At Children’s National, children often present after experiencing an overdose

or having a medical complication because of using these M30, or the fake

Percocet pills. We’ve had kids come in following conditions such as
preliminary hemorrhage, where they were bleeding into their lungs, and
overdose is not the only concern.

Apart from that, we also have had kids presenting actively using these pills.
They haven’t overdosed yet but they’re asking for help to stop using these
pills.

Some things that we have noticed, and this is the trend across the DMV region
… the kids who are presenting to treatment, these are kids who are motivated
to stop – they predominantly identify as Hispanic in ethnicity. Most of them
have Medicaid for insurance.

A lot of them, you know, they come to us – the average age is about 16, 16½
and their first use of opioids, these pills, was about a year ago. So the average
first use was about 15 to 15½ years of age. They are really struggling, and they
want to get better.

From cannabis to crushing fake pills

KALIAMURTHY: Another common trait: cannabis use is quite common in
this population. Pretty much every patient that I’ve come across started off
around age 12 using cannabis products. This includes the flower and bud,
vapes or edibles. Soon they transition to using the M30 pills.

There are various different reasons, one of which is just access. A lot of other
kids are using it. They’re using it in schools. They try it, they like it, and then
it escalates and they stop using other substances.

Most of these kids start off with crushing and try it nasally by snorting it and
then they transition to smoking. What they do is they put these pills on a piece
of aluminum foil, heat it up and inhale the fumes that come up. We haven’t
had anyone come in who reported using any of these pills intravenously.

Their first pill might be fentanyl

WOLF: How is treatment for adolescents different than treating adult users
who are seeking help?

KALIAMURTHY: We have to take into consideration their developmental

age and the psychological development that’s happening in adolescence, which
is very different from adults.

Oftentimes, this is the first point of entry into opioid use for these kids.
Fentanyl, which is one of the most powerful opioids of abuse out there, is the
first point of entry into opioid use for these children.
Where for adults, they might have been prescribed pain medications. Or they
might have started on opioids through other routes and might have used less
potent products before transitioning to fentanyl.

Adolescents today want help

KALIAMURTHY: Historically, adolescents were not always the most
motivated to seek treatment for substance use. What we would see was they
would start off with experimenting, there would be a problem, it would take a
few years and they’re adults by the time they’ve entered treatment and they’re
trying different things to treat themselves before they enter treatment.

With adolescents, now we are seeing that they can tell that they need help, and
they are motivated and they are entering treatment.

We have to take into account the presence of parents or guardians, how the
school system interacts with them, what else do they do in their communities.
There’s an increased association of violence and legal trouble that some of
these patients end up in that we need to address while treating them. And these
are some differences when it comes to treating adolescents versus adults.

There isn’t enough available treatment

WOLF: One local community’s opioid response coordinator stressed to me
that lack of availability of treatment is a real problem. Is that something that
you agree with?

KALIAMURTHY: Absolutely. That is a real problem at this point, because

there is a huge discrepancy between the number of kids who need treatment
and the available resources.

The challenge is we can limit access and prevent these kids from getting the
pills. But then you have a huge population of kids who are dependent on these
pills, who can’t tolerate withdrawal symptoms, who have what we call opioid
use disorder. That is going to perpetuate the problem if we’re not treating
them. We need to do more in terms of increasing access to care for these kids.