How do any of these topics apply to teens and young adults? Sadly use of these substances (opioids including pain pills, heroin and other opiates) is more common than you might believe. And although heroin has been around for a while, nowadays, the path from abusing either pain pills all the way to using heroin is shorter than it may appear. Experts in the area of drug use have said that this is the worst overdose epidemic that has been seen in the history of humanity. That’s a pretty strong statement.
I heard the phrase Substance Abuse Disorder recently. I really like that phrase since it captures a really important concept that if you abuse or misuse these (or any other) drugs, you are not a failure. You are not immoral. You have a brain disease that is affected by exposure to chemicals. This brain disease is what many refer to as addiction, and like other diseases such as heart disease, your family history and genetics play a role as do the substances you expose your body and brain to.
The good news is that you are not alone. (Of course the bad news too is that so many people are affected by substance abuse disorder). How many? 1 in 4 families are touched by addiction. And more good news: there are many instances where people have gone through recovery and have come out the other side. Prevention is best, of course.
So how do teens even get exposed to this stuff in the first place?
- Well, teens might experiment with what they find in bathroom cabinets – adults may have old partially used prescriptions that are sitting around, and it seems like a fun idea to try them. After all, they are prescriptions, so they must be safe, right? (spoiler alert – WRONG!).
- Here is another scenario: You are a star athlete and you suffer a sports injury. You might need surgery or you might have broken a bone and have been given a prescription for pain medicine. Say you have to quit your sport and your dream of going to college on a scholarship or your dream of going pro is destroyed and you are now depressed. Physical pain plus mental pain makes you “need” more medicine.
- Or you are stressed. Between school and your job and your sport and family issues, you are having a really hard time unwinding. Who has the time to take a break?! A friend tells you that these pills she has will help you relax, really quickly. So you try them.
No matter the starting point, as you use, you will need higher and higher doses to get the same effects. So you might buy some pills, but quickly you learn the street cost of these medicines is really expensive. Like $1 a mg. So if you need, say 40 mg at a time and maybe you use it twice a day, you are looking at nearly $100 a day. Ah, but then you hear about heroin. Heroin these days is much purer than the last time there was a big epidemic. Purity used to be about 20 – 25% but now in certain cities heroin is much purer. Closer to 90% purity. So you start buying bags for $5-$10. You never plan to inject, but you do snort it. And here you are. Hooked on heroin. Even if you don’t get to heroin, you can be very dependent or hooked on pain pills too.
Nowadays, 40 people in the US die each day because of an opioid overdose. EACH DAY! The majority of people that do die actually have overdosed on prescription pills. So the risk of overdose is NOT just a heroin problem.
High doses of pain pills or heroin or other opiates like fentanyl, can kill you. I am not saying this to be dramatic. This is just a fact. These are overdoses. Mixing substances is even more dangerous since in combination they are even more likely to cause your breathing slow down and stop. When you stop breathing, you can pass out and if you don’t become conscious again, going too long without breathing causes brain death and death death. You need to know that in combination, these substances can stop breathing with lower doses. Some people mix fentanyl or Xanax or alcohol with pain pills. This is really dangerous.
Quitting and recovery is usually not a straight path, marked by some steps backwards as well as steps forward. Another risky time for fatal overdose is after you have cut back or stopped using altogether. Maybe you got into rehab (congratulations for taking that step) and have been sober. Since recovery is not a straight line, so you might hit a trigger that makes you use again. You remember when you went into detox and recovery you used 160 mg a day. So you take a really high dose even though your body isn’t used to it anymore. High doses are lethal (they kill you).
What is Narcan? Narcan is what is called an “opioid antagonist” which means it will go and block opioids from attaching themselves to those receptors in your body. It can even replace the opioids at those receptors. This means the effects of the overdose are reversed. Narcan saves lives. Many police departments carry it now so that if they find victims of overdose, they can use it, save their lives, and try to get them to medical care and hopefully to treatment. Narcan does not treat opioid substance abuse disorder, but it saves a person’s life so they can get treatment. More and more states are signing laws to make it easier for Narcan to be made available to be given in an emergency such as in schools or other public places. In my state, we have a standing order, which means that you can go to the pharmacy without a prescription to buy Narcan to have on hand in case of an emergency. This is really important since the majority of overdoses that are given Narcan are for heroin, but more people die from overdoses of prescription pills. We need to try to make sure the people who suffer from substance abuse disorder with opioids (and their families) have Narcan on hand in case of emergency.
Now we already talked about how recovery is not a straight line. I say this again and again since I do not want you to get discouraged and feel hopeless. Sometimes the path to treatment is complicated. There may be waiting lists, or there may be shame to get help. If you or someone in your house might be at risk for overdose, you should get Narcan to have in your first aid kit just in case. In many states there is a way to go straight to your pharmacy to buy it to have it on hand. Each state is different. This is a link to a state by state summary of current laws: http://lawatlas.org/query?dataset=laws-regulating-administration-of-naloxone I couldn’t find anything more teen-friendly, but if I do I will add it. If you know of a good resource, please add to the comments below.
What can decrease the risk of abuse and overdose with pain medicines and heroin?
- Honest open education and discussion.
- It really helps to know your family history since that can play a part into how likely you are to develop a problem. Families are often quite about addiction and substance abuse disorders. But since there is an inherited element, it is important for families to talk about this as part of their medical history, just like we talk about whether cancer or heart attacks run in your family.
- Being really careful with taking pain medicines. There are a lot of really effective ways to treat pain that are not opioids, and for chronic longstanding pain, they may not even help at all.
- If you have an injury and are given a prescription for an opioid pain medication, ask if there are other types of medicine that might help or that you can try first.
- Get help for mental illness! We have no problem getting treatment for physical illnesses (broken legs, for instance!), but often we do not treat our mental health the same way. If you suffer from untreated anxiety or depression or bipolar, you might be more at risk to try to self-medicate with many substances including these.
- Find positive ways to manage stress. Exercise, friends, music. There are so many better ways to help decrease stress that are not around a chemical. More on teen stress HERE.
- Let’s get rid of the stigma around addition and abuse. This is neurology and chemistry. So many people in every single community are affected by this problem. We need to talk loudly and often about it to figure out how to solve the problems.
- If you are in recovery and heading off to college, ask about substance free housing. I did the college visits with my son last year and I was really impressed with how many schools offered substance free housing. The schools offered it for students who preferred to live in a setting without drugs and alcohol regardless of whether or not they were in recovery. I thought this was a great thing – just a matter of fact option that might appeal to many students.
- There is no shame in getting help.
- If you see a friend in trouble or heading down that path SAY SOMETHING! Reach out to a trusted adult. Drop off an anonymous note to the school counselor or nurse. Look out for each other!
Finally, some really good resources I have found for you: