Opioid use, addiction, and overdose in youth continue to increase. What can be done?
“It’s not just an opioid crisis, it is a polysubstance crisis,” Scott Hadland, MD, MPH, MS, FAAP, told attendees of the 2022 American Academy of Pediatrics National Conference and Exhibition in Anaheim, CA. Hadland, Chief of Adolescent and Young Adult Medicine at MassGeneral Hospital for Children and Harvard Medical School, shared insights into the use and abuse of opioids in youth in the US. Hadland is triple board certification in General Pediatrics, Adolescent Medicine, and Addiction Medicine.
Addressing the issue in youth is important, Hadland explained, because data shows 2 of 3 individuals in opioid treatment reported first use before age 25 years, and 1 in 3 reported first use before they were 18 years old. Similarly, he pointed to 2021 data from Monitoring the Future that found almost 10% of high school students reported they have used prescription opioids nonmedicinally. Interestingly, data has shown a slight dip in reported opioid use during the pandemic, he said, probably because of lockdown and lack of accessibility.
However, the number of overdose deaths in youth between ages 14 and 18 due to opioids doubled between 2019 and 2021, Hadland said. Overdose deaths due to other substances such as cocaine, methamphetamine, and benzodiazepines also increased, but remained much lower than the approximate 4 in 100,000 rate associated with opioid overdose.
The amount of counterfeit drugs available is partially driving the problem, Hadland said. In fact, he explained it is very difficult to purchase real prescription medications on the street, and the counterfeits are looking more and more like the real thing.
“Fentanyl is everywhere in this country, and it’s [availability] is not going anywhere,” he added. Hadland cited data noting approximately 75% of all overdose deaths in teens are due to fentanyl. Most deaths involve an opioid plus another substance, with cocaine, benzodiazepines, and methamphetamine being the top 3 offenders.
With this in mind, clinicians and pediatricians may be wary of prescribing opioid medications to patients with pain issues, but Hadland noted it can be safe to do so—and it should be done if needed. In fact, data has shown only about 1 in 300 youths who were prescribed opioids become addicted or overdose, he said. The key, he added, is being careful.
Long-acting opioid formulations, high daily opioid dose, and a duration of 7 days or longer are prescription-related risks associated with addiction and overdose, Hadland told attendees. He also noted family history of any addition, mental health disorders, and other substance use (eg, nicotine, alcohol, and cannabis) are patient-level risk factors.
Not surprisingly, youth opioid addiction is related to a cascade of care issue, Hadland added. All youth with opioid addiction has a prevalence of about 1%, he said. Unfortunately, less than half of those individuals will receive a diagnosis; only a smaller portion will receive any treatment; a sliver of those will receive medication; and smaller slivers will remain in treatment 1 month and 6 months. The data is even more alarming for certain populations, he said. Black youth and Hispanic youth are 65% and 74% (respectively) less likely to receive treatment, he explained, and 32% and 58%, respectively, less likely to be retained short-term.
Fortunately, there are some things that can be done in the clinical trenches, Hadland said. Screening is of utmost importance, he noted, and encouraged open dialogues with patients. Overdose prevention and harm reduction are also key to addressing the crisis. Hadland suggested warning patients to be wary of counterfeit pills and advising them to start with a little to assess the effect, avoid polysubstance use (especially benzodiazepines), not to use alone, and to call 911 in case of an emergency. He also has written prescriptions for naloxone.
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