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Addictions to Rx pain medication in teens: What parents need to know and what they can do

Opioid addiction is a growing public health problem in the United States. Young people are one group which is at risk for developing opioid dependence and prescription pain medication (pain killers) addictions. If a teen also has a mental health problem such as:

  • Depression
  • Anxiety
  • Posttraumatic Stress Disorder (PTSD)
  • Attention Deficit Disorder (ADD)

…the risk for developing addictions is increased for several reasons. One reason that teens seek pain killers is that teens with depression, anxiety or trauma may turn to pain medications for numbing distressing feelings. Teens who are having difficulty in school might drift towards social situations and relationships where drug use and taking pills is part of the dynamic.

But, who is most at risk of addiction? What should parents be on the lookout for? A brief summary of the issues here, with a section at the end for your questions.

Teens and prescription painkillers: A background

Is teenage drug use on the rise? Research has shown that teens who are athletes are a high risk group, since they are prone to being prescribed painkillers to treat sports injuries and pain.

Becoming dependent on these medications is not uncommon and in teens can lead to addictive behaviors such as accessing these drugs from sources other than their healthcare provider (e.g. peers, street) to manage their dependence or to maintain feeling better or chasing a certain high. Teens often feel that it is safe to take these drugs because they are also prescribed by medical professionals and are produced in pharmaceutical companies.

In the past several years painkillers have been prescribed at increasing rates and therefore have been readily available in the community. In my practice, it has not been uncommon for a teen who has had a tooth extraction, or who has experienced a sports injury to be prescribed pain killers with a thirty-day supply and refills (substantially beyond what they need for the management of pain for these procedures or injuries).
Then, one of two things can happen:

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1. Teens take the medications for a longer period of time and become addicted.

OR

2. The painkillers are diverted into the community and to peers for recreational use.

Risks of teens taking painkillers

Prescription painkillers can be dangerous in that they can be fatal in overdose, and addiction to these medications is a very serious medical problem.

It becomes more and more difficult for a teen who regularly takes these pills to manage withdrawal (which included a combination of aches, flu like symptoms, sweats and dysphoric/ irritable moods). Medical intervention such as detoxification becomes necessary but also treatment to address the underlying psychological issues of addictions and mental health disorders if also present is usually needed.

The problem is not a deficit in morals or values on the part of teens, parents or families. This is a growing public health and medical problem that we now know crosses racial and socioeconomic lines.

Opiate painkillers – A gateway to heroin use

Among people who become addicted to prescription painkillers, studies suggest 1 in 15 will try heroin within 10 years! So, prescription drug abuse can lead to teen heroin addiction.

The transition of experimenting with non-medical prescription pain killers to heroin addiction is a real possibility. This is because there is a close link between prescription drug abuse and more traditional, and perhaps better understood, drugs of abuse.

Here is why this transition from opiate pain medications to heroin is seen in teenagers:

  1. Heroin works on the same or similar receptors as the painkillers, but can be more potent.
  2. Heroin can create a more intense feeling (especially if injected intravenously).
  3. It is usually cheaper than prescription pills in regards to street value.

This leads to other potential heroin and IV related illnesses such as HIV, Hepatitis C, other infections and diseases of the veins, heart and lungs.

Heroin overdose related deaths have also been growing in prevalence in the United States. Heroin overdose can also be fatal.

Recently, a version of heroin has been available on the street which is combined with Fentanyl to increase its potency. Fentanyl is an opioid painkiller medication which can be 25-50 times more potent than heroin and 50-100 times stronger than morphine, making just a small amount potentially lethal.2 Fentanyl overdose is also more difficult to reverse using the known opioid antidote Narcan (Naloxone) as compared to heroin.

State funded prevention and treatment programs

Prescription pain killers and heroin addiction is a serious problem requiring a major public health response from healthcare and government. So what’s being done about it on the public policy level?

  1. Several states have increased funding and other resources for prevention and treatment.
  2. Physicians are being required to complete continuing education on the responsible prescribing of painkillers.
  3. Some states have instituted laws that limit the number of pills that can be prescribed in a first prescriptions (e.g. 7 pills after a procedure).
  4. Some hospitals have initiated treatment centers that specialize in teens and young adults and for treating addictions and mental health disorders in an integrated fashion when needed.
  5. Some colleges and universities are creating programs especially after overdose deaths have become a concern on U.S campuses.

As mentioned, this is a public health issue and warrants the investment by many. As a parent, keep up to date with the local initiatives and consider offering your voice as a concerned parent to your legislators.

How can you prevent addiction in teens?

The media is full of both good and not so good information about prescription drug use. Celebrity deaths such as the recent death of the musician and performer “Prince” has again brought these drugs to the forefront of discussion. Understanding how to communicate with your teen on this topic is important and could help prevent him or her from misusing these drugs,

Parents play an important role in the prevention of prescription pain killer addictions in teens and young adults. There is one basic principle to keep in mind: open communication is preferred communication. Here is how you can start to talk to your children.

How to talk to teens about painkillers

TIP #1: Find out what your children know using open ended questions.

Ask your children what they’ve heard about prescription painkillers or opioids. Ask them what they know about use of these drugs in their school or community. What do they understand?

You can provide them with important information and facts about risks they may not understand. Consider going to the National Institutes for Drug Abuse website listed below (or others) to look at information together. If you both have questions still, you can write them down and ask your family doctor or pediatrician. Some websites, like this one you are reading on right now, welcome you to post questions. Inquiring together could help with the communication between you about this important topic. You can start these conversations with your child as early as middle school.

TIP #2:Explain the dangers of prescription painkillers.

A major problem is that teens do not always understand the risks. In your conversation discuss how OxyContin, Fentanyl, Vicodin, and other painkillers can be extremely addictive and may lead to heroin use.

TIP #3: Monitor your (and your child’s) prescriptions.

Keep all of your medications locked away. Prescription medication lockboxes are available at many pharmacies. Check on medications regularly, and ask questions if you notice drugs are missing. Don’t let your child carry these medications around with them.

TIP #4: Control your child’s prescriptions.

If a prescriber offers a prescription painkiller prescription for your child ask that they limit the number of pills prescribed and inquire if it is necessary and if there are any other good alternatives. Take note of how many pills are being used and personally monitor any prescriptions. If medication needs to be taken during the day, request that a school nurse or medical professional administer each dose.

TIP #5: Dispose of extra medications.

Dispose of unused prescription drugs safely and responsibly. Find a prescription drug dropbox location in your community to turn in unused or expired painkillers.

Reference Sources: Here are some additional websites that can be helpful for information on prescription pain medications and how to talk to your child about them:
NIDA for Teens: Prescription Drugs
Helpguide.org: Drug abuse and addiction
Substance Abuse and Mental Health Services Administration (SAMHSA): Talking to Your Kids About Prescription Drug Abuse, Substance Abuse and Mental Health Services Administration (SAMHSA)
1 Busch et al. Abuse of Prescription Pain Medications Risks Heroin Use. National Institute on Drug Abuse, Infographic, Jan 2014.
2 Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths–United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016 Jan. 1;64(50-51):1378-82.

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About Dr. Lisa Fortuna, MD, MPH

Lisa R. Fortuna, MD, is board-certified in child and adolescent psychiatry and in addiction medicine, with over fifteen years of clinical experience with children, adolescents, and families. She is currently faculty at Boston University School of Medicine and medical director of Child and Adolescent Psychiatry at Boston Medical Center. She has published highly cited articles in the areas of post-traumatic stress disorder (PTSD), adolescent substance abuse, and Latino and immigrant mental health. She is the author of (with Zayda Vallejo M. Litt), Treating Co-Occurring PTSD and Addiction: Mindfulness Based Cognitive Therapy for Adolescents with Trauma and Substance Use Disorders (New Harbinger, 2015).

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