HEROIN was a scourge of America’s cities in the 1960s and 70s. But then it seemed to go out of fashion. By the 1990s it was less widely used than crack cocaine. In Europe its use has continued to decline, with the number of addicts falling by about one-third in the past decade. In America, by contrast, it is resurgent. Last year nearly 700,000 Americans took the drug, twice as many as a decade ago. It is now more popular than crack, by some measures. What explains heroin’s return?
One cause is the growing popularity of another drug: the prescription painkiller. Opioid painkillers such as OxyContin became more widely prescribed in the 1990s and 2000s. They are effective painkillers, but they are commonly abused: about 11m Americans use them illegally every year. That has led to a crackdown on prescriptions: doctors can now check databases to make sure patients have not already been prescribed the drugs somewhere else, for instance. So they are harder to obtain. But that means that some prescription-pill addicts have turned to heroin, which sates the same craving for a lower cost. More than two-thirds of heroin addicts have previously abused prescription painkillers.