Author: Ruben Bermea, LPC

Teen narcotic abuse is a growing concern in the U.S. In 2017, 14% of teens surveyed reported misusing narcotics, the pain-killing drugs known as opioids.¹ By being aware of the signs of teen opioid abuse, parents can play an active role in protecting their children from the negative consequences of substance misuse.

In This Article:

• What Are Narcotics and Opioids?
• How Do Teens Misuse Opioids?
• What Are Signs of Teen Opioid Abuse?
• How Can Withdrawal Lead to Overdose?
• What Should I Do If I Suspect Teen Narcotic Abuse?

What Are Narcotics and Opioids?

The U.S. Drug Enforcement Agency (DEA) uses the terms “narcotics” and “opioids” interchangeably.² While the narcotics drug category includes a few additional substances, discussion of narcotics is usually referring exclusively to opioids. Opioids are a class of substances that produce pain relief, relaxation, a sense of well-being, and a feeling of euphoria.^2,3 They can also contribute to addiction and progressive health problems when misused.³

Naturally-developed opioid substances, which include heroin, come from a species of the poppy plant called Papaver somniferous.² Synthetic opioids, like fentanyl, do not have a natural component.

Medical professionals may prescribe opioids to manage a person’s pain following surgery, during trauma treatment, during cancer treatment, or as part of end-of-life palliative care.² Examples of prescription opioid medications that teens may misuse include:⁴

• Codeine
• Fentanyl
• Hydrocodone
• Hydromorphone
• Meperidine
• Methadone
• Morphine
• OxyContin
• Oxymorphone

Illicit opioids include heroin, opioid analogs, and counterfeit narcotic substances.² Some illegal manufacturers create analogs (versions) of DEA-approved opioid medications that share chemical similarities with legal prescription opioids. These counterfeit drugs may go by the same names as legal medications but contain different chemicals.

Opioids often receive unique names when sold without a prescription. Some examples of names for illicitly sold narcotics include:^2,4

Fentanyl:	Apache, Fent, Friend, Goodfella, Tango & Cash
Heroin:	Black, Boy, H, Big H, Horse, Mud, Skag, Snow
Hydrocodone:	Bananas, Hydros, Tabs, Vickies, Vikes
Hydromorphone:	D, Dillies, Dust, Footballs, Juice, Smack
Methadone:	Amidone, Dollies, Dolls, Fizzies, Tootsie Roll
Morphine:	Dreamer, God’s Drug, M, Mister Blue, Unkie
Oxycodone:	Blues, Octagons, Oxy, Percs, Roxy, Wheels
Oxymorphone:	Biscuits, Blue Heaven, O Bomb, O’s

How Do Teens Misuse Opioids?

Teen opioid abuse can occur in different ways. Studies show that 53% of children and adolescents 12 and older who obtained opioids for recreational use got them from a friend or relative.⁵

Teens may use opioids that belong to others in their household without their knowledge. Your teen may have their own prescription for an opioid medication and begin misusing it by taking it in larger doses than prescribed. Or they may take it more often than prescribed. They may also continue  to use it when they are no longer in pain. Or they mix it with other substances like alcohol.⁶ They may obtain opioids from their peers who are giving away, trading, or selling prescriptions or illegal opioids.¹

Common ways that people misuse opioids include:²

• Taking opioid pills without a prescription or taking more than prescribed
• Modifying a prescription opioid to turn it into a powder that can be inhaled (i.e., snorted) through the nose
• Mixing powder-form opioids with liquid that can be used intravenously (i.e., via injection)

Many prescriptions are intended to deliver the dose over 8-12 hours. Modifying the form of a prescription opioid in any way removes the time-release coating so that the person taking it receives the full dose immediately. This  can result in more powerful effects—including sedation and feelings of euphoria—and an increased risk of overdose.

Consuming drugs in these different ways can lead to distinct health problems.³ Teens who snort opioids may develop problems in their nasal cavities.⁷ Tears or perforations in the nasal septum may form over time.

Individuals who inject opioids face the risk of acquiring blood-borne illnesses such as hepatitis or HIV if they use nonsterile needles.⁷ Injection sites, veins, and other organs may develop bacterial infections contracted caused by nonsterile environments.⁷ If a person dissolves opioid substances for injection, some of the substance may not fully dissolve, which can lead to blockages in veins and other blood circulation problems.⁷

What Are Signs of Teen Opioid Abuse?

Opioids can contribute to acute and progressive health concerns even when taken as directed by a  physician.³ If your child has a current prescription, it should be for a specified timeframe. If the dose given is high, your child’s prescribing physician should have a plan to decrease and discontinue the dose.

Your teen’s body and mind may adapt to the presence of a narcotic substance, even a prescription medication.⁹ This can make it hard for your teen to function without opioids, especially if they used an opioid medication for an extended period. Many individuals experience uncomfortable withdrawal symptoms when stopping opioids, even when given the medication by a doctor. This is why doctors gradually reduce the dose before taking patients off daily or long-term prescriptions. Discuss the dosage, frequency, and duration of your child’s prescription with their doctor when they start taking an opioid.

Physical dependence, characterized by withdrawal symptoms, can contribute to the development of opioid addiction. Clinically diagnosed as an opioid use disorder (OUD), addiction occurs when a person shows compulsive, uncontrollable drug-seeking or drug use behavior.⁹ Without treatment, the cycle of opioid misuse, addiction, and withdrawal may become complicated and even life-threatening.^3,6,8

Some of the signs of opioid misuse include:^9,10

• Headaches
• Drowsiness
• Dizziness
• Nausea
• Constipation
• Sweating
• Fatigue or low energy
• Vomiting
• Dry mouth
• Low appetite
• Mood changes

According to the American Psychiatric Association, an OUD can develop when your teen shows “a problematic pattern of opioid use leading to clinically significant impairment or distress.”³ In other words, an OUD can cause your teen to experience problems in their life and make it hard for them to function normally.

A qualified professional will look for at least two symptoms associated with opioid misuse to occur in the span of a year before they make an OUD diagnosis.³ The severity of addiction depends on how many signs and symptoms your teen experiences.

Some symptoms of an OUD include:³

• Strong cravings, urges, or desires to use opioids
• Taking narcotics in larger amounts or for a longer period than originally intended
• Not being able to reduce or stop using opioids
• Spending a lot of time seeking, using, or recovering from the effects of opioids
• Experiencing problems at school, work, or elsewhere due to opioid misuse
• Using narcotics even when it results in conflict with family or friends
• Giving up important activities to use opioids
• Using opioids in situations that could lead to physical harm
• Continuing to use opioids even when physical or mental health problems get worse

If you suspect your teen has developed an addiction to opioid substances, seek support as soon as possible. Opioid use can lead to an increased risk of depressed mood, suicidal ideation, and self-harming behavior.³ The withdrawal process can become complicated by several other factors and even contribute to your teen’s risk of narcotic overdose.^3,11

How Can Withdrawal Lead to Overdose?

Withdrawal symptoms will likely occur when your teen tries to stop taking opioid medications.³ This does not mean that teen narcotic misuse or addiction has occurred. These experiences are a normal part of the healing and recovery process following appropriate opioid medication use.³ Medication management by the prescribing doctor can reduce the intensity and occurrence of withdrawal symptoms. If necessary, a specializing clinician can help your child get through uncomfortable and potentially medically significant withdrawal symptoms.

It’s important to be aware that symptoms of opioid withdrawal, while rarely life-threatening alone, can cause severe distress.¹⁰ This distress may contribute to the cycle of misuse and addiction since many people relapse into using opioids to reduce their withdrawal symptoms.

Opioid withdrawal symptoms can include:^3,11

• Uneasy mood or overall dissatisfaction with life
• Vomiting
• Nausea
• Aching muscles
• Runny nose
• Changes to pupil size
• Fever
• Yawning
• Diarrhea
• Inability to sleep
• Excessive sweating

The effects of withdrawal can increase a teen’s risk of experiencing an overdose.^3,11 This is because a teen’s tolerance to opioids decreases as they go through withdrawal, making them more sensitive to drug toxicity.¹¹ If they resume taking an opioid to relieve their uncomfortable withdrawal symptoms in the same or larger amounts as they used previously, they will likely experience a much stronger effect and may overdose.

Symptoms of opioid overdose include:⁶

• Gurgling noises
• Vomiting
• Blue or purple color in your teen’s lips or fingernails
• Limpness throughout the body
• A pale facial color
• Feeling clammy when touched
• Heart rate that slows or stops
• Breathing that becomes challenged or stops completely

Treat all suspected overdoses as an emergency and seek medical attention right away. The medication naloxone can reverse the potentially life-threatening effects of opioid overdose by restoring breathing.¹² In some states, naloxone nasal spray is available without a prescription from your local pharmacy. ¹² Or, you can ask your family doctor for a prescription. Ask for instruction on how to properly use naloxone. Keep in mind that naloxone is only effective in treating an overdose from opioids, not other types of drugs.¹²

If your teen shows signs of overdose, call 911 and administer naloxone if you have it. Lay your child on their side to prevent choking, and try to keep them awake until emergency medical support arrives.

What Should I Do If I Suspect Teen Narcotic Abuse?

As a parent, you can play a key role in the life of your teenager when it comes to preventing or recovering from substance misuse. Research shows that having an open, communicative relationship with your child is one of the most influential factors in a teen’s life growing up.⁵

Your efforts to share your concerns with your teen can be a pivotal part of their recovery.¹⁰ Though there are many ways to approach this vital moment, you do not have to do it alone. Many qualified professionals in your teen’s school, community, and elsewhere can help you address your concerns regarding possible teen narcotic abuse.

Choosing a treatment program that matches your teen’s needs can also seem like a complicated and overwhelming process. Professionals can support you as you find a program that matches your child’s needs. When exploring your child’s treatment options, look for a program that emphasizes:¹⁰

• An evidence and science-based approach to services
• An individualized approach to recovery
• A flexible, yet firm approach to treatment
• Services that give your teen the time they need to heal

Stabilization comes first.⁸ If you have concerns about your child’s immediate safety or their experience of withdrawal, seek support from your local hospital or emergency department. Case managers in these settings may offer guidance and referrals so that your child can get the long-term care that they need.

For more information about professional assessment and treatment options for suspected teen opioid abuse, call 800-934-1582(Who Answers?) today to speak with a treatment specialist.

References

1. Bhatia, D., Mikulich-Gilbertson, S.K., & Sakai, J.T. (2020). Prescription Opioid Misuse and Risky Adolescent Behavior. Pediatrics, 145(2).
2. Drug Enforcement Administration Community Outreach and Prevention Support Section. (2020). Drugs of Abuse: A DEA Resource Guide/2020 edition. U.S. Department of Justice Drug Enforcement Administration.
3. American Psychiatric Association. (2013). Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
4. S. Department of Health and Human Services. (2020, August 20). Commonly Used Drugs Charts. National Institute on Drug Abuse.
5. Substance Abuse and Mental Health Services Administration. Talking With Your Teen About Opioids: Keeping Your Kids Safe.
6. Medline Plus. (2021, June 3). Opioid Overdose. U.S. National Library of Medicine.
7. S. Department of Health and Human Services. (2021, April 13). Heroin Research Report. National Institute on Drug Abuse.
8. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals. The Guilford Press.
9. National Institute of Drug Abuse. (2021). Prescription Opioids DrugFacts.
10. gov. Opioids. Interagency Working Group on Youth Programs.
11. (2021, May 25). Opiate and opioid withdrawal. U.S. National Library of Medicine.
12. National Institute on Drug Abuse. (2021) Naloxone DrugFacts.