Children's Emergency Department is now located in Children's Tower: 1001 E. Marshall Street.
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Children's Emergency Department is now located in Children's Tower: 1001 E. Marshall Street.
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Opioids have been used for hundreds of years to treat pain, cough and diarrhea, but recently they’ve become the center of a frightening crisis. Why and how are these drugs being misused and how can we keep our kids and teens safe?
Opioids are a class of drugs that include heroin as well as prescription pain medicines like oxycodone, hydrocodone, codeine, morphine, fentanyl and others. Kids may have heard terms like “oxy, percs and vikes,” which are all slang terms for opioid pills, and perhaps even taken them without really knowing what they were.
Opioids are naturally found in the opium poppy plant. Some opioid medications are made from this plant while others are developed by scientists in labs. Opioid receptors are found in the brain and nervous system. All opioids interact with these receptors to produce pleasure and relieve pain.
Prescription drug misuse and abuse is an issue that touches people of all socio-economic backgrounds and ages, and the statistics are staggering. In 2013 medical providers wrote 249 billion opioid prescriptions, enough for every American adult to have their own bottle of pills. More than 11 million people abused prescription opioids in 2016 and three out of four people with heroin addiction began with prescription opioids.
On average, 115 Americans die every day from an opioid overdose. In 2016 alone, 119 Virginians ages 24 and younger died of an opioid overdose. Overdoses kill more Americans now than motor vehicle accidents and homicides combined. According to the Centers for Disease Control and Prevention, 52,898 people in the U.S. died from drug overdose in 2015 and roughly 48,600 died from homicides and motor vehicles. From 1999-2016, more than 350,000 people died from an overdose involving any opioid, including prescription pain relievers and illicit opioids like heroin.
Since the mid-1960s when illicit opioids, such as heroin, became more common among America’s youth, illicit drug use has remained a major concern for our nation. It is critical to understand that the majority of people who abuse drugs begin using them in adolescence and young adulthood. I
n fact, by the time teens are in high school, almost 70 percent will have tried alcohol, half will have taken an illegal drug, nearly 40 percent will have smoked a cigarette, and more than 20 percent will have used a prescription drug for a nonmedical purpose. Smoking, drinking and illicit drug use are leading causes of morbidity and mortality during adolescence and young adulthood.
While the rate of adolescents using any illicit drug by the time they graduated high school has remained between 48% and 50% since 2011, misuse of prescription opioids among 12th graders dropped significantly over the last five years according to the 2017 Monitoring the Future survey. Although this is certainly good news, we may be missing opportunities to intervene in the early stages of an opioid addiction, which could stem the tide of rising levels of opioid addiction and deaths from opioid overdose in adults.
People generally use drugs and alcohol for a variety of reasons including feeling good, relieving anxiety and depression, and improving work or school performance. Adolescents also use substances for many of these same reasons. Additionally, adolescents are “biologically wired” to seek new experiences and take risks, as well as carve out their own identity.
Teens who are prone to addiction may find that drug use eases the stress of normal developmental tasks, at least in the early stages of an addiction. However, since brain development continues well into the mid-twenties, adolescents are particularly vulnerable to near-term and long-term consequences of drug use. Early identification and treatment are crucial.
Partnership for Drug-Free Kids is a great place to learn more about how to spot the warning signs. The following list is not specific only to opioids, however, the website has comprehensive resources for all drugs of abuse. There are six broad categories that parents will want to explore:
Behavior changes, such as different peer relationships, frequent late curfew, unexplained car accidents and dents, unavailable even by text for long periods of time, just to name a few.
Mood and personality shifts, such as wider variations between happy and sad, loss of motivation and poor focus, and unpredictable bouts of anger or hostility are a few examples.
Changes in hygiene and appearance, such as unusual smells, including smoke, on breath or clothes, changes in their speech (rapid/slurred), wearing long sleeves in warm weather to hide needle marks or burns from inhaled drugs, and changes in their body, such as flushed cheeks or trouble walking.
Health issues, like frequent runny nose that isn’t related to a cold or allergies, vomiting, sweatiness, unusually tired and changes in weight, either gain or loss.
School and work problems, such as frequent call-outs at work, skipping school and declining grades.
Physical environment, like the disappearance of prescription pills, over the counter pills, money and valuables. Finding objects like pipes, papers, foil or needle caps in the car, and receiving more packages in the mail.
Many factors influence whether an adolescent tries drugs, including the availability of drugs within the neighborhood, community and school, and whether their friends are using them. The family environment is also important: Violence, physical or emotional abuse, mental illness, or drug use in the household increase the likelihood an adolescent will use drugs.
Finally, an adolescent’s inherited genetic vulnerability; personality traits like poor impulse control or a high need for excitement; mental health conditions such as depression, anxiety or ADHD; and beliefs such as that drugs are “cool” or harmless make it more likely that an adolescent will use drugs.
A national survey among U.S. adults with recent opioid medication use examined the pervasiveness of sharing opioid medications, medication storage and disposal practices, and the sources of information received.
The study found that 61% of people saved their unused medications for future use, and that 73% of these people go on to share their unused pain relievers, unaware of the dangers of nonmedical opioid use. It’s not uncommon for unused, forgotten or expired painkillers to get misplaced, lost or stolen and end up in the wrong hands (JAMA Internal Medicine Survey 2016).
Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative or simply take them from the medicine cabinet without parents even being aware. This trend has unintentional yet dangerous consequences.
Proper storage and disposal of narcotics is critical to prevent children from gaining access to these dangerous medications. Fifty percent of parents who take pain medications do not store them out of reach of children and fifty percent don’t know what to do with their unused medication. Teens are not the only ones at risk. Accidental exposure to medicine in the home is a major source of unintentional pediatric poisonings in the United States. Even child-resistant containers cannot completely prevent a child from taking medicines that belong to someone else or unintentional ingestion.
Local drug stores sell lockboxes for storing prescription medications. You can also find them online. If a child is prescribed a narcotic for a sports injury, dental procedure or the like, it is encouraged that parents keep the medication and dose the child as prescribed by the medical provider rather than letting your teen hold onto it.
Many states have year-round drug take-back programs using onsite drug disposal boxes or mail-back programs, or local medication take-back events that are held at temporary sites at different times through the year. The take-back programs are often facilitated by police departments, municipal buildings or pharmacies.
If there are no such programs in your area make sure to check the label and follow any instructions provided for safe disposal. Do not flush the drugs down the toilet unless the label says to do so. If there are no instructions on the label, take the medication out of the container and mix with used coffee grounds or cat litter. Seal the mixture in a sealable bag, can or other container and place the container in the garbage.
Be sure to scratch out all identifying information on the prescription label before throwing it away.
Protective factors that can decrease the risk of drug use include parental monitoring and involvement in children’s lives, having a strong support network and sense of community, academic success and anti-drug policies at school. Getting help for mental health issues like depression, anxiety or learning difficulties is also key so kids don’t turn to substances to feel “normal.”
High schoolers can find drugs through friends, by word-of-mouth and on the internet. Most kids needn’t look any further than their school — nearly 44% of high school students know a classmate who sells drugs.
There is no quick or simple solution for preventing teen drug use, but research shows parents have a big influence on their teens, even when it doesn’t seem that way. Talk openly with your children and stay actively engaged in their lives. Be open and honest without shaking your finger at them, which will only shut them down or make them defensive and not open to listening.
Make sure they know the legal consequences of using or distributing drugs, as well as the risk and consequences of addiction. Share stories you hear in the news and visit reputable websites together to learn about prescription opioids.
For information, tips and videos about how to talk to your kids about drug use and abuse, go to Partnership for Drug-Free Kids at DrugFree.org.
If you suspect that anxiety, depression or other mental health concerns are causing your child to turn to drugs, talk with their pediatrician or contact Virginia Treatment Center for Children at (804) 828-3129 to request an evaluation with a mental health expert.
By Georgia Rosenblatt, MS, APRN, PMHCNS-BC and Wendy Welch, MD, CPE, CHCQM, Virginia Treatment Center for Children
Medical executive editor for mental health blog series: Bela Sood, MD
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