Denver Health officials celebrated the successes of people who completed treatment for opioids and methamphetamine during their annual Overdose Awareness Day event last Wednesday. They educated a small crowd about their programs to reach people who have an addiction. The health experts touted their peer navigator program, which employs people who once used drugs and were homeless or in prison, and whose lived experiences help them reach people in the throes of substance use disorders.
While Dr. Scott Simpson said a lot of people who use drugs deal simultaneously with parallel destabilizing situations, like homelessness or chronic contact with the justice system, he said there's a growing cohort who are nowhere close to street life: kids. It's an emerging issue and one that is harder to deal with since there are not a lot of options for people under 18.
"Denver Health is the only place that offers treatment that young," he told Denverite, referring to in Colorado and possibly the surrounding region.
His colleague, Dr. Christian Thurstone, said he's never seen anything like this moment in the 20 years he's worked to curb addiction.
Thurstone is a child and addiction psychologist who watched as the national opioid crisis spread across the nation and as states like Colorado attempted to respond. Society and pop culture have discussed the problem widely for some time, but he said it's still obvious that substance use disorders are gripping America. His practice serves minors through in- and out-patient settings.
"We used to see about one adolescent per year with opioid use disorder, and for the past year we're seeing two per week," Thurstone said. "We're serving about 600 families per year. That's a lot, and it's still just scratching the surface."
Thurstone said six of his young patients have died from overdoses throughout his entire career. Four of those occurred in the last two years.
But while he can see how things are changing inside his practice, he said it's difficult to know how widespread the problem has become. Thurstone has struggled to parse overdose numbers to better understand how these deaths break down across age groups. Public health agencies, he said, tend not to provide that kind of depth.
"Something really serious is happening with addiction and fentanyl, and we do not have great data on this," he said.
Lisa Raville, executive director of the Harm Reduction Action Center a few blocks east of Denver Health, said she's also noticed a new urgency to help minors.
"Schools have really been reaching out to me in the last month or two," she said. "More groups that work with youth (want) presentations in schools than ever before."
Raville is mostly busy trying to stop deaths among active adult users and doesn't do much with prevention. She said she usually refers concerned parents to Thurstone's clinic.
Still, she has a clear perspective on why young people can get powerful opioids like fentanyl. Injected drugs like heroin have become less present in America. Pills are cheaper and easier to take, and they're more powerful. Plus, little blue fentanyl tablets fit into longstanding patterns of high-school experimentation.
"Drinking and taking pills has been a tale as old as time," she said.
Raville suspects the children of some people who call her don't have serious addiction problems. Their parents maybe catch them using fentanyl as an experiment, or laced with another drug, and responded with an "old school" knee-jerk reaction to stick them in a rehab program.
Fentanyl has invaded other drug supplies, like cocaine and ecstasy, and can easily be used unwittingly, but Thurstone said a lot of the young people he works with are addicted and know what they're doing.
"The youth I see, they know they're using fentanyl and they've tried to stop on their own many times, and failed, and they end up in an emergency room," he said. "The kids I see, it's not like they just wake up one day and have a fentanyl problem."
Treatment for kids is not widely available, but there's usually lots of time to help young people before an addiction develops.
At the moment, Thurstone said there are very few, if any other, clinics in the state that work with kids who are addicted to drugs and accept Medicaid. There is one in-patient facility in Glenwood Springs, the Valley View Youth Recovery Center, but they recently announced they were closing.
"That's a big problem," he said. "We also have the great resignation, 500,000 healthcare workers have left the field recently (nationally)."
While he's seeing growing demand for service with dwindling capacity, deeper issues make it hard to help kids stay sober. Agencies like the FDA haven't studied treatments like methadone in people under 18. So some recovery options available to adults are not on the table for minors. Thurstone has started using a monthly injection of Buprenorphine to help people who are addicted to opioids use the drug less. He said there hasn't been enough research on its effectiveness in young people, but it is legal, and Thurstone said he's seen success in kids who are "notoriously" bad at keeping up with daily pill regiments.
Thurstone said he would like to see more support from governments with more research and treatment facilities. Denver Health has set up eight health centers within Denver Public Schools that can help catch kids developing an addiction, but he said more are needed across Colorado. There are still "gaps" in at-home intervention programs and in-patient clinics, too.
"Treatment still works, and that's the bottom line," he said.
Raville, of the Harm Reduction Action Center, said she'd like to see safer supplies of drugs available to people who will otherwise go to the street. She added Colorado's crackdown on legal drug distribution has pushed users towards more powerful and more dangerous options.
But Thurstone said there's a lot more room for prevention, and parents and communities should be ready to act before kids end up in an ER.
It starts with mental health, he said. Typically, kids he works with experience behavioral issues that lead to problems in school, then experimentation with lower-risk drugs, like marijuana, before they find more serious drugs. Colorado, he said, has some of the worst mental health access of any state in the nation, and he said anyone concerned about kids and drugs should recognize that prevention begins long before anyone tries a pill.
Strong relationships are key to stemming this issue, he said, which means parents need education, too. To that end, he's pushed to include childhood mental health in adult addiction programs.
"We're helping these adults have a great relationship with their children," he said. "That is the strongest protection against future substance use, and that will break the cycle."
