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December 3, 2009

Characteristics of Adolescent Heroin Admissions

In Brief
  • In 2007, there were just over 1,600 adolescent substance abuse treatment admissions for heroin abuse

  • On average, adolescent heroin admissions were 14.8 years old when they first used heroin and 16.3 years old at admission to treatment, indicating approximately 18 months of use before entering treatment

  • More than half (56 percent) of adolescent heroin admissions had at least one prior treatment episode

Heroin is a highly addictive opiate with a large potential for abuse. It poses a considerable danger for adolescents, potentially resulting in serious psychological, social, educational, and legal consequences. Heroin use can also result in significant health problems including overdose and death, and, if sharing needles or other injection equipment, exposure to HIV, hepatitis C, and other diseases.

Using data from the 2007 Treatment Episode Data Set (TEDS), this report examines the characteristics of substance abuse treatment admissions aged 12 to 17 reporting heroin abuse. TEDS collects information on up to three substances of abuse at the time of admission. Of the approximately 132,000 adolescent substance abuse treatment admissions in 2007, slightly more than 1,600 reported heroin as a primary, secondary, or tertiary substance of abuse. Understanding the characteristics of adolescent admissions reporting heroin abuse may help treatment providers offer age-appropriate services, including behavioral support and pharmacotherapy, to help reduce heroin use and associated negative consequences in this population.

Demographic Characteristics

In 2007, adolescent substance abuse treatment admissions reporting heroin abuse were slightly more likely to be male than female (53 vs. 47 percent). More than three quarters (76 percent) of adolescent heroin admissions were non-Hispanic White, and 16 percent were Hispanic (Table 1). The race/ethnicity of adolescent heroin admissions varied when examined by gender. Male adolescent heroin admissions were less likely than their female counterparts to be non-Hispanic White (72 vs. 83 percent) but more likely to be Hispanic (19 vs. 11 percent).

Most (94 percent) adolescent heroin admissions were between the ages of 15 and 17 at the time of admission. On average, adolescent heroin admissions were 14.8 years old when they first used heroin and 16.3 years old at the time of admission to treatment. These findings indicate that the duration of use among adolescent heroin admissions from the time they first used heroin to admission to treatment was approximately 18 months.

Table 1. Percent Distribution of Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse, by Race/Ethnicity and Gender: 2007
 Race/Ethnicity Total Male Female
Total 100% 100% 100%
Non-Hispanic White 76% 72% 83%
Non-Hispanic Black 4% 4% 3%
Hispanic 16% 19% 11%
American Indian/Alaska Native 1% 1% 1%
Asian/Pacific Islander 1% 1% 1%
Other 2% 3% 1%
Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Route of Administration

Among adolescent substance abuse treatment admissions reporting heroin abuse, almost half (48 percent) reported injection as the route of administration, and almost a third (32 percent) reported inhalation (Figure 1). Male adolescent heroin admissions were less likely than their female counterparts to report injection as the route of administration (43 vs. 56 percent), but were more likely than adolescent female admissions to report inhalation as the route of administration (36 vs. 27 percent).

Figure 1. Route of Administration of Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse, by Gender: 2007

Stacked bar chart comparing Route of Administration of Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse, by Gender in 2007. Accessible table below.

Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Figure 1 Table. Route of Administration of Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse, by Gender: 2007
 Route of Administration Total Male Female
Other 1% 1% 1%
Oral 7% 8% 5%
Smoking 12% 12% 11%
Inhalation 32% 36% 27%
Injection 48% 43% 56%
Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Principal Source of Referral

Nearly two thirds of adolescent heroin admissions were referred to substance abuse treatment by the criminal justice system (33 percent) or were individual or self referrals (30 percent) (Table 2). Another 18 percent were referred by an alcohol or drug abuse care provider.

Among adolescent heroin admissions, males were more likely than females to be referred to treatment by the criminal justice system (39 vs. 25 percent). However, males were less likely than females to have been referred to treatment by an alcohol or drug abuse care provider (15 vs. 21 percent).

Table 2. Percent Distribution of Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse, by Principal Source of Referral and Gender: 2007
 Principal Source of Referral Total Male Female
Total 100% 100% 100%
Criminal Justice System 33% 39% 25%
Individual/Self 30% 30% 31%
Alcohol/Drug Abuse Care Provider 18% 15% 21%
Other Community 9% 7% 11%
Other Health Care Provider 7% 6% 9%
School 3% 3% 3%
Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Other Substances of Abuse and Co-Occurring Psychiatric Disorder

Most (87 percent) adolescent substance abuse treatment admissions reporting heroin abuse also reported abuse of other substances. More than half (56 percent) of adolescent heroin admissions also reported marijuana abuse, nearly one third (32 percent) also reported cocaine abuse, and almost one fifth (19 percent) also reported alcohol abuse (Figure 2).

Many adolescents who have a substance use problem also have a co-occurring psychiatric disorder. Almost one third (32 percent) of adolescent heroin admissions reported having a psychiatric problem in addition to their drug use problem (i.e., co-occurring disorders).1 Male adolescent heroin admissions were less likely than female adolescent heroin admissions to report a co-occurring disorder (27 vs. 37 percent).

Figure 2. Other Substances of Abuse Reported by Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse: 2007
Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Bar chart comparing Other Substances of Abuse Reported by Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse in 2007. Accessible table below.


Figure 2 Table. Other Substances of Abuse Reported by Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse: 2007
  Other Substances of Abuse Percent
Marijuana 56%
Cocaine 32%
Alcohol 19%
Other Opiates 12%
Stimulants 10%
Other 11%
Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Prior Treatment

More than half (56 percent) of adolescent heroin admissions had at least one prior treatment episode compared with 30 percent of adolescent admissions for substances other than heroin (Figure 3). Similar percentages of adolescent heroin admissions and adolescent admissions for other substances had been in treatment only once before (24 vs. 19 percent). However, adolescent heroin admissions were almost three times more likely than adolescent admissions for other substances to have had two or more prior treatment episodes (32 vs. 11 percent).

Figure 3. Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse and Other Substances of Abuse, by Number of Prior Treatment Episodes: 2007
Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Bar chart comparing Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse and Other Substances of Abuse, by Number of Prior Treatment Episodes in 2007. Accessible table below.


Figure 3 Table. Substance Abuse Treatment Admissions Aged 12 to 17 Reporting Any Heroin Abuse and Other Substances of Abuse, by Number of Prior Treatment Episodes: 2007
 Prior Treatment Episodes Any Heroin Other Substances
No Prior Treatment 44% 70%
One Prior Treatment Episode 24% 19%
Two or More Prior Treatment Episodes 32% 11%
Source: 2007 SAMHSA Treatment Episode Data Set (TEDS).

Use of Medication-Assisted Therapy

Medication-assisted therapy, using methadone or buprenorphine, is recognized as a highly effective treatment for heroin addiction. Medication-assisted therapy with methadone or buprenorphine was planned for more than one quarter (26 percent) of adult heroin admissions. However, treatment with methadone or buprenorphine was planned for only 3 percent of adolescent heroin admissions.

Discussion

Any use of heroin is a serious concern, and more so when the user is an adolescent. The public health risks faced by adolescents are identical to those associated with adult users including addiction to an opiate; possible exposure to infectious diseases; and, in the long term, the possibility of scarred or collapsed veins, endocarditis, and liver and kidney disease.

The data in this report have clear implications both for prevention and treatment specialists. To be most effective, prevention programs need to be targeted at adolescents before the probable age of initiation of heroin use (age 14). Similarly, treatment specialists may need to examine the programs they provide to adolescents. In addition to cognitive behavioral therapy, opioid maintenance therapy may also be appropriate for adolescent clients who are at least 16 years old and have parental consent. Many experts in the field of opioid addiction treatment believe that buprenorphine should be the treatment of choice for adolescent patients with short addiction histories.2-3 Finally, additional relapse and recovery services that are age appropriate may also be required to promote and sustain recovery for adolescent clients.

End Notes

1 Psychiatric problem in addition to alcohol or drug problem is a Supplemental Data Set item. The 29 States and jurisdictions in which it was reported for at least 75 percent of all admissions in 2007—AR, CA, CO, DE, FL, IA, ID, IL, KS, KY, LA, MA, MD, ME, MI, MO, NC, ND, NE, NM, OH, OK, PR, RI, SC, SD, TN, UT, WY—accounted for 54 percent of all substance abuse treatment admissions in 2007.
2 Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs (Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 05-4048). Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.
3 Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction (Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939). Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004.

Suggested Citation

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (December 3, 2009). The TEDS Report: Characteristics of Adolescent Heroin Admissions. Rockville, MD.

The Treatment Episode Data Set (TEDS) is a compilation of data on the demographic characteristics and substance abuse problems of those admitted for substance abuse treatment. TEDS is one component of the Drug and Alcohol Services Information System (DASIS), an integrated data system maintained by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). TEDS information comes primarily from facilities that receive some public funding. Information on treatment admissions is routinely collected by State administrative systems and then submitted to SAMHSA in a standard format. TEDS records represent admissions rather than individuals, as a person may be admitted to treatment more than once. State admission data are reported to TEDS by the Single State Agencies (SSAs) for substance abuse treatment. There are significant differences among State data collection systems. Sources of State variation include completeness of reporting, facilities reporting TEDS data, clients included, and treatment resources available. See the annual TEDS reports for details. TEDS received approximately 1.8 million treatment admission records from 45 States, the District of Columbia, and Puerto Rico for 2007.

Definitions for demographic, substance use, and other measures mentioned in this report are available in the following publication:

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (December 11, 2008). The TEDS Report: TEDS Report Definitions. Rockville, MD.

The TEDS Report is prepared by the Office of Applied Studies, SAMHSA; Synectics for Management Decisions, Inc., Arlington, Virginia; and by RTI International in Research Triangle Park, North Carolina (RTI International is the trade name of Research Triangle Institute). Information and data for this issue are based on admissions data reported to TEDS through October 6, 2008.

Access the latest TEDS reports at:
http:/oas.samhsa.gov/dasis.htm

Access the latest TEDS public use files at:
http://oas.samhsa.gov/SAMHDA.htm

Other substance abuse reports are available at:
http://oas.samhsa.gov

The TEDS Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

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