Opioids: Nonmedical Use and Abuse in Older Children

Introduction

Alone or in combination with other pain management modalities, the use of opioids can be a mainstay of adequate analgesia. However, increased prescribing and availability of opioid medications correlate with overall medication abuse and misuse rates. Prescription drug nonmedical use is second only to marijuana as the most common form of newly initiated illicit drug use (Fig. 1). (1) Surveys among adolescent populations similarly support a high incidence of nonmedical opioid medication use. (1)(2) Nonmedical opioid use rates among 12- to 17-year-old children have stabilized (Fig. 2), (3) but the overall prevalence of such inappropriate use may prompt pediatricians to consider decreasing opioid prescribing and potentially undertreat pain in an attempt to reduce the abuse of these medications. Pediatricians must be knowledgeable about the prevalence of pediatric nonmedical opioid use, its pattern, and appropriate prevention strategies. This article reviews the nonmedical use of prescription opioids in the pediatric population. The characteristics of such usage are incorporated into prevention, screening, and management strategies.