Teens and opioids: Time for an open conversation

woman shooting heroin

National surveys have found that teens today are much less likely to use alcohol and drugs compared to their parents’ generation. In fact, the proportion of high school seniors who chose not to use alcohol, tobacco, marijuana or other drugs has increased from 3 percent to 25 percent in the last thirty years. This remarkable good news is overshadowed by the growing number of teens who are daily marijuana users and the recent increase in opioid-related deaths among young people. It is important to understand the roots of this discrepancy in order to address it.

Statistics show that between 2014 and 2015, the rates of drug overdoses — mainly due to opioids — increased by 19 percent in teens, and are now double what they were in 1999, proving that young people are an important part of the equation. We know that most adults with addiction problems started using when they were teens and those with opioid use disorders are no exception. As a pediatrician and adolescent health specialist, I see this as both a challenge and an opportunity.

The facts about opioids

Opioids are a class of drugs that includes pain medicines like morphine, codeine and oxycodone, as well as illicit drugs like heroin. All opioids act directly on pain receptors in the brain and body, and can also affect autonomic functions like breathing and heart rate. In high doses, opioids give users a sense of well-being or euphoria. When used as prescribed, opioids are very effective in treating pain. However, when they are used improperly or without medical supervision, opioids can be highly addictive, largely due to their euphoric effect. Also, because of the effects that opioids can have on the heart and lungs, overdoses can be lethal.

Almost 5 percent of 12th graders have used an opioid medication without a prescription in the past year. This is particularly concerning because still-developing adolescent brains are particularly vulnerable to the long-term effects of drugs. Substances like opioids cause irreversible damages to areas of the brain responsible for learning, memory formation and decision making. And science shows us that, the younger people are when they first try using drugs, the higher their chances are of developing a drug addiction.


There are several ways families can help prevent their kids from developing a drug problem. Having open conversations about the risks of taking any medication — including opioids — without a prescription and keeping medications locked away at home are two key first steps. Having clear rules and expectations around curfew, alcohol and drug use also have positive effects on reducing drug-related problems in adolescents.

It is well known that teens who use cigarettes, alcohol or marijuana are much more likely to move on to using other substances, like opioids. Be clear with your teenage children that not using any drugs is the best decision they can make for their health. It’s also important to be sensitive to changes in your teen’s mood, sleep, behaviors, peer group and motivation to engage in school or extra-curricular activities. These non-specific signs suggest a problem — like depression or another mental health problem, a medical problem or drug use — and need to be investigated.


If you discover that your child is using drugs, including opioid medications without a prescription, see a medical professional as soon as possible. If you have caught the problem early, a health care provider can talk to your teen about the risks in order to help your child change his or her behavior. If your child has developed an addiction, there are evidence-based medications and counseling options for teens recommended by the American Academy of Pediatrics; help your teen find a provider who can deliver these treatments. Specialized programs like the Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s Hospital, provide the opportunity for teens and families to have a professional substance use evaluation, support and, if needed, treatment for opioid addiction.

While these types of specialized services are more likely to be available in larger cities, more and more pediatricians in smaller community practices like Wareham Pediatrics are showing interest in acquiring the training and expertise to deliver treatment to adolescents and young adults with opioid use disorders. Boston Children’s Hospital and the Adolescent Substance Use and Addiction Program are working to support local providers throughout the state to offer these services and hope to continue to expand this program over time.

Facing the opioid epidemic

Opioid medications are found in every community and are now affecting a growing number of children and teens. Taking simple measures, such as locking medications away at home and having open conversations about the risks of opioid use can make a major difference. Effectively tackling the opioid epidemic will take time, money, determination and higher-level decisions and policies. In the meantime, families and health providers can help by raising awareness about opioid problems in their community and by remembering that opioid addiction is a “teen problem” just as much as it is an “adult problem.”

Learn more about Boston Children’s Adolescent Substance Use and Addiction Program.

About the blogger: Dr. Nicholas Chadi is a pediatrician, specializing in Adolescent Medicine. He is the first Pediatric Addictions Fellow in North America and is currently conducting clinical and research work with the Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s Hospital. Follow him on Twitter @nicholaschadi or at nicholaschadi.com.