Background and objectives: Rates of opioid misuse among adolescents have risen to epidemic proportions. A
prescription opioid analgesic is the second most commonly chosen substance among those initiating substance misuse,
next only to marijuana. Soaring rates of treatment admissions among youth with opioid problems and reports of overdose
deaths from prescription opioid analgesics and heroin make this issue of substantial public health concern. The objective
of this article is to provide both clinicians and administrators a succinct and comprehensive review of the topic to assist
them in incorporating evidence-based treatments, including medications to address the complex needs of this highly comorbid
but treatable population of youth.
Methods: This article will synthesize the published literature on the epidemiology of heroin use and misuse of prescription
opioids among youth in community samples; summarize findings on demographic and social characteristics and cooccurring
problems in multiple arenas such as academic, substance use, psychiatric, criminal activity and risk for hepatitis-
C and HIV infections; briefly review access, diversion patterns and progression of opioid use; provide an overview of
the existing medication-assisted treatment efficacy literature; and factors that impact treatment outcomes.
Results: The main findings are summarized in this article. The author offers guidance for clinical consideration and future
directions for research.
Conclusions: Physicians, especially adolescent psychiatrists, are well positioned to effectively treat this highly comorbid
population and potentially arrest its persistence into adulthood, which in turn bears high direct and indirect societal costs.