Editor's Note: If you want to know how pervasive and epidemic opiate addiction is today in the United States, just ask all the teenagers you know about their own experiences with opiates. That's what we did for this article. What we uncovered simply by asking was shocking. Every teen, no matter which part of the country they lived in, had a story to tell about trying opiates, having friends who got addicted to opiates, or about being approached by a "nice and laid back" dealer. There are no experts of authority guiding us in this article, only testimonials from teenagers and tips gathered from reputable medical sources on the internet.
This is a critical issue undermining our society and the future of our children.
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By Jessie Hill | March 15, 2017
All It Takes Is One Pill
"My first time experimenting with opiates was smoking half of a Roxicodone pill as a senior in high school. I was 18. It made me physically sick to my stomach to the point I had to lay down for an hour. I'm not exaggerating when I say, as soon as that sickness wore off, the first words out of my mouth were, "Can we do it again?" That's how strong these opiates are and how fast it gets into your system. Within a week, I was smoking 5 a day. Within a month, I was smoking 10 to 15 a day, that's about 400+ mg a day. I lost roughly 20 pounds, my face was sunken in, and my skin color was a grim shade of grey." Sophie,* California
Parents of kids like Sophie think kids who abuse drugs lived in bad neighborhoods and used street drugs. This stereotype of the typical teen drug abuser has left countless parents in the dark about the drug abuse among their “good kids” going to “good schools,” and living in “good neighborhoods.”
Sophie herself says, “I came from a loving family and home environment. I was well taken care of. Looking from the outside, no one expected this of me. I did have a minor drug and alcohol problem before, but it's the opiates that really pushed me over the edge.”
Sophie didn’t expect this of herself. Her boyfriend abused drugs and she had promised herself that she would never do that.
According to Marilyn, a sophomore at an Atlanta college, “In my high school they taught us run of the mill information about how drugs work and names of different kinds of drugs, but addicts I knew would talk about how it was like two people in their head and if they didn't take drugs enough the other voice would get angry. They told me that younger kids try them because they see others do them or to make themselves seem cool and tough. One addict told me that dealers look for young kids who come from middle or upper-class families to supply to because they're young and can be manipulated and have their parent’s money on hand.”
Access to Opioids
"It is my belief that some have a prerequisite for this addiction. I've worked in multiple treatment centers and I've seen people come from all walks of life and we end up in the same place. Yet there's a common theme among us all, and that is we know we probably would have ended up very differently if we had just said "no" to that first opiate. I feel very fortunate to have ended up the way I did because I know dozens of people who didn't make it out of this addiction alive." Sophie, CA
Here are several facts about opioid addiction:
- One in ten high school seniors in the US admits to abusing prescription painkillers.1
- One person dies every 19 minutes from drug overdose in the United States and this increasing trend is driven by prescription painkillers.2
- In the case of prescription opioids, medical use is also associated with a greater risk of future opioid misuse, particularly in adolescents who disapprove of illegal drug use and have little to no history of drug use.3
Where do high school seniors get prescription pain medications? Surprisingly, it isn’t from the internet or even from a bad neighborhood. Drug dealers aren’t targeting poor areas. They go where the money is. Wealthier neighborhoods. Kids with access to their parent’s money. In fact, the most likely place to get prescription pain medication is from a friend or family member. Unfortunately, another common place that teens obtain prescription pain medication is from doctors themselves.
Jack, a neuroscience student in Boston observes, “Becoming addicted to opioids is all too easy -- beguiling dealers may be culpable, but well-intentioned doctors can be even worse. So many become addicted simply from taking their prescribed pain pills. For instance, when I had my wisdom teeth removed when I was 18, the doctor prescribed me a ten-day supply of Oxycodone. And it came with two refills! Even doctors themselves can fall victim to opioids. My friend's father is an acclaimed Radiologist, but even he managed to become addicted to pain medication after back surgery. Even those trained in the chemistry of drugs can fall victim to their power.”
Which Prescription Painkillers Are Being Abused?
A number of different drugs are being abused. Some you may have heard of, some perhaps not. But they are prescribed for pain for even common ailments stemming from dental surgery, gallbladder surgery, sports injuries, etc.
- codeine
- fentanyl
- hydrocodone
- hydromorphone
- meperidine
- methadone
How Do Opiates Affect Teen Brains?
The brain of a teen is still in development. In fact, the brain continues to develop until a person is in his mid 20’s,4 and this makes an adolescent at particular risk for opiate addiction. Other factors that increase the risk of addiction include stress, mental disorders (including ADHD) and genetic predisposition.
Opiate painkillers are regularly prescribed for people following surgery, those with severe pain, or individuals with cancer. These drugs affect the brain by attaching to brain cells and blocking the pain messages from your brain to your body. At the same time, they trigger a pleasure response in the brain, producing a sense of euphoria, or a “high.” It is this high and not the pain relief that becomes overwhelmingly alluring to those who use these painkillers.
Additionally, opiates slow down respiration and digestion. Under a doctor’s care, opiate drugs are carefully prescribed to avoid causing respiratory distress. Constipation is a common side effect of opiate drugs, even when used as prescribed. Of course, teens abusing the drugs are not using them as prescribed. Once they are hooked, they are getting them any way they can and using more than would be prescribed to them if their was a legitimate medical need. They are using them in ways they were never meant to be used (i.e. snorting, smoking, mixing with other drugs).
Unfortunately, opiate drugs begin to change the brain quickly, and the body develops a tolerance to the drug, requiring more of the drug to experience the symptomatic relief it provides or the high that it produces. Tolerance leads an increased craving for the drug and to addiction/dependence. One comes to feel normal only when on the drug.
What Makes Opiates so Addictive?
Jack explain how dopamine levels are affected by opiates and how that affects the brain.
"In essence, a chemical called dopamine controls the brain's reward system. In a restive state, the brain contains a moderate amount of dopamine. When a good event occurs, the brain fills up with dopamine, and you feel great. Imagine eating a juicy cheeseburger when you're famished -- isn't that satisfying? When a bad event occurs, the dopamine supply suddenly slows -- this happens when you miss your train, wake up late, etc.
However, dopamine does more than just make you feel good or bad. Dopamine not only regulates mood, but it also controls learning. And this makes sense, if you think about it. We should seek behaviors that make us feel good like eating a cheeseburger, finding a potential mate, etc., because they help us survive. Conversely, we should avoid behaviors that make us feel bad like running into a lion on the Savannah or being cast out of our social group, because that would reduce our chances of survival.
Drugs are chemicals that trigger immense amounts of dopamine release. As such, they hijack our brain's learning apparatus because we consistently get a biological "this is good" response, despite the obvious negative consequences. Imagine a smoker taking a drag -- they are sputtering and coughing all over the place, and yet they reach for their cigarette again and again. They may not want to smoke, but they are biologically inclined to do so again because the nicotine makes their brain feel good. It then becomes an automatic, learned behavior, and this learned behavior grows ever stronger in a self-reinforcing loop.
It is easy to think, "So what? If the addict had enough willpower, then they could break this dopamine cycle!" And this is somewhat true -- some addicts can indeed break out successfully. But many cannot. To understand this, we need one final piece of intuition: the role of conscious decisions versus subconscious actions.
As you are reading this, your heart is beating. Your stomach is digesting. Your eyes are "seeing". You do not have any control over these functions -- they simply happen as a byproduct of the brain's machinery. On the other hand, somewhere inside your head is a conscious "you". This "you" is in control of your body -- it makes decisions, moves your limbs, thinks, and carries out all the daily processes you are familiar with. But the reality is that your brain is little different than your heart -- it reads its inputs, evaluates its current state, and produces an output. The processing is just a lot more complicated for your brain than your heart.
Addiction essentially takes the actions that your "conscious brain" would normally perform, and transfers them to your unconscious brain. There is a spectrum of "control" we have over our actions, from knee-jerk reflexes to feeling emotions to conscious thought. Normally, the actions are contained to one domain or another, but addiction hijacks our neurological learning machinery to transform "conscious thought" to an automatic, uncontrollable craving for drugs. The dopamine release makes the drug-seeking behavior compulsive -- imagine that the need to seek drugs is stronger than the need to eat or drink, because taking drugs makes your dopamine levels spike even higher than food does.
As such, you can see that drugs hijack the dopamine-sensitive learning machinery of our brain and transform conscious action into unconscious craving. This is why drugs are so addictive.”
How Long Does It Take to Get Addicted to Pain Medication?
In 2010, an estimated 2.4 million people 12 or older met criteria for abuse of or dependence on prescription drugs, the second most common illicit drug use after marijuana. 5
While it is generally believed that opiate addiction doesn’t happen on the first day of use, Sophie’s experience tells another story.
"The first time I experimented with opiates, it was definitely not even a thought that I would become addicted, let alone flip my whole world upside down. Within two months, I was put in my first drug & alcohol treatment center for 40 days. After that I was sent to a sober living home in California. I was 18 years old and alone for the first time in my life, on the other side of the country. I was scared and since I was in a new environment I didn't know where or how to get my usual drug of choice.”
From Bad to Worse
Teens are risk takers. Their life stretches out before them seemingly infinitely and they don’t think bad things will happen to them. They often lack an appropriate fear of consequences. So that first pain pill is just a little risk. A bit of excitement. Then they take risks that are a little bigger. Looking cool and tough feeds the risk taking. Teens will experiment without evaluating the risks or consequences.
Marilyn, a teenager from Atlanta shares, “A problem I've been seeing is teenagers mixing drugs. Because opiates are so addictive once they build up a tolerance they mix different drugs that make them feel good to try and increase the effect. I just heard about a classmate of a friend who mixed large doses of morphine, Prozac and Xanax.”
Unfortunately, for many kids, the next step after painkiller medication is heroin, another opiate which is often easier and cheaper to obtain.
Sophie writes, “I took what was made available to me - heroin. That's what happens once you're addicted- nothing else matters, not even a huge desire to NOT do drugs. Even though I had been physically off the pills for a month, I had developed the phenomenon of craving in my mind. It's like every ounce of your being is compelling you to get high, regardless if it's with a drug you promised yourself you would never ever do..”
How to Talk to Your Kids about Opiate Addiction
Ignoring the problem will not make it go away. Hoping that this will not happen to your teen will not make it not so. You must talk to your kids about drug abuse. Start when they are small. They are never too young for age appropriate drug education. Children whose parents discuss the risks of drug abuse are significantly less likely to use drugs.6
For Toddlers and Preschoolers:
- When you give your child medication, tell them what it is for.
- Remind them to only take medication that the parents, doctors or caregivers give them.
- Tell them too much medication can make them sick.
For Elementary Age Children:
- As in the early years, any time you need to give your children medication, use it as a teaching opportunity.
- Reiterate the teaching you did during the early years. Tell them to never take medication that a friend or stranger gives to them.
- Do not let your elementary age child take medication without adult supervision. Children need to be taught that too much or the wrong medication is dangerous. They need to know that they should never take anyone else’s medication.
- Tell your children to tell you if anyone, friend or stranger offers them medication.
- Make an effort to know your child’s friends. Encourage your child to have his friends to your house.
- Stay involved with your child. Make a point of taking a monthly “date” together just to talk at a restaurant or park. You don’t need a subject, just a habit of spending time together. This is not a time to air frustrations or lecture. It is a time to enjoy your child and build the relationship.
Middle School Age Children:
Middle school age children can be quite independent. However, they should not expect to take medication unless you have given it to them.
“Prescription medicines are now the most commonly abused drugs among 12 to 13 year olds.”6
- Remind them of things you have taught them in the past.
- Teach them that mixing medications can be dangerous.
- Talk to your child about the particular dangers of opiate medications.
- Continue to have your child’s friends in your home.
- Continue to spend special time with your child. A habit of going over your child’s homework together is a great way to keep up with what he is doing on a regular basis.
- If you can volunteer at your child’s school, do so. You will have the opportunity to observe things in this setting that you might not be aware of otherwise.
- Make sure your child has positive activities. Sports, after school clubs, music lessons etc. give children some purpose and positive ways to invest their time.
High School Students:
- Your high school child may be able to take medication independently. If so, always go over dosing of any medication he needs.
- If your child ever needs opiate based pain medication, say, after surgery, you should keep track of this medication for him. If he does not need all of it, be sure to dispose of it appropriately. Do not save it “in case it is needed in the future.” It would be better to just go back to the doctor than have that tempting drug available in your home.
- Continue to talk to your child and spend time with him.
- Continue to have his friends over.
- Continue to talk about the dangers of prescription pain medications.
- Someday your child will not be at home. Prepare him to use medications responsibly when he is on his own.
What to Do if you Suspect your Child has a Drug Problem
Warning Signs of Teen Painkiller Abuse7
- Small pupils
- Slurred Speech
- Forgetfulness
- Weight Loss
- Change in sleeping routines
- Change in appearance
- Change in performance at school
- Aggression
- Defiance
- Bruising or other unexplained injuries
- Change in Friends
- Loss of Long Time Friends
- Unexplained need for money
- Missing medications
Get Help
There is no easy solution for opiate addiction but recovery is possible with professional help. Talk to your child’s doctor or school guidance counselor about good drug treatment centers in your area. You will need help. There are prescription medications that are used to help those addicted to opiates, but a doctor must be involved. And now, more than ever, your child needs your support and help.
The good news is that there is hope and there is help. Here is how Sophie’s story ends….
”Making a long story short, luckily, after a few more attempts, I managed to stay sober and have been since November 4, 2011.”
Don’t wait to talk about painkiller addiction with your child. Now is the time. You could save your child’s future and his life.
Sources:
1. http://www.drugfreeworld.org/drugfacts/painkillers/international-statistics.html
2. http://www.drugfree.org/drug-guide/prescription-pain-relievers/
3.https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse
4.http://ga-sps.org/content/resources/opioids-the-adolescent-brain/opioids-and-the-adolescent-brain.pdf
5. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/can-person-become-addicted-to-medications
6. http://www.drugfree.org/heroin
7. (http://www.soberliving.com/prescription-drugs/articles/15-signs-of-teen-abuse/
(*Sophie’s name has been changed to protect her privacy.)
Additional Articles of Interest:
10 Natural Alternatives to Prescription Pain Medications
