Smashing the silence

February 2, 2017
A female doctor talks to an adolescent girl.

In September 2016 Andy, age 18, overdosed on heroin. Like many other youth, Andy began his drug use with marijuana. He tried prescription opioids at 15, transitioning to IV heroin at 16. 

His death made his pediatrician, Pamela Gonzalez, weep with disbelief and anger that the whole country had not mobilized to prevent such tragedies.

In October Gonzalez, an assistant professor of psychiatry and fellow of the American Academy of Pediatrics (AAP), told Andy’s story in an address to the 2016 National AAP Conference. She called on pediatricians to screen for mental health and substance abuse disorders, and advocate for more resources to meet the growing need for treatment.

She especially took to task the attitude that because prescription opioids are “licit,” they can’t put children at risk.

“Brains don’t differentiate between ‘licit’ and ‘illicit’ substances,” Gonzalez said. “Young brains exposed to even ‘legitimately’ prescribed opioids are at future risk of misusing them. You can’t tell who’s most at risk by looking at them. Instead, it takes ongoing screening, and education of patients and parents.”

Shifting drug scene

In the 1960s, about 80 percent of opioid users began with heroin. But in the 2000s, 75 percent began with prescription opioids, then progressed to heroin. Currently, an estimated 16,000 people use heroin. The highest-growth segment of new heroin users, with a correspondingly increased overdose death rate, is 18- to 24-year-olds—“our patients,” Gonzalez said.

One generally safe and effective treatment is buprenorphine, which, unlike methadone, may be prescribed from a doctor’s office rather than a specialized clinic. But only physicians who undergo specific training may do so, and they are in short supply nationally.

Gonzalez called for more physicians to take the required training to prescribe buprenorphine, and appealed to her pediatric colleagues to break the silence around youth drug addiction and bring the condition into the mainstream of care.

She applauded Andy’s family for speaking out. In hope of warning others, they opened his obituary by saying that their son and brother “… died unexpectedly on Wednesday, August 31st, from a heroin overdose.”