Painkillers can be gateway to heroin for teens

Most teens who use heroin tried narcotic painkillers first, according to a new report.

The transition from painkillers to heroin comes as no surprise to experts who study drug addiction. Prescription narcotics, also called opioids, are prescribed to relieve pain, but they can become addictive. Teens who abuse them often seek a less expensive and more readily available option – heroin.

“The main reason teens graduate from prescription painkillers to heroin is lower cost,” says Dr. Adam Rubinstein, internal medicine and addiction medicine physician at Advocate Condell Medical Center in Libertyville, Ill. “Twenty-five percent of Americans who begin any opioid painkiller never stop using opioids and become addicted or dependent. They often require more pills and higher doses to achieve the same effect, which eventually means avoiding symptoms of withdrawal. They are no longer using to get ‘high.’”

Among the painkillers most often abused are Vicodin, Percocet and OxyContin. Dr. Rubinstein says OxyContin costs about $80 per pill for an 80 milligram dose. Heroin typically costs $10 or less per bag.

“These folks quickly realize they can’t afford to buy the pills on the street, so cheap heroin imported from Mexico becomes their drug of choice,” he says.

In the recently released report, researchers analyzed data from the 2009-2013 Monitoring the Future surveys, which questioned students in more than 100 high schools across the United States. The purpose of the survey was to assess teens’ behaviors, attitudes and values.

The researchers found more than 77 percent of teens who reported using heroin also had used narcotic painkillers. In many instances, the painkillers had been prescribed to the teens’ parents, and the kids stole them from an accessible place in their own homes.

Dr. Rubinstein says parents are advised to buy a simple lock box for all controlled substance medications.

“This prevents teens and others who enter the home such as contractors, delivery folks, potential home buyers or friends of their teens from stealing them,” Dr. Rubinstein says. “It is actually a felony to allow your own prescription pills for pain to be taken by others, even if you were not aware they were stolen. Never assume you can hide the pills safely. Your teens and others likely will find them if they feel motivated enough.”

Dr. Rubinstein says potential solutions to help address the problem could include:

• Refuse prescriptions for narcotic painkillers from doctors and dentists unless you feel they are absolutely necessary.
• Take these pills for the shortest time needed – usually fewer than 14 days. Then, bring the unused pills to your local police station and drop them in the medication collection boxes found in the lobby.
• If a relative dies at home and they were taking prescription narcotics, dispose of those unused pills at the police station immediately. You may be saving a life by driving to the next town to reach a collection box.
• Keep all controlled substances in a lock box at home and do not share the key or combination with anyone.
• Tell your doctors, including surgeons, that you want no prescription painkillers or the fewest pills necessary after an injury or surgery, then change to non-narcotic medications
• Obtain Evzio, an opioid antagonist, which may save the life of someone who overdosed on painkillers or heroin. Beginning in spring 2016, pharmacists in Illinois can prescribe and dispense Evzio and any new similar antidote for opioid overdose directly to you without a doctor’s order. If you find your teen unconscious but alive, one injection of this antidote may save their life. Then, bring them to treatment after a brief stay in the hospital.
• Educate your own children about the dangers of prescription pain pills starting when they are 5 years old. Talk about the topic often, and be non-judgmental. Families must discuss mental health issues and addiction concepts together and frequently so everyone knows how to recognize the signs of an early problem.

“This type of discussion can be the most powerful form of prevention,” Dr. Rubinstein says.