America's 'euphoria' problem: Teens getting high on painkillers likely to start using heroin by the time they leave high school
Teenagers who enjoy the ‘high’ from prescription opioids - and painkillers in particular - will most likely start using other drugs, such as heroin, which can give them a similar feeling of ‘euphoria’ by the time they graduate from high school. The reason - according to the research team from the University of Southern California (USC) and other institutions - is that prescription opioids and heroin activate the brain’s pleasure circuit in similar ways.
“Prescription opioids can produce powerful euphoric effects, particularly when used non-medically and at higher doses. It is possible that youths who enjoy the euphoric effects from non-medical prescription opioid use may become inclined to try heroin because of a desire to experience similar (opioidergic) intoxicating effects at a higher potency,” says the team in the study. The project, which spanned from 2013 to 2017, is reportedly the first study to track prescription opioid and heroin use in a group of teens over time.
“Adolescents are sometimes overlooked in the opioid epidemic discussion. The association between non-medical opioid use and later heroin use in youth is concerning and warrants further research and health policy interventions," says first author Lorraine Kelley-Quon, a pediatric surgeon and assistant professor of surgery and preventive medicine at Children's Hospital Los Angeles and the Keck School of Medicine of USC.
The National Institute on Drug Abuse in the US defines opioids as a class of drugs, which include painkillers (available legally by prescription) such as morphine, oxycodone (OxyContin), hydrocodone (Vicodin), and codeine, among others; synthetic opioids such as fentanyl; and illegal drugs such as heroin. The National Institutes of Health (NIH) calls the misuse of and addiction to opioids a 'national crisis' that severely impacts health and economic welfare.
On average, 130 people die in the US every day from an opioid overdose, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates the total 'economic burden' of prescription opioid misuse alone in the US to be $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. From 1999 to 2017, over 700,000 people died from a drug overdose. The number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) in 2017 was six times higher than in 1999, according to CDC. About 68% of the over 70,200 drug overdose deaths in 2017 involved an opioid. In addition to overdose, health risks of heroin use are highly destructive and include severe addiction, hepatitis C, HIV, and other infections.
The team conducted eight semi-annual surveys to track the use of various drugs by high-school students, from 9th through 12th grade and between October 2013 to July 2017. The team followed 3,298 first-year students from 10 Los Angeles-area high schools through their senior year. The students who participated in the study were asked about their previous and current use of prescription painkillers - such as Vicodin, Oxycontin, and Percocet - to get high. The students were also asked if they used heroin or other substances such as alcohol, marijuana, cigarettes, methamphetamine, and inhalants. When the study was initiated, these high school students were not heroin users, say the researchers.
The analysis shows that 596 students said they were using prescription opioids to get high during the first 3.5 years of their high school. According to the research team, prescription painkiller use made a massive difference in who used heroin later. They found that 13.1% of current prescription opioid users and 10.7% of previous prescription opioid users went on to use heroin by the end of their high school. Only 1.7% of youth, who had never used prescription opioids to get high, had started using heroin by the end of high school, says the study.
“Non-medical prescription opioid use was prospectively associated with subsequent heroin use initiation in adolescents. This is an unforeseen side-effect of the nation’s opioid epidemic: adolescent heroin users,” says the paper. It adds, “The results do not appear to be driven by the tendency of some teens to act out, rebel, or experiment with many types of drugs.”
The findings are extremely concerning, say researchers since many adolescents access prescription opioids from friends or relatives for non-medical reasons.
“Further research is needed to understand whether this association is causal. If evidence of a direct risk pathway from non-medical opioid use to heroin use initiation in adolescence were to be identified in future research, measures to prevent youths from accessing prescription opioids merit consideration as a public health priority,” recommends the team in its findings.
The findings were published in JAMA Pediatrics.