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Opioid pain relievers are most often prescribed following surgery or to treat cancer pain — situations less common to young people.
However, there are situations or ailments for which opioids may be recommended for your child. These include accidental injury, after oral surgery to remove wisdom teeth, sickle cell disease and other pediatric chronic pain conditions.
Should a health care provider recommend or prescribe an opioid for your child, there are important questions to ask, risks to be aware of and safety precautions to take.
What are some common opioid pain relievers?
- Hydrocodone (Zohydro)
- Hydrocodone + Acetaminophen (Vicodin)
- Oxycodone (Oxycontin, Roxicodone)
- Oxycodone + Acetaminophen (Percocet)
- Codeine, Tylenol with Codeine
- Morphine
- Fentanyl
- Tramadol
There are also non-opioid pain relievers (gabapentin, for example) with potential for misuse and abuse, but much lower than that of opioids.
Why is the misuse of opioids so dangerous?
Opioid pain relievers are powerful drugs — very similar to heroin in their chemical makeup and habit-forming by their very nature. This is why the U.S. Centers for Disease Control and Prevention (CDC) strongly recommends against the prescribing of opioids for long-term treatment of chronic pain. Even for treatment of short-term pain, opioid pain relievers should only be prescribed and taken sparingly.
The risk of addiction grows when the patient is a teen or young adult because their brains are still developing and biologically predisposed to experimentation. Suppose your teen or young adult is prescribed an opioid. In that case, you or another caregiver should control the medication, dispense it only as prescribed and monitor closely for signs of misuse or growing dependence.
In addition to the danger of dependence, misuse of opioids can cause dramatic increases in blood pressure and heart rate, organ damage, difficulty breathing, seizures and even death.
What questions should you ask if an opioid is recommended?
Is a prescription opioid necessary?
Ask about alternatives. An over-the-counter (OTC) pain reliever like acetaminophen (e.g., Tylenol) in combination with a non-steroidal anti-inflammatory drug (NSAID) might be just as effective. You can ask about exploring treatments like physical therapy, acupuncture, biofeedback or massage for chronic pain.
What is the quantity and duration of the prescription?
How many pills are being prescribed, and over what period of time? Is it necessary to prescribe this quantity of pills?
What are the risks of misuse?
The prescriber should be able to answer this question for any drug being prescribed.
Should my child be screened to determine their risk of substance use disorder (SUD) before being prescribed this medication?
If not, why not? Common risk factors include co-occurring mental health disorders such as depression or ADHD, as well as a family history of addiction or a recent trauma such as a death in the family or a divorce.
What if an opioid has been prescribed?
Safeguard medication at home
Don’t just leave it in a medicine cabinet where anyone — family or visitors — can access it, and dispose of any unused medication. For proper disposal, look for a local “takeback” event. If none exist, mix the medication with coffee grounds or other unpleasant garbage and throw it out.
Supervise the dispensing of medication
Keep a count of pills to be sure they are being taken as prescribed, and clearly document when the prescription was filled and when a refill will be needed. Be suspicious of any missing medication.
Communicate the risks of misuse
Make sure your child understands the risks associated with prescription pain relievers, and be very clear that their medication, as with any prescription, is not to be shared with others.
Monitor your child’s levels of pain
Communicate regularly with your child about the level of pain they’re feeling, making sure it’s diminishing with time. Stay alert for any signs that your child is growing dependent on the medication.
What are some signs of misuse or dependence?
If your child is asking for pain medication more frequently than prescribed, or they’re insistent on refilling the prescription, this is a cause for concern. Consult the prescriber to help determine whether pain is going beyond its expected range.
Adverse effects of opioids — which could be a sign of misuse — include drowsiness, nausea, constipation, slowed breathing and slurred speech.
Signs of withdrawal — which would occur if your child has become dependent on an opioid and then stopped taking it — include anxiety, irritability, loss of appetite, craving for the drug, runny nose, sweating, vomiting and diarrhea.
If you’re concerned that your child may be dependent, consult the prescriber, who may in turn consult with a pain specialist. They should consider having a substance use counselor complete an assessment that reviews the extent of your child’s drug and alcohol use, their mental and physical health as well as personal, medical and family history.