One in a series of occasional stories about opiate abuse and its consequences
Youth prescription drug abuse is the focus of extensive data collection in several Massachusetts cities, including Brockton and Quincy, as communities prepare to launch federally funded prevention strategies uniquely tailored to address the problem in their area.
Eight cities, also including Boston, Fall River, Lynn, New Bedford, Springfield, and Worcester, have been granted $120,000 each annually for three years to stem the rise in prescription drug abuse in residents ages 12 to 25 — abuse officials say often leads to addiction to opiate drugs such as heroin.
Dependence on pills, especially in adolescents and young adults, is a source of increasing concern in the state, said Steve Keel, director of prevention services at the Massachusetts Department of Public Health, which was awarded $3.6 million by the US Substance Abuse Mental Health Services Administration for the grants.
The state health department is hoping the grants would lead to a measurable drop in youth access to illegal prescription drugs. Community-specific goals will be set after participating cities identify particular ways in which this form of addiction is affecting area youth, said Keel.
Opiate overdose is the leading cause of death from accidental injury in Massachusetts, surpassing falls and motor vehicle fatalities. Meanwhile, use of prescription painkillers appears to be on the increase. From 2001 to 2011, the number of prescriptions for opiate medications, such as oxycodone, increased by nearly 88 percent, from 1.4 to 2.6 million, according to the state’s Prescription Monitoring Program.
“This federal funding is such a great initiative. The number one public health problem is adolescent addiction,” said Joseph Shrand, medical director of a short-term treatment program in Brockton known as CASTLE, for Clean and Sober Teens Living Empowered.
Adolescents are particularly vulnerable to lifelong addiction because of the way the human brain develops, said Shrand, a psychiatry instructor at Harvard Medical School. In Brockton, he runs a neuroscience-based addiction program for up to 24 teens, ages 13 to 17, at the High Point Treatment Center.
A young person who starts using alcohol or drugs before age 18 is at high risk of developing lifelong addiction, about one in four. The risk for an individual using substances after age 21 drops to one in 25, he said.
The adolescent brain is different, said Shrand. The prefrontal cortex, which is the part of the brain where planning and thinking happens, has not fully developed, and its immaturity means youthful decisions are more influenced by the limbic system, the seat of emotions and impulsive pleasure seeking, he said.
Add opiate use to this fragile equation and the developing brain’s “thinking” prefrontal cortex ends up trained to repetitively follow an addictive impulse; it gets stuck in a destructive groove, said Shrand.
Today Shrand runs a Facebook site that helps about 215 current and former heroin-addicted teens connect with one another and, in effect, help heal their brains.
“They are helping each other feel valuable. They are saying, ‘You can do this. We have faith and trust in you,’ ” he said about the website, for which he is seeking a portion of the grant money to hire professional moderators.
Any form of personal connection, said Shrand, releases a calming brain chemical called oxytocin, which helps counteract the pleasure-seeking dopamine that drives an addict to use prescription medication or heroin.
“They are using Facebook to stimulate oxytocin in each other; they are creating social connections; they are rekindling their sense of respect and value. If we can stop the drugs and reconnect them socially, we can redirect the development of the brain,” he said.
All of the communities that are drawing a portion of the $3.6 million youth-focused health grant had more than 300 prescription drug overdoses each between 2007 and 2009.
Impact Quincy, a program of Bay State Community Services, which is implementing the grant in that city, has started gathering information from the local school system, police records, emergency room admissions, service agencies, and community health centers. The process will take until at least mid-February, said program director Alejandro Rivera.
“We will be working with clear facts to get at the root of the issue,” he said.
For instance, if collected data reveal that a growing number of city residents in their early teens are using prescription drugs, then prevention efforts will focus on those at the younger end of the 12-to-25 age spectrum, he said.
“What strategies will address the real needs of the young people in Quincy? Let’s find out,” he said.