By Christine Vestal

BALTIMORE — Teen drug use during the summer often goes unnoticed. It’s when school starts and students nod off in class, exchange pills in the hallways and fail tests that the truth becomes apparent.

This school year, addiction specialists say they’re expecting an onslaught of teens addicted to Xanax and other sedatives in a class of anti-anxiety drugs known as benzodiazepines, or “benzos.” Many teens view Xanax as a safer and more plentiful alternative to prescription opioids and heroin — with similar euphoric effects.

But addiction experts warn that the pills kids are taking, often found in their parents’ or grandparents’ medicine cabinets, can be just as deadly as opioids, especially when taken in combination with other drugs or alcohol. And it’s much harder to kick the habit.

Like any addictive substance, Xanax when used early increases the risk of addiction later in life. According to the U.S. Surgeon General’s 2016 report on drugs and alcohol, nearly 70 percent of adolescents who try an illicit drug before age 13 will develop an addiction within seven years, compared with 27 percent for those who first try an illicit drug after age 17.

Nationwide, prescription drug abuse among adolescents has dropped dramatically in the last 15 years, according to survey results published in December by the National Institute on Drug Abuse. Last year’s results indicate that about 4 percent of high school seniors misused prescription painkillers, a sharp decline from 2004, when nearly 1 in 10 teens misused opioids.

In fact, an increasing percentage of high school kids — at least 26 percent of seniors in 2014, up from 5 percent in 1976 — are abstaining from all substances, including alcohol, marijuana and tobacco, according to an historical analysis of the survey data published in July.

Even so, addiction practitioners say they’re seeing a surge in the number of young patients who are hooked on Xanax. Many take high daily doses of the drug, sometimes in deadly combination with opioids and alcohol.

Addiction treatment centers are “the tip of the spear,” said Sharon Levy, director of adolescent addiction treatment at Boston Children’s Hospital and lead author of the adolescent drug use study. “We see things first. So, I’m not surprised that the spike in Xanax use isn’t reflected in national data yet.”

“Adolescent benzo use has skyrocketed,” Levy said, “and more kids are being admitted to hospitals for benzo withdrawal because the seizures are so dangerous.” At the same time, she said, far fewer kids are seeking treatment for prescription opioid addiction.

“When I ask them if they’re using opioids, they say, ‘No. I wouldn’t touch the stuff.’”

High Doses

Marc Fishman, an addiction psychiatrist and professor at Johns Hopkins University School of Medicine, said benzos are quickly overtaking opioids as the primary prescription drug of abuse among the adolescent patients he sees at Mountain Manor Treatment Centers in Baltimore and other Maryland locations. And many of them are extreme, high-dose users, he said.

The tidal wave of compassion and support for Demi Lovato in the wake of her apparent drug overdose last month is indicative of society’s long overdue, shifting views on addiction. Social media platforms have been inundated since the singer’s hospitalization with comments acknowledging her strength and admiring her courage. Instead of finger-pointing, demeaning or judging her, Lovato’s fans and fellow entertainers are showering her with love, and her friends and family are standing firmly by her side. We are, in essence, offering her a giant group hug.

All of this is encouraging. However, we have a lot of work to do as a society when it comes to applying this inclusive, compassionate approach to non-celebrity, everyday Americans and families dealing with addiction.

Why? Because isolation kills. As Johann Hari writes in his seminal book, Chasing the Scream, “The opposite of addiction isn’t sobriety, it’s connection.” Yet we continue to look the other way and deny the obvious truth: Our children, our friends and our family members are being rejected, judged and shamed for the same struggles that celebrities receive endless support for ― and they are dying alone, desperate and afraid.

The statistics are staggering. More than 175 Americans die of drug overdose every day. As USA Today recently pointed out, that amounts to a daily 737 plane crash with no survivors. It’s an epidemic that’s “moving quietly and stealthily across the country, cloaked in stigma and shame,” author Beth Macy writes in her new book, Dopesick.

And no one is immune. In my small corner of Los Angeles over the past four years, a total of nine kids and young adults I’ve known and loved have died of accidental overdoses. Each one, likely driven by shame and self-loathing, was alone at the time of their deaths ― isolated from their families, sober living communities and those who loved them.

I can’t know exactly how Lovato’s friends and family felt when they got word of her hospitalization, but I can relate to their experience. A few years ago, my then 20-year-old son began waging his own addiction battle. An up-and-coming electronic music producer, he suffered a nonfatal overdose on the night of his very first on-stage performance. I was both surprised and not surprised as I wept on my knees with gratitude that my son survived; the music industry is, and always has been, inextricably tied to substance use.

We praise our favorite artists, admire them and nod to the allure of the altered states that “fuel” their creativity. In other words, for musicians, it’s cool to get high. And if our favorite artists become consumed by addiction, we generally stand by them as fans. Yet when our own fathers, sons, sisters, brothers, mothers, daughters, friends, co-workers and teachers struggle with substance abuse, society abandons them and quickly looks the other way.

LAWRENCE, Mass. ― Rachael Pomerleau, 40, had taken opioids before, having had procedures like wisdom teeth removal and gallbladder surgery.

But during the tumultuous two years that her children, now ages 7 and 8, were born, opioids took over her life, she told HuffPost. She was put on bed rest as a result of complications with the pregnancy of her daughter. A few months after her daughter’s birth, she became pregnant with her son. This time, her back and abdominal pain grew so severe that doctors prescribed Vicodin followed by Percocet during her pregnancy ― which wasn’t an unusual prescription for pregnant women at the time, prior to the onset of the opioid epidemic.

“It hurt so bad,” she said. “There were times when I could hardly walk without being in pain.”

When Pomerleau returned from maternity leave for the second time, she said, she lost her job at a local health care services company. And she kept taking opioids ― oxycodone this time ― this time prescribed to her by her primary care doctor.

Women like Pomerleau, who was prescribed opioids in a medical setting and became addicted to them, are a growing demographic in the United States’ opioid epidemic. Although men continue to have higher rates of substance use than women do, the gap between the sexes is narrowing, with prescription opioid overdose deaths rising 583 percent among women between 1999 and 2016, compared to 404 percent among men, according to the National Institute on Drug Abuse.

But even as prescription opioid death rates grow among American women, doctors, researchers and policymakers don’t yet understand how to properly screen for or address female opioid users’ unique needs. In an essay published in the most recent issue of the medical journal, The Lancet, two Yale medical researchers warn that America won’t be able to address its raging opioid epidemic if it continues to overlook women’s unique pathways to opioid misuse ― and the factors that hinder their access to treatment.

“The system is evolving — but we’re at a point now where there’s a need to have it do so more rapidly, just based on the sheer volume of women who are being impacted,” said Dr. David Fiellin, who directs Yale’s addiction medicine program and co-authored The Lancet article.

Women Have Unique Exposure To Opioids

There are several factors, both biological and cultural, that differentiate women who use opioids. Population-based studies suggest that women are more sensitive to painful stimuli than men are, putting them at a higher risk for chronic illness that includes pain and making them better candidates for painkillers.

There’s also some evidence that women become addicted to substances more quickly than men do, although the biological mechanism for this phenomenon isn’t understood, said Fiellin.

Women are more likely to have medical interventions than men are, including reproductive and childbirth-related procedures. As a consequence, women are more likely than men to be prescribed opioids in medical settings.

Pregnancy and postpartum pain in particular lead to significant initial exposure to opioids. For example, 1 in 300 women who didn’t previously use opioids and had a cesarean section will become a persistent opioid user, according to the American Congress of Obstetricians and Gynecologists. And two separate studies each published this year in the journal Obstetrics and Gynecology found that women were over-prescribed opioids after both vaginal and cesarean births.

Depression and anxiety disorders are also more common among women, as are sexual trauma and partner violence, all of which are risk factors for abusing opioids. Women are also more likely than men to report that they use opioids to cope with negative emotions and pain.

For Pomerleau, physical pain was compounded by an abusive relationship and childhood trauma, she said, that left her with post-traumatic stress disorder, major depression and anxiety. But her steady access to opioids during and after pregnancy was the ignition that has led to a multi-year struggle with addiction that has included homelessness, loss of custody of her children and struggles to get the resources she needs.

Importance Of Screening At-Risk Women For Opioid Addiction

During the five years after her kids were born, oxycodone and constant pain were the backdrops of Pomerleau’s life. Her tolerance for the pain pills grew and she says she sometimes gave them away to family and friends. Then one day, she came home and realized that sharing her prescription had backfired ― her supply had run out and her doctor wouldn’t prescribe her more pills.