Opioids: Nonmedical Use and Abuse in Older Children

Abstract

1. William A. Frese, MD* 2. Kimberly Eiden, APN† 1. *Assistant Professor, Department of Pediatrics, Medical College of Wisconsin and Children's Research Institute, Milwaukee, WI. Formerly Department of Pediatrics, Advocate Hope Children's Hospital, Oak Lawn, IL. 2. †Department of Pediatrics, Advocate Hope Children's Hospital, Oak Lawn, IL. After completing this article, readers should be able to: 1. Characterize the prevalence of overall pediatric opioid use, both medical and nonmedical. 2. Identify demographic and clinical characteristics associated with pediatric nonmedical opioid use. 3. Discuss abuse and dependence comorbidities associated with pediatric nonmedical use of opioids. 4. Describe the pediatrician's role in prevention and screening for pediatric nonmedical prescription opioid use. 5. Explain opioid overdose management. Alone or in combination with other pain management modalities, the use of opioids can be a mainstay of adequate analgesia. However, increased prescribing and availability of opioid medications correlate with overall medication abuse and misuse rates. Prescription drug nonmedical use is second only to marijuana as the most common form of newly initiated illicit drug use (Fig. 1). (1) Surveys among adolescent populations similarly support a high incidence of nonmedical opioid medication use. (1)(2) Nonmedical opioid use rates among 12- to 17-year-old children have stabilized (Fig. 2), (3) but the overall prevalence of such inappropriate use may prompt pediatricians to consider decreasing opioid prescribing and potentially undertreat pain in an attempt to reduce the abuse of these medications. Pediatricians must be knowledgeable about the prevalence of pediatric nonmedical opioid use, its pattern, and appropriate prevention strategies. This article reviews the nonmedical use of prescription opioids in the pediatric population. The characteristics of such usage are incorporated into prevention, screening, and management strategies. Figure 1. Specific drug employed when initiating illicit drug use among initiates of illicit drugs ages 12 years or older in the past year. Reproduced with permission from Results From the 2008 National Survey on Drug Use and Health: National Findings . (1) Figure 2. Nonmedical …