Youth and Opioids in California

Unintended Consequences of Pain Management

Much of what occurs today related to California opioid use, especially among young people, was the unintended consequence of physician’s and other prescriber’s attempts at pain management. Few could have anticipated the deadly consequences that opioid abuse has taken on nationwide. This extends to the youth of California, who may have been born to opioid-addicted parents or witnessed drug and alcohol abuse among their fellow young people.

It’s important to examine how opioids affect young people, the state of opioid abuse in California, what is being done to help young people, as well as how friends and loved ones can help a person seek treatments.

History of Youth and Opioid Use in the State of California

California opioid use affects people of all ages, including young people and their families.  According to the California Health Report, the agency that manages the Medi-Cal program, approximately 21,000 people, including teenagers ages 16 and older will receive addiction treatment via key grants in the next two years.

Some of the hardest-hit areas for the opioid epidemic are the more rural Northern California counties, including Del Norte, Humboldt, Lake, Lassen, Plumas, Shasta, Sierra, and Trinity counties. According to an article in The Sacramento Bee residents filled 18,439 prescriptions for oxycodone, hydrocodone, and other opioids in 2015 – and there are only 13,628 residents in the entire county itself.

Overdose Outbreaks

While Americans have been abusing opioids for some time, the real impact of deaths and overdoses related to abuse is thought to have begun in the late 1990s, when prescription drug sales quadrupled up until 2014. At those times, doctors prescribed prescription opioids for conditions that didn’t necessarily warrant higher-dose medications.

Also, opioid pain medications were originally intended as a short-term pain management method. However, they quickly began to be used in long-term pain management, which created greater availability and reliance on pain medications.

Opioids Origins and the Effect on the Body

Doctors also call opioids narcotics. They are a group of pain medications prescribed to relieve pain. Examples of opioid medications include:

  • Fentanyl
  • Hydrocodone
  • Hydromorphone (Dilaudid)
  • Morphine
  • Oxycodone
  • Tramadol

The History of Heroin

Heroin is also an opioid made from the opium poppy plant. People have been using opium poppies and isolating its effects for thousands of years. Doctors isolated morphine from opium in the 1800s and it was given as a painkiller. Historians have documented instances of Civil War veterans addicted to morphine in the late 1800s after being given the medication to recover from injuries.

Before the ill effects of the drug were fully understood, doctors used to prescribe heroin for medical uses ranging from pain relief to suppressing coughs. The Bayer Co. sold heroin commercially in 1898, a fact that is hard to imagine in today’s climate of opioid abuse. The drug didn’t become illegal until 1924 when doctors began to see the adverse effects of heroin use on the general population.

Rise in Drug Trafficking

In the 1970s, drug trafficking for drugs such as marijuana, cocaine, and heroin had increased. President Gerald Ford started a task force to identify and intercept drug traffickers. During this same decade, the painkillers Percocet and Vicodin were available on the market. While they were initially intended for short-term pain relief, researchers increasingly studied their uses for chronic pain, such as management of cancer pain or after long-term injuries.

Focus on Medical Pain Treatment

In the 1990s, pain started to become more of a priority to treat. Doctors and healthcare agencies started calling pain the “fifth vital sign” and many regulatory agencies added questions such as “Was your pain well-controlled?” to post-hospital and post-surgical surveys that affected medical and hospital reimbursements. In addition to this movement toward better treating pain, the medication OxyContin went on the market in 1996.

The release of this new pain medication, as well as an emphasis on assessing and controlling pain, saw major increases in pain prescriptions. For example, in the early 1990s, an estimated 2 to 3 million prescriptions for pain medication were written each year. This number increased to 8 million by the year 1996, according to CNN.

Soaring Prescription Rates

In 1999 an estimated 11 million opioid prescriptions were written. Even in the early 2000’s, the United States’ medical community had yet to fully recognize the effects of opioid abuse in the United States. For example, in 2001, the Joint Commission, a nonprofit organization that accredits hospitals and medical centers – accreditations which are tied to a hospital’s reimbursements – created a standard that required pain be assessed in all patients.

They also released an educational book that was a requirement for attending education seminars for doctors that claimed: “there is no evidence that addiction is a significant issue when persons are given opioids for pain control”. In 2009, the Joint Commission would remove this standard following an increase in information that pointed to the contrary.

Today, with an opioid epidemic in full swing, America has what started off as good intentions to manage pain that have ended with a nationwide problem. According to CDC Director Dr. Tom Frieden of opioids “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently”.

Effects of Opioids on the Body

When a person abuses opioids, they may experience pain relief. However, they also experience other effects that can cause addiction, such as euphoria when taking the drug. The drug also works on receptors in the body that slow breathing, affect concentration, cause drowsiness, and can create a “mental fog“. Taking the drug several times can cause changes in the brain that lead to addiction. This is when a person will continue to use a particular drug and seek it out, even when they know the drug is likely harming them.

Young people are in no way exempt from addiction and may abuse the drug in other ways, such as snorting or injecting the medication. Although they may have younger, healthier bodies than older persons who abuse opioids, they can still experience opioid side effects and overdoses.

What Is the State of Youth and Opioid Use in California?

Across the country, teen opioid abuse is second to marijuana in terms of drug abuse. According to The Sacramento Bee an estimated 20 percent of teens has abused a prescription pain medication at some point in time. While teenage drug use rates are down nationwide, any young person abusing opiates can be one too many due to the risks of overdose and death that come with opiate abuse.

According to the Department of Health and Human Services, use of pain relievers for non-medical use among those in California ages 12 to 17 is 5 percent. This percentage is the same as the United States’ overall percentage. However, California comes in slightly higher for adolescents ages 12 to 17 who report they needed treatment for illicit drug use. An estimated 4 percent of young people polled reported they needed help for their drug abuse while the national average was 3 percent.

Easy Access to Opioids

Children and young people don’t always get opioids on the streets or from their friends at school. Instead, they may easily access them in a caretaker or loved one’s medicine cabinet. A quick experiment with opioids can quickly turn into an addiction. Additionally, young people may start with prescriptions for opioids but turn to misuse. According to The Sacramento Bee an estimated 1.7 million opioid prescriptions in 2016 were for people ages 15 to 29. This is a slight decrease from 2015’s numbers, which saw 1.9 million prescriptions written for this age demographic.

Parental Drug Abuse

In addition to concerns over the easy availability of opioids, researchers know that children whose parents are addicted to opioids and/or other drugs are at greater risk for addiction themselves. Children of parents who abuse opiates are also at greater risks for experiencing violence at home and have unstable living environments because their parents may have difficulty maintaining regular employment. According to The Children’s Partnership in California, an estimated 1/3 of children who enter foster care in the state do so partially due to parental drug abuse.

What Are the Short- and Long-Term Implications of Youth Opioid Use?

Short-Term Effects of Youth Opioid Use

The most immediate short-term implications for youth opioid use are the dangers of overdosing. Most young people who overdose from opioids may use them in combination with other medications or alcohol, creating a deadly combination that depresses the central nervous system and stops a person’s breathing . As a result, the person does not receive oxygen to their brain and their body cannot function without oxygen. If a young person does receive fairly prompt treatment, a medical team may be able to revive them. However, they may be subject to brain damage or organ damage as a result of the lack of oxygen.

In addition, addiction can cause a young person to engage in risky behaviors. They may steal or engage in illegal activities as a means to get more prescriptions. They can get in trouble with the law at a young age, which can set them on a harmful path. They also are starting an addiction at a very young age that they will likely struggle with their whole lives.

Long-Term Effects of Youth Opioid Use

Long-term implications for drug use include increased risks for infections, such as respiratory infections due to continued respiratory depression. Opioids also slow the intestinal system. This can lead to medical conditions such as small bowel obstruction and chronic constipation. If a young person injects the opioids in their system, they are at increased risks for injection-related medical conditions, such as endocarditis, a serious and potentially deadly infection of the heart’s tissues. A person may also contract viruses associated with needle-sharing such as hepatitis and HIV.

How Is the State of California Addressing Opioid Use?

Fighting the opioid epidemic in California requires the collaborative efforts of local law enforcement, hospitals, drug rehabilitation facilities, pharmacy boards, the California Department of Public Health, the U.S. Drug Enforcement Agency, and many more. In 2014, the Director of the California Department of Public Health launched a workgroup comprised of many prescribers, justice officials, and more to collaborate on ways to slow and ultimately end the opioid epidemic in California. Some of the major areas of focus included:

Boosting the monitoring power and efforts of the state’s Prescription Drug Monitoring Program (PDMP)

Promoting the release and dissemination of the updated Guidelines for Prescribing Controlled Substances for Pain from the Medical Board of California (MBC)

Developing a public education plan that focuses on helping people of all ages understand the dangers of opioid abuse as well as improper storage of opioid medications.

Enhancing access to treatment centers and rehabilitation facilities for those ready to get help for their addiction.

Enhancing naloxone (Narcan) distribution to those struggling with opioid use. This medication is one that can reverse the effects of an opioid overdose, which has proven potentially life saving to many in California and beyond.

What Is Detox from Opioids Like?

Detox from opioids is not considered potentially deadly, as a detox from alcohol or benzodiazepines can be. However, this does not mean that detox from opioids cannot be dangerous or without side effects. Detoxing from opioids can cause symptoms such as:

  • Nausea
  • Tremors
  • Strong cravings for the drugs abused
  • Cold chills
  • Restless legs
  • Aching muscles

Some people describe detoxing from opioids similar to a strong flu. Each person’s experiences can vary based on how long they have used a particular drug, what drug type they used, and their overall health. What doctors do know is that it is very difficult to detox from opioids without professional medical help. This can be especially true for young people, who may not have the education on the effects of opioids and detoxing from them.

What Are Common Struggles for Young People Getting Sober From Opioids?

Breaking free from the cycle of addiction is not easy for people of any age. Addiction truly changes a person’s mind. Even though a person knows they are hurting themselves, their cravings for a drug may be so strong they cannot overcome them through willpower or even wishing they could break free from abuse.

Peer Pressure

A young person may be using these drugs in a social setting, such as at parties with their friends. At a young age, a person’s friends and their opinions are often very important. As a young person struggles to gain independence from their parents and find their own identities, they may associate more with their friends than their families.

As a result, quitting opioid abuse can be very difficult because a person may fear they will lose their friends and status if they stop abusing opioids. They may worry about the stigma that could come with addiction or the need to attend a rehabilitation facility. While today, more and more people are embracing the value of professional medical help to gain sobriety, there is still a stigma within social circles surrounding people who need help for drug addictions. Until this stigma is gone and more education is available, these will remain challenges for young people hoping to overcome their addictions.

Lack of research

One struggle for young people and caregivers alike is that there isn’t a tremendous body of research related to how to help young people overcome their opioid addictions long-term. For example, the medication buprenorphine (Suboxone) is commonly used to help people stop using opioids. This medication blocks some of the pain receptors that can cause unpleasant withdrawal symptoms when a person stops using opioids but doesn’t give a person the same euphoria they get when taking opioids.

This can be a way to transition a person from abusing opioids illegally to slowly tapering these medications off. However, this medication hasn’t been tested on children under the age of 16. Therefore, any physician that prescribes the medication to help teenagers and young people struggling with addiction will be doing so off-label and insurance monies may not cover the cost.

Preventing Opioid Abuse in Younger Generations

Pain Management Alternatives

In addition to emphasizing treatments and treatment approaches for those in California, state agencies are also emphasizing preventive methods for young people. Preventing an addiction from occurring, especially in high-risk youth who have a family history of opioid abuse, is a long-term strategic solution to ending this crisis. There are several strategies parents and caretakers of young people can use to help their child. One example is communication with physicians and prescribers related to opioid prescriptions. If a young person experiences an injury, and a doctor prescribes opioids, a caregiver could ask:

While it is important that children have their pain managed related to illness or injury, there is a fine line between the appropriate medication to manage pain and the medication that may seem easier for a physician to prescribe. Dr. David Sine, the medical director of hospice and palliative care for Valley Children’s Hospital in Madera, California, who was interviewed in the California Health Report said:

“I’ve had patients that go into a clinic with a severe ear pain and leave with a prescription for codeine,” Dr. Sine says. “I’ve never prescribed codeine for a kid with ear pain. Those are the things that happen all the time. I’ve encountered a 14- or 15-year old that’s been taking Vicodin for strep throat. Right there, you have the potential to create an addict.”

Mental Health

In addition to questions about appropriate pain management, it’s important that a caretaker disclose any history of mental health problems, addictions, or abuse in the family. While this isn’t always the case, sometimes a child or teen complaining of pain and discomfort may actually have an underlying mental health issue that could benefit from psychological treatments, not pain medications.

According to Dr. Giovanni Cucchiaro, the director of comfort, pain management, and palliative care program at Children’s Hospital, Los Angeles interviewed in the California Health Report: “Many actually have significant psychological issues (such as) depression or more severe forms like bipolar disorder,” Dr. Cucchiaro says. “The common complaint is pain, but the pain is a psychological problem and they’re treated with opioids rather than addressing the background psychological problem.”

 

Where Can a Young Person Find Help for California Opioid Abuse?

Addiction Treatment

Help is available for those in California who struggle with opioid abuse. One of the most common treatments for opioid addiction is medication-assisted treatment or MAT. This approach involves a combination of medications to help a person stop abusing opioids, counseling, and support from family and other positive influences. These therapies are available at rehabilitation facilities throughout California who can help young people get sober and stay sober. Some areas of the state also have youth-oriented programs that allow a young person to recover and pursue their sobriety among similarly aged people struggling with addiction. This can be helpful in a person realizing that they aren’t alone and hearing more about the struggles others face and how they overcame them.

Aftercare

In addition to initial treatments for addiction, such as medical detox programs that provide a way for a young person to withdraw from opiates with as minimal side effects as possible, it’s important that a young person continues to engage in their sobriety. This can include attending counseling sessions, family therapy, or group therapies, such as Narcotics Anonymous. Because a young person may go to college or the working world where they may again be exposed to drugs, it’s important they continue addiction aftercare programs that help them identify ways to continue to stay sober.

No “cure” for addiction exists. It’s possible a person may always have a thought in the back of their mind about returning to drug abuse. But starting on a drug-free path can be a lifesaving one. If you or a loved one struggles with California opioid abuse, you aren’t alone, and help is available.