Adolescent heroin use: a review.

Use of heroin by American teenagers is beginning to show disturbing increases in national and statewide surveys. According to data from the 1997 National Institute on Drug Abuse monograph Monitoring The Future, heroin use by American high school 12th graders was 100% higher than it was from 1990 to 1996 (0.90-1.8%). In 1997, there was a further increase to 2.1%. Additional support for an increase in heroin use in the United States comes from analysis of recent survey data from California, Texas, and Maryland. Heroin imported from Colombia and from Mexico is now cheaper and of high potency, permitting novices to start with nasal administration of the drug. Most American adolescents now initiate heroin use by snorting it; however, frequent use of heroin by any route rapidly leads to tolerance and intense drug craving. Psychological dependence to heroin, and to the often exciting yet chaotic lifestyle of a heroin addict, is very difficult to overcome. Acute heroin withdrawal syndrome is usually not severe and most addicts in withdrawal can be managed in an outpatient setting. Naloxone must be used with great restraint and in smaller than usual doses in known heroin addicts. Successful long-term management often includes acute detoxification followed by long-term residential drug treatment. Managed care payment issues have impeded placement in appropriate treatment programs. Additional long-term management issues include regular attendance at 12-step meetings (Alcoholics Anonymous or Narcotics Anonymous), biweekly urine tests for drugs of abuse, attention to issues of dual diagnosis (group or family therapy), and reapproachment with family, school, and straight friends.