The image of the heroin user is changing, according to researchers who say the great majority are now white men and women who mostly live outside the cities. 
 
 Their study, published in JAMA Psychiatry, tracked data from almost 2,800 heroin users and found that first-time users are now generally older than those who began taking the drug in the 1960s. About 90 percent are white, according to the study, and 75 percent now live in non-urban areas. 
 
 The research also confirmed a link between the rise of opioid abuse and the growing use of heroin that had been noted in earlier studies. Heroin use has jumped 80 percent to 669,000 users from 2007 to 2012, according to the National Survey on Drug Use and Health, after being relatively stable since 2000. 
 
 Heroin “is not confined to inner-city areas,” said Theodore Cicero, the lead author and vice chairman for research at Washington University School of Medicine in St. Louis, Missouri. “It’s now a main stream problem.” 
 
 The uptick in usage is attributed to users waning off of prescription opioids and turning to heroin because it’s cheaper and more readily accessible than prescription drugs, the researchers said in their report. 
 
 After widespread prescription drug abuse in the 1990’s, prices for prescription drugs have surged. Companies have also made the pills more difficult to manipulate, leading users to choose heroin as an alternative even though it carries a lot of risk, Cicero said in a telephone interview. 
 
 Deadly Overdoses 
 
 “It doesn’t have the safety of a prescription drug,” Cicero said. Because heroin is often cut with other chemicals, and injected through non-sterile solutions, users are prone to infections that can be fatal as well as deadly overdoses. 
 
 “There’s a lot of interest in how whites are getting so many opioids,” said Meghan Ralston, harm reduction manager for the Drug Policy Alliance. “That reflects what research shows -- that blacks and minorities are not even prescribed opioids at the same rates.” 
 
 The study found most people who began using the drug in the last decade were 23-years-old on average. That compares with the 1960’s, the researchers wrote, when users were 16-years-old on average. 
 
 The majority of heroin users surveyed in the study, 94 percent, said that if there were given the choice, they would prefer prescription pills to heroin. 
 
 Cicero said it’s likely that most people are using the drug as self-medication to treat depressive tendencies. Knowing this, better mental health and depression treatments in schools and communities could curb rates of heroin use. 
 
 He is now studying whether there’s a correlation between depression and drug abuse, Cicero said. 
 
 Vermont Addicts 
 
 Vermont is one state among several in the U.S. seeing a surge in heroin addiction in rural areas, with a 260% increase in people receiving treatment since 2000, according to the governor’s office. The number of deaths from heroin overdose almost doubled in 2013 from a year earlier. 
 
 Surging addiction is in part due to a “depressed economy, loss of hope, and challenges with just getting by day-to-day,” said Harry Chen, Commissioner of the Vermont Department of Health. He said it has hurt the “Vermont way of life” through its impact on families, communities, and health-care spending. 
 
 “We’re trying to approach it comprehensively,” Chen said in a telephone interview. 
 
 Drug enforcement officials have in the past been prone to attack the problem only from the supply side, the study author, Cicero, said. 
 
 “Comprehensive policy would address both a demand and a supply side,” he said. “We need some emphasis on why are people using these drugs, and why they find them attractive.” 
 
 To contact the reporter on this story: Sonali Basak in New York at sbasak7@bloomberg.net 
 
 To contact the editors responsible for this story: Reg Gale at rgale5@bloomberg.net Angela Zimm ||||| Importance Over the past several years, there have been a number of mainstream media reports that the abuse of heroin has migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations. 
 
 Objective To examine the veracity of these anecdotal reports and define the relationship between the abuse of prescription opioids and the abuse of heroin. 
 
 Design, Setting, and Participants Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview. 
 
 Main Outcomes and Measures In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids. 
 
 Results Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants’ Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the “high” produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids. 
 
 Conclusion and Relevance Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas. ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. 
 
 When “Glee” TV star Cory Monteith died last year at age 31 after a heroin overdose, the tragedy was underscored by an element of disbelief. 
 
 He was young, affluent and white — the exact opposite of the stereotype of an inner-city user. Drug abuse experts had to expend considerable effort to explain that, in fact, Monteith was the new face of heroin. 
 
 “He is what a heroin user looks like,” Caleb Banta-Green, a University of Washington research scientist who specializes in drug abuse, emphasized at the time. 
 
 Philip Seymour Hoffman's overdose death brought another wave of shock. 
 
 Now comes a new analysis, published in the journal JAMA Psychiatry, which confirms that there’s been a dramatic shift in the demographics of heroin use in the United States. 
 
 In the 1960s, the typical user was an inner-city teenager, likely as not a minority, whose habit started with heroin. Fifty years later, new heroin users in America are more likely to be white suburban men and women in their 20s who get hooked on prescription opiates and then turn to heroin because it’s cheaper and easier to get. 
 
 “Our typical image of a heroin user is a ‘dirty junkie,’” said lead study author Theodore J. Cicero, a professor of psychiatry at Washington University School of Medicine in St. Louis. “This is not the current heroin user.” 
 
 “This has become a mainstream problem. This is now affecting white children living in the suburbs." 
 
 Cicero and his colleagues analyzed data from an ongoing study that included nearly 2,800 heroin addicts entering substance abuse treatment in centers across the U.S. In addition, they conducted intensive interviews with 54 addicts about their experiences and motivations related to using heroin. 
 
 In the 1960s, nearly 83 percent of users were boys and men, with a median age of 16.5, who lived in urban areas and started using heroin as their first opiate, the study found. 
 
 Before the 1980s, whites and other races were equally represented. But in the last decade, nearly 90 percent of new heroin users were white. New users now are typically older, with a mean age of 23, and they start their addiction with prescription narcotics like Oxycontin, only to progress to heroin. 
 
 “This has become a mainstream problem,” Cicero said. “This is now affecting white children living in the suburbs." 
 
 That’s clear to Dr. Jason Jerry, a professor of psychiatry and psychology at the Cleveland Clinic, who treats heroin patients. He wasn’t involved in the new study, but he said it accurately underscores the shift he’s seen. “The crackdown in prescription narcotics has pushed more people over to heroin,” he said. 
 
 To be sure, prescription opiates cause 16,600 deaths a year, according to federal figures. That compares to about 3,000 deaths a year from heroin. But as U.S. Attorney General Eric Holder noted in March, heroin overdose deaths climbed by 45 percent between 2006 and 2010, flagging what he called “an urgent and growing public health crisis.” 
 
 “The typical path to heroin nowadays starts with prescription narcotics.” 
 
 Cynics might suggest that surging heroin use and rising numbers of overdoses have only drawn such high-profile attention because it's becoming a middle-class issue, Cicero noted. "When it was an inner-city problem among minorities, it wasn't a problem," he said. 
 
 The new study should serve as a caution to those who still view heroin use — and opiate addiction — through the lens of old stereotypes. For instance, parents of teenagers should monitor prescription painkillers carefully and keep them away from kids because such early use can easily escalate, the experts said. 
 
 “The typical path to heroin nowadays starts with prescription narcotics,” Jerry said.
– Not too long ago, the profile of the typical heroin user was pretty straightforward: an inner-city male about age 16. No more, says a new study in JAMA Psychiatry. Thanks in part to the surging use of prescription painkillers such as OxyContin and Vicodin, today's typical first-time heroin user is more likely to be a white 20-something, either male or female, from the suburbs or a more rural area, reports Bloomberg. The link to the prescription drugs? People get hooked on them but can't afford to sustain the habit and so turn to cheaper, easier-to-get heroin. “The price on the street for prescription painkillers, like OxyContin, got very expensive,” says the study's author in Forbes. “It has sold for up to a dollar per milligram, so an 80 milligram tablet would cost $80. Meanwhile, they can get heroin for $10.” The result is that 90% of new heroin users in the last decade were white, with the average age of first use at 23. Three-quarters of them got started on prescription meds. The shift to heroin has become even more pronounced as the makers of the prescription drugs take steps to curb abuse, such as making their pills harder to crush. “The crackdown in prescription narcotics has pushed more people over to heroin,” an expert at the Cleveland Clinic not involved with the study tells NBC News. (Click to read how how NYPD officers are going to start carrying a heroin antidote.)