Approaching the Opioid Epidemic as a Community

In the last few years the opioid epidemic in the United States has become a worse threat than terrorists, gun-related violence and car accidents. Our children are not exempt from this killer. A study published in “JAMA Network Open” showed that between 1999 and 2016, 8,986 children and adolescents died from prescription and illicit opioid poisoning. The difference between these other threats and opioids is that the first three are carried out by strangers, while opioids are most often handed out by those we trust the most.

“Ninety percent of this starts with friends and family,” said Director of Behavioral Health, Dr. Christian Thurstone, who has headed the Substance Abuse Treatment, Education, and Prevention (STEP) Program, at Denver Health for 14 years.

Explaining how young people are first exposed to opioids, he said, “Access to medicine through friends and family can start innocently. Someone has a medical procedure in the hospital; they don’t use up all the pain medicine; it’s lying around in a drawer somewhere and a teenager gets a hold of it.”

The next most common path is when they are given medication from a physician after a medical or dental procedure.

Dr. Thurstone, who is also a child psychiatrist and addiction psychiatrist, is an expert on adolescent substance treatment. He said teenagers become addicted to substances much quicker than adults.

“It’s just the way their brain is wired,” he said. “The reward part of their brain works great. But the part which puts on the brakes is not yet fully developed. That’s why it’s important to reduce access and exposure to opioids as much as possible for adolescents. In animal studies, opioids have been shown to change the sequencing of the way the brain develops.”

How Opioids Work

The first step to understanding why opioids are so dangerous is knowing what they are and what they do. They are substances derived from the opium poppy, a flowering plant that was referenced as early as 3400 B.C. It was first cultivated in Southwest Asia and referred to as the “joy plant.” The natural substances that come from the opium poppy are classically referred to as opiates.

A few naturally occurring opiates found in the plant include morphine, codeine and thebaine. Thebaine is converted into other chemicals such as oxycodone and hydrocodone, which are used to make the semi-synthetic opioids such as Percocet and Vicodin. Heroin is another semi-synthetic opioid.

Scientists have also created drugs that mimic the effects of opiates but are not derived from the plant. Some examples of these synthetic opioids are methadone, fentanyl, and meperidine. The terms opiate and opioid have now become interchangeable, and all opioids are highly addictive.

They activate powerful reward centers in the brain. They trigger the release of endorphins, the brain’s feel-good neurotransmitters. Endorphins muffle the perception of pain and boost feelings of pleasure, creating a temporary but powerful sense of well-being.

Dr. Harlon Austin, licensed psychologist and Director of Clinical Quality at the Center for Dependency, Addiction, and Rehabilitation (CeDAR), a division of UCHealth, says a common way to describe the feeling is as if a “warm blanket” has been put over you emotionally.

“That can be very addicting for folks, especially if you have had some distress previously,” he said. “All of a sudden, through the use of the pill, you feel relief from that distress.”

Dr. Austin explains that years ago, practices started to get really loose when prescribing opioids. People would end up with leftover pills, and that created the opportunity for experimentation.

“They use the pills past the point of needing to medicate the pain for which they were originally prescribed, and then they have this dual thing that happens,” he added. “One, they become physically dependent or addicted to it due to the way the drug works. Two, if you have it in your system long enough and then you stop having it in your system, you’ll start to go through withdrawal once you’ve become dependent on it.”

The body’s physical need for it once it’s been in the system long enough, and the psychological component of wanting that “warm blanket” feeling to stay, makes it an exceedingly strong addiction.

About 30 years ago, pharmaceutical companies and medical societies convinced prescribers that the risk of addiction to prescription opioids was very low. They also began to promote the use of opioids in non-cancer related pain, despite lack of data regarding the risks and benefits in these patients.

“The pharmaceutical industry marketed it big time and tried to promote it as a miracle drug to relieve pain,” says Dr. Harvey Milkman, a psychology professor emeritus at Metropolitan State University of Denver. Dr Milkman specializes in working with at-risk youth and preventing harm related to substance abuse and other socially problematic behaviors. He explains the pharmaceutical companies’ role in the opioid epidemic.

“They encouraged doctors to prescribe this medication with almost reckless abandon, thinking it could be managed by the patients for whom it was prescribed,” added Dr. Milkman. “It turned out to be highly addictive. The thinking in the 1980s and into the 1990s was that we undermedicated for pain. We had the all mechanics, and all the tools that could remediate pain, so why should anyone suffer?”

Communities where opioids were readily available and liberally prescribed were the first to experience increased opioid abuse.

Dr. Austin says addiction can escalate quickly. “If you get the prescriptions, you need more and more to get the same effect. That’s what happens with the dependency. And so eventually the prescriptions run out and people buy them on the street. People sell pills but they’re expensive. Eventually, addicts realize that to keep and maintain their high is unaffordable, so then they’ll switch over to less expensive drugs such as heroin. That is a common path we see users taking.”

Eighty percent of heroin users in the United States admitted to misusing prescription opioids before turning to heroin. Everyone wants to believe that their loved ones know better, and that when they are given that prescription for Vicodin after their wisdom teeth are pulled, they will use what they need and it won’t become a problem. And for many people it won’t. But in 2017, 57 people under the age of 24 died from opioid overdose in Colorado. Along with 520 people over the age of 24. Their loved ones probably didn’t think it would become a problem for them either.

How to Determine if Your Loved One Has an Opioid Addiction

It can be difficult to determine if your child has an opioid addiction. Teenagers are already going through many physical and emotional changes. They might already seem to have one or two flags included on a substance abuse list but are simply acting like a typical teenager. But if they are portraying multiple symptoms, you might want to take a closer look. Signs of teenage opiate abuse might include but are not limited to the following:

  • Change in sleep patterns
  • Dramatic mood swings
  • Increased irritability
  • Ditching school
  • More withdrawn or isolated at home
  • Change in grades
  • Change in friends
  • Change in sleep patterns
  • Constricted pupils
  • Constipation
  • Getting in trouble in school or with the law
  • No longer engaging in former activities

Dr. Austin points out that keeping up with your teenager’s interests and friends in today’s world means keeping up with a digital component most of us didn’t grow up with.

“It’s a different looking beast,” he said. “You’ll have your real Instagram account and your fake Instagram account. The fake one is the one that your parents get to see.”

The best thing parents can do is to spend time with their kids and show they are interested. Dr. Austin adds that the more socially involved parents are, the better chance they have at just being able to ask questions.

Lack of Community

Professor Milkman believes that lack of community contributes to teenage opioid addiction. “We retreat into an isolated form of human interaction with social media, and rely less on face-to-face communication. Connecting with others, such as elders, relatives and friends in the community who are living healthy and productive lives is crucial,” he says. “We risk isolation through increased cyberspace communication, which disconnects people with communities that have purpose.”

Dr. Austin said that encouraging social engagement is vitally important. “Addiction isn’t something people just do because it’s fun,” he said. “It turns into an addiction that fills a void they’re otherwise incapable of filling. If we can help them figure out how to do that in a healthy way, that’s a win. Teenagers believe social connection is their highest priority, regardless of how willing they are to admit it.”

How to Handle the Issues

When parents suspect or discover their child has an opiate addiction, they can be at a loss as how to approach the subject. Dr. Thurstone provided the following suggestions:

  1. Take it seriously. I see a lot of parents who think of this as a fad or a phase. They may not deal with it right away and then it gets worse and it’s harder to treat.
  • Stay calm. Many parents have strong reactions to their suspicions or discoveries, which is most typically fear. The fear needs to be controlled. If parents express too much anger and fear, the teenager won’t feel comfortable talking to them or welcoming their help and will likely become defensive. For these reasons, parents need to control their strong emotions in a positive manner.
  • Get treatment sooner than later. Most of the time kids don’t become sloppy about their substance abuse until they’re well into their addiction. They’re good at hiding it at first, but then become less able to keep their needs to themselves, become exposed and get caught.
  • Set clear expectations. “We don’t use substances in our family.” It’s helpful for parents to maintain open communication and continually build a healthy relationship with the child. That’s how children grow up to incorporate positive values as adults.

Dr. Austin suggests that having conversations sooner than later about drugs and addiction with your children is the opportunity to get ahead of the game. Then, you can have conversations later that don’t seem like they’re coming out of left field.

“It’s always going to be much harder if you’ve never had this kind of discussion before, and then suddenly you’re trying to talk about something that comes as a surprise,” added Dr. Austin. “Plus, it’s emotionally charged because you’re worried and you’re scared. Having early and informative two-way discussions, such as asking ‘What do you know about this?’, ‘What are kids in your school talking about?’, ‘What have you heard?’ is important because these days, kids know far more than they used to with technology and various social media platforms. Therefore, having these discussions early and frequently helps immensely. The result is that when you do begin to suspect drug abuse, you can more easily negotiate that realm because you’ve been there before.”

He added that we can look at the facts for the last few decades and see that the concept of “the war on drugs” isn’t working.

“We’re not winning a war,” said Dr. Austin. “I think it’s important for us to think about addiction in terms of how we treat it, instead of how we punish addicts. How do we help the people who are suffering?”

Reading suggestions:

Pathways to Self-Discovery and Change: Criminal Conduct and Substance Abuse Treatment for Adolescents, co-authored by Harvey B. Milkman and Kenneth W. Wanberg.

Clearing the Haze: Helping Families Face Teen Addiction, co-authored by Christian Thurstone and Christine Tatum.

Parents and teens can get more information and help by visiting:

https://www.denverhealth.org/services/behavioral-health/addiction-services/adolescent-substance-abuse-treatment

https://www.addicted.org/colorado-adolescent-programs.html

https://www.hazeldenbettyford.org/treatment/models/specialized-programs/heroin-opioid-addiction-treatment

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