Drug Abuse: Herion Users In High School Start With Opioid Prescriptions

A recent study from New York University, led by Langone Medical Center professor Joseph J. Palamar, examined the associations between the frequency and recency of nonmedical use of opioids and heroin, specifically among high school seniors, who are the students at the highest risk of using the drug. The researchers found that three-fourths, or 75 percent, of high school seniors who use heroin admitting to previously using prescription opioids in nonmedical fashion.

"12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use," Palamar said in a press release. "As frequency of lifetime opioid use increased, so too did the odds for reporting heroin use, with over three-quarters of heroin users reporting lifetime nonmedical opioid use. More frequent and more recent nonmedical opioid use was associated with increased odds for reporting heroin use."

The improper use of prescription opioids, or painkillers, has become an enormous problem in the United States in recent years. Nonmedical use of powerful prescription drugs like Vicodin and Percocet, as well as Oxycontin, have been involved in increasing levels of overdoses, hospital admissions and deaths. On any given day in the U.S., almost 7,000 people are treated in emergency departments for nonmedical prescription drug use.

The United States is currently "in the midst of a prescription painkiller overdose epidemic," according to the Centers for Disease Control and Prevention. This misuse also seems to be contributing to initiation into heroin use, another increasing trend that's skyrocketed 63 percent in the past 11 years. Potential heroin users that were once considered low risk - high income individuals, whites, and women - are using currently using heroin at record levels.

In the study, the team used data from a nationwide annual study of behavior, attitude and values of American secondary school students, called Monitoring the Future, which releases a survey to 130 public and private schools throughout 48 states, assessing a total of 15,000 students each year. The data used for the study was from 2009 to 2013.

They found that recent opioid use (within 30 days) is an enormous risk factor in heroin use. Just about one-quarter, 23.2 percent, of students who had used opioids less than 40 times had reported using heroin. Seventy-seven percent of those who use heroin admitted to also having used prescription opioids nonmedically. White students were shown to have the highest level of use of heroin. The use of heroin by 18 year olds has also increased steadily since 2011, according to Monitoring the Future.

Females, along with students who lived with both parents, were at very low risk levels for heroin use. Black and Hispanic students were also at a lower use level of heroin and opioids than white students.  

"Interestingly, while we found that black and Hispanic students were at low risk for both opioid and heroin use generally, black and Hispanic students were more likely to use heroin without first using opioids in a nonmedical manner," co-author Pedro Mateu-Gelabert of the Center for Drug Use and HIV Research, said. "This suggests that it is primarily the white students who may be transitioning from pill use to heroin." 

The researchers stressed that intervention should be aimed at decreasing nonmedical opioid use by young adults and adolescents, which could in turn prevent initiation into heroin use. Palamar pointed out that a lack of education about prescription opioids could lead to abuse. Teenagers tend to believe that since the government has approved the drugs' use, and that they can be found readily in their parent's medicine cabinets, that they must be safe, according to Palamar.

"Any nonmedical use of opioids can be risky, but special attention needs to be given to adolescents who use more frequently," Palamar said."A teen may take an Oxy a couple of times and remain unscathed. But a lot of teens don't realize these pills can be physically addicting."

Palamar continued that the current warning systems in place for drugs may also be to blame. Teenagers are generally distrusting of warnings against prescription drugs, which are often viewed in a completely different light from illegal drugs, and these warnings need to be adjusted. Teens are "taught that using any drug - even marijuana - even once - will ruin their life forever,"  he said.

"The importance and urgency of the need for prevention, treatment, and intervention cannot be emphasized enough," Mateu-Gelabert said. "Governmental officials at the local, state and federal agencies such as Health and Human Services (HHS) and now the Food and Drug Administration (FDA), are all desperately trying to stem the unprecedented rise in drug overdose deaths, which are now the leading cause of injury death in the U.S."

The researchers found that nonmedical opioid use places teens at a serious risk for heroin use, along the already apparent risk for accidental overdose and dependence on the opioids.

"Teens experimenting with pills need to look at all of these people around them becoming addicted to--and dying from heroin," Palamar said. "Most of these people started on pills and felt they had no choice but to move onto heroin. Targeting this group may prevent future heroin initiation, and decrease the troubling trend nation-wide in opiate-related deaths."

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