Abstract
The use of heroin by American adolescents is at its highest levels since the heroin epidemic of the 1960s. This clinical perspective reviews medical issues associated with adolescent heroin dependence. Older, as well as potential newer, treatments for adolescent heroin dependence are discussed. Multiple obstacles face a heroin-dependent adolescent who seeks treatment, including a lack of evidenced-based research on pharmacotheraputic agents for this population, strict restrictions on medications with demonstrated efficacy in adults, and a general lack of clinical experience in treating this population.
Similar content being viewed by others
References and Recommended Reading
Drug Use by American Young People Begins to Turn Downward. The Monitoring the Future Study. University of Michigan News and Information Service. December 18, 1998.
Arrestee Drug Abuse Monitoring Program (ADAM): 1998 Annual Report on Drug Use Among Adult and Juvenile Arrestees. A Program of the National Institute of Justice. April, 1999:62.
Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Press; 1994.
Crome IB, Christian J, Green C: Tip of the national iceberg? Profile of adolescent patients prescribed methadone in an innovative community drug service. Drugs: Education, Prevention and Policy 1998, 5(2).
Hopfer CJ, Mikulich SK, Crowley TJ: Heroin use among adolescents in treatment for substance use disorders. J Am Acad Child Adolescent Psychiatry 2000, 39:1316–1323. This is one of the first reports in 25 years to examine the substance use characteristics of US adolescents in the treatment of heroin use. This article also examines the Treatment Episode Date Set for trends in the number of adolescents admitted to substance abuse treatment centers and for changes in the routes of heroin administration.
Code of Federal Regulations 21 Part 291. Drugs Used for Treatment of Narcotic Addicts, April 1, 2000 Edition.
Gold MS, Redmond DE, Kleber HD: Clonidine blocks acute opiate withdrawal symptoms. Lancet 1978, 16:599–601.
Gold MS: Opiate addiction and the locus coeruleus. Psychiatr Clin North Am 1993, 16:61–73.
Charney DS, Sternberg DE, Kleber HD, et al.: The clinical use of clonidine in abrupt withdrawal from methadone. Arch Gen Psychatry 1981, 38:1273–1277.
Kleber HD, Riordan CE, Rounsaville B, et al.: Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 1985, 42:391–394.
Cami J, de Torres S, San L, et al.: Efficacy of clonidine and methadone in the rapid detoxification of patients dependent on heroin. Clin Pharmacol Ther 1985, 38:336–341.
San L, Cami J, Peri JM, et al.: Efficacy of clonidine, guanfacine and methadone in the rapid detoxification of heroin addicts: a controlled clinical trial. Br J Addict 1990, 85:141–147.
Washton AM, Resnick RB: The clinical use of clonidine in outpatient detoxification from opiates. Prog Clin Biol Res 1981, 71:277–284.
Washton AM, Resnick RB: Outpatient opiate detoxification with clonidine. J Clin Psychiatry 1982, 43:6.
Martin WR, Eades CG, Thompson JA, et al.: The effects of morphine- and nalorphine-like drugs in the nondependent and morphine-dependent chronic spinal dog. J Pharmacol Exp Ther 1976, 197:517–532.
Jasinski DR, Pevnick JS, Griffith JD: Human pharmacology and abuse potential of the analgesic buprenorphine. A potential agent for treating narcotic addiction. Arch Gen Psychiatry 1978, 35:501–516.
Hambrook JM, Rance MJ: The interaction of buprenorphine with the opiate receptor: lipophilicity as a determining factor in drug-receptor kinetics. In Opiates and Endogenous Opioid Peptides. Amsterdam: Elsevier/North Holland Biomedical Press; 1976, 295–299.
Lewis JW: Buprenorphine. Drug Alcohol Depend 1985, 14:363–372.
Lloyd RA, Katon RN, DuPont RL: Evolution of a treatment approach for young heroin addicts. comparison of three treatment modalities. Int J Addict 1974, 9:229–239.
Nightingale SL, Wurmser L, Platt PC, Michaux WW: Adolescents on methadone: preliminary observations. Proceedings from the 3rd Annual Conference on Methadone Treatment, National Conference on Methadone Treatment, 1970, 91.
Millman RB, Nyswander ME: Slow detoxification of adolescent heroin addicts in New York City. Proceedings from the 3rd Annual Conference on Methadone Treatment. National Conference on Methadone Treatment, 1970, 88.
Vandervort WJ: Treatment of drug abuse in adolescents. Proceedings of the 3rd Annual Conference on Methadone Treatment, 1970, 87–88.
Schooff KG, Stanczak SA: A treatment program for young heroin addicts. Proceedings of the 4th National Conference on Methadone Treatment. New York National Association for Prevention of Addiction to Narcotics, 1972, 457.
De Angelis GG, Lehmann WX: Adolescents and short term, low dose methadone maintenance. Int J Addict 1973, 8:853–863.
Jasinski DR, Fudala PJ, Johnson RE: Sublingual versus subcutaneous buprenorphine in opiate abusers. Clin Pharmacol Ther 1989, 45:513–519.
Mello NK, Mendelson JH, Kuehnle JC: Buprenorphine effects on human heroin self-administration: an operant analysis. J Pharmacol Exp Ther 1982, 223:30–39.
O’Brien CP, Cornish JW: Opioids: antagonists and partial agonists. Textbook of Substance Abuse Treatment, edn 2. Washington, DC: American Psychiatric Press; 1999. This is an excellent recent review of the pharmacology of opioid antagonists and partial µ-opioid agonist medications that are used or have the potential to treat opioid dependence. Drugs such as naltrexone, naloxone, and buprenorphine are reviewed.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rowan, A.B., Fudala, P.J. & Mulligan, J. The medical management of adolescent heroin dependence. Curr Psychiatry Rep 2, 527–530 (2000). https://doi.org/10.1007/s11920-000-0013-7
Issue Date:
DOI: https://doi.org/10.1007/s11920-000-0013-7