadelphia, the rail chasm, as it is called, is at the origin of the opioid epidemic in Philadelphia. 80% of us want to go out, "Jessica said, before pointing out the many ways she tried to get treatment for her addiction. In one case, she said, there were no beds available. In another case, a treatment provider required a positive drug test before delivering help, which means that if she had not used it recently she would be refused. Instead of being treated, she spends her nights trying to keep herself warm on a mattress under a bridge, the same place where she was raped and infected with HIV. People come from every corner of the city, and even from the Midwest, for a remarkably cheap and sheer heroine on the largest heroin market on the east coast. / AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
A paraphernalia of drugs and other garbage strewn a vacant house on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
A man is injected into the heroin foot near a heroin encampment in the Kensington district of Philadelphia, Pennsylvania, on April 14, 2017.
In North Philadelphia, the rail chasm, as it is called, is at the origin of the opioid epidemic in Philadelphia. In and around the camp, a user can buy a bag.
of high quality heroin at a low price and even pay to have another person inject
if, for whatever reason, they are unable to inject. For many people, the addiction process was a slow process that began with a doctor's prescription for pain medication after an accident or surgery. At the end of the treatment, an addiction was born. After looking for drugs on the black market to feed their addiction, the simple economy of heroin triumphed: the price of a single pill could yield between 2 and 10 bags of heroin, an economy that is difficult to ignore when an insurance company no longer supports the cost.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
Washington, DC – September 18: Michael Botticelli, Director of the US National Drug Control Policy, speaks at Fed Up! Rally to end the opioid epidemic on September 18, 2016 in Washington, DC. Activists and family members of people who died as a result of the opioid and heroin epidemic gathered at the National Mall to travel to the Capitol. Some 30,000 people die each year from addiction to the pain pill and heroin. Speakers called on Congress to provide $ 1.1 billion for the Addiction and Recovery Act, which Congress pbaded in July without funding. (Photo by John Moore / Getty Images)
A man uses a syringe to collect the last drops of a salvaged water bottle in order to mix a heroin injection near a heroin encampment in the Kensington district in Kensington. Philadelphia, Pennsylvania, April 14, 2017.
In North Philadelphia, the rail goulch, as it is called, is the zero point of the opioid epidemic in Philadelphia. The tracks and the surrounding property belong to the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX, which operates it. People come from every corner of the city, and even from the Midwest, for a remarkably cheap and sheer heroine on the largest heroin market on the east coast. According to the city's health commission, Philadelphia is on the verge of experiencing a 33% increase in the number of drug overdose deaths in 2017 compared to last year.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
On April 14, 2017, a Philadelphia police officer patrolled under a bridge near a heroin encampment in the Kensington district of Philadelphia, Pennsylvania.
In North Philadelphia, the rail chasm, as it is called, is at the zero point in the opioid epidemic in Philadelphia. The tracks and the surrounding property belong to the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX, which operates it. Last month, Philadelphia Mayor Jim Kenney announced citations against the Consolidated Rail Corporation for what the mayor, in a statement, said was Conrail's inability to clean up and secure his own property. Visitors and gulch homeless residents say the garbage is not their fault and that they are there only because they have nowhere to go. According to the city's health commission, Philadelphia is on the verge of experiencing a 33% increase in the number of drug overdose deaths in 2017 compared to last year.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
Sanford, ME – FEBRUARY 16: Milo Chernin, who lost her son Sam to a heroin overdose on January 16, 2017, is looking at pictures at her home in Sanford. She says Sam, who died at age 25, had addiction problems and could not stay away from heroin despite the treatments. (Photo by Derek Davis / Portland Press Herald via Getty Images)
Washington, DC – September 18: Activists and family members of their loved ones who died during the opioid / heroin epidemic participate in a "Fed Up! Rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on lawmakers to fund the Addiction and Recovery Act, which Congress pbaded in July without funding. In the United States, some 30,000 Americans die each year from addiction to pain pills and heroin. (Photo by John Moore / Getty Images)
GROTON, CT – MARCH 23: A box of the Naloxone opioid antidote, also known as Narcan, is on display at a family addiction support group on March 23, 2016 in Groton, CT . The drug is used to revive people suffering from heroin overdose. The Communities Speak Out group organizes monthly meetings in a public library for family members to explain how their loved ones' addiction affects them and to provide each other with emotional support. Communities across the country are battling the unprecedented epidemic of heroin and pain-fighting opioids. On March 15, the US Center for Disease Control (CDC) announced to doctors guidelines to reduce the amount of opioid painkillers prescribed across the country in order to combat the epidemic. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
NEW LONDON, CT – MARCH 23: A heroin user injects on March 23, 2016 in New London, CT. Communities all over New England and across the country are battling the unprecedented epidemic of heroin and opioid painkillers. On March 15, the US Center for Disease Control (CDC) announced to doctors guidelines to reduce the amount of opioid painkillers prescribed across the country in order to combat the epidemic. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
GROTON, CT – MARCH 23: Family members of heroin and opioid addicts share a story at a support group held on March 23, 2016 in Groton, CT. The Communities Speak Out group organizes monthly meetings in a public library for family members to explain how their loved ones' addiction affects them and to provide each other with emotional support. Communities across the country are battling the unprecedented epidemic of heroin and pain-fighting opioids. On March 15, the US Center for Disease Control (CDC) announced to doctors guidelines to reduce the amount of opioid painkillers prescribed across the country in order to combat the epidemic. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
NEW LONDON, CT – MARCH 14: Jackson, 27, who said he was a prescription drug addict, fell in a public library on March 14, 2016 in New London, CT. Police announced that a growing number of suburban drug addicts were coming to town to buy heroin, which is much cheaper than opioid pain killers. On March 15, the US Center for Disease Control (CDC) announced to doctors guidelines to reduce the amount of opioid painkillers prescribed in the country. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
ST. JOHNSBURY, Vermont – FEBRUARY 06: "Buck," 23, and heroin addict, fires on Suboxone, an opioid-addictive medication that also creates a heavy reliance on Feb. 6 2014 in St. Johnsbury, Vermont. Vermont Governor Peter Shumlin recently dedicated his entire State of the State address to the scourge of heroin. Heroin and other opiates began to devastate many communities in the Northeast and Midwest, resulting in an increase in fatal overdoses in several states. While prescription painkillers, such as OxyContin synthetic opioid, are becoming increasingly expensive and regulated, more and more Americans are turning to heroin to fight the pain or to get caught. Heroin, which has seen a rise in production in places such as Afghanistan and parts of Central America, is being sold at a relatively low price and provides a more powerful effect to the market. 39; user. (Photo by Spencer Platt / Getty Images)
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Specifically, heroin containing fentanyl, 25 to 50 times more potent than pure heroin, is quickly becoming the solution of choice for addicts in large cities.
"Heroin on the East Coast is a lot more deadly than that on the West Coast," said Kiang.
Because heroin is so cheap, drug dealers have gotten into the habit of tying it with fentanyl to increase their profits, and often street vendors do not even know that they're selling Heroin enriched with fentanyl, reported NBC News earlier.
In the west, drug addicts consume black tar heroin that looks more like molbades than the white or brownish powder that predominates on the east coast. As a result, heroin addicts who inject in Los Angeles or Seattle are less likely to be linked, or even replaced, with fentanyl, which is also a white powder.
"The worry is that fentanyl mixes with other drugs that unsuspecting people consume like cocaine," Kiang said. "It's probably the person who cares the most and it has real implications for places like California."
In an earlier study published last year, Kiang and two other researchers had taken note of what was already widely accepted – namely that the epidemic was caused in the 1990s and 2000s by opioids prescribed in the framework of aggressive marketing techniques of the pharmaceutical industry and the evolution of medical standards in the diagnosis and treatment of chronic pain ".
People would become addicted to prescribed painkillers and then to heroin, they said.
But African Americans were less affected because there were "much lower opioid prescription rates in the black population than in the white population," the study says.
However, in recent years, "rates of heroin use and prescription opioid abuse among blacks and whites have begun to converge," according to this study.
From 1999 to 2016, according to the study by Kiang and his collaborators published Friday, 231,264 men and 120,366 women "died of opioids throughout the United States."
The researchers found that the median age of death of men was 39.8 years and that of women 43.5 years.
"The opioid-related mortality, particularly that badociated with synthetic opioids, has increased in the eastern United States," they concluded.
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