COMMENTARY

Where Are Teens Getting Opioids From?

William T. Basco, Jr., MD, MS

Disclosures

June 26, 2019

Opioid prescribing, for both adults and kids, is trending down. But decline is relative. Rates are now similar to those seen in the late 1990s. Lots of patients, including adolescents, are still using the drugs. So if we're not prescribing them, how are teens getting them?

A study conducted in 12 St. Louis-area clinics examined both the prevalence of opioids in the homes of adolescents as well as the attitudes of those teens' parents and caregivers about having the drugs in their home.[1] Over a 3-month period in 2017, 700 caregivers (approximately 80% of the sample) and teens (20% of the sample) were asked to compete a 23-item self-reported survey to explore these questions. Completers reported whether they had any prescribed opioids in the home. Caregivers were additionally asked whether they would give an opioid to a child or adolescent to either control pain or to aid sleep when it was not prescribed by their child's clinician. Survey participants also indicated whether anyone else in their home, other than the person for whom they were prescribed, had used the opioid. Additional questions asked what they knew about the risk for abuse with opioids, the role of opioids in adolescent suicide, and the potential for escalation from opioids to heroin addiction.

The majority of survey respondents (87% of adults and 69% of teens) recognized that opioids are common drugs of abuse. Over 85% also knew that opioids can be addictive, and 61% were aware that opioid use could lead to heroin addiction. Just under half knew that opioids were commonly involved in suicide attempts by adolescents.

A very small minority, about 7%, indicated that they would provide leftover opioids to an adolescent for pain relief, while a mere 1% would provide them to a teen to help with sleep.

Approximately a third of survey completers said they currently had opioids in their home, about evenly split between those who had them because of a current prescription to a family member and those who had saved them from an old prescription. When asked why they kept leftover opioids, two thirds said it was for "future need." Only a quarter planned to dispose of them.

Higher levels of family income and caregiver education were positively associated with the likelihood of having opioids in the home. The authors concluded that opioids are prevalent in the homes of teens and that there are opportunities to inform families of both the risks of opioids as well as methods of proper disposal.

Viewpoint

I was a bit surprised by the finding that fully a third of these participants had opioids in their homes at the time of the survey. First, it is notable that less than half of individuals knew that opioids were common drugs of abuse for teens that could lead to heroin addiction in teens, and are often used in suicide attempts. And remember: 4 out of 5 of these survey participants were adults. Clearly, more education about risk for teens posed by these medications is needed.

These findings point out two opportunities for opioid stewardship, and they demonstrate that there is no one strategy that is needed.

Yes, education about risk is necessary, but that is not enough. A clinician would have a very different conversation with parents who kept the opioids intentionally compared with those who kept them inadvertently or because they didn't know how to properly dispose of them. But given the media saturation with stories about the opioid epidemic, it seems like now is a good time to try to get parents' attention.

Finally, the fact that so many parents intend to keep opioids in case they're needed in the future raises the question of whether it might be easier to limit opioid quantities prescribed in the first place rather than asking patients to part with them later.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....