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We recently spent some time with a young man who was a close friend and fellow opioid user with our son. While he has survived dying from an overdose and has been clean on and off for almost 20 years, he has been on Suboxone for the past nine months, trying once again to be clean after one more cycle of opioid addiction. He has tried many ways to get free of the stranglehold that opioids have on his brain, to no avail. How did this happen?
Our son, like millions of other adolescents, were prescribed opioids for some type of pain: oral surgeries, sports injuries, accidents, etc. John Leif (JL) had his first experience with opioids at 12 when he had teeth extracted before wearing braces. What we didn’t know then (2001) were the facts about opioids and addiction. Why we didn’t know – and most doctors and dentists didn’t either – was due to Purdue Pharma and other drug companies’ propaganda on the safety of oral opioids: “Opioids are not addictive if a person is in pain.” That, of course, is a lie and one they knew perfectly well. The opioid epidemic is the result of their lies.
The more recent information from multiple drug studies is what we wish we would have known 20 years ago: Legitimate use of prescribed opioids before the 12th grade is independently associated with a 33% increase in the risk of future opioid misuse after high school by age 23 compared to those with no history of an opioid prescription. This was among patients with little drug experience and who disapprove of illegal drug use. (1)
Why does an opioid prescription predict future opioid misuse most strongly among individuals with little to no experience with use of illegal drugs – i.e., adolescents? For drug-naïve individuals, an opioid prescription is likely to be their first experience with an addictive substance. Most likely the pain relief is pleasurable, and a safe initial experience with opioids may reduce perceived risk. A pleasurable and safe initial experience with a psychotropic drug is a central factor in theories of who goes on to misuse drugs. (2)
Until recently, the short-term use of opioids to treat pain was thought to carry a negligible risk for precipitating future misuse. But we now know that a person is at risk of developing an addiction to opioids after 3-5 days of taking a prescribed pain reliever. Approximately 3/4 of individuals who use illicit opioids, started by using opioid pain relievers. (3) Taking an opioid for a day or two is not a problem for most people, but some studies show that even the first dose can have physiological effects that can make someone vulnerable to opioid use disorder. (4)
Pain and pleasure are some of nature’s strongest motivators and when combined they can become irresistible. Which is how opioids become such a potent and deadly physiologic addiction. And opioids are so much more addictive than other drugs that feed the brains’ pleasure circuits because the withdrawal from opioids makes them inescapable. It is the fear of sickness and pain – being “dope sick” – that causes a person to crave the next dose of opioids. To better understand how opioids affect the brain, watch this 5-minute video from PBS:
Something to consider: Adolescents prescription opioids were commonly accessed for free from a friend (49%), from their own prescription (35%), or bought from a friend (32%). (2) What can be done? The best thing a parent and those who are involved with pre-adolescents and adolescents can do is to be educated about the drugs that are available and to have open conversations with their young people. And insist that health care practitioners use options other than opioids to treat pain in adolescents. There are very few types of pain that cannot be treated with analgesics or physic therapy. And it is OK for our kids to experience a little pain.
1.Prescription Opioids in Adolescence and Future Opioid Misuse
Richard Miech, PhD, Lloyd Johnston, PhD, Patrick M. O’Malley, PhD, Katherine M. Keyes, PhD, Kennon Heard, MD
PEDIATRICS Volume 136, number 5, November 2015
2.Opioid Use Disorders in Adolescents—Updates in Assessment and Management
Amy M. Yule, M.D1,2,3, Rachael M. Lyons, B.S1, and Timothy E. Wilens, M.D1,2,3
Curr Pediatr Rep. Author manuscript; available in PMC 2019 March 18
Opiate Nation 
This is an outstanding article. Thank you for continuing to keep us aware of the danger of even short-term opioid use.Aldine
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