Opioids: Nonmedical Use and Abuse in Older Children
• Prescription opioids constitute most nonmedical opioid use and abuse in older children, and medical opioid use places pediatric users at increased risk for nonmedical use. • Prevalence data demonstrate that pediatric nonmedical use increases over a person's lifetime, necessitating regular, ongoing prevention and screening measures. • Pain control is the most common reason for nonmedical opioid use. • Research data indicate friends and families are the most common sources for opioid diversion, with recent medical opioid users being at higher risk to divert opioids. • Strong evidence correlates nonmedical opioid use with increased substance abuse, with a significant minority of users experiencing both opioid abuse and dependence. • Central respiratory depression/apnea, severely depressed consciousness/coma, and pinpoint pupils are signs of opioid overdose. • Pediatricians should incorporate prevention strategies into their anticipatory guidance and prescribing practices. • Pediatricians must screen for nonmedical opioid use and associated substance abuse using a combination of clinical questioning and screening tools. • Primary opioid overdose management includes appropriate airway and ventilation management, circulation support, and administration of an opioid antagonist.