Opioid crisis in children: what parents need to know

While we're struggling with the COVID-19 pandemic, it's critical to remember that we are still battling an opioid crisis. Over 45,000 people die every year in the USA from opioids. Unlike COVID-19, opioid deaths disproportionately affect younger people. Before surgery, my patients are concerned about opioid risks and developing addiction. Fortunately, there's a lot you can do to protect yourself and your children against the opioid epidemic.

When parents are prescribed opioids their children are at 53% higher risk of opioid misuse

How parents affect the opioid crisis

Parents: if you are prescribed opioids, your children are at risk. 53% higher risk. Importantly, normal parental opioid prescription use puts children at risk.

This is different from parents that misuse opioids. Yes, if parents misuse opioids, their children are also more likely to misuse opioids. That's on the order of 30% risk to their children. But even "normal" opioid prescriptions to parents increase risk to children in the opioid crisis.

Why do parent actions affect the opioid crisis in children?

We're still not entirely sure why prescriptions to parents affect the opioid epidemic in adolescents. Possible reasons include:

• Genetics for conditions like chronic pain, psychiatric disease, substance use disorder.
• Shared (or learned) family health practices.
• For example, willingness to take pills for pain.
• Access to parents' narcotics and other medications.

Similar trends in alcohol, smoking, and marijuana use in parents and children

Similar to the opioid crisis, similar trends are seen for other drugs:

• Parents who smoke have children with nearly 300% risk of smoking.
• Alcohol use in parents predicts alcohol use in their children. Harsh parental discipline also increases the risk of adolescent alcohol use.
• Children of mothers who use marijuana have 30-70% higher likelihood of using marijuana. Paternal use increases the chance 80-200+%.

As an anesthesiologist, I need to remind you that smoking, alcohol, and marijuana all impact the safety of anesthesia. These are not benign drugs!

Do other drugs or parental behaviors put children at risk in the opioid epidemic?

Yes: if parents use other drugs, their adolescents have higher risk of opioid misuse. For example, parental marijuana use increases the risk of adolescent opioid misuse by 84%.

Aside from parental drug use, parent-adolescent conflict increased the risk by 26%.

This is good news from a certain point of view. These parental behaviors can be modified. This can reduce adolescents' risk in the opioid crisis.

What adolescent factors increase the risk of opioid misuse?

It's not just parents. There are many factors in adolescents themselves that increase their risk in the opioid crisis. For example, adolescent depression increased the risk of prescription opioid misuse by 75%.

Where are adolescents getting narcotics from?

Adolescents get their opioids from many sources. Some sources include:

• From physicians offices (25.9%),
• Friends or relatives (58.4%).
• Other sources (stealing from doctor's office, buying from drug dealer, 15.7%).

These sources, and likely more, contribute to our opioid crisis and epidemic.

How are surgery and anesthesia related to the opioid crisis

Pain is one of the most feared complications of surgery. Undertreated pain has serious harms (see my upcoming article), but misused pain medication can be deadly.

Undertreated pain has serious harms, but misused pain medications can be deadly.

Unmanaged pain can affect 1 in 4 patients and lead to long term opioid use. It only takes 5 days of pain medication to put you at risk.

Unfortunately, narcotics and opioids are used too often after surgery. In the United States, 83% of patients without pain are prescribed opioids! Compared to other countries, patients in the United States are prescribed over 18 times more narcotics than other countries. These also contribute to the opioid crisis and epidemic.

How can you prevent unnecessary opioid use?

Preparing for your surgery can help you reduce your pain. Less pain means less need for narcotics. Fewer narcotic prescriptions are safer for you and your children.

Less pain means less need for narcotics. Fewer narcotic prescriptions are safer for you and your children.

References

Griesler, et al. Assessment of Prescription Opioid Medical Use and Misuse Among Parents and Their Adolescent Offspring in the US. JAMA Netw Open. 2021;4(1):e2031073.

Hudgins, et al. Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Med. 2019;16(11):e1002922. Published 2019 Nov 5. doi:10.1371/journal.pmed.1002922

Slavova, Svetla, et al. "Signal of increased opioid overdose during COVID-19 from emergency medical services data." Drug and alcohol dependence 214 (2020): 108176.

Seamans, et al. Association of household opioid availability and prescription opioid initiation among family members.   JAMA Intern Med. 2018;178(1):102-109

Griesler et al. Nonmedical Prescription Opioid Use by Parents and Adolescents in the US. Pediatrics. 2019 Mar;143(3):e20182354. doi: 10.1542/peds.2018-2354. PMID: 30804077; PMCID: PMC6398371.

Kandel, et al. Intergenerational Patterns of Smoking and Nicotine Dependence Among US Adolescents. Am J Public Health. 2015 Nov;105(11):e63-72. doi: 10.2105/AJPH.2015.302775. Epub 2015 Sep 17. PMID: 26378847; PMCID: PMC4605183.

Alati,  et al.  The role of parental alcohol use, parental discipline and antisocial behaviour on adolescent drinking trajectories.   Drug Alcohol Depend. 2014;134(Jan):178-184.

Madras, et al. Associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse.   JAMA Netw Open. 2019;2(11):e1916015.

McCabe, et al. Medical and nonmedical use of prescription opioids among high school seniors in the United States.   Arch Pediatr Adolesc Med. 2012;166(9):797-802

Boyd, et al.  Medical and nonmedical use of prescription pain medication by youth in a Detroit-area public school district.   Drug Alcohol Depend. 2006;81(1):37-45

Tick, Heather, et al. "Evidence-based nonpharmacologic strategies for comprehensive pain care: the Consortium Pain Task Force white paper." Explore 14.3 (2018): 177-211.

El Moheb, Mohamad, et al. "Pain or no pain, we will give you opioids: relationship between number of opioid pills prescribed and severity of pain after operation in US vs non-US patients." Journal of the American College of Surgeons 231.6 (2020): 639-648.

Kaafarani, Haytham MA, et al. "Opioids after surgery in the United States versus the rest of the world: the international patterns of opioid prescribing (iPOP) multicenter study." Annals of Surgery 272.6 (2020): 879-886.