Heroin use in our society today has reached considerable numbers.  In 2015, the U.S. Centers for Disease Control and Prevention (CDC) released figures indicating a 63 percent increase in heroin use within a decade and a near quadrupling of heroin-related overdose deaths.

Heroin is a powerful depressant drug with serious and often fatal effects.  When heroin enters the body, it reconverts into morphine, binding to opioid receptors on brain cells.

Data collected in the 2015 Monitoring the Future Survey indicates annual prevalence of opioid use by adolescents in grades 8, 10, and 12 ranges between 2.3 and 2.5 percent. These numbers aren’t staggering at first glance. However, when applied to the 50,385,000 students currently enrolled in public school grades K-12, the rate suggests roughly 280,055 young people used opioids in this country last year in grades 8, 10 and 12 alone. An incredible number to consider for sure. 

The surge in opioid and heroin drug-poisoning and overdose deaths since 1999 has made addressing the heroin crisis and preventing a new generation of users a top priority for our nation’s leaders, organizations, and schools.  The recent high levels of overdose deaths, many involving high profile people, has prompted a 2015 White House recovery and prevention plan to more aggressively address the problem.

No longer confined to inner-city streets, the effects of today’s heroin epidemic are evident across the U.S. in schools, families, and communities from suburban and urban to rural areas.  The problem is also not confined to adults.  It’s an epidemic that claims no demographic and knows no boundary; however, young people are especially vulnerable.  Ninety percent of heroin abuse starts in the teen years, and of that percentage, 80 percent of teens who try heroin become addicted.

Heroin is a powerful depressant drug with serious and often fatal effects.  When heroin enters the body, it reconverts into morphine, binding to opioid receptors on brain cells.  Short term effects include nausea, vomiting, clouded thinking, and drowsiness.  Heroin use affects the areas of the brain and central nervous system responsible for control of automatic life, including blood pressure and respiration.  These areas of the brain become fatigued and shut down with excessive use and overdose, often resulting in death.

So why the surge in teenage heroin use? There is a causal link between prescription opioid misuse and heroin use.  A recent article from the New England Journal of Medicine addresses the relationship between nonprescription opioid use and heroin use. Nonmedical users who initiated heroin use did so within five years of beginning nonmedical use of prescription opioids. 

The path to heroin addiction and dependency most often start one of two ways.  According to the National Institute on Drug Abuse, prescription drugs are among the most commonly abused drug of teens 14 and older.  Teen addiction and dependency can start with a prescription for pain relievers to aid recovery from injury, dental procedure, or surgery.  Teen addiction can also start with adolescent peer influence and the social pressure to experiment with prescription opioids at parties with friends.

Tolerance to the euphoric effects of opioid use develops quickly with repeated use requiring a higher dosage to achieve the same effect.  In addition, because opioids activate the receptors in the brain responsible for reward and pleasure, the body quickly adapts and begins to crave the experience. Users eager to maintain their high or searching for a more potent high often turn to heroin.

Recent efforts to limit prescriptions and the refills of prescriptions of pain medicines and other regulations designed to restrict access to these drugs have effectively limited legal access to prescription opioids.  The limited access has pushed addicted users to the black market to source the drugs.  However, the limited supply has also significantly increased the street cost of these drugs.  Users find heroin is more easily accessible on the black market and much cheaper than synthetic opioids.

How can we prevent a new generation of drug users?  The answer is not as simple as instructing young people to just say “No.”  Without guidance and education, responsible medicine taking can quickly become misuse. 

Teens who seem unlikely to begin using heroin surprise us if we don’t trace the path of origin back to misuse of prescription medicine.  We are left mystified by the heroin overdose death of the star football player on track to a full scholarship to college.  And yet the answer lies in the progression from misusing “harmless” medications to using hard drugs.  There is a passive implication that prescriptions are safe because they are prescribed by a doctor.  Indeed, children and adolescents are bombarded with advertisements reinforcing the notion of a pill for every ill.  Children and adolescents are regularly prescribed drugs to address behavior and depression.  It is no wonder that teens would assume anything prescribed is safe. 

Of course, it is the true power of these drugs and their addictive nature that warrant their prescription in the first place.  Without a true understanding of the safe and appropriate use of any drug, whether it be an over the counter cough syrup to a prescribed anti-depressant, children and teens are left ill-equipped to make the right decision when faced with a risky choice.  It is clear that young people need to be advised of the negative consequences of prescription drug abuse, as well as be prepared with reliable peer-refusal strategies. 

Positive youth development is the foundation for equipping children and teens to make responsible decisions.  By the time adolescents enter middle and high school, the availability of drugs is prevalent, and so it is best for children to begin social skills-based prevention education from a young age.

The development of social and emotional skills should begin early to build habits and attitudes consistent with productive and healthy norms and attitudes. Without a proper foundation of social skills including self-awareness and social awareness skills, teens are ill-equipped to manage the stresses of their social and academic lives.  Without the capacity to identify and manage emotions and stress, teens can turn to unhealthy coping mechanisms like escape through substance use or other risky behavior.

An undiagnosed depression presents a risk factor that, unmet, could potentially lead to substance abuse.  Without the protective factors of self-management skills, teens could turn to self-medication through alcohol and tobacco and, today, prescription anti-anxiety drugs and pain relievers.

Learning how to set and reach achievable goals helps young people set obtainable objectives through courage, self-discipline, and responsibility while building self-efficacy and a stronger sense of hope for the future.  By staking a claim in their own future, the choices young people make suddenly have more relevance, because they are invested in the outcome.  Today, many educators are perplexed by students who aren’t fazed by the prospect of punishment, suspension, or expulsion.  Students with no hope for anything better in their own lives see no cost in these punishments.  Lack of positive role models in their lives reinforces an idea that life has little to offer.

Young people who feel safe, secure, and confident, and who are encouraged to engage in home, school, and community activities, have fewer behavioral problems and are able to grow into responsible adults. Providing the opportunity to try and fail and try again with the encouragement to keep trying builds a resiliency that will help teens manage the more challenging obstacles that life will offer later. 

Children and teens equipped with responsible decision-making, emotion management, and effective communication skills are more likely to make confident, healthy decisions to avoid engaging in risky behaviors and facing their negative consequences. Adolescents who recognize how their emotions influence their decisions are better prepared to make thoughtful, rational choices consistent with their goals. 

Effective communication and problem solving skills ready young people for handling conflict peacefully, sharing feelings, and sharing ideas with others, enhancing cooperation and relationship building. These skills in turn help them create and maintain healthy relationships that foster belonging and connectedness.  Peer-selection skills, including the ability to make and maintain positive friendships, are critical protective factors against risky behaviors.  Adolescents surrounded with positive peer influences make more responsible decisions and are more likely to reach the goals they set for themselves. These adolescents feel more connected and less alone.

With these healthy development skills in place, young people have the secure foundation to confidently make less-risky choices.  However, it is also essential for youth to understand the damaging effects of substance abuse on the developing healthy brain and body and the social and academic negative consequences of abusing substances.

During the transition from childhood to adulthood, desires to experiment, take risks, and try new behaviors become risk factors for misuse and abuse of prescription and OTC drugs.  Adolescents often underestimate the power of prescription drugs and the effects of their misuse.  Establishing a clear perception of harm of prescription drug abuse, and how easy it is to misuse, builds protection within young people to mitigate the risk of abuse. Additionally, educating young people on healthy risk-taking, such as exploring an extreme sport or trying out for the lead role of the school play, offers positive alternatives to negative risk-taking.

The epidemic of prescription medicine misuse and heroin use has taken us by surprise because we simply weren’t expecting it.  What once was a problem with a limited demographic has spread into new demographics including teenage use.  And what has become apparent in recent years is that someone isn’t at high risk for substance use until they are actually using.

The spark of greatness inside every child needs nurturing.  A proactive prevention education approach to develop social and emotional skills, under the guidance of caring adults, can build the protective factors to mitigate engaging in risky behaviors. These skills, in addition to effective refusal skills and an awareness of the harm of abusing substances, give youth the confidence and strength to resist negative influences.  These skills can and should be taught from an early age so children can secure for themselves a healthy and successful future.

Charles Mendez III is Vice President of the Mendez Foundation. For information, visit https://www.toogoodprograms.org/too-good-for-drugs.html

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