“Drug overdoses killed more Americans in 2017 than guns, car accidents, or breast cancer” (Salmond & Allread, 2019). Opioid misuse is an epidemic in the United States that is continuing to grow rapidly around the world. Access to opioids has become relatively simpler due to the availability of prescriptions from health care providers and leftover opioids from friends and/or family that were not discarded properly. Opioid misuse has risen severely among the adolescent population. Adolescents who use opioids improperly (ways that that the prescriber did not intend) are at greater risk to becoming addicted to opioids and illicit drugs (Persons & Napier, 2019).
During my Nursing 487 experience I have come across many adolescents admitted with drug overdoses, drug abuse and drug seekers. When asking patients how their addiction began many stated they received drugs through prescriptions from health care providers, leftover opioids from their friends and/or family members. Most patients described they started taking opioids due to complaints of pain, anxiety, difficulty sleeping, and/or to experience the euphoric effects that opioids can produce. Opioid misuse and opioid addictions especially those found in adolescents are very pertinent issues in the healthcare setting. As nurses we encounter many patients that have used opioids improperly by the past. It is of upmost importance that we, as nurses, have the knowledge and skills to care for these patients and to help them overcome these difficulties (Nursing’s Role in Addressing Nation’s Opioid Crisis, n.d.).
An observational study was performed to research the link between opioid prescriptions and opioid misuse by adolescents in the United States. Data was collected by viewing the national poison data, the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) between the years 2005 to 2010. NAMCS and NHAMCS provided data on the amount of opioid prescriptions prescribed during the time of the study. (Sheridan, et al., 2016).
This study was performed due to “the limited data on the effect of opioid prescriptions on adolescent recreational ingestions of these medications” (Sheridan, et al., 2016). Researchers wanted to discover if opioid prescriptions prescribed to the entire population had an effect on adolescent ingestion and/or abuse of these drugs. For an estimate of 582 133 766 opioid prescriptions the national poison data received 4186 calls from adolescents related to opioid misuse between the years 2005 to 2010. Calls were received from all around the country with the West having the least amount of calls and the Midwest the highest. According to data collected it was seen that even when there was a slight decrease in opioid prescriptions the amount of calls by adolescents slightly increased. The question aroused: where were adolescence obtaining the opioids that they reported? It is unknown whether the adolescence used medications prescribed to them or medication easily accessible to them, since the national poison data dos not include if the adolescents ingested personal prescribed drugs or drugs prescribed to others. A previous study performed in emergency departments reported “10% of adolescents surveyed reported that they had used these agents for a nonmedical use before…12%-14% of the adolescents interviewed had a home prescription for these agents” (Whiteside, et al., 2013). In addition, many adolescents who complained of severe migraines received prescription opioids. One can see how it is becoming easier for adults to have access to opioids due to personal prescriptions (Sheridan, et al., 2016).
Opioid misuse in adolescents can cause many adverse effects later on in life. Studies have shown that adolescents who abused opioids and/or prescription drugs were more likely to develop depression. Moreover, patients with depression are more likely to turn to drugs to solve their problems. All health care members must be aware of underlying problems that can cause patients to misuse drugs and to look out for (Sheridan, et al., 2016).
Research was performed to study the motives of adolescents who misused opioids, and the differences between gender and race. This study was performed by creating a paper and web survey for the public middle schools and high schools in Detroit. This study assessed only the use of prescription opioids it did not include abuse of over the counter medications or any other substances. Data was collected over a five-month period. This study contained 2 694 adolescents with an equal number of males and females (McCabe, West, & Boyd, 2013).
The survey concluded the most common cause for misusing opioids was to relieve pain: “pain relief motivated more than 4 out of 5 adolescents who misused their pain medications either medically or nonmedically” (McCabe, West, & Boyd, 2013). The second common motive that adolescents stated to misuse opioids was to experience a “high”. Many more motives were listed including to aide in sleeping, decrease anxiety, to experiment the feeling, etc. When looking at differences between genders and motives none were seen except that females were more likely to report misuse than males. However, there were differences in prevalence and motives when examining different races. It was concluded that African Americans were more likely to misuse opioids for the sole purpose of pain relief when compared to the white population (McCabe, West, & Boyd, 2013).
In 2015, an experimental study was performed to determine if exposure to opiates, especially oxycodone, alter the effects of morphine later in life. This study was performed by exposing adolescent male mice to oxycodone followed by a withdrawal period. After the mice finished the withdrawal period they were exposed to morphine. Researchers studied the effects that the oxycodone had on the mice. They searched for any differences in the reward pathways and/or any development of mental illnesses such as depression and anxiety (Sanchez, Carpenter, Yohn, & Blendy, 2016).
During adolescence, the body and brain are developing rapidly. There are many changes that are taking place in the reward pathways. If an adolescent consumes opioids when these changes are taking place it is highly possible that they will disrupt the normal development and cause permanent changes in these pathways. When a person consumes oxycodone the main neurotransmitter that causes the rewarding effect is dopamine. When an adolescent consumes oxycodone a higher dopamine response takes place then when an adult consumes the same exact dose. In addition to the dopamine receptors, evidence shows that mu receptors can also be affected and increase the reward like feeling. It was concluded that adolescent mice who received oxycodone displayed an increased reaction to morphine’s rewarding effects in their adult years indicating that “adolescent oxycodone exposure may induce long-lasting alterations in the reward pathway, specifically in response to opioids” (Sanchez, Carpenter, Yohn, & Blendy, 2016).
This study did no link the development of anxiety to ingesting opioids in adolescence. Adolescent mice exposed to oxycodone did not display more anxiety when compared to mice who were not exposed. In previous studies adolescent exposure to oxycodone and other opiates were linked to mood-like disorders such as depression (Sanchez, Carpenter, Yohn, & Blendy, 2016).