Teenagers and the Opioid Crisis – PediaCast 430

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  • Join us for the compelling story of teenagers affected by the opioid crisis… and the adolescent medicine doctor who journeys with them on the road to recovery. We also check in with the Ohio Opioid Education Alliance to learn more about their important work.

Topics

  • Opioid Crisis
  • Teenage Addiction
  • Ohio Opioid Education Alliance
  • National Take Back Day

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Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. 

It is Episode 430 for April 16th, 2019. We're calling this one "Teenagers and the Opioid Crisis." I want to welcome everyone to the program.

0:00:57

I think it's clearly understood by everyone, if you're listening. that we have a pretty significant opioid crisis here in the United States. I don't think it really matters where you live, you hear about it. You're affected. Families are affected. Lots of peoples are impacted.

In many cases, it's folks who really never imagined that this would be a problem within their family. And yet it is a common issue and a common problem, and we should really normalize talking about it. I think sometimes there's some shame associated with if you have family member who's dealing with opioid addiction.

But it's common and we need to talk about it in order to help folks who are dealing with opioid addiction. And that includes teenagers, there are a lot of teenagers who deal with this. It can start out in many ways. It may begin with vaping, cigarette use, marijuana use. Folks experiment with different drugs and then you experiment with one. You experiment with another and another.

0:02:04

You may find some pain pills in your parents' medicine chest in the home. And it can start that way, and before you know it, you're addicted to pain pills which can be expensive and that leads to heroin and IV drug use. You never thought that it would go this far just by starting with something like vaping. 

It can also start with an injury, sports injury, a broken bone. It can be in the middle school-aged kids, high school kids where you start with some pain medicine and it's opioid medicine. You've heard of the things like oxycodone, hydrocodone. There are street names but prescription names like the OxyContin, Percocet, Vicodin. Street names, things like oxys, percs, vikes, those sort of things.

Maybe, it may start with getting a hold of some of those after an injury or again finding them in a medicine cabinet or getting them from someone at school.

0:03:04

Regardless of how it get started, these things can lead to addiction. And sometimes, it's also the provider's fault, the physicians who are prescribing maybe without thought or for too long with too many, not kind of following up on what's happening with your patient. 

Often, it's not that we can place fault or blame in one location. It's often a complex combination or factors that are at play, which ultimately lead to addiction. 
And then, of course, that can again spill over into the use of street drugs as addicts by pills from dealers and then that gets expensive. Heroin is cheaper, fentanyl is often cheaper. And in the process, addiction occurs and the lives and families are really disrupted and there's almost always a long difficult road to recovery.

And as you think about someone addicted to painkillers, your first image might be an adult.  Maybe someone who is a little unclean, unshaven. You just have this picture in your mind of what an opioid addict looks like. 

0:04:12

We'll get that picture out of your mind because it's not true. Opioid addiction affects all folks, all socioeconomic levels from families and neighborhoods where you live. And, of course,  teenagers also become addicted to opioids. And again, it can begin with something easy like an injury or chronic condition and a simple prescription of pain medications. 

Regardless of the source, teenage addiction opioids is a very real problem and can really affect and open lives just as it is does in adults. Now, fortunately, we have people who care, people who want to address this problem head on and help teenagers who find themselves addicted. And they work hard to prevent teenagers and adults from abusing drugs in the first place and really trying to erase the negative impact to that this whole problem has on lives and families.

0:05:08

One of the organizations leading the way in that effort is the Ohio Opioid Education Alliance. And we have a representative from the group joining us in the studio to talk about their work. 

We're also going to talk with a adolescent medicine physician, Dr. Erin McKnight, who works with teenage addicts, teenagers who find themselves addicted to opioids. She journeys with them down the road to recovery. And she's going to talk with us what opioid addiction looks like in teenagers, what do these families go through, how do they find help, what is treatment look like, what is recovery look like, all really important things.

And then, probably the most important thing out of this podcast today is just this idea that we really only need to talk to our kids about this from a young age. Start talking about drug abuse and where it can lead and what it can do and just normalizes conversations.

And this is a number that you're going to hear in the course of this podcast several times but it's such an important number that simply talking about drug abuse in your family with your kids on a regular bases decreases their risk of actually using drugs by about 50%. You can half the risk of potential drug use in your kids by simply talking about it.

0:06:21

So really important and we'll have our little panel discussion on opioid use in teenagers. Really important conversation today.

Before we get to that, I do want to remind you we are on social media. We're on Facebook, Twitter, and Instagram. 

Also, on SoundCloud now and we appreciate it when you like us and listen there. 

Also, we really care what you think in terms of topics and suggestions, and ideas for this podcast. If there is topic you're interested in, you like us to cover that relates to pediatric health, child health or parenting, please do little me know. It's easy to get in touch. Just head over to pediacast.org and click on the Contact link.

0:07:02

I also want to remind you that the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination. 

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org.

So let's take a quick break and then I will be back as we consider the opioid crisis in teenagers. That's coming up right after his.

[Music]

0:08:08

Dr. Mike Patrick: Dr. Erin McKnight is an adolescent medicine specialist at Nationwide Children's Hospital and an assistant professor of pediatrics at the Ohio State University College of Medicine. She is co-chair of the Opioid Safety Task Force at Nationwide Children's and she treats and supports teenagers who find themselves addicted to opioids and journeys with them down the difficult road of recovery. I really appreciate you joining us today.

Dr. Erin McKnight: Thank you. It's great to be here.

Dr. Mike Patrick: We also have Aimee Shadwick in the studio. She is with the Alcohol Drug and Mineral Health Board of Franklin County, also known as ADAMH and also with the Ohio Opioid Education Alliance. She's in the studio. And I'm anxious to hear about the work of the Alliance, how they got started, who they help, how they help, and the ways in which their work benefits everyone regardless of where you live. Thanks to you two for stopping by today.

Aimee Shadwick: Thanks for having us.

Dr. Mike Patrick: Really appreciate both of you being here. Dr. McKnight, let's start with you. How does opioid addiction begin in teenagers?

0:09:04

Dr. Erin McKnight: In many of the patients that I take care of, they all have a similar story. And that story often begins around the age of 11 or 12 where people start experimenting with using cigarettes or vaping. They start using marijuana and alcohol. 

And then, the cycle really starts with substance abuse at that point in time. As they are exposed to those types of things, kids start to become more curious. They'll be at parties or they'll go into their own household cabinets or friends' household cabinets and start finding pills and other substances like that.

They often will start using prescription opioids, misusing those. And the need and the want to take more and more become stronger and eventually, it just becomes too expensive. Actually, pills are really expensive for kids to get and they end up transitioning to heroin.

0:10:06

Heroin is pretty cheap. As we know, the country is in the midst of an opioid epidemic and many are turning to heroin. Unfortunately, here in Ohio, we actually have more fentanyl now than heroin. And so, more kids are actually even using fentanyl without knowing it. 

Kids start off first by ingesting it by mouth, then by smoking it, snorting it, and then eventually a lot turn to IV drug abuse and all the complications that arise from IV drug abuse as well.

Dr. Mike Patrick: Going back to the very beginning, you mentioned vaping is kind of an entry into substance use. And we've heard lots in the news about the increase rate of vaping within high school students and people have this idea that, "Hey, this is safer than cigarettes." Speak to that. 

Dr. Erin McKnight: I would say  anything that's kind of like starting point for getting into substance use can just be a catalyst to continue on down the road.

0:11:03

The patients that I have seen who are older now, vaping wasn't a thing when they, obviously, first started using a cigarettes and marijuana. But nowadays, more kids are starting out with vaping than with cigarettes. I think we're all concerned that it's just can be the same starting point, just a different method within that regard.

And it's all about just the perception of substances and starting to use something to make yourself feel different. And that's what a lot of these kids are doing and using and it just as they start using things, they want to start experimenting more and using more and trying different things. And that's where we really just start to get into this progression where all of a sudden you never in a million years would think that you would move to IV heroin. But at some point, you might find yourself down that road.

Dr. Mike Patrick: And I think a lot of the conversation and especially among teenagers themselves and among parents and in public health circles as we see in social media, the idea that vaping is better than cigarettes because maybe it doesn't have as many carcinogens and that. Although, we don't know what all the smelly and tasty chemicals do.

0:12:14

And then. the nicotine, of course, is higher in concentration than in traditional cigarettes. But really our focus needs to be even beyond what chemicals are in the vaping product itself and really how it can be an entry into much worse things. I mean, that's really as compelling of a reason not to do it as what's in itself.

Dr. Erin McKnight: Exactly. And I think the thought about marijuana and using it medically or using it for other things also is just something that we need to be careful about really not diminishing the fact that marijuana is something that can alter one state of mind as well, just like alcohol can. Even though obviously alcohol is legal. 

But all of those types of things that make people different, maybe make them feel better, make them feel more relaxed, any of those types of things are something that kids are going to experiment with and continue to kind of use that as an entry point to go further down the road.

0:13:17

Dr. Mike Patrick: As long as you don't lump coffee into that.

[Laughter]

Dr. Mike Patrick: Which you know. 

Dr. Erin McKnight: Yeah, exactly.

Dr. Mike Patrick: Yeah, we won't go there. And then what about injury, like sports injuries? Do you see some teenagers that kind of be the entry route?

Dr. Erin McKnight: We can.

Dr. Mike Patrick: Where they have a legitimate need for some pain medications.

Dr. Erin McKnight: We can. I have seen some teenagers where they'd have an injury and then starting to use opioids from that. I've seen teenagers from a sports injury or from a car accident or from a dental surgery, any of those types of things, where that was their first experience with using an opioid or anything like that. 

And all of a sudden, they were giving a whole bunch of medications and sometimes really not giving the best way to transition off of them or other pain medications to use, or how to manage their pain and kind of use the opioids in a way to use the smallest amount in the shortest amount of time, and then transition off quickly. Maybe they were given a month prescription and when that runs out, they're like, "Well, now, what do I do? I felt great on that. Now, I really actually think I need this all the time."

0:14:20

And so, that can be another entry point where maybe not necessarily starting with this marijuana and the alcohol than moving to pills but really starting just with the pills from an injury or an accident or something like that.

Dr. Mike Patrick: And we have a lot of medical pediatric providers who also listen to this program, in addition to parents. And so, we also have a responsibility as we manage kids with pain in terms of managing that safely and not just sort of losing them to follow up.

Dr. Erin McKnight: Exactly. And as part of the Opioid Safety Task Force here at the institution, our work has been to really educate providers on appropriate prescribing practices.

0:15:02

As well as when you do have to prescribe an opioid for pain, really giving education to the patient and family on what to do with that medication, how to have it safely in your home, what to do to transition off of it safely. And really just to make sure that all of us are being mindful of the medication we're prescribing, thinking of other things that we can do for pain, and keeping our patients and our community safer by really just trying not to send so much opioids out there.

Dr. Mike Patrick: And I think that message is slowly percolating out there . And in my work in the emergency department in our urgent care centers, sometimes kids will come in with an acute bone break or bone fracture and we want to get them comfortable quickly. And so we offer some fentanyl that actually gets squirted up the nose and it's fast acting. It works wonderfully. 

But this is something I hadn't encountered even two or three years ago, I have a lot of families saying, "Wait, it's fentanyl. I don't know that I want my child to have that." Or even teenagers saying, "Oh, I don't want fentanyl." And then you explain, "Hey, it's going to help you feel better. It's a one-time dose." And usually, they're fine with it when they do. But I think there's enough awareness that people are concerned about that now.

0:16:12

Dr. Erin McKnight: And I think that's great. I think that's great that people are understanding those words and hearing those words like fentanyl and being like, "Wait a minute, hold on. Do I want that? Is there something else that maybe I should be using?" and advocating for themselves in that manner.

And just bringing it up and being able to have a conversation with their medical provider about it, "Is this the best way to treat my pain? What else can we do?" And I think that's a great thing both for the patient to do, but also for the provider, to just have those open lines of communication.

Dr. Mike Patrick: Yeah, absolutely. You had mentioned that one factor that results in all these is that it becomes expensive, the pills do that they're buying at school, on the street or wherever you get pills. And then, there must be consequences beyond just the price of it, right? What is addiction to opioids look like in terms of how it affects the teenager themselves beyond just the cost?

0:17:07

Dr. Erin McKnight: Not something that a lot of parents always wonder like, "How can I tell if my kids is using opioids or is taking pills or using these drugs?" There are some signs that I always tell parents to keep a watch out for. And one of those things is, is your kid acting different than usual? And I know everybody is like, "My kid is a teenager. They act a way different than I ever thought they would." 

But are they being a lot more secretive about things? Do they all of a sudden have a loss of interest in all of the stuff that they used to do. So for instance, they were on the track team. They don't want to run track anymore. They don't want to hang out with all their old friends that they used to hang out it. They're hanging out with a completely different group of friends. 

They're starting to have difficulties in school. They're starting to have their grades drop. They're starting to become a lot more irritable and spending a lot more time alone, secretive behaviors that you're worried about. 

You're noticing things missing around the home, things like jewelry, electronic stuff that's missing around the home that maybe they're selling. Or you're noticing that things are missing from your cabinets. Medications are missing from your cabinets, all of that kind of stuff.

0:18:14

Also, there's just kind of a big change in kids' mental health when they are using as well. And a lot seemed to just appear like they're more depressed and things in that manner. 

And that's where when you're talking about just from a pill usage. Obviously, there's different signs if your kid's using IV drugs that you can watch out for as well, such as track marks and kind of a picking issue where they'll pick at marks on their skin. And there's a lot of scabs and everything like that all over. And that's what we see kind of a more moving on unto an IV drug use picture. 

But I think just really being aware of kind of your kids behavior and anything new or different is always something that you should bring up with them or have a conversation about. Being like, "This seems really different than what you used to do. What's going on?"

0:19:05

Dr. Mike Patrick: You'd mentioned other mental health issues, with the things like anxiety and depression. And you can understand that these teenagers who find themselves addicted, I'm sure there's some shame associated with that. "This is something I have to hide. I wish I wasn't doing it but I can't stop on my own. I don't know how to get help but I don't' want to reach out for help because there's shame. And I'm concern about this." You can see how that would have lead to anxiety and depression issues.

Dr. Erin McKnight: Definitely. And some kids have anxiety and depression before. A lot of times, using all these substances is the way to self medicate. They haven't been properly diagnosed or haven't been diagnosed with anxiety or depression before starting. And so, they are using substances in order to help feel better or to help calm down and not feel so anxious and that kind of stuff. 

And so, when I see kids, it's all matter of taking at first like six to eight weeks to decide after we get them sober and not using substances, is there depression from substance use or was it something that was present before? Or something that is there anxiety, something that was because they were using substances?

0:20:12

Or is it something that happened beforehand and really kind of having a flush-out period of using drug and saying, "Do we need treat your depression and anxiety with a legal method like an SSRI and help you do that in order to help you continue to stay substance free?"

Dr. Mike Patrick: Yeah, absolutely. I would imagine in addition to parents noticing a difference, it might be at school where folks are noticing a difference, whether it be friends or teachers. And so, they kind of have a role to play in terms of identifying these kids.

Dr. Erin McKnight: They do. And some of the things that our taskforce has been doing is kind of helping prepare a tool kit for schools out there and piloting that in some of the schools, as far as what should administrators coaches, athletic trainers, school nurses, things like that, watch out for, look for or see as something being different in the students that they're seeing every day. And if they do have concerning behavior, what do you do about it? How do you address that?

0:21:08

Dr. Mike Patrick: Yeah, absolutely. I think that's a great segue into what do you do if you're a parent and you do have these suspicions. You've mentioned talk to your kids. I mean, there must be a nuance way of approaching that, right, rather than just accusing?

Dr. Erin McKnight: Yeah, I think having an accusatory tone or this yelling, having a huge fight about it, that is obviously one approach. And I can understand how the realization that your child is using drugs would automatically kind of make that be the first approach that most parents would go for. But I think what works better is having a calm, if you can, conversation and sitting down and really just filling out, "This is what I found. This is what I see. This is what I'm worried about. What's going on?"

I can't say that the kid is going to be honest and truthful in that manner. One of the hallmarks of addiction is the ability to lie about the drug use and really minimize the drug use. But I think having the parent let the kid know that they're concerned and then the parent figuring out and reaching out for help.

0:22:18

At Nationwide Children's, we have our Medication Assisted Treatment for Addiction Program. We treat kids who are addicted to prescription opioid, as well as heroin and now are moving into fentanyl. And we can use medication therapy such as Suboxone for that. And then, we also help them get linked with one of our counselors within our program or depending on where they live, a drug treatment program for that behavior health treatment within the area of where they live. 

Some kids need more than others. Some we'll meet, and we think they might just need to go away to a residential program originally. However, that's expensive. Not all insurances cover it and it can be hard to think I have to send my kid away.

Dr. Mike Patrick: And hard for the kid to be sent away.

0:23:01

Dr. Erin McKnight: Hard for the kid to be sent away. So we really try to work with what we can with the families and the resources that are in those areas for them. 

And we have wonderful social workers in our program who really work on that case management piece if we do have people who aren't seeing or counseling our program but are working within behavior health drug treatment centers within wherever they're living and contacting with their therapist. And keeping it as a point where the medication that we give definitely helps people avoid cravings and not being withdrawal but it's a manner to just help them live a functional life. The actual therapy is what is going to keep them clean.

Aimee Shadwick: And then, I just wanted to also comment on the tips around in terms of how to talk to your kids and piggy back on Dr. McKnight. There's actually...

Dr. Mike Patrick: This is Aimee Shadwick.

Aimee Shadwick: This is Aimee Shadwick, yes, from the ADAMH and the Ohio Opioid Education Alliance. There's actually a website, dontliveindenial.org. One of the pieces of information on that website is actually how to your kids about drugs. It actually links back to information created by the Partnership for Drug-Free Kids. 

0:24:18

And what it does which is a really great resource, it actually breaks done how to have that conversation with kids in an age-appropriate way. Literally, it even gives you tips for young children as young as six, seven, eight years old to be able to start to have that conversation about medication and how to use it safely. 

With the six-year-old, you might talk about, "This is your vitamin that you take and you only take that if mommy or daddy or the doctor gives it to you." Obviously, the tips look very different for a teenager, for a 16, 17, 18 years old. But there's some really good resources on that link. And, again, Partnership for Drug-Free Kids kind of approached that and looked at it from a prevention perspective. So it's some good information.

0:25:06

Dr. Mike Patrick: And we'll put a link to that and we'll have lots of resources that will talk about in a bit in the show notes for Episode 430 over at pediacast.org.

Dr. Erin McKnight: And it's wonderful that they have all of those resources because studies show that if you are able to talk to your kids and if you can talk to your kids about drugs and just having that conversation, they're 50% less likely to use. And so it's a wonderful prevention effort just to talk. 

But it can be uncomfortable and I think I've looked at that website and I looked at all those different tips and talked to families about how to talk to their kids about drugs. And they give great resources that are age specifics. So it's definitely a thing that all parents should check out if they're wanting to start to have those conversation at that young age, at that elementary school age, which is important.

Dr. Mike Patrick: I imagine the younger that you start talking about it, then the more comfortable it will be as they move on to middle-school age and then to high school.

Dr. Erin McKnight: Exactly. And it's not a one-time conversation. It's something that needs to just be continued to have as your kid grows and as they move on in their stages of life and are exposed to new friends and new things. It's definitely a great resource for parents to check out.

0:26:10

Even providers, if they're wanting to know how do I help my parents in my practice, how do I give them information on how to talk to kids?

Dr. Mike Patrick: I want to say that statistic one more time because I think it's so important that if families talk about this, then there's a 50% less chance that kids will end up using substances. It's really important conversation to have.

When you do suspect that your child maybe using opioids or abusing any prescription drugs, and you had mentioned that first feeling is anger and you don't necessarily want to shout. One thing that I think can help parents get into that mindset is just to have some empathy that these kids, once you really get addicted, it's not like there's a choice especially when there's a physical addiction involved. And as a parent, you can easily find yourself in that same situation.

0:27:04

Dr. Erin McKnight: Exactly. And I think that just the entire stigma around addiction makes it hard for people not be angry at and not have kind of this initial reactions that a lot do. What I tried to really get out there to patients, parents, the community is that it's a disease. It's a disease just like diabetes, just like asthma. It's not something that this kid asked for. 

No one wants to be an opioid addict. No one wants to be addicted at these substances. It's not how they want to live their life. No one asked for this, no one would say, "When I grow up, I want to be an IV heroin addict." It is something that there is a lot of research out there about who's more at risk and who's not and all these different factors that are at play. But we know that it is a chronic neurological disease that needs to be thought of like all chronic diseases. 

0:28:00

And so, really, it is a part of our process of just getting the child and their parent, their family, and all their support people on that same page, that this is a lifelong chronic disease that we have to manage. 

And taking away kind of those myths, as well as kind of moral dilemmas that people have when thinking about addiction and drug use and all of the stuff that surrounds it, that can make it just really hard or those struggling with these problems do not feel stigmatized.

Dr. Mike Patrick: It's been a little while but we've talked on this program in the past about epigenetics and how our DNA is surrounded by molecules that sort of changes. We live our life and those changes are passed on to our kids.

And one of those things that can change epigenetics we're seeing is drug use. And, in fact, I think there was a mouse study that looked at cocaine use and the offspring of mice who had been exposed to cocaine were more likely to want to get to cocaine when offered it. Not to say that it's parents' fault but this is why we sometimes see it running in families.

0:29:10

Dr. Erin McKnight: Yes. And I have some patients who there are generations of family members who struggle with addiction. And then, I have some patients who they're the first person in their family or anyone that they know who is struggling with addiction. 

And so, I think it's definitely something that everyone is trying to figure out and what can we do, how can we figure this out before they become addicted to substances, and all that kind of stuff. And definitely like other mental illnesses, addiction can have a hereditary component as well.

I think that's even more important when you're a provider talking with someone about prescribing a medication. Are there substance use in the family? Is there someone who has substance use disorder in the family? And just knowing that, that might tip the scale a little bit more towards this person is maybe more likely or programmed more likely to use.

0:30:00

Dr. Mike Patrick: And even more important to talk about it. 

Dr. Erin McKnight: Exactly. 

Dr. Mike Patrick: Well, important for everyone. 

In terms of numbers, some that I had come across that about a quarter of all teenagers will misuse or abuse prescription drugs at least once in their lifetime. And that 42% of teenagers who do misuse or abuse prescription medications get them from their parents' medicine cabinet. And so it's going to be really important not to store those things in the home.

Dr. Erin McKnight: Yes, exactly. And so one of the things that we really try to get out there from information, here our institution and through our task force is really this four tenets of opioids safety that patients and families need to be given when they're given an opioid. 

The first one is to monitor, so monitor the medication that you're giving. Know how much is in there, know how many pills are in there, know how much you've been prescribed. 

Two is to secure. Secure the medication in a lock box. Secure all medications up. Just because we're having an opioid epidemic right now doesn't mean that all the other medications in your cabinet aren't harmful as well if they're taken inappropriately. So secure all of your medications.

0:31:13

And this is not just to say from your own teenager but also from other people who come in and out of your house -- your teenager's friends, other family members who might take them, all of that kind of stuff. So secure your medications.

And then, transition. How do you transition off of this opioid if you were given it for pain? How do I use medications like Tylenol, ibuprofen, things like that in order to treat pain and get myself off these opioids sooner?

And then, dispose. Once you are done with it, don't keep it in the cabinet for like, "Oh, when I maybe fall and sprain my ankle, and I don't want to go to the urgent care. And I need some pain medicine. " Don't just keep it around, get rid of it. Dispose of it. 

And there are drug disposal boxes kind of all throughout the city. You can go on to website and type in your ZIP code and get that information of where you can dispose of the medication. Also, here at Nationwide Children's Hospital, we do have three drug disposal boxes at each one of our pharmacy sites that you can dispose of those medications at.

0:32:13

Dr. Mike Patrick: And we'll put links again in the show notes with resources on exactly where you can find those, where you can get dispose of drugs. So, you should not flush them down the toilet? Put it on the trash can?

Dr. Erin McKnight: If you have to flush them down the toilet, I guess you can, if that's the only way you can get rid of them. I would recommend taking it to a disposal drop box. I would not put it in a trash can. That is an easy way for people to just rifle through.

Aimee Shadwick: There's actually also resource that we're offering through ADAMH and the Alliance and it's actually a drug disposal bag. And so, the bag actually has the same carbon material that, from what I understand, you all would use in the emergency room if somebody would come in, maybe too much alcohol in their system. But basically, you can put the medication in the bag, you add hot water, you seal it up, and you're able to throw it in the trash.

0:33:08

And so, that's something as another tool or element that we're trying to provide to the community. So as well on the ADAMH website, you can actually go in, put in your information and we'll mail you one of those bags. If you're limited by transportation or you may not feel comfortable going into a law enforcement agency to dispose of your medication, you're able to use one of these bags. 

And again, we feel comfortable with them as well because the DEA and the EPA have both lifted these products. And so the medication is deactivated, so someone, even if they ingested it, you would not get the effects of the medication. And then, it leaves very little biomass, so it's environmentally friendly.

Dr. Mike Patrick: So that the carbon just sticks to the drug and then it's not active anymore. That's fantastic and a great resource.

0:34:04

Aimee, tell us more about the Ohio Opioid Education Alliance. What exactly is that and what do they do? 

Aimee Shadwick: Sure. Let me tell you a little bit just about the genesis of the Alliance. Almost two years ago now, the Franklin County commissioners and the mayor of Columbus, Andrew Ginther, brought a lot of the public sector organizations together and said, "We're all spending a lot of time and resources around the opioid epidemics. So let's put together a more focused plan of how we're going to address the epidemic." And they asked ADAMH to lead that development of the plan.

Fast forward two years later, the plan included elements around community, prevention, education, treatment, healthcare and also law enforcement. But there was one specific item in the plan under community prevention and education that talk about the need for community-wide education campaign about how do we prevent the next generation from misusing prescription opioids.

0:35:13

So that's really the genesis of the Alliance. It was actually Nationwide, in fact, as the first organization who took a look at the plan. They do a lot of work in their organization already around employees and their substance use issues. They reached out to ADAMH and they said, "How can we help?" They took a look and said, "Where would it make it sense for us to help?" 

And that's where things really started. They said, "We're not experts in behavioral health or any of those areas but we're experts in marketing. So how can we bring that to the table?" That was really the start of the development of the actual Denial Ohio Campaign, which is really the key tenet of the Alliance.

But then, we realized does the campaign developed and as we rolled it out that there was a lot of interest in Central Ohio and across the state that other organizations wanted to be a part of something, wanted to bring their resources to the table to be able to contribute to the opioid epidemic. 

0:36:19

So that was how the Alliance started, and now there's over 50 organizations that are a member of the Alliance. And it's actually now started as a Central Ohio focus and has expanded to be a statewide group of organizations. And the list goes every day.

Dr. Mike Patrick: And you have terrific resources, Don't Live in Denial, Ohio. And I love that like it's an address, right? Don't Live in Denial, Ohio, great website, lots of resources. We'll put a link to it on the show notes for Episode 430 over at pediacast.org. You also have a pretty active Facebook page?

Aimee Shadwick: Yes. Hopefully, if folks haven't seen the ads, so the actual campaign is, again, based on the fictional town of Denial, Ohio.

0:37:03

We did a lot of research and actually a lot of community members recognized that the opioid epidemic is impacting our community. But where we saw the gap was family members, feeling like it could impact their families. The research showed us that only about 19% of families thought that the opioid epidemic could harm their families. To put that in perspective, 18% of people in that same research think that their family maybe impacted by a commercial airline crash. The risk threshold is pretty low.

So, the goal of the campaign, it really emphasizes what Dr. McKnight was saying here today, is there are two goals off when you watch that commercial and you read the information on the website, you see the videos -- talk to your kids about drugs. We know it works. Fifty percent less likely to use if you continue to have those conversations and dispose of your leftover medication. Because again, to your statistic, Dr. Mike, we know that a large percentage of young people are getting that medication from medicine cabinets.

0:38:18

Dr. Mike Patrick: Yeah, a very, very important message. 

We've talked about sort of identifying teenagers who maybe addicted to opioids and other substances and sort of talking about it, getting them plugged in to help. And I think how does that plugging in works? Where should parents go? So you've had the conversation but where do you go for help?

Dr. Erin McKnight: Like I said, we have our program here at Nationwide Children's Hospital. Also, I think what needs to happen first is child needs to have a substance abuse assessment. So they need to go somewhere and get a substance abuse assessment. Oftentimes, people come to our program first, then we can direct them to areas where they get that substance use assessment done within their community.

0:39:05

And that all depends on age to be honest with you. There are fewer places that will see those under the age of 18 than are those that will those over the age of 18. So it becomes just a kind of moving target of where do I live and what resources are available for me. And that's something that really really we try to help families out with. 

And like I said, we do have our substance abuse therapist within our program as well that is able to see those kids under the age of 18 for where they might not have those resources in their community.

And so, really, the substance abuse assessment is what drives kind of their level of care and the behavioral health therapy that they need in order to kind of move forward with drug treatment. And so, that's really kind of where we have family start, from that standpoint.

0:40:00

Dr. Mike Patrick: And that's a fantastic service here in Central Ohio. For folks who live elsewhere, if you don't know where to go, your child's doctor is a great place to start and they're going to know what resources are available in a particular area and state county, where do I send my patients for this kind of thing? They're going to know. 

And really, please don't be ashamed to ask your doctor about that because they've been asked many times and they'd rather be asked than not asked.

Dr. Erin McKnight: And I feel like sometimes people are afraid, especially old doctors who's taking care of them since they were a baby and knows the whole family. Families can feel afraid to bring that concern to their primary care doctor just because they're like, "Oh my gosh, I don't know that I want them to know this." 

But like I said, it's just another illness, disease, like they are used to treating for all of their patients. By all means, starting with your pediatrician. And we got calls from pediatricians about like, "What do I do now? What do I do? I got this child here and this is what's going on. What can I do? Where should I send them? What should I do at this point in time?" And so having that first opt is always a great idea is to talk to your pediatrician.

0:41:11

Dr. Mike Patrick: And as pediatricians and family practice doctors, nurse practitioners, physician assistants, we can start to normalize that conversation by bringing it up often and just making it a normal part of every well-child check regardless of who the patient and family is. Say, "Hey, this is something that happens. I just want to give you the opportunity that if this is a concern in your family, bring it up with me anytime. I'm happy to talk about it. It's something that a lot of people deal with. It's not just you."

Dr. Erin McKnight: And I think that that's a great thing for providers to do because I know a lot of patients that I take care of have difficulty with the medical system. And they often feels stigmatized and judged and things like that. And so they don't want to reach out as much as they should to the medical system. And they feel they've had difficult interactions and it can be uncomfortable for them. So I think like you were talking about just normalizing conversation and bringing it up is an important thing for providers to do. 

0:42:07

Aimee Shadwick: It is really important. We hear from so many families as well, just the shame and stigma and they feel so alone. And so, I think any time, a pediatrician can help to proactively bring that up. They really does help to normalize and hopefully reduce some of that stigma that they're feeling.

Dr. Mike Patrick: Yeah, absolutely. So they've been plugged in to the system, they are getting some help for their addiction. What does life look like beyond recovery? Is this something as a one and done, or are they at risked for using again? What does it look like?

Dr. Erin McKnight: It's a chronic disease. Like chronic diseases, there can be relapses. And there can be kind of ebbs and flow and how their disease is, much like you would think of someone with asthma. Like sometimes their asthma maybe not well controlled or they'll have an asthma flare. 

0:43:02 

We have people who do have relapses. That doesn't mean that they're not going to be able to get back into "recovery". It's just a part of the lifelong illness that they have. And they require a support through all of it. It's not a moral failing to relapse. It's a part of the disease.

And so, knowing that during those times, more support is needed. And then at other times, knowing that maybe they don't need as intensive counseling as intensive therapy but when there's relapses, when there's big stressors in life knowing that more support could be needed around those times.

I think it's always important to recognize that when someone is in recovery, that when relapses happen, the risk of overdose is very real and out there, especially as we are seeing stronger opioids infiltrating our market like fentanyl. And then in Ohio, we had carfentanyl which if taken are lethal, lethal doses for someone who's even been exposed to opioid and who'd been using them regularly.

0:44:03

For people who are in recovery, who don't have a tolerance anymore, just going back to using what they previously use as their old dose is enough to kill them. Let alone being mixed in with these higher concentrations of opioids that are out there. 

So always talking about in how to prevent risk of overdose with intranasal naloxone, with naloxone kits there out there. In our institution, we have a program called Project Help where we give all of our patients in our clinic an intranasal naloxone kit. And we teach them and their support person how to use it and what the science of overdose are and what to do with it. 

So that if they are somewhere and they witness someone with an overdose, they can use it. Or if their support person, family member, whoever they're with witnesses them overdosing, that they can use the medication that can be life-saving.

Just knowing that this is not a one-and-done thing. This is not "I need to go to a 30-day rehab program. I'm going to come out and I'm going to be great." That is, unfortunately, not the case for really anyone. And having that mentality really sets someone up for failure and for risk of overdose and death.

0:45:06

So knowing that constant support, checking in and being mindful with all of those things that can happen is really what someone needs in order to live a safe life and recovery.

Dr. Mike Patrick: So important. You've mentioned naloxone. For folks who maybe heard this word before, what exactly is that?

Dr. Erin McKnight: What this is, it's a medication that reverses the effect of the opioid. And so when someone has overdose on an opioid, it makes them really somnolent, lethargic, sleepy. Their respiratory drive, so their ability to breathe, is very decreased. Their heart rates slows, everything becomes much slower.

Dr. Mike Patrick: You stop breathing and that's the end.

Dr. Erin McKnight: So what naloxone does is it actually goes to all those cells where those opioids are on the receptors and it pops them off. And so it reverses the effect of the opioid. 

And so, it is a medicine that a lot of our first responders carry, that you can now go to the pharmacy and get, that really is just great to have out there in the community. I mean, even people...

0:46:09

Aimee Shadwick: I have one in my purse.

Dr. Erin McKnight: Yes, I have one in my purse. You're at the Burger King and someone in the bathroom's overdose. You can use it and save their life.

Dr. Mike Patrick: This is a medicine you're allowed to have like Joe Q. Public can have this on them without any fear of, "I shouldn't have this medicine on me."

Dr. Erin McKnight: Nope. There's no fear to have this medicine on you. There's no fear to use it on someone as far as you being...

Dr. Mike Patrick: This is one medicine you should not take back.

[Laughter]

Aimee Shadwick: Correct.

Dr. Erin McKnight: Yes, this is one medicine you should not take back.

Aimee Shadwick: And we will, again, included in your links there some programs and sites across Franklin County and across the state that you can get a free naloxone kit. And many individuals who have private insurance, you actually can go to most of the local pharmacies and use your private insurance to get a naloxone kit. You don't need a prescription for it.

Dr. Mike Patrick: Interesting. So, you can just go to a pharmacy counter and say, "I want one"?

Aimee Shadwick: Yes.

0:47:00

Dr. Mike Patrick: And your insurance should pay for it, hopefully.

Aimee Shadwick: And if not, there are some other programs and we'll provide you these links that folks can also get a free kit.

Dr. Mike Patrick: Okay, great. We had mentioned National Take Back Day. Aimee, what exactly is that and when is it?

Aimee Shadwick: Yes, sure. National Take Back Day is actually an initiative that spearheaded by the DEA, the Drug Enforcement Agency. They actually work with local law enforce entities across the country to do Take Back Days, to take back medication. And so it actually happens twice a year. It typically happens in April and October. On Saturday, April 27th is the upcoming National Drug Take Back Day.

Here in Central Ohio, most of the local law enforcement agencies actually participate, have take back sites some of the pharmacies like Krueger actually participates as well, 10 AM to 2 PM. 

The DEA actually has a website. It's deatakeback.com. You can actually go to that website and put in your information and they will actually pull up all of the local sites that are offering take back.

0:48:13

But again, it's an opportunity. Just put your medication and you take it and drop it off. The nice positive thing about it is it's fairly anonymous and you stay in your car. It's basically just like a drive-thru. You pull up, there's law enforcement there. They take your medication and you drive off. 

Even if you have large volume of medication, maybe you've had a person in your family. Often, we hear of older individuals who have passed away. Maybe they've had cancer. They have a large amount of opioids on hand. It's a great opportunity to just take and dispose of all of that medication and get it out of your home. 

Dr. Mike Patrick: And you won't be alone. In 2018, 457 tons of medication was collected on the National Take Back Day. And you can imagine just how much that is when you consider what little pill weighs. So 457 tons of medication returned on National Take Back Day last year. Definitely take advantage of that.

0:49:13

But National Take Back Day can happen any day because there are collection sites. We had mentioned at three pharmacy locations here at Nationwide Children's. We'll have links in the show notes where you can find places across the whole United States. Just put in your ZIP code, then they'll have where all the collection boxes are where you can take medication back.

We will have a link to Don't Live in Denial, Ohio and all the resources at that site. 

The Ohio Opioid Educational lines or Facebook page, their Twitter account, we'll have links to all of that. 

Also, Partnership for Drug Free Kids, National Take Back Day, The National Institute on Drug Abuse. Especially if you're more science-y and want to know more about addiction science, they have some great resources on their site. 

And then the National Institute on Drug  Abuse for Teens has some great information on drug use in the teenage brain, and then some information for teenagers that talks all about opioids in language that they can understand and is kind of fun to go through and look through just some great resources. All of these will be on the show notes for Episode 430 over at pediacast.org.

0:50:20

All right. So, Dr. Erin McKnight, adolescent medicine physician here at Nationwide Children's Hospital and Aimee Shadwick with the Alcohol Drug and Mental Health Board of Franklin County and the Ohio Opioid Educational Alliance, thanks to both of you so much once again for being here today.

Dr. Erin McKnight: Of course. Thank you.

Aimee Shadwick: Thank you.

[Music]

0:51:09

Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. I really do appreciate that.

Thanks to our guests Dr. Erin McKnight with Adolescent Medicine here at Nationwide Children's Hospital, and Aimee Shadwick with the Alcohol Drug and Mental Health Board (ADAMH) of Franklin County and also the Ohio Opioid Education Alliance. I really appreciate all the thoughts and resources that they shared.

There's going to be even more resources in the show notes. After we turned the microphones off, everyone was like, "Hey, there's also this and that and this other thing." And it's all fabulous in terms of resources that you can use as you are thinking about talking to your kids about drug use, getting rid of drugs that are in the house, and just increasing awareness and helping support for this problem since it's so big in so many parts of the country.

0:52:00

So do be sure to check out the show notes over at pediacast.org, Episode 430. We'll also have links to the drug abuse programs here in Nationwide Children's Hospital, all the educational materials that we have here. And I think I wasn't quite clear on where you find Take Back dropbox locations across the country.

If you go to the website, the Denial Ohio website, Don't Live in Denial, Ohio, that one, that particular link, one of the things that they have is a tool that you can put in your ZIP code anywhere in the United States and it will take you to the drop box locations. 

And there's also information on how to obtain one of those bags with carbon in it that Aimee had mentioned in the course of her interview. So that if you're not able to get to one of those drop boxes, there is a way that you can get a bag mailed to you. You can  put your drugs in there, add a little warm water, shake it up and that could be dispose right in the trash, as Aimee had mentioned. 

And so there is information of obtaining those, National Take Back Day, take back every day where those dropbox locations are throughout the United States. And again, that's all at the Don't Live in Denial, Ohio website. Be sure to visit that, along with all the other educational resources and stuff.

0:53:16

Again, not just here at Nationwide Children's Hospital, the folks here in Central Ohio and our surrounding region, lots of great resources for you locally, but we also have lots of information for those who do not live in Central Ohio. So for everyone far and near, be sure to check out the show notes this week over at pediacast.org.
 
Don't forget, you can find PediaCast in all sorts of places. We are in the Apple podcast app, iTunes, Google Play, iHeart Radio, Spotify, and now SoundCloud. And I had mentioned in SoundCloud, we're able to make playlist. We already have playlist on dental health. We have our Pediatrics in Plain Language Panel. That's already there. So you can find we have playlist with our Continuing Medical Education podcasts. 

0:54:05

We are going to put a playlist together on behavioral health topics, mental health topics for kids and teenagers. I have a feeling today's program will make that particular playlist. And I think sports medicine will be an up and coming playlist over at SoundCloud as well. 

We also have our landing site pediacast.org where you will find our entire archive of past programs, show notes, transcripts, our Terms of Use Agreement, and handy contact page so you can ask questions and suggest topics of your own. 

Also, reviews are helpful wherever you listen. And don't forget to also connect with us on Facebook, Twitter, and Instagram.

We also have a program. If you are a pediatric provider or you know one, you could let them know about it. We have a show for them as well, PediaCast CME. That stands for Continuing Medical Education. It is similar to this program. We turn up the science a couple of notches and offer free Category I Continuing Medical Education Credit for those who listen.

0:55:02

Shows and details for that program are available at the landing site. They're at pediacastcme.org. And that one is also in Apple podcast, iTunes, Google Play, iHeart Radio, Spotify. Wherever you find podcast, you'll find PediaCast and PediaCast CME. Simply search for PediaCast.

Thanks again for stopping by and until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.
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