I will be continuing with the Transgender Teens posts, but a recent study came out that I want to highlight, as it’s an important one. It involves teens, pain, and substance abuse- specifically, chronic pain, and the dangers that can come when careful attention is not paid to how teens are treated.

Chronic pain is generally defined as pain that lasts beyond a certain amount of time: usually 3 or 6 months. Sometimes, it can be difficult to understand exactly what is causing it. For a parent, it is exhausting and miserable to watch your child suffer day after day. You should always be vigilant and ensure that your child’s pain is being appropriately treated; but if they are on certain medications, your vigilance needs to extend even further.

Pain, and the science of treating it, is very complicated. We know that pain can be worsened by anxiety and depression in a very real, tangible way. A recent research study by Drs. Laura Richardson and Cari McCarty of our Adolescent Medicine team (along with other researchers) has highlighted how a combination of chronic pain with anxiety and/ or depression can lead to substance dependence or abuse.

The study focused on opioid pain medications, also known as narcotics. This class of medications includes hydrocodone (in Vicodin), oxycodone (in Percocet), and others. Results show that teen patients with anxiety and/ or depression, compared to those who do not have anxiety or depression, are twice as likely to be prescribed these medications long-term.

Why? It is most likely because these teens are reporting greater pain that is going on for a longer time. They aren’t lying or faking it; like I mentioned above, they do truly feel the pain. We don’t have all the data on exactly how it happens, but pain and depression/ anxiety can interact and strengthen each other, leading teens down a spiral of increasing pain and worsening mental health.

Mental health disorders like depression and anxiety already increase the risk of drug abuse. Someone with depression and/ or anxiety and access to a long-term supply of opioids has a much higher risk of engaging in substance abuse in the future. Teens who take long-term opioids are more likely to become dependent on them- and are more likely to abuse other drugs as well. These might be other prescription medications, or illegal substances like heroin.

I don’t mean to imply that teens with depression and/ or anxiety should not receive opioid pain medications, or even long-term opioid medications; sometimes it is medically necessary. But if they are on these medications, you need to pay close attention. Ask your medical provider how long they expect your teen will need this medication. Ask what precautions you and your teen can take to avoid dependence on them. Ask if they screen their patients for anxiety and/ or depression before starting these medications, and if they can offer that screening to your teen.

It’s a good idea to keep any opioid medication in your custody, so you’re aware of your teen’s pattern of taking them. If they are using more than is prescribed, or seem to need it more and more frequently, let your doctor know. It could be a sign that something is medically wrong, or it could be a sign that they are becoming dependent on the medication. Either way, your medical provider can be an invaluable partner in preventing your teen’s prescription from becoming a gateway to substance abuse.