When children die from opioid use, few seem to care.
A recent issue of the Journal of the American Medical Association (JAMA) documented a three-fold increase in opioid deaths among people 19 years of age and younger from 1999-2016. I work as a pediatrician in an emergency department in rural Maryland and have treated children who overdose on opioids. As shocked as I was to learn of this sobering statistic, I was more concerned about the lack of coverage that this information generated among mainstream media outlets.
I have generally applauded the response many segments of society (including the media, governmental bodies, law enforcement, etc.) mounted in response to this opioid epidemic. Learning from the wrong-headed approach to the war on drugs of the 1980s in which people who used drugs often bore the brunt of the negative vitriol and related consequences, current approaches have viewed drug use as more of a health condition. Instead of criminalizing drug use, many jurisdictions have set up “drug courts” to help people with drug use disorders get treatment and keep them out of the criminal justice system. Even with this more well-informed approach, shortcomings exist—particularly as it is related to addressing opioid misuse for minors. More specifically, many of the modalities used to treat opioid misuse (medications, treatment centers, etc.) are difficult for minors to access.
When minors are discussed with regard to the opioid epidemic, the focus is often on prevention and awareness. While laudable, such efforts do not address the needs of minors who are already misusing opioids and need treatment.
The federal government and some municipalities have made great strides in their financial support to expand centers where people with a history of opioid misuse can get help. However, there are very few centers throughout this region and country that will treat minors who misuse opioids. There are also medications that help people wean off of opioids (e.g. suboxone) but very few providers are certified to provide this medication for people less than 18 years of age.
There was another misconception that was dispelled in this JAMA article. While there is an overall three-fold increase in opioid deaths among all minors, the authors found that minors who are African American have nearly a four-fold increase in mortality. This statistic upends our conventional understanding about the demographics of this crisis. The opioid epidemic has largely been framed as a problem confined primarily to white and/or rural America. This framing has kept many of us less aware that inner-city African American communities are also affected by the opioid epidemic as outlined in a recent Washington Post story. As strides are being made to address the lack of resources from one invisible group impacted by the opioid epidemic (minors), we must also remember to redouble such efforts to provide resources for the “doubly-invisible” group—minors who are African American.
In addition to ensuring that efforts to mitigate the opioid epidemic address the increasing number of minors who misuse opioids, there are other ways to address this epidemic that can improve the lives of all people who misuse opioids. First, Congress can work to address the near 600% price increase of the medications (e.g. Naloxone) used to save the lives of people who overdose. That this price increase has come in the height of the opioid epidemic is unconscionable.
Additionally, any health care provider that can prescribe opioids should be mandated to have training on the best evidence-based practices for pain management. Some states have opioid education mandates (e.g. Massachusetts) while others simply recommend training (e.g. Maryland). I had been in practice for six years before I was mandated by a state medical board to obtain such training. There is at least one way to ensure that all providers obtain such training. The Drug Enforcement Agency (who issues opioid prescription licenses to health care providers) can mandate training when health care providers apply for and/or renew their licenses.
Given the many ways this opioid epidemic has manifested over the past few years, multifaceted approaches will likely be necessary to successfully end it. As a pediatrician and parent, it is my hope that all proposed interventions keep in mind children are also increasingly dying in this epidemic.
David Myles is a pediatrician, Fellow of the American Academy of Pediatrics (AAP), a member of the AAP’s Committee on State Government Affairs, and serves on the Rockville Goes Purple Opioid Awareness Committee and on the Montgomery County Mental Health Advisory Committee. He is a candidate for Rockville City Council; to learn more about his past accomplishments and vision for Rockville, visit DavidEricMyles.com.
Did you know? The City of Rockville is actively involved in opioid issues, including legal action against drug manufacturers and distributors for their role in the nationwide opioid crisis and bringing awareness to opioid abuse by “going purple” in September for National Recovery Month. According to the Washington Post, from 2006 to 2012 there were 104,031,619 prescription pain pills, enough for 15 pills per person per year, supplied to Montgomery County. Ambulatory Care Pharmacy in Rockville received the highest number of pills: 4,281,820.