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Adolescents and Abuse of Opioid Narcotics

Adolescents and Abuse of Opioid Narcotics. Glen R. Hanson, Ph.D., D.D.S. Professor in Pharmacology, University of Utah Director of the Utah Addiction Center, University of Utah Senior Advisor, National Institute on Drug Abuse, NIH . What Do We Mean When We Say Narcotic Abuse?.

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Adolescents and Abuse of Opioid Narcotics

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  1. Adolescents and Abuse of Opioid Narcotics Glen R. Hanson, Ph.D., D.D.S. Professor in Pharmacology, University of Utah Director of the Utah Addiction Center, University of Utah Senior Advisor, National Institute on Drug Abuse, NIH

  2. What Do We Mean When We Say Narcotic Abuse? Use: Prescribed and clinically appropriate Misuse: Either not prescribed or clinically inappropriate

  3. Drug Abuse- use of a drug in a manner not medically or “socially” approved. Prescription abuse “Pharm Party”

  4. Dependence: Persistent use resulting in adaptations typically accompanied by accommodation or tolerance (causing compensatory escalation) and withdrawal (e.g., aches, diarrhea, depression and cravings) Drug addiction: Compulsive drug use that consists of repetition to satisfy intense urges, despite severely negative consequences

  5. …indicate whether you have ever used that pain killer when it was not prescribed for you, or that you took it only for the experience or feeling it caused. Example for Survey Question Prescription Pain Killers:

  6. Drugs are not inherently good or bad… What is good or bad is the way we use them.

  7. How many people are abusing (misusing?) prescription drugs? Approximately 9 million Americans use prescription drugs at least once for “nonmedical” reasons a year. Approximately 4 million Americans report using prescription drugs “nonmedically” monthly. Survey Results:

  8. Percent reporting nonmedical use within previous month of 2005 18-25 yrs >26 yrs Non-med use Pain rel. 4.7% 1.9% OxyContin 0.4% 0.1% Stimulant 1.3% 0.2% Sedatives 0.2% 0.1%

  9. Environmental • Factors • opportunity • expectation • life style trauma (TBI) adolescence mental & neur. Disorder (~50%) genetics stress drugs Criminal behavior Antisocial behavior Violence Drug Abuse Gambling Addiction Overview Addiction Vulnerabilities Poor Decision Making; Destructive Outcomes

  10. Prefrontal cortex (selects behaviors) Consequence: adolescents often make poor decisions that are driven by immediate rewards (impulsivity). Adolescent development of Prefrontal Cortex Differences in gray-matter density between: 16 year olds (adolescents) and 23-30 year olds (young adults) Source: Sowell, E.R. et al., Nature Neuroscience, 2(10), pp. 859-861, 1999

  11. We Know That Despite Their Many Differences, Virtually All Opioid narcotics Enhance Brain Dopamine (neurotransmitter) • Other transmitter pathways also • involved!

  12. Opioids Examples: OxyContin, Vicodin How They Work… Attach to Opioid Receptors in the Brain and Spinal Cord, Blocking the Transmission of Pain Messages to the Brain and Causing An Increase in the Activity of Dopamine (a chemical messenger associated with pleasure pathway) in the Brain

  13. Opioids Are Generally Prescribed For: Postsurgical pain relief Management of acute or chronic pain Relief of coughs and diarrhea

  14. Addiction Cycle for Prescription Drugs Relieve medical condition (e.g., pain, anxiety, stress, weight gain) • causes reinforcing effects • induces physical dependence • often there is a tolerance and withdrawal • issue (usually occurs due to lengthy drug use) • patients often have substance abuse risk • before treatment • patient uses various strategies to maintain • drug supply (often illegal)

  15. Prolonged Drug Use Changes the Brain In Fundamental and Long-Lasting Ways

  16. Narcotics decrease protein targets for dopamine Source: Wang, G-J et al., Neuropsychopharmacology, 16(2), pp. 174-182, 1997.

  17. Young man Rx Lortab for wisdom • teeth extractions • Starts stealing mom’s OxyContins Case study • Fights withdrawals • Tries to go on mission for LDS • Church-but fails

  18. High school principal • Took chronic Lortab, with • escalating doses • Doc backs off Rx and pt. gets • caught forging prescription Case study-potential long-term impact: • Ex athlete- with back injury • as an adolescent

  19. Encourage doctor/pharmacist to • do their jobs (don’t ask for • special favors) Prevention • Give accurate history (any drug • abuse problems in family or • personally?)

  20. Only use the Rx to treat the • condition for which it was prescribed • Recognize the symptoms of • dependence and addiction • Promptly dispose of the leftovers • Rx addiction is a relapsing disorder • and often requires professional help

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