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How the Opioid Epidemic is Affecting Youth in the United States

The problem of opioid addiction is growing in the United States. Opioid drugs have always been a problem, but only in recent years has this problem grown to such an unprecedented level. The Center for Disease Control and Prevention has actually labeled the opioid problem as an epidemic.

The issue isn’t only affecting adults. The amount of youth abusing opioid drugs has skyrocketed in recent years, and the overdose statistics are increasing alongside. It’s important to make sure that youth are properly educated about drugs, because the best way to prevent drug addiction is to stop it before it even takes place.

Unfortunately, it’s not always that easy. The problem is compounded when you realize that youth are much less likely to receive treatment for their addiction than adults. Today we’re going to address the problem of opioid addiction in the United States, and how it affects the nation’s youth.

The problem of youth addiction is expanding

In the last two decades, the United States has seen a shocking increase in the number of youth abusing opioid drugs. Between 2001 and 2014, The number of young people abusing opioids has increased six-fold. This rapid increase suggests that youth are not able to access the information that they need to stay safe and sober.

To make the problem even worse, new research suggests that only one out of every four teens with addictions receives medication for their treatment, even though they have good insurance plans. In some areas, doctors are simply not able to keep up with the demands of addicted youth. This has compounded with a growing trend of over-prescribing painkillers to young patients, and this has led the United States into the worst addiction crisis in its history.

One of the main reasons that addiction is so widespread these days is because people are not educated about it. Many people who become addicted to opioids have no idea how the drugs work in their body or their brains. This is particularly tragic in the case of youth becoming addicted, because their brains are still developing and are thus more susceptible to damage in the form of sickness or mental illness.

How do opioids work in the body?

Opioids are a very powerful family of drugs. They work by stimulating the opioid receptors which are located all over the brain and the body. The opioid system is responsible for a number of things like regulating pain, nausea, anxiety, comfort.

Opioids are typically used in clinical settings because one of their primary effects is analgesia. Opioids are great for short-term usage, such as for surgery or temporary painful conditions. Unfortunately, long-term usage of opioids can lead to serious addiction and dependency.

Opioids cause addiction because of the way that they flood your opioid system. Your body produces its own opioids, which are known as endorphins (endogenous morphine). When you take opioids from an external source, your body is unable to differentiate between the external opioids and your natural endorphins. In response to the influx of opioids, the receptors in your opioid system undergo a process known as downregulation.

    • Downregulation is your body’s response to an influx of neurotransmitters. If your neurotransmitter receptors – in this case, your opioid receptors – are being bombarded by a higher concentration of neurotransmitters than usual, then they will essentially desensitized themselves to compensate for the excessive stimulation.
      • Downregulation is the biological process that’s responsible for drug tolerance. When you need more and more of a drug to experience the same effects, this is because your receptors have downregulated to the point that they cannot respond in the same way to the same amount of stimulation. The only way to get around this is to continue ingesting larger and larger amounts of the drug.
    • Downregulation is also partially responsible for physical dependency and addiction. If you were to stop using opioid drugs after your receptors had downregulated, your body would not able to respond to the amount of neurotransmitters that you produce on your own. Since your opiate system is responsible for feeling pleasure, comfort, and for regulating mood, you’ll be very uncomfortable if your system is downregulated. This is what causes some of the opioid withdrawal symptoms. Without your body’s natural endorphins you will feel uncomfortable, depressed, and anxious.
    • Another the reason that opioids are known for having such severe withdrawal symptoms is because of the way they affect the adrenaline system. The adrenaline system is responsible for modulating energy, anxiety and fear, awareness, and the ‘fight-or-flight’ response to stimuli (which is also a form of anxiety.)
      • The opioids suppress the adrenaline system, which is why they’re known for causing extreme relaxation and sedation. When you stop using opioids, the system goes into rebound. This is what causes such unpleasant effects as the ‘crawling skin’ sensation, extreme anxiety, paranoia, and sweating.
    • One of the reasons that opioid addiction is so difficult to recover from is because it has an impact on the glutamate system. The glutamate system is responsible for the formation of memories as well as developing new neural connections.
      • When you are going through withdrawal, your glutamate system is working in overtime. Since this system is already a huge part of your ability to form memories, an overactive glutamate system greatly solidifies the behavioural response of an addict during withdrawal or when a craving strikes. These responses become learned behaviours that are much more difficult to unlearn than by simply quitting the drug

How does opioid addiction affect youth differently?

Using opioids – prescribed legally or otherwise – can be very dangerous for youth. Younger people are still developing their brains and their bodies. It’s important to avoid any intoxicating or mind-altering substances for a growing person’s neurotransmitter systems to develop properly. Exposing them to drugs at an early age can cause long-term downregulation and other unpleasant problems as a result of stunted development.

Of particular interest regarding opioid addiction in youth is the prefrontal cortex:

    • The brain’s prefrontal cortex is heavily involved in a person’s decision making, as well as other ‘higher order’ functions that can include making long-term goals, self-reflection, and laying out plans to move forward in life.
    • However, the prefrontal cortex is typically not fully developed until a person reaches 25 years of age. At that point, a healthy person is usually capable of controlling their impulses and avoiding rash decisions.
    • If a developing person engages in habitual drug use, it can be catastrophic for the development of the prefrontal cortex. Instead of developing an ability to override impulses, younger drug addicts often grow into adulthood with drug-seeking behaviours becoming second nature.
        • Since these behaviours become second nature, they are much more difficult to get rid of and often require extensive therapy and counseling.

It’s not just the brain that’s hypersensitive to the use of drugs at an early age. If a younger person uses drugs, they are putting themselves at a much greater risk of physical damage as a result. An older person who shoots heroin, for example, puts themselves at risk of collapsing their veins. A young person who does this is likely to prevent their veins from developing properly in the first place, which will make them much more susceptible to damage down the road.

Opioid drugs are particularly appealing to young people who are attending school and struggling with social anxiety or a difficult home life. They allow a person to develop a false sense of security by blanketing their anxieties and emotions. Since opioids affect a natural system in our bodies, the resulting effect feels ‘right.’ This can make it hard for some to realize that they have a problem.

Opioids are also particularly appealing for young people because they don’t cause an immediate hangover like other drugs, such as ecstasy or alcohol, do. The first few times somebody uses heroin, they might not feel any after-effects at all aside from being a bit sleepy. While opioids will eventually subject users to some extremely difficult withdrawals, they certainly don’t give that impression at first. Many youth are dragged into the world of opioid addiction because the symptoms of withdrawal and dependency creep up so slowly.

The emergence of new opioids in the youth drug scene

One of the reasons that the opioid epidemic is affecting so many people is because of the emergence of new, extremely potent opioids on the streets.

An opioid’s potency is typically evaluated by how strong it binds to the mu opioid receptor. One of the strongest opioids used in clinical practice is fentanyl, which is dozens of times stronger than morphine. Fentanyl is so strong that doses in the microgram range can kill an inexperienced user.

Many drug dealers have begun lacing their heroin with fentanyl. This is dangerous for several reasons.

    • Since fentanyl is so much stronger than heroin, if the drug dealer doesn’t explain to the youth how potent to their new product is, the chance of overdose is greatly increased.
    • If a user becomes accustomed to using fentanyl instead of their regular opioid, their tolerance will increase until they can no longer feel the effects of their usual opioid. If they are unable to get fentanyl, their typical opioids will do little to take them out of withdrawal. This will not only be an extreme financial burden, it will also help to solidify drug seeking behavior by forcing the user to put extra effort into finding fentanyl.

Studies in the United States have shown that while the frequency of experimenting with opioids has decreased, the chance of having an overdose has increased. This is likely because of the newfound popularity of fentanyl.

Difficulties in intervening and preventing youth drug addiction

It is recognized that the best way to prevent a drug addiction is to stop it before it becomes a problem. Unfortunately, in the case of opioids, it is not always easy for parents and teachers to recognize the symptoms of use.

It is quite easy for parents to notice when their child comes home drunk, or even if they’re using stimulants like crystal meth. Unfortunately, many of the symptoms of opioid use can be passed off easily. They include sleepiness, disorientation, constipation, and nausea. Many opioid-addicted youths are able to function in school without anybody suspecting that they are using drugs.

Another problem that faces America’s youth is the overprescribing of opioid painkillers. Many youths have noted that first encounter with opioid drugs was signed off for them by their doctor. Unfortunately, many doctors prescribe either too many opioids – which can lead to addiction and dependency – or are uneducated about the proper procedures for weaning their patients off of opioids. Both of these situations put youth at serious risk of opioid addiction.

      • If a doctor prescribes more pain medication than is necessary, a youth becomes extremely vulnerable to drug abuse. If your child is prescribed medication, make sure that you lock it up and only provided them with the medicine as needed.
      • If a doctor doesn’t take time to slowly wean their patients off of opioid pain medication, the withdrawal can be intense and uncomfortable that many youths will seek out opioids on the street just to ease the pain.
          • Withdrawal symptoms can include fever, sweating, insomnia, anxiety, paranoia, anhedonia, crawling skin, extreme cravings, vomiting, diarrhea, just to name a few.

One of the solutions to this problem would be helping doctors realize the impact that over or under-prescribing drugs can be. Making sure that doctors limit the number of refills they provide as well as regulating the frequency of doses is important for preventing youth from developing an addiction.

There were 1.27 million visits to the emergency room or inpatient rehabs as a result of opioids alone in 2014, according to the Agency for Healthcare Research and Quality. This is a staggering 99% increase since 2005, and is indicative of the changes that need to be made among the public and the medical community.

You can try to help the problem on your own by talking to your kids about their opioid use. However, instead of directly approaching a youth and asking them if they have used drugs or abused their prescriptions, it might be wise to ask them what sort of behaviour they’re seeing in their schoolyard or around town.

Ask them if others are using drugs, and ask if they’re aware of the potential consequences of drug use. This can open up a better line of communication for talking to them about their own drug use.

Treating opioid addiction among youth

Brendan Saloner, an addiction researcher who works at John Hopkins Bloomberg School of Public Health, says that ”young people may be dying because they are not getting the treatment they need.” He wrote an editorial that was published with a study in JAMA pediatrics that evaluated opioid abuse among young people.

The study looked at almost 21,000 patients. All these patients were between 13 and 15, and were current members of UnitedHealthcare insurance. All met the criteria for being addicted to opioids, and yet only 27% of them were given opioid maintenance drugs between the years of 2001 and 2014.

The use of other opioid receptor agonists in the treatment of opioid addiction that has been controversial, but it has consistently proven to make it easier for an addict to return to a stable, functional life. Opioid maintenance therapy eliminates the need for youth to have to lie, cheat, or steal to fund their addiction.

There are two main opioid maintenance drugs that are commonly used.

      • Methadone was the primary drug used to treat opioid addiction for many years. Methadone is a long-lasting, potent opioid receptor agonist. People who take part in a methadone maintenance therapy program must often make an appearance every morning at their methadone clinic. They will be given a single dose for the day, which they must drink on-site to prevent the resale or abuse of the drug
      • Buprenorphine is becoming more and more popular as an alternative to methadone. It is much safer for youth, because it does not affect the body in the same damaging ways as methadone.Buprenorphine is also a partial agonist of the opioid receptors, which makes it particularly useful in treating opioid addiction.
          • Most opioids, like morphine and fentanyl, are full agonists. This means that they will fully activate the opioid receptor site that they bind to.
          • Since buprenorphine is only a partial agonist, but it has an extremely high binding affinity (which means it is more likely to bind to the receptors than other opioids with lower affinities) it is able to fully occupy a receptor size while only partially activating it. This means that the user will only feel partial effects, and they will be less likely to become addicted to and crave the buprenorphine when compared to a full agonist.

Many parents are encouraging other parents to help their addicted youth get onto an opioid maintenance program. Young opioid users often attend a treatment program, complete it successfully, but are not given medication and relapse shortly after. While it’s not necessary for every patient attending a rehabilitation program to leave with a prescription for methadone or buprenorphine, these drugs can be immensely helpful for people who are resistant to other treatment methods .

Finding treatment for youth struggling with opioid addiction

There are several different kinds of treatment available for youth struggling with opioid addiction. The two most common forms of treatment are inpatient and outpatient rehab.

      • Outpatient rehab is recommended for people who have not developed a very severe addiction. Outpatient rehab is not nearly as intensive as inpatient rehab, and for this reason, it’s often recommended for youth so they can knock out the problem before it becomes too serious.
          • Outpatient rehab can be more difficult to complete if the youth is falling too deep into addiction. Since you are not required to stay at the rehab facility, a patient can come and go as they please. If they have to pass through areas that they have used drugs in on the way to rehab, this can trigger them into having a relapse.
      • Inpatient rehab is a much more intensive form of treatment and is recommended for people who have already tried and failed other methods of treatment.
          • Patients attending an inpatient rehab must be at the facility at all times until their treatment is complete. This prevents them from encountering any external triggers and also prevents them from being able to contact drug dealers.
          • Many inpatient rehabs provide their patients with a medically supervised detox. This period can be essential in helping youth get through their withdrawal symptoms, which are often too intense and unpleasant to go through alone. They will likely be given medication to help them cope with the symptoms.
          • Since somebody attending an inpatient rehab will be at the facility 24 hours a day, they will also be able to access medical care 24 hours a day. This is great because it offers patients security in the case of an emergency.

It is also possible for youth to get onto an opioid maintenance plan without needing to attend a traditional rehab facility. Any doctor in the US can apply for a waiver that allows them to provide buprenorphine to patients for the purpose of opioid maintenance therapy. It could be worth your time seeking out a doctor who is licensed to provide this type of treatment.

However, it’s important to remember that not every doctor is educated in the same way. Clinics that offer opioid maintenance therapy but don’t specialize in treating addictions can actually make the problem worse. If a young person seeks help from an uneducated doctor who prescribes them more medication than they need or doesn’t provide a proper long-term solution for the addiction, the youth can end up dealing with a lifelong problem.

In conclusion

The problem of opioid addiction among youth is at the highest level it’s ever been in the United States. A lot of the reason the problem has been able to expand this much is due to a lack of proper education among the public and among medical professionals.

It’s important to make sure that any youth in your care have a good understanding of what opioids are and how they affect the brain and body. It’s also important to make sure that your family physician is well-educated and reliable, and won’t put you or your children in danger of developing an addiction.