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Tennessee teenagers are using heroin and shooting up drugs at twice the national average, according to a report from the U.S. Centers for Disease Control and Prevention.

And many more — roughly one in every five — pop pills for recreational use. The Youth Risk Behavior Surveillance Report reveals that their appetite for hard drugs grew dramatically over a five-year period and that Tennessee teenagers are putting themselves in danger in a multitude of ways. The 251-page report, based upon surveys of high school students and released every two years by the CDC, looks at behaviors ranging from dietary choices to driving habits.

The survey period was between September 2012 and December 2013 — a time frame when heroin was making a comeback.

In Tennessee 4.4 percent of high schoolers reported ever having used heroin and 4.9 percent answered yes to ever having used methamphetamines. The percentage who said they had ever injected illegal drugs was 4.7 percent, while the national average was 1.7 percent.

Nineteen percent of Tennessee's teenagers said they had taken prescription drugs without medical authorization.

"This is particularly concerning given the problems we are seeing in Tennessee with prescription drug abuse and misuse and downstream consequences like drug overdose and neonatal abstinence syndrome," said Dr. Michael Warren with theTennessee Department of Health.

Doctors are treating teenagers from Nashville and Williamson County for heroin addiction, Dr. Chapman Sledge, the chief medical officer of Cumberland Heights, told The Tennessean in February. Young people, who have not built up a tolerance for narcotics, are making heroin the first opiate they use — a dangerous gamble because the potency can vary greatly.

He said heroin is easier to obtain than prescription opioids.

"The way it seems in Nashville, it's like ordering pizza," Sledge said.

Law enforcement agencies are targeting supply networks. U.S. Attorney David Rivera announced Friday that 22 people were indicted on various charges related to a large drug ring that brought heroin and fentanyl into Middle Tennessee.

Teenagers are getting all types of drugs on campus from one another, according to the CDC report. One out of four students, 24.8 percent, reported access to illegal drugs on school property.

Experts with Oasis Center in Nashville, which serves at-risk youth, were not surprised by the drug use numbers. They attributed the increase to Tennessee's slow recovery from the Great Recession — an economic reality that has forced parents to work multiple part-time jobs, dried up employment opportunities for teenagers and left young people with too much idle time and little or no supervision.

"Employers weren't going to hire a 16-year-old or a 17-year-old for a job when there was a 30-year-old applying," said Cheryl Mendez, senior director of clinical and residential services for Oasis Center.

While the increased popularity of hard drugs is reason for concern, the activities that put more Tennessee teenagers at risk for serious injuries and death involve being on the road. Forty-one percent said they texted while driving and 19.8 percent reported riding with someone who had been drinking alcohol.

A local childhood trauma prevention expert believes the true numbers for texting while driving may be even higher.

"Just with all the work we've done with our youth, I feel those numbers may be slightly low," said Purnima Unni, a trauma epidemiologist with Monroe Carell Jr. Children's Hospital at Vanderbilt. "They may not be completely sharing what they are doing."

However, she noted that the nationwide data indicate older high school students are more prone to do it.

"Sixty percent of kids in the 12th grade were texting and driving, but only 17 percent of the ninth-graders," Unni said. "I think maybe they are testing the waters. As you get older, you get more confident. Then you think you can text and drive."

Ninety percent of Tennessee teenagers rarely or never wore a bicycle helmet — a figure that Unni said is alarming. A cultural change is needed for how people think about bicycle helmets, which can prevent or reduce the severity of brain injuries, she said.

Oasis Center gives away helmets to the youth who go through The Bike Workshop, a six-week program where they learn how to take apart and refurbish bicycles.

Transportation is important for teenagers, Mendez said, because it empowers them to get beyond their surroundings and be involved in positive activities. The Nashville Metro Council's recent decision to provide high school students with free access toMetropolitan Transit Authority buses is a step forward, she said.

The free bus rides will allow more students to participate in after-school activities and get to places such as the Oasis Center or the Boys & Girls Clubs of Middle Tennessee. Teenagers who feel like they have a purpose are less likely to try drugs, she said.

Unni agreed about the importance of giving teenagers transportation and access to positive activities.

"Our trauma center goes from May to September," Unni said. "The reason is very simple. It is because school is out. When school is out, there is not much for them to do. They are getting into all these kinds of behaviors that can be troublesome."

Nationwide, the CDC surveyed 13,633 high school students, including 1,904 in Tennessee. The agency weighted the statewide averages for factors such as the distribution of students by grade and their race to obtain a more apples-to-apples comparison.

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