According to a Centers for Disease Control and Prevention review, the heroin overdose death rate in the United States is on the rise. Rates were taken from a review of 28 states that showed statistically significant increases for both sexes, all age groups, all census regions, and all but one ethnic group.

While the distribution of the study closely matches the U.S. population by age, sex, and race or ethnicity, the findings are not necessarily nationally representative, the authors noted. But existing data show that heroin deaths nationally rose by 45% from 2010 to 2011, the biggest annual jump since 1999. The review found that the death rate from heroin overdoses doubled during that two-year span to from 1 to 2.1 deaths per 100,000 people.

Death rates from overdosing on prescription opioid pain relievers (OPR), such as oxycodone, hydrocodone, or methadone, fell from 6 to 5.6 deaths per 100,000 from 2010 to 2012, after quadrupling from 1999 to 2010. But despite this slight drop, the CDC said years of over-prescription of painkillers has led to the recent surge in street heroin deaths.

"The rapid rise in heroin overdose deaths follows nearly two decades of increasing drug overdose deaths in the United States, primarily driven by (prescription painkiller) drug overdoses," the study found.

In a sample of heroin users in treatment programs, 75% who started using heroin after 2000 said they first abused prescription opioids. They said heroin was easier to get, cheaper, and more potent than prescription drugs.

"In contrast, among those who began use in the 1960s, more than 80% indicated that they initiated their abuse with heroin," the study said.

"The findings indicate a need for intensified prevention efforts aimed at reducing overdose deaths from all types of opioids while recognizing the demographic differences between the heroin and OPR-using populations. Efforts to prevent expansion of the number of OPR users who might use heroin when it is available should continue," they added.

The study, Increases in Heroin Overdose Deaths - 28 States, 2010 to 2012, was published in the CDC's Morbidity and Mortality Weekly Report.