Jaime Lewis (Host): Maybe you've noticed concerning reports about opioid exposure in children and teens. While these medications play an important role in pain management, their misuse can have devastating consequences. Today, we're joined by Dr. Rudy Kink, Medical Director of Pedi-Flite and Pediatric Emergency Medicine Specialist at Le Bonheur Children's Hospital. He's here to discuss opioid safety and childhood prevention, education, and intervention.

This is the Peds Pod by Le Bonheur Children's Hospital. I'm Jamie Lewis. Dr. Kink, thank you for being here.

Dr. Rudy Kink: Well, thank you, Jamie, for having me.

Host: How do pediatric pain management needs differ from those of adults?

Dr. Rudy Kink: The dosages of the medications are different for pediatrics. We base a lot of our medications on the weight of the patient. Adults, they're more standard medications.

Host: When are opioids typically prescribed for children and what conditions or situations warrant their use?

Dr. Rudy Kink: So, I'm also a pediatric ER physician at Le bonheur. And we take care of children with fractures, severe burns and injuries like that to get the children through those injuries. We utilize the opioid medications for only a day or two.

Host: And what would be the risks of a long-term opioid exposure in a child and how can those risks be minimized?

Dr. Rudy Kink: Some of the long-term risk would be addiction to the opioids. So, what we try to do is educate the parents on the front end at the beginning and talk to them about small dosages of opioids and that we'll do it for a short period of time and that we will encourage other forms of pain relief such as acetaminophen or ibuprofen to augment and treat the pain after the opioids, after we get through the worst part. But addiction is probably one of our big concerns. Remember in pediatrics, their brain is still forming. And so, addiction may be easier for these kids compared to adults.

Host: When we talk about accidents, let's say, what role does parental or caregiver opioid misuse play in accidental pediatric exposure or addiction risks? How can parents prevent accidental ingestion at home?

Dr. Rudy Kink: First of all, it starts at the home. So, if parents are using opioids not as they're originally prescribed, or hanging on to them after they've already been through an initial event, that allows the pediatric patient, the teenager access to the medications. So, that's one.

Prevention would be eliminating the medicines. And if you do need it, the parent has a medical problem that requires opioids, then securing them in a safe or in a lockbox and things like that and keeping them out of reach of children.

Finally, and I find probably the most important, is for parents to talk with the children about opioids. We see a lot of it, educating them, talking to them about the dangers of opioids. Starting at home is probably one of the first things I would do, and I do with my children.

Host: You mentioned still forming brains of adolescents. What factors make them particularly vulnerable to opioid addiction in the first place?

Dr. Rudy Kink: One of the things that makes them most vulnerable is that we see it in social media and peer pressure. Those two kind of go hand in hand. They try it, they see things, and they're very impressionable. Teenagers want to be more daring, and so they're more likely to try these medications without really truly knowing the effects that it will have on them, short term, as well as long-term.

Host: As a parent, are there any specific warning signs I should look for that may indicate some kind of misuse or dependence on opioids?

Dr. Rudy Kink: Be involved in your child's life. One of the early signs you may start to notice is a change in their behavior, things that they used to have fun doing, playing basketball, going out with friends. They may become more withdrawn. They may actually see a decrease in their school performance, and teachers may be inquiring why the child's missing or sleeping through classes or even acting out. So, these are some of the early warning signs you may see in your child that may be abusing opioids.

Host: Let's say I suspect that my child has ingested an opioid. As a caregiver, what should I do right away if I suspect that?

Dr. Rudy Kink: If you suspected that they ingested the opioid immediately, and they are altered, they're confused, and they're having problems, your first step should contact 911. If your child ever ingests a medication, and they're okay. But you're still worried, you can always call Poison Control and it's a 1-800 number for the United States. And no matter where you're calling, you'll be contacted with a poison specialist. If you feel your child's abusing opioids, you may want to reach out to your primary care physician, your pediatrician, and talk to them or a school counselor, and see what types of resources there are for your child.

Host: We touched a little bit on addiction What are the long-term effects of opioid misuse or overdose in children? How can that be addressed?

Dr. Rudy Kink: Some of the long-term effects of opioid, besides dependence would be poor school performance, as well as it leading to other medical problems, such as accidents and things like that. They can become addicted to other medications, drop out of school, and things like that. Now, these are long-term effects.

Other physiologic effects will be harder for them to stop the medicine. So, having the withdrawals from the opioids is very difficult for anyone, and going through those withdrawals physiologically are very challenging and would require special observation to do.

Host: I think about how daunting it feels to try to relate to a child who's dealing with an opioid dependence. How can I, as a caregiver, provide emotional support to that child.

Dr. Rudy Kink: Realize that that was never their intention. Realize addiction is almost like a disease. It's not a personal choice. I personally do not feel people wake up and want to be addicted to medications, whether they're an adult or child. I think the best analogy I've ever heard was from an addiction medicine specialist who said that we generally can hold our breath for 15, 20, 30 seconds, But then, that desire to breathe overtakes our body and we just have to breathe, and that's how some of these people who are addicted to medications feel. They may withhold from taking the medicine for a day, but their body will crave it and, ultimately, they may cave in. And that's why having these programs are out there to address these addictions is so important.

Host: That's a great analogy, especially because it really taps into the idea of something being involuntary at a certain point, and it gives us compassion for the people who are going through it and helps us to relate to them. I'm curious, outside of just personal interaction with somebody who's dependent, what steps are being taken at the national or the community level to address opioid safety in children and adolescents?

Dr. Rudy Kink: There's always legislation on the national level, which is really good, talking to prescribers on trying to minimize the amount of opioids we prescribe, watching pharmacies and things like that to make sure that opioids are not being dispensed in a large amount. On a community level, schools, communities, hospitals do provide education to parents, families. You can always get a local group. There are actual national groups, Mothers Against Addiction, who provide a lot of education about opioids addiction and things like that, as well as not only talking about addiction, but also alternatives to opioids for pain. You can use the over-the-counter medicines, physical therapy. You can even use cognitive behavior therapy to get through some painful things that patients may have.

Host: Closer to home, are there any Le Bonheur programs or resources that are available to aid parents like me in learning about opioid misuse and prevention?

Dr. Rudy Kink: Yeah, the Le Bonheur website does have a lot of information on opioids and programs. One thing that we have done internally in the hospital is monitor the amount of opioids we prescribe and looking at some of the children who have fractures, we were able to see that using over-the-counter Tylenol and ibuprofen did alleviate the children's pain just as well as opioids. And so, we have been adopting that practice in kids and decreasing the amount of opioids we prescribe.

Host: Well, Dr. Kink, thank you so much. This has been incredibly informative.

Dr. Rudy Kink: Jamie, thank you for having me.

Host: You're so welcome. That was Dr. Rudy Kink, Medical Director of Pedi-Flite and Pediatric Emergency Medicine Specialist at Le Bonheur Children's Hospital. Want to hear more from our experts on the Peds Pod? Visit lenonheur.org/podcast. podcast. Thanks for listening.