Opioid Addiction in Adolescents: A Background and Policy Brief

Adam Wenner, MSN, RN, CPNP-AC; Kristin Hittle Gigli, MSN, RN, CPNP-AC, CCRN

Disclosures

J Pediatr Health Care. 2016;30(6):606-609. 

In This Article

Background

Opioids are a class of drug that range from common prescription medications like oxycodone and morphine to illicit substances like heroin. All drugs of this class are chemically related and act on the opioid receptors in the brain and nervous system to reduce pain or produce euphoric experiences. National surveys of high school seniors from 2002 through 2006 found that 1 in 8 students used or experimented with prescription opioids, and 70% of these students mixed opioids with other substances (McCabe, West, Teter, & Boyd, 2012). Access to prescription opioids is an ongoing problem. Most adolescents who misuse prescription opioids report receiving these drugs from friends or relatives for free (ASAM, 2016). Additional attention should be draw to the volume of adolescent opioid prescriptions, which nearly doubled from 1994 to 2007, because a third of 12th graders who abuse opioids were prescribed the medications (ASAM, 2016; National Institute on Drug Abuse, 2016). Nonprescription opioid use also occurs, with an estimated 28,000 adolescents using heroin annually in the United States; more than 60% of these develop addiction (ASAM, 2016).

The use of opioids places adolescents at risk not only for addiction and its associated short-term narcotic affects but for long-term, secondary comorbidities. Short-term problems include depressed respirations, clouded judgment, nausea and vomiting, and suppression of pain response (National Institute on Drug Abuse, 2016). Over the past decade the number of adolescents in the United States who die each year from drug overdose has doubled from 3.1 to 7.3 per 100,000 deaths (Thompson, 2015). Those who live with addiction are at risk of long-term secondary complications that include infections associated with intravenous drug use such as bacteremia, endocarditis, hepatitis B, and HIV. Up to 10% of all new HIV diagnoses are related to sharing injection devices (Centers for Disease Control and Prevention, 2012). Additionally, a variety of chemicals are used to dilute or "cut" illicit street drugs, each with its own unique adverse effects and complications. Examples of these substances include caffeine, sugars, and fertilizer components like ammonium chloride, which acts as an expectorant, inducing mucosal irritation of the respiratory and gastrointestinal tracts (Cole et al. 2010).

Treatment of opioid addiction should include modalities to decrease access to opioids while increasing access to treatment. No single treatment modality is completely effective for individuals with ongoing opiate dependence. Ideally, treatment plans should encompass care of the patient through addiction, detoxification, relapse prevention, and ultimately a drug-free state. In an acute overdose situation, naloxone can be used and acts as a complete or partial reversal of both synthetic and natural opiates by competing and saturating opiate receptor sites for a limited time. Multiple doses of naloxone may be required in acute overdose, and prompt medical attention should be sought in conjunction with naloxone use. Medication-assisted treatment (MAT) has shown great success for long-term opiate addiction. A MAT treatment plan uses interdisciplinary teams and typically includes a comprehensive psychosocial evaluation; ongoing counseling and behavioral therapy; and medications used to block the euphoric effects of the opioids, alleviate cravings, and normalize body functions with drugs including buprenorphine, methadone, and naltrexone (Substance Abuse and Mental Health Services Administration, 2016). The use of these treatments in concert with preventive strategies to avoid drug use can affect the pervasive opioid epidemic.

processing....