ATLANTA - Heroin use has risen dramatically in the Pacific Northwest, with overdoses in the Portland, Ore., area accounting for nearly as many deaths among young and middle-aged men as cancer or heart disease, the government said Thursday.
The drug, at about $20 a dose, is cheap on the West Coast, and black tar heroin from Mexico or South America is readily available there, the Centers for Disease Control and Prevention said.
Other studies have indicated heroin overdoses increasing in most U.S. cities in the 1990s, but not as dramatically as in Seattle and Portland.
Multnomah County, Ore., which includes Portland, analyzed medical examiner reports and found that heroin overdose deaths climbed steadily from 46 in 1993 to 111 in 1999, a 141 percent increase. Eighty-seven percent of the overdoses were among men.
In 1997, 67 men ages 25 to 54 died of heroin overdoses in the county, compared with 88 from cancer, 73 from heart disease and 44 from AIDS.
The CDC said the report probably underestimated heroin overdoses. Many deaths were excluded because they may have been suicides, and 52 were excluded because the victims were not residents of Multnomah County.
The Seattle area saw a similar increase, as the number of heroin overdose deaths climbed from 47 in 1990 to 110 in 1999, a 134 percent rise. The population of King County increased 11.3 percent during the same period.
Deaths from overdoses of heroin and other opiates peaked in 1998 with 140 deaths.
As in Portland, more than 84 percent of the victims were male and many overdoses were not included in the statistics because they were believed to be suicides or because the victims were not residents.
The CDC has not tracked heroin overdoses nationally, but statistics from the Drug Abuse Warning Network indicate that use of the drug is increasing in most large cities.
During 1994 to 1998, DAWN received reports of 20,140 drug-induced deaths in the United States where heroin or related opiates were detected. During that four-year span, heroin overdose deaths increased 25.7 percent.
Injection increases the risk of death because of the rapid rise of opiate levels in the blood, the CDC said. Black tar heroin is usually injected because it is too impure to snort. In most opiate overdose deaths, alcohol and other drugs were also involved, the CDC reported.
Dr. Gary Oxman, director of the Multnomah County health department, said price, availability and a glamorization of the drug in movies and music have contributed to the rapid growth.
''In today's economy you can work a minimum-wage job and scrape up enough for housing and food and be a heroin addict. It used to be a lot more expensive,'' he said. ''We've also seen that heroin at various times has been seen as a fashionable drug.''
Oxman said heroin users develop a tolerance to higher doses and most users eventually stop injecting for periods of time, usually when they are jailed, run out of money or seek rehabilitation. When they resume, they often inject the same dose, and since the body's tolerance has declined, they often overdose.
Three fourths of the users in Seattle interviewed said they hesitate to call for emergency assistance for fear of being arrested.
''We need enhanced prevention and treatment for opiate addiction and we're going to need a better balance of resources,'' said Dr. Alonzo Plough, director of the Seattle-area public health office.
He said federal dollars should be diverted from drug-trafficking programs and placed into treatment, which has proved to be more successful.
''These death rates can be brought down with aggressive prevention and more treatment capacity,'' he said.
On the Net: Drug Abuse Warning Network: http://www.health.org/pubs/dawn