Teens and young adults often experiment with substances, including opioids. Opioids are a class of drugs that are commonly misused. They are highly addictive and provide a mellow and euphoric “high.”
Nearly 50,000 people in the United States died from an opioid overdose in 2019. The opioid misuse and opioid use disorder (OUD) epidemic is rampant. Of the 4,777 drug overdose deaths in youth and young adults between the ages of 15 and 24, most of them (almost 4,000) involved an opioid drug.
Prescription pain relievers are often viewed as “safe” by teens and adolescents, as they are obtained through a medical professional and therefore not seen as quite as dangerous as street drugs. These are highly potent drugs, however. They are highly addictive, and they can lead to an unintentional and fatal overdose in as little as one use.
The majority of teens who misuse these medications get them from a friend or family member who often has a legitimate prescription. The risk for overdose and addiction goes up when these medications are mixed with other drugs or alcohol, which is common.
Teens & Young Adults Opioid Use Statistics
Opioids are one of the most addictive classes of drugs. Opioids include both prescription painkillers like OxyContin (oxycodone) and Vicodin (hydrocodone/acetaminophen) as well as the illegal opioid drug heroin and the extremely potent synthetic fentanyl.
Prescription pain relievers are misused more than the illicit opioid heroin. In 2020, approximately 9.5 million people ages 12 and older misused prescription pain relievers compared with just over 900,000 abusing heroin. 4.1% of youths between the ages of 18 and 25 report misuse of prescription opioids. Just over 1.5% of teens between the ages of 12 and 17 report misusing these medications.
As many as one out of every five adolescents and young adults reports misusing an opioid at some time in their life. Misusing opioid drugs before the brain is fully formed can increase the risk for an opioid use disorder (OUD) later in life Two thirds of adults with OUD first used an opioid drug before the age of 25.
Signs of Opioid Use in My Child
Opioids are used illicitly to cause euphoric “high”. Using an opioid drug can lead to physical, social, emotional, and behavioral changes particularly in adolescents.
The following are signs that your child could be using an opioid drug:
- Changes in sleep patterns
- Stomach upset, including nausea, constipation, vomiting, or diarrhea
- Loss of appetite and changes in eating habits
- Potential weight fluctuations
- Mood swings and shifts in personality
- Social isolation and withdrawal
- Decline in school and work production
- Not consistently fulfilling regular obligations
- Possible financial trouble
- Increased risk-taking behaviors
- Decline in personal appearance and self-care practices
- Changes in social circle
- Decreased interest in things that were previously important
Drug Identification Chart
Adolescence is a time of great change, and it brings many challenges. Peer pressure and the desire to fit in can be risk factors for trying drugs or alcohol.
High stress and pressures as well as childhood trauma, neglect, and a lack of family support or supervision can all make teens more vulnerable to opioid misuse. Teens and young adults who are homeless, those who live in stressful or dangerous environments, minority populations, and those in the child welfare system are particularly vulnerable to opioid misuse.
The brain is not fully formed until the mid-20s, which makes teens and young adults more impulsive and less able to fully comprehend or think through the potential consequences of their actions. In addition,mental health conditions like depression and anxiety increase the risk for alcohol or drug misuse. Addiction also has a genetic component and is observed to often run in families.
A teen is more likely to misuse an opioid drug if their parent has a legitimate prescription for these medications that they can easily access. Ease of access to opioid drugs can be a serious risk factor.
Using prescription opioids as a teenager even with a medically necessary and legitimate prescription, raises the risk of future opioid misuse by as much as 33%.
Young adults and older adolescents, those between the ages of 16 and 30, are at the highest risk for starting opioid use, misusing opioids, OUD, and death from overdose. There are many factors that can help protect a teen or young adult from OUD and opioid misuse:
Both academic and social involvement are important. Teens who are involved in school, sports, and a healthy social life are less likely to misuse drugs.
Parental involvement is key also. Parents who are supportive and engaged with their teenagers can be a protective factor against drug misuse and addiction.
Teenagers who are engaged in the world around them and forward thinking tend to misuse drugs less. Those who have good self-esteem, healthy and supportive peer and family relationships, and the ability to regulate emotions successfully have less risk for misusing drugs or developing an OUD. These can all be protective factors against substance use.
Addiction Myths vs. Facts
Myth: Addiction is a choice people make, and they could stop doing drugs if they tried hard enough.
Fact: Addiction is a disease that impacts brain chemistry and changes the way the brain works, making it difficult to stop using drugs without professional help. It is not just a matter of willpower and often requires professional therapy and in some cases medication assisted treatment (MAT).
Myth: Addiction is a behavior problem, and only “bad” kids are addicts.
Fact: Addiction makes physical, emotional, and behavioral changes to a person. The drive to continue using drugs becomes a compulsion, not a decision. Drug use and addiction are not character flaws, and anyone can be impacted by addiction. Many vibrant, successful young adults develop addiction disorders. All parents should therefore monitor their children for substance use.
Myth: Addiction is a parent’s fault for lack of discipline.
Fact: While structure and a supportive and loving home can be protective factors for drug use, a single person is never to blame for SUD. Addiction is a chronic disease. It has many predisposing factors, and is never the result solely of one person such as a parent.
Myth: Only teens with no direction start using drugs.
Fact: Opioid drugs are often passed around among teens as “safe” since they are often gained via a medical prescription. People of all ages, cultures, genders, races, and walks of life struggle with opioid misuse and addiction.
Myth: Substance misuse is a “phase” and teens will “grow out of it.”
Fact: Opioids are highly addictive drugs. Once a physical and behavioral dependence has formed, it can be difficult to stop using these substances. Intense cravings and withdrawal symptoms can make a person “need” to keep taking these drugs to feel “even.” Opioid use in teens puts them at high risk for developing an OUD later in life.
Mental Health Among Teens & Young Adults
Teens and young adults are particularly vulnerable to mental health conditions, and mental health problems such as mood disorders are on the rise for this age group. Young adults between the ages of 18 and 25 are some of the most prone to mental health conditions, with nearly 10% of Americans in this age demographic having serious mental illness (SMI) in 2020 — the highest of any age group.
Mental health conditions can increase the risk for substance misuse. The reverse is also true. Opioid misuse and OUD can exacerbate and increase severity of mental health conditions.
These are common mental health conditions among teens and young adults:
- Depression: In 2020, over 4 million teens between the ages of 12 and 17 had a past-year major depressive episode (MDE) and 12% had a MDE with severe impairment. Rates of past-year MDE with severe impairment are highest for young adults between 18 and 25 at 17%. As many as one out of every three students in high school experienced persistent feelings of hopelessness or sadness in 2019, and one out of six made a suicide plan.
- Anxiety: Nearly 5% of teens, ages 15 to 19, have an anxiety disorder. Anxiety can be caused by chronic stress, environmental aspects, and biological factors.
Anxiety symptoms can be a reason to self-medicate with opioid drugs as a method of “mellowing out.” This can inadvertently make the anxiety disorder or symptoms worse and also lead to the development of OUD.
Anxiety and mood disorders often are related to brain chemistry or function and can impact similar regions of the brain that opioid drugs do. This means that someone with anxiety can also be vulnerable to addiction and vice versa. Drugs are a common form of stress relief; however nonmedical use of these substances can appear to temporarily relieve acute anxiety, they can often exacerbate anxiety conditions over time.
- ADHD: Around 3.5 million teens between the ages of 12 and 17 have ADHD (attention deficit hyperactivity disorder).
ADHD is characterized by hyperactivity, attention difficulties, and focus issues. Teens with ADHD are often impulsive, prone to risk taking, and commonly struggle in school. These are all risk factors for substance misuse as well. There is a direct correlation observed between adolescents and development of co-morbid substance use disorders.
- Bipolar disorder: Bipolar disorder can cause extreme changes in moods and difficulty regulating emotions. Nearly 3% of adolescents have bipolar disorder, and many of them have severe impairment. Bipolar disorder also raises the odds for developing a co-occurring substance use disorder (SUD).
How to Talk to Your Child About Opioids
It is important to have the conversation about opioid drugs early and often. Opening the door to an honest and open dialogue can go a long way toward preventing future issues.
Talk to your child about what opioid drugs are. Make it clear that they are not safe to take without a prescription for any reason. Most prescription opioid drugs that are misused are obtained from a family member or friend. If you have opioids in the house, make sure they are secured while being used and properly disposed of once they are no longer needed.
Keep talking to your child about the risks and hazards of these drugs. Even if it seems like they are not listening, they hear you.
Tips to Prevent Substance Misuse
Prevention often starts with a conversation. Talk to your teen about drugs and alcohol — what they are, how they work, and the hazards they present. Stay engaged and present in their lives. Ask questions about what they are doing, where they are going, and whom they are with. Know who their friends are and what if any experimentation they are doing with alcohol or other substances.
Be supportive and loving, and provide them with an outlet when needed. It can be helpful to work together to create an exit strategy in case they are ever in a situation where drugs are being offered.
These are additional tips for substance use prevention:
- Set clear and established ground rules and boundaries.
- Keep them involved in school activities, sports, or other recreational activities that provide a healthy and supportive environment.
- Be a good role model.
- Keep prescription medications locked up and inaccessible.
- Plan family activities and time together.
- Practice healthy habits, such as eating balanced and nutritious meals, exercising, and maintaining a good sleep schedule.
- Encourage a healthy support system, and be accessible for conversations.
What to Do if Your Son or Daughter Is Using Opioids
- Step 1: Recognize the signs. Watch for behavioral, physical, and psychological changes associated with opioid use.
- Step 2: Collect evidence. Check hiding places and trash cans to look for prescription pill bottles, tablets, powder residue, and drug paraphernalia.
- Step 3: Have a conversation. If you suspect opioid use, it’s time to step in and have a conversation with your child. Start the conversation when they do not appear to be under the influence of drugs.
Prepare for anger, outbursts, and denial. It may take more than one conversation. Keep the expectations low and set small goals to work toward.
- Step 4: Set clear expectations and consequences. Stay calm and be clear about your expectations. Set rules and boundaries that you plan to stick to with clear consequences.
It’s important not to enable drug-using behavior. Only set consequences you are going to enforce, and define clear limits you plan to stick to.
- Step 5: Enlist help. It can be helpful to involve a professional, such as your child’s doctor, school counselor, or a professional treatment provider, in the conversation.
- Step 6: Find a treatment program. Look for a specialized professional treatment program that is geared for teens or adolescents to manage OUD.
Treatment Options for Teens
Find a treatment program that understands the specific needs and circumstances of teens and young adults. These programs can have varying levels of care, depending on what you need.
In extreme cases, inpatient or residential treatment program might be necessary. Residential or inpatient programs provide on-site for structured programming and around-the-clock monitoring and support.
Outpatient programs are more flexible, as programming can often be scheduled around school or other obligations. This is often a good option if you have a solid family support system at home.
Treatment programs will often include group and individual behavioral therapies that can help to identify problem behaviors and negative thought patterns as well as to develop healthy habits, emotional regulation skills, and coping mechanisms. Group and individual counseling sessions aim to improve self-esteem and self-reliance.
Family and peer support is important. Support groups made up of other teens or young adults can foster healthy social interactions. Family members can also engage in counseling sessions and educational programs to learn how to offer the best support to their loved one.
OUD treatment often involves Medication for Addiction Treatment (MAT). These medications can help to reduce opioid misuse, minimize cravings, and manage difficult withdrawal symptoms. Ultimately, MAT promotes long-term recovery. People often remain on medication for months or years safely in order to prevent relapse.
Questions to Ask Treatment Programs
- What kind of assessment or evaluation will be done prior to admission?
- What types of treatment programs and modalities do you offer?
- What are the credentials of the staff and licensing or accreditation of the center?
- Do you offer dual diagnosis integrated treatment (when applicable)?
- What specialized programs or methods do you have for treating teens?
- Do you have developmentally appropriate programming?
- Are the treatment methods evidence-based?
- Does the program evolve as my child’s needs change?
- What types of medications, if any, are used?
- What happens after treatment? Do you have an aftercare program for ongoing support?
- What is the level and nature of family support?
- What types of payments do you accept? Can insurance coverage be used?
- Do you have a payment plan or financing option if insurance is not applied?
By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
- The Drug Overdose Epidemic: Beyond the Numbers. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/opioids/data/index.html. March 2021. Accessed February 2022.
- Drug Overdoses in Youth. National Institutes on Drug Abuse (NIDA). https://teens.drugabuse.gov/drug-facts/drug-overdoses-youth. Accessed February 2022.
- Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf. October 2021. Accessed February 2022.
- The Opioid Epidemic: A Needed Focus on Adolescents and Young Adults. Health Affairs. https://www.healthaffairs.org/do/10.1377/forefront.20191115.977344/full/. November 2019. Accessed February 2022.
- Assessment of Prescription Opioid Medical Use Among Parents and Their Adolescent Offspring in the US. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774704. January 2021. Accessed February 2022.
- Prescription Opioids in Adolescence and Future Opioid Misuse. Pediatrics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834210/. November 2015. Accessed February 2022.
- Preventing Opioid Use Disorder. National Institutes of Health (NIH). https://heal.nih.gov/research/new-strategies/preventing-opioid-use-disorder. February 2022. Accessed February 2022.
- Mental Health Issues on the Rise Among Adolescents, Young Adults. AJMC. https://www.ajmc.com/view/mental-health-issues-on-the-rise-among-adolescents-young-adults. March 2019. Accessed February 2022.
- Mental Health. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/healthyyouth/mental-health/index.htm. May 2021. Accessed February 2022.
- Adolescent Mental Health. World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. November 2021. Accessed February 2022.
- Data and Statistics About ADHD. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/ncbddd/adhd/data.html. September 2021. Accessed February 2022.
- Bipolar Disorder. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/bipolar-disorder. Accessed February 2022.
- Talking With Your Teen About Opioids. Substance Abuse and Mental Health Services Administration (SAMHSA). https://store.samhsa.gov/product/talk-they-hear-you-talking-with-your-teen-about-opioids-keeping-your-kids-safe-parent-brochure/PEP20-03-01-002. Accessed February 2022.