Dr. Mike Smith (Host): This is Children's Mercy, the Parent-ish podcast. I'm Dr. Mike. And with me is Dr. Michelle DePhillips from Children's Mercy. Today, we'll be diving into the critical topic of Growing Up Aware: Teens, Drugs, and Digital influence. Dr. DePhillips, welcome to the show.

Dr. Michelle DePhillips: Thank you and thank you for having me.

Host: What an important topic today, especially the digital influence. So, I'm really glad we're talking about it. What are good age-appropriate resources to share with our preteens as they approach the teenage years.

Dr. Michelle DePhillips: It's hard, I know. And I know part of this question was we don't have the DARE Program anymore that some of us grew up with. But there are some good resources out there. So, I'll always say childrensmercy.org has some great resources. If you either look at opioid use or you look at substance use, there's some good age-appropriate resources that come up-- how to talk to your kids about drugs, some common questions that teens or young children may have about drugs.

And then, there's also a really good resource on-- so, NIDA, which is the National Institute on Drug Abuse, which is through the NIH, so nida.nih.gov. That has some really good resources too, and some that are a little bit more specific to all the different types of illicit substances, drugs that teens, adolescents could potentially get into that are very age-appropriate. So, those would be my go-tos for parents and talking or giving the resources to their children.

Host: And those resources, correct me if I'm wrong, they can make all of their material and videos and whatever else they have age-appropriate, you know, for the preteen, for the teenager, right? Is that correct?

Dr. Michelle DePhillips: Yes. That is correct.

Host: Now, okay, let's talk about social media. How is that contributing to, number one, access to drugs?

Dr. Michelle DePhillips: Yes. It's there. I mean, kids can get on any of the different platforms. And people who are selling these drugs, these illicit substances are very creative and that an emoji means X, or this certain word means y and kids can get in contact with people who will sell them these illicit substances or drugs online using their social media platforms. That's our biggest concern.

Host: So, it's almost like with the emojis and stuff, they have their own language, you know, like, I'm selling this" with this emoji, right? But before they even get to that point, how do you think social media is influencing just the idea of taking something?

Dr. Michelle DePhillips: Yeah. So, I think it's multifactorial. One, I think it's very easy to find videos of people doing anything on social media in the web, right? So, you get on and use see that this person has taken this drug and it caused them to feel euphoric, or they're saying, 'It makes me feel great, and it was very safe" or the child searches for resources for mental health concerns because they're feeling anxious or they're feeling depressed. And lo and behold, what pops up is an advertisement or a video of a teen that says, "Oh, I took this drug, and it made me feel better." So, a lot of different ways that they're exposed to it.

Host: When I was growing up, just watching some of my favorite movie stars just smoking a cigarette and not even telling me to do it, but as a preteen, teen, you're like, "That looks cool."

Dr. Michelle DePhillips: Exactly. And marijuana, I mean, again, we go back to it being legalized and you see people doing it a lot of places. It's not infrequent that we all see people using. So again, in a child's mind or a teen's mind, you could see how, "Well, it's legal now. It can't be that bad."

Host: So, what do you think motivates all this? We've touched on some things, but what do you think really motivates kids to seek out drugs?

Dr. Michelle DePhillips: I think a lot of it is going to be pressure from peers. They have changed schools. They're going through a stressful time. There's been a big life change. They see their friends doing it, they're peer pressured. I think those are probably going to be the main things. Again, social media, they're self-medicating because they're feeling anxious, depressed.

I think all those things in that time, right? I think many of us, when we were in middle school, high school, it was a rough time for a lot of people. And you're going through a lot of bullying or stressful times. And so, I think it can be- I don't know, I don't want to say an outlet, but something that they experiment with as they're going through some of the stresses that those years bring.

Host: Now, what are some of the most common substances you're seeing in your area when it comes to teens?

Dr. Michelle DePhillips: Yeah. So, I would say we're still seeing a lot of cannabinoids, marijuana. We're still seeing a lot of those substances. Another thing that really has become more of an issue lately is kratom-derived substances, and I'm not talking about kratom in its pure form, but 7-hydroxymitragynine is the active substance in it; 7‑OH is what it's otherwise known as. And you can buy it in gas stations, you can buy it online. But it basically functions as an opioid, but it's more potent than morphine. And these kids are getting it everywhere. You talk to an adolescent, they'll say, "Oh yeah, I saw some of my peers in school taking. It was in the hallway. There's packages in the hallway that are littering the hallways of this 7‑OH product." So, we're seeing a lot more of that.

And then, opioids are still an issue too. We still see a lot of kids who are coming in either in active overdose from fentanyl, opioids, they have opioid use disorder, they're coming in an opioid withdrawal. So, that's still a common one for us too. And then, again, a lot of the other medications, over-the-counter medications, I'm talking more of the illicit substances, but any of those other medications that they're misusing too.

Host: The kratom's interesting, right? Because it's available, easily accessible, right? And do you think that leads to more opioid, like true opioid ingestion? Like, is that almost like a stepping stone for a lot of the kids?

Dr. Michelle DePhillips: So, I don't know if it's a stepping stone as much as it is. It's just way easier to get than your typical-- you know, the kids that are taking their Perc 30s or their fentanyl, whatever it may be. So, I don't know if it's a stepping stone in their mind as much as it's much easier to get access to it.

Host: It's just easy.

Dr. Michelle DePhillips: Yeah. But you know, we're seeing kids who are coming in. They've been using long enough that they're coming in in opioid withdrawal because they've been using these products for so long. And it's hard because our good drug screens will catch it, but they're not the most sensitive thing. So, are we seeing some of these kids who are coming in and maybe we're not recognizing it? But yeah, it's scary stuff, and it's gaining national recognition. I think there's starting to be some legislation that's hopefully going to help with some of these things, but it's an issue.

Host: Cannabis is becoming more and more legal throughout the country. And I, think where you're at, it is legal now for over 18. Is that right?

Dr. Michelle DePhillips: Right.

Host: So, are you seeing more teens now?

Dr. Michelle DePhillips: Yes, I would say we have more teens who are coming in and it's varying symptoms, right? I mean, I know that there's a lot of kids that use that never get to the point where they're coming in because they're so symptomatic from it. But we do, we do. And sometimes you have it that it's potentially laced with other things depending on what they're smoking or what's in it. And that's really what gets them in trouble or more symptomatic.

The scary thing, and the thing that we've seen more is the toddler and this young school age kids who are getting into parents' gummies or edibles and very, very symptomatic from ingesting those substances. So, that is what we have seen way more of since it's become legalized.

Host: A good friend of mine is a veterinarian and they're seeing dogs and cats having ingested some of this stuff too, coming in in Emergencies. Let's stick with the cannabis thing just for a moment, because it may be legal, but isn't one of the big issues is how they're regulating how strong the THC content is? Is that an issue where you're at? Because I know in some places, like in Florida, there's no real regulation on how strong that can be. And some of the products, the milligram strength of THC is crazy.

Dr. Michelle DePhillips: It's crazy. It's absolutely crazy. And I cannot sit here and quote exactly what Missouri's laws are on if there's a so much or there's a highest or a max. But yeah, I mean, you'll have these kids that come in and you'll really get to asking, and it's grandparents gummies and they're a hundred milligrams and you're thinking, "Oh my gosh, a hundred milligrams in this young 2-year-old." I mean, these kids are altered and sleep as all get-out for hours. I mean, 24 hours sometimes when they're taking these huge doses. So even if it's "one gummy", if it's these huge milligram doses, then kids can be extremely symptomatic from them.

Host: Well, and especially with the gummies, that's a big problem, right? Because they don't just want one. They want two and three and four. And now, gosh, you're dealing with a huge issue. Let's bring this down to what we really need to talk about is the addiction aspect of all this. How do we spot addiction in our kids?

Dr. Michelle DePhillips: Addiction. Yeah. So, I think it's going to be sort of more of these chronic changes. So if you see these big swings in their behavior, so a kid who normally is very bubbly and outgoing, and now they're very depressed, they're withdrawn, they're anxious, they're irritable. They were once a good student and now they're failing a lot of their classes. They were interested in all these activities, and now they just don't really want to do anything. They're evasive. You catch them lying. I would say things like that should tip you off.

You know, we think of addiction to certain things, and one of the biggest things I always think of is opioid addiction, right? So, these kids that develop opioid use disorder. And so, you're going to see these kids be very tremulous. They're going to be sweating. They're going to have a lot of GI symptoms, nausea, vomiting, diarrhea in between use when they're withdrawing. So, that's some of the keys you can think of with that.

Interestingly enough as we're talking about this, we've started to see-- and probably this is more with the legalization of, marijuana-containing substances also, but we're starting to see more kids present with cannabinoid hyperemesis syndrome, which for those who don't know what that is, yep, kids, anybody, adults in general who are using it more chronically, then they will get a lot of GI symptoms. So, these kids come in with severe, just generalized abdominal pain, tons of nausea, lots of vomiting, a lot of times refractory to the typical things that will do in those situations. Sometimes they have to be admitted. And so if you're seeing your kid maybe have these cyclical episodes of vomiting, belly pain, there's not a great explanation, hot showers, they find that hot showers or warm compresses help with their symptoms. So, you're noticing that sort of cycle with them, that should be something to be aware of too.

Host: So, what do parents do though? Okay, so they start noticing some of this stuff, right? What's step one? Because here's where I think it would be helpful. Like, okay, so I'm a parent, I'm recognizing some of this stuff in my child, I'm worried. What's my step one? Like, how do I begin with this journey?

Dr. Michelle DePhillips: So, I think step one is trying to talk to your kid and see if-- again, a big if-- if they will disclose that they are ingesting or taking anything or what their symptoms may be. So, I would try that first, even though full well knowing that we were all teenagers once and weren't always the most open with our parents.

The second thing I would say is taking them to their regular pediatrician's office. Sometimes, a lot of the things that patients disclose to us is a patient provider confidentiality. And so, sometimes kids will feel more comfortable opening up with someone that's not their parent. So, I would try that first. And then, again, I'll give a plug for Children's Mercy. We have an adolescent and young adult medicine clinic that will address kids who have drug use, substance use disorder, alcohol, any of those things, mental health, mental health issues. And so, they have really great resources there too. And a lot of times, again, just being in that environment that's a little bit more specialized toward the teenager or young adult, we found that they'll open up and have a little bit more trust in that environment too. So, that's where I would start.

Host: Dr. DePhillips, this has been fantastic. You obviously are full of information. And I know Children's Mercy takes all this very seriously. Thank you so much for coming on the show today.

Dr. Michelle DePhillips: Absolutely. Thank you so much for having me.

Host: For more information, go to childrensmercy.org/parent-ish. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Children's Mercy, the Parent-ish podcast. I'm Dr. Mike. Thanks for listening.