Opioid Abuse


Opioid overdose has become an epidemic and significant health problem in the United States taking the life of thousands of adolescents per year. Prescribed opioids and mostly synthetic opioids are involved in almost two-third of all types of drug overdose with 42,249 deaths in 2016. Opioid overdose began in the 1990's with prescribed opioids, then it changed in 2010 characterized by heroin deaths. Now potent synthetic opioids mainly involved in the last wave of 2013 include illicitly manufactured fentanyl and fentanyl analogs. Opioid poisoning in children one to four years of age has increased 200% between 1997 and 2012. Opioid abuse in adolescent causes problems in continuous appropriate acute pain management. Children who abuse opioids and are in household where parents struggle with substance abuse are more likely to experience neglect and nonaccidental trauma. Availability of FDA approved opioid medications, pharmaceutical companies marketing campaigns and inadequate education or knowledge about the risk of prescribing opioids from managing chronic noncancer pain has contributed to the increased in prescribed opioids. There has also been a substantial increase in the risk of hospital readmissions in the first years of life among children with neonatal abstinence syndrome and documented exposure to maternal opioids. Physicians must prescribe opioids more cautiously for acute and chronic pain. They should also use nonopioid substitutes analgesics and non-pharmaceutical approach more often. Patient education should include the risk of using prescribed opioids. By decreasing the quantity of prescribed opioids and discarding or returning unused medication less nonmedical use will occur. Easy access to medical treatment programs using buprenorphine, naltrexone and methadone should be encouraged.  

References:
1- Seth P, Scholl L, Rudd RA, Bacon S: Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants - United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 67(12):349-358, 2018
2- Wu LT, Ghitza UE, Burns AL, Mannelli P: The opioid overdose epidemic: opportunities for pharmacists. Subst Abuse Rehabil. 8:53-55, 2017
3- Witt CE, Rudd KE, Bhatraju P, Rivara FP, Hawes SE, Weiss NS: Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study. J Perinatol. 37(10):1124-1129, 2017
4- Groenewald CB et al: Trends in opioid prescription among children and adolescents in the United States: a nationally representative study from 1996 to 2012. Pain 157: 1021, 2016
5- Austin AE, Shanahan ME, Zvara BJ: Association of childhood abuse and prescription opioids use in early adulthood. Addict Behav 76: 265, 2018
6- Allareddy V, Rampa S, Allareddy V: Opioid abuse in children: an emerging public health crisis in the United States! Pediatr Res. 82(4):562-563, 2017


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