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How do you get an 11-year-old off heroin?

BBC News Magazine
Jan 30 2006

A primary schoolgirl is undergoing heroin withdrawal treatment after admitting to using the drug for two months. But how do you treat a child drug abuser?

The 11-year-old girl was taken to Glasgow's Royal Hospital for Sick Children after collapsing in her primary school class last Wednesday.

It was thought the girl had fallen asleep in class but hospital staff were stunned when the child said she had been "chasing the dragon" for two months.

It's understood the girl is undergoing "cold turkey" - that is medically unaided withdrawal - because doctors are concerned she is too young to cope with the drugs normally used to treat heroin problems.

So how do you help a schoolchild withdraw from heroin?

Treatment for children differs markedly from that for adults, many of whom have been using - and injecting - heroin for years.

Adults may be prescribed methadone - a powerful pain reliever used as a heroin substitute - to help addicts progress to full withdrawal.

But putting an 11-year-old on methadone would be the very last resort, according to Dr Clare Gerada, Royal College of GPs spokeswoman on drugs and member of the government's Advisory Council on the Misuse of Drugs.

"An 11-year-old is developing very rapidly and the way the drug would be handled by that child's body is very different to an adult," she says.

Overdose risk

"Methadone is stored in the body's fat, and a child's body is constantly changing and developing. You might find that the right dose one week is not the right dose the next. This is a serious drug which can cause an overdose in its own right."

Dr Gerada also says methadone is known to rot people's teeth and disrupt menstrual cycles, something doctors would also want to avoid in a pre-pubescent girl.

This means going "cold turkey" - a phrase than conjures up horrific images of a painful and distressing withdrawal.

But Dr Gerada says depending on the level of misuse of heroin, the child's experience of withdrawal would most likely resemble "flu and last for three to four days". She would recommend using conventional pain relief.

Child drug abuse and addiction is regarded as much more complex and involves a wide range of professionals. The child's background, emotional development, family circumstances and mental health would be investigated.

"Drug abuse by children is rarely about having a drug problem, it is most probably a symptom that something - perhaps everything else - is going pear-shaped in their lives," says Dr Gerada.

The Bolton Drug Action Team (Dat) was one of the first substance misuse centres in the country to set up a specialist service for under-19s. Sandy Saunders, its Drugs Misuse Strategy Manager, agrees methadone would hardly ever be recommended for a child.

For her team, the primary objective is to establish how long and how often the child has been using heroin and then to get them off drugs entirely as quickly as possible.

Generations

"The most important thing is that all the relevant support services are offered quickly - that includes education, social services, and drugs counselling," says Ms Saunders.

She says it is vital the family is fully involved from the beginning for the child to be successfully treated.

"Young people using sometimes have parents who are using too. We are seeing second and third generation drug users coming forward for treatment," she says.

For both Dr Gerada and Ms Saunders the important question to ask is why an 11-year-old would want to smoke heroin in the first place?

"Dealers do not usually target children so young because they would not risk increased police interest. You've got to ask how and why a child of 11 is buying drugs at one of our shopping centres."