The grip that opioid addiction has on adolescents often resembles that on addicted adults. Both groups crave the next high at all costs.
“Basically, they’re living to find their next heroin or opioids because their ‘feeling good’ completely depends on it,” Steven C. Matson, MD, , chief of the division of adolescent medicine at Nationwide Children’s Hospital, Columbus, Ohio, said in an interview. “They’re up in the morning, out trying to hustle money constantly, and then using and rebounding, and doing it over and over again. It gets to be a pretty dismal way of life.”
courtesy Lindsey Pulfer, RN
Dr. Steven C. Matson
After losing several friends to opioid overdoses, a 17-year-old patient of Leslie Hulvershorn, MD, became so emotionally hardened that she thought little of her own young life. “She suffers from depression and PTSD and has talked from time to time about how she doesn’t really care if she lives or dies,” said Dr. Hulvershorn, a child and adolescent psychiatrist who runs an adolescent addiction treatment outpatient program at Riley Hospital for Children, Indianapolis.
Parents often have no clue that their child is addicted to opioids, whether prescription forms like oxycodone or synthetic forms like heroin. “It usually only becomes clear when it comes to the attention of a probation officer or a school that insists on treatment,” said Dr. Hulvershorn, who is also medical director for the State of Indiana’s Division of Mental Health and Addiction, which licenses and certifies all of the opioid treatment programs in the state. “It’s not uncommon to see adolescents who get out of the house at night and go out and use or sell or do something that’s really dangerous. The situations are usually very high risk, very concerning.”
Dr. Leslie Hulvershorn
The scope of the problem
The 2015 National Survey on Drug Use and Health (NSDUH) found that 6.5 million Americans over the age of 12 years used controlled prescription medicines nonmedically during the past month, second only to marijuana and more than past-month users of cocaine, heroin, and hallucinogens combined. According to the Centers for Disease Control and Prevention, 91 Americans die every day from an overdose of opioids. In fact, opioid overdoses in the United States increased four times since 1999 and were highest among persons 25-54 years of age. In 2015, the five states with the highest rates of death resulting from drug overdose were West Virginia (41.5 per 100,000), New Hampshire (34.3 per 100,000), Kentucky (29.9 per 100,000), Ohio (29.9 per 100,000), and Rhode Island (28.2 per 100,000).
The CDC also found that, between 2013 and 2014, the number of children aged 0-14 years who died from a drug overdose increased slightly from 105 to 109. The number of children aged 15-24 years who died from a drug overdose rose from 3,664 to 3,798, an increase of 3.6%. While the precise path to opioid addiction differs from patient to patient, experts interviewed for this story noted that adolescents who currently smoke marijuana or drink alcohol on a regular basis face an increased risk of progressing to opioid use, compared with peers who lack substance abuse problems. In such cases, “go ahead and refer for substance abuse treatment at that point, rather than waiting for them to get into something much more dangerous,” Dr. Hulvershorn advised. “Neither of those drugs is good for adolescents either, but you could easily be preventing a worse outcome later. Sometimes physicians will ask, ‘You really want me to refer kids who are smoking pot?’ The answer is, ‘Absolutely.’ That’s probably our best shot at providing them with skills early on, before they get into heavier stuff.”
Dr. Marc Potenza
In October 2016, as part of the Comprehensive Addiction and Recovery Act, the Drug Enforcement Agency announced plans to reduce the amount of almost every Schedule II opiate and opioid medication that may be manufactured in the United States in 2017 by 25% or more. That – coupled with increased media attention in recent years to the perils of opioid addiction in adults, mandatory prescriber education on the use of opioids pain management, and other national efforts to promote safe prescribing practices – has helped to stymie the supply of opioids for illicit use. However, addicts young and old are turning to dangerous alternatives, like heroin, which may be tainted with fentanyl.
“There are even stronger agents like carfentanil, or carfentanyl, a strong veterinary opioid, which is used to put elephants to sleep,” Dr. Matson said. “Suddenly, you read that 18 people die because they got a hold of that. It’s hard to understand. It doesn’t make a lot of sense why somebody trying to make money off of selling drugs would sell you something that would kill you, but most people develop tolerance after long enough use of heroin. People are always trying to reach that new level of high.”
The implication of developing an opioid addiction at such a young age rarely registers with users, yet it can interfere with development “in substantial ways,” said Marc N. Potenza, MD, PhD, professor of psychiatry in the Child Study Center at Yale School of Medicine, New Haven, Conn. “If one is addicted, a lot of time, effort, energy, and attention is focused on the addiction, rather than on things like school, family, and friends.”
