Are doctors inadvertently introducing teens to narcotics?

In our media, young people are often introduced to narcotics by someone who is evil incarnate. On TV, these pushers act like witches in Grimms' fairy tales and often give an evil little laugh after the youth buys the drugs, just to show their nastiness. The reality is that young people who are abusing opiates usually had been given a prescription for opiates from their doctor initially, not by an illegal source, found a study in Pediatrics released online today.

Researchers used an ongoing study, Monitoring the Future, which had been interviewing teenagers from 135 high schools for over 40 years.  In this completely anonymous dataset which had been shown in the past to be very accurate as to adolescents actual behavior in many areas of medical interest including substance use, sexuality, and other social activities such as bullying and media use. About one in four teenagers admitted to have used opiates either medically or non-medically. Of the non-medical use, the majority reported that their introductory experience was from prescribed narcotic medication.

The study also found as medical use of opiates have declined over the last decade, so has reported non-medical opiate use in this population. These researchers conclude that knowing the strong correlation between legitimate prescribing of opiates, and opiates’ non-medical use, that prescribers should be extra careful in this population. 

Many states have recently made any use of opiates by providers more difficult. For example, a doctor in Pennsylvania is encouraged to look up recent prescriptions for that patient for these drugs in a state wide data base before issuing a new prescription. And the prescribing of opiates has declined a little nationally.

However, a commentary in Pediatrics says that these downward prescribing trends are not always true locally. West Virginia has the second highest rate of prescribing opiates and also has the highest rate of opioid overdose deaths nationally— an astounding 42 per 100,000 population each year.  In pediatrics we are also seeing massive increases in rural areas of Neonatal Abstinence Syndrome, babies born to opioid affected mothers who end up having drug withdrawal, because of the ongoing increases in opiate addiction in these areas.

Another article in this same issue of Pediatrics shows the high rate of opiate ingestion in children under 20 years old. An average of 12,000 reported in the US yearly between 2000 and 2016. This is most common in children 5 and under where we assume the ingestions are accidental, but are most likely to result in death in older adolescents where many of the ingestion are considered suicidal in nature. These ingestions went up until 2009 when opiate prescribing was discouraged and have gone down since except with buprenorphine which has become more frequently prescribed.

The common thread is that the more narcotics are prescribed, the more likely they are to be diverted to non-medical uses whether accidentally or on purpose. Also, doctors have to realize that non-narcotic pain killers such as non-steroidal anti-inflamatants or even acetaminophen also work well. When narcotics are left in medicine cabinets, they're not always used for good purposes.

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