Teens will be teens. They sleep late, fail a test here and there or get uncharacteristically moody. But what if these behaviors are happening more often than usual, or all at the same time? You know your teen better than anyone, but it is important to know what to look for if you suspect he or she may be abusing medicine.
Health concerns. Keep an eye out for changes in your teen’s physical health, like constricted pupils, nausea or vomiting, flushed skin or dizziness. Look further into anything that seems strange.
Changes in behavior. The signs of medicine abuse aren’t always physical. Look for changes in behavior – like sudden changes in relationships with their family or friends, anxiety, erratic mood swings or decreased motivation. It’s no secret that teens can be moody, but be on the lookout for drastic differences in the way your child behaves.
Home-related signs. If you’ve noticed belongings disappearing around the house, or found some unusual objects appearing – like straws, burnt spoons, aluminum foil or medicine bottles – this could be a sign of medicine abuse. Count – and lock up – the medicine you have in your home and safely dispose of any expired medicine.
Trouble in school. Take note of how your teen is doing in school, including any change in homework habits and grades. A rapid drop in grades, loss of interest in schoolwork and complaints from teachers could be indicators that there’s a problem.
Things just seem off. You know your child better than anyone and you know when something’s not right. Trust your gut, and talk to your teen about your concerns.
With one in four kids reporting abuse of prescription drugs in their lifetime, it’s important to take action right away if you do suspect medicine abuse. Don’t be afraid to talk – and listen – to your teen, work through things together and get help if necessary.
More than 40 addiction treatment, health care and consumer groups are urging the Food and Drug Administration (FDA) to reverse its decision to approve the prescription painkiller Zohydro ER (extended release), CNN reports.
The drug is a pure form of the painkiller hydrocodone. The FDA approved Zohydro ER in October for patients with pain that requires daily, around-the-clock, long-term treatment that cannot be treated with other drugs. Drugs such as Vicodin contain a combination of hydrocodone and other painkillers such as acetaminophen. Zohydro ER is set to become available in March, the article notes.
In December 2012, a panel of experts assembled by the FDA voted against recommending approval of Zohydro ER. The panel cited concerns over the potential for addiction.
Zohydro is designed to be released over time, and can be crushed and snorted by people seeking a strong, quick high. The opioid drug OxyContin has been reformulated to make it harder to crush or dissolve, but Zohydro does not include similar tamper-resistant features.
In a letter to FDA Commissioner Dr. Margaret Hamburg, the coalition of health groups, wrote, “In the midst of a severe drug epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous, high-dose opioid. Too many people have already become addicted to similar opioid medications, and too many lives have been lost.”
The health groups include the American Society of Addiction Medicine, Public Citizen Health Research Group, Phoenix House, the Hazelden Foundation, and Physicians for Responsible Opioid Prescribing.
In December, 28 attorneys general wrote to Commissioner Hamburg, saying they believe the approval of Zohydro ER “has the potential to exacerbate our nation’s prescription drug abuse epidemic because this drug will be the first hydrocodone-only opioid narcotic that is reportedly five to ten times more potent than traditional hydrocodone products, and it has no abuse-deterrent properties.”
When she was 18, Arielle would come home every day and embark on what she calls an “Easter egg hunt.” She wasn’t looking for candy. Arielle was hunting behind stairwells and inside closets in her suburban Long Island home for the OxyContin bottles her cousin brought home from work at a pharmacy and was hiding from her mother around the house.
“I found them one day, and I wanted to try them because all of my friends were already hooked,” said Arielle, who asked that her last name be withheld to avoid hurting her chances of getting a job. “I would see [my cousin] nodding out on the couch and not really being present, and that was how I wanted to feel. My best friend had just passed away, so I was numbing out the feelings.”
It took about a year before Arielle moved from prescription painkillers into the illegal drug that killed her best friend: heroin. She snorted it for the first time after tagging along with a friend who was going to buy some. “I was like, ‘I love it,'” she said. Heroin was cheaper than prescription pills — about $10 a bag, compared to $60 to $80 per pill — and gave her a more potent high.
Her friend helped her inject the drug. “It was a feeling that I don’t think anyone should experience. Because once you experience it, you want to experience it over and over again,” she said. “ Next thing I know, I’m addicted.”
Arielle landed in a Long Island jail last year after she was caught breaking into a house and stealing money to buy drugs. Now 26 and living at a substance abuse treatment center, she says she’s all too aware that her story isn’t unique.
Between 1996 and 2011, the number of people who ended up in substance abuse treatment centers in Suffolk County, where Arielle lives, as a result of heroin jumped 425 percent, according to a 2012 special grand jury report from the county’s Supreme Court. During the same period, the number of people who landed in substance abuse treatment for opioid pill use spiked 1,136 percent, the report found.
Long Island is one of many areas of the country where heroin addiction is reaching harrowing levels, according to Gregory Bunt, the medical director at Daytop Village, a New York-based substance abuse treatment center. The crisis is getting renewed attention after actor Phillip Seymour Hoffman died last month from an apparent heroin overdose. The rise in heroin use mirrors a decade-long spike in abuse of prescription opioids — painkillers that are a medical cousin to heroin, but are legal as long as they’re prescribed by a doctor.
In recent years, more prescription drug abusers have started turning to heroin for a cheaper high as the price of pills skyrockets on the black market, Bunt said. Two factors have contributed to the cost increase: opioid addiction boosting demand and doctors becoming more cautious about prescribing opioids, decreasing supply, Bunt said.
Another reason for the price increase: The Drug War, according to a January 2012 report from Radley Balko. Government crackdowns have made it difficult for even reputable doctors to prescribe pain pills. To fill the void, doctors and others looking to make a buck off the prescription pills created so-called “pill mills” — offices that prescribe pain medication in high volume and often serve people addicted to the drugs.
The result: Nearly four out of five people who recently started using heroin used prescription painkillers first, according to a 2013 study from the Center for Behavioral Health Statistics and Quality.
“A lot of people who got in trouble with the prescription opiates are switching over to heroin, and they get more for their buck, so to speak,” Bunt said. In his experience, he added, much of the heroin available today is laced with other additives, like additional painkillers — making it more dangerous.
“Once you inject the heroin that’s available today, you’re at very high risk for fatal overdose,” he said.
Infographic by Alissa Scheller for The Huffington Post
For decades, opioid painkillers, like oxycodone, hydrocodone and morphine, had been used successfully to treat conditions like intense pain at the end of life for cancer patients and acute pain after an injury like a broken bone.
But everything changed when OxyContin — and the marketing campaign that came with it — started in the 1990s, experts say. The drug, developed by Purdue Pharma, had a time-release mechanism that spaced out its effects over a longer period of time.
In dozens of seminars in ritzy hotel conference rooms across North America, the company sold doctors on the idea that the time-release function made OxyContin perfect for a population of patients who were suffering from chronic pain. Representatives also argued that the drug’s spaced-out effects made it less likely that patients would get addicted — which was the main factor deterring many physicians from prescribing opioids for chronic pain.
“This campaign focused on convincing doctors that they shouldn’t worry about addiction, so the medical community was taught to believe that addiction to opiates was relatively rare,” said Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing.
The pitch was convincing, Kolodny said, because no doctor wants to believe that they’re keeping a patient in pain unnecessarily. By 2001, OxyContin had exceeded more than $1 billion in sales, and by 2003, nearly half of the doctors prescribing OxyContin were primary care physicians, according to a 2004 report from the Government Accountability Office.
“As prescriptions began to take off, it led to an epidemic of opioid addiction,” Kolodny said. “We all became much more likely to have opioids in our homes, so it created a hazard.”
“We have now this incredibly unusual public health crisis that’s essentially caused by physicians, caused by the health care industry,” said Meldon Kahan, the medical director of substance use services at the Women’s College Hospital in Toronto.
Purdue Spokesman Raul Damas wrote in an email statement to The Huffington Post that “like any public health issue, opioid abuse is the result of many factors, not just one drug or one company.” Brand-name OxyContin represents a small share of oxycodone-based drugs on the market, and Purdue has taken steps to curb the addiction epidemic, like paying for addiction hotlines and working with law enforcement to help them better identify pills that are frequently abused.
“The recent increase in heroin abuse is an unfortunate result of many different factors, and what often gets lost is that prescription opioids play an important role in helping patients and physicians address the very real issue of chronic pain.” Damas wrote. “Purdue has led the development of abuse-deterrent opioids, but these efforts need to be complemented by public education and treatment, so that we address demand, as well as supply.”
People typically become addicted to the prescription pills in one of two ways, Kolodny said. The majority of younger users, like Arielle, find the pills lying around at home or at friends’ houses. But the other demographic suffering from prescription painkiller addiction — middle-aged Americans — typically get the pills from their doctors for things like chronic back or head pain. Once their bodies adjust, their doctors have to up the doses to mitigate the pain.
Betty Tully experienced this phenomenon firsthand. She went to her doctor in January of 2001, looking for a fix for the pain that had plagued her lower back for decades. Tully’s doctor said he had just the thing, a new “miracle drug” that could help her pain without putting her at risk of addiction. He started her on 20 milligrams of OxyContin. Soon, she was asking for more, so he upped her doses.
“By June, I was an absolute zombie. I couldn’t work anymore, I couldn’t drive my car anymore. I left my car running one day on the street,” the former real estate agent said. “I was calling his office and screaming that I needed this medicine.”
By the end of 11 months, Tully was on 280 milligrams of OxyContin per day. The mother of two, who had held down jobs since she was 12 years old, refused to leave the house for fear she’d miss a dose and go through terrible symptoms of withdrawal like nausea and profuse sweating. When she decided to get clean, it took her six years to completely get off the drug, and she says she’s lucky she was able to finally kick the habit. Indeed, according to Kolodny, “middle-aged women getting pain pills from doctors” are dying from overdoses at some of the highest rates in history. In 2010, 40 percent of U.S. drug overdose deaths were women, many of whom died from abusing prescription pills.
“I should be among those statistics,” Tully said. “There’s not many people that can take that much and be breathing every day.”
CORRECTION: Language was changed to clarify that while 40 percent of drug overdoses in 2010 were women, not all of them died from taking prescription pills.
The life of a heroin addict is not the same as it was 20 years ago, and the biggest reason is what some doctors call “heroin lite”: prescription opiates. These medications are more available than ever, and reliably whet an appetite that, once formed, never entirely fades.
The actor, who quit heroin more than 20 years ago, reportedly struggled to break a prescription painkiller habit last year. Experts in addiction say that the use of medications like Vicodin, OxyContin and oxycodone — all opiates like heroin — has altered the landscape of addiction and relapse, in ways that affect both current users and former ones.
“The old-school user, pre-1990s, mostly used just heroin, and if there was none around, went through withdrawal,” said Stephen E. Lankenau, a sociologist at Drexel University who has surveyed young addicts. Today, he said, “users switch back and forth, to pills then back to heroin when it’s available, and back again. The two have become integrated.”
Rates of prescription opiate abuse have risen steadily over the last decade, while the number of people reporting that they used heroin in the past 12 months has nearly doubled since 2007 to 620,000, according to government statistics. That’s no coincidence, researchers argue: more people than ever now get a taste of opiates at a young age, and recovering addicts live in a world with far more temptations than there were a generation ago.
“You can get the pills from so many sources,” said Traci Rieckmann, an addiction researcher at Oregon Health & Science University. “There’s no paraphernalia, no smell. It’s the perfect drug, for many people.”
Millions of people use these drugs safely, and doctors generally prescribe them conscientiously. But for some patients, prescription painkillers can act as an introduction — or a reintroduction — to an opiate high. The pills set off heroin craving in recovering addicts, doctors say, every bit as well as they soothe withdrawal in current users.
Dr. Jason Jerry, an addiction specialist at the Cleveland Clinic’s Alcohol and Drug Recovery Center, estimates that half of the 200 or so heroin addicts the clinic sees every month started on prescription opiates.
“Often it’s a legitimate prescription, but next thing they know, they’re obtaining the pills illicitly,” Dr. Jerry said.
In many parts of the country, heroin is much cheaper than prescription opiates. “So people eventually say, ‘Why am I paying $1 per milligram for oxy when for a tenth of the price I can get an equivalent dose of heroin?’ ” Dr. Jerry said.
Investigators do not yet know whether Mr. Hoffman was taking prescription opiates at the time of his death. Toxicology tests are pending, and the purity and content of the heroin found in his apartment will certainly be a focus.
While the deluge of prescription painkillers is new, other risk factors for overdose have not changed in decades.
“These are common danger zones,” said Dr. Nicholas L. Gideonse, the medical director of O.H.S.U. Richmond Community Health Center in Portland.
Even a change in where a person uses his or her drug of choice can increase the likelihood of an overdose, studies suggest. “If you habitually use in your car, for example, the body prepares itself to receive the drug when it’s in that environment,” Dr. Rieckmann said. “It’s called conditioned tolerance. When people using are in an unfamiliar places, the body is less physically prepared.”
The risk of dying from an overdose is higher when people are using alone. “Another person, sober or not, can notice when someone nods off, or just say, ‘Hey man, slow down,’ ” Dr. Lankenau said. “And users act as a gauge for each other of when they’re doing something dangerous.”
Many needle exchange programs and clinics now have overdose prevention courses, teaching users to notice danger signs and administer the drug naloxone, an opiate blocker that E.M.T.s use to revive addicts who have overdosed.
None of which might have spared Mr. Hoffman. One thing that has not changed for heroin addicts over the past 20 years is the certainty that this next shot will not be deadly.
“You have to understand that addicts inject three or four times a day for years and years on end,” Dr. Gideonse said. “They don’t perceive any one shot to be dangerous or potentially deadly, because in their experience, there’s no reason to.”
By Rick Nauert PhDSenior News Editor Reviewed by John M. Grohol, Psy.D. on February 19, 2014
Teen prescription drug abuse programs have experienced mixed levels of effectiveness, ranging from big drops in drug abuse to no measurable effect.
The finding comes from a study of 11,000 teenagers by researchers at Duke and Pennsylvania State universities.
The best results came from pairing a school-based program with a home-based intervention, resulting in a 10 percent decrease in abuse rates.
By contrast, most school-based programs were ineffective when used by themselves, with just one exception.
While the results are sobering (no pun intended), the six-year study is among the first to measure the success and cost-effectiveness of prescription drug abuse prevention efforts.
Abuse of prescription opioids, a form of painkiller, is the fastest-growing form of illicit drug use in the country, affecting more than 12 million Americans and killing more people annually than heroin and cocaine combined, according to the Centers for Disease Control and Prevention.
As a result, the U.S. Food and Drug Administration has recommended restricting access to painkillers such as Percocet, Oxycontin, and Vicodin.
“These drugs are very available, and highly addictive,” said Max Crowley, Ph.D., an NIH Research Fellow at Duke’s Center for Child and Family Policy.
“There’s a growing national debate about whether we should restrict access to these drugs, but at the same time, the drugs are hugely important for pain management. What’s being left out of the debate is the role of prevention.”
Crowley and his co-authors found that only one school-based program was effective when used by itself.
The Life Skills Training program resulted in 4 percent lower drug abuse rates, compared with a control group. The 18-session course teaches social skills that build competence and encourage assertiveness.
“Life Skills Training was also among the most cost-effective programs studied, costing an average of $15 per child,” Crowley said. “By contrast, the study notes that prescription drug abusers cost society an average of $7,500 each for treatment and other expenses, by conservative estimates.”
Life Skills was among four prevention programs the researchers studied.
The team looked at 28 rural public school districts in Iowa and Pennsylvania, tracking students from grades 6 through 12. They examined a home-based program called Strengthening Families 10-14 and three school-based programs: Life Skills Training, Project Alert, and All Stars.
All four were “universal” programs that were offered to all teenagers in a given district.
The researchers analyzed pairs of demographically similar school districts. Within each pair, one community received a prevention program or programs, and the other did not.
The research team surveyed teenagers each year, asking teens to anonymously report whether they had ever used a prescription painkiller for nonmedical purposes. The authors then compared drug use levels in districts that received interventions versus those that did not.
In communities that received no intervention, a quarter of high school seniors reported having misused prescription painkillers.
The most substantial reductions in abuse rates occurred when the Life Skills program was combined with the Strengthening Families program. The All Stars intervention also yielded reductions when it was used alongside the Strengthening Families program.
Crowley said he hopes policymakers and educators will put the findings to use.
“Policymakers and other leaders are actively searching for efficient ways to curb prescription drug abuse,” Crowley said.
“These results give policymakers options regarding how to handle this growing epidemic.”