According to recent data, nearly 50% of adolescents who misuse prescription opioids report obtaining the drugs from relatives or friends. Understanding the parental origins of adolescent prescription opioid medical use and misuse has important public health implications. Adolescents and young adults who use prescription opioids are more likely to experience substance-related morbidity and are also at increased risk for suicide, overdoses, and death.
Parental Prescription Opioid Use, but Not Misuse, Associated With Adolescent Use
For a study published in JAMA Network Open, Denise B. Kandel, PhD, Pamela Griesler, PhD, and colleagues analyzed samples of 15,200 parent-adolescent dyads from the annual 2015-2017 National Survey on Drug Use and Health to examine associations between parental and adolescent prescription opioid medical use and misuse. The primary endpoint was past 12-month medical prescription opioid use or misuse among adolescents. Respondents included 9,400 mother–child and 5,800 father–child dyads in the same household, and children were aged 12 to 17.
After controlling for other factors, the study showed that parental medical prescription opioid use was associated with adolescent prescription opioid medical use (adjusted odds ratio [aOR], 1.28) and misuse (aOR, 1.53). However, parental medical prescription opioid misuse was not associated with adolescent prescription opioid medical use. The research team also found that parental medical prescription stimulant use was associated with adolescent medical prescription opioid use (aOR, 1.40).
Several factors increased risks for adolescent prescription opioid misuse, including parental marijuana use (aOR, 1.84), parent-adolescent conflict (aOR, 1.26), and adolescent depression (aOR, 1.75). Adolescent delinquency (aOR, 1.55) and perceived schoolmates’ drug use (aOR, 2.87) were also associated with adolescent misuse. Adolescents’ perceived harm of drug use decreased risk for misuse (aOR, 0.73). When these key variables were controlled for, the association between parental and adolescent prescription opioid misuse did not persist.
The rate of parental use of prescription opioids in the United States is an important source of prescription opioid exposure for children, says Dr. Kandel. The data indicate that one in three parents and one in six adolescents used a prescription opioid in the previous 12 months, she says. Of note, approximately one-third (31.5%) of parents used opioids only for medical purposes and 4.1% misused these medications, whereas 15.7% of adolescents used opioids only for medical purposes and 3.2% misused them (Table).
Preventing Adolescent Prescription Opioid Misuse
Findings from the study highlight the important link between parental prescription opioid medical use and offspring medical use and misuse. The results also illustrate the unintended consequences of opioid prescribing practices in the US. “Prescribing these medications to adults—in particular parents—can increase risks of misuse by their offspring,” says Dr. Kandel. Role modeling and availability of parents’ opioid medications in the household are significant familial risk factors for prescription opioid misuse among young people, but it is also important to note that adolescents can also access prescription opioids from individuals outside of their family.
Despite steady declines in opioid prescribing since 2015 and the implementation of prescription drug monitoring programs nationwide, more work is needed to reduce the burden of the opioid crisis. Decreasing the availability of prescription opioids in the household and potential for diversion is essential. Strategies for preventing adolescent prescription opioid misuse include:
- Limiting opioid prescribing to parents
- Conducting patient education programs that emphasize risks of parental opioid medications to their children
- Adhering to guidelines for medication use practices, including safe storage and disposal, use of lockboxes, and collection of leftover medications
Clinicians are urged to proactively assess parental use of medically prescribed opioids as part of pediatric patient care. Psychological and behavioral interventions should also become the preferred approach to treating chronic pain, and a targeted focus is needed to address adolescent mental health, particularly depression. In addition, clinicians should keep in mind that a combination of both structural and environmental factors are crucial contributing factors to opioid misuse.
Griesler PC, Hu MC, Wall MM, Kandel DB. Assessment of prescription opioid medical use and misuse among parents and their adolescent offspring in the US. JAMA Netw Open. 2021;4(1):e2031073. Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774704.
Griesler PC, Hu MC, Wall MM, Kandel DB. Nonmedical prescription opioid use by parents and adolescents in the US. Pediatrics. 2019;143(3):e20182354.
Griesler PC, Hu MC, Wall MM, Kandel DB. Medical use and misuse of prescription opioids in the US adult population: 2016-2017. Am J Public Health. 2019;109(9):1258-1265.
Clayton HB, Bohm MK, Lowry R, Ashley C, Ethier KA. Prescription opioid misuse associated with risk behaviors among adolescents. Am J Prev Med. 2019;57(4):533-539.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain: United States, 2016. JAMA. 2016;315(15):1624-1645.