The widely used terms “opioid crisis” and “opioid epidemic” refer to the high rates of opioid misuse, dependence, addiction, and overdose in the United States. (You’ll find a breakdown of what these terms mean just below.)
Opioids, also called narcotics, are used for sedation and pain relief. They come in one of three categories:
- Natural: Some opioids, like heroin, morphine, and codeine, come from the poppy plant. They’re sometimes called opiates.
- Semi-synthetic: These opioids are synthesized from naturally occurring opioids. They include oxycodone, hydrocodone, and hydromorphone.
- Synthetic: Other opioids are made in a lab. These include methadone, tramadol, and fentanyl.
Both natural and synthetic opioids have important medical uses. They act on your brain’s reward centers to trigger the release of endorphins and relieve pain. This makes them essential after major surgery, like an appendectomy, or a serious injury, like a broken arm.
But taking these medications for more than a few days can raise your chances of developing dependence. Dependence can progress to a substance use disorder (SUD), a risk that exists for children as well as adults.
People of all ages can develop opioid use disorder (OUD). Yet due to regulations around ethical experimentation, most existing research involves adult participants only.
This lack of information can make opioid pain treatment and OUD treatment difficult to navigate for children, teens, and their families. Read on to learn what science knows so far about how opioids affect youth, and how to get support for your child.
A note on terminology
“Dependence” and “addiction” are sometimes used interchangeably, but they mean different things:
- Dependence means your body has grown used to a substance. When you stop using that substance, you’ll generally experience withdrawal symptoms.
- Addiction refers to substance use you can’t stop when you try to, even if you experience unwanted consequences, like physical symptoms or relationship conflict. Healthcare professionals diagnose this as a substance use disorder (SUD).
- Misuse describes any use of a prescription medication other than the prescribed use. Taking four pills at a time when a doctor prescribed only one would fall into this category.
- Overdose happens when you take more of a substance than your body can handle. This can happen intentionally or accidentally. Opioid overdose, or opioid intoxication, can suppress breathing and cause death.
A doctor may prescribe opioids to children and teens to treat severe postsurgery pain.
Opioids can sometimes cause short-term side effects, with the
- vomiting, reported by 40% of kids
- itching, reported by 20% to 60% of kids, depending on the study
- constipation, reported by 15% to 90% of kids, depending on the study
Doctors may try to minimize opioid side effects by:
- combining opioids with other forms of pain relief so kids and teens need less opioids overall
- using local anesthesia during operations if possible to numb specific parts of the body only
- prescribing medication to help prevent specific side effects, such as laxatives for opioid-induced constipation
Respiratory depression, or slow and ineffective breathing, is a potentially life threatening side effect, but it remains very rare: It only occurs in about
Long-term health effects
Research from 2018, though it only involved adult participants, suggests the longer you use opioids, the more likely you’ll develop long lasting health effects, like:
Can treatment affect child development?
Opioid receptors in the brain don’t just influence pain. They also affect attention, memory, and learning.
Consequently, some people have expressed concerns that opioid treatment could affect child development by derailing neuron growth in the still-developing brain.
Researchers in a 2014 literature review considered four studies that followed up with children years after they received short-term opioid treatment.
None of the studies found significant differences in behavior, intelligence, or vocabulary. One study did find some decrease in visuoconstructional ability, which includes the understanding of visuospatial relationships and fine motor skill coordination.
To date, no studies have explored how long-term opioid treatment may affect child development. The
Take, for instance, a child living with severe pain from advanced cancer or an orthopedic condition. Weaning them off opioid medication could cause severe withdrawal symptoms, with little benefit.
Doctors who prescribe opioids to children and teens will typically consider a variety of factors, including quality of life, to make the best choice for each child’s unique situation.
In other words, they’ll weigh the possibility of opioid dependence against the likelihood of increased pain and distress for the child.
Opioid misuse among children and teens might involve:
- taking a higher dose than prescribed by a doctor
- using opioids for longer than prescribed
- using illegal opioids like heroin
Children and teens can also develop OUD. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), roughly 396,000 adolescents ages 12 to 17 misused opioids in 2020, and around 80,000 adolescents had OUD.
Adolescents have much lower rates of opioid misuse and OUD than adults. This may partially relate to the fact that they depend on adults for transportation and financial support, and thus may have less access to opioids.
Case in point: That 2020 research found
OUD is less common among adolescents. But teens who use opioids have a higher risk of OUD: They are more likely to experience greater euphoria from opioids and develop a rapid tolerance to opioid pain relief.
Adolescents who stop using opioids in their youth may experience milder withdrawal symptoms than average. But if they stop using opioids in adulthood, they may experience more severe withdrawal symptoms than someone who started and stopped using opioids after the age of 18.
A family member’s opioid use or OUD can also affect younger family members. In 2017:
- 3.3 million children were living with an adult who misused opioids
- 548,000 children were living with an adult who had OUD
OUD doesn’t automatically make someone a poor caregiver. However, young children who have a parent with OUD do have a
Even outside the context of maltreatment, youth in these situations may encounter traumatizing situations, such as:
- family separation during OUD treatment or incarceration
- bullying and stigma related to their family member’s condition
- parentification, which happens when a child has to take on adult roles and responsibilities
- witnessing a loved one’s opioid overdose
- death of a primary caregiver
- think they caused their caregiver’s OUD by being a “bad kid”
- believe they should have tried harder to keep their caregiver from using opioids
- feel guilty for getting their caregiver “in trouble,” if the adult with OUD is incarcerated or sent to mandatory treatment
Foster care and the opioid crisis
Due to data privacy laws, experts don’t know exactly how many children have entered foster care due to opioids in the United States.
However, a 2018 U.S. government report found counties with higher opioid death and hospitalization rates tend to have higher child welfare caseloads.
During that same time period, the 2018 report noted above found that national foster care entries increased by 10%, from 397,600 to 437,500.
While the opioid crisis may not hold the sole responsibility for this rise, the report authors say it’s likely a strong contributor.
The gold-standard treatment for OUD involves a combination of psychotherapy and medication-assisted treatment (MAT).
Youth with OUD
However, while therapy can have benefits, it’s generally not enough to address OUD on its own. Research from 2017 suggests youth who receive only psychosocial interventions frequently drop out of treatment. In fact, they’re more likely to stop treatment than youth who also receive MAT.
Still, treatment is often hard to access
One major issue is the fact that children and teens often have a much harder time accessing MAT than psychotherapy. Due to a lack of research on youth, many restrictions make it difficult for doctors to prescribe medications used in MAT to children.
Two common MAT drugs, buprenorphine and naltrexone, can only be prescribed to teens ages 16 and up. Methadone can be prescribed to children under the age of 18, but only if they have:
- already made two ineffective attempts to manage withdrawal
- written consent from a parent or guardian
Even youth who qualify for MAT are much less likely to receive this treatment than adults with the same diagnosis. According to a large 2017 study involving people in publicly funded treatment programs:
- For those in treatment for heroin addiction: Only 2.4% of adolescents received MAT, compared with 26.3% of adults.
- For those in treatment for prescription opioid addiction: Only 0.4% of adolescents received MAT, compared with 12% of adults.
Lack of access to the full range of OUD treatments can make it much harder for children and teens to get effective care.
An adult’s OUD frequently affects the entire family, including their partner and children. OUD treatment programs can help the adult with physical symptoms, but family therapy can go a long way toward helping repair relationships.
Most research on this family dynamic focuses on therapy for both adults and children, rather than child-focused interventions.
In general, though, the type of therapy a child or teen will find most helpful will typically depend on the specific concerns they experience. A therapist who specializes in concerns related to substance use can offer guidance and support in addressing:
- grief over the childhood they wanted but didn’t have
- feelings of abandonment, including a belief the caregiver “chose” opioids over them
- anger, especially if they were separated from their caregiver for a long time
- difficulty trusting adults to take care of their physical and emotional needs
- guilt or shame for “allowing” their caregiver to develop an OUD
- anxiety about their caregiver overdosing or resuming opioid use
Older children and teens may also find support groups and online forums helpful. Some support groups are specifically designed to help family members of a person with OUD:
- Nar-Anon Family Groups: This 12-step program for family and friends of people with OUD has both virtual and physical meetings.
- SMART Recovery forums: You’ll find a Concerned Significant Others forum and a Teen & Youth forum for kids ages 14 to 18.
- Sober Recovery forums: You’ll find six forums for friends and family of people living with SUDs.
While opioids play an essential role in the management of pain after surgery and severe chronic pain, these powerful medications can have significant side effects, including a risk of dependence or addiction.
Their impact on children and teens ranges widely, from temporary side effects after prescribed treatment to long-term emotional distress related to a parent’s OUD.
Research on opioid use and its side effects on youth remains limited, but experts do know one thing for certain: Treatment, including therapy and medication, can help address the impact of opioid use.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.