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Teens still commonly prescribed opioids, study finds

Opioids are still commonly prescribed to teens and young adults during emergency room visits.

Linda Carroll, NBC, May 28, 2019

Opioid prescriptions remain common for teens and young adults, a new study finds.

From 2005 to 2015, nearly 15 percent of teens and young adults received an opioid prescription during an emergency room visit, according to the study, published Tuesday in the journal Pediatrics. That's compared with 3 percent among those who were seen in an outpatient clinic.

What's more, ER visits for dental issues resulted in an opioid prescription nearly 60 percent of the time.

"Adolescents and young adults are such a high-risk population for opioid misuse and future addiction," said the study's lead author, Dr. Joel Hudgins, a clinical instructor at Boston Children's Hospital and Harvard Medical School. "We found the rates of opioid prescriptions were pretty high, at 15 percent, which is right in line with adult data."

In 2016, nearly 400,000 young adults, ages 18 to 25 had an opioid-use disorder in the previous year, according to the Substance Abuse and Mental Health Services Administration. And it's estimated that one in eight deaths in teens and young adults is linked to opioids, according to an editorial published alongside the new study.

To get a sense of how many teens and young adults, ages 13 to 22, were receiving prescriptions for opioids in the ER and outpatient clinics -and for what conditions - Hudgins and his colleagues turned to two nationally representative databases: the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey.

The raw samples from 2005 through 2015 from those databases included 47,159 visits to ERs and 31,271 visits to outpatient clinics. Extrapolating those numbers to the entire U.S. population would represent 197 million visits to an ER and 801 million visits to an outpatient clinic.

While opioid prescriptions might be understandable for collarbone fractures and certain other types of bone breaks, Hudgins and others were perplexed by others, including those for sore throats, for which opioids were prescribed at 12.5 percent of visits, urinary tract infections, prescribed at 16.7 percent of visits and dental problems, prescribed at 57.9 percent of visits.

Hudgins was particularly struck by the numbers relating to dental issues. "The actual recommendation for this is for Tylenol or ibuprofen, not opioids," he told NBC News.

That may be so, but it appears that U.S. dentists also prescribe a lot of opioids. A separate study, published on Friday in the journal JAMA Network Open, found that in 2016, the proportion of prescriptions for opioids written by U.S. dentists was 37 times greater than the proportion written by British dentists.

Opioids, adolescents and young adults

What's most concerning is that the prescriptions for opioids discussed in the new research are being written for adolescents and young adults, said Dr. Deanna Wilson, an addiction specialist and an assistant professor of medicine and pediatrics at the University of Pittsburgh Medical Center.

"This reiterates what I see," Wilson told NBC News. "The vast majority of young adult and adolescent patients using fentanyl and heroin started with a prescription for opioids."

People have to remember that adolescents are especially vulnerable to addictive drugs because their brains haven't finished developing, Wilson said. "My favorite analogy is to think of it as a car that has a gas pedal but the brakes aren't fully developed," she added.

Part of the solution to the problem may be more education for both physicians and the public, said Dr. Christopher Hammond, an assistant professor of psychiatry and medical director of the Co-occurring Disorders in Adolescents and Young Adults Program at Johns Hopkins Medicine.

"I think [the new study] frames an area that future public health initiatives and training should be targeting: how to reduce opioid prescriptions in these ER settings and how to use non-opioid pain medications and other pain approaches in the acute care setting," Hammond told NBC News. "The antecedents for opioid misuse start in adolescence and early adulthood."

Indeed, doctors need to look beyond opioids for pain control, said Dr. C. Anthoney Lim, director of pediatric emergency medicine for the Mount Sinai Health System and an assistant professor of pediatrics at the Icahn School of Medicine at Mount Sinai.

"Physicians should be suggesting NSAIDs, like Motrin, unless there is a counter-indication. And parents should be told to give the NSAID time to work. If after that the pain is uncontrollable, you can use [less-strong opioids such as] Tylenol-Codeine or Percocet."

Ultimately, it may be up to parents to combat the problem for teens, Lim told NBC News, adding "it's important for parents to ask about [non-opioid pain medications] and alternative approaches to pain control."

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