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About 1 in 20 high school seniors now acknowledges taking OxyContin, a prescription drug for managing severe pain that, when abused, can be powerfully addictive. In its annual survey of teen drug use, the National Institute on Drug Abuse reports that OxyContin use by 12th graders is up 40 percent nationwide in just three years. Five times as many 12th graders report using OxyContin than report using methamphetamine. The results have been tragic.

Fast-Forming Addiction

Prescription drugs are the second-most used drugs among teens, behind marijuana. Teens are doing stimulants, barbiturates and painkillers. Many don’t realize how highly addictive and dangerous some of these pills can be — OxyContin in particular.

“I was sick as a dog and I was in bed and I couldn’t believe it. I was actually scared,” recalls 17-year-old Ryan, a high school senior from Tewksbury, Mass.

Ryan, who asked that NPR use only his first name, is enrolled at a drug-treatment clinic at Children’s Hospital in Boston. He says he first tried OxyContin at a party when he was 16. Kids crush up the 12-hour time release pills and snort them, so they get hit with all the opiate at once. Ryan says pot made him feel “weirded out.” OxyContin just made him feel good — warm and relaxed. And it’s easy to get.

“There’s always someone who has it,” he says. “There’s kids selling it. I know alone, like, 10 kids selling it themselves.”

But just a week after he started using OxyContin, Ryan realized that if he didn’t get a pill every day or two, he’d start to feel sick. So he kept using it. He says he had no idea how bad he was hooked until the next time he tried to stop.

“It was like somebody was inside of your head with a hammer,” Ryan recalls. “You feel like you’re going to die. Just laying there in the bed, sweat pouring off of you… Then five minutes later, you’re freezing… then you’d be throwing up.”

A Pricey Habit

OxyContin is very expensive on the street: $80 for one pill. To pay for his habit, Ryan says he cashed $7,000 in savings bonds his aunts had given him on birthdays. He sold his PlayStation, leather jackets, cell phone — everything he had — just to stay high and keep from getting sick. He finally broke down and asked his parents for help. Looking back on it, Ryan says he didn’t think using OxyContin would be that dangerous because it was a prescription pill — that made it seem safe. Many different kids at his high school were playing around with it, he says: “People from every sort of group — the burnouts, athletic kids, the geniuses and, like, girls playing wicked-good softball [who were] offered scholarships to places — they would be using it.”

That sentiment is echoed by 18-year-old Mike, a recovering OxyContin addict in Winthrop, Mass. Mike says he was always an athlete and played football. Until his sophomore year in high school, he attended a prep school with wealthier students; he later transferred to the local public school. He says that, if anything, he saw more OxyContin at the prep school.

“All the popular kids — that was the cool thing to do,” Mike says. “It seemed like it was cool because it was so expensive, this big rich drug. And a lot of rich kids were doing it because the poor kids couldn’t afford it.”

OxyContin is so expensive that many teens turn to stealing to support their habit.

“I stole so much money from my parents,” says Katie, 18, who is also a recovering OxyContin habit. She says she and a friend both stole their parents’ ATM cards to support their habits. “I stole $5,000 from my parents in two months.”

Katie also wrote checks from her mother’s checkbook. Katie’s parents say she and her friends stole cameras and jewelry from their house. Somebody stole her father’s wedding ring out of his top drawer.

“It’s like someone just punched you in the stomach,” Katie’s father said in an interview with NPR. “You know you’re never going to get it back. And what did it get used for? The addiction.”

Gateway to Heroin

Katie’s parents say they feel lucky to still have their daughter. More than a year has passed since they enrolled her into a treatment program. She’s relapsed twice. Doctors say OxyContin addiction can plague people for years. And some users move on to heroin. It is much cheaper than OxyContin, and it satisfies the same craving. Instead of $80 a pill, heroin costs about $5 a bag around Boston. One night when Katie was getting sick and desperate, she called a women she’d used OxyContin with before whom she knew also used heroin.

“I didn’t think if she had heroin I would do it,” Katie recalls, “but then when I had that option — to be sick or do this — I did that.”

Deadly Consequences

All the teens interviewed for this story said they knew at least one young person who had overdosed and died recently either on OxyContin or on heroin after first getting hooked on OxyContin. Cheryl Oates of the middle-class suburb of Burlington, Mass., knows the deadly repercussions of OxyContin addiction all too well. Two months ago, her 19-year-old son, Christopher, died of a heroin overdose.

Oates says her son was not the kind of teen one would expect to become a drug addict. He was a captain of his football and wrestling teams at Burlington High School and popular among his teammates. He got good grades and didn’t have behavior problems, Oates says.

“He was the kind of kid who would walk through the mall with me and hold my hand,” Oates says. “He didn’t care what other people thought and said. Christopher was just his own person.”

But by his junior year, Christopher was experimenting with Percocet, another opioid painkiller. It had been prescribed to him for a football injury. By his senior year, he and some friends were using OxyContin; they got hooked. Soon after he graduated, he started using heroin, too.

“The night before Christopher overdosed, we sat in the kitchen and we talked until three in the morning,” Oates says. “And he said he knew he needed help. He was such a good kid and he loved so much. And he got grabbed by something that was greater than him.”

Oates says she’d tell other parents to keep all prescription medications in a locked cabinet, just to make it harder for teens to start experimenting with them. She says it is frightening that more than 5 percent of high school seniors nationally now report using OxyContin in the past year.

Dozens of opiates and related drugs (sometimes called opioids) have been extracted from the seeds of the opium poppy or synthesized in laboratories. The poppy seed contains morphine and codeine, among other drugs. Synthetic derivatives include hydrocodone (Vicodin), oxycodone (Percodan, OxyContin), hydromorphone (Dilaudid), and heroin (diacetylmorphine). Some synthetic opiates or opioids with a different chemical structure but similar effects on the body and brain are propoxyphene (Darvon), meperidine (Demerol), and methadone. Physicians use many of these drugs to treat pain.

Opiates suppress pain, reduce anxiety, and at sufficiently high doses produce euphoria. Most can be taken by mouth, smoked, or snorted, although addicts often prefer intravenous injection, which gives the strongest, quickest pleasure. The use of intravenous needles can lead to infectious disease, and an overdose, especially taken intravenously, often causes respiratory arrest and death.

Addicts take more than they intend, repeatedly try to cut down or stop, spend much time obtaining the drug and recovering from its effects, give up other pursuits for the sake of the drug, and continue to use it despite serious physical or psychological harm. Some cannot hold jobs and turn to crime to pay for illegal drugs. Heroin has long been the favorite of street addicts because it is several times more potent than morphine and reaches the brain especially fast, producing a euphoric rush when injected intravenously. But prescription opiate analgesics, especially oxycodone and hydrocodone, have also become a problem.

In anyone who takes opiates regularly for a long time, nerve receptors are likely to adapt and begin to resist the drug, causing the need for higher doses. The other side of this tolerance is a physical withdrawal reaction that occurs when the drug leaves the body and receptors must readapt to its absence. This physical dependence is not equivalent to addiction. Many patients who take an opiate for pain are physically dependent but not addicted: The drug is not harming them, and they do not crave it or go out of their way to obtain it.

Detoxification

For some addicts, the beginning of treatment is detoxification — controlled and medically supervised withdrawal from the drug. (By itself, this is not a solution, because most addicts will eventually resume taking the drug unless they get further help.) The withdrawal symptoms — agitation; anxiety; tremors; muscle aches; hot and cold flashes; sometimes nausea, vomiting, and diarrhea — are not life-threatening, but are extremely uncomfortable. The intensity of the reaction depends on the dose and speed of withdrawal. Short-acting opiates, like heroin, tend to produce more intense but briefer symptoms.

No single approach to detoxification is guaranteed to be best for all addicts. Many heroin addicts are switched to the synthetic opiate methadone, a longer-acting drug that can be taken orally or injected. Then the dose is gradually reduced over a period of about a week. The anti-hypertensive (blood pressure lowering) drug clonidine is sometimes added to shorten the withdrawal time and relieve physical symptoms.

Methadone Maintenance

Since the 1970s, professionals who care for opiate addicts have reluctantly recognized that many of them will not or cannot stop taking the drug. The solution is maintenance — dispensing opiates under medical supervision. More than 100,000 American addicts are now using methadone as a maintenance treatment. Although it is still politically controversial, this practice has better scientific support than any other treatment for any kind of drug or alcohol addiction.

Because there is a risk of diversion to the illicit market, addicts must come to specialized clinics for methadone, which they take daily in liquid form. A single dose lasts 24–36 hours, and there are few side effects. Some methadone clinics also provide other medical and social services.

Addicts who switch from illicit opiates to methadone avoid the highs and lows and the medical risks of intravenous injection and the criminal behavior that supports it. Studies show that they are less depressed, more likely to hold a job and maintain a family life, less likely to commit crimes, and less likely to contract HIV or hepatitis. Methadone can be continued indefinitely, or the dose can be gradually reduced in preparation for withdrawal. It has been estimated that about 25% of patients eventually become abstinent, 25% continue to take the drug, and 50% go on and off methadone repeatedly.

Buprenorphine

A promising approach to maintenance is the partial opioid agonist buprenorphine. This drug is taken three times a week as a tablet held under the tongue. It occupies opiate nerve receptors and produces a mild opiate-like effect. At higher doses, it continues to produce the same weak effect while displacing more potent drugs. In a person who is physically dependent on opiates, buprenorphine causes a withdrawal reaction. There is some risk of abuse if the tablet is dissolved and injected, so buprenorphine has been made available in combination with the short-acting opiate antagonist naloxone, which has little effect when absorbed under the tongue but neutralizes the effect of injected opiates.

The main advantage of this combination, sold under the name Suboxone, is that patients do not have to come to clinics to take it, because there is no illicit market and no danger of diversion. Since 2002, individual physicians with proper training and certification have been allowed to prescribe buprenorphine in their offices for patients to take home.

There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop heroin (or other opiate) use and return to more stable and productive lives.

In November 1997, the National Institutes of Health (NIH) convened a Consensus Panel on Effective Medical Treatment of Heroin Addiction. The panel of national experts concluded that opiate drug addictions are diseases of the brain and medical disorders that indeed can be treated effectively. The panel strongly recommended (1) broader access to methadone maintenance treatment programs for people who are addicted to heroin or other opiate drugs; and (2) the Federal and State regulations and other barriers impeding this access be eliminated. This panel also stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive services to enhance retention and successful outcomes in methadone maintenance treatment programs. The panel’s full consensus statement is available by visiting the NIH Consensus Development Program Web site at consensus.nih.gov.

Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates.

Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor’s office. Several other medications for use in heroin treatment programs are also under study.

For the pregnant heroin abuser, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. There is preliminary evidence that buprenorphine also is safe and effective in treating heroin dependence during pregnancy, although infants exposed to methadone or buprenorphine during pregnancy typically require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.

There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.