No one will argue with the medical need for pain relief with an opioid when medically indicated by a physician—but what happens long-term after being on a prescription opioid in regard to misuse of narcotic agents? Miech et al. (doi/10.1542/peds.2015-1364) identified teens given a prescription opioid in a prospective cohort of more than 6000 12th graders surveyed for the next five years and tracked these students for nonmedical use of opioids as young adults.
Sadly the risk of misuse of opioids is far higher in this population than one would expect—and even higher given that most teens started on a prescription opioid had no prior history of drug use and disapproved of illegal drug use prior to high school graduation. So what happens to enable misuse to occur? Perhaps some of the blame rests with us in how we educate our teen patients before prescribing them an opioid.
This study is worth sharing with the teens for whom we prescribe opioids and their families, and in turn may increase our monitoring and prevention efforts for drug abuse if we do administer prescription opioids even to patients with no drug history. Better yet, perhaps we need to think even more carefully about understanding pharmacologic and non-pharmacologic options for pain in adolescents before we write what we might think is a short-term limited opioid prescription. For a dose of sobering reality, read this study and then share it with your teens for whom you prescribe opioids as needed.
