A heroin crisis is deepening across New York City, and in total, 420 people fatally overdosed on heroin in 2013 out of 782 total overdoses. This marks the city's highest death toll from the drug since 2003, The New York Times reported.

The death toll from heroin has more than doubled in the past three years, presenting an increased challenge to city authorities who have been unable to turn the increase around. On Staten Island, an effort to curb prescription pill abuse has seen overdoses from opioid pills level off during the same time period, with 215 deaths in 2013.

The biggest rise was in Queens, where 81 people died last year, compared with just 53 the year before. This was attributed by the city health department primarily to a rise in use among young white men. That trend is even more pronounced on Staten Island, where all but two of the 32 residents who died from an overdose were white.

The profile of a user has shifted in the last decade, Dr. Andrew Kolodny, an addiction specialist who was at the health department in 2003, told the New York Times.

"It was almost exclusively Central Brooklyn, South Bronx, East Harlem and overlapped with New York City's highest-need neighborhoods," Dr. Kolodny, now the chief medical officer at the Phoenix House Foundation, a drug-treatment center, told the New York Times. "The rest of the city - Staten Island, Queens, most of Manhattan - close to nothing."

A new generation of younger and usually affluent users begin by abusing prescription opioid pulls that deliver the same effects as heroin and then start using the illegal drug because it provides a more intense high for less money, sometimes as little as $5.

That progression describes the growth in heroin abuse on Staten Island, where use of prescription pills was the highest in the city by far. Authorities have closed many rogue pain clinics, where young users could obtain illegal prescriptions.