The crackdown on illegal use of prescription painkillers in some parts of the country has fueled increased use of heroin -- a cheaper and more dangerous alternative -- among teens. Both the painkillers and heroin are opiates, a class of drugs derived from the poppy plant.

If parents suspect their teens are using opiates, quick action is urged.  Warning signs include:

• Missing pills from prescription bottles in the home. Adults who’ve been prescribed opiate painkillers should be vigilant about storing them out of reach of teens. Young people often think the drugs are safe because a doctor prescribed them.
• Behavioral changes, such as diminished interest in school, extracurricular activities and friends.
• Indifference or even sleepiness, because opiates are sedatives.
•  Constant requests for money with nothing to show for it. Opiate users eventually build up tolerance to the drugs, so they need increasing amounts to achieve the same effects.
• Needle marks or unseasonable long-sleeved shirts to cover them up. Injecting heroin carries the added risk of disease transmission by shared needles. Heroin’s purity is increasing, though, so teens can get the same high from snorting it as from injecting it.

“Parents should not hesitate to force their kid to seek help for this,” says Dr. Joe Gay, an Athens, Ohio, psychologist who treats addiction, noting the “ever-present danger” of overdose. “This is such a critical condition, and it’s progressive. It’s important to get help as soon as you can.”

And studies show that the earlier it’s treated, the greater the likelihood of long-term abstinence, says Dr. Lynn Fiellin, a Yale internist who treats and studies addiction.

What to do
Treating teens is particularly challenging, she says, because their parents are usually the ones seeking help, not the teens themselves.

There are two medications used to treat addiction to opiates and opioids, which are synthetic opiates: methadone and buprenorphine, sold under the brand name Suboxone. Methadone is available only at methadone clinics, so patients must go to a clinic every day to drink the drug. But patients can get a prescription for buprenorphine --  launched in 2003 in the United States -- at their local pharmacy and take the pills in the privacy of their own home.

“Methadone is still considered the treatment of choice for maintenance in adolescents,” Fiellin says. “Increasingly, there’s more use of buprenorphine in teenagers, but it’s still limited.”

The safety and effectiveness of Suboxone in children under age 16 has not been established, according to Food and Drug Administration-approved prescribing information. In 2009, fewer than 1 percent of doctors who prescribed buprenorphine were pediatricians, according to government data. However, a growing body of research supports the use of buprenorphine in teens, Fiellin says.

SAMHSA, the federal Substance Abuse & Mental Health Services Administration, has a searchable substance abuse treatment locator at findtreatment.samhsa.gov. SAMHSA also maintains a searchable locator of physicians and treatment programs that use buprenorphine.

Related stories:

• Mom's last resort: Opiate antidote saves lives
• How prescription painkillers pave the way to heroin