HEROIN IS FOR HARD-CORE users – your kid would never touch it, right? Teen heroin use has been declining since it peaked around the late 1990s, a University of Michigan study shows. Today, the prevalence of heroin use within the past year is roughly 0.5 percent, or 1 in 200 teens. Even so, heroin overdose deaths are rising, particularly among young adults ages 18 to 25, according to the Centers for Disease Control and Prevention.
"Heroin's one of those things – you don't want to mess with it; you don't want to toy with it," says Melvin Patterson, an agent with the U.S. Drug Enforcement Administration. "You really, really can become addicted the first time you have it."
However, kids often believe they're "invincible," says Patterson, who, as staff coordinator for the DEA's public affairs department, travels to schools to speak about the dangers of drug use. In that role, and as the father of three adolescent kids, he says, "It's frustrating to me that with everything that's out there, people are still choosing to take these ridiculous risks."
Behavior and appearance changes are signs kids may be in trouble, Patterson says. "The color in their face," he says. "Their hygiene habits go completely out the door." It's not just taking on a grungy look, he says, but a deterioration in their appearance. "As a parent, if you're connected in any way, if you're plugged into your kid – you'll know immediately. You may not know exactly what it is, but something's not right," he says.
The types of drugs people abuse tend to change in cycles, says Dr. Laura Offutt, with stimulants and sedatives alternating as most in vogue every 20 years or so. "Now we're back in the cycle where sedating drugs are quite popular, for lack of a better word," says Offutt, founder of the teen health website Real Talk With Dr. Offutt.
Opioid drugs suppress the central nervous system, Offutt explains, and heroin slows movement and physical activity. "It makes you sleepy," she says. "It slows breathing. And you may notice that kids have pinpoint pupils because of the way it affects the nervous system in the eyes. The pupils can be very revealing."
Certain social signs can point to substance use in kids, Offutt says: "Has their friend group changed? Are they withdrawing more?"
Withdrawal is normal to a point, Offutt notes, as teens grow more independent. However, it's a concern if withdrawal becomes much more pervasive. "If they've lost interest in things that used to motivate them; if their grades are dropping without another explanation – those sorts of things," she says.
Heroin use can start with prescription painkiller abuse, experts warn. It might begin with legitimate medical use of an opioid painkiller for a severe sports injury, for instance. If a young athlete had surgery to repair a torn anterior cruciate ligament, Offutt says, it wouldn't be inappropriate for a doctor to prescribe an opioid to ease postoperative pain.
"But it's the type of injury where they're taken out of their sport for a long time, and so much of their identity is tied up with being an athlete – that might be a source of significant stress and despair for them," Offutt says. That could lead to what's officially known as "nonmedical use of prescription pain meds," she says, with kids using more than they originally intended.
Emotional problems contribute to risk. "Like anyone else, how do you manage stress in your life, and are your mental health needs being addressed?" Offutt says. If teens don't have healthy ways to deal with stress, she says, and their mental health issues are overlooked, they may be more vulnerable to substance abuse of any type.
Patterson says prescription opioids may be overprescribed for kids. "So they're on them a little too long and develop an addiction," the DEA agent says. "And once the prescription runs out, they've got to replace that, because they start suffering withdrawal. So the cheapest way to do that, as opposed to getting more pills on the black market – they switch over to heroin, which is a lot cheaper than the pills."
Heroin can be sniffed, smoked or injected. An overdose can happen any time, but people may be particularly vulnerable at certain stages in life. Young kids just starting out on heroin, with no experience or sense of its dangers, are at heightened risk for accidental overdose, Patterson says.
Ironically, overdose risk also increases when people are trying to quit. "Recovery is one of those two-steps-forward, one-step-back sorts of paths," Offutt says. "If someone stops using, and they have a trigger that sets them off again, and they start using, often they'll go back to their old dose or old amount." Because the body has lost the tolerance it once built, she says, jumping back in with an escalated dose could prove fatal.
If you know or suspect a family member is hooked on heroin, or you're concerned that a recovering user has the potential to relapse, you can take an emergency precaution.
Naloxone, also known as Narcan, is a drug that reverses heroin overdoses. Long used by first responders and emergency room providers, naloxone is now in some schools, which are stocking it as part of their overdose-prevention programs. Naloxone comes in injectable and nasal-spray forms and is becoming increasingly available to the general public.
"A family member can contact their local pharmacy to identify if the pharmacy participates in any program that allows them to get a Narcan medication kit without a prescription," according to an email from Mohamed Jalloh, an American Pharmacists Association spokesman. Currently, he says, Rhode Island, Maine, New Mexico, California and Washington state have specific legislaton allowing such access. However, he adds, pharmacies in other states may also allow people to pick up Narcan without a presciption, even though that's not directly addressed in a state law.
By entering your city and state or ZIP code in this overdose prevention program locator, you can find and contact the programs near you.
"If you or someone in your family is struggling with dependence or substance abuse with opioids, you should keep Narcan in your house." Offutt says. "You should put it in your first-aid kit. Because it is something that will save your life long enough to get to medical care."
If you think your child is using heroin, approach him or her about it, Offutt says. "You really emphasize that there is no shame," she says. With an estimated one in four families touched by addiction, she says, you're not alone. "I also like thinking about it as talking about chemistry and neurology and biology – that's what addiction is," she says. "It is not a moral failing."
Don't delay or wait for your child to recover on his or her own, Offutt says. "I've heard repeatedly of parents who know their kid is struggling with addiction, who say, 'I know if I can get them to college, they'll be fine when they get there,'" she says. "And I can understand from the standpoint that you want them in a new environment where their triggers are gone and they have a new friend group."
However, she says, the fact is that whatever made them become dependent on a substance will persist. "Often, you start peeling back the layers of the onion, and a parent will remember that their parent had an issue with alcohol," she says. "You see there's a genetic component in the family."
With college decisions looming, Offutt tells high school students to get their mental health in order before going anywhere. "If you have a pathologic relationship with substances, you have to address that now," she says. "Because if you go to college, you're going to have stress. You're going to be away from your support system. And you'll be really alone with this problem."
Many college campuses offer substance-free housing, Offutt points out. This option can benefit students working to maintain their recovery or those who simply want to live in a drug- and alcohol-free environment