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From Prescription Pill Abuse to Heroin Use 

February 27, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

During the past week, prescription pill abuse and heroin overdoses dominated the headlines in local newspapers: Two Fatal Overdoses Reported and Police Partner With Gosnold To Make Home Visits After Overdoses in the Falmouth Enterprise; and, New Data Shows 'Tsunami' of Addiction Grips Region in the Cape Cod Times.

According to the National Institute on Drug Abuse, nearly half of young people who inject heroin reported abusing prescription opioids (such as Percocet, Oxycontin, Vicodin) before starting to use heroin. Some individuals reported taking up heroin because it is cheaper and easier to obtain than prescription opioids. Many of these young people also report that crushing prescription opioid pills to snort or inject the powder provided their initiation into these methods of drug administration

Teens who abuse prescription pain medications may start in one of two ways. Some teens begin abusing an opioid drug at a party or when offered by friends because they are curious or think it will make them look cool and feel good. Other teens and young adults may start using a painkiller legitimately when it is prescribed by a physician after an injury or by a dentist following a dental procedure, such as extraction of a “wisdom” tooth. Occasionally, legitimate use turns to drug dependence, opiate pill addiction and then heroin use. 

Jason: One Teen's Experience with Prescription Pill Abuse and Heroin

The following is the journey of one teen, his prescription drug abuse, heroin use, and recovery from addiction.

Jason, a college sophomore, suffers a serious sports injury that requires surgery. Throughout the long healing process at home his surgeon prescribes Oxycodone, a narcotic painkiller. (Prescription drugs are the most commonly-abused drugs among 12-13 year olds.)

After six weeks of taking the painkillers, Jason notices that they don't work as well or last as long. He begins taking more pills than were prescribed by his surgeon. (25% of teens report having abused or misused a prescription drug at least once in their lifetime.)

Jason quickly runs out of his painkillers—and feels like he needs it. He begins stealing pills from his grandmother's house where she keeps her medications in a basket on her kitchen counter, and then from a friend's medicine cabinet. Jason knows that crushing and snorting his pills can help him feel better, faster. (More than 2/3 of teens who abuse prescription pain relievers say that they get them from family or friends.)

Jason's parents notice that he is behaving strangely. When they find a baggie of loose pills in his room, they became concerned and confront him. Jason denies that he has a problem. (95% of parents believe their child has never taken a prescription drug for a reason other than its intended use.)

Jason asks both his surgeon and his primary care physician (PCP) for more painkillers, but they refuse. Jason's PCP recommends that he use a non-narcotic pain reliever. Jason cannot find enough narcotic pills and he begins to suffer from withdrawal. One of his college friends says he is not able to "score" any prescription pills but has heroin. Jason never thought that he would use heroin, but feels desperate to stop the withdrawal symptoms. He starts snorting heroin. (4 out of 5 heroin users began first with recreational use of Rx pain relievers.)

Jason's tolerance is very high and he needs increasing amounts of heroin to snort, but he cannot afford the amount he needs to keep away his powerful cravings. His college friend says he can use less heroin if he injects it. Jason is afraid of the needles, but his friend offers to inject the heroin for him. Jason agrees and his friend injects the heroin not knowing that this batch is laced with Fentanyl, a potent pain killer that some drug dealers add to heroin to make the “high” or “rush” stronger. After a short period of time, Jason's friend notices that Jason is breathing very slowly and is turning blue. He calls 911 and leaves him. (Nearly 1/2 of young people who inject heroin start by abusing Rx drugs.)

The emergency response team finds Jason and administers Narcan (naloxone), which reverses the effects of the heroin overdose. Jason is watched closely at the hospital. Jason's parents, with Jason’s okay, enroll him in a recovery program, which includes medication-assisted treatment, counseling and support. (Medication-assisted treatment is the use of medication therapy and support to address withdrawal, cravings and relapse prevention.)

After his initial treatment, Jason moves into a facility in his community that provides support and ongoing therapy for young men with substance abuse issues. Jason remains in the facility for two months and then moves into his family home and continues long-term counseling that includes his parents and teenage sister. (Most people who get into and remain in treatment stop using drugs.)

One year after his sports injury, Jason is in recovery and working hard to stay sober. He has returned to school and continues to participate in a campus program for addicts in recovery. (With ongoing recovery support, it is possible to lead a healthy, productive life after addiction.

Jason's story is only one example of the many faces of opiate addiction. 

A Different Outcome for Jason

Following Jason’s surgery for his sports injury it was important and appropriate for him to receive prescription painkillers, not only to make him feel more comfortable but to promote healing. However, it may not have been appropriate for him to be receive a six-week supply of narcotics without careful monitoring and significant education about the potential dangers of long-term use. Most young adults who have had a surgical or dental procedure can be switched to non-narcotic painkillers within days of surgery. In addition, there are other techniques that can be used to counter pain, such as the application of cold packs and other methods.

Recently, a close friend had a surgical procedure at one of Boston’s most prestigious medical centers. He required a morphine pump in the hospital for 24 hours and then a full day of long-acting Oxycodone. At the time of discharge, he was given a bottle of 100 Oxycodone, a 25 day supply. He was not given any information about the possibility of developing tolerance or what else he could do to alleviate pain. My friend used the Oxycodone for two days after returning home and then switched to Tylenol and Aleve. His wife put the remainder of his narcotic pills in the drug disposal kiosk at the Falmouth Police Department!

Some food for thought: According to the Massachusetts Department of Public Health, in 2013 30,775 individuals in Barnstable County received 6,982,337 doses of narcotic painkillers. That amounts to more than 225 pills per person. Much of it is needed and appropriate, but many of those pills wind up in the drug kiosks in all the police stations on the Cape and in the hands of our kids.

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