Clinical Brief – August 9th
Opioid addiction is pretty bad, especially when it happens to kids and young adults.
But looking at treatments for opioid addiction, there is concern that girls and minority youths may be left behind.
Opioids aren’t the only thing hooking kids and young adults these days. Now, there’s evidence that e-cigs, more popular than cigarettes in US high schools, may act as a gateway drug to cigarette smoking for kids and young adults.
Side bar: Doctors trying to avoid prescribing opioids may be turning to alternative meds despite the lack of evidence and potential risk of abuse.
Opioid addiction by the numbers
Opioids addiction in youths…It’s been reported that 2 in 3 people in treatment for opioid addiction said they were under 25 when they first tried their first dose; 1 in 3 said they were under 18.
Between 2001 and 2014, the number of the so-called youths (aka those 13 to 25 years old) diagnosed with opioid addiction shot up by nearly 6-fold, according to a study in the journal JAMA Pediatrics.
Treating opioid addiction: Falling behind…For so many who start at such an early age, only 1 in 12 adolescents and young adults who need care for any type of addiction actually receive treatment.
Buprenorphine and naltrexone are two approved treatments shown to prevent relapse and overdose among addicted youths.
Between 2001 and 2014, the same study found that scripts for buprenorphine and naltrexone for youths jumped by more than 10-fold.
Encouraging news. But looking closely at the youths who got treated, the study found that 17% fewer girls got treated than boys. Put another way, while nearly 1 in 4 boys received treatment, only 1 in 5 girls did.
Similarly, significantly fewer non-Hispanic black and Hispanic youths received treatment vs non-Hispanic white youths.
Follow the smoke
The CDC reported that e-cigs are now more popular than cigarettes among US high school students.
Turns out, someone who’s 14 to 30 years old smoking an e-cig is nearly 4-times more likely to start smoking a cigarette than someone who’s never used an e-cig; according to a study in the journal JAMA Pediatrics.
Even after adjusting for demographic, psychosocial, and behavioral risk factors for cigarette smoking, the odds of an e-cig user were still more than 3-times higher vs someone who’s never used an e-cig.
A substitute for opioids?
As the US becomes more conscientious of its growing opioid addiction problem, doctors may be turning to another class of drugs called gabapentinoids as a potentially off-label alternative, reports a study in the journal NEJM.
Gabapentinoids include drugs such as gabapentin (Neurontin) and pregabalin (Lyrica).
In 2016, 64M scripts for Neurontin were handed out, up from 39M in 2012. At the same time, Lyrica pulled in $4.4B in sales, behind only three other patented drugs used by family physicians to treat diabetes and COPD – two of the most common chronic conditions.
What’s the problem here? The study raises three:
- We don’t know if these drugs actually work to manage general pain.
- They have some troublesome side effects and can mess around with other drugs if taken at the same time.
- And this: evidence suggests that there’s a risk for abuse.
At the end of the day, addiction may be less dependent on the substance rather than the psychology behind it. Treatment, therefore, shouldn’t just be another script.
“Patients who are in pain deserve empathy, understanding, time, and attention.”
– Goodman CW and Brett AS