The great American relapse

PICTURE a heroin addict. “A bum sitting under a bridge with a needle in his arm, robbing houses to feed his addiction,” is what many people might imagine, believes Cynthia Scudo. That image may have been halfway accurate when heroin first ravaged America’s inner cities in the 1960s and 1970s. But Ms Scudo, a smartly dressed young grandmother from a middle-class Denver suburb, knows that these days it is not always like that. Until not so long ago, she was a heroin addict herself.

The face of heroin use in America has changed utterly. Forty or fifty years ago heroin addicts were overwhelmingly male, disproportionately black, and very young (the average age of first use was 16). Most came from poor inner-city neighbourhoods. These days, the average user looks more like Ms Scudo. More than half are women, and 90% are white. The drug has crept into the suburbs and the middle classes. And although users are still mainly young, the age of initiation has risen: most first-timers are in their mid-20s, according to a study led by Theodore Cicero of Washington University in St Louis.