Treating Teenagers’ Drug Habits

The number of adolescents abusing prescription opioids, such as the painkillers Vicodin and OxyContin—and, to a lesser degree, heroin—is increasing. In response, mental health experts are retooling their treatment strategies to meet the unique needs of teens. Until recently, most opioid treatment programs were designed for older clients, and little was known about teenage users.

Prescription narcotics are the second most commonly abused drug in the United States, second only to marijuana, said psychiatrist Ramon Solhkhah, director of the Child and Family Institute at St. Luke’s and Roosevelt Hospitals in New York. He was speaking at the American Psychiatric Association meeting in May in Washington, D.C. By 12th grade, more than 13 percent of high school students in the U.S. have tried prescription opioids, up from a little more than 1 percent in 1989, according to national studies. From 1995 to 2002, the rate of heroin use among 12- to 17-year-olds increased from 0.1 to 0.4 percent (see http://monitoringthefuture.org for more stats).

Where opioid use starts

Adolescent opioid users, most often white males, typically start using drugs, including nicotine and alcohol, as early as age 10. Compared with marijuana and alcohol users, they are more likely to be victims of physical, sexual and emotional abuse. They generally end up in treatment, courtesy either of their parents or the juvenile justice system, researchers reported at the APA meeting.

Teens start taking prescription opioids in part because they don’t recognize the risks, says Solhkhah’s colleague, psychologist Lisa Marsch. The drugs are readily available, as doctors prescribe them more frequently than in past years. “A big factor is how easy you can get them,” she says.  Kids steal their parents' or grandparents’ painkillers, then pass the drugs on to other adolescents. They get addicted in a matter of weeks.

More teens are using heroin, in part because the drug is cheaper than in past years, Marsch says. It’s also much more pure, which means users can snort it to get high, instead of having to inject it. The purity of heroin in the U.S. has increased from about 7 percent a couple decades ago to just less than 70 percent. “It should be called a different drug now,” she says.

Fighting opioids with opioids

To help prevent withdrawal symptoms and cravings, treatment centers and doctors in private practice can now prescribe the drug suboxone, an alternative to methadone.  ”Me and my fiancé call it the miracle drug,” says Alex, a former (he hopes former) heroin user who completed the St. Luke’s outpatient treatment program at the end of March. “You take it [suboxone] and for 24 hours you’re fine, so then you just take it every day.” Almost 19, Alex (not his real name) began using heroin when he was 16. He and his girlfriend “were smoking a lot of weed but we wanted something to get us more high,” he says.

Suboxone is a combination of buprenorphine (pronounced byoo-pre-NOR-feen) and naloxone (NAH-lox-own). Buprenorphine is a weak opioid that reduces withdrawal symptoms. If users inject suboxone in an effort to get high off of the buprenorphine, then the naloxone kicks in, quickly causing withdrawal symptoms.

“We were the first group to do a clinical trial of behavioral and pharmacological treatments for teens addicted to opioids,” Marsch says. “We had some really exciting results showing that buprenorphine with behavioral interventions is very safe and effective.” In that study, almost two-thirds of the participants went on to taking just naltrexone, which blocks the effects of narcotics, after withdrawing from opioids.

“We stabilize [patients] on the medication then gradually reduce the dose,” Solhkhah explained. Buprenorphine “gets them to a place where … we can focus on life style changes,” he said.

Adds Marsch: “There’s a lot of reluctance among providers to give teens drugs to get over their addictions, probably because we haven’t had the research on how to do it effectively.”