He’s prescribed a pill a day for his knee pain. He sneaks a second one after dinner, because he sleeps more easily after taking the prescribed muscle relaxer. He takes one in the morning, one before his train ride home because sitting aches, and one before bed. Every day. Although his doctor prescribed only one pill with breakfast, it relieves his pain to take more, so he assumes his doctor won’t mind.
Roughly 21 to 29 percent of people prescribed chronic pain relievers abuse them, according to the National Institute on Drug Abuse (NIDA). Sadly, the hypothetical scenario above is very much a reality today. You may have heard of it: the opioid epidemic. NIDA defines the opioid epidemic as the “misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl.”
In 2016, this epidemic was responsible for nearly 2,000 deaths in Massachusetts alone—over five times as deadly as it was in 2000, according to the Massachusetts Department of Public Health. Of these 2,000 victims, over 150 were younger than 25 years old.
Dr. Nicholas Chadi, Pediatric Addictions Fellow at Boston Children’s Hospital, works with adolescents who struggle with substance abuse, and agrees that the opioid epidemic is a rising issue among our youth. “We’re seeing these opioids become a lot more available on the streets,” he said.“We’re seeing severe cases and overdoses a lot more than we used to.”
Teenagers access opioids in a multitude of ways, from their own prescribed medications to stealing family member’s pills to buying off the streets. The recreational use of opioids such as fentanyl and morphine is becoming common among teenagers because of the feelings and side effects they produce. Seventeen-year-old Josie D. from Dallas, Texas, has been prescribed many heavy opioids for chronic pain. While she did not become addicted, she realizes how dangerous they are. Josie compares the experience of taking biweekly morphine treatments to being high.“I didn’t like the feeling,” she said. “But I can understand why someone would like it because you’re not thinking about your life or your problems.”
For teenagers, that in itself is plenty reason to try opioids. They are easier to use than other drugs in terms of convenience and secrecy, and don’t leave behind any smell or mess. It’s much easier to slip a pill than it is to go out and obtain other drugs.
“I’ve had situations where people have approached me at school, knowing my pain condition and assuming that I am on painkillers, and they’ll ask me if they can have some,” Josie said. “The opioid epidemic is definitely a pressing issue among our youth today. When something has reached such a level that you can’t walk down your school hallways without other kids mentioning it, you know it’s important to teenagers.”
Dr. Sarah Bagley, Medical Director of Boston Medical Center’s Catalyst Program, also agrees this pressing issue requires more attention from youth. She spends her days seeing patients and helping them with their addictions as well as researching ways to engage young adults after non-fatal overdoses. She has worked with patients as young as nine years old and believes that opioids are not only dangerous, but a gateway to other drugs.
“Teenagers who are exposed to opioids and start using them regularly are really at more serious risk for developing addiction,” Dr. Bagley said. “Addiction is loss of control; it’s compulsion.” She works to prevent this by diagnosing patients with a moderate, mild, or severe opioid use disorder. To treat this, she and her team use alternative therapy approaches and even switch patients from opioids to other medications such as buprenorphine or methadone. “We are using medications to treat a disease instead of to get high,” she said. “These medications allow you to stay in school, get a job, and reduce the chance that you’ll get HIV.”
Dr. Navil Sethna, Medical Director of Boston Children’s Pediatric Pain Rehabilitation Center, also works to wean his chronic pain patients off of opioids. His approach involves a slow wean off the opioids to allow the patient’s body to adjust and help with withdrawals. He prefers to try to prevent the problem before it occurs rather than fix it afterwards. To do this, he believes our society must focus on education.
“We can educate the health care prescribers and providers in terms of dosing and appropriate prescription.” he said. “We need to inform parents and patients on the pill’s purpose, duration and side effects.”
Dr. Chadi agrees. “Education is the first step,” he said. “It starts with educating the prescribers, and then it has to go into the schools. Schools need to know when students start using; students need to know the risks of using.”
Josie also feels that society as a whole should combat the opioid epidemic. “As a society, we should work on denormalizing trends that are addictive,” she said. “We need to start shutting down the gateways.”