Prescription Opioids: What Parents & Caregivers Need to Know

November 8, 2022

Bottom Line

• Opioid misuse can be very dangerous, and even deadly.
• Misuse of opioids is common amongst young people.
• Most of those who use this drug take it from family members without them knowing.
• The risk of overdose is high.
• With fentanyl, even small amounts can kill, and because it is sometimes mixed into other street drugs, young people may not be aware they are putting themselves at great risk.

What are prescription opioids? 

When used appropriately, prescription opioids can be very effective in treating severe pain. 

There are two types of opioid medications: 

1. Over-the-counter opioids, which include drugs containing codeine, such as Tylenol 1 or some cough syrups.
2. Opioids that must be prescribed by a doctor or dentist which include stronger pain medications like Tylenol 2, 3 and 4, Percocet, and OxyNeo (replaced OxyContin) and the fentanyl patch.

Unfortunately, these medications are also now some of the most commonly misused substances amongst Ontario youth. 

What is fentanyl? 

Fentanyl is a powerful prescription medication, 100 times stronger than morphine, that is usually prescribed for severe pain, such as experienced with cancer. It is manufactured under strict guidelines and should only be used under medical supervision. Sometimes prescribed fentanyl patches are sold on the illegal drug market and accessed by young people. Fentanyl can also be produced illegally here, or smuggled into Canada from other regions. Use of illegally-produced fentanyl is particularly risky because it is impossible to know the strength and composition of the drugs. Even very small doses of fentanyl, as little as the size of two grains of salt, can be lethal. In addition, illegally-produced fentanyl can be found in counterfeit prescription pills, and cut into other drugs including those sold as heroin, cocaine and ecstasy. For these reasons, a person may not even know that they are using fentanyl. 

Fentanyl has been found in fake prescription pills, which are made to look like opioid prescription pain relievers. It has also been cut into other street drugs, such as cocaine and heroin. Students may not know they are taking this drug. It does not have a color, taste or smell, making it very difficult to detect.

Why should I be concerned about prescription opioid misuse? 

Many parents and caregivers may not realize the extent of prescription opioid misuse among youth. According to results from the 2015 Ontario Student Drug Use and Health Survey (OSDUHS), misuse of prescription opioids has replaced tobacco as the fourth most commonly used drug among Ontario teens (at about 10%), behind alcohol, marijuana and e-cigarettes. Survey findings show that students in grades 7 and 8 are misusing opioids in greater numbers than marijuana. Misuse peaks in grade 12, when 13% of students reported using opioid prescription painkillers without a prescription in the last year. 

Parents and caregivers also may not realize how harmful misuse of these drugs can be. Many people think that because opioid painkillers are prescribed medicines they are not as dangerous as other drugs like cocaine or methamphetamine. This is a myth. Opioids can have harmful effects even when they are used as prescribed. When they are used without medical supervision, or combined with alcohol or other drugs, the harmful effects can increase and can be life-threatening. 

How do young people get access to prescription opioids?

Most young people report that they access opioids from home. In the OSDUHS survey, 59% of teens who indicated they had misused prescription opioids said they took them from a at home. parent, sibling or someone else they live with. As noted above, when youth get drugs from friends or street sources, they may not be aware they are using fentanyl, as it can be hidden in other drugs.

How can I help prevent problems? 

• Create opportunities for your children to talk to you about their feelings and experiences. Start early when children are young and maintain that connection with your teens even as they are gaining independence. Let them know you are there for them when they need to talk.
• Create the opportunity for open and clear communication about medication and drug use. Consider using the Youth Info-Sheet about opioids and fentanyl as a tool for discussing these drugs and their effects and risks. Ensure that family members know to call 911 if an overdose is suspected.
• Negotiate clear rules with your teen about the appropriate use of prescription opioids for medical purposes (e.g., never take prescription opioids with alcohol or other medication, never share medication prescribed to you with others).
• If you or your teen needs pain relief, talk to your health care provider about trying alternatives to opioids first (e.g., ibuprofen or acetaminophen). If opioids are needed, try a less powerful type of opioid first, and ask for an opioid prescription with fewer pills.
• Keep opioids and all other drugs in a safe and secure place—if possible, locked in a security box or cabinet.
• When you are taking prescription opioids for a medical concern, keep track of the number of pills in a container. If the number of pills doesn’t match your normal use or you need to refill your prescription sooner than expected, someone else may be taking your medication.
• Model safe and appropriate use of medication and other legal substances that you may use, such as alcohol.
• Always follow the directions on the label of prescribed medication. Call your health care provider if you have questions. Never share your medication.
• At least once a year, clean out your medicine cabinet and bring leftover or old medications to your local pharmacist for safe disposal. Do not flush medications or throw them in the garbage.
• Spread the word. Ask your friends and family to put these tips into action in their homes. Share this information with others.

How do I recognize the signs of a problem? 

Signs of a problem with opioids or other substances may include: 

• mood changes (e.g. irritability, depression or agitation)
• personality changes
• dropping grades or failing classes
• lack of interest in school or other activities
• changes in energy, sleep or appetite
• change in friends or hangout locations
• secretiveness
• borrowing money or having extra cash.

Around the house, watch for missing pills or unfamiliar pills. If your teen has a prescription, keep control of the bottle and be aware if they run out of pills too quickly, lose pills or request refills

What should I do if I suspect my child might be misusing opioids?

• Pick a good time to have a quiet conversation—when everyone is calm and there are no distractions. Raising the issue when you are angry or when the young person is under the influence of opioids is not a good idea.
• Let your teen know that you care, and that is why you are asking them about this.
• Refer to specific events that have concerned you. Talk about what you observed in a factual, honest but tactful way. For example, “I’m really concerned about you. You didn’t seem to be yourself when you came home last night. Tell me about what’s going on for you so I can help you the right way”.
• Ask questions that encourage your teen to talk rather than to give yes or no answers. Allow empty space and let your child fill in these spaces with their words.
• Focus your comments on the effects that opioid misuse has on them, you, and others in the family.
• Offer support. Let your teen know that you are prepared to help change things that may be contributing to his or her use of opioids.
• Get support from someone you trust, like a family member, friend, counselor, doctor or faith leader.
• Learn as much as you can about prescription painkillers and other opioids and find the help that is available in your community.

Article excerpted from CAMH – School Mental Health Ontario publication.