FFFOpioid Use in Adolescents

No. 144; June 2025


Alcohol, marijuana, and nicotine continue to be the most commonly used substances among adolescents. However, the consequences of opioid use are more severe, therefore understanding the risks and recognizing warning signs of opioid use is important for families. Additionally, overdose related deaths have sharply increased due to the growing presence and availability of synthetic (man-made) opioids.

Opioids can be prescription medications such as: oxycodone, hydrocodone, oxycontin, codeine, and morphine, and illegal drugs such as heroin and synthetics like fentanyl which is 50-100 times more potent than morphine. Opioids may be prescribed by healthcare providers on a time-limited basis to reduce severe pain. Opioids can be highly effective for pain management, however both prescription and illegal opioids can lead to dependence or addiction.

Fentanyl is now the leading cause of overdose deaths and is central to the opioid crisis. Fentanyl exposure can be intentional or unintentional when mixed with other substances. Examples include:

  • Fake pills that resemble prescription medications.
  • Marijuana or other drugs laced with fentanyl, often without the user's knowledge.

Due to its potency and availability, fentanyl has surpassed heroin as the most common illicit opioid. Street names for opioids include blues, fent, fent powder, oxy, 30s, M30s, and others.

Adolescents are at risk for opioid misuse for several reasons:

  • Development: adolescents are more likely to engage in risky behaviors, are less likely to consider the long-term consequences, and are more likely to become addicted to substances they try.
  • Peer pressure: the desire to fit in can lead to experimentation with substances.
  • Access to medications: many adolescents may use opioids that were initially prescribed to them or a family member.
  • Stress and mental illness: adolescents may use substances as a form of self-medication.

Genetics and Home Environment: Teens who have a family history of substance use are at increased risk.

Warning signs of opioid use:

  • Physical: pinpoint pupils, drowsiness, sleeping at odd hours, decreased appetite/weight loss, constipation, nausea.
  • Behavioral: spending more time alone, secretive behavior, change in friends and hangouts, declining school attendance and performance.
  • Emotional: sudden mood swings and increased irritability.
  • Other: overusing prescribed medications, missing/lost medications, burnt aluminum foil, bags with powder residue, unknown pills, burnt spoons, syringes.

Regular opioid use can lead to physical dependency. Stopping or reducing use may lead to withdrawal symptoms such as nausea/vomiting, diarrhea, stomach cramps, increased heart rate, goose bumps, anxiety and irritability, tremor or shakiness, enlarged pupils, yawning, and runny nose. These symptoms are very uncomfortable and may create a major barrier to stopping opioid use.

Prevention and harm reduction:

  • Open and positive relationships with caregivers reduce the risk of substance use.
  • Discuss the risks of opioid use including overdose and addiction with your child.
  • Keep prescription medications in a secure location and dispose of unused/unneeded medications properly, especially prescription pain medications.
  • Model and encourage healthy coping by finding positive outlets for stress and boredom rather than using substances (including alcohol, tobacco, cannabis) as a means to cope.
  • Consider having naloxone (Narcan) - an emergency medication to reverse opioid overdose readily available.
  • Fentanyl test strips can be used to make sure fentanyl isn’t present as a contaminant.

Treatment recommendations are often multi-faceted and may depend on a teen’s symptoms and appropriate resources available:

  • Medications prescribed for opioid use disorder help by reducing cravings and withdrawal symptoms, and may decrease the risks of overdose. These medications are available as oral, daily medications or long-acting injections that last about a month. Examples include medications such as buprenorphine/naloxone combination and methadone.
  • Treatment can take place in inpatient, residential, or outpatient settings. An adolescent may need to receive care in different settings as they progress through recovery.
  • Withdrawal management is the medical and psychological support of youth who have experienced dependence.
  • Therapy can include individual therapy, group therapy, and family therapy.
  • Ongoing treatment of any other mental health disorders is necessary to best support recovery.

Opioid overdoses can be fatal, so recognition and rapid response is critical. Signs of overdose include:

  • Slow, shallow breathing.
  • Blue or gray skin, lips, fingernails.
  • Pinpoint pupils.
  • Excessive sleepiness, unresponsiveness.
  • Limp body.

What to do in the event of a possible overdose:

  • Call 911 immediately.
  • Administer naloxone (nasal spray or injectable) if available. Naloxone is an emergency medication to quickly reverse an opioid overdose. It is a short-acting medication so it’s crucial to call 911 in the event of an overdose, even if the person seems fine immediately afterwards.
  • Stay with the person until emergency help arrives.

If you have questions or concerns about your child’s opioid use, contact your primary care physician, qualified mental health professional, and/or substance use/addiction treatment providers.

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