Drug Abuse
Signs, Symptoms, and Effects
The path to drug addiction begins with the act of taking drugs. Over time, a person's ability to choose not to take drugs is compromised. This in large part is a result of the effects of prolonged drug use on brain functioning, and thus on behavior. Addiction, therefore, is characterized by compulsive, drug craving, seeking, and use that persists even in the face of negative consequences.
In This Article:
For information on treatment and self-help for a drug problem, see Help guide's Getting Help for Drug Abuse and Addiction.
What is drug abuse and substance abuse?
Drug abuse, also known as substance abuse, involves the repeated and excessive use of a drug to produce pleasure or escape reality—despite its destructive effects. The substances abused can be illegal drugs such as marijuana and cocaine, or legal substances used improperly, such as prescription drugs and inhalants like nail polish or gasoline. But whatever the drug of choice, substance abuse can be identified by the maladaptive way in which it takes over the user's life, disrupting his or her relationships, daily functioning, and peace of mind.
For those in the grips of drug abuse and addiction, their drug controls them, not the other way around. As the director of The National Institute on Drug Abuse states, “uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences” is the essence of drug addiction. Drug addiction can be physical, psychological, or both. The Substance Abuse and Mental Health Services Administration refers to psychological dependence as “the subjective feeling that the user needs the drug to maintain a feeling of well-being." Using a drug to numb unpleasant feelings, to relax, or to satisfy cravings are examples of psychological addiction. On the other hand, physical dependence refers to the physiological effects of drug use. Physical addiction is characterized by tolerance—the need for increasingly larger doses in order to achieve the initial effect—and withdrawal symptoms when the user stops.
What are the signs and symptoms of drug addiction and abuse?
The more drug use begins to affect and control a person's life, the more likely it is that he or she has a drug problem. Unfortunately, substance abusers are often the last ones to recognize their own symptoms of dependence and addiction. If you suspect that a friend or loved one is abusing drugs, it's important to remember that drug abusers often try to conceal their symptoms and downplay their problem. But there are a number of warning signs you can look for:
Substance Abuse Signs & Symptoms
Tolerance
Needing to use more of the drug to achieve the same effects.
Withdrawal
Experiencing withdrawal symptoms (e.g. nausea, restlessness, insomnia, concentration problems, sweating, tremors, anxiety) after reducing or stopping chronic drug use. Taking a drug in order to avoid withdrawal symptoms.
Doing more drugs than intended
Taking a larger amount of a drug than planned. Using a drug more frequently or for a longer period of time than intended.
Unable to stop using
Desire or unsuccessful attempts to cut down or stop drug use.
Preoccupation with drug
Spending a lot of time getting, using, and recovering from the effects of a drug.
Giving up/reducing other activities
Abandoning or spending less time on previously-enjoyed activities, such as hobbies, sports, and socializing, in order to use drugs.
Failure to fulfill obligations
Neglecting school, work, or family responsibilities (e.g. flunking classes, skipping work, neglecting your children) because of drug use.
Risky drug use
Using a drug under dangerous conditions, such as while driving or operating machinery. Taking risks while high, such as starting a fight or engaging in unprotected sex.
Drug-related physical or psychological problems
Continuing to use despite physical problems (e.g. blackouts, flashbacks, infections, injuries) or psychological problems (e.g. mood swings, depression, anxiety, delusions, paranoia) the drug has caused.
Drug-related legal problems
Legal troubles because of drug use, such as arrests for disorderly conduct, driving under the influence, or stealing to support drug habit.
Drug-related social or interpersonal problems
Losing old friends and loved ones due to drug use. Arguing or fighting with others.
If you are abusing drugs, you may be in denial about the magnitude of the problem or the negative impact it's had on your life. However, if you feel you should cut back or feel guilty about your drug use, you may have a substance abuse problem. Other warning signs include criticism from friends and family regarding your drug use and the need to use drugs in order to get through the day. For more help identifying a drug problem in yourself, answer the questions in this online Drug Abuse Screening Test.
What are the signs and symptoms of drug use and abuse in teens?
There are several telltale signs of possible drug use or abuse in teenagers. The challenge for parents is to distinguish between the normal, sometimes volatile ups and downs of adolescent development and the red flags of substance abuse.
According to the National Drug Intelligence Center, sudden or extreme changes in personality, appearance, school performance, or extracurricular activities may indicate teen drug use. For example, a previously well-behaved, respectful teenager may become emotionally volatile, hostile, or violent. A teenager who is abusing drugs may also withdraw from family and friends, drop previously-enjoyed activities, and neglect schoolwork. Secretive behavior and lying to cover up drug use is also common. In addition, teen drug users may steal, ask for money, or sell valuable possessions in order to support their habit.
Warning Signs of Teen Drug Use
For more information, see Is My Child A Substance Abuser?
Why do people use and abuse drugs?
There are many reasons why people use drugs. Some people use drugs because they like the rush it gives them or because they are thrill-seekers. Others may try a drug out of curiosity or because their friends do it. However, many people use drugs in order to cope with unpleasant emotions and the difficulties of life. In fact, the National Alliance on Mental Illness estimates that around 50% of drug abusers also suffer from a mental illness such as depression, anxiety, bipolar disorder, or schizophrenia.
People who are suffering emotionally use drugs—not in order to get high—but to feel normal. Drug use can be a seemingly attractive and easy escape from all kinds of problems. Speed might be used to fight feelings of inferiority, sleeping pills to deal with panic attacks, or painkillers to numb depression. However while drug use might make a person feel better in the short-term, this attempt to self-medicate ultimately backfires. Instead of treating the underlying problem, drug use simply masks the symptoms. Take the drug away and the problem is still there, whether it be low self-esteem, stress, or an unhappy family life. Furthermore, prolonged drug use eventually brings its own host of problems, including major disruptions to normal, daily functioning. Unfortunately, the psychological, physical, and social consequences of drug abuse and dependence are often worse than the original problem the user was trying to cope with or avoid.
See Helpguide's Dual-Diagnosis for more on co-occuring psychological disorders and substance abuse problems.
What drugs are most commonly abused and what are their effects?
Almost all drugs have the potential for addiction and abuse, from caffeine to prescription medication. However, the majority of non-alcohol-related drug problems are due to use of the substances listed below. These drugs affect users' brains and bodies in different ways, producing symptoms of intoxication and abuse that are unique to each substance.
Marijuana and Cannabis Abuse
Believed to be the most commonly used illegal drug, marijuana enhances the senses and brings on feelings of relaxation and well-being. Marijuana is also used medicinally to relieve pain, reduce nausea and vomiting, and stimulate appetite. However, there are drawbacks to extended use, including learning and memory impairment, lung and respiratory problems caused by the smoke, and infertility. According to The National Youth Anti-Drug Media Campaign, marijuana abuse has also been linked to low achievement, delinquent behavior, and poor family relationships.
SIGNS & EFFECTS OF MARIJUANA
Types and Street Names
Depressants, commonly known as downers, are substances that slow down the central nervous system. Sleeping pills and prescription medications for anxiety such as Xanax and Valium fall into this drug category, as do Rohypnol and GHB, known as “date rape” drugs due to their frequent use in sexual assaults. Downers are often abused by individuals suffering from anxiety and low self-esteem. But while they induce relaxation, they also impair the user's ability to think clearly and react quickly. People abusing depressants may appear to be drunk—exhibiting signs such as losing their balance and slurring their words. Additionally, they may suffer from amnesia and delusions. Downers are highly addictive, and withdrawal is severe, with symptoms including nausea, vomiting, and cramps. Downers are lethal in high doses, particularly when mixed with alcohol.
SIGNS & EFFECTS OF DOWNERS
Types and Street Names
Stimulants, or uppers, are drugs which speed up the central nervous system. Commonly-abused uppers include cocaine, methamphetamine, crack, and prescription drugs such as Ritalin and Adderall. While stimulants will initially boost energy and confidence, their use over time leads to symptoms such as anxiety, aggression, sleep difficulties, hallucinations, and paranoid thinking. As uppers wear off, users experience a “crash,” characterized by depression, fatigue, and irritability. Overdose can result in heart failure, stroke, and death.
SIGNS & EFFECTS OF UPPERS
Types and Street Names
Hallucinogens and dissociative drugs, also known as psychedelics, are mind-altering drugs that affect the user's sensory perceptions and thought processes. Hallucinogens such as LSD and peyote can promote insight, contemplation, and euphoria—with some users reporting spiritual or out-of-body experiences. But on the flip side, these same drugs can result in “bad trips” characterized by panic and psychotic breaks with reality. Ecstasy, a popular club drug with both hallucinogenic and stimulant properties, boosts empathy and feelings of interpersonal closeness. Risks include a dangerous increase in body temperature, liver damage, and heart problems. The dissociative drugs PCP and ketamine block perception of pain and induce a trance-like state. Adverse effects can be severe and include violent reactions, complete disorientation, and terrifying delusions and hallucinations.
SIGNS & EFFECTS OF HALLUCINOGENS
Types and Street Names
Narcotics, or opioids, are powerful pain relievers that mimic the effects of endorphins, the body's natural “feel-good” chemical. Commonly-abused narcotics include heroin, morphine, codeine, and prescription painkillers such as Vicodin and Oxycontin. These drugs elevate mood and induce a tranquil, relaxed state. Side effects include nausea, vomiting, and sever itching. Tolerance and physical dependency will develop if opioids are used for any extended period of time. If a narcotics abuser quits “cold turkey,” he or she will experience withdrawal symptoms. While not dangerous, withdrawal from heroin and other narcotics is extremely unpleasant, with symptoms including muscle and joint pain, fever, nausea, sweats, chills, stomach cramps, and diarrhea. Overdose is another risk of narcotic abuse, especially if the user is shooting the drug. Another danger of intravenous opioid or heroin use is infection from dirty needles. Intravenous drug users are at a higher risk of contracting viruses such as HIV and hepatitis, and often suffer from abscesses, collapsed veins, and bacterial infections.
SIGNS & EFFECTS OF NARCOTICS
Types and Street/Brand Names
Inhalants are chemicals which cause intoxication when sniffed or inhaled. They include common, household solvents, aerosols, and gases such as paint thinner, dry-cleaning fluid, gasoline, glue, felt-tip marker fluid, deodorant and hair sprays, spray paint, air fresheners, butane lighters, and propane tanks. Other abused inhalants include medical anesthetics such as “laughing gas,” ether, and chloroform. While “huffing” gives users a brief high, this high often comes with side effects including nausea, vomiting, delusions, confusion, and loss of consciousness. Prolonged inhalant abuse can also cause damage to the brain and other organs of the body. But the biggest risk involved with inhalant use is death by overdose. Inhalant use can cause sudden heart failure, or “sudden sniffing death syndrome,” even in individuals who are young and healthy.
SIGNS & EFFECTS OF INHALANTS
Types and Street Names
Unlike other drugs of abuse, anabolic steroids don't have any intoxicating effects. They are used, not to get “high,” but to improve athletic performance and build muscle. But while steroids may help would-be athletes bulk up or obtain an edge on the field, they come with serious side effects and health risks. Steroid abuse causes blood pressure to skyrocket, increases bad cholesterol (LDL) while decreasing good cholesterol (HDL), triggers violent and aggressive behavior, results in severe acne, and brings growth to a halt in adolescents. Women taking steroids can develop facial hair, a deep voice, and male-pattern baldness. Men, on the other hand, can develop breasts, infertility, shrinking of the testicles, and baldness.
SIGNS & EFFECTS OF STEROIDS
Types and Street Names
References and resources for drug abuse and addiction:
Help guide's series on abuse & addictions:
Family Abuse
Child Abuse: Types, Signs, Symptoms, Causes and Help
Elder Abuse: Types, Signs, Symptoms, Causes and Help
Domestic Violence and Abuse: Types, Signs, Symptoms, Causes and Effects
Domestic Violence and Abuse: Help, Treatment, Intervention and Prevention
Drug & Alcohol Abuse
Alcohol Abuse and Alcoholism: Signs, Symptoms, Effects and Testing
Alcohol Abuse and Alcoholism: Self-Help, Prevention and Treatment
Drug Abuse and Addiction: Signs, Symptoms and Effects
Drug Abuse and Addiction: Rehab, self-help and Treatment Options
Other Addictions
Dual Diagnosis: Information and Treatment for Co-occurring Disorders
Self-Injury: Types, Causes and Treatment
Ways to Quit Smoking: Self-help, support, and tips for smoking cessation
Gambling Addiction: Signs, Symptoms and Treatment
Internet, Porn, and Cybersex Addictions: Symptoms, self-help, and tips for parents
Other related links
Treatment for Drug Abuse and Addiction – Describes types of drug treatment programs, including rehab and peer support groups.
Alcohol Abuse and Alcoholism – Guide to the signs, symptoms, adverse effects, and causes of problem drinking.
Treatment for Alcohol Abuse and Alcoholism – Guide to treatment options, prevention, and self-help for alcoholism.
Depression Signs and Symptoms – Overview of depression and its warning signs, symptoms, and risk factors.
Anxiety Attacks and Disorders – Covers types of anxiety disorders, including symptoms, causes, and treatment.
Coping with Suicidal Thoughts and Feelings – Find out how to get help if you're feeling suicidal.
Dual Diagnosis – Learn about the relationship between mental illness and substance abuse and how both problems can be treated.
Emotional and Psychological Trauma – Learn about the causes, symptoms, effects, and treatment of emotional trauma.
Ways to Quit Smoking – Learn about options for quitting, common withdrawal symptoms, and tips for coping with cravings.
Gambling Addiction – Covers the signs and symptoms of problem gambling and how to get help.
Internet and Cybersex Addiction – Guide to the signs and symptoms, its negative effects, who is at risk, and how to overcome the problem.
General resources for drug abuse and addiction
Major Forms of Drug Use – Research report on the incidence of drug use in America by drug type. (National Institute on Drug Abuse)
Drug Abuse – Provides comprehensive information on drug addiction, including sections on prevention, treatment, coping skills and the effects of different chemicals on the brain. (Mayo Clinic)
Why Do Sally And Johnny Use Drugs? - Covers the different reasons people abuse drugs and how to prevent the problem. (National Institute on Drug Abuse)
Commonly Used Drugs – A comprehensive list of about 50 commonly used drugs with their intoxicating effects and health consequences. (National Institute on Drug Abuse)
Substance abuse signs, symptoms, and causes
Drug Addiction: Signs and Symptoms – General and specific signs and symptoms of being addicted to seven classes of drugs. (Mayo Clinic)
Addictions and Life Page: Signs and Symptoms – Information on seven different drugs and the signs and symptoms associated with their use and abuse. (Cenla Chemical Dependency Council)
Crossing the Line to Addiction: How and When Does it Happen? – An article on the Bill Moyers series Moyers on Addiction: Close to Home. (PBS Online)
How Can We Tell if Someone is Abusing or Addicted to Drugs? – Diagnostic symptoms of drug abuse. (SAMHSA)
Teens and young adults
The Science Behind Drug Abuse – Educational site for teens provides facts on drugs, learning activities, real stories, and an ‘ask the doctor’ feature. (National Institute on Drug Abuse for Teens)
TeensHealth: Drugs and Alcohol – Straightforward talk on drug and alcohol abuse in a question and answer format, written for teens. (Nemours Foundation)
Drugs: Why Do You Use? – A brief checklist of warning signs for drug abuse, plus links to government sites and an animated video narrated by actress Sarah Jessica Parker. (facetheissue.com)
Delving Deeper in to Drug Abuse and Addiction
Drugs of Abuse – In-depth look at commonly abused drugs and their effects. Includes photos of the drugs. (U.S. Drug Enforcement Agency)
New Addiction on Campus: Raiding the Medicine Cabinet
By Elizabeth Bernstein : WSJ Article : March 25, 2008
Parents have long worried whether their kids at college are drinking too much or getting stoned. But alcohol and marijuana aren't the only substances they should be concerned about: In recent years, a growing number of young people have begun abusing prescription opiates.
The problem is part of a larger trend of abuse of prescription drugs among teenagers. Several years ago, attention-deficit drugs such as Ritalin and Adderall became popular among students, who used them to improve concentration or lose weight. Now there is evidence that young people are increasingly moving on to even more dangerous drugs -- powerful painkillers such as OxyContin, Vicodin and Percocet.
Earlier this month, several drug experts testified at a congressional hearing called Generation Rx about the rising abuse of prescription and over-the-counter drugs among America's youth. In 2006, 2.2 million people ages 12 and older said they started abusing pain relievers within the past year, with young adults ages 18-25 showing the greatest overall use of any age group, according to Nora D. Volkow, director of the National Institute on Drug Abuse.
To be sure, college students use these drugs much less often than alcohol and pot. Still, the development is alarming because these painkillers are highly addictive. From 2002 to 2006, the annual prevalence of use of narcotics other than heroin among college students rose to 8.8% from 7.4%, according to a University of Michigan study funded by the National Institute on Drug Abuse. For OxyContin, annual prevalence of use doubled, to 3%; the use of Vicodin rose to 7.6% from 6.9%.
The trend is being spurred by the availability of these drugs. Thanks to the huge increase in the number of prescriptions over the past decade, many kids can easily find drugs in mom or dad's medicine cabinet or obtain them from a friend. If all else fails, they can purchase them from an online pharmacy.
Some people don't perceive prescription drugs to be dangerous, precisely because they are government approved. And not only do young people underestimate how addictive opiates are, many don't even know what drug they are taking. For some, keg parties are being replaced by "pharm parties," where kids bring whatever pharmaceuticals they can find, mix the drugs up in a big bowl and eat them like candy, according to the Drug Enforcement Administration.
The results can be tragic. Leonard J. Paulozzi, an epidemiologist with the Centers for Disease Control and Prevention, told the congressional hearing that mortality rates from unintentional drug overdoses are currently four to five times as high as they were during the "black tar" heroin epidemic of the 1970s and more than twice what they were during the peak years of crack cocaine use of the early 1990s. From 1999 to 2005 -- the most recent information available -- the increase was driven largely by prescription opiates.
There is anecdotal evidence that students who start with prescription opiates may be graduating to heroin. "My friends convinced me that it would get me a lot higher," says Chris Arnold, a 25-year-old from Monroe, Conn., who says his switch from OxyContin to heroin ultimately caused him to drop out of college.
Although fewer than 1% of college students report using heroin, a number that's remained steady for years, some emergency-room doctors say they're seeing more heroin overdoses among college students.
Don't rely on your child's school to tell you about possible drug use. Federal law allows a college to inform parents if a student under 21 receives a drug or alcohol violation, but some schools choose not to. So what do you look for?
Experts say that signs of opiate abuse in students are similar to those of other drugs: a sudden drop in grades, loss of interest in studies or favorite activities, change of friends, lying, stealing, unexplained mood swings and financial problems. "Attend to what the bank account looks like -- a first sign is if it goes very quickly," says David Deitch, chief clinical officer at Phoenix House, which runs drug-rehabilitation programs in nine states.
As always, you should talk to your child about the dangers of drugs, including prescription ones. Stay in touch, visit your child if you are concerned and ask to meet their friends. In addition, you may want to keep medicines at home locked up. Parents and teens who want more information on drug abuse and prevention can find it on several Web sites: justthinktwice.com, drugfree.org, dare.org or parents4achange.com.
"I tell parents with kids who are away: Go with your gut," says Mary Marcuccio, founder of Parents 4 a Change, which works to raise awareness about the use of opiates and heroin among teenagers. "If there is something odd or out of line, investigate it."
John Dorsey, Jaelline Jaffe, Ph.D., Jon Slotnick, M.A., Melinda Smith, M.A., and Robert Segal, M.A., contributed to this article. Last modified on: 2/19/07.
The path to drug addiction begins with the act of taking drugs. Over time, a person's ability to choose not to take drugs is compromised. This in large part is a result of the effects of prolonged drug use on brain functioning, and thus on behavior. Addiction, therefore, is characterized by compulsive, drug craving, seeking, and use that persists even in the face of negative consequences.
In This Article:
- Drug abuse and substance abuse
- Signs and symptoms
- Signs of drug abuse in teens
- Why do people abuse drugs?
- Types of drugs and their effects
- References and resources
For information on treatment and self-help for a drug problem, see Help guide's Getting Help for Drug Abuse and Addiction.
What is drug abuse and substance abuse?
Drug abuse, also known as substance abuse, involves the repeated and excessive use of a drug to produce pleasure or escape reality—despite its destructive effects. The substances abused can be illegal drugs such as marijuana and cocaine, or legal substances used improperly, such as prescription drugs and inhalants like nail polish or gasoline. But whatever the drug of choice, substance abuse can be identified by the maladaptive way in which it takes over the user's life, disrupting his or her relationships, daily functioning, and peace of mind.
For those in the grips of drug abuse and addiction, their drug controls them, not the other way around. As the director of The National Institute on Drug Abuse states, “uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences” is the essence of drug addiction. Drug addiction can be physical, psychological, or both. The Substance Abuse and Mental Health Services Administration refers to psychological dependence as “the subjective feeling that the user needs the drug to maintain a feeling of well-being." Using a drug to numb unpleasant feelings, to relax, or to satisfy cravings are examples of psychological addiction. On the other hand, physical dependence refers to the physiological effects of drug use. Physical addiction is characterized by tolerance—the need for increasingly larger doses in order to achieve the initial effect—and withdrawal symptoms when the user stops.
What are the signs and symptoms of drug addiction and abuse?
The more drug use begins to affect and control a person's life, the more likely it is that he or she has a drug problem. Unfortunately, substance abusers are often the last ones to recognize their own symptoms of dependence and addiction. If you suspect that a friend or loved one is abusing drugs, it's important to remember that drug abusers often try to conceal their symptoms and downplay their problem. But there are a number of warning signs you can look for:
- Inability to relax or have fun without doing drugs.
- Sudden changes in work or school attendance and quality of work or grades.
- Frequently borrowing money, selling possessions, or stealing items from employer, home, or school.
- Angry outbursts, mood swings, irritability, manic behavior, or overall attitude change.
- Talking incoherently or making inappropriate remarks.
- Deterioration of physical appearance and grooming.
- Wearing sunglasses and/or long sleeve shirts frequently or at inappropriate times.
- No longer spending time with friends who don't use drugs and/or associating with known users.
- Engaging in secretive or suspicious behaviors, such as making frequent trips to the restroom, basement, or other isolated areas where drug use would be undisturbed.
- Talking about drugs all the time and pressuring others to use.
- Expressing feelings of exhaustion, depression, and hopelessness.
- Using drugs first thing in the morning.
Substance Abuse Signs & Symptoms
Tolerance
Needing to use more of the drug to achieve the same effects.
Withdrawal
Experiencing withdrawal symptoms (e.g. nausea, restlessness, insomnia, concentration problems, sweating, tremors, anxiety) after reducing or stopping chronic drug use. Taking a drug in order to avoid withdrawal symptoms.
Doing more drugs than intended
Taking a larger amount of a drug than planned. Using a drug more frequently or for a longer period of time than intended.
Unable to stop using
Desire or unsuccessful attempts to cut down or stop drug use.
Preoccupation with drug
Spending a lot of time getting, using, and recovering from the effects of a drug.
Giving up/reducing other activities
Abandoning or spending less time on previously-enjoyed activities, such as hobbies, sports, and socializing, in order to use drugs.
Failure to fulfill obligations
Neglecting school, work, or family responsibilities (e.g. flunking classes, skipping work, neglecting your children) because of drug use.
Risky drug use
Using a drug under dangerous conditions, such as while driving or operating machinery. Taking risks while high, such as starting a fight or engaging in unprotected sex.
Drug-related physical or psychological problems
Continuing to use despite physical problems (e.g. blackouts, flashbacks, infections, injuries) or psychological problems (e.g. mood swings, depression, anxiety, delusions, paranoia) the drug has caused.
Drug-related legal problems
Legal troubles because of drug use, such as arrests for disorderly conduct, driving under the influence, or stealing to support drug habit.
Drug-related social or interpersonal problems
Losing old friends and loved ones due to drug use. Arguing or fighting with others.
If you are abusing drugs, you may be in denial about the magnitude of the problem or the negative impact it's had on your life. However, if you feel you should cut back or feel guilty about your drug use, you may have a substance abuse problem. Other warning signs include criticism from friends and family regarding your drug use and the need to use drugs in order to get through the day. For more help identifying a drug problem in yourself, answer the questions in this online Drug Abuse Screening Test.
What are the signs and symptoms of drug use and abuse in teens?
There are several telltale signs of possible drug use or abuse in teenagers. The challenge for parents is to distinguish between the normal, sometimes volatile ups and downs of adolescent development and the red flags of substance abuse.
According to the National Drug Intelligence Center, sudden or extreme changes in personality, appearance, school performance, or extracurricular activities may indicate teen drug use. For example, a previously well-behaved, respectful teenager may become emotionally volatile, hostile, or violent. A teenager who is abusing drugs may also withdraw from family and friends, drop previously-enjoyed activities, and neglect schoolwork. Secretive behavior and lying to cover up drug use is also common. In addition, teen drug users may steal, ask for money, or sell valuable possessions in order to support their habit.
Warning Signs of Teen Drug Use
- Negative changes in schoolwork, missing school, or declining grades.
- Increased secrecy about possessions or activities.
- Use of incense, room deodorant, or perfume to hide smoke or chemical odors.
- Subtle changes in conversations with friends (more secretive, using “coded” language).
- New friends.
- Change in clothing choices — new fascination with clothes that highlight drug use.
- Increase in borrowing money.
- Evidence of drug paraphernalia, such as pipes and rolling papers.
- Evidence of inhaling products and accessories, such as hairspray, nail polish, correction fluid, paper bags and rags, and common household products.
- Bottles of eyedrops, which may be used to mask bloodshot eyes or dilated pupils.
- New use of mouthwash or breath mints to cover up the smell of alcohol.
- Missing prescription drugs — especially narcotics and mood stabilizers.
For more information, see Is My Child A Substance Abuser?
Why do people use and abuse drugs?
There are many reasons why people use drugs. Some people use drugs because they like the rush it gives them or because they are thrill-seekers. Others may try a drug out of curiosity or because their friends do it. However, many people use drugs in order to cope with unpleasant emotions and the difficulties of life. In fact, the National Alliance on Mental Illness estimates that around 50% of drug abusers also suffer from a mental illness such as depression, anxiety, bipolar disorder, or schizophrenia.
People who are suffering emotionally use drugs—not in order to get high—but to feel normal. Drug use can be a seemingly attractive and easy escape from all kinds of problems. Speed might be used to fight feelings of inferiority, sleeping pills to deal with panic attacks, or painkillers to numb depression. However while drug use might make a person feel better in the short-term, this attempt to self-medicate ultimately backfires. Instead of treating the underlying problem, drug use simply masks the symptoms. Take the drug away and the problem is still there, whether it be low self-esteem, stress, or an unhappy family life. Furthermore, prolonged drug use eventually brings its own host of problems, including major disruptions to normal, daily functioning. Unfortunately, the psychological, physical, and social consequences of drug abuse and dependence are often worse than the original problem the user was trying to cope with or avoid.
See Helpguide's Dual-Diagnosis for more on co-occuring psychological disorders and substance abuse problems.
What drugs are most commonly abused and what are their effects?
Almost all drugs have the potential for addiction and abuse, from caffeine to prescription medication. However, the majority of non-alcohol-related drug problems are due to use of the substances listed below. These drugs affect users' brains and bodies in different ways, producing symptoms of intoxication and abuse that are unique to each substance.
Marijuana and Cannabis Abuse
Believed to be the most commonly used illegal drug, marijuana enhances the senses and brings on feelings of relaxation and well-being. Marijuana is also used medicinally to relieve pain, reduce nausea and vomiting, and stimulate appetite. However, there are drawbacks to extended use, including learning and memory impairment, lung and respiratory problems caused by the smoke, and infertility. According to The National Youth Anti-Drug Media Campaign, marijuana abuse has also been linked to low achievement, delinquent behavior, and poor family relationships.
SIGNS & EFFECTS OF MARIJUANA
Types and Street Names
- Marijuana (pot, dope, weed)
- Sense of relaxation
- Heightened sensory awareness
- Increase in appetite
- Slowed thinking and reaction time
- Impaired coordination
- Respiratory problems
- Red, dilated eyes
- Memory and learning difficulties
- Increased heart rate
- Anxiety and paranoia
Depressants, commonly known as downers, are substances that slow down the central nervous system. Sleeping pills and prescription medications for anxiety such as Xanax and Valium fall into this drug category, as do Rohypnol and GHB, known as “date rape” drugs due to their frequent use in sexual assaults. Downers are often abused by individuals suffering from anxiety and low self-esteem. But while they induce relaxation, they also impair the user's ability to think clearly and react quickly. People abusing depressants may appear to be drunk—exhibiting signs such as losing their balance and slurring their words. Additionally, they may suffer from amnesia and delusions. Downers are highly addictive, and withdrawal is severe, with symptoms including nausea, vomiting, and cramps. Downers are lethal in high doses, particularly when mixed with alcohol.
SIGNS & EFFECTS OF DOWNERS
Types and Street Names
- Barbiturates (downers, sedatives)
- Benzodiazepines (downers, tranqs)
- Methaqualone (Qualudes)
- Decreased anxiety
- Sense of relaxation and well-being
- Lowered inhibitions
- Drowsiness and fatigue
- Slowed breathing and pulse
- Depression
- Confusion and disorientation
- Slurred speech
- Impaired coordination
- Impaired memory and judgment
Stimulants, or uppers, are drugs which speed up the central nervous system. Commonly-abused uppers include cocaine, methamphetamine, crack, and prescription drugs such as Ritalin and Adderall. While stimulants will initially boost energy and confidence, their use over time leads to symptoms such as anxiety, aggression, sleep difficulties, hallucinations, and paranoid thinking. As uppers wear off, users experience a “crash,” characterized by depression, fatigue, and irritability. Overdose can result in heart failure, stroke, and death.
SIGNS & EFFECTS OF UPPERS
Types and Street Names
- Amphetamines (uppers, speed)
- Cocaine (coke, blow)
- Crack cocaine
- Methamphetamine (meth, crank)
- Crystal meth
- Ritalin and other ADHD drugs
- Feelings of exhilaration and euphoria
- Increased energy and hyperactivity
- Rapid or irregular heart beat
- Reduced appetite and weight loss
- Aggressive or impulsive behavior
- Anxiety and restlessness
- Insomnia
- Irritability
- Paranoia
- Rapid speech
Hallucinogens and dissociative drugs, also known as psychedelics, are mind-altering drugs that affect the user's sensory perceptions and thought processes. Hallucinogens such as LSD and peyote can promote insight, contemplation, and euphoria—with some users reporting spiritual or out-of-body experiences. But on the flip side, these same drugs can result in “bad trips” characterized by panic and psychotic breaks with reality. Ecstasy, a popular club drug with both hallucinogenic and stimulant properties, boosts empathy and feelings of interpersonal closeness. Risks include a dangerous increase in body temperature, liver damage, and heart problems. The dissociative drugs PCP and ketamine block perception of pain and induce a trance-like state. Adverse effects can be severe and include violent reactions, complete disorientation, and terrifying delusions and hallucinations.
SIGNS & EFFECTS OF HALLUCINOGENS
Types and Street Names
- Psilocybin (magic mushrooms)
- MDMA (ecstasy)
- Ketamine (Special K)
- Heightened sensory awareness
- Hallucinations
- Euphoria
- Impaired perception of reality
- Increased heart rate and blood pressure
- Nausea and vomiting
- Flashbacks
- Panic or paranoia
- Impaired motor function
- Memory loss
Narcotics, or opioids, are powerful pain relievers that mimic the effects of endorphins, the body's natural “feel-good” chemical. Commonly-abused narcotics include heroin, morphine, codeine, and prescription painkillers such as Vicodin and Oxycontin. These drugs elevate mood and induce a tranquil, relaxed state. Side effects include nausea, vomiting, and sever itching. Tolerance and physical dependency will develop if opioids are used for any extended period of time. If a narcotics abuser quits “cold turkey,” he or she will experience withdrawal symptoms. While not dangerous, withdrawal from heroin and other narcotics is extremely unpleasant, with symptoms including muscle and joint pain, fever, nausea, sweats, chills, stomach cramps, and diarrhea. Overdose is another risk of narcotic abuse, especially if the user is shooting the drug. Another danger of intravenous opioid or heroin use is infection from dirty needles. Intravenous drug users are at a higher risk of contracting viruses such as HIV and hepatitis, and often suffer from abscesses, collapsed veins, and bacterial infections.
SIGNS & EFFECTS OF NARCOTICS
Types and Street/Brand Names
- Heroin (smack, junk)
- Opium
- Morphine
- Codeine
- Hydrocodone (Vicodin)
- Fentanyl (Duragesic)
- Oxycodone (Oxycontin, Percocet)
- Hydromorphone (Dilaudid)
- Meperidine (Demerol)
- Propoxyphene (Darvon)
- Pain relief
- Euphoria
- Drowsiness and sedation
- Nausea
- Constipation
- Confusion
- Slowed breathing
- Depression
Inhalants are chemicals which cause intoxication when sniffed or inhaled. They include common, household solvents, aerosols, and gases such as paint thinner, dry-cleaning fluid, gasoline, glue, felt-tip marker fluid, deodorant and hair sprays, spray paint, air fresheners, butane lighters, and propane tanks. Other abused inhalants include medical anesthetics such as “laughing gas,” ether, and chloroform. While “huffing” gives users a brief high, this high often comes with side effects including nausea, vomiting, delusions, confusion, and loss of consciousness. Prolonged inhalant abuse can also cause damage to the brain and other organs of the body. But the biggest risk involved with inhalant use is death by overdose. Inhalant use can cause sudden heart failure, or “sudden sniffing death syndrome,” even in individuals who are young and healthy.
SIGNS & EFFECTS OF INHALANTS
Types and Street Names
- Solvents (paint thinners, gasoline, glues)
- Aerosols (hair spray, spray paint)
- Gases (butane, propane)
- Nitrous oxide (laughing gas)
- Nitrites (poppers)
- Brief “high”
- Loss of inhibition
- Headache or lightheadedness
- Nausea or vomiting
- Seizures
- Impaired motor coordination
- Impaired memory
- Weakness and fatigue
Unlike other drugs of abuse, anabolic steroids don't have any intoxicating effects. They are used, not to get “high,” but to improve athletic performance and build muscle. But while steroids may help would-be athletes bulk up or obtain an edge on the field, they come with serious side effects and health risks. Steroid abuse causes blood pressure to skyrocket, increases bad cholesterol (LDL) while decreasing good cholesterol (HDL), triggers violent and aggressive behavior, results in severe acne, and brings growth to a halt in adolescents. Women taking steroids can develop facial hair, a deep voice, and male-pattern baldness. Men, on the other hand, can develop breasts, infertility, shrinking of the testicles, and baldness.
SIGNS & EFFECTS OF STEROIDS
Types and Street Names
- Anabolic steroids (roids, juice)
- Stunted growth in adolescents
- Breast enlargement in men
- Facial hair growth in women
- Hostility and aggression
- Acne
- High blood pressure
- Infertility
- Liver disease
- Cardiovascular disease
- Cholesterol changes
References and resources for drug abuse and addiction:
Help guide's series on abuse & addictions:
Family Abuse
Child Abuse: Types, Signs, Symptoms, Causes and Help
Elder Abuse: Types, Signs, Symptoms, Causes and Help
Domestic Violence and Abuse: Types, Signs, Symptoms, Causes and Effects
Domestic Violence and Abuse: Help, Treatment, Intervention and Prevention
Drug & Alcohol Abuse
Alcohol Abuse and Alcoholism: Signs, Symptoms, Effects and Testing
Alcohol Abuse and Alcoholism: Self-Help, Prevention and Treatment
Drug Abuse and Addiction: Signs, Symptoms and Effects
Drug Abuse and Addiction: Rehab, self-help and Treatment Options
Other Addictions
Dual Diagnosis: Information and Treatment for Co-occurring Disorders
Self-Injury: Types, Causes and Treatment
Ways to Quit Smoking: Self-help, support, and tips for smoking cessation
Gambling Addiction: Signs, Symptoms and Treatment
Internet, Porn, and Cybersex Addictions: Symptoms, self-help, and tips for parents
Other related links
Treatment for Drug Abuse and Addiction – Describes types of drug treatment programs, including rehab and peer support groups.
Alcohol Abuse and Alcoholism – Guide to the signs, symptoms, adverse effects, and causes of problem drinking.
Treatment for Alcohol Abuse and Alcoholism – Guide to treatment options, prevention, and self-help for alcoholism.
Depression Signs and Symptoms – Overview of depression and its warning signs, symptoms, and risk factors.
Anxiety Attacks and Disorders – Covers types of anxiety disorders, including symptoms, causes, and treatment.
Coping with Suicidal Thoughts and Feelings – Find out how to get help if you're feeling suicidal.
Dual Diagnosis – Learn about the relationship between mental illness and substance abuse and how both problems can be treated.
Emotional and Psychological Trauma – Learn about the causes, symptoms, effects, and treatment of emotional trauma.
Ways to Quit Smoking – Learn about options for quitting, common withdrawal symptoms, and tips for coping with cravings.
Gambling Addiction – Covers the signs and symptoms of problem gambling and how to get help.
Internet and Cybersex Addiction – Guide to the signs and symptoms, its negative effects, who is at risk, and how to overcome the problem.
General resources for drug abuse and addiction
Major Forms of Drug Use – Research report on the incidence of drug use in America by drug type. (National Institute on Drug Abuse)
Drug Abuse – Provides comprehensive information on drug addiction, including sections on prevention, treatment, coping skills and the effects of different chemicals on the brain. (Mayo Clinic)
Why Do Sally And Johnny Use Drugs? - Covers the different reasons people abuse drugs and how to prevent the problem. (National Institute on Drug Abuse)
Commonly Used Drugs – A comprehensive list of about 50 commonly used drugs with their intoxicating effects and health consequences. (National Institute on Drug Abuse)
Substance abuse signs, symptoms, and causes
Drug Addiction: Signs and Symptoms – General and specific signs and symptoms of being addicted to seven classes of drugs. (Mayo Clinic)
Addictions and Life Page: Signs and Symptoms – Information on seven different drugs and the signs and symptoms associated with their use and abuse. (Cenla Chemical Dependency Council)
Crossing the Line to Addiction: How and When Does it Happen? – An article on the Bill Moyers series Moyers on Addiction: Close to Home. (PBS Online)
How Can We Tell if Someone is Abusing or Addicted to Drugs? – Diagnostic symptoms of drug abuse. (SAMHSA)
Teens and young adults
The Science Behind Drug Abuse – Educational site for teens provides facts on drugs, learning activities, real stories, and an ‘ask the doctor’ feature. (National Institute on Drug Abuse for Teens)
TeensHealth: Drugs and Alcohol – Straightforward talk on drug and alcohol abuse in a question and answer format, written for teens. (Nemours Foundation)
Drugs: Why Do You Use? – A brief checklist of warning signs for drug abuse, plus links to government sites and an animated video narrated by actress Sarah Jessica Parker. (facetheissue.com)
Delving Deeper in to Drug Abuse and Addiction
Drugs of Abuse – In-depth look at commonly abused drugs and their effects. Includes photos of the drugs. (U.S. Drug Enforcement Agency)
New Addiction on Campus: Raiding the Medicine Cabinet
By Elizabeth Bernstein : WSJ Article : March 25, 2008
Parents have long worried whether their kids at college are drinking too much or getting stoned. But alcohol and marijuana aren't the only substances they should be concerned about: In recent years, a growing number of young people have begun abusing prescription opiates.
The problem is part of a larger trend of abuse of prescription drugs among teenagers. Several years ago, attention-deficit drugs such as Ritalin and Adderall became popular among students, who used them to improve concentration or lose weight. Now there is evidence that young people are increasingly moving on to even more dangerous drugs -- powerful painkillers such as OxyContin, Vicodin and Percocet.
Earlier this month, several drug experts testified at a congressional hearing called Generation Rx about the rising abuse of prescription and over-the-counter drugs among America's youth. In 2006, 2.2 million people ages 12 and older said they started abusing pain relievers within the past year, with young adults ages 18-25 showing the greatest overall use of any age group, according to Nora D. Volkow, director of the National Institute on Drug Abuse.
To be sure, college students use these drugs much less often than alcohol and pot. Still, the development is alarming because these painkillers are highly addictive. From 2002 to 2006, the annual prevalence of use of narcotics other than heroin among college students rose to 8.8% from 7.4%, according to a University of Michigan study funded by the National Institute on Drug Abuse. For OxyContin, annual prevalence of use doubled, to 3%; the use of Vicodin rose to 7.6% from 6.9%.
The trend is being spurred by the availability of these drugs. Thanks to the huge increase in the number of prescriptions over the past decade, many kids can easily find drugs in mom or dad's medicine cabinet or obtain them from a friend. If all else fails, they can purchase them from an online pharmacy.
Some people don't perceive prescription drugs to be dangerous, precisely because they are government approved. And not only do young people underestimate how addictive opiates are, many don't even know what drug they are taking. For some, keg parties are being replaced by "pharm parties," where kids bring whatever pharmaceuticals they can find, mix the drugs up in a big bowl and eat them like candy, according to the Drug Enforcement Administration.
The results can be tragic. Leonard J. Paulozzi, an epidemiologist with the Centers for Disease Control and Prevention, told the congressional hearing that mortality rates from unintentional drug overdoses are currently four to five times as high as they were during the "black tar" heroin epidemic of the 1970s and more than twice what they were during the peak years of crack cocaine use of the early 1990s. From 1999 to 2005 -- the most recent information available -- the increase was driven largely by prescription opiates.
There is anecdotal evidence that students who start with prescription opiates may be graduating to heroin. "My friends convinced me that it would get me a lot higher," says Chris Arnold, a 25-year-old from Monroe, Conn., who says his switch from OxyContin to heroin ultimately caused him to drop out of college.
Although fewer than 1% of college students report using heroin, a number that's remained steady for years, some emergency-room doctors say they're seeing more heroin overdoses among college students.
Don't rely on your child's school to tell you about possible drug use. Federal law allows a college to inform parents if a student under 21 receives a drug or alcohol violation, but some schools choose not to. So what do you look for?
Experts say that signs of opiate abuse in students are similar to those of other drugs: a sudden drop in grades, loss of interest in studies or favorite activities, change of friends, lying, stealing, unexplained mood swings and financial problems. "Attend to what the bank account looks like -- a first sign is if it goes very quickly," says David Deitch, chief clinical officer at Phoenix House, which runs drug-rehabilitation programs in nine states.
As always, you should talk to your child about the dangers of drugs, including prescription ones. Stay in touch, visit your child if you are concerned and ask to meet their friends. In addition, you may want to keep medicines at home locked up. Parents and teens who want more information on drug abuse and prevention can find it on several Web sites: justthinktwice.com, drugfree.org, dare.org or parents4achange.com.
"I tell parents with kids who are away: Go with your gut," says Mary Marcuccio, founder of Parents 4 a Change, which works to raise awareness about the use of opiates and heroin among teenagers. "If there is something odd or out of line, investigate it."
John Dorsey, Jaelline Jaffe, Ph.D., Jon Slotnick, M.A., Melinda Smith, M.A., and Robert Segal, M.A., contributed to this article. Last modified on: 2/19/07.
Under the influence of methadone
There’s a better, cheaper option for opioid addicts. So why isn’t it widely used?
By Lawrence Harmon Globe Columnist May 15, 2011
While the early-morning South Shore commuters crawl along Southern Artery waiting for their coffee to kick in, the Habit OPCO methadone van pulls into the parking lot of a shuttered VFW hall in Quincy. Inside, a nurse pumps doses of liquid methadone for arriving opioid addicts, who range from burly workmen to young moms with kids in tow. Outside, a sharp-eyed guard swoops down on an unwelcome visitor. This and similar scenes at methadone clinics across the state have represented the gold standard in addiction treatment for 40 years. But it’s looking more tarnished every day.
The synthetic narcotic in methadone binds to the same brain receptors as heroin, preventing cravings and withdrawal symptoms in addicts. Medically speaking, it’s a “full agonist,’’ meaning it packs a wallop. Methadone is strongly addictive and has been linked to an alarming increase in overdoses and poisonings in recent years. It’s so susceptible to abuse that doctors can’t prescribe it for addiction treatment in their private offices.
Something safer came on the market in 2002. Buprenorphine, sold under the brand name Suboxone, is a partial opioid agonist, meaning it activates receptors in the brain sufficiently to prevent cravings and withdrawal symptoms in addicts. But it does not produce the same high — which addicts describe as being wrapped in a narcotic blanket — as do full agonists such as methadone, OxyContin, or heroin. Suboxone also contains an opioid antagonist — naloxone — as a way to curb abuse. When taken as directed, the naloxone has no effect. But if Suboxone is crushed and snorted or injected, it causes immediate withdrawal symptoms, including cramping, vomiting, and muscle aches. Suboxone is gaining traction in academic medicine as the safest and most effective treatment for opioid addiction.
The prestigious McLean Hospital in Belmont now recommends Suboxone combined with counseling for most of its opioid-addicted patients. Stable patients are generally given a one-month, take-home supply of the drug, according to Dr. Kevin Hill, a psychiatrist at the hospital’s alcohol and drug abuse treatment program. Suboxone has fewer side effects than methadone and minimal risk of overdose, said Hill. And that allows it to be prescribed for addiction from a physician’s office.
Medical research that came out shortly after the introduction of Suboxone suggested that methadone may be more effective with long-term hardcore addicts. But the growing consensus now is that Suboxone should be the first choice for treating opioid addiction because it is highly effective and causes fewer side effects, a win-win for patients and their doctors.
So one might think that state public health officials would vigorously embrace the newer drug. They don’t. Or that MassHealth — the government insurance plan for low-income residents — would give its recipients access to the safest formulation of Suboxone. It doesn’t. Or that doctors, especially psychiatrists, would be lining up to learn more about the drug. They aren’t.
How distorted is this picture? Consider that each of the 33,000 physicians and many of the 6,500 nurse practitioners in Massachusetts have authority to prescribe powerful narcotics that can lead to addiction. Yet only about 900 physicians in Massachusetts have taken the required course and sought the federal waiver needed to prescribe Suboxone, and only about 400 appear on a physician locator list — less than 2 percent of the total. And only about half of them are accepting new patients. The state spends liberally on methadone and sparingly on Suboxone for low-income addicts. Meanwhile, about 600 people die annually in Massachusetts of narcotic overdoses.
Dr. Hilary Smith Connery, the clinical director of the alcohol and drug abuse program at McLean Hospital, asked, “How do you have such a deadly disease and such an effective treatment, and the two aren’t brought into proportion?’’
Marianne Tucker, 60, was 15 when she ran away from an abusive household in Albany and settled in Fall River, where she became addicted to heroin. She spent roughly 25 years in methadone treatment programs, including at the clinic now operated by Habit OPCO in Fall River, one of 10 methadone clinics in the state run by the Boston-based, for-profit company. She, like many addicts, describes her years on methadone as an endless cycle of daily dosing and methadone-related appointments. Tucker, who received state-subsidized treatment, said she sought to reduce her dosage, but staffers told her not to concentrate on the milligram number, just on how she felt.
“The for-profits keep you so high, you don’t know what you’re doing,’’ said Tucker.
The worst part, she said, was the daily experience of being around other addicts who weren’t committed to recovery. “This is the best place to hook up if you want to do dope,’’ she said.
About five years ago, she walked away from the clinic and sought Suboxone treatment from Dr. Claude Curran, a controversial addiction specialist in Fall River. Unlike with methadone, her Suboxone dose has gone down over time. And while methadone made her feel high, Suboxone makes her feel like the person she was before she started to use heroin — a feeling of freedom described by many addicts who switch from methadone to Suboxone.
Curran uses the term “nihilidation’’ to describe the loss of an addict’s normal drives, interests, and goals. They become enslaved to opioids, he said. And it is the responsibility of treating physicians to give hobbled addicts “the lightest chains possible.’’ That’s what Curran said he was trying to do in 2005 when he was fingered by the federal Drug Enforcement Administration for prescribing Suboxone to hundreds more patients than allowable under a federal cap of 30 patients per year. Curran remains under scrutiny for his prescribing practices by the state Board of Registration in Medicine. But he also remains outspoken.
“Who ordained methadone as the standard of care for opiate dependence?’’ he asked.
Switching to Suboxone is no easy matter for methadone patients. The average therapeutic dose of methadone now stands at 80 to 120 milligrams, according to Dr. Christopher Lukonis, the chief medical officer for Habit OPCO. That’s about double what it was a few decades ago. Lukonis defends the trend.
“People were under-medicated back then,’’ he said.
Dosage strength is a big issue for patients. Going cold turkey off opioids practically guarantees a relapse into street drugs when the dope sickness sets in. Transitioning to Suboxone is a safer way than cold turkey to clear a patient’s system of full opioid agonists such as heroin, oxycodone, hydrocodone, or methadone. But best practice requires patients to reduce their daily methadone intake to 35 milligrams to assure a safe changeover to Suboxone, a procedure that can be done in the privacy of a doctor’s office. That leaves addicts and their advocates desperately, and often unsuccessfully, trying to convince methadone clinics to reduce doses.
Lukonis said that Habit OPCO not only honors requests for dose decreases, but informs patients about Suboxone as part of the medical admission process. But the drug isn’t available at the company’s Massachusetts clinics, which serve at least 4,000 addicts. And Habit OPCO makes no bones about what business it is in. Its website states as “fact’’ that “methadone, combined with life skills counseling, has been shown to be the best treatment available for opiate-dependent individuals.’’ Like any other company selling a service, Habit OPCO depends on volume to make a profit. And weaning addicts can’t be good for business.
Michael Botticelli, who heads the state’s Bureau of Substance Abuse Services, gets testy at questions comparing methadone and Suboxone. He says that both drugs are important pieces in the state’s “continuum of care’’ for opioid addicts, along with psychosocial services, detox beds, and long-term residential placements. But if one follows the public money, it’s a lot more likely to lead to a methadone clinic than a treatment program offering Suboxone.
In 2007, MassHealth paid $325 million to treat 18,000 low-income addicts with either methadone or Suboxone, according to a 2009 legislative report. Of that amount, $276 million was spent on methadone programs for 14,000 addicts. The average cost per subsidized patient was $19,799 for methadone and $11,820 for Suboxone.
The same imbalance can be seen in other state agencies. The state Department of Public Health spent $6 million last year on methadone treatment for addicts whose insurance policies won’t cover the drug. By contrast, the department provided only $1.5 million for Suboxone programs in 14 community health centers across the state.
MassHealth reimburses for Suboxone tablets, but not the thin, quick dissolving film that is placed under the tongue. The film has the advantage of coming in individually numbered pouches that are harder to divert into the illegal market. They can’t be crushed for snorting or injection. And a spokesman for the manufacturer, Reckitt Benckiser, said the drug company can provide the film to the state at a lower contract cost than the tablet equivalent.
Medicaid officials aren’t buying it, literally or figuratively. They say the Suboxone film is more a marketing strategy than a medical advance. And they remain focused on finding generic, therapeutic equivalents. Yet there is no generic equivalent. And Massachusetts is one of only five states where the product is not available to Medicaid patients. Private insurance companies here cover the film. By refusing to do so, MassHealth could exacerbate health disparities in Massachusetts.
Meanwhile, taxpayer money is spilling away on urine tests for illicit drugs. The Attorney General has uncovered all manners of scams, including straw companies, medically unnecessary screening, and kickbacks to drug treatment programs and sober houses from clinical testing labs. There would be a lot less opportunity for such monkey business if more doctors treated addicts in private offices, and monitored them with inexpensive and easily available urine testing kits. Monthly visits to a doctor’s office would also eliminate much of the need for the subsidized vans and taxis now used by low-income addicts to get to methadone clinics for their daily doses. When asked, state health officials couldn’t break out how much is spent annually on transportation to methadone clinics.
McLean's Dr. Connery is studying barriers to the wider acceptance of Suboxone within the medical profession. Medical schools and residency programs, she said, focus too little attention on addiction. Historically, that left the field wide open to non-medical, peer-led groups, such as spiritual and 12-step programs.
How little interest is there in addiction medicine? In February, Connery offered a workshop on Suboxone at a psychiatric training conference in Austin, Texas. Only one person showed up.
Connery is pushing back. She requires psychiatrists-in-training at Massachusetts General Hospital and McLean to attend a one-day training session on Suboxone that makes them eligible for the federal waiver needed to prescribe the drug. Recently, she and her colleagues pored through case studies with about 20 trainees. They found Suboxone to be the right call in cases ranging from a 19-year-old college student who had been snorting heroin for 15 months to a 37-year-old school teacher who has been in a methadone maintenance program for nine years following a period of injecting heroin.
Those who complete the training can prescribe the drug to no more than 30 patients in the first year. After that, they must observe a patient cap of 100. Such caps and shortages of prescribers create opportunities for so-called “script docs’’ who insist on high cash payments for prescribing Suboxone, even though the drug is covered by most insurers. That won’t change until more physicians seek the federal waiver needed to prescribe the drug and state officials get serious about funding Suboxone clinics in community health centers.
At McLean Hospital, at least, there were signs that young psychiatrists will be more willing to accept the concrete challenges of addiction medicine than their older colleagues who prefer the ambiguities of psychotherapy.
Like methadone, the long-term maintenance use of Suboxone doesn’t address the underlying causes of addiction. But it does give addicts an opportunity to succeed in behavioral or talk therapy. Suboxone won’t fill the “hole in the soul’’ of addicts, as identified by 12-step programs, either. But it could open up treatment to a lot of people — especially middle-class addicts — who wouldn’t be caught dead in a methadone clinic or a peer-led program such as Narcotics Anonymous.
Opioid addiction is a chronic medical illness. Suboxone holds out the best hope for treatment in decades. But physicians and state health officials have fallen into the habit of thinking about methadone as the default treatment. And bad habits are hard to break.
There’s a better, cheaper option for opioid addicts. So why isn’t it widely used?
By Lawrence Harmon Globe Columnist May 15, 2011
While the early-morning South Shore commuters crawl along Southern Artery waiting for their coffee to kick in, the Habit OPCO methadone van pulls into the parking lot of a shuttered VFW hall in Quincy. Inside, a nurse pumps doses of liquid methadone for arriving opioid addicts, who range from burly workmen to young moms with kids in tow. Outside, a sharp-eyed guard swoops down on an unwelcome visitor. This and similar scenes at methadone clinics across the state have represented the gold standard in addiction treatment for 40 years. But it’s looking more tarnished every day.
The synthetic narcotic in methadone binds to the same brain receptors as heroin, preventing cravings and withdrawal symptoms in addicts. Medically speaking, it’s a “full agonist,’’ meaning it packs a wallop. Methadone is strongly addictive and has been linked to an alarming increase in overdoses and poisonings in recent years. It’s so susceptible to abuse that doctors can’t prescribe it for addiction treatment in their private offices.
Something safer came on the market in 2002. Buprenorphine, sold under the brand name Suboxone, is a partial opioid agonist, meaning it activates receptors in the brain sufficiently to prevent cravings and withdrawal symptoms in addicts. But it does not produce the same high — which addicts describe as being wrapped in a narcotic blanket — as do full agonists such as methadone, OxyContin, or heroin. Suboxone also contains an opioid antagonist — naloxone — as a way to curb abuse. When taken as directed, the naloxone has no effect. But if Suboxone is crushed and snorted or injected, it causes immediate withdrawal symptoms, including cramping, vomiting, and muscle aches. Suboxone is gaining traction in academic medicine as the safest and most effective treatment for opioid addiction.
The prestigious McLean Hospital in Belmont now recommends Suboxone combined with counseling for most of its opioid-addicted patients. Stable patients are generally given a one-month, take-home supply of the drug, according to Dr. Kevin Hill, a psychiatrist at the hospital’s alcohol and drug abuse treatment program. Suboxone has fewer side effects than methadone and minimal risk of overdose, said Hill. And that allows it to be prescribed for addiction from a physician’s office.
Medical research that came out shortly after the introduction of Suboxone suggested that methadone may be more effective with long-term hardcore addicts. But the growing consensus now is that Suboxone should be the first choice for treating opioid addiction because it is highly effective and causes fewer side effects, a win-win for patients and their doctors.
So one might think that state public health officials would vigorously embrace the newer drug. They don’t. Or that MassHealth — the government insurance plan for low-income residents — would give its recipients access to the safest formulation of Suboxone. It doesn’t. Or that doctors, especially psychiatrists, would be lining up to learn more about the drug. They aren’t.
How distorted is this picture? Consider that each of the 33,000 physicians and many of the 6,500 nurse practitioners in Massachusetts have authority to prescribe powerful narcotics that can lead to addiction. Yet only about 900 physicians in Massachusetts have taken the required course and sought the federal waiver needed to prescribe Suboxone, and only about 400 appear on a physician locator list — less than 2 percent of the total. And only about half of them are accepting new patients. The state spends liberally on methadone and sparingly on Suboxone for low-income addicts. Meanwhile, about 600 people die annually in Massachusetts of narcotic overdoses.
Dr. Hilary Smith Connery, the clinical director of the alcohol and drug abuse program at McLean Hospital, asked, “How do you have such a deadly disease and such an effective treatment, and the two aren’t brought into proportion?’’
Marianne Tucker, 60, was 15 when she ran away from an abusive household in Albany and settled in Fall River, where she became addicted to heroin. She spent roughly 25 years in methadone treatment programs, including at the clinic now operated by Habit OPCO in Fall River, one of 10 methadone clinics in the state run by the Boston-based, for-profit company. She, like many addicts, describes her years on methadone as an endless cycle of daily dosing and methadone-related appointments. Tucker, who received state-subsidized treatment, said she sought to reduce her dosage, but staffers told her not to concentrate on the milligram number, just on how she felt.
“The for-profits keep you so high, you don’t know what you’re doing,’’ said Tucker.
The worst part, she said, was the daily experience of being around other addicts who weren’t committed to recovery. “This is the best place to hook up if you want to do dope,’’ she said.
About five years ago, she walked away from the clinic and sought Suboxone treatment from Dr. Claude Curran, a controversial addiction specialist in Fall River. Unlike with methadone, her Suboxone dose has gone down over time. And while methadone made her feel high, Suboxone makes her feel like the person she was before she started to use heroin — a feeling of freedom described by many addicts who switch from methadone to Suboxone.
Curran uses the term “nihilidation’’ to describe the loss of an addict’s normal drives, interests, and goals. They become enslaved to opioids, he said. And it is the responsibility of treating physicians to give hobbled addicts “the lightest chains possible.’’ That’s what Curran said he was trying to do in 2005 when he was fingered by the federal Drug Enforcement Administration for prescribing Suboxone to hundreds more patients than allowable under a federal cap of 30 patients per year. Curran remains under scrutiny for his prescribing practices by the state Board of Registration in Medicine. But he also remains outspoken.
“Who ordained methadone as the standard of care for opiate dependence?’’ he asked.
Switching to Suboxone is no easy matter for methadone patients. The average therapeutic dose of methadone now stands at 80 to 120 milligrams, according to Dr. Christopher Lukonis, the chief medical officer for Habit OPCO. That’s about double what it was a few decades ago. Lukonis defends the trend.
“People were under-medicated back then,’’ he said.
Dosage strength is a big issue for patients. Going cold turkey off opioids practically guarantees a relapse into street drugs when the dope sickness sets in. Transitioning to Suboxone is a safer way than cold turkey to clear a patient’s system of full opioid agonists such as heroin, oxycodone, hydrocodone, or methadone. But best practice requires patients to reduce their daily methadone intake to 35 milligrams to assure a safe changeover to Suboxone, a procedure that can be done in the privacy of a doctor’s office. That leaves addicts and their advocates desperately, and often unsuccessfully, trying to convince methadone clinics to reduce doses.
Lukonis said that Habit OPCO not only honors requests for dose decreases, but informs patients about Suboxone as part of the medical admission process. But the drug isn’t available at the company’s Massachusetts clinics, which serve at least 4,000 addicts. And Habit OPCO makes no bones about what business it is in. Its website states as “fact’’ that “methadone, combined with life skills counseling, has been shown to be the best treatment available for opiate-dependent individuals.’’ Like any other company selling a service, Habit OPCO depends on volume to make a profit. And weaning addicts can’t be good for business.
Michael Botticelli, who heads the state’s Bureau of Substance Abuse Services, gets testy at questions comparing methadone and Suboxone. He says that both drugs are important pieces in the state’s “continuum of care’’ for opioid addicts, along with psychosocial services, detox beds, and long-term residential placements. But if one follows the public money, it’s a lot more likely to lead to a methadone clinic than a treatment program offering Suboxone.
In 2007, MassHealth paid $325 million to treat 18,000 low-income addicts with either methadone or Suboxone, according to a 2009 legislative report. Of that amount, $276 million was spent on methadone programs for 14,000 addicts. The average cost per subsidized patient was $19,799 for methadone and $11,820 for Suboxone.
The same imbalance can be seen in other state agencies. The state Department of Public Health spent $6 million last year on methadone treatment for addicts whose insurance policies won’t cover the drug. By contrast, the department provided only $1.5 million for Suboxone programs in 14 community health centers across the state.
MassHealth reimburses for Suboxone tablets, but not the thin, quick dissolving film that is placed under the tongue. The film has the advantage of coming in individually numbered pouches that are harder to divert into the illegal market. They can’t be crushed for snorting or injection. And a spokesman for the manufacturer, Reckitt Benckiser, said the drug company can provide the film to the state at a lower contract cost than the tablet equivalent.
Medicaid officials aren’t buying it, literally or figuratively. They say the Suboxone film is more a marketing strategy than a medical advance. And they remain focused on finding generic, therapeutic equivalents. Yet there is no generic equivalent. And Massachusetts is one of only five states where the product is not available to Medicaid patients. Private insurance companies here cover the film. By refusing to do so, MassHealth could exacerbate health disparities in Massachusetts.
Meanwhile, taxpayer money is spilling away on urine tests for illicit drugs. The Attorney General has uncovered all manners of scams, including straw companies, medically unnecessary screening, and kickbacks to drug treatment programs and sober houses from clinical testing labs. There would be a lot less opportunity for such monkey business if more doctors treated addicts in private offices, and monitored them with inexpensive and easily available urine testing kits. Monthly visits to a doctor’s office would also eliminate much of the need for the subsidized vans and taxis now used by low-income addicts to get to methadone clinics for their daily doses. When asked, state health officials couldn’t break out how much is spent annually on transportation to methadone clinics.
McLean's Dr. Connery is studying barriers to the wider acceptance of Suboxone within the medical profession. Medical schools and residency programs, she said, focus too little attention on addiction. Historically, that left the field wide open to non-medical, peer-led groups, such as spiritual and 12-step programs.
How little interest is there in addiction medicine? In February, Connery offered a workshop on Suboxone at a psychiatric training conference in Austin, Texas. Only one person showed up.
Connery is pushing back. She requires psychiatrists-in-training at Massachusetts General Hospital and McLean to attend a one-day training session on Suboxone that makes them eligible for the federal waiver needed to prescribe the drug. Recently, she and her colleagues pored through case studies with about 20 trainees. They found Suboxone to be the right call in cases ranging from a 19-year-old college student who had been snorting heroin for 15 months to a 37-year-old school teacher who has been in a methadone maintenance program for nine years following a period of injecting heroin.
Those who complete the training can prescribe the drug to no more than 30 patients in the first year. After that, they must observe a patient cap of 100. Such caps and shortages of prescribers create opportunities for so-called “script docs’’ who insist on high cash payments for prescribing Suboxone, even though the drug is covered by most insurers. That won’t change until more physicians seek the federal waiver needed to prescribe the drug and state officials get serious about funding Suboxone clinics in community health centers.
At McLean Hospital, at least, there were signs that young psychiatrists will be more willing to accept the concrete challenges of addiction medicine than their older colleagues who prefer the ambiguities of psychotherapy.
Like methadone, the long-term maintenance use of Suboxone doesn’t address the underlying causes of addiction. But it does give addicts an opportunity to succeed in behavioral or talk therapy. Suboxone won’t fill the “hole in the soul’’ of addicts, as identified by 12-step programs, either. But it could open up treatment to a lot of people — especially middle-class addicts — who wouldn’t be caught dead in a methadone clinic or a peer-led program such as Narcotics Anonymous.
Opioid addiction is a chronic medical illness. Suboxone holds out the best hope for treatment in decades. But physicians and state health officials have fallen into the habit of thinking about methadone as the default treatment. And bad habits are hard to break.
