Opioids and the Urgent Need to Focus on the Health Care of Young Adults

During the 20th century, adolescence emerged as a unique period in the human life span that warranted specific scientific focus.^1,2 Similarly, in the 21st century, young adulthood has been recognized as another unique period in the life span.^3,–5 Despite calls for research to advance the health and health care of the young adult population, young adults are underrepresented in medical research.^6,7 When they are included, data on young adults are often aggregated with data of adolescents or older adults. Thus, the study by Hudgins et al⁸ in this issue of Pediatrics is notable for its focus on an important health topic and for its separate analyses of opioid prescriptions written for adolescents and for young adults.

Using nationally representative data, the authors present trends and characteristics associated with opioid prescriptions written for adolescents (ages 13–17 years) and young adults (ages 18–22 years) from 2005 to 2015 in ambulatory care settings. The study found that opioid prescriptions were common for both groups but approximately twice as common for young adults. Opioids were prescribed in ∼10% and 18% of emergency department visits and in 1.6% and 4.2% of outpatient visits by adolescents and young adults, respectively. Acute injuries, abdominal pain, acute pharyngitis, and dental pain were associated with the greatest numbers of prescriptions. Dental and low-back–pain diagnoses were associated with the highest rates of opioid prescriptions. The authors also describe variations in rates of opioid prescriptions by geographic location and prescriber specialty.

These data are timely given alarming trends in morbidity and mortality for adolescents and young adults. Unintentional injuries are the leading cause of death for both adolescents and young adults, but mortality rates for young adults are more than double the rates for adolescents.⁹ Despite reductions in mortality related to motor vehicle crashes, increases in mortality due to unintentional drug poisonings have led to increases in overall mortality for adolescents and young adults (ages 15–34 years).¹⁰ It is estimated that 1 of every 8 deaths among adolescents and young adults (ages 15–24 years) is attributable to opioids.¹¹ The prevalence of opioid misuse among young adults is more than twice that of adolescents. A recent study estimated that 3.1% of adolescents (ages 12–17 years) and 7.3% of young adults (ages 18–25 years) misused opioids (most commonly, prescription pain medications) in the previous year.¹² Studies suggest that adolescents and young adults most commonly misuse opioid medications prescribed to them, a friend, or a relative.¹³ Thus, prescriptions written for young adults and their peers provide much of the reservoir of opioids that are misused by the young adult population.

Health care research and advocacy is more formalized for adolescents than young adults. This study’s findings reflect many of the unique attributes of health care use by young adults. As they transition from pediatric to adult-oriented care, young adults make fewer visits for preventive health care. Young adults seek care for acute conditions and injuries, chronic conditions, and reproductive care and receive a greater proportion of their care at emergency departments than any age group except for the elderly.^14,15 Relative to adolescents and older adults, young adult health care is characterized by episodic, sporadic encounters delivered in varied settings distributed among a variety of specialties. These attributes contribute to the difficulty in advancing an agenda to improve young adult health care. Efforts to improve research and health care for young adults are further hindered by (1) the lack of a consensus definition of young adulthood, (2) the false perception that young adults are healthy, (3) fragmented health insurance coverage during young adulthood, and (4) little organized advocacy on behalf of young adults.

This study was not designed to evaluate the appropriateness of opioid prescriptions written for adolescents and young adults. The data sets do not include information about the chronicity of the conditions for which the opioids were prescribed, previous exposure to opioids, or the dose or duration of the opioid prescription. The data sets do not include dentists, another specialty that often treats adolescents and young adults in pain. The study’s strength is that it provides a broad overview of opioid prescriptions written for both the adolescent and young adult populations.

The findings by Hudgins et al⁸ suggest important opportunities and settings for future research on opioid prescribing for adolescents and young adults. That research will be critical to informing strategies for effective pain management that minimizes individual and societal risks of prescription opioid misuse in both the adolescent and young adult populations. It took much of the 20th century to establish the research and health care infrastructure that is in place for adolescents. For the young adult population, it is imperative that research and health care advance at a faster pace. Those advancements are dependent on studies, such as that of Hudgins et al,⁸ that provide specific data about the young adult population.