More and more teens and young adults are showing up in emergency rooms addicted to opioids, researchers reported Friday. And they say their findings are probably only the tip of the iceberg.
Most of the youths are not showing up because they’re addicted, the researchers said in a report for an annual meeting of pediatricians. They are coming in for some other reason and doctors are discovering they are also addicted to or dependent on opioids.
The United States is in the middle of an opioid overdose epidemic, the Centers for Disease Control and Prevention says.
“Opioids (including prescription opioids and heroin) killed more than 33,000 people in 2015, more than any year on record. Nearly half of all opioid overdose deaths involve a prescription opioid,” CDC says.
“We know that opioid crisis is a major problem for the adults in the United States. And now for the first time, we have shown that this problem also exists in the pediatric age group,” said Dr. Veerajalandhar Allareddy, medical director of the pediatric intensive care unit at the University of Iowa Stead Family Children’s Hospital.
“In our opinion, this is a pediatric public health crisis.”
Allareddy’s team looked at a database of insurance payments made to emergency departments from 2008 to 2013.
They found 32,235 children and young adults under the age of 21 were diagnosed with some kind of opioid dependency at an ER in 2008. By 2013, that number had risen to 49,626. Most were aged 18 to 21, they told the American Academy of Pediatrics national conference in Chicago.
“In our opinion, for sure this appears to be the tip of the iceberg,” Allareddy told NBC News.
“Probably this is underestimated because we have looked only at the kids who come into the emergency department,” Allareddy added.
“We don't know what's happening at the clinic level and also the urgent care — also those kids who get admitted into the hospital for other reasons.”
Most people who end up addicted to opioids first took one as a legitimate prescription, according to the CDC.
The CDC has been trying to get doctors to prescribe opioids only when absolutely necessary, and to prescribe as low a dose as possible for the shortest time possible. Other pain options include ibuprofen or acetaminophen, ice and even relaxation techniques.
It can be difficult for doctors, who are trying to relieve suffering.
Dr. Purva Grover, medical director of the Cleveland Clinic Pediatric Emergency Departments, is trying, especially with children and teenagers.
“It’s all about setting expectations,” Grover said. Patients — even children — cannot always expect to have no pain at all after an injury or surgical procedure.
“When I see a patient who has a really bad forearm fracture or a really bad infection for which they will need pain medication, it’s setting expectation with the patient and the parent. Setting the expectation that I hope and my plan is to take this pain from a scale of 10 to 4 or 3 but I cannot promise you that the pain will go to a zero,” Grover told NBC News.
“So when the parent or the child goes in with the expectation that, ‘I will have some discomfort. I will have some pain, some anxiety, and this will take time’, they are much more open to what is yet to come."
The risk comes doctors give patients medication and them they will be pain-free.
"That’s when we are setting ourselves and our patients up for failure,” said Grover.
Kids suffering withdrawal
Another study being presented at the pediatrics meeting found more kids are suffering from opioid-related side-effects, including withdrawal symptoms, in the hospital.
"We found opioid-related problems were relatively common in hospitalized children," said Dr. Jessica Barreto of Nicklaus Children's Hospital in Miami.
In 2013, 13 kids out of every 10,000 treated had an opioid-related problem. This nearly doubled by 2012 to more than 20 for every 10,000 treated.
Problems ranged from constipation to altered mental status, cardiac arrest and anaphylaxis.
"For the past two decades, doctors have been increasingly recognizing and treating pain in children,” Barreto said.
“Unfortunately, the efforts to improve pain management in children have led to a significant rise in the use of opioids both within hospitals as well as in the outpatient setting.”