Category: 6. Substance Use

Assessing how to handle an adolescent’s substance abuse is a decision that few parents are prepared to make alone. We suggest consulting a mental health professional who specializes in this field. If you are having trouble knowing where to get help, speak with your child’s pediatrician. He may be able to begin intervention himself, then refer you to an experienced local practitioner.

Other sources for recommendations include:

• The psychiatry/psychology departments at area hospitals
• Your state or county department of mental health or public health
• State or county chapters of professional organizations such as the American Psychiatric Association, the American Psychological Association and the National Association of Social Workers The American Medical Association
• Any of the following three national help lines:
  • National Council on Alcoholism and Drug Dependence (NCADD)
  • Substance Abuse Treatment Facility Locator sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA)

The direction therapy will take depends on the extent of a youngster’s involvement with drugs. Typically, the problem is more serious and goes back farther than the parents imagined and the teenager is willing to admit. According to Dr. Schwartz, the types of substances and paraphernalia used reveal a great deal about an adolescent’s experiences with substances.

“Let’s say that you find a bag of marijuana in your kid’s room,” he says. “It’s almost always going to be his, even though he may claim that he’s ‘holding’ it for someone else. This tells you that the teenager has gone beyond the passive acceptance of marijuana at a party once or twice and has actively made a purchase. Also, he wants the drug badly enough that he’s willing to risk storing it at home.

Your child’s behavior and willingness to quit using and engage in treatment and other mental health or behavioral problems will also help guide treatment will also influence which intervention is most suitable.

• Treatment ranges from outpatient to residential with many different levels of intensity in between. The majority of kids with drug problems can be managed in an outpatient treatment program. 
• Kids who are likely to have withdrawal benefit from medical support during the initial phases of treatment. 
• Kids who have co-occurring mood, anxiety or thought disorders may need an “Acute Residential Treatment” setting where they can be stabilized for days to weeks before coming back home. 
• Some kids have so much trouble remaining sober in their usual surroundings they need a residential program to help them get into a solid recovery.
• Finally some kids refuse to engage in any type of treatment.  If this is the case and your child is using drugs, the state’s law enforcement or social services agencies may be able to help support you and your child, though generally involving these agencies is a last resort when a child is unwilling or unable to engage in any other treatment and continues to use drugs.

Would you recognize an e-cigarette if you saw one? Not all e-cigarettes look alike, and vaping is easy to hide.

Why is vaping easy for teens to hide?

Electronic nicotine devices can look like a pen, a computer memory stick or flash drive, a car key fob, or even an asthma inhaler. Instead of inhaling tobacco smoke from a cigarette, e-cigarette users inhale vapor from liquid “e-juice” that has been heated with a battery-powered coil. This is called vaping. The juice is flavored and usually contains nicotine and other chemicals.

E-cigarettes are unhealthy and addictive.

The Centers for Disease Control and Prevention (CDC) are investigating an outbreak of severe lung disease related to vaping that has caused severe illness and death in many US states. The American Academy of Pediatrics joins the CDC to remind parents that e-cigarette use is never safe for youth, young adults, or pregnant and/or breastfeeding women.

Here’s what you should know about teen vaping trends:Teens might use different words to talk about e-cigarettes and vaping, including the brand of the e-cigarette device. For example, “JUULing” is a popular word to describe using a brand of e-cigarette.Teens can order “e-juice” on the Internet. The legal age to buy e-cigarettes is 21, but online stores don’t always ask for proof of age.E-cigarette juices are sold in flavors like mint and menthol. Most have the addictive ingredient nicotine. The more kids vape, the more hooked they become.Kids who vape just once are more likely to try other types of tobacco. Their developing brains make it easier for them to get hooked.E-cigarettes may not help people quit using tobacco. Some adults use e-cigarettes when they want to stop smoking tobacco cigarettes. While a recent report found e-cigarettes are “less toxic” than cigarettes, most people who use e-cigarettes do not quit using cigarettes. The healthiest option is for parents and their children to quit.

Talk with your pediatrician

If you have questions about vaping, talk with your pediatrician. Your regional Pediatric Environmental Health Specialty Unit (PEHSU) have staff who can also talk with parents about concerns over environmental toxins.

​​Drug overdoses are a leading cause of unintentional de​ath in the United States, and opioids are a major force behind these deaths. All ages and communities ​are affected by opioid addiction.

Opioid overdoses have been growing worse during the COVID-19 pandemic. More than 40 states have seen rising deaths from opioids. Some of these deaths are from an illicit form of a powerful prescription drug called fentanyl. The rapid increase in deaths from these synthetic opioids is especially alarming.

Treating and preventing opioid use disorder is a responsibility we all must share. Here’s why it is now more important than ever for families to have access to the care they need, including help with drug addiction.

What are opioids?

Opioids are a category of highly addictive narcotic substances that include prescription pain medicine and illicit opioids like heroin. They are products, or synthetic versions, of the opium produced in small amounts by poppy plants. Large doses can slow body’s heart and breathing rate to the point of stopping completely.

Killing more than pain

According to the Centers for Disease Control and Prevention (CDC), 128 people in the United States die every day from an opioid overdose. Prescription opioids are found in millions of households across the country. In fact, the U.S. consumes the majority of the world’s prescription opioid supply. According to the CDC, there have been more opioid prescriptions reported in some states than there are people living in those states.

Examples of opioid medication used nonmedically in the United States Oxycodone – Found in brands such as OxyContin, Percodan, Percocet, Oxecta, Oxycet, and Roxicodone. Some of the common non-prescription or “street” names used for these drugs are Kicker, 30s, 40s, 512s, Oxy, Bean​​s, Blues, Buttons, Cotton, Kickers, Killers, Percs, and Roxy.Fentanyl – Including Actiq, Duragesic, Fentora, Lazanda and Sublimaze, is 50 to 100 times stronger than heroin. Street names for fentanyl or for fentanyl-laced heroin include Apache, Birria, Blonde, Blue Diamond, China Buffet, China White, China Girl, Dance Fever, Facebook, Friend, Goodfella, Jackpot, Murder 8, Snowflake, TNT, Tango and Cash, White Ladies.Hydrocodone or dihydrocodeinone – Found in Vicodin, Norco, Zohydro, Hysingla Co-gesic, Liquicet, Lorcet, Dolacet, Anexsia, Zydone, and Xodol. Common street names for the pill version and cough syrup forms are Robo or Tuss, Vikes, Veeks, Idiot Pills, Scratch, 357s, Lemonade, Bananas, Dones, Droco, and Lorries.Codeine, like hydrocodone – Sometimes found in cough syrup form, it may be called syrup on the street. Brands of acetaminophen, such as Tylenol, that include codeine might be called schoolboy or Cody.Morphine – Including brands such as AVINza or Kadian. On the street, it may be referred to as Mister blue or dreamer.​

How opioid use can lead to addiction

Opioids produce short-term positive feelings by mimicking the body’s natural endorphins. In addition to decreasing pain, many experience a “rush” or “high,” while others feel improved mood, and/or reduced anxiety or stress. These effects are short-lived, and with continued use, people quickly develop tolerance to opioids, needing higher doses to try to reach the same effects. When they stop using, they may experience withdrawal symptoms such as anxiety, sweating, and flu-like symptoms. When this happens, people’s opioid use shifts to focus on relieving and preventing withdrawal.

For many people who develop addiction to prescription opioids, when their prescription runs out, they may start buying drugs from dealers or turn to another opioid — heroin. Studies show four out of five new individuals using heroin started by prescription painkillers for nonmedical purposes.

The opioid epidemic’s effect on children & teens

• Addiction doesn’t care. Addiction harms children and teens in many ways. Families may be broken apart when a parent is arrested and sent to jail ​for buying or selling opioids. Parents​ who develop addiction may become unable to prioritize the needs of their family and children. Heartbreaking news describe tragic examples of babies who died of thirst or starvation, for example, after their parents overdosed.
• Prenatal exposure. Babies exposed to opioids during pregnancy can be born with neonatal opioid withdrawal syndrome (NOWS). Federal reports show that a baby with NOWS or neonatal abstinence syndrome (NAS) was born every 15 minutes. Facing lengthy hospital stays, babies with NOWS are more likely to have low birthweight, trouble breathing and eating, seizures and tremors, and can experience long-term problems with learning and behavior. Doctors encourage pregnant mothers who use opioids to reach out for treatment and recovery care and services and ask them for help.
• Poisoning and overdose. Children and teens hospitalized for opioid poisoning tripled between 1997 and 2012. Most of the overdose patients were teens, but the largest increase in poisonings was among toddlers and preschoolers. According to one study, children whose mothers are prescribed opioids face a much higher risk for unintentional overdose compared to children whose mothers received a non-opioid prescription, such as ibuprofen, for pain.

What can parents do?

• Talk to your kids. Tell your children about how dangerous opioid drugs can be, and why it’s important to use them only–and exactly–as prescribed. Children who learn about the risks of drugs at home are less likely to use drugs than those who don’t learn this at home. Make sure they understand that it is illegal to share opioid medications. More than half of individuals 12 and older who used pain relievers nonmedically said they were given by, bought from, or taken from a friend or family member.
• Store medicines safely. Keep opioids and other prescription medicine up and away in a secure place. Count and monitor the number of pills you have and lock them up. Do not allow your child or teen unsupervised access to these medications. Never let your child take someone else’s prescription medication.
• Dispose leftover prescription medication. Return leftover prescriptions to a hospital, doctor’s office, or pharmacy. Many communities offer “take-back” events to collect unused prescription medications.
• Use only when nothing else works. If your child has a surgical procedure, you may be concerned about how to help your child manage pain and discomfort. If your doctor has prescribed a pain reliever that contains an opioid, it is important to monitor your child’s use of it. It should be taken exactly as prescribed, and for the shortest time necessary.
• Consider the alternatives. Many people believe opioids work best for pain, but recent studies show that non-opioid medicines such as ibuprofen and naproxen, as well as non-medical approaches can be just as effective. Your doctor may suggest trying certain complementary and alternative treatments—such as acupuncture—as a first step for treating and managing chronic pain.
• Ask for help. If you think you or your child may be using opioids nonmedically, or developing addiction, don’t hesitate to seek help. Opioid use disorder is a chronic, treatable condition that can be managed successfully with medication and recovery support services. Your child’s pediatrician can explain treatment and resources available for teen and young adult patients with opioid use disorders, or provide referrals to other providers who can help. Similar treatment is available for pregnant individuals with opioid addiction, as part of a comprehensive public health approach.
• Know what to do in an overdose emergency. Ask your pediatrician about naloxone, which can prevent opioid overdose deaths. Learn the signs of a possible overdose, such as, difficulty and shallow breathing, severe sleepiness, and not being able to wake up. Always call 911 if you believe someone is experiencing an overdose, even if you give them Naloxone. Know that in many states, Good Samaritan laws provide legal protection to people acting to help someone who has overdosed.

​​​​Most teenagers are aware that tobacco use is a leading cause of death. However, this doesn’t stop them from trying tobacco products. Trying tobacco just one time puts them at risk for addiction to nicotine.

The American Academy of Pediatrics (AAP) supports actions to help prevent teens from using tobacco, including restricting advertising and raising the product prices and purchase age of tobacco products.

Health Concerns and Fast Facts

• Health problems caused by tobacco use include tooth decay, damaged metabolism, frequent coughing, increased phlegm, decreased physical fitness, and breathing problems.
• 90% of daily tobacco users begin by age 18.
• In 2014, 25% of high school students reported current use of a tobacco product, including 13% who reported current use of two or more tobacco products.
• Types of tobacco products used by high school students include: e-cigarettes, hookah, cigarettes, cigars (including small cigars or cigarillos like Swisher Sweets or Black and Milds), smokeless tobacco, pipes, snus, bidis, and dissolvable tobacco.
• Factors that can influence tobacco use are:
  • Use of tobacco products by friends or family members
  • Lack of parental support or involvement
  • Accessibility, availability, and price of tobacco products
  • Low levels of academic achievement
  • Low self-esteem
  • Exposure to tobacco advertising (including in movies, TV, or video games)

Tips to Keep Teens from Using Tobacco Products

• Be a role model for your children. Children of current and former smokers face an elevated risk of becoming a smoker.
• If you smoke, try to quit. Enlist your family’s support. Seeing how difficult it is for you to quit may be enough to keep your kids from starting. Designate your house and car as smoke-free zones.
• Be aware of smoking that children see in movies, video games, and on TV. The AAP recommends any movie, TV show, or video game showing tobacco use to be rated for adults only.
• Tell your children about the side effects of smoking. Smoking hurts athletic ability, causes wrinkles, stinky breath, stained teeth, and costs a lot of money.
• If teens do start to smoke, encourage them to quit. By quitting, people can add years to their lives. It isn’t easy, but every attempt should be considered a success.
• Think beyond cigarettes. Smokeless tobacco, hookah, e-cigarettes, and cloves are all addictive and can cause health problems. None are safe to use.

Warning: The tobacco industry often creates youth smoking prevention programs that they claim are designed to prevent children from becoming smokers. These programs have been found to be ineffective and to do more harm than good. Always look closely at a youth smoking prevention program or campaign and see who is behind it before introducing your children or students to the information. Programs for smoking prevention should be evidence-based and not have any industry oversight in educational content.

How can I tell if my son or daughter is having a problem with gambling?

Look for the following warning signs:

• Finding gambling “stuff” like lottery tickets, betting sheets, and casino chips
• Excessive TV sports watching and an overly intensive interest in the outcome of sports events
• Visits to a casino, despite being underage
• Excessive “checking in” or spending time on the Internet
• Unexplained debts
• Flaunting large amounts of money or buying expensive items
• Absences from school or work
• Anxiety and nervousness
• Stealing for gambling money

Any game of chance or skill that is played for money is gambling. Most forms of gambling are illegal for anyone younger than 18 years. However, teens find their own ways to gamble, including

• Playing cards or dice games for money
• Playing games of skill for money (for example, pool, basketball)
• Buying lottery tickets and scratch cards
• Playing casino- and arcade-type games (like pull tabs and slot machines)
• Placing bets on sports events
• Gambling on the Internet

What You Can Do

You are the best role model for your children. Take a close look at your own attitudes and habits. Do you spend your last dollar on lottery tickets? Do you make frequent visits to the casino with hopes of striking it rich? While gambling may be okay for you, you may be sending a message to your teen that gambling is a safe and healthy activity.

Talk with your children about gambling. Remind them that gambling is illegal for teens. Be clear about how you feel about gambling, and let them know what you expect of them. Help your children develop ways to resist gambling and develop interests in other activities. Don’t take your children with you to the casino even if child care is offered.

Identifying a gambling problem early is the key to successful treatment. If you feel your teen may have a problem, there are people in your community who can help, including pediatricians, counselors, teachers, and elders or clergy.

Compulsive gambling is like other addictions. Outside help may be the only way a person can stop. Talk with your pediatrician for information about treatment options, like individual counseling or family therapy, that can give compulsive gamblers the strength they need to quit.

“Are you listening to me?” Sometimes it seems as if half of what parents say to teenagers skips off their consciousness like rocks skimmed across the surface of a lake. When discussing the subject of drugs, however, you’re liable to have an unusually attentive audience. The Partnership for a Drug-Free America’s annual “Partnership Attitude Tracking Study,” the largest survey on drug-related attitudes in the United States, sampled the opinions of approximately nine thousand youngsters aged nine to eighteen. Three-quarters of the fourth-graders said that they wanted more information about drugs from their parents.

Your words carry weight, too. According to the 1998 survey, the stronger and more frequent the antidrug messages at home, the less likely a child is to become a user. Only 26 percent of adolescents who said their parents had taught them “a lot” about the dangers of drugs had smoked marijuana. But among youngsters who claimed to have learned “a little” or “nothing” from their families, the rates of pot use were progressively higher: 33 percent and 45 percent, respectively. That pattern remained consistent for other drugs, too. Overall, boys and girls whose parents ignored the issue were about two times as likely to use drugs than kids who learned “a lot” at home.

A mere one in four teens felt that they were receiving adequate parental guidance. Clearly, more of us have to broach the subject with our youngsters, and on a regular basis. We present some ideas of what to say.

Tips For Talking To Your Child About Substance Use

Leave No Doubt As To Where You Stand

“You are not to use any drug, including tobacco or alcohol, under any circumstances.” Then explain why:

• Because we love you.
• Because drugs are dangerous, and we don’t want to see you harm yourself.
• Because it is against the law.

As When Setting Any Limit, Clearly Spell Out The Consequences For Defying The Rules:

What the punishment will be and how it will be implemented? Later, we suggest plans of action for parents who discover that their child is smoking, drinking and/or using illicit drugs.

Don’t Hesitate To Aim For The Emotional Jugular

Remind your teen that you would be deeply disappointed in his behavior if he were to disobey you on this matter. Research shows that when a child is deciding whether or not to indulge, a key consideration is, What will my parents think?

When Discussing The Dangers of Drugs, Emphasize The Immediate Consequences

“Parents have to keep in mind where their children are at developmentally,” notes Dr. Richard Heyman, a pediatrician from Cincinnati and former chair of the American Academy of Pediatrics’s Committee on Substance Abuse.

“Younger teens tend to think mainly in terms of today, tomorrow and the next day,” he explains. “It’s not until much later in adolescence that kids begin to contemplate how their actions could impact on their lives down the line.” They’re also still at a stage of thinking that they are invincible. Therefore, warnings that cigarette smokers are more than ten times as likely to die of lung cancer than nonsmokers are probably going to elicit little more than a shrug from a thirteen-year-old. Or a twenty-year-old, for that matter.

Instead, stress how smoking tobacco causes bad breath, hoarseness and a hacking cough; stains teeth yellow; impairs athletic performance; and in general makes other people not want to be around the smoker. In an American Cancer Society survey, eight in ten boys and seven in ten girls aged twelve to seventeen said they wouldn’t date someone who smoked.

Remind Your Teenager That Smoking, Drinking and Drugging Aren’t Just Harmful, They’re Expensive

A youngster with a pack-a-day cigarette habit sees close to a thousand dollars a year go up in smoke. Surely your son or daughter could find better ways to spend all that money, whether it’s buying CDs and clothing or saving up for a car and college.

Appeal To An Adolescent’s Natural Independent Streak By Praising His Determination To Avoid Using Drugs

“I admire the way you’ve stuck to your principles and refused to use drugs. It takes courage to not always go along with the crowd, and I’m proud of you.”

Explain To Your Child That Once People Start Using Drugs, They May Not Be Able To Stop

Addiction is poorly understood, by both substance abusers themselves and those who care about them. The young person with an addiction tells himself and everyone around him that he can quit whenever he wants.

But with prolonged use, the addictive substance triggers long-lasting changes in the chemical composition of the brain. At that point professional treatment is required to cure him of his compulsive behavior. Even then, many tobacco users, alcoholics and drug abusers will relapse and revert to their old ways.

Cocaine and Crack

The use of cocaine, the scourge of the prosperous 1980s, crashed resoundingly by the end of the decade, as did a number of those who abused it. Ironically, when the stimulant first attracted the attention of the baby boomer generation, it had been touted as harmless and non-habit-forming. A recreational drug.

Hardly. Even now, with cocaine use less than half of what it once was, addiction to the drug accounts for more admissions to publicly funded rehabilitation programs than any other form of substance abuse, with the exception of alcohol.

At the height of the mid-1980s surge in cocaine abuse, roughly one in eight high-school seniors had used the drug in the previous year. Another one in twenty-five had tried the new smokable permutation crack, which is made by mixing the powdered “salt” cocaine with a dangerously flammable chemical to convert it back to its original “freebase” form. Smoking the small rocks of hardened paste produces an immediate, more intense high. (The name refers to the crackling sound the drug makes when freebased.) Crack is more addictive than powdered cocaine and also more affordable. However, the effect is short-lived: five to ten minutes, as opposed to the fifteen-to-thirty-minute high from cocaine. Thus teenagers who are dependent on crack need hits more frequently.

The hazards of coke and crack received massive news coverage. Presumably, the reports scared off a sizable portion of young substance abusers, because both drugs took a tumble in popularity. Use of other stimulants has also dipped sharply from the 1981 high of one in four twelfth-graders. In 1998, only one in ten admitted to having taken uppers.

MDMA (Ecstasy)

Sometimes a substance arrives linked to a cultural phenomenon, as with Ecstasy, also called “Adam” or “XTC” on the street. The amphetamine is frequently taken in preparation for attending large late-night dances called raves, supposedly to enhance the experience. Ecstasy is an analog, one of the “designer drugs” synthesized by underground chemists in an attempt to evade the Controlled Substance Acts.

An analog closely resembles another chemical structurally, but the clandestine laboratories alter the formula just enough to render it a different compound and thus not covered under the law. The Drug Enforcement Administration (DEA) began adding these modified drugs to its list of controlled substances in 1984, but new analogs promise to keep materializing on the street.

Disciples of Ecstasy, a synthetic amphetamine with hallucinogen-like properties, insist that it breaks down barriers of communication, enhances music and promotes warm, tranquil vibes—echoing the claims once made about LSD.

Ecstasy is a dangerous chemical and should not be used. However, one in twelve high-school seniors who responded to the 1999 Monitoring the Future Study (a national survey that tracks drug-use trends among America’s adolescents) admitted to having tried MDMA, an increase of nearly 40 percent over the year before.

Some young people have gravitated toward herbal ecstasy, which is marketed as a “natural” alternative and is available over the counter in most states. “Many of the herbal ecstasy products are junk,” Dr. Schwartz says bluntly. “They have no effect.

“Other brands, though, contain an ancient Chinese herb called ephedra, or ma huang. The active chemical in ephedra is ephedrine, a stimulant. It can elevate blood pressure, but it also dries you out by preventing sweating and salivation. That combination can cause heat stroke and a number of other problems.” Ephedrine-laced dietary supplements have been implicated in seventeen deaths and hundreds of adverse reactions, leading several states to ban the products.

Methamphetamine

Methamphetamine is the only other stimulant besides Esctasy to have widened its hold on young people. It has been approved for attention deficit hyperactivity disorder in children, though it is often difficult to obtain. Physicians prescribe the powdered form sparingly, though, because meth, or “speed,” is extraordinarily addictive.

Like cocaine, the drug can be processed illegally into smokable clear crystallike chunks sold on the street as “ice.” Either form propels users on an intense high lasting anywhere from two to twenty-four hours. But once the effects wear off, they come crashing down into an oppressive psychological low that can linger for days. Chronic methamphetamine abusers may experience hallucinations and emotional disturbances virtually indistinguishable from schizophrenia, a major mental disorder.

Related Paraphernalia

• Vials
• Resealable plastic bags
• Syringes
• Cotton balls
• Matches
• Butane lighters
• Spoons, bottle caps and other implements for “cooking” the drug over a flame
• Straws, rolled-up dollar bills, for snorting

Cocaine/Crack

• Mirrors
• Razor blades
• Straws, small plastic tubes, rolled-up dollar bills, for snorting
• Scales
• “snow seals” (folded pieces of white paper) and foil strips, for storing
• Tiny plastic bags
• Syringes
• Matches
• Butane lighters
• Glass vials
• Glass pipes
• Bottles of ether, sodium bicarbonate or ammonia, used in freebasing
• Ceramic mortar and pestle, for crushing rock cocaine

Legal or Illegal

Cocaine, amphetamines and methamphetamine are available only with a written prescription.

Signs of Stimulant Use

• Excitability
• Mental clarity
• Euphoria
• Talkativeness
• Restlessness
• Aggressive behavior
• Following the high, a “crash,” or depression, marked by irritability, anxiety, paranoia, agitation
• Dilated pupils
• Visual and auditory hallucinations
• Rapid, irregular heart rate
• Elevated blood pressure
• Fever
• Convulsions
• Dry nose and mouth
• Stuffy nose and sniffing, from snorting cocaine

Effects of Ecstasy

• Confusion
• Depression
• Sleep disturbances
• Drug craving
• Severe anxiety and paranoia during and sometimes weeks after taking mdma (psychotic episodes have been reported)
• Muscle tension
• Involuntary teeth-clenching
• Nausea
• Blurred vision
• Rapid eye movement
• Faintness
• Chills or sweating
• Increased heart rate and blood pressure

Possible Long-Term Effects of Stimulants

• Violent or erratic behavior
• Hallucinations
• Drug-induced psychosis
• Appetite loss
• Insomnia
• Impaired sexual performance
• Chronic respiratory problems
• Nosebleeds, ulceration of the mucous membrane of the nose and perforation of the nasal septum, from snorting cocaine
• Blockage of the tear ducts from snorting cocaine, leading to serious eye infections and eventually the destruction of the bone in the eye sockets cardiac or respiratory arrest
• Irregular menstruation

A couple of guys on my team are using steroids. Are they really that dangerous?

You may have heard steroids called roids, juice, hype, or pump. Anabolic-androgenic steroids are powerful prescription drugs that some athletes use not for medical reasons, but as a way to boost athletic performance and build muscle and body mass. They work by acting like the body’s natural male hormone, testosterone.

Know the Risks

Steroid use always causes bad side effects. They can really mess up your body. Megadoses do not give faster results and using in cycles is not safer. Stacking is really dangerous. Even though some of the side effects go away when you stop using steroids, some may not.

Remember! These steroids act like the male hormone testosterone—so for both guys and girls, they can cause

• Acne, really bad acne, especially on face and back
• Baldness
• A slow down of growth in athletes who aren’t done growing yet
• High blood pressure, unhealthy cholesterol changes, and heart disease
• Blood clots and stroke
• Liver damage, jaundice, or liver cancer
• Headaches, aching joints, and muscle cramps
• Nausea, vomiting, and diarrhea
• Sleep problems
• Increased risk of ligament and tendon injuries, which can end your athletic career for good

In addition, anyone injecting steroids with a needle and sharing needles with other users is at high risk for serious infections like hepatitis or HIV, which cause the AIDS virus. Using one type of illegal drug may also make other drug use more likely, and cause even more health risks.

In guys, steroid use causes the body to produce less testosterone. The result? Your testicles shrink. What else?

• A low sperm count
• Impotence (inability to get an erection)
• Breast and nipple growth
• Enlarged prostate (a gland in the penis)

Steroids can be pretty tough on girls’ bodies too, causing

• Breast shrinkage
• More face and body hair
• Voice deepening
• Problems with menstrual periods
• Clitoris enlargement

Steroids Can also Mess with your Mind and Cause

• “Roid rage”—severe, aggressive behavior that may result in violence, such as fighting or destroying property
• Severe mood swings
• Hallucinations—seeing or hearing things that are not really there
• Paranoia—extreme feelings of mistrust and fear
• Anxiety and panic attacks
• Depression and thoughts of suicide

Better Safe Than Sorry!

If you are serious about your sport and your health, you don’t need drugs to prove yourself. Instead, keep yourself healthy by

• Training safely, without drugs
• Eating a healthy diet
• Getting plenty of rest
• Setting realistic goals (Be proud of yourself when you reach your goals!)
• Getting training, coaching, and advice from reliable professionals
• Playing safely and using protective gear
• Talking with your pediatrician about your health and nutrition, and how to prevent injuries and gain strength safely

Share this information with friends and teammates. Take a stand against the use of anabolic steroids and other drugs. Truly successful athletes combine their natural abilities with hard work to achieve their best. There is no quicker or easier way.

Tobacco use is the leading cause of preventable death in the United States. Many high school students would turn 18—the previous legal age to purchase tobacco and e-cigarettes in most states—during their senior year of high school. Often, they would purchase tobacco and e-cigarette products for younger students.

Fixing the problem

In December 2019, a federal Tobacco 21 law was passed that raised the national purchase age for all tobacco products, including e-cigarettes, to 21 years old. This law put the onus on the retailer by making it illegal to sell any tobacco product to a minor under the age of 21. This law is generally enforced through fines and protects younger adolescents from accessing tobacco products through friends who are legally able to buy them.

Fast facts

• According to 2021 data from the National Youth Tobacco Survey, over 13% of high school students (2.06 million) currently use a tobacco product. Current tobacco product use was highest for e-cigarettes (11.3%), followed by cigars (2.1%) cigarettes (1.9%), smokeless tobacco (1.2%), hookah (1.2%), heated tobacco products (0.8%), and pipe tobacco (0.4%).
• Cigarette smoking is responsible for more than 480,000 deaths per year in the U.S., including nearly 42,000 deaths resulting from secondhand smoke exposure. This is about 1 in 5 deaths annually, or 1,300 deaths every day.
• A 2015 Centers for Disease Control and Prevention (CDC) study showed that 75% of the American public, including 70% of current smokers, supported a minimum tobacco purchase age of 21.

How Tobacco 21 laws help

• Youth brains are susceptible to the addictive properties of nicotine, because their brains are still developing.
• The majority of smokers (90%) start by age 18. These young smokers often get their cigarettes from their older friends.
• Raising the tobacco purchase age would ensure that older high school students and young college students cannot buy tobacco products for younger friends. This can prevent or delay initiation of tobacco use by adolescents.
• A purchase age of 21 is consistent with the laws for alcohol. Raising the legal drinking age to 21 has helped reduce drunk driving fatalities and reduce alcohol dependence among youth.

Components of the federal Tobacco 21 law

• Includes all types of tobacco products: cigarettes, smokeless tobacco, electronic nicotine delivery systems (including e-cigarettes), and hookah.
• Includes information about who will manage compliance.
• Does not penalize underage tobacco users for possession of tobacco products. Instead, the onus is placed on retailers and generally enforced through fines.

Nearly half of young people who use heroin start by abusing prescription pain medicine such as Vicodin, OxyContin, Percocet, codeine, and Fentora—all of which are opioids.

The rise in prescription drug abuse:

In recent years, there has been an uptick in the number of teens who abuse prescription drugs. About 1 in 5 high school students said they have abused prescription drugs, according to a 2009 study by the Centers for Disease Control and Prevention (CDC). Drug overdoses are the leading cause of accidental death in the United States.

Why are teens doing this?

Teens are engaging in this dangerous behavior for a variety of reasons. In some cases, they do it to party and get high, but also to manage stress or regulate their lives. Many teens are abusing pain relievers to cope with academic, social, or emotional stress.

Opioids create a temporary feeling of euphoria, followed by dysphoria, which can easily lead to addiction. Some people end up taking increasingly larger doses in order to regain the euphoric effect, or escape the unhappiness caused by withdrawal. Others find they need to continue taking the drugs not only to reduce withdrawal symptoms but to simply feel normal. Opioids also depress your heart rate and breathing. Large doses can cause sedation and slowed breathing to the point that breathing stops altogether, resulting in death.

Where are teens getting prescription pain medicine?

Two-thirds (66%) of teens who report abuse of prescription pain relievers are getting them from friends, family, and acquaintances. Some teens share prescription medicines among themselves—handing out or selling their own pills or those they’ve acquired or stolen from classmates. Many start abusing it at a party or with friends, because they’re curious or think it will make them feel good.

A very small minority of teens start taking it legitimately when prescribed by a doctor after an injury or dental procedure—but in some cases, legitimate use turns to dependence, abuse, addiction.

Why are opioid-addicted teens turning to heroin?

Heroin and prescription pain medicines both belong to the opioid class of drugs and function similarly in the body and brain. One main factor that contributes to the popularity of a drug is availability, and while efforts to reduce the availability of prescription pain medicine have begun to show success, the supply of heroin has been increasing. Heroin is also far cheaper and easier for teens to obtain than prescription opioids.

About heroin:

Heroin can be smoked or injected, and many teens opt to avoid needles and smoke the drug. Street names for heroin include “Black tar” and “China white.” Unfortunately, needle use is rampant among heroin users—increasing a teen’s risk of HIV, hepatitis C, and other injection-related illnesses.

With regular use, greater amounts are needed to achieve the same intensity, and physical dependence and addiction develop. Reducing the dosage or quitting “cold turkey” will bring on days of agonizing withdrawal symptoms. Addicts ultimately depend on heroin not to feel good but to avoid feeling bad.

 What should parents do?

• Educate yourself. Visit drugfree.org and MedicineAbuseProject.org for information, tools, resources and support.
• Communicate the risks of prescription medicine abuse to your kids. Children who learn a lot about the risks of drugs at home are at least 20% less likely to use drugs than those who do not get that critical message from their parents.
• Safeguard your medicine. Keep prescription medicine in a secure place, count and monitor the number of pills you have and lock them up—and ask your friends and family members to do the same.
• Get help. If you think your child has a problem with prescription medicine abuse, please visit drugfree.org/get-help or call the toll-free helpline to speak to a parent specialist: 1-855-DRUGFREE (1-855-378-4373).