Will Banning Oxycodone for Young Patients Roll Back the Opioid Crisis?

One California state senator thinks it might. Pain patients and researchers? Not so much.

When Anne Fuqua was a teenager she came down with a rare neurological disorder that caused her muscles to involuntarily twist, contort and spasm. She compared the ache to having a perpetual Charley horse. At 14 years old, her only reprieve from constant cramping came in the form of opioid pain relievers.

But the same painkillers that helped Fuqua achieve enough relief to eventually go to school and become a nurse for psychiatric patients are at the center of a debate on how to stem America’s opioid crisis. As overdose deaths from opioids like oxycodone have more than quadrupled since 1999, politicians and policymakers are reckoning how to end the tragic trail of overdoses affecting their communities.

One attempt to reduce overdoses comes in the form of a bill proposed by California Sen. Anthony Portantino (D-La Cañada Flintridge) that would prohibit prescriptions of the painkiller oxycodone for patients under the age of 21.

“I want to make sure that highly addictive forms of painkillers aren’t given to a 16-year-old soccer player who gets addicted after his first sports injury and then becomes a heroin addict,” Portantino said, alluding to a story a concerned mother living in his district told him.

Portantino’s bill was introduced February 15 and is waiting to be heard by the Senate Public Safety Committee.

The problem for prescribers lies in distinguishing patients – like the soccer player – who might become addicted from patients like Fuqua, who does not misuse her opioids and without them would suffer from intractable pain. The several pain researchers and doctors specializing in addiction interviewed for this story think this complication makes the outright banning of any opioids too simplistic a solution to address a public health crisis.

“This [bill] has a germ of appropriate concern at its heart and it has been transformed into an absolutely nonsensical policy solution,” said Dr. Stefan Kertesz, an associate professor of preventive medicine at the University of Alabama’s Birmingham School of Medicine.

“The risk of opioids and their misuse are of special concern in youth and young adults,” Kertesz, a prominent researcher in the addiction field, added. “But sometimes young persons need them, and when we offer these drugs the parents need to maintain strict control.”

If such caution is exercised, few young adults will develop a new addiction to opioids.

The latest trends demonstrate why that is the case. For example, 75 percent of prescription opioid misuse begins when young people get their hands on pain pills from friends, family or drug dealers — not from doctors, according to the Substance Abuse and Mental Health Services Administration.

Compared to five years ago, prescription opioid misuse dropped 45 percent among 12th graders, according to the latest survey from Monitoring the Future, an annual survey tracking drug use among America’s students.

More to the point, the latest national prescribing data indicate the number of total opioid prescriptions has declined 12 percent since their peak in 2012. Yet overdose deaths continue to rise in record numbers, especially among middle-aged whites.

Between 1999 and 2015, there has been a 500 percent increase in overdose deaths among adults ages 45 to 54, the majority of whom are white men, though white women are set to close the gap, according to the Centers for Disease Control.

This group of middle-aged men and women continues to be at the highest risk for drug overdose.

As for young people ages 15 to 24, the number of opioid overdose deaths rose from 514 in 2014 to 999 in 2015, the latest year for which there is data. But taking into account the aforementioned survey results, the source for the majority of these opioids were not a doctor’s prescription pad.

That is why the senator’s bill misses the mark, said Terri Lewis, who teaches counselors and program managers about addiction program design and public policy at Southern Illinois University. She thinks politicians are ill equipped to legislate the individual needs of patients.

“The evidence for prohibition for prescribing under the age of 21 is not supported by the weight of the evidence about what is known,” Lewis said, adding that the risk of overdose is not greater at less than 21 years old than at more than 21 years old.

“Closing the door to scientific practice is an over response to a social problem rooted in personal behavior, not necessarily judicious medical practices,” Lewis concluded.

Fuqua’s experience as a young woman in need of opioids has led her to become a patient advocate. At 36 with a background in nursing, now she’s helping other young patients receive quality care. She said there remains stigma attached to opioids that can be combatted with better education.

She still suffers from chronic pain and though she isn’t thrilled about it, has been on opioids for most of her life.

“Oxycodone shouldn’t be the first line opioid for children and most healthcare providers realize this,” she said.

But she thinks it should be available when it’s needed, even for young patients.

Zachary Siegel is a master’s degree candidate at the University of Southern California’s Annenberg School for Communication and Journalism. He covers science and health for numerous news outlets. Follow him on Twitter.