The Heroin Epidemic in San Francisco: Estimates of Incidence and Prevalence

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Abstract
Much attention has recently been focused on the question of the extent of heroin use in the USA. In an effort to call public attention to the problem, many estimates of its size have evidenced a tendency toward exaggeration. Methods of estimation of the extent of heroin addiction which, when carefully employed, should effectively correct such distorted estimates are presented. Two general types of estimation are employed, incidence and prevalence. Incidence estimates are concerned with new cases of heroin addiction that occur in a specific population within a given amount of time. These estimates are based upon self-report data from addicts regarding date of 1st addiction. When corrected for the lag phase (that period of time between onset of 1st addiction and eventual visit to a treatment program), these data permit accurate retrospective charting of incidence trends. Prevalence estimates focus on all known cases of heroin addiction in a specific population within a given amount of time. Three separate types of prevalence estimates from 3 separate sources are outlined: estimates based on overdose death data, estimates based on crime statistics and estimates of "unknown" addicts. In outlining these methods this article describes the fluctuations in heroin addiction in a major USA city, San Francisco, California. Data from a sample of 2367 addicts contacted over a 3 yr period suggest that the incidence of heroin addiction seems to have declined after 1970. Possible factors underlying this apparent decline in heroin addiction are discussed, including the post-1970 maturation of the population at risk, the effectiveness of antidrug media messages, changing drug fashions in the heroin subculture, and the gradual deterioration of the quality and potency of street heroin.

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