Characteristics of Adolescents in Residential Treatment for Heroin Dependence

Abstract

A retrospective review of the clinical charts of 97 adolescents who had received residential treatment for heroin dependence was conducted to determine predictors of heroin use. The average age for the adolescent patients reviewed was 17 years. Almost half of the adolescents (48%) were female and over half of the adolescents (53.6%) used heroin intravenously. Both males and females had substantial heroin habits, but differing amounts of use. Boys used an average of six bags of heroin per day and girls used an average of four bags of heroin per day. Using gender, age, number of heroin dependence symptoms, and other substances as predictors, 64.21% of the adolescents were correctly classified as injectors or noninjectors of heroin. Heroin appears to be a significant drug of abuse among these predominately white, middle class, suburban adolescents.

Opioid Use Disorders

“…Age of first use is correlated with the lifetime risk of OUD xxix,xxx ,and earlier age of onset of opioid use is associated with a higher prevalence of dependence, increasing clinical severity, and worsening consequences. Adolescents who are primarily abusing opioids have an earlier age of onset of any substance use compared to those who are currently using marijuana or alcohol (avg age 11.7 vs.12.6) xxxi .The age of onset of opioid use for those who have opioids as their first illicit drug is much earlier compared to those who switch from other substances to opioids xxviii,xxxii,xxxiii .Heroin users have first substance use much earlier than those who use non-heroin opioids xxxiv .Adolescents with earlier onset of prescription opioid or heroin use also have a more rapid progression from non-injection to injection heroin use xvi,xxxiii,xxxv,xxxvi . The strongest predictor for progression to regular heroin use is earlier initial heroin use, while age of initial use of any opioid, and age of regular use of other substances drugs (alcohol, marijuana) are also strong risk factors xxxvii .…”

“…More male than female adolescents enter treatment for heroin use, but compared to other SUDs the representation of females among treatment seeking youth is much closer to even with males. xvi,xxxi, xxxvi Among females seeking treatment for SUDs, there is a higher rate of heroin as their primary substance of use compared to male adolescents xxxix .Female adolescents with heroin addiction are more likely to prefer injection use than male adolescents xl and are also more likely to initiate injection heroin use at a relatively younger age compared to males In fact, female adolescents often initiate injection heroin use within a year from their first illicit drug use,a faster rate of progression to injection use than male adolescents xli . Possible explanations include influence of a romantic partner (often an older male IV drug user,) having a history of victimization/ongoing victimization, gender specific personality traits and a rapid development of tolerance to opioids.…”

“…Typically, inhaled (smoked or snorted) heroin is a precursor to injection heroin use xlii .There are varying estimates of the proportion of adolescents with any form of opioid addiction who transition to injection heroin use, ranging from 40-90% ii,xxxv Almost 70% of young heroin users (age 18-25) eventually transition from nasal to injection heroin xliii ,and almost half of adolescents with current heroin addiction are injection heroin users xviii,xliv . Among patients seeking treatment for heroin addiction, the percentage of injection heroin use is even higher (62-83%) xvi,xxxiii,xxxvi . Sociodemographic factors associated with injection heroin use include poverty or unemployment, homelessness xlv ,and history of childhood adversities xlvi, xlvii,xlviii,xlix .…”

“…Although the cost of prescription opioids on the street remains very high xv ,the cost of heroin has declined xvi and its purity has increased dramatically in recent years xvii .This makes heroin a more economical alternative to prescription opioids, based both on price and potency (“cheaper and better”), once opioid addiction has become established.…”

Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use

“…As a group, they tend to have a higher proportion of females. They also have higher rates of school drop-out, substance use severity, multiple substance use disorders, health risk behaviors, and psychological distress (Clemmey et al, 2004; Gordon et al, 2004; Hopfer et al, 2000, 2002; Marsch et al, 2005; Subramaniam et al, 2009, 2010). In addition, Clemmey et al (2004) found that adolescent heroin users engaged in more days of criminal behavior than non-heroin users.…”