Some teenagers may be particularly at risk for problems with opioids, especially those who have had substance use problems in the past and those who have mental health problems.
For patients at higher risk, Dr. Hadland, like patients with anxiety or depression or those with drug problems, can still be prescribed opioids when needed. "However, we should be very careful."
When one of his patients, a young adult with alcohol use disorder, had to undergo an operation, Dr. Hadland: "Myself and the patient were both concerned about the possible abuse of opioids because of the history of addiction." He and the surgeon have teamed up, he said, and both agreed that Dr. Hadland would perform postoperative pain management because he was more readily available and more comfortable to work with a patient with this history. He prescribed very small amounts of oxycodone, he said, discussing with the patient how it felt to take the medication at each stage. "We had open communication and things were going really well."
The guidelines go beyond discussing when to use opioids and cover the importance of educating children and their parents and caregivers about the possible side effects of opioids (oversedation and respiratory depression), the importance of carefully following medical instructions, and over You must keep these medications safe (that is, in a locked area) and safely get unused cans out of the house (they should be returned to a secure opioid disposal container).
None of the other specialists I spoke to suggested changing the specific recommendations for multimodal pain relief, for using opioids when other drugs are inadequate for effective pain control, and for good parenting, leading to careful monitoring , closed storage and safe disposal of unused cans.
"The spirit behind these guidelines is right," said Dr. Hadland. "Prescribe the lowest effective dose for the shortest amount of time, use only short-acting formulations, and talk to families about risks and monitor dosing and lock up medication."
Parents and doctors can feel confident that when children use these drugs as prescribed to manage pain, "they are not at a significantly higher risk of developing opioid-related problems".
"If your child needs surgery, talk to your doctor and ask questions about what pain to expect," said Dr. Kelley-Quon. Ask if opioids are used, and if so, how to use them and how to safely dispose of them, she said. "We want to be at the sweet spot, treat pain appropriately, maximize benefits and minimize risks."