Fewer teen opioid prescriptions coincided with increasing opioid-related harms over time.
A large Canadian study is challenging the belief that opioid prescription medicine to teenagers after an emergency room visit is a major reason young people later develop opioid addiction or experience overdoses. Researchers found that opioid prescribing for adolescents dropped sharply over a ten-year period, yet opioid-related harm continued to increase, suggesting other factors are driving the problem. The study was led by researchers at the University of Alberta and published in the journal Pediatrics. The team reviewed nearly 1.2 million emergency department visits involving patients between the ages of 12 and 17 across Alberta from 2010 through 2020. They wanted to learn whether opioid prescriptions given for injuries, such as broken bones or severe muscle injuries, were connected to later opioid-related medical emergencies.
As opioid prescription concerns continue to rise, doctors have become much more cautious about prescribing these addictive medications over the past decade. Many parents also worry that even a short prescription after an injury could increase the chances of addiction later in life. Researchers wanted to find out whether those concerns matched what was happening across a large population.
The numbers showed a major drop in opioid prescribing. In 2010, about 3.3% of emergency room visits for teenagers resulted in an opioid prescription. By 2020, that number had fallen to just 1.2%. Despite that decline, opioid-related harm among teenagers increased during the same period. Medical visits involving opioid withdrawal, overdoses, or treatment for opioid use disorder rose from 0.15% to 0.28%.
According to the researchers, those findings suggest that prescriptions from emergency departments are probably not a major reason for the rise in opioid-related problems among adolescents. Instead, they point to today’s illegal drug supply as a much larger concern. Street drugs contaminated with powerful synthetic opioids, including fentanyl and carfentanil, have become a leading cause of overdose deaths across all of North America.
The findings do not mean opioids should be handed out freely. Researchers stressed that these medicines should still be prescribed carefully and only when needed. For many common injuries, non-opioid pain relievers such as ibuprofen remain the preferred starting treatment. Earlier research from the same university found that children with fractures and sprains often receive effective pain relief from ibuprofen without needing opioid medications.
There are still situations, however, where stronger pain relief may be appropriate. Some injuries cause severe pain that does not improve with medications like acetaminophen or ibuprofen alone. In those cases, a short course of opioid medication may help patients stay comfortable while they recover. Researchers hope the new findings will reassure families that carefully supervised, limited opioid use for acute injuries does not appear to be a major driver of the youth opioid epidemic.
The study also points out that not every teenager faces the same level of risk. Previous research has shown that adolescents with mental health conditions or existing substance use disorders may have a greater chance of experiencing opioid-related problems. Because of that, doctors often consider each patient’s medical history before deciding whether an opioid prescription is appropriate. Researchers plan to continue studying which factors place certain teenagers at higher risk. Future work will compare outcomes based on age, sex, gender, income level, medical conditions, and other personal characteristics. The goal is to give doctors and families better information when deciding whether the benefits of opioid treatment outweigh the possible risks for a particular patient.
Sources:
ER opioid prescriptions unlikely to be significant drivers of future substance use among adolescents
Emergency Department Prescribing and Opioid-Related Harms Among Adolescents in Alberta: 2010-2020
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