The number of Americans using heroin has increased five-fold in the last decade and dependence has more than tripled, research conducted at Columbia University’s Mailman School of Public Health indicated. The study of 43,000 users published Wednesday in JAMA Psychiatry found the increases were greatest among males, whites and those with low income and little education.

Heroin use disorder, the compulsion to shoot up, increased significantly among younger individuals, especially whites between the ages of 18 and 44.

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The study found heroin use increased from 0.33 percent in 2001-02 to 1.6 percent in 2012-13 while heroin use disorder rose from 0.21 percent to 0.69 percent in the same periods. While percentages were fairly even among whites and nonwhites in the 2001-02 period, heroin use among whites totaled 1.9 percent of the population compared to 1.1 percent among nonwhites in 2012-13.

The researchers found nonmedical use of prescription painkillers was behind some of the uptick. Among whites, 53 percent of those studied in the 2012-13 period said they had started with prescription drugs, up from 36 percent in the earlier period.

"Because the effects of heroin seem so similar to widely available prescription opioids, heroin use appears to have become more socially acceptable among suburban and rural whites," Dr. Silvia Martins, associate professor of epidemiology, said in a statement.

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"We are seeing that heroin use has increased in the past 10 years," she told Reuters. "It is more prominent among whites with lower incomes and education and young adults."

The American College of Physicians Tuesday released a paper, published in the Annals of Internal Medicine, recommending substance abuse be treated like a chronic illness. The group noted 22.5 million people in the U.S. needed drug or alcohol abuse treatment in 2014 but only 18 percent received it, far below the treatment rates for diseases like hypertension (77 percent), diabetes (73 percent) or major depression (71 percent).

The Centers for Disease Control and Prevention reports heroin-related overdose deaths have quadrupled since 2010 with nearly 13,000 people dying in 2014. The highest death rate was among men ages 25-44, who overdosed at a rate of 13.2 per 100,000.

New Jersey Gov. Chris Christie was appointed Wednesday as head of a federal commission to combat opioid addiction, an issue with which he has been involved for years.