Teen use of any alcohol or drug is riskier than adult use. And teenagers often think that a prescription medication, used under doctor's orders or without them, is somehow safer than other drugs. But, really, if a kid is looking for a way to change the way he or she feels, all alcohol or other drug use—including the use of opioid painkillers—can be risky. Let us look at the world the way a teen may see it. A young person may observe the way a friend or sibling uses a prescription medication under a doctor's orders. The young person may see how that friend's use of that prescription takes away their pain. This observation may encourage the teen to be more willing to use a prescription drug when feeling low, or when looking to feel high, even without the same conditions of a doctor's orders. The idea that prescription medication is safer than "illegal drugs," contributes to opioid dependence. It's important to stress that prescription drugs can be used illegally: It's illegal to use a prescription drug in ways not prescribed. It's illegal to use a drug prescribed to someone else. Since every person's body and chemical makeup are different, how one prescription impacts an individual can be very different to how it impacts another person in different circumstances. Opioid medications are more likely to promote overdose and addiction when they are used: in dosages higher than their prescription; for longer durations than prescribed; or, by persons without a prescription, especially developing teens. These ever-present risk factors of medicinal opioid use and dependence have contributed in the present day to more prescription drug overdoses in the United States than heroin and cocaine combined. Opioid Prescribing Practices While opioids are used in many places, New Zealand and the United States are the only two countries in the world where pharmaceutical companies are permitted to advertise their branded prescription medications. Young people that live in these countries are inundated with prescription drug messaging. One conclusion teens may come to is that any physical or mental ailment can be cured with a pill. Unfortunately, prescribing physicians living within these countries receive similar pressure to prescribe medications from both pharmaceutical companies and consumers. Think of how many times you've heard, "Ask your doctor if this drug is right for you." This advertising works. Surveys conducted in both the United States and New Zealand show that when a patient asks their doctor for a specific drug by name, the patient is more likely to receive a prescription for that drug. In a system battling such pressures, major shifts in prescribing trends have also occurred. For example, opioid drugs have recently begun being prescribed, against the suggestion of the World Health Organization, for non-chronic cancer pain. With opioids being prescribed for more and more conditions, the overall number of these prescriptions has increased greatly over a short period of time. The total number of opioid pain relief prescriptions in the United States was 76 million in 1991, but well over twice that figure in 2013 when 207 million prescriptions were written. With the availability of prescription opioids increasing in the United States, the country's patients consume 81% of the world's oxycodone and almost all of the world's total hydrocodone prescriptions. The health risks of opioid injury and addiction are linked to the prevalence of opioids in society. In 2014, each day of the year, 80 people in the United States fatally overdosed as a result of opioid abuse. A far greater number faced the negative health consequences of opioid addiction and other problems related to dependency on the drug. The "Opioid Epidemic" and How it Affects our Youth It is clear how the opioid conversation has changed and why it is currently such an important prevention topic. For many reasons, communities in the United States and world are experiencing increasing levels of opioid addiction and death. When opioids are ingested into the body, the effects can be very powerful. As a depressant, opioids slow breathing. Coupled with another side effect of opioid use—the potential loss of consciousness—a person under the influence of opioids may pass out and stop breathing. This is a real, scary, and unfortunately an all too common occurrence for the 2.5 million people in the United States who are either addicted to opioids or who are using opioids in ways that promote the development of an addiction. At the same time, we at Hazelden Betty Ford Prevention Solutions know that one of the most effective ways to ensure our youth are protected from the risks of alcohol and other drugs is to keep our focus and theirs on how the majority of their peers are healthy—i.e., choosing not to use. When it comes to opioids, most teens do not use them, and most are not addicted. In fact, less than one percent of the entire United States population, and even fewer teens than adults, are addicted to or are using prescription or other opioids in risky ways. Over 99% of us, and an even greater number of teens, are not a part of the opioid epidemic. Still, alcohol and other drug addiction is a disease of relationships, and the impact of a father, mother, friend, or child's opioid dependence goes far beyond just themselves. The ripple effect of an opioid addiction impacts many lives. As with health issues like obesity and cancer, one person's chronic disease affects us all. The good news is, despite what the media may tell us, most teens not only do not misuse opioids, but an overwhelming majority (95% of 12th graders surveyed in the University of Michigan's most recent Monitoring the Future study) also disapprove of opioid misuse by others. Your Role in Preventing Student Opioid Use All of this information brings us to two important conclusions about opioids and adolescents: most young people are healthy, and those at higher risk for opioid addiction do not knowingly or willingly intend to put themselves at this risk. Knowing this, we can start vital conversations and build crucial skills in our teens to ensure they understand the risks of opioid use and protect themselves against these risks. Build Routine Dialogues Too often, the first or only conversations kids have with adults about alcohol and other drugs are punitive in nature. These conversations may focus on the consequences of breaking family or school rules, and are often laden with heated emotion. Having conversations with children before any use occurs, on the other hand, can help to develop foundations of comfort and familiarity when it comes to the topic of alcohol and other drug use prevention and protection. These talks give young people the opportunity to see that they can tell you what they are thinking or hearing—without the fear of repercussion or punishment. These conversations are vitally important. When adults regularly initiate such conversations, and keep looking for their kids' perspectives and input, teens eventually learn to feel more comfortable speaking about this topic with an adult who cares. Teens who are consistently heard by adults gain confidence in expressing their thoughts, sharing their worries, and turning to adults who they trust for later support. While adolescents are more likely to talk to their peers about alcohol and other drugs in general, they are more likely to think that alcohol and other drug information coming from adults is more accurate and trustworthy. Do your research about opioids, and start building regular dialogues with the kids in your life. You can help to to correct the misinformation teens may hold about opioids and provide teens with resources that keep them healthy. Act on Teachable Moments Outside of formal dialogues, keep teachable moments alive in conversation. Unfortunately, young people are bound to hear the same stories we hear about the opioid epidemic in the news or on TV. Ask teens about their perceptions of opioids in the media. These teachable moments invite impromptu conversations from which everyone involved can learn. Be Mindful of Unspoken Awareness By having open lines of communication with the young people in your life, you will be in better touch with their thoughts, feelings, and circumstances. More open talk, from a health perspective, about alcohol and other drugs, will provide you with an unspoken awareness about what is going on in your children's day-to-day lives and about the people they share those lives with—including anyone who may be participating in higher-risk behavior. By building these relationships over time, you will be able to address any opioid risk warning signs that appear in their lives. It is also important to know and be aware of what medications you have and are responsible for as an adult. What medicines might you have in your home, your bag, or other personal and professional space, that might harm an adolescent should he or she get ahold of them? Studies have shown that the majority (68%) of people who start to abuse opioids do so by obtaining them from a friend or relative for free or without asking9. Your local police station, fire department, hospital, or health department will assist you in disposing of any unused and unneeded medication you may have. Underlying Knowledge Above all, continue to become better educated and informed about what is going on regard to opioids in your area. The more you understand, the more you can add to the opioid addiction prevention efforts of your community. Your help is needed. Your preparation will make you most equipped and alert if a teen for whom you care starts to participate in unhealthy behaviors. This knowledge, coupled with the actions described above, can help you make a difference in the lives of teens.