Contrary to what researchers reported 50 years ago, today's average first-time heroin user isn't a 16-year-old male of color. She's actually much more likely to be a 23-year-old white woman. This, researchers conclude in a study published today in JAMA Psychiatry, represents "a marked shift in the demographics of heroin users seeking treatment over the past several decades."

52 percent of users who seek treatment are women

According to the study, caucasian women and men have embraced prescription pills as their drug of choice. But heroin, which is much cheaper, eventually becomes more attractive. This means the drug once considered a "first opioid of abuse" is now more widely viewed as a last resort — and a popular one at that. Notably, heroin use in women has "increased from what was a very small percentage of about 20 percent back in the '50s to about 52 percent of the current population [of heroin users]," says lead study author and Washington University neuropharmacologist Theodore Cicero.

In the study, researchers surveyed over 9,000 opioid-dependent patients in 150 drug treatment centers across the US. Of those patients, about 2,800 reported heroin use. "Most people tend to be prescription drug users first and then graduate to heroin," Cicero says. Cost and accessibility are the main reasons people try heroin in the first place, he says, but the drug's strength causes many to stick with it. "The additive properties of heroin are manifold greater than prescription drugs," he says. "It gets into the brain much more quickly than other opiates" and causes "a rush" that is far stronger than that of prescription pills.

the migration of heroin from inner cities to the suburbs.

The study also found that 90 percent of people who started using heroin in the past decade are white, and most of them are in their late 20s. But Cicero cautions that this doesn't mean heroin has become less popular among young men of color in urban centers. "That number has probably increased too," Cicero says. The difference is that heroin has moved into suburbia as well. In fact, 75 percent of the survey's respondents who had taken heroin did so while living in small cities or non-urban areas. "We suddenly saw an explosion of heroin use in areas that were previously not interested in the drug," Cicero says, "the biggest development being the migration of heroin from inner cities to the suburbs and rural areas."

"The unfortunate part is the graduation from the relative safety of pills to the unsafe properties of heroin is that the risk of overdose becomes enormous," Cicero says. The purity of the drug, or lack thereof, is an important factor in heroin-related deaths: other ingredients often include things like talcum powder, and because the drug isn't sterile, people who use it come into contact with a plethora of bacterial contaminations that can cause infections. And the risk of HIV and hepatitis C infection that accompanies sharing needles continues to pose a threat.

That's why a more widespread geographic distribution of heroin use is extremely worrisome, Cicero says, adding that the US government's skewed view of how the illegal drug trade operates might be the reason it persists today. "We are trying to cut down on the amount of heroin available, but we aren't really addressing the problem," he says. "We need to focus a lot more on why people find these drugs so attractive [or] we aren't going to be solving the abuse problem at all."