While the United States has had a recognized problem with opiate addiction since the 19th century, it is only in the past decade that a highly potent and cheaper heroin has been widely available on our streets. There has also been a widespread recognition that chronic pain has been generally undertreated and thus physicians have been encouraged to prescribe opioids for moderate to severe chronic pain. This has resulted in more prescription opioids being available. A combination of these 2 factors has led to an increase in opioid availability and increased use by adolescents. As Marsch and colleagues1 point out in their report in the current issue of the ARCHIVES, the use of heroin among adolescents has more than doubled in the past 10 years and the use of prescription opioids has increased to the point that in the last high school survey 10.5% of 12th graders reported recreational use of hydrocodone bitartrate.
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