We read stories about the opioid crisis or hear about an adolescent or a young adult who has overdosed on opioids almost on a daily basis. The Centers for Disease Control and Prevention (CDC) reported a tripling of the number of deaths related to opioids from 1999 to 2014, with deaths of 15-to 24-year-olds doubling during that time. Such statistics are frightening, and parents need to be educated on the risks opioids pose to their adolescents.
Opioids are a class of drugs used to reduce pain. They are sometimes called narcotics. Prescription opioids are used to treat moderate-to-severe pain, often after an injury or following surgery, or to treat pain associated with cancer.
Common prescription opioids include codeine, hydrocodone, oxycodone, morphine and methadone. Fentanyl is a synthetic opioid used to treat severe pain, such as cancer pain not responding to other opioids. Heroin is an illegal opioid, which is seeing increasing use during the opioid crisis.
Prescription opioids are a valuable pain-management tool, but all opioids have side effects and carry a risk for dependence. Side effects of opioid medications include sleepiness, dizziness and confusion; therefore, anyone taking a narcotic pain reliever should not drive. Another common side effect is constipation, due to the drug’s effect on the digestive system.
All opioids have a risk of developing tolerance, in which higher doses are required to get the same effect. Cancer patients are often on high doses of these medications to treat their pain due to tolerance. If taken at high doses, all opioids can slow or stop breathing, and can be fatal. The recent rise in opioid-related deaths is partly due to the illegal use of fentanyl, which is very strong and can cause someone who has not developed a tolerance to opioids to stop breathing at low doses.
Is Your Adolescent at Risk?
Every parent would hope their child would never use drugs. Yet opioid use is common among adolescents. A 2017 study in the journal Pediatrics reported that up to 20 percent of high school seniors surveyed nationwide said they had taken prescription opioids at some point. A concerning trend found in the study was that high school seniors who reported nonmedical use of opioids had often previously been prescribed an opioid. One-third of adolescents who reported nonmedical use of opioids — or using opioids to get high — indicated they were using leftover medications that had been prescribed to them. White adolescents were more likely to use prescription opioids for nonmedical reasons than black adolescents, a finding consistent with a CDC study of opioid use in adults that reported opioid use more common among white than black adults.
A 2013 study in the American Journal of Public Health reported that sports-related injuries were a common reason adolescents were prescribed opioids — with cheerleading, football and wrestling the most reported sports causing injury for which pain medications were prescribed. A concern in this study is the high rate of reported nonmedical use of opioids among student athletes, who often get medications from teammates or use leftover medication prescribed for an injury. Another common reason adolescents are prescribed opioids is oral surgery. A large amount of opioids are prescribed after the surgery, when patients should only need a day or two of prescription pain medication.
An adolescent prescribed an opioid in the past — particularly if there is leftover medication — is at risk for opioid abuse. According to the CDC, opioid abuse is more common in small towns and cities.
It’s important to be aware of the risk for opioid misuse and abuse in your adolescent. Steps to take follow.
* Anytime an opioid is prescribed for your adolescent, ask your provider the reasons for prescribing it and how many days the medication should be taken.
* Ask about non-opioid pain relief such as taking ibuprofen or acetaminophen, applying ice or elevating the area.
* Have an adolescent needing more pain medication than the injury indicates reevaluated by a provider.
* Dispose of any leftover medication, either by flushing it down the toilet, mixing it with dirt or kitty litter and putting in the trash, or taking it to an authorized collection site.
* Clean out the family medicine cabinet of all unused opioid medications. It is not uncommon for adolescents to use a family member’s medication to get high.
* If you suspect misuse or abuse of opioids, make an appointment with your adolescent’s primary care provider to assess the situation for opioid misuse. You may want to call in advance or ask to speak with the provider ahead of time to express your concerns.
* Be an advocate to get your adolescent with a diagnosed opioid use disorder into treatment. Early intervention is critical to successful treatment.
Remember, a provider prescribes opioids for pain or a medical condition for a limited amount of time. Using a prescribed opioid as directed does not lead to addiction, but issues can arise when adolescents take leftover medication or borrow it from a friend for nonmedical reasons.
Teri Moser Woo, PhD, CPNP-PC, FAANP, has been a PNP for 24 years, practicing in pediatric primary care and urgent care. She is a Professor and Associate Dean of Graduate Nursing Programs at Pacific Lutheran University and a national expert on nurse practitioner prescribing.