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Opioids and Adolescents

Dr. Sarah Bagley from CATALYST Clinic at Boston Medical Center: Adolescent Substance Use, Addiction, and Treatment

Watch and learn about substance use in adolescence and effective approaches to treating addiction, including opioid addiction.

The opioid crisis has received much attention in the United States. More people than ever are dying from opioid overdose; in 2016, more than 42,000 people were killed by opioids.1 Across 52 areas in 45 states opioid overdoses increased by 30 percent from July 2016 through September 2017. In October 2017, President Trump declared the opioid crisis a public health emergency and pledged resources to address it. 

Some opioids, such as heroin, are illegal. However, many opioids are legal and are prescribed by health care providers to treat pain; these include oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine, among others. Use of these prescription drugs for short durations, as prescribed by a doctor, is generally safe. However, use of illegal opioids and misuse of prescription opioids can lead to addiction and even overdose or death. Misuse can include taking a drug that has been prescribed for someone else, taking a prescribed medicine differently than prescribed (for example, at a higher dose or for a longer period of time), or taking it to get high.

Fortunately, there is a concerted and multi-pronged response to this significant public health problem. Federal and state governments are prioritizing the problem, and various government and public health agencies are offering tools (many listed below) to help community-based organizations, healthcare providers, and parents and families deal with the problem. The scientific and medical communities are working to develop and encourage the use of safe, effective, non-addictive treatments to manage chronic pain as well as more effective treatments for opioid use disorders (OUDs). Parents and families of adolescents are also key to the prevention of and early intervention in opioid misuse.

Prevalence of Adolescent Opioid Misuse

Prescription drug misuse, which can include opioids, is among the fastest growing drug problems in the United States. In 2016, 3.6 percent of adolescents ages 12-17 reported misusing opioids over the past year. This percentage is twice as high among older adolescents and young adults ages 18-25.2 The vast majority of this misuse is due to prescription opioids, not heroin. 

Fortunately, opioid misuse is decreasing. For example, among high school seniors, past-year misuse of pain medication, excluding heroin, decreased from a peak of 9.5 in 2004 to 3.4 percent in 2018. The past-year misuse of Vicodin decreased from a peak of 10.5 percent in 2003 to 1.7 percent in 2018, and Oxycontin misuse has decreased from the peak rate of 5.5 percent in 2005 to 2.3 percent in 2018. Furthermore, students in the 12th grade believe that opioids are harder to obtain than in the past. In 2010, 54 percent of students in 12th grade believed that these drugs were easily accessible, as compared to 32.5 percent in 2018.3

Death from overdose is the most serious consequence of prescription drug misuse. And while the number of deaths from drug overdose remains quite low overall, the rate of overdose deaths among adolescents is increasing. In 2015, 4,235 youth ages 15-24 died from a drug-related overdose; over half of these were attributable to opioids.4 The health consequences of opioid misuse affect a much larger number of people. For example, the Centers for Disease Control and Prevention (CDC) estimates that for every young adult overdose death, there are 119 emergency room visits and 22 treatment admissions.5

Risk and Protective Factors

All adolescents are at risk for misusing opioids, though, as documented in this report, there are a wide range of factors that can either increase the risk of prescription drug misuse or help protect against it. For example: 

  • Individuals at increased risk of opioid misuse include those with: acute and chronic pain, physical health problems, or a history of mental illness (such as depression) or other substance use or misuse. Youth who have witnessed a family member overdose or who have a large number of friends who misuse prescription drugs also are at increased risk. National data show that nearly half of adolescents ages 12 to 17 who reported misusing pain relievers said they were given or bought them from a friend or relative. This number is over half for young adults ages 18 to 25 who reported misusing pain relievers.6
  • Individuals at lower risk include those who commit to doing well in school and finishing school and those who are concerned about the dangers of prescription drugs. Additionally, youth who have a strong bond with their parent and whose parents express disapproval of substance use have a lower risk of misuse.

How to Prevent Opioid Misuse

There are a number of concrete ways that parents, family members, and other concerned adults can help prevent opioid misuse among adolescents. The fact that the adolescent brain is still growing means that teens are vulnerable to addiction, but the adolescent brain also is ripe for learning healthy habits and behavior.

Caring adults can make sure that adolescents who are struggling with opioid misuse get appropriate treatment and support. Few adolescents with an opioid use disorder receive treatment. For example, between 2001 and 2014 only one in four insured youth with an OUD received treatment. Females were less likely to receive treatment than males, and youth who were Hispanic or black were less likely to receive treatment than their non-Hispanic white counterparts.7

To help prevent opioid misuse, those who care about and for adolescents should:

  • Treat pain cautiously. Adolescents often are initially exposed to opioids through prescriptions; dentist prescriptions account for 31 percent of adolescents’ first exposure to opioids.8 Some promising alternatives for pain management already exist, while others are being developed. Healthcare providers should turn to other treatment options before prescribing opioids for acute and chronic pain. The National Institutes of Health has pain information for health professionals, and the Turn the Tide pain treatment toolbox also has a range of resources.
  • Talk with teens in your life about pain treatment and management. Regardless of drug use history, reach out to youth. Building strong relationships with adolescents is the first step to connecting with youth on drug prevention. Collaboration between and within youth-serving sectors and community partnerships presents opportunities to reach at-risk and drug naïve adolescents by increasing the efficiency of care, communicating across providers, and breaking down stigmas. Combining services such as trauma-informed care and psychological support with mentors and peers in the same location also can be an effective way to reach and help youth. 

How to Get Help 

  • Act when you suspect an adolescent or someone close to them is misusing opioids. Signs of opioid misuse may include: drowsiness, constipation, nausea, dizziness, vomiting, dry mouth, headaches, sweating, and mood changes, among others. If you are concerned about opioid misuse, call Substance Abuse and Mental Health Service’s National Helpline at 1-800-662-HELP (4357) and consult the directory for opioid treatment programs in your area. When seeking substance use disorder programs, know which questions to ask

Additional Resources 

  • Best Practices. The American Academy of Pediatrics’ Committee on Substance Use and Prevention outlines best practices for the health sector to screen, treat, and refer adolescents with substance use disorders. Healthcare providers who prescribe opioids should consider prescribing or co-prescribing naloxone, an overdose reversal medication, and providing education about its use for patients who are at risk of opioid overdose.
  • Latest Research and Resources. The NIH Public-Private Initiative to Address the Opioid Crisis researches “new and improved” approaches to prevent, detect, and reverse overdoses as well as identify nonaddictive treatments for chronic pain. Also, OAH’s Adolescent Health Library has a range of relevant resources on illicit and non-illicit drug use.
  • Lesson Plans. Educators can find lesson plans from the National Institute on Drug Abuse for Teachers that help them inform their students and answer questions about the nature of prescription drug misuse.
  • Relationship-building. Keeping Youth Drug Free provides parents and caregivers with tips on building strong relationships with teens, guidance for tough conversations about substance use, and a list of common drugs and their street names. OAH also has tips on how parents and caregivers can start these conversations with their teen.
  • State Laws. The Prescription Drug Abuse Policy System keeps track of important state laws about prescription drug misuse, such as prescription drug monitoring programs, opioid prescribing guidelines, and Good Samaritan overdose prevention laws.


Centers for Disease Control and Prevention. (2017). Drug overdose death data. Retrieved from https://www.cdc.gov/drugoverdose/data/statedeaths.html.
2 Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.
3 Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2019). Monitoring the Future national survey results on drug use 1975-2018: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, University of Michigan. Retrieved from http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2018.pdf.
4 The National Institute on Drug Abuse Blog Team. (2017). Drug overdoses in youth. Retrieved from https://teens.drugabuse.gov/drug-facts/drug-overdoses-youth.
6 Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf.
7 Hadland, S. E., Wharam, J. F., Schuster, M. A., Zhang, F., Samet, J. H., & Larochelle, M. R. (2017). Trends in receipt of buprenorphine and naltrexone for opioid use disorder among adolescents and young adults, 2001-2014. Jama Pediatrics, 171(8), 747-755. doi:10.1001/jamapediatrics.2017.0745.
8 Volkow, N. D., McLellan, T. A., Cotto, J. H., Karithanom, M., & Weiss, S. R. B. (2011). Characteristics of opioid prescriptions in 2009. JAMA, 305(13), 1299-1301. doi:10.1001/jama.2011.401.
Content created by Office of Adolescent Health
Content last reviewed on May 13, 2019