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.
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