Almost half of American teens who misused a prescription opioid in the past year got the pills from a friend or relative for free, according to government statistics.
Now some doctors are concerned about the diversion of prescription opioids in the other direction — from child to parent.
There’s no data on how many parents misuse the opioid medication that their child is prescribed for pain.
But some doctors say it’s common enough that pediatricians should be cautious when prescribing opioids to children and teens.
A pediatric oncologist from New Hampshire recently brought this issue to light in an article she wrote for The Huffington Post.
One of her young patients was prescribed 200 tablets of the opioid hydromorphone (Dilaudid) from four different doctors over four weeks. Dr. Julie Kim suspects the boy’s mother was using some of those tablets.
This kind of “doctor shopping” should trigger a red flag in the state’s prescription drug monitoring program (PDMP), but Kim wrote that the boy’s cancer diagnosis exempted him from opioid prescription limits.
Kim also wrote that parents with an opioid use disorder may try to get more pills by telling a doctor that “their child’s pain responds only to opioids.”
She said that one mother even “threatened to punch [her] for refusing to prescribe more Dilaudid for her child” and “later threatened to get a gun from her car.”
Not common, but still concerning
Parents siphoning off their child’s opioid medication, or making up a diagnosis of pain for their child in order to get more medication, is rare compared to other types of diversion.
“It’s not uncommon, but it’s not something that you would see all the time because it’s really hard to pull off,” said Sal Raichbach PsyD, LCSW, chief of clinical compliance at Ambrosia Treatment Center.
In his years of treating addiction, Raichbach has only come across a few parents using their child’s opioid prescription.
One case involved a child whose parents were divorced. Because the child moved back and forth between the parents’ houses, it was easier for the opioid medication to go missing.
“The child’s doctor found out later that the parent was actually taking the child’s medication and telling the child that he doesn’t need it anymore,” Raichbach told Healthline.
The other parent caught on to the missing pills when the child continued to complain about pain and the pills in the bottle didn’t add up to what the child should’ve taken.
Still, Raichbach thinks it’s difficult for parents to misuse a child’s medication, even if they wanted to.
Recommendations for doctors
The Centers for Disease Control and Prevention guidelines recommend only three days of opioid pills for most acute pain cases, such as injuries and postsurgery. That means fewer pills go missing.
The guidelines also recommend that doctors be more cautious when prescribing opioids for longer-term pain, such as cancer.
Older children are more likely to tell a doctor about their pain levels and how many pills they’ve been taking. That leaves younger children’s prescriptions as the main source of opioids for a parent with a substance use disorder.
“Exaggerating the pain level of a child’s injury or condition is hard to sell, unless the child is really small,” said Raichbach, “because most kids describe their own tolerance for or level of pain to their physician.”
And eventually a doctor or another adult will notice any pills that go missing.
“A parent may say the first or second time that the medication spilled or the medication wasn’t taken well by the child and they spit it out,” said Raichbach. “There are ways to steal pills, but after a while it raises red flags.”
Screening for parent addiction
Even though this is a low-risk type of diversion, Raichbach and others think that it should still be on the radar of doctors who prescribe opioids to children.
“I think today, especially with divorced parents or other adults supervising a child, it’s important to know the family history,” said Raichbach.
“If there are opioid medications being given, it’s important to know who’s administering those medications,” he added. “And if there is a family history of alcoholism or addiction, it’s important to know that, too.”
The Cincinnati Children’s Hospital Medical Center recently developed a system for identifying which pediatric patients are at risk of opioid misuse.
This screening questionnaire also asks whether anyone in the child’s home has a history of drug use or mental health problems.
The researchers who developed the system wrote that parents and patients interviewed were open about drug use in and outside of the home. The screening also enabled doctors to have conversations with families about the risks and benefits of opioid medications.
Last year, Pennsylvania released guidelines for safely prescribing opioids to kids. These don’t mention the risk of parents using a child’s medication, but they do recommend that doctors screen for family history of substance use disorders.
The guidelines also address diversion of opioid medications by teens, such as stealing pills from their parents or taking a friend’s leftover pills. This is a much larger problem than parents siphoning off their child’s pills.
Kim wrote that her concern over parents using their child’s opioid medication, along with the other risks of long-term use of opioids, led her to adopt a more pro-marijuana stance. She’s prescribed medical marijuana to patients as young as 3 years old.
Two studies published last week suggest that more people may be turning to medical marijuana to relieve their pain.
One study in JAMA Internal Medicine found that opioid prescriptions among Medicare enrollees were 14 percent lower in states with easy access to medical marijuana. The other study in the same journal found similar results with Medicaid enrollees.
The results, though, may not apply to people outside of Medicare and Medicaid. The studies also don’t show that people are opting for marijuana instead of opioids.
Even medical marijuana won’t solve the opioid crisis by itself. And marijuana has its own risks — including possibly increasing the risk that a person will develop an opioid use disorder.
Whether doctors are prescribing opioids or medical marijuana for their pediatric patients’ pain, they still need to keep an eye out for the risks to the child and other family members.
“When you take your child to a doctor, there’s a whole list of questions that are asked of the parent, such as cancer or high blood pressure history in the family,” said Raichbach. “I think we should also ask about family history of drug abuse or alcoholism, and even nicotine.”