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Individual risk can also be influenced by the structural risk environment including the illicit drug market. We hypothesized that components of the <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> illicit drug market, specifically heroin source\/type, price and purity, will have independent effects on the number of heroin\u2010related overdose hospital admissions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Yearly, from 1992 to 2008, <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>etropolitan <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>tatistical <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>rea (MSA) price and purity series were estimated from the <jats:styled-content style=\"fixed-case\">US D<\/jats:styled-content>rug <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>nforcement <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>dministration data. Yearly heroin overdose hospitalizations were constructed from the Nationwide Inpatient Sample. Socio\u2010demographic variables were constructed using several databases. <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>egative binomial models were used to estimate the effect of price, purity and source region of heroin on yearly hospital counts of heroin overdoses controlling for poverty, unemployment, crime, <jats:styled-content style=\"fixed-case\">MSA<\/jats:styled-content> socio\u2010demographic characteristics and population size.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Purity was not associated with heroin overdose, but each $100 decrease in the price per pure gram of heroin resulted in a 2.9% [95% confidence interval (CI)\u2009=\u20094.8%, 1.0%] increase in the number of heroin overdose hospitalizations (<jats:italic>P<\/jats:italic>\u2009=\u20090.003). Each 10% increase in the market share of <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>olombian\u2010sourced heroin was associated with a 4.1% (95% CI\u2009=\u20091.7%, 6.6%) increase in number of overdoses reported in hospitals (<jats:italic>P<\/jats:italic>\u2009=\u20090.001) independent of heroin quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Decreases in the price of pure heroin in the <jats:styled-content style=\"fixed-case\">United States<\/jats:styled-content> are associated with increased heroin\u2010related overdose hospital admissions. Increases in market concentration of <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>olombian\u2010source\/type heroin is also associated with an increase in heroin\u2010related overdose hospital admissions. Increases in <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> heroin\u2010related overdose admissions appear to be related to structural changes in the <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> heroin market.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.12664","type":"journal-article","created":{"date-parts":[[2014,6,17]],"date-time":"2014-06-17T13:39:37Z","timestamp":1403012377000},"page":"1889-1898","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["The relationship between <scp>US<\/scp> heroin market dynamics and heroin\u2010related overdose, 1992\u20132008"],"prefix":"10.1111","volume":"109","author":[{"given":"George","family":"Unick","sequence":"first","affiliation":[{"name":"University of Maryland School of Social Work  Baltimore MD 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