Karen Siska-Creel fought pushback when she decided that all schools in her district should use life-saving medicines to treat overdoses of heroin, but she would not wait for someone to die.
Far fewer people in the United States started using heroin last year, but the decline among young new 18- to 25-year-old heroin users was almost imperceptible – and that age group saw a major leap forward in the use of methamphetamine and marijuana, a new research finds.
The 2017 National Survey on Drug Use and Health emphasizes what makes these transitional young people & # 39; because they have higher percentages of cigarette use, alcohol abuse and heroin-use disorders, and they use more cocaine, meth and LSD than people who are younger and older.
The report, released by the Substance Abuse and the Mental Health Services Administration on Friday, showed a positive change among 18- to 25-year-olds: They use less opioid prescription less. In 2015, SAMHSA estimated 8.5 per cent of people in prescription opioids prescribed in that age group; that fell to just over 7 percent in 2017.
The report helps government officials, medical professionals, researchers and caregivers to understand the extent of substance use and mental illness in different age groups nationally, by state and in more local areas. It also helps them to measure the need for treatment services and to make policy decisions, says SAMHSA assistant secretary Elinore McCance-Katz, a psychiatrist.
There was more alarming news. The use of illicit drugs, including cocaine, marijuana and opioids by pregnant women, increased significantly between 2015 and 2017. About 7 percent of pregnant women reported the use of marijuana. Three percent said they used it daily.
McCance-Katz says that the use of marijuana is linked to fetal growth problems, premature births, stillbirths, hyperactivity and reduced cognition in newborns.
Those who have treated people with addictive disease and people in recovery describe the transition from heroin to meth as predictable.
With all the publicity surrounding heroin-infested deaths with fentanyl, psychiatrist Sally Satel says that most addiction experts expect a step away from the drug – just as crack cocaine was out of favor decades ago.
"I was waiting for this," says Satel, who specializes in addiction care. "This is how it works.
"People still want to change their mental state, so they look for what is cheap and what is available and the reputation of the medicine."
Jim Beiting is CEO of Transitions, the largest organization for treatment and recovery of drugs in Northern Kentucky. He says meth is "magnetic" for some who suffer from addiction.
"It's cheaper," he says. "It is better available, and the potential is higher than before."
McCance-Katz, who worked for addiction treatment in Rhode Island before joining the Trump administration, says, "Often people will use both drugs to reduce unwanted effects from one medicine to another."
A stimulant can help them become "euphoric," she says, and another drug – or alcohol – could prevent them from feeling "shaky and paranoid."
Jenny Bogart says she started using meth at the age of 14, after a traumatic youth in a small town in Wyoming. She moved to New York as an adult, she says, was offered heroin and was immediately addicted.
Heroin was her most important medication for two years, she says. Then she moved back to Wyoming and "went right back in grammes of meth."
Now she has been drug-free for more than a year, she says.
"I think a heroin user turns to meth to ease the withdrawal or stop the use of heroin," says Bogart.
The new report shows that there were 81,000 new heroin users in 2017, less than half of the 170,000 reported in 2016.
• The use of marijuana among young people aged 12 to 17 was higher than all previous years, according to SAMHSA. Trends differed between adolescents and young adults, but the use of marijuana for both groups was found to be associated with opioid use, heavy alcohol use and depressive episodes.
• Those 18 to 25 had a higher percentage of mental illness. More than 5 percent of men and nearly 10 percent of women in this group had a serious mental illness and 6 percent of men and 11 percent of women had a so-called depressive episode with severe limitations. Rates of suicidal thoughts or behavior also increased significantly for the age group.
• The percentage of people with substance use disorders receiving treatment increased from 10 to 14 percent.
Psychiatrist Sally Satel specializes in addiction and mental health and is a regular scientist at the conservative American Enterprise Institute. (Photo: American Enterprise Institute)
Yet McCance-Katz says that few people who want treatment can get it.
If caregivers certified to use buprenorphine for the treatment of opioid addiction saw as many patients as they had, McCance-Katz said there would be sufficient treatment for anyone who, according to the report, has an opioid use disorder.
The problem, according to her, is that these doctors, nurse practitioners, pharmacists and other caregivers are not always in the communities where people struggle with addiction. She says that "telehealth" – a virtual connection between care providers and patients – is needed in more remote or rural areas.
SAMHSA expands training and technical assistance and sets up mental health programs in each of the 10 regions of the Ministry of Health and Human Services, she says.
HHS got a big boost to its budget for the 2018 budget to expand access to treatment through grants to states and communities, but McCance-Katz says the results might not be clear for a while. "These things need time to be reflected."
Satel says there is a great need for more facilities where people with an addiction disease can detoxify, and a wider range of options, from the most intense supervision to the least.
"The treatment infrastructure is horrific," she says.
Satel says that only so much HHS can do to tackle addiction without integrated social services. The treatment funded through the HHS currently does not include housing and vocational training, which is the competence of other federal agencies.
"Why stay clean if your prospects were still as gloomy as when you became addicted?" she asks.
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