The prescription opioid crisis in this country seems to be getting worse every time we hear about it on the news but just how bad is it? We published two studies that shed further light on this important health issue in children and teens.
The first study by McCabe et al. (10.1542/peds.2016-2387) looks at trends in the medical and nonmedical use of prescription opioids in US adolescents. The authors used data from 40 nationally represented high school senior cohorts who self-reported their usage of prescription opioids and the reason for this use from 1976 through 2015. The good news is that medical usage of these narcotics, though at its highest in 1989 and 2002, has finally begun to decline over the past few years. With that decline, nonmedical use has also started to decline as well, although nonmedical use in individuals appears to be associated with their first using the drugs for medical purposes. Despite this optimistic news, in this study about a quarter of those surveyed self-report use of prescription opioids for medical or nonmedical reasons—a percentage that is far higher than most of us probably expected to see. To learn more about just what are the risk factors or sociodemographic attributes that are more common with opioid usage in teens, write yourself a prescription to give this article some important attention.
Along with the McCabe et al. study is a second study by Allen et al. (10.1542/peds.2016-3382) that shares National Poison Data System information as to the prevalence of unintended exposures to prescription opioids prompting poison center calls from 2000 to 2015 in children and teens. The authors share with us details on 188,468 opioid exposures in this population with exposures increasing during the first decade of this century and commensurate with prescription usage in the first study, showing a decline over the past three years. The most common accidental exposure or overexposure involved ingestion of hydrocodone (28.7%) but other narcotics also contribute heavily to this data such as buprenorphine ingestions in children (which have increased in frequency) leading to a hospitalization almost half the time this drug was ingested. Sadly, the rate of prescription opioid-related suicides that warranted poison center attention increased by just over 50% during the 15 years of data collected for this study.
Both these studies will increase your awareness of the seriousness of prescription opioid use in our adolescents and the complications that can ensue when these drugs are found or used by children as well. To help make sense of these studies and suggest next steps, anesthesiologists Dr. David Rosen and Pam Murray offer their perspective in an accompanying commentary (10.1542/peds.2017-0209). While these studies and commentary may be bitter pills to swallow, they need to be ingested and then acted upon through better education of our patients and ourselves so we are even more careful to limit our prescribing of them by turning to other less addictive pain-relief strategies, as well as clearer indications as to when to use these drugs. We welcome your thoughts on the opioid crisis in our young patients through comments you can share via this blog, on the article webpages you can link to, or by posting on our Facebook or Twitter social media sites.