By Iliana White
Senior Program Manager, Adolescent Health
As the opioid epidemic ravages communities across the country, the maternal and child health field has properly devoted more and more resources toward helping mothers (including pregnant women) who have become addicted and babies born with neonatal abstinence syndrome. But there is also a significant need among youth that may not be garnering the same spotlight.
The fastest growing drug problem among youth is abuse of prescription drugs, including opioids that are medically prescribed. According to the U.S. Department of Health's 2016 National Survey on Drug Use and Health, 3.6 percent of teens ages 12-17 had misused opioids in the previous year. Furthermore, after years of decline, the rate of drug overdose deaths involving opioids had a statistically significant uptick in 2015. The risk for misuse and addiction increases as youth develop and age into older adolescents and young adults.
Because of opioids' accessibility through prescriptions and household medicine cabinets, it is imperative to address ways to reduce risk of misuse and addiction among teens. Youth pose unique challenges to combating this crisis. Many teens may first be exposed to opioids via prescription to treat acute or chronic pain, such as from a dental procedure or a sports-related injury. In addition, this age group is particularly vulnerable to behavioral health issues, such as depression. Given the lack of adequate resources to combat the magnitude of mental health needs for young people (as well as long referral timeframes when there are resources), teens and young adults may resort to substance use as a coping mechanism and not receive adequate treatment. Furthermore, the stigma associated with opioids may deter youth from speaking to a trusted adult or provider about possible misuse or addiction.
Even though there may not be the abundance of opioid-targeted MCH interventions for youth as there are for mothers and newborns, there are still strategies that Title V programs and partners can follow to help adolescents. Encouraging the monitoring of pain medicine intake is critical to help curb misuse. Health care providers should consider other treatment options for pain management before resorting to opioid prescriptions for their patients in this age group. Although the challenges with associated factors such as mental health conditions are far broader to tackle than opioids alone, states should continue to invest in efforts that build protective measures for youth to reduce the risk of misuse, addiction, incidences of overdose, and related deaths. These efforts range from interpersonal interactions to systems of care. For example, family members and other caregivers need support and resources to assist them in having these difficult conversations about substance abuse with their child or relative. In addition, there are best practices in health care delivery that can support screening, treatment, and referrals for youth that may have an opioid abuse problem; many of these guidelines can be implemented in variety of health care settings, such as a pediatrician's private practice or through school-based health services.
Prevention and other intervention efforts on opioid abuse should not be limited to the tail ends of the MCH life course (e.g., babies and mothers); the needs and experiences of adolescents and young adults should be prioritized as well. Consider programming and other initiatives that are youth-led, so that adolescents can learn from their peer group. In Ohio, there are several examples of efforts in which young people direct prevention and education strategies through their statewide Prevention Action Alliance, such as the Ohio Youth-Led Prevention Network (a partnership with the state Department of Mental Health and Addiction Services). In addition, young leaders from the Ohio 4-H Healthy Living Program created the display, "What's in your medicine cabinet?" as a way to raise awareness about prescription drug misuse.
Similar to its impact on other MCH populations, the opioid crisis is affecting adolescents and young adults in ways that requires concerted and coordinated efforts among parents, trusted adults, medical providers, mental health professionals, health care systems, and young people themselves. The developmental, social, and environmental experiences of adolescents should be incorporated into initiatives that are geared toward reducing their risk for opioid misuse, as well as access to effective and timely treatment options.
The Opioid Epidemic: Implications for MCH Populations, AMCHP Issue Brief, May 2017
Opioids and Adolescents, Office of Adolescent Health, DHHS, November 2017