Changes in grades, mood, weight, sleep patterns, friends. Extreme emotions. Scratching. Missing money, or missing pills from the medicine cabinet.
At a forum to educate parents about the dangers of heroin and opioid addiction, Nassau Assistant District Attorney Kristen M. Fexas shared the warning signs with those gathered at a Syosset middle school auditorium Tuesday night.
Taken individually, Fexas said, some symptoms might just be the result of adolescence. But they could also point to drug addiction.
"What's so disturbing about the opioid addiction is that, yes, over a prolonged time, you will see an effect on someone's appearance," Fexas said. "But you don't get that right away."
On a projector screen, Fexas showed photographs of crystal meth users, their sunken faces covered in scratches, their mouths full of rotting or missing teeth. Then came the picture of healthy, tan, vibrant 18-year-old Natalie Ciappa on the night of her senior prom in 2008, a few weeks after her first heroin overdose and before the overdose that would end her life.
"What is so important about this picture is it should defy all perceptions, all preconceived ideas about what a heroin addict looks like," Fexas said. "She was a full-blown heroin addict in this picture."
District Attorney Kathleen Rice's office has been hosting these "Not My Child" forums for six years, with Fexas, deputy chief of the Street Narcotics and Gang Bureau, at the helm of the discussion. She told the crowd at H.B. Thompson Middle School Tuesday that the use of heroin among young people exploded in 2008, and has grown in popularity for a number of reasons.
"One of the things we learned, and I hear this every time I go to a school and ask kids . . . is that heroin addicts really many times started doing drugs they found at home," she said, referring to prescription pain killers. When those run out or become too expensive, she said, they turn to heroin, which is much cheaper on the street.
Rice called prescription pills a "gateway drug."
"Pharmaceutical drugs are in almost every household and almost every medicine cabinet," she said. "That's how kids are beginning their introduction to drugs, and these are wildly addictive pills."
Fexas said the stigma that prevailed in earlier decades against injecting drugs intravenously is no longer a concern, Fexas said -- the drug is now being manufactured so that it can be snorted or smoked, making it easier for young people to try it out.
Fexas recommended parents get to know each of their children's friends by meeting them face-to-face, and creating an environment at home where their children feel comfortable hanging out.
Rice said because of new statewide laws making it more difficult for pain pill abusers to get access to prescriptions, heroin overdoses and arrests may continue to go up as addicts switch over.
"We've seen a spike in heroin arrests and heroin overdoses as well as a result of that because prescription drugs are going to be harder to get and more expensive," she said. "It's just something that we have to be really vigilant about."