In the latest sign that the nation’s opioid epidemic is accelerating, the rate of drug overdoses and the death rate for young adults between the ages of 25 and 34 rose sharply in recent years, according to the Centers for Disease Control and Prevention. In 2016, nearly 35 out of every 100,000 people between the ages of 25 and 34 died of a drug overdose, according to the CDC. That’s a nearly 50 percent increase from the rate of overdose fatalities in that age group in 2014, when about 23 out of every 100,000 deaths was from a drug overdose. These figures include all drug overdose deaths, not just those from opioids.
The spike in overdose deaths is a factor in the rise in death rates for millennials. Between 2015 and 2016, the death rate for people in the 25 to 34 age group rose by more than 10 percent, according to a CDC report. Overdose deaths of young people are one of the key drivers of the opioid epidemic. In 2016, 42,249 people in the U.S. died of overdoses linked to opioids; that represented 66 percent of the nearly 63,600 overdose fatalities that year.
A number of factors make young adults vulnerable to opioids addiction and to fatally overdosing, says Howard Samuels, a licensed therapist and founder and chief executive officer of The Hills Treatment Center in Los Angeles. Samuels is in recovery from heroin and cocaine addiction and has been sober for more than 30 years. The emergence of synthetic opioids like fentanyl as a readily available street drug is one key reason so many millennials are fatally overdosing, Samuels says. Fentanyl is 50 to 100 times stronger than morphine and up to 50 times more potent than heroin. Of the more than 64,000 overdose deaths in the U.S. in 2016, more than 20,000 involved fentanyl or fentanyl analogs, according to the National Institute on Drug Abuse. Fentanyl analogs are drugs that have been designed to “mimic the pharmacological effects of the original drug,” as described by the Minnesota Department of Health. Some manufacturers create new fentanyl analogs to avoid an illegal classification or policy restrictions on drug manufacturing or detection in drug tests, according to the department.
Many people with substance misuse disorder begin using drugs in their teens, which helps explain why the opioid epidemic is hitting millennials so hard, Samuels says. “The opiates are so plentiful it becomes one of those drugs that people automatically try when they’re starting out,” he says. “So, they start out by smoking weed, then they try ecstasy and cocaine, and then heroin is so plentiful you may as well try that. It’s a natural progression. And once you start doing heroin, a ‘feel-good’ drug, you want to do it again and again. Before you know it, you’re an addict to the stuff.”
Adding opioids to street drugs
Some drug dealers add fentanyl to heroin, greatly increasing the drug’s potency and the odds that the user will overdose, Samuels says. “Fentanyl is an additive to make the heroin more powerful, but it is so powerful that it is deadly,” he says. “But it’s not in all heroin. You buy heroin, it’s like flipping a coin, you just don’t know. Heroin doesn’t come with a list of ingredients on the side. It makes the heroin much more dangerous today than it was when I was shooting up 35 years ago.”
To some people seeking their next high, the fact their drug of choice is potentially fatal isn’t a deterrent; it could be an attraction, Samuels says. “Millennials feel that they can live forever. They have no concept of dying because they are young,” he says. “When I was a kid using heroin, I never thought I would ever die. In fact when there was a brand of heroin on the street that was killing people, we wanted that brand because it meant it was really, really good. Our rationale was, ‘Well, the person who overdosed and died just didn’t know what they were doing.’ And that’s what [some] millennials think today.”
Samuels, 65, grew up in New York state and was using drugs and alcohol regularly by the time he was 14. He started using heroin at age 16 and three years later was arrested for possession of cocaine and heroin. A judge gave him the choice of going to a treatment center or prison for four years, and he chose rehabilitation. Samuels kept drinking and using drugs for more than a decade after his first stint in rehab, and finally stopped for good after his father died suddenly of a heart attack in 1984. He eventually started a treatment center and has remained sober.
Helping people struggling with opioids addiction
Helping people struggling with addiction get better is immensely rewarding, Samuels says. But most people with substance abuse disorder never get treatment, research shows. In 2016, an estimated 21 million people age 12 or older in the U.S. needed substance misuse treatment, but only 2.1 million people got it, according to the National Survey on Drug Use and Health. That represents about 11 percent of those who needed treatment. These figures include people who needed treatment for drugs other than opioids as well as people who needed help for misuses of alcohol. The survey also found that 93 percent of young adults ages 18 to 25 who needed substance misuse treatment did not get it.
Many people, including large numbers of millennials, simply don’t have access to substance abuse treatment because they don’t have health insurance, says Edward “Eddie” Haaz, a certified addictions specialist and licensed counselor in Bucks County, Pennsylvania. He’s also a board member with the Livengrin Foundation, a nonprofit substance abuse treatment center in Bensalem, Pennsylvania.
Treatment for substance misuse can be pricey. Haaz notes. Stays in rehab centers typically range from a few thousand dollars per month to more than tens of thousands of dollars for every 30 days. A stay at a “meat and potatoes” facility without “steam rooms, massage therapists or culinary experts” will cost a minimum of about $450 a day, Haaz says. Some high-end programs charge $50,000 to $75,000 a month. “Unless a person is gainfully employed in a job with health benefits, the access to treatment is challenging at best,” Haaz says.
Of course, there’s no guarantee that treatment will work for everyone, as Clare Amoruso of Cabin John, Maryland, would attest. Amoruso is a member of Surviving Our Ultimate Loss, or SOUL, a support group for mothers who have lost a child to an opiate overdose. In December, 2016, her son, Nicholas, died of a heroin overdose at age 37.
“His problems started in high school, when he started smoking marijuana,” she says. Nicholas transferred to a high school for kids with substance misuse disorder, a facility where recovery from drug addiction and alcoholism was a part of the curriculum, with support group meetings and drug testing, she says. Nicholas regularly attended support group meetings and stopped using drugs for a couple of years. But by the time he graduated with honors with a degree in finance from the University of Maryland, he’d stopped going to meetings and had resumed using marijuana, and at about age 27 started using heroin.
Over the years, Nicholas did stints at five or six rehab facilities, but he couldn’t stay away from drugs. In 2016, Nicholas moved in with his parents after he had back surgery and took a leave of absence from his job. One morning about two weeks before Christmas his mom found his body. “I think the cravings were just overpowering,” Amoruso says.
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