In recent years, there’s been a significant increase in opioid abuse among young people, especially in prescription medications, such as OxyContin. Among younger adolescents, prescription opioids are the most
commonly abused substances after
alcohol and marijuana.
"Kids are starting with OxyContin because they think it’s safe, since it’s a pharmaceutical product," says John Knight, MD, director of the Center for Adolescent Substance Abuse Research (ceASAR)
at Children’s Hospital Boston. "But
they rapidly develop an addictive
disorder and switch to heroin because they can’t afford the cost of daily OxyContin. These are ๋the kids next door’ from nice families who never thought they’d inject heroin, but that’s exactly what they end up doing." According to
Dr. Knight, the younger a person is when she starts using drugs, the greater the likelihood that she’ll become dependent.
Dr. Knight estimates that a quarter of
adolescent patients have a drug problem or disorder and says that doctors can
identify many of them through routine screening. Starting at age 12, pediatricians should screen for use of tobacco, alcohol and other drugs. Seven percent will have a diagnosis of abuse and at least 3 percent will have dependence. Dr. Knight points out that substance abuse affects both boys and girls, teens from all races and ethnicities and all socio-economic groups. "There’s a stereotype of inner city minorities having higher rates of drug use, but drug use rates are slightly higher among white youths living in the suburbs," he says. Drug use rates rise with each year of age, as does the prevalence of drug dependence, which peaks in the late teens and early 20s.
If a patient is using opioids, Sharon Levy, MD, director of the Adolescent Substance Abuse Program (ASAP) at Children’s, suggests that the pediatrician make an immediate referral to ASAP or to a clinician-specialist, such as a psychiatrist, psychologist or
addiction medicine specialist.
ASAP is an evaluation and treatment program for adolescents with suspected
substance abuse disorders. On initial presentation, teenagers receive a multidisciplinary evaluation to assess the extent of substance use and screen for mental health, behavioral or other medical problems. ASAP has a specific track for adolescents with opioid
dependence and all pediatricians and psychiatrists at ASAP are licensed to offer Suboxone, a new treatment that contains buprenorphine and naloxone. Buprenorphine is a partial mu-opioid-receptor agonist that blocks the activity of other opiates. Naloxone is an opioid antagonist that is not absorbed when taken as prescribed (sublingual tablet), but causes immediate narcotic withdrawal symptoms if the tablet is ground up and taken intranasally or injected.
However, Dr. Levy says that in order to effectively help adolescent patients, a comprehensive treatment program is needed, not just medication. Patients who come to ASAP with drug problems usually have at least one co-occurring mental disorder such as anxiety, depression or attention-deficit/hyperactivity disorder, according to Ximena Sanchez-Samper, MD, an addiction psychiatrist in ASAP. "If you manage to stabilize and treat the opioid dependence, but don’t treat the co-occurring mental health conditions, you increase the chance of relapse," she says.
Data from ASAP show that 40 percent of patients who receive Suboxone are drug-free six to nine months after beginning treatment, and another 30 percent stop using opioids but occasionally test positive for marijuana or alcohol. "What’s still unknown is how long adolescents should be kept on Suboxone," says Dr. Knight. He anticipates that ASAP will start a study looking at how long treatment should continue and how to make the decision to taper off.
ASAP currently has two studies exploring methods of how best to reduce drug use in adolescents. One test is motivational enhancement therapy, an intervention of three counseling sessions, during which adolescents consider how drug use affects their
values and goals, and make plans for positive behavioral change. The other study
investigates the use of random laboratory testing as an adjunct to treatment.