Trends in Adolescent Heroin and Injection Drug Use in Nine Urban Centers in the U.S., 1999–2017

Purpose: Although estimates of heroin and injection drug use (IDU) among U.S. adolescents have remained low and stable, national data may mask local variation in use. Adolescent use may be higher in urban areas, many of which have historically high rates of heroin use and IDU. We investigate trends in heroin use and IDU among 9th–12th grade students in major urban centers in the U.S. Methods: We used local Youth Risk Behavior Survey data from all large, urban school districts (n = 9) with at least 5 years of weighted, publicly available data. We used time series mean estimation to estimate the prevalence of heroin use and IDU among high school students from 1999 to 2017 and used logistic regression to test for linear and quadratic trends. Results: We observed statistically significant linear increases in (1) lifetime heroin use in New York (β = .43, 1%–3.9%), Chicago (β = .15, 3.1%–4.6%), and Milwaukee (β = .35, 2.8%–7.4%); and (2) lifetime IDU in New York (β = .34, .8%–2.7%), Orange County (β = .17, 2.2%–3.5%), and Miami-Dade County (β = .16, 2.7%–3.9%). Only San Bernardino experienced significant decreases in heroin use (β = −.34, 4.6%–1.6%) and IDU (β = −.20, 2.5%–1.9%) over the time period. Conclusions: In contrast to national trends, the prevalence of heroin use is increasing among adolescents in certain urban centers in the U.S. Our results illustrate that national averages mask local variation in adolescent heroin use. Further research with locally representative samples is needed to inform public health policy and practice, especially in cities where heroin problems have been historically endemic and continue to rise.