Expert’s Corner: Opioids, medication misuse and your practice

medicine cabinet prescription opioid abuse
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Every day, 2,500 American youth misuse a prescription pain medication (i.e., take without a prescription) for the first time, according to Foundation for a Drug-Free World. Though prescription medication misuse has declined among high school students since its peak 10 years ago, it remains a health concern.

Chances are that, like most pediatricians and primary care providers (PCPs) who treat teens, you typically don’t prescribe opioids to your patients.

The biggest source of misused medications is diversion from the family medicine cabinet, and many of these medications were left over from someone else’s prescription. Even though pediatricians may not be the source, they can help prevent problems by discussing the responsible use of medications and the risk of experimenting with opioids with our adolescent patients.

Sharon Levy, MD, MPH, director of the Boston Children’s Hospital’s Adolescent Substance Abuse Program, details the why’s and how’s for this recommendation.

Where the opioids are

“Pediatricians are not major prescribers of pain medications for kids. Dentists, orthopedists and emergency room doctors prescribe opioids much more often than primary care physicians. And many teens that use opioids got them from someone else’s prescription. So we have to remember to talk about opioids even when we aren’t prescribing them,” explains Levy.

Teens and their parents may not be aware that prescription opioids are dangerous. “No one ever intends to become addicted, but it can happen really quickly, in some cases even with the first use,” Levy says.

“One of the best ways to frame the conversation is to tell teens never to take a medication that is not prescribed to them, whether they are prescription opioids or not. Tell them why: Prescription medications can cause all kinds of side effects, are dangerous in overdose and can be addictive,” she continues.

A two-part message that combines clear advice (“don’t take non-prescribed medications …”) with health information (“because they can cause dangerous side effects …”) gives teens what they want.

“They want more than a simple instruction,” Levy notes, citing an unpublished National Institute on Drug Abuse survey that looked at how teens prefer to communicate with their doctors. “They want to know why not.”

The biggest source of misused medications is diversion from the family medicine cabinet.

Providers can remind patients and their parents to develop a structure around all prescription medications. “It’s so important for parents to set a good example and avoid sharing medications between siblings, even if they have the same condition. We want to teach kids to respect medications and medical instructions,” Levy says.

PCPs may also advise children and parents only to take medications that are given to them by a trusted adult — a parent or a school nurse. “If a teen has a headache they should speak to an adult rather than getting a pill from a friend.”

And finally, parents and teens should be reminded to dispose of all unused medication, especially opioids, when they are no longer needed. “There is a temptation to hold onto medications just in case you need it later. But keeping medications in the medicine cabinet is dangerous. Even if parents are sure their teen wouldn’t touch them, their friends or other visitors to the house might.”

Overcoming the time barrier

Most doctors report time as a barrier to counseling patients about medication misuse. But Levy says, “It can fit in nicely with a screen or when writing a prescription.”

When a teen reports no past year substance abuse on a screen, it’s an ideal time to give positive reinforcement. Providers can say, “That’s terrific. It’s so good for your health,” says Levy, and then slip in appropriate messaging about prescription medications.

The messaging also fits in with routine counseling messages like, “Wear your seat belt. Use your bike helmet. Don’t take anyone else’s prescription medications.”

The American Academy of Pediatrics plans to address the medication misuse in an upcoming clinical report. In the interim, providers can refer to this clinical report focused on substance abuse and ADHD medication.