Be aware of the potential for opiate(heroin) drug abuse in adolescents
Be aware of the potential for opiate(heroin) drug abuse in adolescents: Excerpt from Avoiding Common Pediatric Errors
Author: Michael S. Potter and Anthony Slonim, MD
What to Do -Gather Appropriate Data
Heroin use in the United States has seen a steady decline since the 1980s and
is less of a concern today than it has been in past decades. Unfortunately,
it is important for pediatricians to be familiar with the manifestations and
management of heroin abuse if it presents in their patients.
Depending on the route of delivery, heroin's affects on the body will
be different. Heroin induces euphoria, blunts pain, and results in pinpoint pupils. A lowered body temperature is suggested as a sign of heroin's
affect on the hypothalamus. Vasodilation is a major cardiovascular manifestation, and alveolar hypoventilation is a characteristic of respiratory depression. "Track marks," which are hypertrophic linear scars that follow the
course of large veins, are a frequently occurring dermatologic lesion associatedwithchronicheroinuse;however,moreeasilyoverlookedarethesmaller
peripheral scars that occur from injection into smaller veins. If injected
subcutaneously, heroin causes fat necrosis, lipodystrophy, and atrophy. Not
surprisingly, abscesses secondary to unsterile drug administration techniques are a common occurrence. In addition, endocarditis with Staphylococcus aureus, cerebral microabscesses, and viral infections with hepatitis B
andhumanimmunodeficiencyviruscanallresultfromunsteriledrugadministration.Althoughitscauseisunknown,alossoflibidoisalsoacharacteristic
of heroin use. Addicted children may often find themselves in difficult circumstances to support a drug habit and prostitution is not an uncommon
means of supporting these addictions. Constipation results from decreased
smooth muscle propulsive contractions and increased anal sphincter tone.
Finally, abnormal serologic reactions are frequent with heroin abuse, which
include false-positive Venereal Disease Research Laboratory (VDRL) and
latex fixation tests.
After approximately 8 hours without the use of heroin, a withdrawal
syndrome begins in chronic users, which is characterized by a period of
physiologic disequilibrium for a period of 24 to 36 hours. Early signs of
this syndrome include yawning, lacrimation, mydriasis, inability to sleep,
voluntarymusclecramping,diarrhea,tachycardia,andsystolichypertension.
In rare cases, the patient may experience seizures. Methadone and diazepam
are both safe medications to assist with the detoxification from heroin.
A heroin overdose is an acute reaction that may lead to death if not
managed appropriately in drug users. Stupor, coma, seizures, respiratory
distress, cyanosis, and pulmonary edema are common signs of overdose.
Naloxone, an opiate antagonist, can be administered intravenously to assist
with managing the heroin toxicity. Treatment for heroin overdose includes
supporting the airway, breathing, and circulation. Naloxone can be administered by intravenous infusion.
Thedangerofheroinoverdose,althoughconsiderablylessfrequentthan
20 years ago, is still a threat to pediatric patients. Peer and social pressures
can make illicit drug use seem more appealing to adolescents, and pediatricians should be adequately prepared to handle acute and chronic drug abuse
problems in their patients.
Suggested Reading
Jenkins RR. Substance Abuse. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook
of Pediatrics. 17th ed. Philadelphia: Saunders; 2004, pages 653–61.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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» Next page: Do not assume that a negative drugscreen means that no drugs of abuse were used. Many drugs of abuse are not identified on standard urine drugscreening samples (Avoiding Common Pediatric Errors)
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